Milton S Hershey School of Medicine, Hershey, PA, USA.
There is presently a trend in facial rejuvenation surgery for the “less dramatic”. At the 2004 AAPS Meeting, Patrick Tonnard presented the MACS lift, emphasizing the simplicity of technique and non-operated appearance of the result. This senior author, intrigued by the simplicity of this technique, performed 25 consecutive MACS lifts and reports on these results.
25 patients seeking facial rejuvenation were selected with the aide of computer imaging. Patients were selected, for this procedure, that were seeking a less invasive procedure, with a short downtime, minimal anesthesia, who did not desire a brow lift, and who had a limited budget. These patients did not desire a brow lift. The majority of cases were performed utilizing the “extended MACS lift”, as described by Tonnard, with three vertical permanent purse-string suspension sutures. These sutures suspend the malar fat pad, the central SMAS, and a U-shaped extension to the platysma. Autologous fat grafts from suction lipectomy of the neck were utilized, when appropriate, in patients for rejuvenation of the lip and peri-oral region. Over 50% of the patients were performed in the office under local anesthesia and Valium (10mg p.o., 20 minutes prior to the procedure). Pre- and 6 month post-operative photographs were obtained and compared in all patients. Patient satisfaction was noted. In addition to the 25 primary cases, the technique was also utilized in cases of facial paralysis, correction of ectropion, in combination with endoscopic brow lifting, and in secondary lifts.
All 25 patients felt that they had excellent results that surpassed their anticipated results. There were no post-operative complications among the patients. There were no hematomas, surface irregularities, infections, skin sloughs, unsightly scars, or neuropraxias. Digital imaging confirmed significant improvement in the mid-face. Comparison of the results of this procedure with the subperiosteal endoscopic techniques previously utilized by the author showed an equivalent effect, with less swelling and risk of complication. Return to normal activity ranged from 4 days to 2 weeks. Neck laxity was improved, even with the minimalist approach to the neck.
This presentation should confirm that this technique is a valuable tool for facial rejuvenation. It is simple, with a fast learning curve. Exposure is open and there is minimal risk to vital structures. It may be performed under local anesthesia and has a very short recovery time. Patient satisfaction is surprisingly high for such a non-invasive procedure. The impact on the midface and neck is significant. These factors would make it the ideal procedure to allow residents in training to offer a safe and effective facelift.