MACS-Facelift (Minimal Access Cranial Suspension) is a procedure that leaves you looking fresher and youthful. People may not notice that you have had surgery, just that you look refreshed. The MACS-Lift helps to remove excessive jowling around the chin, deep creases that appear between your nose and mouth, and restores the outline of the jaw. The MACS-Lift is less invasive than other facelift procedures and leaves a shorter scar. This type of facelift will lift and hold up sagging tissues in the neck, cheeks, chin, or near the nose with suspension sutures in the deeper tissues. This operation is done on an outpatient basis while you are under local anesthesia.MACS FaceLift provides natural rejuvenation with shorter operative time, quicker recovery, and less potential for complications compared with traditional face lifts. Fat grafting and Blepharoplasty can enhance the final result.
7. 1907 First Anti-aging
procedure by Miller
He was eradicating wrinkles
by subcutaneously sectioning
the facial muscles and use
paraffin for volume restoring
History
8. Cutaneous Period (1900-1970): Eugen Höllander
SMAS Period (1970-1980): Tord Skoog
Deep Plane Period (1980-1991): Tessier
Volumetric Period (1991-today) surgeons started to care more about
minimizing scars, restoring the
subcutaneous volume that was lost during
the ageing process and they started
making use of a cranial direction of the
History
“lift” instead of posterior.
10. MACS lift (Minimal Access Cranial Suspension)
• Introduced by Tonnard and Verpaele in PRS in
2002 as a modification of a previous described mini
lift “S-Lift”)
• It combines the advantages of a mini face lift with
the effectiveness of more invasive techniques
11. Traditional MACS
In MACS-lifting, the horizontal
In traditional facelifting, an oblique vector is
component of the lifting is avoided
used for redraping the skin, which can be
as much as possible to create an
decomposed into a vertical and oblique
antigravitational lifting of the facial
component
features.
12.
13. Column 1: Full Incision with SMAS
Plication
Column 2: Short Scar Incision with
SMAS Plication
Column 3: Short Scar Incision with
MACS
3 different face-lifts in Triplets
16. Skin Marking
• Starts at the lower limit of the
lobule, going up in the preauricular
crease
• Incisura intertragica, the marking
makes a 90-degree turn backward
• posterior edge of the tragus toward
the helical root
• follows the small hairless recess
between the sideburn and the
auricle, turns downward to follow
the inferior implantation of the
sideburn
17. Solution
• 100 ml 0.9 % NaCl
• 20 ml 2% lidocaine
• 10 ml 10 mg/ml
ropivacaine
• 2 ml 8.4% sodium
bicarbonate
• 0.2 ml 10 mg/ml
Adrenaline
• 10 mg triamcinolone
inflitration
18. • 3mm cannula
• Two or three incisions are
used to crisscross the
marked area optimally
• preplatysmal plane
• A maximal lipectomy is
performed
Neck Liposuction
19. Incision into hair
An incision parallel to the hair shafts
will produce a scar at the border of the
temporal hairline.
An incision perpendicular to the hair
shafts will produce hair regrowth
through the scar into the cheek flap.
The final scar will be hidden a few
millimeters within the hair-bearing
temporal skin and will be less visible
20. A limited skin flap is undermined
in an oval area extending from 1
cm above the zygomatic arch to the
mandibular angle caudally and
about 5 cm in the anterior
direction
Skin Undermining
23. 1st Suture: U- shape to the
mandibular angle and the platysma
2nd Suture: O – shape follows the
anterior border of the skin
undermining
3rd Suture: U-shape from the lateral
orbital rim to the malar fat pad
Placement of sutures
24. Skin resection
The correct vector of skin redraping is
vertical. There will be no dog ear around
the earlobe, and a small dog ear at the
superior edge of the incision can be
corrected by extending the incision for 1
cm.
25. The temporal hairline
incision is mandatory in any
vertical face lift technique to
avoid unnatural raising of
the sideburns.
No skin resection in the
preauricular region.
After vertical redraping of
the skin flap, the earlobe
will be folded upward, and a
small skin excision is made
to place the earlobe back in
its natural position
26. When the skin of the neck is very loose
and wrinkled because of excessive sun
damage, vertical folds may appear in
the infralobular region at the end of
vertical skin redraping
27. (A) a zigzag incision is performed
just within the occipital hairline.
(B) The skin flap is created by
blind dissection at a superficial
subcutaneous level.
(C) The skin is redraped in the
occipital direction, and the skin
excess is determined.
(D) Skin closure
Posterior Cervicoplasty
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33. Literature Review about the complications after
incisionless lifting with threads
The complication rate ranges from 2.8% to 69 %
2011, Sulamanidze: 609 complications occurred for
6,098 patients
3% asymmetry
2.8% contour irregularities in 2.8 %
2.7% early relapse
In 1968 Tord Skoog introduced the concept of subfacial dissection, therefore providing suspension of the stronger deeper layer rather than relying on skin tension to achieve his facelift In 1979, Tessier demonstrated that the subperiosteal undermining of the superior and lateral orbital rims allowed the elevation of the soft tissue and eyebrows with better results than the classic face-lifting
All traditionalfacelift designs have an oblique vectorof traction on the SMAS which can be decomposedinto a horizontal and a vertical component(Fig. 49.1). The horizontal component of this vector oftraction on deep tissues and skin does not really rejuvenatethe face. It rather flattens the face and puts itundertension
Fig. 6. (A) Skin incision. The marking starts at the lower limit of the lobule, going up in the preauricular crease. At the level of the incisuraintertragica, the marking makes a 90-degree turn backward for preserving the integrity of this anatomic landmark. The marking then follows the posterior edge of the tragus, ascending toward the helical root. At the superior limit of the ear the marking follows the small hairless recess between the sideburn and the auricle and then turns downward to follow the inferior implantation of the sideburn. (B) Skin undermining. The lowest point of the undermining lies two fingerbreadths below this point and corresponds with the cranial border of the platysma. The extent of the undermining is marked starting from the lowest point of the incision at the lobule, down to the lowest point described above, and then curving anteriorly to a point halfway between the tragus and the oral commissure. The oval is then closed toward the sideburn. In an extended MACS-lift, the undermining includes the area over the malar fat pad.
The final solution is about 150 cc. 50 cc are inflitrated at each cheek and 50cc at the neck for the liposuction. When is performed under local anesthesia is important to include sodium bicorbonate as it increases the action of the local anesthetic. When the lifting is performed under general anesthesia is not clear if the tumescent anesthesia is helpful. However personally I think that apart from hemostasis the inflitration helps to make the dissection of the flap easier
Neck liposuction should always be performed even in cases that at first seems that will not be necessary. The liposuction will make the skin of the neck more moveable during the skin redraping
. Comparison of temporal hairline incisions parallel and perpendicular to the hair shafts (in the manner of Camirand).
The anchor point for the first two sutures is the deep temporal fascia 1cm above the zygomatic arch in front of the helical rim. For the third suture the anchor point is the anterior part of the deep temporal fascia, lateral to the lateral orbital wall.
From the lateral orbital rim and the superior edge of the zugomatic arch
The purse-string suture is continued in a narrow U-shape, first in a craniocaudal direction, descending in front of the ear from the first bite down to the mandibular angle, making a U-turn, and returning 1 cm anteriorly in a parallel cranial direction to the starting point. A firm amount of parotid fascia in the cranial part and of platysma in the caudal part is taken with every bite of the needleA second purse-string suture is started at the same point and is directed in an angle of about 30 degrees anterior to the original vertical purse string in a more open, oval shape to correct the jowling and the marionettegrooves. The suture is carried to the edge of the undermined area and then taken back to the starting pointU-shaped purse-string suture is placed between the anterior part of the deep temporal fascia and the malar fat pad (Fig. 3, right). By putting tension on this suture, anobvious flattening of the nasolabial groove and raising of the malar fat pad will result.
A lateral redraping of the skin will produce tension and flattening of the face, and a dog ear will be created below the earlobe. To correct this, a retroauricular dissection will have to be performed. To avoid a retroauricular scar, this lateral skin redraping should not be done. (B) In the MACS-lift, the correct vector of skin redraping is vertical. There will be no dog ear around the earlobe, and a small dog ear at the superior edge of the incision can be corrected by extending the incision for 1 cm.