Your skin type, age and the extent of sagging are important factors when deciding which surgical technique to apply. The MACS lift is the second in the series of facelift variants.
A MACS lift can restore the smoothness and contours of your face and lower jaw, so that you look younger. The MACS lift stands for Minimal Access Cranial Suspension lift and is a more extensive intervention than the s-lift or mini-lift, in which only the skin is tightened, without including the underlying tissues.
With the MACS lift, just as with a face and neck lift, the underlying supporting tissue (SMAS) is also stretched back to its original position. However, this does not include the skin of the neck.
A MACS lift may be combined with an eyelid correction and/or endoscopic forehead lift.
- Anesthesiageneral anaesthetic
- Duration2 to 2,5 hours
- Time to recover7 to 14 days
What does a MACS lift cost
LOperation with local anaesthesia
OOperation requires a overnight stay (price incl. overnight)
NOperation with general anaesthesia (price inclusive narcosis)
Rates MACS lift
Combined neck/faceliftON€ 6.250,-
Extra price correction upper eyelids€650,-
Extra price correction lower eyelids€1.150,-
Extra price correction upper and lower eyelids€1.500,-
Extra price Tissucol€750,-
There are a number of different facelift variants which vary in technique and cost. It can be seen as a three-stage procedure:
1. S-lift: With an s-lift, only the skin of the cheek is lifted via an s-shaped incision (also referred to as a mini-lift). The underlying supporting tissue is not lifted.
2. MACS lift: With a MACS lift (Minimal Access Cranial Suspension lift), the skin of the cheeks is lifted together with the underlying supporting tissue (SMAS) via the same incision. This variant does not make any difference to the skin of the neck.
3. Face-neck lift: With a face-neck lift, an elongated incision is made behind the ear, which is used to lift the skin of the cheeks, the underlying supporting tissue (SMAS) as well as the skin of the neck.
Unlike with the s-lift superficial skin correction, a MACS lift tightens the underlying tissue layers as well as the skin of the face. Because this SMAS (Superficial Muscular Aponeurotic System) tissue is heavier than the actual skin, it can cause the top layers of tissue (skin and fatty tissue) to sag. This results in jowls or “hamster cheeks”.
The consultation is always held with the plastic surgeon who will be carrying out your procedure.
This consultation will determine whether a MACS lift can remedy your complaints and achieve what you are looking for. The plastic surgeon will ask you a number of questions, such as your medical history, what medication you are taking and whether you have any allergies.
The plastic surgeon and consultant will focus as much as possible on you personally, any case history you may have and your specific circumstances, when discussing the intended procedure. It is therefore important to leave sufficient time for this consultation, and bear in mind that appointments can sometimes run over, although we do our utmost to ensure that you are kept waiting as little as possible. We are also there for you after your consultation, to answer any questions you may have. If necessary, an additional consultation can be arranged.
After this, the plastic surgeon will show you before and after photos of MACS lift procedures they have previously carried out. They will also discuss the pros and cons of the facelift, possible complications and any risks with you. The aim of the consultation is to provide you with as much clarity and detail as possible, so that you can make a well-informed decision.
Following on from your first consultation with your plastic surgeon, you will have an appointment with your consultant. The aim of this appointment is to tell you about the general aspects to be arranged with respect to your MACS lift.
You are expected to arrive at the Boerhaave clinic half an hour before your MACS lift.
The operation is carried out under general anaesthetic. Before the procedure, the plastic surgeon carefully marks out what they are going to do. The general anaesthetic is then administered. With a MACS lift, the plastic surgeon makes an incision from the temple in the hairline downwards around the ear, ending behind the ear.
Once the skin has been separated from the layer of connective tissue between the skin and muscles (MACS), the plastic surgeon returns this connective tissue to its original position. They then shorten the connective tissue by pleating it or folding it in half, and attach it to the underlying layers. This creates more volume around your jawline. The top layer of skin is then pulled back in the same direction. The skin is then attached using absorbable stitches at the location of the incision.
Once the excess skin tissue has been removed, the skin is stitched up again around and behind the ear using absorbable stitches. This skin is placed under tension, because skin has been removed. Because of this tension on the skin and stitches, there is a risk that the scars may not heal very nicely.
Your plastic surgeon therefore uses Tisseel, a skin glue. This glue is applied to the underlying tissue before stitching up the incision, so that there is less tension placed on the stitches. As a result, the scar heals much more nicely. But the Tisseel glue does more than that. It is also used to achieve effective haemostasis, in other words tiny burst blood vessels are sealed, so there is less chance of post-operative bleeding. The airtight layer of glue also reduces the generation of tissue fluid (oedema), which in turn aids recovery and speeds up the end results. As a result, very few patients nowadays need a drain or pressure bandage after a MACS lift (drains are small plastic tubes that are often left in after an operation, to allow excess fluid exuding from the wound to drain away). You are free to go home a few hours after your treatment (assisted by another adult) wearing just a headband.
Because deeper layers of tissue are also lifted in a MACS lift, it is a much longer-lasting solution than an s-lift. Unlike with an s-lift, a MACS lift can eliminate the deep creases around the mouth and elevate jowls. A MACS lift is always performed as a day care procedure. This means that you are generally free to go home on the same day.
Video animation of MACS-lift procedure at the Boerhaave Medical Centre
After care and recovery
MACS lifts are performed under general anaesthetic, so you will usually be kept at the clinic for a further 3 to 4 hours after the procedure. After the operation, you will be taken to the recovery room, where your blood pressure, heart rate and other vital signs will be monitored. You will stay there for about half an hour, after which you will rest in a bed in the day care department for a further 3 to 4 hours. You will not be free to go home until the nursing staff and anaesthetist give their approval for you to leave. In consultation with the plastic surgeon or nurse, you will immediately make an appointment for your first post-op check-up at the clinic.
Once home, you may eat and drink easily digestible food, such as water, tea and rusks. This also helps prevent nausea and vomiting, which in turn reduces the chance of post-operative bleeding and/or pressure on the wound. It is therefore recommended to keep up your liquid intake after the procedure. For example, drink a glass of water every hour.
You may feel mild pain and pulling after your facelift. You are bound to have a pulling sensation, because the skin and tissue are slightly under tension. There may also be sensitivity around the ears. This is normal and will disappear after a couple of days.
As with every surgical procedure, the body takes time to recover. The treated area will initially be bruised, sore and swollen. The scars may also be reddish in colour and raised immediately after the MACS lift. You shouldn’t worry about this, as it is your body’s natural reaction. Swelling and bruising will usually be worse in the first 3 days after the procedure, and will then gradually start to disappear.
Your skin will feel hard for a couple of weeks. This is because the layers of tissue are adhering together and scars are forming. The skin may sometimes be quite sensitive. This is a normal reaction to the procedure and will gradually disappear. The stitches will dissolve and swelling and bruising will gradually subside.
At your first check-up, you will be given a scar care cream to take home with you. Once the wound has closed and the scabs have disappeared, you can start applying the scar cream. If you apply this cream to the closed wound twice a day, you increase the chance of the wound healing nicely.
Your face will look strange to you for a number of weeks into the healing process. Once the swelling and bruising subside, you will have more of an idea of your new youthful appearance. Because the healing process takes a while, you will have to wait a couple of weeks before you really start seeing the “new you”. Small changes may continue to take place in the months following your MACS lift. Most patients are pleased with the results, especially if their expectations are realistic.
The scar from a MACS lift is mainly hidden in the hairline, with only a small part of it passing in front of the ear. The plastic surgeon will do everything they can to ensure that the scars are virtually invisible. The scars will initially be red and swollen, but this will start to fade after a couple of weeks. It is useful to know that a scar takes 1 to 1½ years to completely calm down. Take care to keep the scars out of the sun, and treat them carefully.
Risks and complications
It is important you are aware that every surgical intervention can entail risks and complications. Plastic surgery procedures are in principle carried out on healthy people, so the risks and chances of complications are low. We make sure any risks are reduced to an absolute minimum, by providing plenty of information, taking a thorough medical history (noting your case history, including medication, any problems experienced in previous operations, allergies, etc.) and applying our professional procedures.
A MACS lift is a very common procedure. In experienced hands, the risk of complications is very low. A MACS lift entails the same risks as any other operation. You can help reduce certain risks by carefully reading through the instructions you are given prior to your MACS lift.
Possible complications of a MACS lift may be:
- Haematoma (blood clot under the skin which has to be removed)
- Adverse reaction to the sedation
- Change in sensitivity
- Permanent scars
- Damage to underlying structures
- Unsatisfactory aesthetic result.
Patients who smoke or use tobacco or nicotine products (such as nicotine patches and chewing gum) at the time of their surgery have a greater risk of complications, such as skin loss and impaired wound healing. People who are exposed to passive smoking may also have an increased risk of complications such as these. What’s more, smoking may have a negative effect on the anaesthesia, which may in turn lead to an increased risk of bleeding. People who are not exposed to tobacco smoke or nicotine-containing products have a significantly lower risk of such complications. It is important not to smoke for at least 2 weeks prior to the operation and to keep this up for the entire recovery process.