What is a MACS-lift?

The aim of a MACS-lift (Minimal Access Cranial Suspension) is to achieve rejuvenation of the lower one-third of the face with the least possible discomfort and risk. This lifting procedure mobilises and suspends the sagging subcutaneous tissues towards the fixed hair bearing area (cranial suspension), through a small skin incision (minimal access). Skin mobilisation in front of the ear is restricted simply to allow for repositioning of the deeper sagged layers in order to restore the young full curvature of the chin and neck region. Skin tissue is redraped vertically and subsequently removed without tension, so that a 'nice' scar is obtained. In contrast to other techniques, this intervention can be performed exceptionally under local anesthesia with sedation (in a one-day surgical setting), due to the restricted tissue mobilisation, nevertheless general anesthesia is preferred in most of the cases.

The intervention

General anesthesia is used in most of the cases. However, if the intervention is carried out under local anesthesia, an additional sedative is given intramuscularly. Your face will be disinfected and sterile drapes are applied. The surgical area is anaesthetized for approximately 2 hours by means of local infiltration.

The surgery starts with liposuction of the neck area if necessary. Hereafter, the skin incision is made, followed by skin mobilisation in front of the ear. Deeper tissues are suspended by the use of two looped sutures redraping these tissues to correct the effect of age sagging. Bleeding will be controlled and a small drain is placed in order to drain the excess of wound fluid. Wounds are closed and finally a compressive bandage is applied.

After the intervention

Bandage and drains will be removed next day. Showering and washing your hair is then allowed. Your face and neck will appear to be swollen, and a slight discolouration may be present. This condition will take a period of two weeks to diminish. During this period you will suffer very little of pain. Once at home, try to be as inactive as possible during the first three days. If you want to sleep do so with your upper body elevated in a position 60 of degrees. Prevent bending forward or lying in a horizontal position since these bodily movements and positions will lead undoubtedly to increased swelling. Swelling and discolouration can be reduced by means of application of cool packs. However, do never apply ice directly to the skin. Scars will appear in front of the hairline, in front of the ear and also ending behind the ear. Initially these scars are red-coloured. Fortunately, these will fade within a year and gradually become unnoticeable. The scars may initially show some skin folds at the ends, but these will also disappear within a few months.

During the first week, you may experience discomfort when opening your mouth, due to the deep sutures. However, this feelings and sensations disappear quickly. The area in front of the ear will postoperatively show some irregularities and thickening. These will diminish within several weeks. Social disability due to the intervention lasts approximately 2 to 3 weeks.

Risks and complications

Severe complications are rare. If major bleeding occurs within the first hours after surgery, the wound needs to be re-explored in order to stop bleeding. In this case discolorations will take some more time to disappear. Infection is seldom seen, but if it occurs it can successfully be treated with antibiotics in most cases. Smokers, who continue to practice their habit, are very likely to suffer from delayed wound healing at the incision site; the final scar in these patients may remain wider than normal.


The final result of the intervention is partly dependent on the pre-operative conditions, especially on the skin quality and the amount of sagging. Sometimes, the result is rather spectacular. In other cases it is rather considered as discrete facial refreshment. Nevertheless, in any case signs of aging will be reduced. This type of intervention does not distort individual features of your face, nor does it cause the over tightened face-lift look to occur, since mainly structures located deeper into the skin are redraped vertically.

Your face will be rejuvenated for some years to come. Lifestyle factors and genetic background do have an influence the durability of the result.