The MACS lift (minimal access cranial suspension lift) was described as a modification of the S-lift.
 The incision is limited to the skin hairline junction above the ear and anterior to the ear.  There is no extension behind the ear.
The area of undermining, unlike a conventional facelift, is much smaller and essentially involves a portion of the cheek.  Because there is less undermining, the blood supply to the skin is much more robust and the technique is, therefore, safer in smokers.  There is much less risk of any skin necrosis, unlike other lifts.
Permanent suspension sutures are used to elevate the underlying tissue.  These pass down to the neck, jowls and malar fat pad.  Unlike many other facelifts which do not include significant mid face elevation the MACS lift elevates the malar fat pad reducing the naso labial folds.
Because the undermining and dissection are much more limited the post-operative swelling  is much less than in normal facelifts and recovery is, therefore, quicker.
Because the malar fat pad is elevated it combines very well with lower lid blepharoplasty.  It essentially reduces the height of the lower eyelid giving a more youthful, smooth appearance.
In nearly all cases liposuction is performed to the neck area below the angle of the mandible, both to remove excess fat here and also to free up the skin to allow it to be re-draped by the suspension sutures.
MACS lift produces results at least equivalent, or in most cases,better than a conventional facelift.  It is ideally suited to the younger patient with a sagging mid face.  In patients with really excess skin facility in the neck region, it may be necessary in some cases to make an incision posterior to the ear to take up this slack, but in most cases, this is not necessary.
Details of Procedure
The operation usually is performed under local anaesthesia.  The operation generally takes about two hours and in nearly all cases should be combined with lower lid blepharoplasty, as lifting up the malar fat pad also lifts up the lower eyelids and it is relatively simple to remove the excess skin.
Stitches in the lower blepharoplasty incision are removed at three days, those in front of the ears and alternate stitches in the hairline are removed at five days.  MACS lift is a significant advancement in facial rejuvenation surgery as it involves relatively little undermining and consequently, the recovery is quicker. It also has the significant advantage of improving the mid face and malar area which other facelift techniques do not tend to help.
This lift is ideally suited to the younger patient with mid face ageing changes and moderate changes in the neck.