MACS Facelift

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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.

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  • 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.
  • MACS Facelift

    1. 1. MACS LIFT for Facial Rejuvenation Stamatis Sapountzis M.D. China Medical University Hospital
    2. 2. Clinical Cases
    3. 3. Patient 1
    4. 4. Patient 2
    5. 5. Patient 3
    6. 6. Rhytidectomy remainsthe “Gold Standard” in facial rejuvenation
    7. 7. 1907 First Anti-aging procedure by Miller He was eradicating wrinkles by subcutaneously sectioning the facial muscles and use paraffin for volume restoringHistory
    8. 8. Cutaneous Period (1900-1970): Eugen HöllanderSMAS Period (1970-1980): Tord SkoogDeep Plane Period (1980-1991): TessierVolumetric 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 theHistory “lift” instead of posterior.
    9. 9. “Mini” Face Lifts have gained popularity + -
    10. 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. 11. Traditional MACS In MACS-lifting, the horizontalIn traditional facelifting, an oblique vector is component of the lifting is avoidedused for redraping the skin, which can be as much as possible to create andecomposed into a vertical and oblique antigravitational lifting of the facialcomponent features.
    12. 12. Column 1: Full Incision with SMAS Plication Column 2: Short Scar Incision with SMAS Plication Column 3: Short Scar Incision with MACS3 different face-lifts in Triplets
    13. 13. PRS, 200682 patientsEvaluation:1 and 24months • Shorter operating time • More post-op pain No difference in the cosmetic results
    14. 14. Surgical Technique(MACS Lift)
    15. 15. 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
    16. 16. 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 triamcinoloneinflitration
    17. 17. • 3mm cannula • Two or three incisions are used to crisscross the marked area optimally • preplatysmal plane • A maximal lipectomy is performedNeck Liposuction
    18. 18. Incision into hair An incision parallel to the hair shaftswill produce a scar at the border of thetemporal hairline.An incision perpendicular to the hairshafts will produce hair regrowththrough the scar into the cheek flap.The final scar will be hidden a fewmillimeters within the hair-bearingtemporal skin and will be less visible
    19. 19. 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 directionSkin Undermining
    20. 20. Anchor point
    21. 21. Frontal Branch of Facial nerve
    22. 22. 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 padPlacement of sutures
    23. 23. Skin resectionThe correct vector of skin redraping isvertical. There will be no dog ear aroundthe earlobe, and a small dog ear at thesuperior edge of the incision can becorrected by extending the incision for 1cm.
    24. 24. The temporal hairlineincision is mandatory in anyvertical face lift technique toavoid unnatural raising ofthe sideburns.No skin resection in thepreauricular region.After vertical redraping ofthe skin flap, the earlobewill be folded upward, and asmall skin excision is madeto place the earlobe back inits natural position
    25. 25. When the skin of the neck is very looseand wrinkled because of excessive sundamage, vertical folds may appear inthe infralobular region at the end ofvertical skin redraping
    26. 26. (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 closurePosterior Cervicoplasty
    27. 27. Literature Review about the complications after incisionless lifting with threadsThe complication rate ranges from 2.8% to 69 %2011, Sulamanidze: 609 complications occurred for6,098 patients 3% asymmetry 2.8% contour irregularities in 2.8 % 2.7% early relapse
    28. 28. Thankyou

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