Dr. Buchanan rejuvenates the face, neck, cheek and lower eyelid using the MACS Lift. This is a simple and effective procedure designed to lift the sagging lower two-thirds of the face and neck to a natural position, instead of pulling them unnaturally backward like older facelifts. The “simple” MACS Lift (perfect for the early signs of aging) elevates the lower face and neck and, to some extent, the cheek. The “extended” MACS Lift also rejuvenates and adds volume to the mid-face and lower eyelid area. It is this area that older procedures do not address.Only a limited amount of excess skin needs to be removed, and there will be nothing but an inconspicuous scar under the sideburn and in the crease in front of the ear, and, for the extended MACS Lift, under the eye. These scars tend to be almost invisible in a few months. In most cases, (unless you have unusually lax neck skin) there is no scar behind the ear. The procedure is ideal if you are younger or have already had a facelift and “just want to look fresher.” It is also perfect if you “need a little more,” and, with slight modifications, works better than the older procedures even if you have considerably lax tissues.

Late 40's, Extended MACS Lift
Before Facelift	After Facelift

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Further Advantages:

• Adds volume to the cheek and mid-face without implants or fat grafts,
• Prevents a pulled ear and elevated sideburn,
• Returns the mouth to it’s normal, happy appearance without pulling it,
• Safer – no dissection around the facial nerve and much less undermining,
• Faster recovery – most back to normal activities in 1-2 weeks.

If the brow has also fallen, which is frequently the case, then a Brow lift or Brow tack will be necessary to eliminate bunching of the tissues in the temple. As the face ages, the forehead and temple area also drops. This flattens the normally arched eyebrow and bunches the skin and the circumferential (orbicularis) muscle beside the eye. When the cheek tissues are elevated, this bunching is worsened. We eliminate this excess by using a full brow lift or by tacking it up through a small lateral temporal incision in the hair. The modern Browlifts is as advanced as the MACS Lift. Dr Buchanan uses four, or occasionally five, small incisions hidden in the hair. Through these, the brow is released and elevated and the muscle between the eyebrows is resected using an endoscope. This eliminates the need for Botox®, does not cause loss of sensation, and adds no time to the recovery. Frequently the incisions heal so quickly that it is hard to find the stitches when it is time to remove them.

Frequently the Browlifts is all that is necessary to correct any problem in the upper eyelids. If, however, there is still excess skin or abnormal fat in the upper eyelids, then an Upper Blepharoplasty is added to the procedure.

Excess fat in the neck is removed with Liposuction. This allows the sutures in the underlying supporting tissues (the SMAS and Platysma muscle) to better drape the skin flat and define the neck. With a marked wattle or unusually loose skin in the neck, an incision behind the ear may be necessary to remove all the wrinkles from the neck and flatten the area below the chin. Usually this is just behind the hairline, and hair grows back in front of the scar, thus hiding the scar. On very rare occasions, with significant wattles and excess skin, the standard facelift scar behind the ear is required.

Mid 70's, Extended MACS Lift, Brow Lift, Upper Blepharoplasty, Neck Lift
Before Eyelid Surgery & Neck Lift	After Eyelid Surgery & Neck Lift

Almost everyone requiring a facelift will also require rejuvenation of the skin. One of the reasons some of the older facelifts left you looking “pulled” and “tight” was the attempt to pull the skin tight enough to reduce the wrinkles caused by sun damage and muscle pull. A natural appearance results when the skin is laid loosely over the corrected underlying structures, as with the MACS Lift, and the skin is rejuvenated separately. The muscle wrinkles are corrected by eliminating the unnatural muscle pull as part of the surgery. The sun damage is corrected with the Obagi® Skin Care System and, if necessary, the laser IPL.

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FREQUENTLY ASKED QUESTIONS

• What does MACS stand for?
• Is the MACS Lift like any other face lift?
• How does the face age?
• What results are to be expected?
• How long will the results last?
• What makes this procedure different from other face lifts?

What does MACS stand for?

MACS is an acronym for Minimal Access Cranial Suspension. This is derived from how the procedure is performed. It uses a short incision below the sideburn and in front of the ear instead of one beginning in the scalp above the ear and extending around the ear and into or along the hair. This is about 1/3rd as long as before, thus, Minimal Access. The MACS Lift also Suspends the elevated face and neck from a solid bony point of the Cranium to provide longer lasting results.

Is the MACS Lift like any other Facelifts?

The MACS Lift was derived from the “S-Lift,” a revival and vast improvement of a facelift done in the first part of the 20th Century. The “S” describes the shape of the incision, which goes under the sideburn, in front of the ear and then just behind the ear. The Lifestyle Lift™ and QuickLift™ are similar. The MACS Lift is an advancement on these by changing the pull to directly upward. This is the direction from which the tissues originally came. This also allows the MACS Lift to eliminate the scar behind the ear necessary in the other lifts because of their slightly posterior pull.

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How does the face age?

Facial aging is caused by intrinsic aging of the tissues, the sun, muscle action and gravity. The sun causes fine wrinkles and crinkles by thinning the dermas (the skin support layer) and reducing moisture. Thickening of the outer dead cell layer hides the skin’s normal color and makes it feel dryer. It also causes reduction of normal blood supply and multiple abnormal fine squiggly blood vessels. Brown spots also appear. Loss of support and muscle action causes deep wrinkles, particularly in the lip, around the eye and in the forehead. Gravity adds to this by making some muscles work harder, and then creates folds and loss of normal contours by pulling the tissues downward. Many deformities, such as the jowls, the naso-labial folds, and the area under the eyes, are caused by adherence of the skin to the bone in these areas, preventing descent of some tissues.

What results are to be expected?

The results vary. Much will depend on your looks before surgery. In one patient, the results may be quite spectacular, whereas in another, the results will be more subtle. This can also depend on your specific expectations as discussed in advance with Dr. Buchanan. Signs of aging and weakening of the tissues will definitely be less conspicuous and may often virtually disappear.

You do not have to worry about your individual features or expression. The feared “wind-tunnel” face-lift look, with flattening of the face, is caused by over-tightening the skin and backward pull. However, in a modern facelift and especially in a MACS lift, the skin is tightened very little. Rather, Dr. Buchanan elevates the tissues and the volumes of the subcutaneous tissues are enhanced, thus restoring the youthful contours of the face.

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How long will the results last?

You must realize that no plastic surgery procedure can stop time. A facelift can, however, turn back the clock and be effective for a number of years. The MACS Lift is designed, by anchoring the tissues of the face to the cranial bone, to slow further aging as much as possible. How long the results last will also depend on your life style, previous loss of support tissue and, possibly, genetic factors. Rest assured that most patients are happy with the results of their MACS Lift for a good many years.

What makes this procedure different from other facelifts?

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WHAT TO EXPECT

We provide the following information before surgery so patients undergoing the MACS Lift will know how to prepare for their rejuvenation and its postoperative course.

Two weeks before surgery:

• You should take no medications containing aspirin (acetyl salicylic acid) or other anti-inflammatories other than Tylenol® (acetaminophen), since these products affect the blood’s clotting mechanism and, therefore, may lead to excessive bleeding during and after surgery.
• If pain medication is necessary, we recommend that you take Tylenol® (acetaminophen).
• You should take no vitamin or food supplement other than the ones we provide each patient. Our vitamins are specifically formulated to improve your healing and reduce bleeding and bruising.
• You should stop taking any hormones, estrogen containing medications or birth control pills, if possible. These increase your risks of developing clots in your legs.
• IF YOU SMOKE OR USE TOBACCO PRODUCTS, YOU MUST QUIT 2 months before surgery and continue off all tobacco products until 2 months after surgery. Smoking causes narrowing of the blood vessels, which leads to a decrease of blood supply to the skin, thus slowing the healing process and risking loss of some skin.
• You should be sure to inform Dr. Buchanan of any medications you take, as well as possible allergies (to certain medications, tape, Band-aids, latex and so on.)
• Any preliminary examinations that are necessary, such as a blood test, lung X-Ray, or an electrocardiogram (EKG) will be performed at this time.

On the day of the operation:

• You should not wear any makeup.
• You should wear loose, comfortable clothing that does not need to be pulled over your head.
• You must not eat or drink anything for 6 hours before the operation unless instructed to do so by the anesthesiologist.
• You should make certain you have someone to take you home after surgery. You MUST NOT drive a car until you have been off all medications for at least a full day and can move your neck easily.
• You will be given preliminary medications to calm you. A light general anesthetic, administered by a Board Certified Anesthesiologist will be used during the procedure.
• At the end of the operation, a thin tube will be placed under the cheek skin and will exit behind the earlobe to drain any blood that might collect. This is usually removed in 24-72 hours.
• After finishing the procedure, your face will be cleansed and your head loosely wrapped in bandages. 
• Approximately 1-2 hours later, you may be taken home or admitted overnight, depending on how much was done and your preference.

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After Surgery:

• You should try to remain as quiet and relaxed as possible. Keep your head elevated because lying flat or bending over will increase the swelling or cause bleeding.
• If serious bleeding should suddenly occur within the first few hours after a facelift procedure, it might be necessary for Dr. Buchanan to open the wound under local anesthesia to stop the bleeding. This is extremely unusual.
• You should not lift, push, pull, strain in any way, or bend forward for 96 hours.
• You should take Arnica Montana which we provide. This helps reduce bruising and helps what bruising that does occur resolve faster.
• Bruises will occur, but these will fade over the first few weeks. They can be covered with makeup. You will be provided the means and instructed how to do this.
• You will have been given medication for pain. You may take this or Tylenol® (acetaminophen), but not both.
• Because of the deep stitches, your jaw might ache or pull when you open your mouth wide.  However, that annoying sensation will pass in a few days. Because of this, you should eat only things that are soft and require minimal chewing for the first 4 to 5 days.
• If you had an extended lift, you should keep ointment in your eyes at least 3 times a day for the first week.
• Infections are rare but, when they occur, they can be treated with antibiotics. For this reason, you should report any unusual swelling or redness.
• If you have nausea that the medication supplied does not control, increasing pain or discomfort, any fever over 101, any visual impairment, or problems having a bowel movement, you should contact the office or Dr. Buchanan.
• If you have questions about any of this, contact us.

Post-operative course:

• The drains will usually be removed the day after surgery. Occasionally they need to stay longer.
• You can take a shower or wash your hair from that point on. You should be careful, as hot water can cause you to faint.
• Sutures will be removed between days 3-10.
• You should be able to go for a walk or shop within several days after surgery, but you should count on not being socially active for about a week or more.
• The bruising will turn from blue/black to yellow/green in 3-7 days and disappear over another 7-10 days. You will be provided makeup to conceal the discolorations.
• The swelling will start to subside after 3 days and will hardly be visible after 2 weeks, though there will be some deep swelling and irregularity for several months.
• The incisions in front of the ear and around the eyes will fade quickly though there may be some slight redness for several months. (This is easy to disguise.) The incision at the sideburn usually heals as fast, but there are occasionally some hairs that grow through in front of the incision that may need to be encouraged. (This is because of the technique that hides the incision within the hair.)
• After 2 to 3 months, you will only notice the final results of the operation.

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