If you have previously had a facelift or other facial rejuvenation, you may wish to freshen it after a number of years, or you may desire revision because of a disappointing result. Either way, a modification of the MACS Lift can solve your problem. This advanced procedure avoids the problems, such as being over pulled, and unnatural, of older techniques and can safely and more simply rejuvenate the “faded facelift.”

In most practices, re-do facelifts constitute only a small percentage of the facelifts each surgeon does. However, after moving to Highlands, NC, they make up over 50% of the facelifts Dr. Buchanan does. These secondary procedures are much more difficult than a primary facelift. This is because scar is much harder to deal with than unoperated tissue, the original anatomic positions have been altered, and there are frequently problems created by how the original procedure was done, how it healed or how you subsequently aged.

Though he was not a stranger to secondary facelifts, once in Highlands, and doing many more repeat facial rejuvenations, Dr. Buchanan was impressed with the need for a better solution than the standard facelift and the scarcity of literature on the subject. He, therefore, began to explore the problems and develop solutions. The first obvious solution was to stop separating the facial tissues into two layers. This process is hard the first time and impossible the second. He adopted the method of an internationally known Atlanta surgeon from the 1970’s, Dr. John Ransom Lewis. Dr. Lewis used sutures to reef the underlying support layer without trying to separate it and move it. Dr. Lewis’ results were spectacular and long lasting. This also allowed Dr. Buchanan to adjust the correction to each person’s individual needs. He then discovered the work of Drs. Patrick Tonnard and Alexis Verpeale from Gent Belgium. Their procedure incorporated the tissue reefing, but used a shorter incision. Dr. Buchanan learned the MACS Lift from Drs. Tonnard and Verpeale, and has adapted it with what he learned from his previous quest to fit your needs.

Late 50's, Extended MACS Lift, wishing to look happier and refreshed years after a previous Face Lift
Before Facelift	After Facelift

PROBLEMS WITH PREVIOUS FACELIFTS

The Swoosh:

Older facelifts take the SMAS (the underlying support structure of the face) loose from the only place possible, near the ear and below the lateral cheekbone. Although trying to “lift” the face, the only direction possible is up and back. With these techniques, the central face is left mostly unmoved. This is why some people developed the “Mid-face Lift,” a procedure totally unnecessary with the MACS Lift. As time goes by, the unfixed central face descends more than the relatively scared lateral face. This creates a “Swoosh” like appearance, occasionally with bands from the mouth, upward and lateral. The more sun damaged, the worse this appears.

A secondary facelift by Dr. Buchanan using the MACS Lift corrects this problem by lifting and securing the mid-face and cheek, correcting the pull to a natural upward direction. This repositions the entire face to its original position.

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Upper Cheek Crescent:

This is a crescent shaped fullness below and lateral to the eye that is composed of part of the orbicularis (eye closure) muscle and the upper lateral fat that slides down and medial on the cheek bone. When seen from the opposite side, the cheek should have a gentle “S” shaped, ogee curve. With aging, and, particularly after a conventional facelift, this curve begins to look like a “3.” This looks even more dramatic next to the hollow created by older blepharoplasties that use fat removal as the main corrective measure.

The extended MACS Lift performed by Dr. Buchanan can correct this problem by lifting the cheek fat and reefing the orbicularis muscle. This restores the natural ogee curve to the cheek and helps hide some of the orbital hollow.

Hollow, Rounded Eyes:

The orbicularis muscle around the eye is attached to the bony orbital rim. Gravity pulls the cheek tissues down, but the lower bony attachment of the orbicularis stops the descent. As the lateral canthus (the attachment of the lateral corner of the eye to the lateral bony orbit) stretches and the temporal tissue descends and moves medially, the extra tissue that results in the lower eyelid accumulates above the orbital rim attachment of the orbicularis muscle. This, together with the fat that has usually been removed with previous Blepharoplasty, creates a very hollow, elongated eyelid and the telltale “tear trough” under that.

Raising the orbicularis and cheek eliminates most of this. By further elevating the orbicularis and suspending it from the bony orbit and repositioning the canthus to its normal position, Dr. Buchanan completes the correction.

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Earlobe Malposition:

Frequently standard rhytidectomies, which do not anchor the tissues to something solid, pull on the earlobe and stretch it down and forward as gravity and the tightly stretched skin pull on the tissue to which it was attached. This is corrected automatically with the MACS Lift. Since the tissues that are elevated are attached to solid bone, there is little chance that the earlobe will descend again.

Elevated Sideburn:

This is an unfortunate consequence of how most facelifts are done. Unfortunately, there is nothing short of hair grafts that will correct this. The MACS Lift is designed to not worsen this problem (and, in primary procedures, prevents it).

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Imbalanced Forehead:

For many years a “Facelift” consisted of a cheek lift and upper and lower Blepharoplasty (eyelid lift). Some of this was due to the truly unnatural appearance of the forehead and the difficulty of operating on the forehead because of the way the procedure was done. Some was due to the lack of understanding of the aging process. Several things happened. The upper eyelid skin was over-resected and helped pull the forehead further down. Gravity also continued to pull on the lateral brow and caused further crowding of the upper eyelid as well as bunching of the orbicularis muscle. This caused recurrence of the eyelid deformity and an increase of the “crow’s feet” wrinkles. This also caused a significant imbalance of the upper and lower face.

Because of the marked upward pull of the MACS Lift, there is also frequently a bunching of the temporal tissues. To prevent this and rebalance the face, Dr. Buchanan frequently adds a full brow lift or a temporal lift. The full brow lift is usually done endoscopically with small incisions in the hair that heal rapidly with no visible scar and no nerve disturbance. It also removes the unnatural muscle pull between the eyebrows and preserves the forehead muscle function. This adds essentially no time to the post operative recovery. The temporal lift heals even faster, but does nothing in the central forehead.

Imbalanced Skin:

Most facial rejuvenation in the past has concentrated on removing the sags and folds. Someone with tight, but crinkled, spotted skin, still looks old. Some surgeons have tried to correct the skin problems by tightly stretching the skin. This does not work, but causes many of the over-pulled problems of older facelifts. In order to truly rejuvenate the face, the skin also has to be addressed. Dr. Buchanan has several modalities available to accomplish skin restoration. The main method he uses is the Obagi® Skin Care System. This system addresses all the problems of skin aging except the abnormal blood vessels that occur in some people. It removes the thick outer dead cell layer that masks your true color, moisturizes the skin, corrects nuclear abnormalities, corrects pigmentary problems, and thickens the thinned dermis support layer. By thickening the dermis and moisturizing the skin, it eliminates many wrinkles. If crinkles and wrinkles remain, Dr. Buchanan can use one of several different peels or the advanced Luxor® CO2 Laser. For the red areas, he has the Elipse® IPL, the newest advance in light technology.

Whether your problem is one of the above or all of them, by modifying the MACS Lift, Dr. Buchanan can improve your appearance and rejuvenate your face. Contact the office to set up an appointment.

We can provide information on lodging and local activities for accompanying family or friends.

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