Facelifts

Facelifts

Hi, I’m Dr. Tony Prochazka, a cosmetic surgeon working in Sydney and Melbourne. I’ve been doing this work for about 16 years, and I’ve qualified as a fellow of the Australasian College of Cosmetic Surgery, and I’m also a fellow of the Cosmetic Physicians College of Australasia.

I’d like to talk to you a little bit about my approach to face lifting. Face lifting is a field that’s actually been around for over 100 years, believe it or not, but the early facelifts were very crude. Face lifting, I guess, in my opinion, really came into its own probably about 25, 30 years ago. During my training I was learning the very long involved and invasive facelift procedures that involve a very large incision that goes all the way behind the ear, down into the hairline here, a very large amount of dissection, and then actually also identifying the main supportive membrane of the face, cutting into it, undermining it, sometimes cutting a bit of it out, and then pulling it up, stitching it to itself. You can imagine this is really a very invasive procedure.

In the year 2002, a Belgian plastic surgeon by the name of Dr. Patrick Tonnard published a seminal paper on a new less invasive type of facial lift, called the MACS lift, M-A-C-S, it stands for minimal access cranial suspension. Minimal access really just means short scar. Cranial suspension really just means vertical lifting, lifting upwards towards the cranium. The old style facelift with a lot of dissection behind the ear tended to pull all the tissues up pretty much behind the ear. This is a more oblique direction, can actually cause distortion of the corners of the mouth, so you get that kind of fish mouth look, and it can also give a windswept appearance. It’s a very effective lift, but I don’t think it’s 100% natural.

The MACS lift, in my hands at least, gives a very natural result. It is still a true facelift because we are still identifying that deeper structural layer, and we are repositioning that. But instead of cutting it and stitching it to itself, the repositioning is done through the use of loop sutures, suspensory sutures that go into the midface and go down into the neck. We can actually get very effective neck lifting through those sutures. These are loop sutures that are then anchored to the cheekbone here.

So it is a true facelift, we are actually lifting the main structural supporting membrane of the face, and so you do get a very good duration, 8 to 10 years, possibly even longer, with the MACS lift, but it is less invasive than the traditional facelift, and it’s also quicker to perform. And for all of those reasons, of course, it’s also less expensive for the patient. So really I think it’s a win-win. I’ve pretty much stopped doing the more invasive lifts. I think there’s probably still a place for them here or there, but I prefer to do the MACS lift in just about all cases.