Eur J Plast Surg (2004) 27:311
P.L. Tonnard, A.M. Verpaele: The MACS-Lift: Short Scar Thytidectomy
Quality Medical Publishing, St. Louis, 2004, 300 pp (ISBN 1-57626-191-3), $320 US
Published online: 22 September 2004
Patrick Tonnard and Alexis Verpaele are to be congrat-
ulated on developing a concept which has simplified fa-
cial rejuvenation and, perhaps more important than that,
they have increased safety in face lifting. They, together
with some of their colleagues and with K. Berger of
Quality Medical Publishing, have produced a beautiful
and well-organized book on the minimal access cranial
suspension lift (MACS) lift. The first chapter provides a
concise but comprehensive history of face lifting from
superficial methods to complex—and in some hands
dangerous—methods. They then present their method
based on safer and more logical principles.
The MACS lift is such a procedure. The basic concept
is that sufficient exposure can be obtained through a short
scar to allow the non-undermined SMAS to be plicated
and suspended with permanent purse-string sutures; the
latter are anchored to the temporal fascia.
From personal experience of a significant number of
patients treated in this way, this is a technique that fulfills
many of both surgeon and patient requirements. It is
quick, secure, and has a short recovery time. Perhaps even
more importantly is that it can be very easily modified at
a later date.
The concepts of volume shift and vertical skin tight-
ening are emphasized—very important in all face-lifting
procedures. The method for placement of sutures and the
essential positioning in relation to the facial nerve are
presented clearly with excellent illustrations. The essen-
tial part of the technique is plication of the SMAS, and
again this is well explained and illustrated.
The management of the incisions has evolved from
straight lines to zigzags. This is well explained with di-
agrams and illustrations.
The chapter on indications for the simple and extended
MACS lift has been researched carefully. Here, the au-
thors point out that smoking is not a contraindication to
this procedure. In this section an excellent information
brochure for patients is reproduced.
In the third chapter, the procedure is comprehensively
described, including sedation and administration of local
anesthesia. Markings and raising of the facial flap are well
illustrated. The most important part of the procedure is
well explained, that is how and where to place the sus-
pension sutures. Finally, their technique of excess skin
resection is carefully explained. Many useful tips are
discussed and shown in a series of illustrations. The au-
thors postoperative management is then well illustrated
The fourth chapter provides a series of cases which
have consistently good results. The important aspect of
these patients is that they are greatly improved and still
remain within the range of normality.
Chapter five consists of a selection of cases presenting
for secondary surgery. These cases are well presented,
analyzed, the treatment is proposed and illustrated, and
the end result is shown. This is a very useful chapter and
bears careful reading.
The final chapter is that all-important one of “Prob-
lems and Complications.” This is honestly presented and
is “required reading.”
The bibliography is modest. I enjoyed the quotations at
the beginning of each chapter, and the “surgical pearls” at
the end of the book.
Even after having used this technique in many cases, I
learned a lot of subtle techniques which will improve my
results. If you wish to learn a relatively quick, nontrau-
matic, and safe method of face lifting which can be re-
vised easily, this is the book for you.
I. Jackson (