{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T16:55:39Z","timestamp":1772556939360,"version":"3.50.1"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While facelifts remain central to facial rejuvenation, ancillary procedures are essential for addressing aspects of aging not corrected by facelifting alone, such as soft tissue atrophy and skin quality. Despite their routine use, few reviews describe their role alongside facelifts in modern practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To define the range of ancillary procedures used with the Minimal Access Cranial Suspension (MACS) lift in current practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was conducted on all MACS-lift procedures performed by the senior authors from January 1, 2018, to December 31, 2024. Data collected included demographics, surgical and ancillary procedures, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The MACS-lift technique has evolved to include deep neck reduction, centrofacial lipofilling, and skin resurfacing. Among 380 patients (356 females, 24 males), 81.8% underwent a primary facelift. Ancillary procedures were performed in 98.9% of cases, with an average of 5.8 procedures per patient, with this average being higher for female than for male patients (6.0 vs 4.5), and higher for patients 55 years or older than for younger patients (6.17 vs 5.13). The most common ancillary procedures were lipofilling (96.3%), brow lift (72.6%) neck lift (67.9%), nanofat microneedling (64.7%), blepharoplasty (57.4%), and lip lift (27.6%). Mean operative time was 3.93 hours. No major complications occurred. Minor complications included neuropraxia (4.7%), infection (2.9%), skin necrosis (2.9%), sialoma (2.6%), seroma (2.4%), hematoma (1,6%) and wound healing disturbances (1,3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Ancillary procedures are frequently and safely combined with the MACS-lift to address facial ptosis, volume loss, and skin aging, enhancing overall rejuvenation outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence IV<\/jats:title>\n                    <jats:p>\n                      This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-025-05143-w","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T13:45:03Z","timestamp":1756993503000},"page":"582-591","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Use of Ancillary Procedures in Combination with the MACS-Lift for Facial Rejuvenation: A Retrospective Cohort Study"],"prefix":"10.1007","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9789-9221","authenticated-orcid":false,"given":"Pehr","family":"Sommar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenaleen","family":"Law","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janne","family":"Ongena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis","family":"Verpaele","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Tonnard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"5143_CR1","doi-asserted-by":"crossref","unstructured":"Tonnard P, Verpaele A, Bensimon R. Centrofacial rejuvenation. First edition. ed. New York: Thieme; (2018).","DOI":"10.1055\/b-0038-149609"},{"key":"5143_CR2","doi-asserted-by":"publisher","first-page":"ojad063","DOI":"10.1093\/asjof\/ojad063","volume":"5","author":"MJ Stein","year":"2023","unstructured":"Stein MJ, Aston SJ. Ancillary procedures to facelift surgery: what has changed? Aesthet Surg J Open Forum. 2023;5:ojad063.","journal-title":"Aesthet Surg J Open Forum"},{"issue":"6","key":"5143_CR3","doi-asserted-by":"publisher","first-page":"2074","DOI":"10.1097\/00006534-200205000-00046","volume":"109","author":"P Tonnard","year":"2002","unstructured":"Tonnard P, Verpaele A, Monstrey S, Van Landuyt K, Blondeel P, Hamdi M, et al. Minimal access cranial suspension lift: a modified S-lift. Plast Reconstr Surg. 2002;109(6):2074\u201386.","journal-title":"Plast Reconstr Surg"},{"issue":"2","key":"5143_CR4","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.asj.2007.01.008","volume":"27","author":"P Tonnard","year":"2007","unstructured":"Tonnard P, Verpaele A. The MACS-lift short scar rhytidectomy. Aesthet Surg J. 2007;27(2):188\u201398.","journal-title":"Aesthet Surg J"},{"key":"5143_CR5","unstructured":"Tonnard P, Verpaele A, Slayden C. Short-scar face lift : operative strategies and techniques. St. Louis, Mo.: Quality Medical Pub.; 2007."},{"issue":"4","key":"5143_CR6","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1007\/s00266-005-0047-7","volume":"29","author":"P Tonnard","year":"2005","unstructured":"Tonnard P, Verpaele A, Gaia S. Optimising results from minimal access cranial suspension lifting (MACS-lift). Aesthetic Plast Surg. 2005;29(4):213\u201320.","journal-title":"Aesthetic Plast Surg"},{"issue":"3","key":"5143_CR7","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1007\/s00266-003-0062-5","volume":"27","author":"A Fogli","year":"2003","unstructured":"Fogli A. Temporal lift by galeapexy: a review of 270 cases. Aesthetic Plast Surg. 2003;27(3):159\u201365.","journal-title":"Aesthetic Plast Surg"},{"issue":"6","key":"5143_CR8","doi-asserted-by":"publisher","first-page":"1536","DOI":"10.1007\/s00266-019-01486-3","volume":"43","author":"F Viterbo","year":"2019","unstructured":"Viterbo F, Auersvald A, O\u2019Daniel TG. Gliding brow lift (GBL): a new concept. Aesthetic Plast Surg. 2019;43(6):1536\u201346.","journal-title":"Aesthetic Plast Surg"},{"issue":"1","key":"5143_CR9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00266-013-0202-5","volume":"38","author":"A Auersvald","year":"2014","unstructured":"Auersvald A, Auersvald LA. Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthet Plast Surg. 2014;38(1):1\u20139.","journal-title":"Aesthet Plast Surg"},{"issue":"1","key":"5143_CR10","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.clindermatol.2021.08.010","volume":"40","author":"A Dayal","year":"2022","unstructured":"Dayal A, Bhatia A, Hsu JT. Fat grafting in aesthetics. Clin Dermatol. 2022;40(1):35\u201344.","journal-title":"Clin Dermatol"},{"issue":"Suppl 1","key":"5143_CR11","doi-asserted-by":"publisher","first-page":"i17","DOI":"10.1093\/bjd\/ljad282","volume":"189","author":"T Griffiths","year":"2023","unstructured":"Griffiths T, Watson R, Langton A. Skin ageing and topical rejuvenation strategies. Br J Dermatol. 2023;189(Suppl 1):i17\u201323.","journal-title":"Br J Dermatol"},{"issue":"1","key":"5143_CR12","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.asj.2007.10.005","volume":"28","author":"R Bensimon","year":"2008","unstructured":"Bensimon R. Croton oil peels. Aesthet Surg J. 2008;28(1):33\u201345.","journal-title":"Aesthet Surg J"},{"issue":"5","key":"5143_CR13","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1177\/1090820X12445082","volume":"32","author":"A Zeltzer","year":"2012","unstructured":"Zeltzer A, Tonnard P, Verpaele A. Sharp-needle intradermal fat grafting (SNIF). Aesthet Surg J. 2012;32(5):554\u201361.","journal-title":"Aesthet Surg J"},{"issue":"4","key":"5143_CR14","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1097\/PRS.0b013e31829fe1b0","volume":"132","author":"P Tonnard","year":"2013","unstructured":"Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: basic research and clinical applications. Plast Reconstr Surg. 2013;132(4):1017\u201326.","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"5143_CR15","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1097\/PRS.0000000000005455","volume":"143","author":"A Verpaele","year":"2019","unstructured":"Verpaele A, Tonnard P, Jeganathan C, Ramaut L. Nanofat needling: a novel method for uniform delivery of adipose-derived stromal vascular fraction into the skin. Plast Reconstr Surg. 2019;143(4):1062\u20135.","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"5143_CR16","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1097\/PRS.0000000000001123","volume":"135","author":"L Charles-de-Sa","year":"2015","unstructured":"Charles-de-Sa L, Gontijo-de-Amorim NF, Maeda Takiya C, Borojevic R, Benati D, Bernardi P, et al. Antiaging treatment of the facial skin by fat graft and adipose-derived stem cells. Plast Reconstr Surg. 2015;135(4):999\u20131009.","journal-title":"Plast Reconstr Surg"},{"issue":"suppl_3","key":"5143_CR17","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.1093\/asj\/sjx078","volume":"37","author":"S Cohen","year":"2017","unstructured":"Cohen S, Hewett S, Ross L, Delaunay F, Goodacre A, Ramos C, et al. Regenerative cells for facial surgery: biofilling and biocontouring. Aesthet Surg J. 2017;37(suppl_3):S16\u201332.","journal-title":"Aesthet Surg J"},{"issue":"4","key":"5143_CR18","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.trsl.2013.11.009","volume":"163","author":"L Kokai","year":"2014","unstructured":"Kokai L, Marra K, Rubin J. Adipose stem cells: biology and clinical applications for tissue repair and regeneration. Transl Res. 2014;163(4):399\u2013408.","journal-title":"Transl Res"},{"issue":"6","key":"5143_CR19","doi-asserted-by":"publisher","first-page":"e2075","DOI":"10.1097\/GOX.0000000000002075","volume":"7","author":"RJ Rohrich","year":"2019","unstructured":"Rohrich RJ, Mohan R. Role of ancillary procedures in facial rejuvenation. Plast Reconstr Surg Glob Open. 2019;7(6):e2075.","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"39","key":"5143_CR20","doi-asserted-by":"publisher","first-page":"e12333","DOI":"10.1097\/MD.0000000000012333","volume":"97","author":"R Anlatici","year":"2018","unstructured":"Anlatici R, Ozerdem G, Demiralay S, Ozerdem OR. Face-neck lifting and ancillary procedures: a series of 203 cases. Medicine (Baltimore). 2018;97(39):e12333.","journal-title":"Medicine (Baltimore)"},{"issue":"5","key":"5143_CR21","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1097\/00000637-198105000-00001","volume":"6","author":"BL Kaye","year":"1981","unstructured":"Kaye BL. The extended face-lift with ancillary procedures. Ann Plast Surg. 1981;6(5):335\u201346.","journal-title":"Ann Plast Surg"},{"issue":"1","key":"5143_CR22","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1001\/archfaci.6.1.8","volume":"6","author":"FF Becker","year":"2004","unstructured":"Becker FF, Bassichis BA. Deep-plane face-lift vs superficial musculoaponeurotic system plication face-lift: a comparative study. Arch Facial Plast Surg. 2004;6(1):8\u201313.","journal-title":"Arch Facial Plast Surg"},{"issue":"2","key":"5143_CR23","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1093\/asj\/sjad283","volume":"44","author":"J Grotting","year":"2024","unstructured":"Grotting J, Saheb-Al-Zamani M, Rhee S. Superior vector plication of the mobile anterior midface: the delta facelift. Aesthet Surg J. 2024;44(2):144\u201359.","journal-title":"Aesthet Surg J"},{"issue":"4","key":"5143_CR24","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1016\/j.cps.2018.05.002","volume":"45","author":"FG Bravo","year":"2018","unstructured":"Bravo FG. Reduction neck lift: the importance of the deep structures of the neck to the successful neck lift. Clin Plast Surg. 2018;45(4):485\u2013506.","journal-title":"Clin Plast Surg"},{"issue":"2","key":"5143_CR25","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1097\/PRS.0000000000003030","volume":"139","author":"M Pelle-Ceravolo","year":"2017","unstructured":"Pelle-Ceravolo M, Angelini M, Silvi E. Treatment of anterior neck aging without a submental approach: lateral skin-platysma displacement, a new and proven technique for platysma bands and skin laxity. Plast Reconstr Surg. 2017;139(2):308\u201321.","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"5143_CR26","doi-asserted-by":"publisher","first-page":"xv","DOI":"10.1016\/j.fsc.2020.03.013","volume":"28","author":"AA Jacono","year":"2020","unstructured":"Jacono AA. Face-lift surgical techniques. Facial Plast Surg Clin North Am. 2020;28(3):xv\u2013xvi.","journal-title":"Facial Plast Surg Clin North Am"},{"issue":"5","key":"5143_CR27","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1055\/s-0035-1566270","volume":"31","author":"C Botti","year":"2015","unstructured":"Botti C, Botti G. Facelift 2015. Facial Plast Surg. 2015;31(5):491\u2013503.","journal-title":"Facial Plast Surg"},{"issue":"3","key":"5143_CR28","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1097\/PRS.0000000000001526","volume":"136","author":"BC Mendelson","year":"2015","unstructured":"Mendelson BC, Tutino R. Submandibular gland reduction in aesthetic surgery of the neck: review of 112 consecutive cases. Plast Reconstr Surg. 2015;136(3):463\u201371.","journal-title":"Plast Reconstr Surg"},{"issue":"1","key":"5143_CR29","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1097\/PRS.0000000000011419","volume":"155","author":"K Basaran","year":"2025","unstructured":"Basaran K, Comert M. LigaSure-assisted submandibular gland excision in deep-plane neck lift: review of 83 patients. Plast Reconstr Surg. 2025;155(1):35\u201345.","journal-title":"Plast Reconstr Surg"},{"issue":"12","key":"5143_CR30","doi-asserted-by":"publisher","first-page":"e274","DOI":"10.1097\/GOX.0000000000000240","volume":"2","author":"A Auersvald","year":"2014","unstructured":"Auersvald A, Auersvald LA. Innovative tactic in submandibular salivary gland partial resection. Plast Reconstr Surg Glob Open. 2014;2(12):e274.","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"5","key":"5143_CR31","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1007\/s00266-018-1179-x","volume":"42","author":"T Marten","year":"2018","unstructured":"Marten T, Elyassnia D. Facial fat grafting: why, where, how, and how much. Aesthet Plast Surg. 2018;42(5):1278\u201397.","journal-title":"Aesthet Plast Surg"},{"issue":"5","key":"5143_CR32","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1001\/jamafacial.2018.0102","volume":"20","author":"TK Krastev","year":"2018","unstructured":"Krastev TK, Beugels J, Hommes J, Piatkowski A, Mathijssen I, van der Hulst R. Efficacy and safety of autologous fat transfer in facial reconstructive surgery: a systematic review and meta-analysis. JAMA Facial Plast Surg. 2018;20(5):351\u201360.","journal-title":"JAMA Facial Plast Surg"},{"key":"5143_CR33","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.amsu.2017.06.059","volume":"20","author":"F Simonacci","year":"2017","unstructured":"Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E. Procedure, applications, and outcomes of autologous fat grafting. Ann Med Surg (Lond). 2017;20:49\u201360.","journal-title":"Ann Med Surg (Lond)"},{"issue":"2","key":"5143_CR34","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/j.jaad.2018.11.060","volume":"81","author":"CG Wambier","year":"2019","unstructured":"Wambier CG, Lee KC, Soon SL, Sterling JB, Rullan PP, Landau M, et al. Advanced chemical peels: phenol-croton oil peel. J Am Acad Dermatol. 2019;81(2):327\u201336.","journal-title":"J Am Acad Dermatol"},{"issue":"12","key":"5143_CR35","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1093\/asj\/sjad177","volume":"43","author":"S Yalamanchili","year":"2023","unstructured":"Yalamanchili S, Talei B, Azizzadeh B, Auersvald A, Frankel AS. Wound healing complications with tranexamic acid: not the silver bullet after all. Aesthet Surg J. 2023;43(12):1409\u201315.","journal-title":"Aesthet Surg J"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-025-05143-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-025-05143-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-025-05143-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T14:53:59Z","timestamp":1772549639000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00266-025-05143-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":35,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["5143"],"URL":"https:\/\/doi.org\/10.1007\/s00266-025-05143-w","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,4]]},"assertion":[{"value":"5 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The senior authors AV and PT receive royalties from Tulip Medical for surgical instruments and from QMP and Thieme for authored books.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors. For this type of study formal consent is not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"All participants have given written informed consent for publication of photos and figure legends.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}