Die vierte Naht im MACS-Lift

The main drawback of the classic MACS-lift is the poor lifting effect in the medial neck and submandibular area, which results in a suboptimal aesthetic outcome in cases of severe excesses of neck skin, as well as poor outcome in cases of severe platysmal banding. To overcome these limitations, we describe a modification of the original technique, which maximizes the rejuvenation effect on the neck while keeping the proven advantage of short and less visible scars. Modifying the technique by introducing a 4^th SMAS suture to perform lateral platysma plication through a caudally extended dissection 3?C4?cm below the mandibular arch/jaw line creates a more accentuated submandibular angle resulting in a sharper, more defined jaw line. Combined with extensive submandibular liposuction/lipectomy and in some cases closed platysma myotomy, this technique creates a concave submandibular space which enables redraping of a large volume of midneck skin, often eliminating the need for additional posterior or anterior cervicoplasty (??convex becomes concave??).