Facial rejuvenation has transformed dramatically over the past decades. What once relied on simply tightening the skin has evolved into highly anatomical, structured lifting techniques that restore youthful contours by addressing deeper tissues. Among modern facelift options, two of the most frequently compared methods are the Deep Plane Facelift and the MACS-Lift (Minimal Access Cranial Suspension Lift).
Both procedures aim to reposition sagging facial structures and restore harmony between the face and neck. Yet they differ in depth, dissection, recovery, and ideal patient profile. For medical tourism professionals advising international patients, understanding these differences is essential for guiding them toward safe, realistic expectations.
This article offers a clear, detailed breakdown of each technique—its indications, biological rationale, and expected outcomes—followed by expert insights from Dr. Patrick Tonnard, a globally respected leader in facial rejuvenation and co-developer of the MACS-Lift.
Understanding Facial Aging: Why Technique Matters
Facial aging is not a superficial process. It is a multi-layered, structural transformation involving:
- Loss of skin elasticity
- Descent of the SMAS (Superficial Musculoaponeurotic System)
- Redistribution of superficial and deep facial fat
- Laxity of supporting ligaments
- Neck fat accumulation and muscle banding
Traditional facelifts focused mainly on stretching the skin, but this created the classic “pulled” appearance—because the deeper tissues that truly define facial shape were left untreated. Over time, modern facelift philosophy shifted toward repositioning the deeper layers, not the skin alone, resulting in natural and lasting results.
Both MACS-Lift and Deep Plane Facelift are rooted in this anatomical approach. The difference lies in how deep each technique goes, and how much repositioning is required.
What Is the SMAS—and Why Is It Important?
A pivotal moment in facelift evolution occurred in 1976, when surgeons Mitz and Peyronie identified the SMAS, the fibromuscular layer beneath the skin that controls facial expression and supports its youthful contours.
Repositioning this layer—rather than stretching the skin—became the foundation of modern facial rejuvenation.
The MACS-Lift: Vertical Lifting with Minimal Access
The MACS-Lift, co-developed at the Coupure Centre for Plastic Surgery in Ghent, Belgium, modernized facelift surgery by offering natural results through minimal access. Using a short, discreet incision placed in front of the ear, the technique lifts tissues vertically, mimicking the direction of aging rather than pulling backward.
How the MACS-Lift Works
- It uses a short incision hidden in the natural ear crease—without extending behind the ear.
- Through this incision, the surgeon places suspension sutures that reposition the SMAS and underlying fat pads vertically.
- The vertical vector avoids the “windblown” effect and maintains natural facial identity.
- The limited dissection leads to less bruising, lower risk, and faster recovery.
Ideal Candidates
The MACS-Lift is often recommended for:
- Early to moderate signs of aging
- Mild jowling
- Patients needing a lifted mid-face and jawline
- Individuals prioritizing shorter recovery
- Cases where combined procedures will be performed (fat grafting, eyelid surgery, neck work, laser resurfacing)
In fact, as stated in the retrieved content, only 1% of MACS-lifts are performed alone. The vast majority are combined with ancillary procedures such as fat grafting, neck lift, blepharoplasty, or skin resurfacing as part of a comprehensive rejuvenation plan.
Advantages of the MACS-Lift
- Shorter operative time
- Reduced risks due to minimal dissection
- Quicker recovery
- Natural vertical lift
- Ideal for combined rejuvenation techniques
- No posterior ear scarring
The Deep Plane Facelift: Anatomical Repositioning at a Deeper Level
The Deep Plane Facelift works underneath the SMAS, moving the skin, SMAS, and facial fat as one anatomical unit. This allows powerful correction of deeper sagging, especially in the midface and nasolabial folds.
How the Deep Plane Technique Works
- It goes beneath the SMAS, allowing repositioning of deeper ligaments and fat compartments together.
- It corrects midface descent and deep facial folds more dramatically.
- It preserves blood supply by keeping skin attached to the deeper layer.
- It can produce very long-lasting and highly natural results when expertly performed.
Ideal Candidates
Deep Plane is typically recommended for:
- Advanced midface drooping
- Deep nasolabial folds
- Heavier facial structures
- Secondary facelifts
- Patients wanting maximum lifting power
Advantages of the Deep Plane Lift
- Strong correction of deep facial sagging
- Dramatic yet natural improvement in the midface
- Ideal for older or heavier faces
- Long-lasting results
Considerations
The technique is more technically demanding and involves greater surgical depth than MACS-lift. It requires exceptional anatomical knowledge and experience. Recovery may be longer due to deeper dissection.
Why Technique Alone Doesn’t Determine the Result
One of the most important insights is this:
“Results depend far more on who performs the procedure than on the specific technique chosen.”
Even when surgeons use the same technique, outcomes vary dramatically based on:
- Artistic vision
- Precision of tissue dissection
- Ability to read facial anatomy
- How naturally facial identity is preserved
Thus, the choice of surgeon is even more critical than the choice of technique.
The Doctor: Insights from Dr. Patrick Tonnard
Dr. Patrick Tonnard, based in Ghent, Belgium, is an internationally respected plastic surgeon known for pioneering the MACS-Lift and Nanofat technology.
- He has authored four medical textbooks and over 100 scientific articles related to facial rejuvenation and regenerative fat technologies.
- He co-developed the MACS-Lift at the Coupure Centre for Plastic Surgery, a private Belgian facility with a reputation for surgical precision and natural results.
- His approach emphasizes vertical repositioning, minimal trauma, and comprehensive rejuvenation of both face and neck.
- He integrates MACS-Lift with fat grafting, neck lifting, blepharoplasty, and skin resurfacing for balanced outcomes—aligned with the data showing combined MACS-lift cases exceed 99% in his practice.
- He is recognized globally as the father of Nanofat, a regenerative technique that rejuvenates skin using the body’s own cellular biology.
Dr. Tonnard is respected not only for surgical skill but for redefining facelift philosophy toward natural, biologically-sound rejuvenation.
How Medical Tourism Professionals Can Guide Patients
When advising international patients:
1. Assess Their Aging Pattern
- Midface collapse? → Deep Plane
- Mild jowls with early aging? → MACS-Lift
- Heavy neck? → Combined MACS-Lift + neck procedures
2. Educate Them on Vector
- Vertical repositioning (MACS) yields natural harmony.
- Deep plane provides deeper, structural correction.
3. Emphasize Surgeon Expertise
Technique ≠ outcome.
The surgeon’s experience, training, and aesthetic sense define the result.
4. Manage Expectations
- Younger patients want refinement → MACS
- Older patients expect deeper correction → Deep plane
5. Discuss Add-On Procedures
True harmony often requires:
- Necklift
- Fat grafting
- Eyelid surgery
- Skin resurfacing
These are routinely performed in expert-level facelift centers.
Which One Is ‘Better’?
In the end, Neither the MACS-Lift nor the Deep Plane Facelift is universally superior. Each has a clearly defined role based on anatomy, age, tissue quality, and patient expectations.
The MACS-Lift is ideal for natural, vertical, minimally invasive rejuvenation with fast recovery.
The deep plane lift excels when deep structural lifting is required.
Looking for the most natural and regenerative approach to facial rejuvenation?
If you are considering a facelift, regenerative fat-based rejuvenation, or comprehensive aging-face surgery, we recommend Patrick Tonnard, MD, PhD, one of Europe’s most respected leaders in modern aesthetic medicine.
Dr. Tonnard is a world-renowned, board-certified plastic and reconstructive surgeon and the CEO and Founder of the Coupure Center for Plastic Surgery and the Aesthetic Medical Center 2 (EMC²) in Ghent, Belgium. He is internationally recognized for breakthroughs such as the MACS-lift and nanofat grafting, techniques that have influenced the global shift toward natural and long-lasting facial rejuvenation.
His approach focuses on anatomical precision, scientific integrity, and subtle improvements that restore your own facial harmony. Patients value his expertise in advanced facelift methods, regenerative procedures, and male and female facial aesthetics. The goal is always the same: results that look refreshed, youthful, and authentically you.
Explore Dr. Patrick Tonnard’s Profile and Request a Consultation
https://www.better.medicaltourism.com/providers-platform-single?provider=patrick-tonnard-md-phd
