The MACS-Lift Short Scar Rhytidectomy.
By Patrick L. Tonnard, M.D., and Alexis M. Verpaele, M.D. Pp. 285. Quality Medical Publishing, Inc., St. Louis, Mo., 2004. Price: $320.
With the current trend toward noninvasive procedures, this timely, well-written text introduces the surgeon to one of the newer short scar rhytidectomy techniques. Minimal access cranial suspension lift, or MACS-lift, summarizes Tonnard and Verpaele's approach in this well-illustrated text. The accompanying compact disc is an operative demonstration with an emphasis on key concepts, beginning with preoperative markings and concluding with the postoperative result.
The book is divided into six chapters. There is an excellent, concise introduction discussing the history and evolution of rhytidectomy. Chapters 1 and 2 deal with basic principles and patient selection. Chapters 3 and 4 provide step-by-step descriptions of the minimal access cranial suspension lift in both its simple and extended forms. Chapter 5 covers secondary and ancillary procedures. The authors describe a posterior cervicoplasty for patients with extreme neck laxity and poor elastosis. Adding this to the minimal access cranial suspension lift essentially eliminates the “short scar” and changes the operation to a classical rhytidectomy approach with full retroauricular incisions into the hairline. Perhaps this type of approach should not be included in the name “MACS-lift.”
Perhaps the weakest chapter is on “Problems, Complications, and Revisions.” The authors' experience in treating more than 250 patients over a 4-year period is addressed briefly and superficially. Whenever a new surgical technique is introduced, there is always a learning curve. It is important for any author to review these initial problems, so that other surgeons can avoid them.
Most of the case examples had a postoperative follow-up of only 1 year. In addition, in the majority of the postoperative photographs, hair covered many of the incisions. Any rhytidectomy presentation should avoid hair covering the incisions and ears, as this is a critical part of the evaluation.
Despite these criticisms, I believe Drs. Tonnard and Verpaele have produced a well-written text and compact disc that clearly demonstrate the general principles of the minimal access cranial suspension lift. The text is well illustrated with high-quality figures. The book should be of interest to experienced surgeons as well as to beginners in the field of rhytidectomy.
Daniel C. Baker, M.D.
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