How is endoscopic midface lift different from subperiosteal midface lift? How long does each one last?

An excellent question for a very confusing area of the body!

There are two primary areas of the mid face to rejuvenate: the area below the eyes and the area to the side of the eyes.

In my practice, we rejuvenate the lateral mid face with a high-SMAS facelift, and the area below the eyes with a superficial checklist, about which I have written several papers (drbrent.com).

Volume replacement is accomplished with autologous fat fascial grafts, which are alive and do not require injection, centrifugation etc.

Brent Moelleken MD FACS
Associate Clinical Professor, UCLA
Private Practice, Beverly Hills


The subperiosteal space is unforgiving with respect to healing times, and does not directly accomplish elevation of the soft tissues, since the periosteum is unyielding.

Your title asks about subperiosteal versus endoscopic, and in your comment, you ask about endoscopic vs SMAS, which is an entirely different set of choices. I will address all three. The subperiosteal and endoscopic mid-facelift are both endoscopic. Both are incisions in the scalp. The subperiosteal approach usually separates the fascial attachment at the lateral orbital rim, then the plane glides on top of the muscle in the midface. I would imagine the endoscopic approach is similar without dividing fascial attachments to bone. The problem with both involves anchoring the lift in the lateral scalp, which can be unreliable because you can only anchor to the temporalis fascia and muscle. Scalp excision is limited because the incision in both is small. Both will give limited long term results.

The SMAS lift done by most surgeons will not lift the midface, even the high SMAS vertical lift will not pull the midface. Your best option would be a deep plane lift in which the surgeon elevates over the orbicularis muscle and adequately connects it to the dissection over the zygomaticus muscle, which should be entirely freed up. This part is not done in SMAS lifts and is sometimes not done completely in deep plane lifts.

It's best to go for personal consultations. Best of luck in your search