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

Question

I am debating between endoscopic approach and SMAS to address sagging and fat loss in the mid area of my face.

Brian K. Machida, MD, FACS · Answer

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

Stephen Prendiville, MD · Answer

The purpose of a SMAS based lift (I perform a deep plane facelift) is to address soft tissue descent in the cheek, jawline, and neck.  A subperiosteal mid-facelift is designed to address your cheeks only.  With the introduction of facial volumizers and fat injections, the subperiosteal midface lift has waned in popularity.  In fact, I rarely use the procedure and I think that you will find this with most Surgeons that you talk to.  Only a consultation will help make your decision.

Leo McCafferty, MD · Answer

Thank you for your question.  The difference between the two procedures, at least in part, has to do with the level of the face that’s treated.  One does not last necessarily last longer than another and one is not necessarily better.  The longevity of any procedure is based to some degree on how each individual ages.  There are multiple procedures that can address the mid-face, some less invasive than others.  Your question suggests that it might be best to get yet another opinion from a board certified plastic surgeon experienced in facial rejuvenation.  Remember, the most invasive procedure is not necessarily always the most effective.

Brent Moelleken, MD · Answer

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.

Philip S. Schoenfeld, MD, FACS · Answer

There is no short answer to your question.  The sub periosteal mid face lift can be performed endoscopically or with a small incision in the temporal hairline.  A SMAS lift will not elevate the mid face to any significant degree.  A deep plane face lift will elevate the mid face soft tissue.  If you are volume depleted, not uncommon as we age, then fat injections will likely be necessary even with a well performed mid face lift.

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

Answers (10)

Answer: Midface rejuvenation

Answer: Midface rejuvenation

Answer: Mid face aging

Answer: Mid face aging

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

Answers (10)

Answer: Midface rejuvenation

Answer: Midface rejuvenation

Answer: Mid face aging

Answer: Mid face aging

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Recommended reading

Everything you need to know about Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.