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.

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.

Ronald J. Edelson, MD · Answer

In my opinion neither of those techniques is at all worthwhile. They do t do what you think and there can be problem. Keep it simple and get a standard facelift from a reliable surgeon and forget those other bells and whistles

Zoran Potparic, MD · Answer

Once we started using volume replacement techniques to compensate for fat volume loss in cheeks and periorbital area, midface lift itself has lost a lot of interest. It may be reserved for very specific cases where true lifting is needed (eyelid deformities for example). Volume filling with fat grafts or fillers may be considered in particular if midface lift is a part of face/neck lift? Considering that you have two slightly different opinions, you may seek a third consult as well. Good luck.

Romy Ahluwalia, MD · Answer

An endoscopic approach is minimally invasive and is helpful at repositioning deeper structures. It is not helpful at repositioning or removing excess skin. Generally speaking a smas or subsmas lift can address both muscle as well as excess skin in the mid face or elsewhere if necessary.

Endoscopic surgery was extremely popular in the recent past and part of the popularity associated with midfacelift endscopic surgery is/was because of the cachet associated with endoscopic surgery. Nowadays we focus more on lifting the sub orbicularis fat superiorly fat grafting and if necessary tightening and removing excess skin.

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.

James Hoyt, MD (retired) · Answer

Both endoscopic midface lift and subperiosteal midface lift are surgical techniques used to address sagging and aging in the midface region, but they differ in their approach and longevity of results.1. Endoscopic Midface Lift:• Approach: In an endoscopic midface lift, small incisions are made near the hairline, and an endoscope (a thin, flexible tube with a camera) is used to visualize and lift the underlying tissues of the midface. The surgeon may use sutures, anchors, or other fixation devices to secure the lifted tissues in a more youthful position.• Benefits: Endoscopic techniques offer the advantage of smaller incisions, reduced scarring, and less disruption to surrounding tissues compared to traditional open approaches.• Longevity: The longevity of results from an endoscopic midface lift can vary depending on factors such as individual aging patterns, skin elasticity, and lifestyle factors. Generally, results can last around 5 to 10 years before further signs of aging may become noticeable.2. Subperiosteal Midface Lift:• Approach: A subperiosteal midface lift involves lifting the soft tissues of the midface from the underlying bone (periosteum). The surgeon creates incisions typically within the hairline or along the lower eyelid and elevates the tissues, often using sutures or other techniques to secure them in a more lifted position.• Benefits: Subperiosteal midface lifts provide a more extensive lift by directly addressing the deeper layers of tissue and muscle. This approach can achieve significant rejuvenation of the midface area.• Longevity: Subperiosteal midface lifts tend to provide longer-lasting results compared to endoscopic techniques, often lasting 7 to 15 years or more. However, individual results can vary, and additional factors such as lifestyle choices and natural aging processes can impact the duration of results.It's important to note that the longevity of results from both types of midface lifts can be influenced by various factors, including the patient's skin quality, underlying bone structure, and the skill of the plastic surgeon. Additionally, ongoing maintenance with skincare, sun protection, and possibly non-surgical treatments may help prolong the results of a midface lift.Ultimately, the choice between an endoscopic midface lift and a subperiosteal midface lift will depend on individual anatomical considerations, aesthetic goals, and the recommendations of a skilled plastic surgeon. A thorough consultation with a board-certified plastic surgeon can help determine the most suitable approach for achieving your desired results.

Benjamin Gelfant, MD, FRCSC (retired) · Answer

Hello from vancouver,
While endo brow lifts have a long established record of good results in the right patient when done by the right surgeon ( I have been doing them since 1995), mid face endo surgery is much less successful. Both endo midface lift and sub periosteal midface lift are sub periosteal approaches. Neither produce reliably natural looking outcomes with minimal risk of complications. In my opinion, you are best to undergo a facelift done by an experienced surgeon with a proper, anatomical approach to both the skin and the SMAS-platysma layer.
Best wishes,Benjamin Gelfant MD FRCSC

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

Answers (10)

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