Is it possible to perform a full deep plane facelift endoscopically and achieve results comparable to the traditional approach?

Question

I’ve been researching deep plane facelifts and I understand that, traditionally, they require incisions around the ears, which can leave a more noticeable scar. Recently, however, I’ve come across several clinics advertising full deep plane facelifts performed endoscopically, using only small incisions instead of the classic periauricular approach. For patients who have more muscle laxity than skin laxity, the idea sounds promising. I’m aware that the ponytail facelift has become popular, but my understanding is that it mainly addresses the upper third of the face (temples/midface), and is more of a gliding lift rather than a true deep plane release, so results may not be as long-lasting. With that in mind, may I ask: 1. Is it technically possible to perform a full deep plane facelift endoscopically and achieve results comparable to the traditional open approach? 2. Are these procedures genuinely deep plane lifts, or more likely modified ponytail/midface lifts marketed as full deep plane results? 3. Is there a limitation in terms of lifting the lower third of the face when performed endoscopically? I haven’t found many surgeons offering a full endoscopic deep plane technique — only mid-face or temporal lifts. I’d be grateful for your expert opinion on whether this approach is realistic, long-lasting, and currently practiced in a comparable way to the conventional deep plane facelift. Thank you in advance for your insight

Stephen Prendiville, MD · Answer

The whole concept about noticeable facelift scars is a false argument.  Clearly, there are Surgeons who do not understand or practice basic principles of wound tension and produce bad scars.  However, the average facelift incision/ scar in my practice is extremely hard to see.  I would say the same about the vast majority of my colleagues.  The endoscopic facelift is designed for a younger patient who requires little to no skin removal and in which it is debatable about whether there are facelift indications. Everyone Surgeon trained in the modern era has facility with and knows how to use an endoscope, which is applicable for endoscopic brow repositioning.  However, there is a reason for the lack of acceptance/ utilization of the endoscope for a facelift for a reason.

Zoran Potparic, MD · Answer

It would be very difficult to provide good lift based on SMAS mobilization using purely endoscopic approach. However, it does not mean that one day we will not be able to do it?

Is it possible to perform a full deep plane facelift endoscopically and achieve results comparable to the traditional approach?

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