Is suspension stitch or endotine preferred method for modern midface lifting?

Is suspension stitch or endotine preferred method for modern midface lifting? And does lift via gum and temples risk a horizontal cheek widening result rather than mouth incision only with vertical lift in mind?

Doctor Answers 6

Is suspension stitch or endotine preferred method for modern midface lifting?

In my office and in the offices of many plastic surgeons whom I know the answer would be no.  There are exceptions however and doctors offer those procedures for patients who seek a visible improvement with minimal expense and recovery time.  I personally feel that these procedures are not long lasting and do not provide long-term patient satisfaction but others may disagree.

My best advice is that you get several opinions from different ABPS board-certified or facial plastic surgeons before making your decision. Good luck and best wishes.

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews

Midface lift versus full facelift

Thanks for your question-- it sounds like you have either done research around facial rejuvenation or have spoken to a physician regarding facelift procedures.  In addressing aging around the mid face, there is laxity in a vertical dimension due to gravity changes and atrophy of the soft tissues.  If one is to suspend these deflated cheek tissues in a more elevated position around the cheek bones, a midface lift results.  Sometimes there may not be enough soft tissue to give the look and appearance one may desire.  The use of injectable fillers and/or fat can help accentuate areas of soft tissue "deflation".  Furthermore sagging skin around the jowls and lifting the subcutaneous tissues can be accomplished best with a full facelift in my opinion.  Some patients may not require this but a face-to-face consultation with a board certified plastic surgeon would be able to outline your options and provide a facial rejuvenation plan best suited to your goals and desires.

Best of luck!

Midface Lift anchoring using suspension stitch or endotine

Dear milliemils9:

Both a suspension stitch or endotine will work in the proper hands depending on the mid-face lift technique. 

If the midface lift is performed using a endoscopic approach, the use of sutures is limited and therefore endotine while more expensive can work if properly anchored to the bone and the overlying periosteum. Some techniques use a oral incision to more fully elevate and mobilize the tissues for upward positioning but potentially opens the space to a higher infection rate. I prefer a open approach through a blepharoplasty incision which allows greater release of tissues and proper suspension and anchoring to periosteum left on the bone although a endotine can be used here as well. 

Cheek widening may occur from the image change in elevating the cheek higher and reducing the added jowl heaviness; ie. surgical facial shortening with a rebalancing of the cheek (point of maximal projection) upwardly. 

When properly selected, the results of a midface lift are awesome. Please consult with a Board Certified Plastic Surgeon with great experience and skill at this highly advanced procedure. All the best! 

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.8 out of 5 stars 67 reviews

Face lift suture suspension and endotine

Thank you for asking about your mid-face lift.

  • The preferred approach is usually a surgical one, rather than a suture suspension.
  • The Endotine only secures the surgery in place - 
  • The cheek widening can occur from swelling or from lifting the cheek tissues to the side of the face, causing a distorted appearance.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Vertical lift

As we age, the structures that support the mid face start to elongate and this produces the jowls, descent of the tissue over the cheeks, and looseness of the neck.  The best and most long lasting results are obtained with a vertical suspension of the SMAS fascia.  Many times the cheek bones can be augmented and this can help add support.  

Barry N. Silberg, MD, FACS
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 4 reviews

Is suspension stitch or endotine preferred method for modern midface lifting?

Hi, I have performed facelifts for over 30 years and have performed many minimally, invasive type facelifts on women in their late twenties and early thirties.  Non smiling photos of your face from the front and side would help in the evaluation.  Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face. If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.

 If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.  My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
  • very small incisions
  • minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
  • can be performed in 90 minutes or less, with or without general anesthesia
  • no incisions within the hair = no hair loss
  • excess fat can be removed
  • excess skin removed
  • cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
  • most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.  As mentioned above suspension sutures or threads will not afford effective results and do not allow for removal of excess skin.  They are more marketing hype than an effective facelift technique in my humble opinion.

Hope this helps.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.