Endoscopic Periorbital and Midface Rejuvenation with Direct Fixation: An Alternative to Suspension Techniques

Early aging changes of the periorbital-midface unit frequently present as lateral brow descent, lid-cheek elongation, and early midface ptosis. Conventional facelift procedures may be unnecessarily invasive in such patients, while isolated brow-lifting techniques often fail to adequately address the functional continuity of the periorbital-midface complex.

This study introduces the endoscopic periorbital and midface rejuvenation with direct fixation technique, which is designed to achieve stable repositioning of the periorbital-midface unit through anatomically guided mobilization and direct periosteal fixation.

The technique includes a transtemporal incision and dissection under endoscopic visualization, sequential release of temporal ligamentous structures, entry into the prezygomatic space, vertical mobilization, direct fixation of the malar fat pad to the periosteum of the lateral orbital rim and temporal lifting using barbed sutures. Objective outcomes were assessed using standardized photographic measurements, and patient-reported outcomes were evaluated using FACE-Q domains.

The study included 62 patients with a mean follow-up of 15.2 months. Significant improvements were observed in brow height (mean increase 18.3%), lateral canthal angle (8.4%), and lower eyelid length (mean reduction 19.7%) (p < 0.05). FACE-Q scores improved significantly across all evaluated domains. No major complications and no temporary or permanent zygomatic branch injury occurred. Transient frontal branch neuropraxia lasting longer than 1 month was observed in three patients (4.8%).

Endoscopic periorbital and midface rejuvenation with direct fixation provides effective improvement of the brow-periorbital-midface complex with a favorable safety profile.

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