This approach brings about a concurrent improvement of forehead and midface sagging, similar to a single site lift. First, Dr. Chuang creates 4–5 incisions of 1–2 cm on the scalp and an incision of 2 cm at the upper gingiva in the mouth. Next, deep skin layers near the forehead and cheekbone are separated with the aid of an endoscope. After the forehead and midface skin is completely detached from the periosteum and the space connecting these two areas is opened up, a long Endotine implant specific for midface lift is placed in the temporal incision and mouth incision to suspend the skin at the midface submalar triangle and forehead posterior–superiorly. Another Endotine implant is applied to the forehead incision for the lifting of the forehead and brow. Then, all Endotine implants are secured inside the incisions of the scalp.
This comprehensive endoscopic surgery is a long pathway lift whose incisions are located posterior to the scalp hairline and gingiva, leaving no scar on the face. Therefore, patients attain a natural effect in a subtle way. The primary advantage of this surgery is the comprehensive improvement of forehead and midface sagging, which may avoid any uneven facial appearance between the upper and lower face, which might occur in single forehead or midface lift, or even the necessity of secondary revision in the future. Hence, it is suitable for overall facial rejuvenation for women in their 30s to 40s who still have elastic skin or for a relatively long-lasting facelift with a quick recovery for middle-aged and elderly patients.