Lower Face Endotine Ribbon Lift

Patients with relatively plump or fat cheeks suffering from lower face laxity or elderly patients with an already obvious laxity of the jawline who are not suitable for jawline suspension lift may consider lower face Endotine Ribbon lift. The incision for this surgery is made only at the turning point posterior to the earlobe or near the superior temporal hairline. The subcutaneous tunnel between the skin and deeper fascial layer is dissected via a small incision of approximately 2–3 cm. Through this tunnel, Dr. Chuang can place a long Endotine Ribbon implant to fix the distal (near the chin) fascial layer and stretches the jawline and lowers the facial skin toward the front of the ear. Then, the Endotine Ribbon implant is secured in the retroauricular deep fascia. After the tight fixation of the implant, the excess skin is removed and the wound is sutured.

The specifically designed multiple pins of the Endotine Ribbon implant closely adhere to the fascia layer, and the larger contact area will make the tightening force more even. Therefore, it is effectively used for patients with early lower cheek or jawline sagging, lower face hypertrophy, or obvious skin laxity of the upper neck and chin. Compared with jawline suspension only using the lift thread fixation, this surgery will achieve a better lift and tightening with longer effects. Its drawback is that the Endotine Ribbon implant is relatively hard, which may cause temporary hollowing and a stiff expression after the surgery. In addition, the result may not last for long because there is not much skin removed, and only the tension from the Endotine implant is relied on to sustain the skin firmness. Moreover, because the Endotine Ribbon is a temporary biodegradable implant automatically metabolized by the body within approximately 6 months, patients must pay attention to daily skin care and rest well to maintain long-lasting effects. The surgical scars will fade away gradually within 3–6 months following the surgery.

Surgical conditions


  • Type of anesthesia: IV sedation + local anesthesia
  • Type of incision: An incision of approximately 3 cm from the anterior to posterior of the earlobe
  • Recovery: 3–5 days
  • Removal of sutures: 7–10 days

General instructions

No food and water on the day of surgery
Anticoagulants, if any, should be suspended for 1 week.

  • Rubbing or pressing the incisions on the forehead and scalp should be avoided for 1 month postoperatively.
  • Hair dying or perming should be avoided for 2 months postoperatively to prevent unwanted irritation or allergy.
  • Scar care should be continued for 3 months postoperatively.

Ideal candidates

  • Individuals with moderate lower face laxity near the jawline.
  • Individuals with jawline sagging due to facial skin thinning from fat or collagen loss.
  • Patients with premature lower face aging.
  • Patients with jawline loss and a concurrent double chin.
  • Thick-skin patients with lower face laxity.
  • Patients who have already received a non-surgical or thread embedding lift but with indistinct results.

Potential complications

  • Scar hypertrophy
  • Temporary facial skin stiffness or numbness
  • Earlobe deformity
  • Foreign body reaction

Surgical advantages

  1. Prior sharp face lines are rapidly restored, and the result is instant.

  2. The surgical area is confined to near the jawline and ear, so there is no obvious postoperative swelling, but a quick recovery.

  3. The Endotine implant provides a strong lift than conventional fascial suspension sutures.

  4. Surgical incisions are small, leaving almost no scar.

  5. The surgical result lasts longer than a common thread embedding lift (averaging 3–5 years).

  6. No risk of facial nerve or vessel injuries.

Surgical drawbacks

  1. Patients with skin hypertrophy or severe laxity may not achieve the desired results.

  2. Unable to radically resolve overall facial sagging and the duration of the results may vary.

  3. The subcutaneous Endotine Ribbon implant may be felt by patients who have very thin skin.

Before & After

These photographs represent typical results, but not everyone who undergoes plastic surgery will achieve the same.

Lower Face Endotine Ribbon Lift