This surgery is similar to midface temporal fascial lift but uses fixation with an Endotine Ribbon implant to enhance the pulling force on the cheek and fat pads around the mouth. It is performed by making 1.5-cm incisions in the scalp at the temples. Via the incision, a doctor blindly detaches the skin and subcutaneous superficial fascia with tissue scissors to below the middle region of the cheek. Then, a long Endotine Ribbon implant is placed through this subcutaneous space to stretch the superficial fascia in a posterior–superior direction to the temples. The Endotine Ribbon implant may be adjusted to a suitable lift angle and tension to render optimal facelift effects. After the vector and tension of the Endotine implant is confirmed, it may be sutured to the deep temporal fascia of the scalp. Finally, any loosened skin near the incision is removed before the wound is closed.
This surgery requires a wider range of dissection for implant application. When combined with fixation by an Endotine Ribbon implant, it boasts more significant and longer-lasting effects than the conventional midface fascia lift, lasting 3–5 years or more on average. It is suitable for patients with thick and heavy skin or with a relatively wide face and sagging skin. However, its drawbacks are that the placed Endotine Ribbon implant may cause a temporary foreign body reaction or lump in the cheek, and excess tightening may result in cheek hollowing. Therefore, patients should consult surgeons about contraindications before undergoing this surgery.