Direct Vision Endomidface: The Technique

The quest for facial rejuvenation that combines natural results, safety, and rapid recovery has driven the evolution of surgical techniques. In this scenario, Direct Vision Endomidface, created by renowned Dr. Robério Brandão, emerges as an innovative approach for lifting the midface.

With over 18 years of experience and more than 1,000 facial surgeries performed, Dr. Robério Brandão, creator of the Modern Face philosophy, developed this minimally invasive technique that offers remarkable results with optimized recovery time and, most importantly, safety.

This comprehensive article explores in detail the Endomidface technique, its principles, indications, benefits, and step-by-step procedure. Discover how this innovative approach can transform your face, providing natural and lasting rejuvenation.

What is Direct Vision Endomidface?

Direct Vision Endomidface is a surgical technique aimed at rejuvenating the midface, the area comprising the cheeks and cheekbone region. Unlike traditional techniques, Endomidface stands out for:

• Superior access: The incision is made in the temporal region, using the same access as frontoplasty (forehead lift).
• Direct vision: The procedure is performed without the use of an endoscope, allowing the surgeon a three-dimensional and more intuitive view of facial structures.
• Deep plane: The technique acts on the sub-SMAS (Superficial Musculoaponeurotic System) plane, repositioning tissues more naturally and permanently.

This combination of factors results in a minimally invasive procedure, with shorter recovery time, discreet scars, and remarkable results.

What are the benefits of Direct Vision Endomidface?

Direct Vision Endomidface offers a series of benefits over traditional facelift techniques, including:

• Natural results: The technique repositions tissues gently and harmoniously, preserving the patient’s identity and expressiveness.
• Minimal scars: The incision is made in an area hidden by hair, making scars practically imperceptible.
• Rapid recovery: Recovery time is reduced compared to traditional facelifts, allowing a faster return to daily activities.
• Safety: The technique minimizes risks of nerve injuries and other complications, ensuring a safer and more predictable procedure.
• Durability: By acting on the deep plane, Endomidface provides longer-lasting results, delaying the facial aging process.

Additionally, Direct Vision Endomidface can be combined with other procedures, such as frontoplasty, blepharoplasty, and fat grafting, for complete and personalized facial rejuvenation.

Who is Endomidface indicated for?

Direct Vision Endomidface is indicated for patients who present:

• Midface laxity: Sagging cheeks, loss of volume in the malar region.
• Nasolabial folds: Lines that form between the nose and the corner of the mouth.
• Elongated lower eyelids: Appearance of tired and aged eyes.
• Loss of jaw definition: Retracted chin, jowls.

The technique is also an excellent option for patients who desire facial rejuvenation with natural results, minimal scars, and rapid recovery.

Understand the anatomy behind Endomidface

To understand the effectiveness of Endomidface, it is fundamental to know the anatomical structures involved in the procedure:

• SMAS (Superficial Musculoaponeurotic System): Tissue layer that covers facial muscles and is responsible for skin support and firmness.
• Facial ligaments: Structures that connect skin to facial bones, providing support and definition.
• Fat compartments: Fat deposits located in different areas of the face, contributing to facial volume and contour.
• Facial nerves: Responsible for innervating facial muscles, allowing facial expression.

During Endomidface, the surgeon acts on the sub-SMAS plane, repositioning fat compartments and facial ligaments, restoring facial volume and contour. The technique also allows the release of specific ligaments, such as zygomatic and masseteric ligaments, for more effective midface elevation.

Direct Vision Endomidface: The Step-by-Step

Direct Vision Endomidface is a surgical procedure that requires careful planning and precise execution. The procedure steps include:

1. Marking: The surgeon performs precise markings on the patient’s face, delimiting areas to be treated and incision lines.
2. Anesthesia: The procedure is performed under local anesthesia with sedation, ensuring patient comfort and safety.
3. Incision: The surgeon makes an incision in the temporal region, following the lines marked in planning.
4. Dissection: The surgeon carefully dissects facial tissues, creating a space between the skin and SMAS.
5. Ligament Release: The surgeon releases facial ligaments, allowing tissue elevation and repositioning.
6. Repositioning: The surgeon repositions facial tissues, restoring facial volume and contour.
7. Fixation: Tissues are fixed in their new position with internal sutures, guaranteeing result durability.
8. Closure: The incision is closed with delicate sutures, minimizing scars.

Risks and Post-Operative Care

Like any surgical procedure, Direct Vision Endomidface presents some risks, such as hematoma, edema, infection, sensitivity changes, asymmetry, or nerve injuries (rare).

To minimize risks and ensure proper recovery, it is fundamental to follow the surgeon’s post-operative instructions, which include:

• Rest: Avoid intense physical activities and sudden movements with the face.
• Cold Compresses: Apply cold compresses to the face to reduce swelling and pain.
• Medications: Use medications prescribed by the surgeon, such as painkillers and anti-inflammatories.
• Scar Care: Protect the scar from the sun and follow the surgeon’s instructions for proper healing.
• Lymphatic Drainage: Perform lymphatic drainage sessions to reduce swelling and accelerate recovery.

Endomidface vs Deep Plane: Which is the Best Option?

Both Endomidface and Deep Plane are effective techniques for facial rejuvenation, but present important differences regarding access, area of action, and results.

The choice of the most appropriate technique should be made together with the surgeon, taking into account the patient’s individual characteristics and treatment goals.

For Dr. Robério Brandão, the choice is quite clear:

“The Endomidface technique allows safer and more effective access to the mobile SMAS, even in patients using biostimulators. This is because it avoids the fibrosis area caused by these products, minimizing the risk of nerve injuries and other complications.”

Where to Find a Qualified Professional?

Performing Direct Vision Endomidface requires an experienced and qualified plastic surgeon, with deep knowledge of facial anatomy and mastery of the surgical technique.

To find a qualified professional, follow these tips:

• Research: Look for plastic surgeons with experience in Endomidface and other facial rejuvenation techniques.
• Verify: Ensure the surgeon is a member of the relevant plastic surgery society and possesses board certification.
• Consult: Schedule a consultation with the surgeon to discuss your expectations, evaluate your case, and clarify all your doubts.
• Trust: Choose a surgeon with whom you feel comfortable and safe, and who conveys confidence and professionalism.

Relevant Anatomy for This Procedure

Anatomical knowledge is fundamental to understand how results are achieved safely and effectively.

Key Structures

The face is composed of layers that must be understood together:

• Skin: most superficial layer, reflecting aging through wrinkles and laxity
• Subcutaneous tissue: contains fat that redistributes with age
• SMAS (Superficial Musculoaponeurotic System): fundamental layer connecting muscles to skin
• Facial muscles: responsible for expression and dynamic support
• Retaining ligaments: anchor skin to facial skeleton
• Facial nerves: control movement and sensitivity

Surgical Planes

In Modern Face philosophy, we work in specific planes:

• Superficial plane: above SMAS, used in less invasive procedures
• Deep plane (sub-SMAS): below SMAS, allows more lasting results
• Subcutaneous plane: used for fat grafting and fat treatment

Why This Matters

Understanding anatomy explains:

• Why certain procedures last longer than others
• How natural results are achieved
• Why surgeon experience is crucial
• How complications can be avoided

“Respect for anatomy is what separates a natural result from an artificial one. In Modern Face, each structure has its role and must be preserved or repositioned with precision.” — Dr. Robério Brandão

Comparison: Techniques and Approaches

Understanding the differences between available techniques helps in informed decision making.

Overview of Approaches

Advantages of Modern Approach

The Modern Face technique offers specific benefits:

• More natural results: vertical vector respects facial anatomy
• Shorter recovery time: minimally invasive techniques accelerate healing
• Superior durability: work in deep plane offers longer-lasting support
• Less visible scars: strategic and smaller incisions
• Preservation of expressiveness: face remains natural and mobile

When Each Technique is Indicated

The choice of technique depends on individual factors:

• Degree of aging: more advanced cases may require more comprehensive approaches
• Areas of concern: midface, lower face, or neck have specific techniques
• Patient expectations: balance between desired result and acceptable recovery
• History of previous procedures: revisions require special planning

Detailed Post-Operative Care

Procedure success depends on both surgical technique and post-operative care.

First Days: Critical Phase

In this phase, small precautions make a big difference:

• Elevated rest: keep head elevated at 30-45° even when sleeping
• Cold compresses: apply in first 48h to reduce edema
• Strict medication: follow exactly prescribed schedules
• Light diet: prefer soft foods and avoid excessive chewing
• Abundant hydration: water helps with tissue recovery

First Week: Intermediate Care

As healing advances:

• Careful hygiene: clean area as directed, without rubbing
• Avoid sun exposure: use hat and sunscreen when necessary to go out
• Gentle facial movements: avoid exaggerated expressions
• Adequate sleep: body recovers mainly during sleep
• Avoid alcohol and tobacco: both impair healing

Weeks 2-4: Gradual Return

Return to activities should be progressive:

• Light activities: short walks are allowed
• Remote work: can be resumed as comfortable
• Light makeup: generally allowed after 2 weeks
• Moderate exercise: only with medical clearance
• Lymphatic drainage: indicated to accelerate recovery

What to Avoid

Throughout recovery period:

• Direct sun exposure on operated areas
• Intense physical activities before clearance
• Alcohol consumption in first 2 weeks
• Smoking (ideally stop 4 weeks before and after)
• Non-prescribed anti-inflammatories
• Sudden movements with face

Conclusion

Direct Vision Endomidface is an innovative and effective technique for facial rejuvenation, offering natural results, minimal scars, and rapid recovery. If you are looking for a solution for midface laxity, talk to a qualified plastic surgeon and discover if Endomidface is the ideal option for you.

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Want to know more about the Endomidface technique and how it can transform your face? Schedule a consultation right now with Dr. Robério Brandão and discover the power of Modern Face!

Related Content

• Modern Face: The Concept That Revolutionized Facial Surgery
• Endomidface vs Deep Plane: Which is the Best Technique for You?
• Facelift: Complete Guide for Natural Rejuvenation

⚠️ Disclaimer

This content is educational and represents the author’s technical opinion based on documented clinical experience. Surgical decisions should be individualized.

Author: Dr. Robério Brandão, CRM-CE 8596 Last update: January 2026