Midface

Middle Third

The most complex region of the face. Mastering its anatomy is prerequisite for safe Endomidface.

The middle third — from the inferior orbital rim to the nasolabial fold — is the region most affected by gravitational aging. It's also the most anatomically complex, with multiple spaces, ligaments, and nerve structures in proximity.

For Direct Vision Endomidface, three anatomical elements are critical: surgical spaces (where we dissect), retaining ligaments (what we release), and nerves (what we protect).

Surgical Spaces

Endomidface dissection planes

Pre-Zygomatic Space

Between SMAS and zygomatic periosteum. Main portal for Endomidface.

Safe

Pre-Masseteric Space

Lateral to zygomatic major. Access to lateral ligaments.

Safe

Buccal Space

Contains buccal fat pad. Transition area to lower third.

Caution

Retaining Ligaments

Ligament	Description	Release
Zygomatic Ligament	Bone insertion on zygoma body. Main midface anchor.	Partial
Zygomatic-Cutaneous Ligament	Extensions from main ligament to skin.	Total
Masseteric Ligament	Insertions on anterior masseter border.	Selective

Critical Nerves

Zygomatic Branch

Medium Risk

Branches to orbicularis oculi. Protected by SMAS.

Buccal Branch

High Risk

Motor to lip elevators. Highest attention zone in midface.

Infraorbital Nerve

Low Risk

Sensory. Emerges from infraorbital foramen.

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