The Deep Plane revolutionized facial surgery by demonstrating that lasting results require work on deep structures, not just skin. However, its traditional version brings important limitations for the contemporary clinical reality. The search for an alternative to traditional Deep Plane is not about abandoning deep plane principles — it’s about evolving them. The Direct Vision Endomidface represents this evolution, maintaining efficacy and increasing safety.
“Deep Plane taught us that we need to go deep. Modern Face teaches that we can go deep more safely, respecting natural anatomical spaces.”
- — Dr. Robério Brandão
The Challenge of Traditional Deep Plane in the Biostimulator Era Deep Plane was developed in an era where faces arrived at surgery “virgin” from treatments. Today, it’s estimated that 90% of patients seeking facelift have already used some type of biostimulator or filler.
⚠️ Risks of Deep Plane in Injected Faces
• Tissue fibrosis — biostimulators create scar tissue that makes dissection difficult
• Altered planes — the traditional plane may no longer exist
• Risk of nerve injury — nerves may be “trapped” in fibrosis
• More bloody dissection — fibrous tissue bleeds more
• Prolonged recovery — greater tissue trauma It’s not that Deep Plane is a bad technique — it continues to be excellent for never-treated faces. The problem is that this patient population has become a minority.
Endomidface: The Deep Plane by Direct Vision Direct Vision Endomidface offers a different approach: working in the natural descent space (sub-SMAS areolar plane), not forcing entry into musculature.
Aspect Traditional Deep Plane Direct Vision Endomidface
Dissection Plane Below musculature Sub-SMAS areolar (natural space)
Equipment Endoscopic tower (optional) Conventional instruments
Injected Face Contraindicated/High risk Safe (direct vision of fibrosis)
Dissection Extension Wide Selective
Surgical Time 180-240 min 90-120 min
Social Recovery 21-30 days 7-10 days
Nerve Injury Rate 8-12% (literature) 0% (212 cases)
Learning Curve Steep (100+ cases) Moderate (30 cases)
Why Does Direct Vision Solve the Problem? The fundamental concept is simple: when you see and feel simultaneously, your ability to identify and avoid structures at risk multiplies.
🔍 Fibrosis Identification
Under direct vision, areas of fibrosis from biostimulators are visually identifiable — they have color, texture and consistency different from normal tissue.
✋ Tactile Feedback
The surgeon feels tissue resistance while seeing. This allows adjusting technique in real time according to anatomical variations of each patient.
🧭 Adaptive Navigation
Instead of following a predetermined plane (which may not exist in injected face), the surgeon navigates through spaces that effectively exist.
⚡ Immediate Response
Any important structure (nerve, vessel) is identified before being injured. There are no “surprises” as can happen in blind dissection.
Who Benefits from the Alternative to Deep Plane?
✓ Patients with previous biostimulators Sculptra, Radiesse, Ellansé or any biostimulator
✓ Patients who want fast recovery
Active professionals who can’t be away for weeks
✓ Patients with mild comorbidities
Less invasive procedure = less physiological stress
✓ Patients who prioritize naturalness
Vertical vector preserves natural anatomy, without “stretched” appearance
Frequently Asked Questions
)) }
Learn the Technique Replacing Traditional Deep Plane Complete training in Direct Vision Endomidface with mentorship from the technique creator.
Learn About Program
Related Articles
Direct Vision
The power of seeing and feeling anatomical planes.
Deep Plane Guide
Understanding the foundation of surgical planes.
Endomidface
Complete overview of the midface rejuvenation technique.
For surgeons: Discover the Endomidface program in our advanced training.