The search for a minimally invasive facelift that delivers consistent results without the risks of traditional techniques led to the development of Direct Vision Endomidface. Created by Dr. Robério Brandão, this technique represents a paradigm shift in midface surgery. The fundamental differential is in the concept of direct vision: the surgeon visualizes anatomical structures with his own eyes, not through a monitor. This allows simultaneous tactile feedback, real three-dimensional perception and greater control over each movement.
“Direct vision is not a technical limitation — it’s an evolution. When you feel and see at the same time, your safety multiplies. The endoscope shows; direct vision reveals and allows feeling.”
- — Dr. Robério Brandão, creator of Endomidface
Why Direct Vision instead of Video Endoscopy? Facial video endoscopy emerged as an attempt to minimize incisions. However, it brings important limitations that compromise safety, especially in modern faces treated with biostimulators.
Limitations of Video Endoscopy:
✗ 2D vision on monitor — loss of depth perception
✗ No simultaneous tactile feedback — surgeon doesn’t feel while seeing
✗ Equipment dependency — video tower, camera, lighting
✗ Steep learning curve — indirect eye-hand coordination
✗ Risk in fibrous faces — difficult to navigate altered tissue
Advantages of Direct Vision:
✓ Natural 3D vision — real depth perception
✓ Simultaneous tactile + visual feedback — seeing and feeling at the same time
✓ No special equipment — conventional instruments
✓ Moderate learning curve — 30 cases to mastery
✓ Safe in injected faces — visual identification of fibrosis
How Direct Vision Endomidface Works The technique works in the sub-SMAS areolar plane of the midface, using strategic access that allows direct visualization of structures without need for large incisions.
1. Surgical Access
Temporal incision (within the hair) + access through lower eyelid when necessary. Scars are completely hidden.
2. Dissection Plane
Dissection in sub-SMAS areolar plane (natural descent space). Different from Deep Plane that enters musculature, Endomidface respects natural anatomical spaces.
3. Ligament Release
Controlled release of retaining ligaments (zygomatic-cutaneous, orbito-malar) under direct vision, allowing vertical tissue mobilization without excessive tension.
4. Traction Vector
Vertical vector at 90° (not oblique as traditional techniques). This corrects true ptosis without creating “pulled” appearance or distorting natural anatomy.
5. Deep Fixation
Fixation to stable structures (deep temporal fascia), ensuring result longevity without depending only on skin.
Facial Surgery without Endoscopic Tower: Technical Liberation One of the biggest barriers for surgeons to master advanced facial rejuvenation techniques is dependency on expensive equipment. Video endoscopy towers cost tens of thousands of dollars, require constant maintenance and can fail during procedures.
💡 Real Economic Advantage
Direct Vision Endomidface uses only conventional surgical instruments. This means that any well-trained surgeon can execute the technique in any adequate surgical center, without additional investment in equipment. This “technical liberation” democratizes access to excellence results. What was once privilege of few centers with sophisticated equipment can now be reproduced by trained surgeons in any hospital structure.
Documented Results: Proven Safety
The series of 212 consecutive cases by Dr. Robério Brandão demonstrates the safety and efficacy of the technique in real scenario. 0% Permanent Nerve Injury 212 Documented Cases 7-10d Social Recovery <3% Minor Complications These numbers gain even more relevance when we consider that a large portion of patients already had faces previously treated with biostimulators — exactly the scenario considered “at risk” for traditional techniques.
For Whom is Direct Vision Endomidface Indicated?
✓ Ideal Indications
- • Midface ptosis (descended malar)
- • Deep nasolabial fold
- • Faces with previous biostimulators
- • Patients who want natural result
- • Patients seeking fast recovery
- • Complement to Browlift or Deep Neck
✗ Limitations
- • Doesn’t treat jowls (requires complement)
- • Doesn’t address neck in isolation
- • Excess skin requires additional procedure
- • Unrealistic expectations of result
Frequently Asked Questions about Direct Vision Endomidface )) }
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