Why This Comparison Is Necessary? In the world of facial surgery, there’s a tendency to polarize techniques: “my technique is the best, others are inferior.” This doesn’t help patients or surgeons. The reality is more nuanced. Direct Vision Endomidface and traditional Deep Plane solve different anatomical problems, work in different planes, and have different risk-benefit profiles. Choosing the right technique depends on the patient, not dogmatic preference. This article offers an objective analysis — with data when available — to help in clinical decision-making. The perspective is from [Dr. Robério Brandão, creator of Endomidface, who also teaches when Deep Plane is the right choice.
Complete Comparative Table
Aspect ENDOMIDFACE DEEP PLANE
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Detailed Analysis
- Anatomical Focus: Where Each Technique Acts
ENDOMIDFACE
Focus on the midface: malar region, zygomatic eminence, nasolabial fold, lower eyelid. Works in the subperiosteal space to vertically elevate the descended malar complex. Ideal for: Malar ptosis, tear trough, deep nasolabial fold
DEEP PLANE
Focus on the lower third: SMAS, platysma, jowl, mandibular contour, neck. Works in the sub-SMAS plane to reposition the superficial musculoaponeurotic system. Ideal for: Severe jowl, loss of mandibular contour, cervical laxity This difference in focus explains why the techniques are complementary: a patient with malar ptosis AND jowl may need both.
- Safety: Relationship with the Facial Nerve This is perhaps the most clinically significant difference:
ENDOMIDFACE: The subperiosteal plane is deep to the facial nerve branches. You never cross the nerve risk zone during dissection. This confers inherent protection to the technique.
DEEP PLANE: The sub-SMAS plane crosses the zone where the zygomatic, buccal and mandibular branches of the facial nerve are located. Safe dissection requires precise anatomical knowledge and meticulous technique.
📊 Safety Data — Endomidface (Dr. Robério Brandão)
- • Total cases: 1,500+
- • Permanent nerve injury: 0 (zero)
- • Temporary weakness: <2% (complete resolution)
- • Significant hematoma: <1%
- Modern Face: The Biostimulator Factor Here is a significant advantage of Endomidface that is often not discussed: The Modern Face patient — one who has already received fillers and biostimulators — has altered tissue planes. The sub-SMAS, where Deep Plane works, may be compromised by fibrosis, granulomas and unpredictable adhesions. The subperiosteal space, where Endomidface works, is rarely affected by injectable treatments (which remain more superficial). This makes Endomidface particularly suitable for the contemporary patient.
- Vectors: Vertical vs Oblique The vector difference has important aesthetic implications:
Vertical (Endomidface): Lifts where gravity pulls down. More natural result, without lateral tension that creates the “pulled look”.
Oblique-lateral (Deep Plane): Repositions SMAS posteriorly and superiorly. Effective for jowl but can create lateral tension if poorly executed.
When to Choose Each Technique
✅ Choose ENDOMIDFACE when:
- • Main problem is midface
- • Deep nasolabial fold
- • Flat or descended malar
- • Patient with history of injectables
- • Preference for fast recovery
- • Wants to avoid general anesthesia
- • Age 45-65 with moderate aging
✅ Choose DEEP PLANE when:
- • Main problem is jowl/jawline
- • Significant SMAS redundancy
- • Important cervical laxity
- • Patient 65+ with advanced aging
- • Significant excess skin
- • Virgin tissue (no previous injectables)
- • Willingness for longer recovery
🔄 Consider COMBINING when:
- • Patient has malar ptosis AND significant jowl
- • Aging affects midface AND lower third
- • Patient wants comprehensive result in one surgery
- • Anatomy allows safe combined approach The Combo Legacy](/en/about/dr-roberio-brandao) from Modern Face Institute teaches exactly this strategic combination.
Frequently Asked Questions
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Conclusion: The Decision Is Individual There is no universally superior technique. Endomidface excels in the midface, especially in Modern Face patients. Deep Plane excels in the lower third and neck, especially in significant redundancy. Complete surgeons master both — and know when to use each. The [Modern Face Institute teaches this complete approach: not just the Endomidface technique, but the decision framework to select the correct approach for each patient.
Learn Both Approaches
Combo Legacy includes Endomidface + Deep Neck — the two essential techniques of Modern Face.
View Training Programs
Related Articles
Endomidface Guide
Technical overview of the midface technique.
Deep Neck Guide
Complete guide to deep cervical rejuvenation.
Alternative View
Why direct vision is replacing traditional cameras.
For surgeons: Master the Endomidface and Deep Neck techniques.