The search for ideal facial rejuvenation leads surgeons and patients to explore various techniques, each with its nuances, advantages, and limitations. Among the most discussed options, Endomidface and Deep Plane stand out as approaches aiming for lasting results through deep plane treatment. But what is the best choice for each case?
This article offers a complete technical comparison between the two techniques, analyzing in detail surgical access, treatment planes, safety, learning curve, expected aesthetic results, and the philosophy behind each approach. By the end, you will have a concise guide to make the most informed decision and offer the best treatment for your patients.
What Is Endomidface?
Endomidface, especially in the Modern Face philosophy developed by Dr. Robério Brandão, is a minimally invasive facelift technique focusing on repositioning the midface.
Unlike techniques that pull skin superficially, Endomidface acts on a deep plane, lifting and remodeling underlying structures for a more natural and lasting result.
Main Features of Endomidface:
- Access via discreet incisions in the temporal region, hidden in the scalp
- Dissection in sub-SMAS (Superficial Musculoaponeurotic System) plane
- Vertical repositioning of midface tissues
- Generally faster recovery than traditional techniques
[Image: Schematic illustration showing temporal access and sub-SMAS plane in Endomidface]
What Is Deep Plane?
Deep Plane Facelift, in turn, is a more invasive technique that also acts on a deep plane, but with a different approach.
The goal is to release facial retaining ligaments and reposition tissues en bloc, restoring volume and projection lost with aging.
Main Features of Deep Plane:
- Access via larger incisions, generally around the ear
- Dissection in a deep plane, below SMAS and retaining ligaments
- Repositioning of tissues en bloc, restoring volume and projection
- Results generally more lasting, but with longer recovery
[Image: Schematic illustration showing access around the ear and dissection plane in Deep Plane]
Detailed Technical Comparison
To assist in choosing between techniques, we present a detailed comparison of main technical aspects:
| Aspect | Endomidface | Deep Plane |
|---|---|---|
| Surgical Access | Discreet incisions in temporal region (scalp) | Larger incisions, generally around ear |
| Dissection Plane | Sub-SMAS, with focus on midface | Deep plane, below SMAS and retaining ligaments |
| Repositioning | Vertical vector, lifting midface tissues | En bloc repositioning, restoring volume and projection |
| Retaining Ligaments | Does not always need complete release, depending on case | Complete release is essential for repositioning |
| Surgical Time | Generally shorter, ranging from 2 to 4 hours | Generally longer, can exceed 4 hours |
| Recovery | Faster, with social return in about 7 to 10 days | Longer, with more pronounced swelling and bruising |
| Scars | Smaller and more discreet, hidden in scalp | Larger and more visible, around ear |
| Results | More subtle and natural, focus on midface | More dramatic and lasting, with global facial improvement |
| Risks | Lower risk of nerve injury, but may not be sufficient for severe laxity cases | Higher risk of nerve injury, but may be necessary for severe laxity cases |
| Learning Curve | Shorter, with more accessible technique | Longer, requiring greater experience and anatomical knowledge |
| Cost | Generally lower, due to shorter surgical time and less need for sophisticated equipment | Generally higher, due to longer surgical time and greater need for sophisticated equipment |
| Ideal for | Patients with mild to moderate midface laxity seeking natural results and fast recovery | Patients with severe laxity and volume loss seeking dramatic and lasting results, willing to undergo longer recovery period |
| SMAS | Accesses mobile SMAS, bypassing fibrosis areas | Traverses fixed SMAS, with higher risk in fibrosis areas |
Safety: A Decisive Factor
Safety is always the top priority in any surgical procedure.
Although both techniques are considered safe when performed by experienced surgeons, Endomidface presents some advantages over Deep Plane:
Endomidface:
- Lower risk of nerve injury, due to less invasive access and dissection in a more superficial plane
- Lower risk of bleeding and hematoma, due to shorter surgical time and less tissue manipulation
Deep Plane:
- Higher risk of nerve injury, due to more invasive access and dissection in a deeper plane
- Higher risk of bleeding and hematoma, due to longer surgical time and greater tissue manipulation
IMPORTANT: The choice of technique must be individualized, taking into account patient anatomy, degree of laxity, and aesthetic goals.
[Infographic: Visual comparison of risks and benefits of each technique]
Endomidface and “Biological Superglue”
A crucial point in choosing the technique is the increasing prevalence of patients with history of fillers and facial biostimulators.
These products can cause fibrosis and tissue adhesion, making dissection more difficult and increasing risk of nerve injury.
In this scenario, Endomidface presents a significant advantage, as access from above allows bypassing the fibrosis area, minimizing complication risk.
In the words of Dr. Robério Brandão: “Endomidface is the safest technique to operate on the modern face, which frequently presents fibrosis due to previous aesthetic procedures.”
Results: Subtlety or Transformation?
Both techniques can provide remarkable results, but with distinct nuances.
Endomidface:
- Focus on more subtle and natural results
- Improvement of midface contour and projection
- Softening of expression lines
- Rejuvenation of look, with lower eyelid elevation
- More discreet results, ideal for those seeking a “refresh” without major transformations
Deep Plane:
- Focus on more dramatic and transformative results
- Global repositioning of facial tissues
- Correction of laxity and volume loss
- Significant improvement of jaw and neck contour
- More impactful results, ideal for those seeking complete rejuvenation
[Side-by-side comparative table with before and after photos of each technique, showing typical results]
IMPORTANT: The choice of technique must be aligned with patient expectations, seeking a result that harmonizes with their individual characteristics.
Learning Curve and Expertise
The learning curve is an important factor to consider, especially for surgeons early in their careers.
Endomidface:
- More accessible technique with shorter learning curve
- Ideal for surgeons seeking safe and effective introduction to deep facial surgery
Deep Plane:
- More complex technique with longer learning curve
- Requires greater anatomical knowledge and surgical experience
- Ideal for experienced surgeons seeking transformative results
Dr. Robério Brandão, creator of Modern Face philosophy and Endomidface technique, offers a complete training program for surgeons wishing to master the technique safely and efficiently. Learn more here.
Which Technique to Choose?
The choice between Endomidface and Deep Plane depends on a series of factors, including:
- Degree of laxity and volume loss
- Patient facial anatomy
- Aesthetic goals
- Expectations regarding recovery time
- Surgeon experience and expertise
In general, Endomidface is an excellent option for:
- Patients with mild to moderate laxity
- Patients seeking naturally subtle results
- Patients desiring faster recovery
- Patients with history of fillers and biostimulators
Deep Plane, in turn, may be more suitable for:
- Patients with severe laxity and volume loss
- Patients seeking dramatic and lasting results
- Patients willing to undergo longer recovery period
[Video: Dr. Robério Brandão explaining how to choose the ideal technique for each patient]
To conclude, the final decision must be made together with the patient, after complete evaluation and honest discussion about risks, benefits, and limitations of each technique.
FAQ (Frequently Asked Questions)
What is the main difference between Endomidface and Deep Plane?
Endomidface accesses the deep plane from above, while Deep Plane accesses from the side.
Which technique is safer for patients with biostimulators?
Endomidface, as it bypasses the fibrosis area, unlike Deep Plane.
Which technique has faster recovery?
Endomidface, with social return in about 7-10 days.
Which technique offers longer lasting results?
Both can have long-lasting results, but Endomidface delivers a more natural result.
What is the learning curve for each technique?
Endomidface has a shorter curve (16-30 cases). Deep Plane requires more experience.
Do I need an endoscope to perform Endomidface?
No. Direct Vision Endomidface dispenses with the use of an endoscope.
Post-Operative Warning Signs
Knowing warning signs allows recognizing any complication early and acting quickly.
When to Seek Surgeon Immediately
Some signs require urgent medical evaluation:
- Active bleeding that does not stop with light compression for 10-15 minutes
- Fever above 38°C (100.4°F), especially if accompanied by chills
- Intense and sudden pain not controlled with prescribed medication
- Abrupt asymmetry — much larger swelling on one side may indicate hematoma
- Skin color change — paleness or darkening in specific areas
- Purulent discharge with unpleasant odor
Normal Signs (Do Not Worry)
These symptoms are expected and do not require concern:
- Moderate edema in the first days, especially in the morning
- Bruising (purple spots) that change color progressively
- Tingling or numbness temporarily in the operated area
- Pulling sensation as tissues heal
- Small temporary asymmetries due to irregular edema
- Difficulty smiling or moving face in the first days
Safety Protocol
In case of doubt, follow this protocol:
- Document — take photos and note symptoms
- Contact — call the surgeon’s team
- Do not self-medicate — avoid non-prescribed medications
- Stay calm — most complications are manageable
“In Modern Face, every patient receives a direct communication channel for emergencies. Safety is not a luxury, it is a priority.” — Dr. Robério Brandão
What to Expect: Recovery Timeline
Recovery is a journey that requires patience and specific care in each phase. Knowing what to expect helps reduce anxiety and optimize results.
First 24-48 Hours
This is the most delicate period. It is normal to present:
- Moderate to intense edema: swelling is maximum in this period
- Bruising: purple spots may appear and are a natural part of healing
- Controllable discomfort: pain is generally mild to moderate, controlled with prescribed painkillers
- Need for absolute rest: avoid sudden movements and keep head elevated
First Week (Days 3-7)
From the third day, you will start to notice progressive improvements:
- Swelling begins to decrease gradually
- Bruises change color (purple → green → yellow)
- Stitches and dressings can be removed as per medical guidance
- Light activities can be resumed with caution
Weeks 2-4
Important transition phase:
- Gradual return to social and professional activities
- Residual edema still present, but less noticeable
- Result begins to define itself, although not yet definitive
- Lymphatic drainage massages may be indicated
Months 1-3
Final result consolidates progressively:
- Tissues settle in their definitive position
- Scars mature and become less visible
- Sensitivity returns gradually to normal
- Final result visible between 3-6 months
“Patience is fundamental. The final result of a facial procedure can only be evaluated after 6 months, when all tissues have already stabilized.” — Dr. Robério Brandão
Essential Questions for Consultation
A well-utilized consultation is fundamental for the procedure’s success. Prepare with the right questions.
About Surgeon’s Experience
- “How many procedures similar to my case have you performed?” — Case volume indicates experience
- “Can I see before and after photos of patients with characteristics similar to mine?” — Real results are the best reference
- “What is your specific training in facial surgery?” — Specialization makes a difference in results
About Proposed Technique
- “Why do you recommend this specific technique for my case?” — Understand clinical reasoning
- “What are the alternatives and why is this the best option?” — Compare approaches
- “Where will the scars be and how do they evolve over time?” — Realistic expectations
About Risks and Recovery
- “What are the most common risks and how are they managed?” — Transparency is essential
- “How long will I be away from normal activities?” — Proper planning
- “What type of anesthesia will be used?” — Anesthetic safety
- “What is the post-operative follow-up protocol?” — Continuous support
Signs of a Good Surgeon
- Answers your questions clearly and patiently
- Shows real results from previous cases
- Discusses risks transparently
- Does not promise unrealistic results
- Is part of an adequate team and structure
Conclusion
Both Endomidface and Deep Plane are valuable techniques for facial rejuvenation. Choosing the best option must be individualized, considering needs and expectations of each patient, as well as surgeon expertise.
Dr. Robério Brandão, creator of Modern Face philosophy and Direct Vision Endomidface technique, offers a complete training program for surgeons wishing to master the technique safely and efficiently. Learn more here.
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⚠️ 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