Technical Honesty
Technique Limitations
Transparency about what the technique can and cannot do is fundamental for aligned expectations and satisfactory results.
Endomidface is a powerful technique for midface rejuvenation, but it's not universal. Recognizing its limitations is as important as mastering its execution. Clear communication of these restrictions to the patient is an essential part of the process.
What Endomidface Does NOT Correct
Doesn't Correct
Jowls (Bulldog)
Why
Mandibular line laxity is not treated by Endomidface. Traction acts on upper midface, up to mouth region.
Alternative
Deep Neck + pre-auricular incision with plication and skin resection
Doesn't Correct
Significant Cervical Excess
Why
Flaccid neck with multiple folds or significant skin excess doesn't respond to isolated Endomidface.
Alternative
Complete Deep Neck (fat + digastric + fasciotomy + platysmorraphy)
Doesn't Correct
Severe Mandibular Ptosis
Why
Marked tissue descent below mandible requires broader approach.
Alternative
Lifting with pre-auricular incision, mandibular ramus dissection
Doesn't Correct
Severe Skin Redundancy
Why
Patients >70 years with very redundant SMAS don't achieve adequate results with Endomidface.
Alternative
Traditional Deep Plane with skin resection
"In cases of greater midface laxity and jowls, Deep Plane achieves better results. This is an objective limitation for cases of extreme laxity, especially in the lower third."
When to Combine Techniques
Face + Flaccid Neck
Endomidface + Deep Neck + retroauricular incisions (if needed)
Complete rejuvenation of middle and lower thirds
Upper + Middle Third
Browlift + Endomidface (same temporal portal)
Modern Face gold standard, single scar
Long Lower Eyelid + Bags
Endomidface + 'No Touch' Blepharoplasty
Midface elevation naturally repositions bags
Jowls + Midface
Endomidface + Plications + Skin Resection
Equivalent result to Deep Plane with less morbidity