Surgical Protocol
Step by Step
Complete Endomidface protocol in 9 steps. Average surgical time: 90-120 minutes.
90-120
Minutes
9
Steps
Local
+ Sedation
5-10 min
Pre-operative Marking
Intracapillary incision design (~5cm), anatomical landmarks.
10-15 min
Anesthesia & Infiltration
Local anesthesia with sedation. Tumescent infiltration in temporal/frontal regions.
5 min
Incision & Temporal Access
Intracapillary incision and entry into plane between temporal fasciae.
15-20 min
Temporal Dissection
Dissection over deep temporal fascia until temporal crest.
10-15 min
Frontal Dissection (Subperiosteal)
Progression to frontal region, orbital rim release.
15-20 min
Midface Dissection (Sub-SMAS)
Entry into pre-zygomatic and pre-maxillary spaces.
5-10 min
Myotomies (Optional)
Weakening of mimic muscles under direct vision.
10-15 min
Fixation
Anchor mobilized tissues with vertical vector.
10-15 min
Closure
Scalp suture without tension.
Critical Tips
Loss of resistance: When the dissector suddenly "sinks", you've entered pre-zygomatic space. Tilt upward and continue.
Dissector direction: Aim from eye corner toward nasal ala. Never dissect toward lower eyelid (chemosis risk).
Tilt toward surface: In midface, always tilt dissector upward. Motor nerves are in the floor.
Learning Curve
Phase 1: Initiation
Cases 1-5
~150 minutes
Phase 2: Consolidation
Cases 6-15
~120 minutes
Phase 3: Proficiency
Cases 16-30
90-100 minutes