ENDOMIDFACE® by Direct Vision

ENDOMIDFACE® by Direct Vision is a midface lifting technique developed by Dr. Robério Brandão beginning in 2006. The name refers to the anatomical approach — entering the subperiosteal space of the midface — not to endoscopic equipment.

The technique addresses a specific anatomical problem: descent of the midface unit. This includes the malar fat pad, the orbicularis muscle, and the soft tissue that creates the nasolabial fold and contributes to lower eyelid appearance.

Traditional SMAS techniques don't adequately address the midface because they work in a different plane and vector. Deep Plane techniques can address the midface but require extensive dissection and work in planes that may be disrupted in the Modern Face patient.

ENDOMIDFACE® provides a direct approach to the midface using:

• Subperiosteal plane dissection — a defined, safe anatomical space
• Vertical vector elevation — counteracting gravitational descent directly
• Direct Vision — surgical loupes and headlight, no cameras
• Minimal incisions — temporal and sometimes intraoral

Endoscopic facial surgery was developed to provide visualization in deep spaces without large incisions. The camera allows the surgeon to see areas they couldn't otherwise access visually.

But endoscopes come with significant trade-offs:

• Equipment cost: $100,000-$150,000 for a proper tower setup
• Equipment dependency: Malfunction = compromised procedure
• Learning curve: Hand-eye coordination with camera view
• 2D limitation: Loss of stereoscopic (3D) vision
• Camera delay: Slight lag between movement and display
• No tactile feedback: You feel less through instruments designed for camera work

Dr. Brandão's insight was simple: if you can achieve equivalent or better visualization without the camera, the trade-offs aren't worth it.

With proper incision placement in ENDOMIDFACE®, the temporal incision provides direct line-of-sight to the subperiosteal plane of the midface. Surgical loupes provide magnification. A headlight provides illumination. You see directly, in 3D, with zero delay, and with full tactile feedback preserved.

The safety record of more than 1,000 facial surgeries without any irreversible motor nerve injury validates that Direct Vision doesn't compromise outcomes — it may actually enhance them.

For a detailed comparison, see: Direct Vision vs Endoscopic Tower: Myth vs Reality