Transtemporal Endoscopic Deep Plane Face Lift

Abstract

Background: Facial aging involves multifactorial changes affecting the bone, superficial musculoaponeurotic system, fat pads, and skin, primarily manifesting as the downward displacement of these structures. The transtemporal endoscopic deep plane face lift (TEDPF) suggests a vertical lifting method, targeting these issues without a preauricular incision.

Methods: A retrospective study was conducted on 140 patients (133 women and 7 men) 33-67 years of age who underwent TEDPF from February 2020 to March 2023. Of these, 42 patients also received a neck lift. The surgical technique involved endoscopic dissection and vertical lifting and fixation of the superficial musculoaponeurotic system layer using specific suture points. An objective photographic analysis was performed by measuring preoperative and postoperative lower eyelid lengths to assess aesthetic outcomes.

Results: The follow-up period ranged from 18 to 36 months. Temporary frontal neuropraxia occurred in 5 patients, resolving within 3 weeks to 3 months. Revision surgery was required for 6 patients due to excess preauricular skin or temporal skin accumulation malar dimpling. Significant improvements were observed, especially in periorbital, nasolabial, and jowl areas, enhancing eye shape and reducing the need for lower blepharoplasty. Objective photographic analysis showed a significant reduction in lower eyelid length postoperatively, with a mean percentage reduction of 22.45% in eyelid length (P < 0.05).

Conclusions: TEDPF achieves effective vertical lifting for facial rejuvenation, minimizes scarring, and reduces surgery time. It provides notable aesthetic improvements with manageable complications, suitable for patients prone to keloids or seeking less invasive options.

Fig. 1.

Illustration showing the descent of superficial fat pads over the lip elevator muscles in an inferomedial direction during midfacial aging. © Levent Efe. Used with permission.

Fig. 2.

Preoperative markings showing key anatomical landmarks to guide precise dissection and lifting. ITS, inferior temporal septum; LOT, lateral orbital thickening; ORL, orbicular retaining ligament; STS: superior temporal septum; TT, tear trough ligament; ZMa, zygomaticus major; Zyg Sp, zygomatic space. © Levent Efe. Used with permission.

Fig. 3.

Five fixation points from the lower premasseteric space to the upper temporal compartment for vertical lifting and SMAS fixation. © Levent Efe. Used with permission.

Fig. 4.

Preoperative and postoperative photographs of a 40-year-old female patient showing improvements in periorbital region, infraorbital hollowing, malar bag, nasolabial fold, and jowl deformity. A, Preoperative picture in frontal view. B, Postoperative picture in frontal view.

Fig. 5.

Preoperative and postoperative results of a patient undergoing the TEDPF, highlighting aesthetic improvements from different angles. A, Preoperative result in oblique view. B, Postoperative result in oblique view.

Fig. 6.

Preoperative and postoperative results of a patient undergoing the TEDPF, highlighting aesthetic improvements from different angles. A, Preoperative picture of a 47-year-old female patient in frontal view. B, Postoperative result in frontal view.

Fig. 7.

Preoperative and postoperative results of a patient undergoing the TEDPF, highlighting aesthetic improvements from different angles. A, Preoperative picture of a female patient in oblique view. B, Postoperative result in oblique view.