How Does an Endoscopic Midface Lift Fix Sagging Cheeks?
An endoscopic midface lift raises descended cheek tissue upwards and outwards through short incisions hidden in the temporal hair, guided by a camera. In a study of 143 patients, the improvement in the lid–cheek junction was still measurable 5 to 15 years later, while cheek fullness held for 3 to 5 years. Suitability is decided at consultation.
What is an endoscopic midface lift?
An endoscopic midface lift is an operation that lifts sagging cheek tissue through short incisions hidden in the temporal hair, using a thin camera (endoscope) to see and release the deeper layers. It targets the cheeks and the area where the lower eyelid meets the cheek. Depending on the technique and extent, extra short incisions may be added, but no incision is needed on the lower eyelid. Because the surgeon works from a screen, the deep ligaments and fat pads can be reached without lifting the skin widely. The term “endoscopic facelift” is sometimes used for wider operations; this article covers the midface. For incision locations, see the illustration in our facelift scars article.
Why do the cheeks sag?
Cheek sagging comes from several layers changing at once, not from loose skin alone. Cadaver research has shown that facial fat sits in separate compartments rather than one continuous layer; what is often called “malar fat” is made up of three distinct compartments [1]. According to the authors, the face does not age as a single mass, and compartments changing and shifting against each other may contribute to soft-tissue malposition [1].
- Fat pads thin and slide downwards, so the cheek looks flatter.
- Ligaments and the SMAS (the fibrous support layer under the skin) loosen, the cheek descends and the nasolabial fold (nose-to-mouth line) deepens.
- The lower eyelid looks longer and a groove appears between lid and cheek.
- Bone and volume are also lost around the cheekbone; lifting alone does not replace them.
How does an endoscopic midface lift fix sagging cheeks?
It repositions the descended cheek tissue upwards and outwards from the temple. The general steps are:
- Access: short incisions in the temporal hair, with extra small access points in some techniques.
- Release: the tissues around the cheekbone are freed under camera view. Techniques differ here: some surgeons recommend complete release of the retaining ligaments [4], while one long-term series used an approach that disturbs these ligaments as little as possible [2].
- Repositioning: the cheek fat pads and overlying tissues are lifted, shortening an elongated lid–cheek junction [2].
- Fixation: tissues are secured in their new position; some techniques use multipoint absorbable fixation [4].
Because it uses the same temporal incisions, it can be planned together with an endoscopic brow lift [4].
Endoscopic midface lift: what it can and cannot target
The effect is greatest at the lid–cheek junction and over the cheekbone; jowls and the neck are not its main target. This is a general framework; the decision is made at consultation.
| Area / concern | Effect of an endoscopic midface lift | Option that may suit better |
|---|---|---|
| Long lower eyelid, tear trough groove | A main target; in a 143-patient series, improvement in the under-eye hollow was still present after 5 years [2] | Lower eyelid surgery if bags are prominent |
| Flat, descended cheek over the cheekbone | A main target; in the same series, upper and lower cheek fullness held at 3–5 years and tended back towards baseline after 5 years [2] | Facial fat grafting if volume loss dominates |
| Nasolabial fold | Indirect, limited softening as the cheek is lifted | Deep plane facelift, fat grafting |
| Jowls, neck | Not its main target | Facelift, neck lift |
| Low brows, forehead | No effect on its own | Endoscopic brow lift or temporal lift (same session possible) |
| Weak cheekbone support | Lifting does not replace missing bony support [3] | Facial implants or volume procedures |
In a 150-patient study of surgical midface rejuvenation (not specific to endoscopy), more than one technique (for example lifting and volume) was combined in 34% of patients [3], so sagging cheeks are often treated with a tailored combination rather than one procedure.
Endoscopic midface lift vs deep plane facelift vs lower-lid midface lift
- Midface lift with lower eyelid surgery: often done through the same incision as lower eyelid surgery, so under-eye bags can be treated in the same operation. See our midface lift page.
- Endoscopic midface lift: done from the temple through short incisions in the hair; no lower eyelid incision. If bags are prominent, lower eyelid surgery can be planned separately.
- Deep plane facelift: done through incisions around the ear; treats the midface together with the jawline and, if needed, the neck. See deep plane facelift vs SMAS lift.
How long does an endoscopic midface lift last?
Long-term data are limited, but in a series reporting long-term results for this technique, part of the improvement was still measurable 5 to 15 years later. In a single surgeon's 143 patients, midfacial height (measured from the inner corner of the eye to the line between the cheekbones, reflecting an elongated lower eyelid) shortened by a median of 3.4 mm; in patients followed for more than 5 years, a 2.1 mm shortening was still present at 5 to 15 years [2]. Improvement in the under-eye hollow and global aesthetic scores also held beyond 5 years, while cheek fullness tended back towards baseline after 5 years [2]. These are retrospective results from one practice, not a personal prediction; the face keeps ageing after surgery. For the wider picture, see how long does a facelift last?
Who is not a good candidate?
- People whose sagging is mainly in the jowls and neck (a facelift and neck lift are usually more relevant)
- People whose main concern is volume loss rather than sagging (fat grafting or fillers may suit better)
- Those with a markedly underdeveloped cheekbone: in a 150-patient study of surgical midface rejuvenation (not specific to endoscopy), dissatisfaction was 41% in this group versus 7% in others [3]
- Those with marked loss of skin elasticity: 16% versus 3% in the same study [3]
- Smokers unwilling to stop, and anyone with uncontrolled blood pressure, diabetes or heart disease
- Anyone expecting no incisions or no recovery period
Recovery, risks and travelling from abroad
The incisions are small, but deep tissues are released, so this is surgery with a real recovery period. Swelling and bruising around the cheeks and eyes, and tenderness or numbness over the cheekbone, are expected in the first weeks. Possible risks include bleeding (haematoma), infection, asymmetry, temporary hair loss around the incisions and, because the surgery is done from the temple, usually temporary weakness of the nerve branch that raises the brow. A review of one surgeon's 30 years of endoscopic brow and midface experience reports overall complication rates of 3% to 10% with careful patient selection and technique [4].
If you are travelling to Istanbul, assessment starts with a photo-based virtual consultation and the plan is confirmed face to face. When you can fly home depends on the extent of surgery and your recovery, so confirm the planned length of stay before booking. See international patients.
Results vary from person to person; which approach suits you is decided at consultation.
Assoc. Prof. Dr. Yalçın Bayram's approach
Assoc. Prof. Dr. Yalçın Bayram is a specialist in plastic, reconstructive and aesthetic surgery who builds a personalised surgical plan rather than applying one standard method. He performs the endoscopic midface lift in suitable patients. Consultations and checks take place at his Nişantaşı practice in Istanbul; surgery takes place in a hospital. Beyond the cheeks, the nasolabial area, neck, skin quality, lip shape and volume, upper and lower eyelids, brow position, temples and volume loss are assessed together, to decide whether an endoscopic approach, a midface lift with lower eyelid surgery, a deep plane facelift or volume procedures should lead. In his view, the final appearance after a facelift usually settles within 3 to 6 months.
See the midface lift page and about us, or arrange a consultation via contact.
Frequently Asked Questions
What is the difference between an endoscopic midface lift and a facelift?
An endoscopic midface lift is done through short incisions in the temporal hair with a camera and mainly targets the cheeks and the lid–cheek junction. A facelift is done through incisions around the ear and can treat the jawline and neck as well as the midface. Which suits you depends on where the sagging is.
Does an endoscopic midface lift leave scars?
The incisions are short and hidden in the hair at the temples, so once healed they are usually not obvious. Every incision still leaves a scar, temporary hair loss around it is possible, and scar quality varies between people.
How long do endoscopic midface lift results last?
In a study of 143 patients, the shortening of the lower eyelid–cheek distance was still measurable 5 to 15 years after surgery, while cheek fullness held for 3 to 5 years and then tended back towards baseline. The face keeps ageing, so duration varies.
Does an endoscopic midface lift help tear troughs?
Lifting the cheek shortens the junction between the lower eyelid and cheek, which can soften the groove. If under-eye bags are prominent, lower eyelid surgery is assessed separately.
Is an endoscopic midface lift better than a deep plane facelift?
Neither is better for everyone. An endoscopic midface lift focuses on the cheeks and under-eye area without incisions around the ear; a deep plane facelift also treats the jawline and neck. The choice depends on where your sagging is and is made at consultation.
Is an endoscopic midface lift less invasive, with a faster recovery?
The incisions are shorter and hidden in the hair, but deep tissues are still released, so it is surgery with a real recovery period, including swelling and bruising in the first weeks. How quickly you recover depends on the extent of surgery and your own healing.
References
- Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007;119(7):2219-2227. PMID: 17519724 · DOI: 10.1097/01.prs.0000265403.66886.54
- Shtraks JP, Fundakowski C, Yu D, Hartstein ME, Sarcu D, Lu X, Wulc AE. Investigation of the longevity of the endoscopic midface lift. JAMA Facial Plast Surg. 2019;21(6):535-541. PMID: 31621793 · DOI: 10.1001/jamafacial.2019.1015
- Jacono AA, Ransom ER. Anatomic predictors of unsatisfactory outcomes in surgical rejuvenation of the midface. JAMA Facial Plast Surg. 2013;15(2):101-109. PMID: 23348366 · DOI: 10.1001/jamafacial.2013.443
- Saltz R, Scala F. Endoscopic techniques in facial rejuvenation: indications, technical refinements, and avoidance of unsatisfactory results. J Craniofac Surg. 2026 (online ahead of print). PMID: 42853816 · DOI: 10.1097/SCS.0000000000013389
Last reviewed: November 2026
Medical review: This article has been medically reviewed by Assoc. Prof. Dr. Yalçın Bayram, specialist in plastic, reconstructive and aesthetic surgery (Şişli, Istanbul). For his background and academic publications, see about us. This article is for general information; the right approach for you is decided at consultation.
