Transtemporal Endoscopic Subcutaneous Face-and-Neck Lift with SMAS Plication

Introduction: Facial aging is characterized by progressive soft-tissue descent, affecting all anatomical layers—from bone structures to the skin envelope. Early manifestations include downward displacement of the midface soft tissues, deepening of the nasolacrimal and nasolabial folds, and the appearance of soft-tissue “puckering” in the lower third of the face. At this stage, patients typically seek aesthetic correction to restore youthful facial contours with minimal or no visible signs of surgical intervention. Methods: This study is an observational analysis of a prospectively maintained surgical database including 201 female patients who underwent TESL between 2006 and 2024. Patient demographic data, surgical technique specifics, and postoperative outcomes were collected. A total of 612 procedures were performed. The cohort was stratified into two age groups: 30–35 years (n = 72) and 36–45 years (n = 129). Results: No cases of facial nerve injury or neurological complications were observed. Complications included 13 cases of localized cicatricial alopecia (6.47%) and four postoperative hematomas (1.99%). Eleven patients (5.47%) required minor secondary revision to address preauricular skin pleating. The technique demonstrated consistent and favorable outcomes in restoring soft-tissue volume and positioning, eliminating early lower-face “puckering,” and improving the cervicomental and mandibular contours. Conclusions: For patients under 45 years of age presenting with early signs of facial soft-tissue ptosis, endoscopic subcutaneous midface elevation with vertical SMAS plication is a safe, effective, and minimally invasive approach to rejuvenating the mid and lower face.