Endoscopic suture-suspension midface lift

Background: Midface aging is characterized by descent of the malar fat pad, elongation of the lid-cheek junction, deepening of the nasolabial fold, and loss of malar projection. While endoscopic midface lift techniques provide effective rejuvenation with concealed incisions, many approaches require specialized fixation devices, intraoral access, or extensive dissection, limiting widespread adoption. We describe a hybrid endoscopic-preauricular suture-suspension midface lift designed to preserve the advantages of endoscopic visualization while simplifying execution and reducing cost. Methods: A limited temporal endoscopic approach is combined with a focused preauricular or hairline incision for direct SMAS engagement. Through a 1.5-cm temporal incision, blunt endoscopic dissection is performed in a suprafascial plane along the deep temporal fascia, extending into the sub-SMAS plane toward the malar eminence. A 3-0 Ethibond suture is placed through the mobilized SMAS at the point of maximal elevation via the lower incision. An endoscopic suture passer retrieves the suture superiorly, and vertical suspension is achieved by anchoring to the deep temporal fascia. Three patients underwent the described procedure. Results: All procedures were completed successfully without intraoperative complications. No hematoma, infection, nerve injury, or lower eyelid malposition occurred. Early postoperative recovery was uneventful. All patients demonstrated improved midfacial projection, shortening of the lid-cheek junction, and softening of the nasolabial fold. Patients with up to a one-year follow-up maintained durable elevation with preserved eyelid function and no delayed complications. Conclusion: The hybrid endoscopic-preauricular midface lift provides reproducible vertical SMAS suspension with limited incision burden and reduced device dependence. Early results demonstrate safe, effective midface rejuvenation with streamlined recovery, representing a practical evolution of minimally invasive midface lifting.