Endoscopic Techniques in Facial Rejuvenation: Indications, Technical Refinements, and Avoidance of Unsatisfactory Results

Endoscopic techniques have largely replaced open coronal approaches for brow and midface rejuvenation, offering enhanced visualization, minimal scarring, and lower complication rates. Here, we review indications, technical principles, and strategies for avoiding unsatisfactory results in endoscopic brow and midface rejuvenation, drawing on the senior author's 30 years of experience and more than 2500 cases, with attention to complication management and the selective role of adjunctive CO2 laser resurfacing for concurrent cutaneous photoaging. Endoscopic access is achieved through temporal and paramedian incisions guided by a 3-zone anatomical framework, with complete retaining ligament release and multipoint absorbable fixation of the brow and midface; CO2 laser resurfacing, when indicated, is applied to nonundermined periorbital and perioral units. Patient satisfaction rates have consistently reached 90% to 95% at 1 year, with overall complication rates of 3% to 10% when proper patient selection and meticulous technique are used. Endoscopic facial rejuvenation, with or without adjunctive CO2 laser resurfacing, provides natural, durable results with a favorable safety profile when guided by sound anatomical principles, complete retaining ligament release, and appropriate fixation.