Transoral-Transtemporal Endotine-Assisted Endoscopic Midface Lift (TTEEM): Technical Considerations and Objective Long-Term Outcomes

Introduction: Durable correction of midfacial descent remains technically challenging, and no single operative approach has emerged superior. The transoral–transtemporal Endotine-assisted technique has been described yet lacks robust long-term outcome data. Objective & Hypotheses: Evaluate long-term effectiveness of transoral-transtemporal Endotine-assisted endoscopic midface lift (TTEEM). Study Design: Retrospective cohort study Methods: Any patient undergoing TTEEM lift with photographic documentation from 2003–2025 were included (n=113, 97.3% female, mean age 61.7 years). Photographs were assessed using a validated midface scoring scale, GAIS, and intraclass correlation coefficients. Results: Statistically significant improvements were observed: infraorbital hollow (1.71 to 1.24, p<0.00001), upper cheek fullness (2.01 to 1.27, p<0.00001), lower cheek fullness (1.71 to 1.36, p<0.0001), and nasolabial fold depth (1.58 to 1.32, p=0.0007). Mean GAIS score was 2.96. Follow-up photographic analysis averaged 2.6 years, extending to 17 years. Conclusion: TTEEM lifts produce durable improvements in midfacial contour, and is worthy of consideration when planning midface lift surgery.