What it unlocks
An endoscopic facelift raises the brow, the outer eye and the cheek through several short incisions hidden inside the hairline, using a camera and fine instruments rather than a long incision around the ear. It is often described as a scarless facelift. No operation is truly without incisions, but these sit within the hair and leave nothing visible on the face.
Our approach
We perform endoscopic lifting as one of the practice’s main facial procedures, most often for patients in their thirties and forties whose concern is descent of the upper and middle face rather than jowls and loose neck skin. In many cases we combine it with a deep neck lift, which addresses the jawline and neck the endoscopic approach cannot reach. The two together rejuvenate the whole face without a traditional facelift incision.
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What to expect
- Setting
- Outpatient surgery in our AAAASF-accredited operating suite
- Anesthesia
- General anesthesia, or deep sedation in selected cases
- Duration
- Two to three hours. Longer when combined with a deep neck lift
- Recovery
- One to two weeks for primary recovery. Final settling over six to twelve months
- Downtime
- Most patients are presentable at ten to fourteen days
- Candidacy
- Adults with descent of the brow, outer eye and midface, and skin that still has good elasticity
- Results timeline
- Initial result at three to four weeks. Final result at six to twelve months
The procedure in detail
- How it’s performed
- Several short incisions are made within the hairline at the temples and above the forehead. An endoscope is passed beneath the tissue so the surgeon can see the plane on a monitor, the retaining attachments are released under direct vision, and the brow, outer eye and midface are elevated and fixed in their new position. No skin is removed in front of the ear.
- Preparation
- Stop blood-thinning medication, supplements, and tobacco for two weeks before surgery
- Follow-up
- Suture or fixation review at one week. Follow-up at one month, three months, and twelve months
- Expected outcome
- Durable elevation of the brow, outer eye and midface, with no visible facial scar
- Possible complications
- Bleeding, hematoma, infection, temporary numbness or itching of the scalp, hair thinning near an incision, asymmetry, temporary weakness of a nerve branch to the forehead, and under-correction if the technique was applied to the wrong anatomy
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Questions patients ask
What is an endoscopic facelift?
An endoscopic facelift lifts the brow, the outer eye area and the midface through several short incisions hidden inside the hairline. A small camera lets the surgeon work and release the retaining attachments under direct vision without opening the face. Nothing is removed in front of the ear.
Is an endoscopic facelift really scarless?
No operation is truly scarless, and we will always say so. The incisions are short and sit within the hair, so there is no scar visible on the face or around the ear in ordinary life. Scarless is a description of where the scars are, not a claim that none exist.
Who is a candidate for an endoscopic facelift rather than a traditional one?
It suits patients whose concern is descent of the brow, outer eye and midface while the jawline and neck are still reasonably clean, typically in the thirties and forties. If there is jowling or loose neck skin, a deep plane facelift addresses that far better.
Why do you often combine it with a deep neck lift?
The endoscopic approach lifts the upper and middle face and does not reach the jawline or the neck. Many patients have early changes in both areas, so we combine the two in one operation and rejuvenate the whole face without a traditional facelift incision.
How long is recovery?
Because no skin is removed in front of the ear and the incisions are short, recovery is generally quicker than a full facelift. Most patients are presentable at ten to fourteen days. Scalp numbness and itching can persist for some weeks and resolve.
Is this the same as a ponytail facelift?
Ponytail lift is a trademarked name belonging to another surgeon, who uses it for his own proprietary variation of endoscopic lifting. We are not affiliated with him and we do not offer a procedure under that name. What we perform is endoscopic facelifting, the broader category that branded technique belongs to, and it addresses the same regions: the brow, the outer eye and the midface. Dr. Saman has completed training in these techniques.
What to expect
The consultation
A consultation for endoscopic lifting begins with what you dislike rather than with a technique. We look at where your brow sits, how much the outer eye has descended, whether the cheek has slid downward, and, importantly, what your jawline and neck are doing.
That last part decides most of the plan. If the lower face is still clean, an endoscopic lift alone may be the whole answer. If there are early jowls or neck banding, we discuss combining it with a deep neck lift, because lifting the top of the face while leaving the bottom untreated produces an imbalance patients notice quickly.
We will also tell you when the honest answer is to wait, or when a deep plane facelift would serve you better. This procedure is frequently requested by patients whose anatomy does not suit it.
The surgery
The operation is performed under general anesthesia, or deep sedation in selected cases, in our accredited operating suite. Several short incisions are placed within the hair at the temples and across the top of the scalp.
An endoscope, a fine camera, is passed beneath the tissue so the working plane appears on a monitor. This is what makes the approach possible: the surgeon can see and release the attachments holding the brow and midface down without opening the face to reach them. The tissue is then elevated and fixed in its new position.
Alone it takes roughly two to three hours. Combined with a deep neck lift it takes longer, and that combination is how we perform it in a large share of cases.
Recovery
Day one to three: swelling and bruising develop, concentrated around the forehead and eyes rather than the lower face. The scalp feels tight. Rest with the head elevated.
Week one: swelling begins to settle. Fixation and any sutures are reviewed at about one week. Most bruising is fading.
Week two: most patients are presentable and returning to non-physical work and social activity. Numbness and itching of the scalp are common at this stage and are not a complication.
Month one to twelve: the brow settles from its initial slightly over-elevated position into its final one. Scalp sensation returns gradually. The final result is judged between six and twelve months.
Are you a candidate?
The right candidate has descent of the brow, the outer eye and the midface, with skin that still has good elasticity and a jawline that has not yet developed significant jowling. That combination is most common in the thirties and forties, though structure decides this rather than age.
It is the wrong operation for a face whose main problem is the lower third. Loose neck skin, jowls along the jawline, and platysmal banding are not reachable through incisions in the hairline, and no amount of lifting from above will correct them. Those faces need a deep plane facelift, a deep neck lift, or both.
A very high hairline changes the planning, because the incisions live in the hair and lifting from above can raise the hairline further. A prior brow or forehead operation also changes it. Both are assessed individually rather than ruled out.
Frequently asked questions
Where exactly are the incisions?
Several short incisions, generally under two centimetres each, placed inside the hairline at the temples and across the top of the scalp. Nothing is placed in front of the ear, behind the ear, or under the chin, which is what distinguishes this approach from a traditional facelift.
Will the incisions affect my hair?
They are made between hair follicles and closed so hair grows through and over them. Thinning of hair immediately adjacent to an incision can occur and usually recovers. Patients with a very thin or receding hairline are counselled differently, because the incisions rely on hair to conceal them.
What are the advantages over a traditional facelift?
No visible facial scar, no incision around the ear, shorter operating time, quicker recovery, and no risk of the earlobe distortion or hairline step-off that poorly executed traditional lifts can produce. It also lifts the brow and outer eye, which a standard facelift does not address.
What are the disadvantages?
It does nothing for the jawline, the neck, or loose skin, because it cannot reach them. No skin is removed, so it repositions rather than redrapes. In a face with significant lower-third laxity it under-delivers, and applying it to that anatomy is the most common way patients end up disappointed.
Does an endoscopic facelift last as long as a traditional one?
The elevation is durable because the tissue is released and fixed rather than pulled on tension. Because it is usually performed earlier in life, many patients later have further rejuvenation as aging continues in the lower face. It postpones rather than replaces a future facelift.
Will it change my eyes or make me look surprised?
It should not. The aim is to restore the outer brow and the tail of the eyebrow to where they used to sit, not to raise the whole brow. The surprised look comes from over-elevating the central brow, which is a judgment error rather than a property of the technique.
Is this the same as an endoscopic brow lift?
An endoscopic brow lift addresses the forehead and brow alone. Endoscopic facelifting as we perform it extends the same approach further, releasing and elevating the outer eye area and the midface as well. The instruments and the incision positions are similar.
Can it be combined with eyelid surgery?
Frequently, yes. Lifting the brow changes how much upper eyelid skin appears excessive, so when both are indicated we plan them together and assess the eyelids after the brow position is settled rather than before.
Is it performed with the deep neck lift in one operation?
In many of our cases, yes. The endoscopic lift handles the upper and middle face and the deep neck lift handles the jawline and neck, so a single anesthetic and a single recovery covers both. Whether both are needed is decided in consultation.
What is the difference between this and a thread lift?
A thread lift suspends tissue on barbed sutures placed through the skin without releasing what holds it down, and the effect is measured in months. An endoscopic lift releases the retaining attachments under direct vision and fixes the tissue in its new position. They are not comparable operations.
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