Endoscopic Facelift (Brow and Mid-Face Lift)

What is an endoscopic facelift?

An endoscopic facelift is an operation in which the forehead, brows and mid-face are lifted back into a more youthful position through a few small incisions in the scalp, with the help of a thin camera called an endoscope. The camera shows the ligaments and nerves beneath the tissues magnified on a screen, which makes it possible to work in the deeper layers without long incisions.

The aim is not to pull the skin tight to erase surface lines. Instead, the soft tissues of the brows, the area around the eyes and the cheekbones, which have gradually descended over the years, are returned to where they belong. The goal is a rested, refreshed expression rather than a "pulled" look.

As an ENT and head and neck surgeon, Dr. Özlem Yüksel Coşar evaluates the face not only for appearance but also for function: how well the eyelids close, where the facial nerve branches run, and how natural facial expression can be preserved.

How does ageing show in the upper and middle face?

The face does not age at the same speed everywhere. For many people the first changes appear around the eyes and cheeks, typically between the ages of about 35 and 55:

• The brows, especially their outer ends, drop and the eyes start to look tired or sad
• The upper eyelids feel heavier because the brow is pressing down on them
• The junction between the lower eyelid and the cheek becomes more visible and the tear trough deepens
• The fat pad over the cheekbone slides down and the cheek looks flatter
• The outer corner of the eye takes on a downward tilt

These changes can appear years before any sagging of the lower face. An endoscopic facelift is aimed precisely at this stage: early descent of the upper and middle face.

Who is a good candidate?

An endoscopic facelift is usually considered for people who:

• Have noticeable brow descent and mid-face volume shift but still have good skin elasticity
• Are mostly between 35 and 55, with ageing signs concentrated around the eyes and cheeks
• Do not have significant sagging along the jawline or in the neck
• Are in good general health and do not smoke, or are ready to stop

Age alone is not decisive. In older patients the procedure can also be combined with a lower face operation. Realistic expectations matter too: this operation refreshes the expression, but on its own it does not improve fine wrinkles, skin texture or sun damage.

What an endoscopic facelift cannot do

Knowing the limits of this operation from the start is the most important step in choosing the right approach. An endoscopic facelift is not suitable for correcting jowls along the jawline, neck laxity, neck bands or significant excess skin in the lower half of the face.

If these are your main concerns, a deep plane facelift, which focuses on the lower face and neck, is likely to be more appropriate. In some patients the two approaches are combined in a single operation to treat the whole face in balance. If only the brows have dropped, a brow lift on its own may be enough.

Consultation and planning

At the first consultation we listen to the changes that bother you most, then assess brow position, forehead height and hairline, eyelid structure, cheek volume and skin quality in detail. We also ask whether your eyelids close fully and whether you have dry eyes.

Photographs of your face are taken from several angles and the planned changes are discussed on these images. If you are travelling from abroad, you can send photographs in advance for a preliminary opinion; the final plan is always made after an in-person examination. Before surgery:

1. Your medications are reviewed, especially blood thinners, certain painkillers and herbal supplements.
2. Routine blood tests and an anaesthetic assessment are carried out.
3. If you smoke, you will be asked to stop before and after surgery, as smoking impairs wound healing.
4. Previous filler or botulinum toxin treatments are taken into account.

How is an endoscopic facelift performed?

The operation is carried out under general anaesthesia in a hospital operating theatre and usually takes 2–4 hours, depending on its extent.

Incisions

A few short incisions, usually 1–2 cm long, are made within the scalp: at the top of the forehead and in both temples. The mid-face is reached through the temple incisions; in some patients a small incision inside the mouth, above the upper gum, is added.

Releasing and lifting the tissues

Using the endoscope, the ligaments that hold the brow and cheek down, together with their attachments at the rim of the eye socket, are released in a controlled way. The sensory nerves of the forehead and temple and the forehead branch of the facial nerve are protected throughout. The released brow and cheek tissues are then moved upwards and slightly outwards.

Fixation

The tissues are secured in their new position with stitches to the deeper layers or, where needed, with dissolving fixation devices attached to the bone. The incisions are closed and, if necessary, thin drains and a light compression bandage are applied for a short time.

Most of our patients go home the same day or after one night in hospital.

Recovery after an endoscopic facelift

Recovery varies from person to person, but the general timeline looks like this:

In the first weeks the brows may look slightly too high and the eye area a little tight; this usually softens as the swelling goes down. Numbness of the forehead and scalp is common and in most patients improves over the following months.

We see patients at 1 week, 1 month, 3 months and 6 months. For patients who live abroad or in another city, interim check-ups can be done by video call, and you can reach our team in English throughout your recovery.

Risks and things to be aware of

As with any surgery, an endoscopic facelift carries risks. These include:

• Bleeding, haematoma and infection
• Numbness or itching of the forehead and scalp, which can last for some time
• Temporary or occasionally permanent hair thinning around the incisions
• Weakness of the forehead branch of the facial nerve, which is usually temporary
• Asymmetry of the brows or cheeks
• Temporary tightness or change in the shape of the lower eyelid after mid-face lifting
• Temporary tightness when chewing or smiling in the first days if an incision was made inside the mouth
• A result that does not fully meet expectations and, occasionally, the need for a touch-up

The best ways to reduce these risks are a thorough examination, a realistic plan and careful adherence to aftercare advice. Before surgery we go through all the risks and any factors specific to you during the written consent process.

Combining it with other procedures

An endoscopic facelift can be planned in the same operation as procedures for other areas of the face. The most common combinations are:

• Eyelid surgery for excess upper eyelid skin or lower eyelid bags
• Fat grafting, using your own fat, to areas that have lost volume
• A deep plane facelift if there is sagging in the lower face and neck

Which procedures are combined is decided by weighing operating time, recovery and your general health together. Our aim is to treat each area in harmony with the face as a whole, not in isolation.