By Dr Scott J Turner, Specialist Plastic Surgeon | Sydney, Brisbane & Canberra
The term “one stitch facelift” has gained significant attention in cosmetic surgery marketing, yet the phrase encompasses vastly different procedures depending on the clinical context. This educational article examines the distinctions between simplified marketing terminology and the sophisticated surgical techniques that underpin endoscopic midface procedures.
At Dr Scott J Turner’s clinics in Sydney, Brisbane and Canberra, comprehensive patient education forms an essential part of the consultation process. Understanding what different facial procedures involve helps patients make informed decisions about their surgical care.
Marketing Terminology Versus Surgical Technique
When researching facial surgery options, patients frequently encounter terminology that can be misleading. The phrase “one stitch facelift” illustrates this challenge particularly well, as it may refer to procedures that differ dramatically in complexity, duration, and expected outcomes.
Simplified Clinic-Based Procedures
In some cosmetic clinic settings, “one stitch facelift” describes procedures marketed primarily for convenience. These typically involve small incisions near the ear where a single suture is placed into the SMAS layer, performed under local anaesthesia in under one hour.
Without releasing the underlying ligaments that anchor facial tissues to bone, a single suture cannot effectively reposition the cheek tissue. The tissue tends to relax around the tension point as the suture gradually cuts through soft tissue. Outcomes from such simplified approaches may fade within 6 to 12 months.
Endoscopic Deep Plane Lifting: A Distinct Approach
When performed by Specialist Plastic Surgeons, “one stitch” terminology refers to something fundamentally different: the specific method of tissue fixation following extensive surgical dissection. The endoscopic deep plane midface lift represents a sophisticated procedure involving:
- Complete release of the zygomatic and masseteric ligaments
- Wide undermining of the deep plane facial tissue
- Repositioning of the malar fat pad and deeper facial structures
- Secure fixation to the deep temporal fascia using long-lasting sutures
The “single suture” in this surgical context refers only to the final suspension step. The actual procedure involves several hours of meticulous surgical work under general anaesthesia.
How Endoscopic Midface Surgery Works
The endoscopic midface lift uses small incisions concealed within the temporal hairline to access and reposition deeper facial structures. Understanding the surgical stages helps patients appreciate what the procedure involves.
Surgical Access and Dissection
The procedure begins with infiltration of dilute local anaesthetic containing adrenaline to reduce bleeding. This is particularly important when operating with endoscopic visualisation, where even minor bleeding can obscure the surgical view.
A small incision (typically 2-4 centimetres) is made within the temporal scalp, approximately 2 centimetres behind the hairline. This placement ensures the resulting scar remains entirely within hair-bearing tissue.
Working Around Critical Anatomical Structures
As dissection approaches the zygomatic arch, the surgeon navigates around critical anatomical structures. The frontal branch of the facial nerve typically lies close to this area. Under endoscopic magnification, meticulous care protects this nerve while the dissection transitions into the midface.
Ligament Release and Tissue Mobilisation
In the midface, the surgeon works in the deep plane overlying the facial muscles. The zygomatic ligaments appear as firm white bands originating from the malar bone and inserting into the overlying cheek fat. These ligaments undergo complete division using sharp dissection or electrocautery.
An immediate release or give in the tissue confirms adequate mobilisation, allowing the cheek to move as a single cohesive unit. Further dissection along the masseter releases additional ligaments, mobilising the lateral cheek tissues.
Tissue Repositioning and Fixation
With the midface fully mobile, repositioning begins. A heavy-gauge suture captures the malar fat pad and deeper fat compartments. The suture is directed along a carefully planned vector to restore facial contour.
The suture anchors under tension to the deep temporal fascia, providing stable fixation against which healing occurs. Unlike traditional facelifts, no skin is typically excised from the cheek area. Excess skin created by lifting redistributes superiorly into the temporal region.
Complementary Procedures
The endoscopic midface lift may be performed alongside complementary facial procedures to address multiple facial zones during a single anaesthetic.
Brow Lift Procedures
The temporal incision used for midface lifting also provides access for lateral brow lift. By extending dissection medially across the orbital rim, the surgeon may lift the brow and cheek as a single unit. This combined approach may also address lateral hooding of the upper eyelid.
Volume Restoration with Fat Transfer
While lifting repositions existing tissue, it cannot replace volume lost to atrophy. Ageing involves deflation of deep fat compartments, particularly in the temples and deep medial cheek. During the same anaesthetic, facial fat transfer may be performed to address these concerns.
Lip Lift Considerations
Midface lifting elevates the cheek but can occasionally leave the upper lip appearing relatively long by comparison. A sub-nasal lip lift removes a strip of skin beneath the nose, shortening philtral length—restoring proportional relationships between facial zones.
Eyelid Surgery Considerations
Endoscopic midface lifting may reduce the need for traditional lower blepharoplasty in some patients because elevating the cheek can address concerns created by prolapsing orbital fat. However, additional eyelid procedures may still be appropriate depending on individual anatomy.
Patient Selection and Suitability
Patient selection is an essential consideration for successful outcomes with endoscopic midface techniques. This approach may be appropriate for patients in their late twenties to late thirties who demonstrate early signs of facial ageing such as mild midface descent, early nasolabial fold deepening, and subtle cheek flattening. Good skin elasticity is essential, as this technique relies on the skin’s ability to contract and adapt following structural repositioning.
When More Comprehensive Surgery May Be Indicated
Patients presenting with significant jowling, neck laxity, platysmal banding, substantial skin excess, or marked loss of skin elasticity typically require more comprehensive surgical techniques. The deep plane facelift or vertical facelift addresses these concerns through extended access that permits skin excision and comprehensive lower face correction.
For patients with isolated neck concerns, procedures such as neck lift, platysmaplasty, or deep neck lift may be more appropriate. In some cases, neck liposuction alone may address submental fullness when skin quality remains adequate.
Alternative Facelift Approaches
Depending on the individual presentation, other surgical options may be considered:
- Mini facelift – A less extensive procedure that may suit patients with mild to moderate facial laxity
- Ponytail facelift – An approach using temporal incisions concealed within the hairline
- Revision facelift – For patients who have previously undergone facial surgery and wish to address recurrent concerns
Risks and Potential Complications
All surgical procedures carry inherent risks. Patients should understand these considerations before proceeding with any facial surgery.
Nerve Injury: The frontal branch of the facial nerve lies within the operative field. Temporary weakness (neuropraxia) may occur in a small percentage of cases, usually resolving within several months. Permanent injury remains uncommon with experienced surgeons.
Temporal Hollowing: Dissection in the temporal area may affect the temporal fat pad.
Scarring and Hair Changes: Incisions within the hairline may cause temporary or, rarely, longer-term changes to hair growth patterns.
Asymmetry: Differences in suspension tension may produce visible asymmetry in cheek position.
The likelihood of complications may be reduced when surgery is performed by a qualified Specialist Plastic Surgeon (FRACS) with specific experience in endoscopic facial procedures.
The Principles of Deep Plane Facial Surgery
The evolution of facial surgery over recent decades reflects a shift in understanding how faces change with age and how surgical approaches may address these changes.
Moving Beyond Skin-Only Approaches
Earlier facelift approaches focused primarily on skin excision and tension-based correction. While these techniques addressed skin laxity, they did not always correct underlying structural changes.
Deep plane concepts emerged from recognition that addressing tissues at the fascial layer, retaining ligaments, and deep fat compartments may provide more comprehensive correction of facial changes.
The Role of Ligament Release
Whether performed through traditional extended incisions or endoscopic temporal access, deep plane techniques share a common foundation: release of retaining ligaments that tether facial tissues to fixed skeletal points. Only after these anchoring structures are divided can the facial soft tissue envelope be repositioned.
Selecting an Appropriate Surgeon
The technical demands of endoscopic facial surgery require specific training and experience distinct from traditional facelift techniques.
Endoscopic Surgical Experience
Operating through small access points with camera-assisted visualisation requires different skills than direct-vision surgery. Surgeons must navigate complex three-dimensional anatomy using two-dimensional monitor displays while maintaining meticulous haemostasis to preserve visibility.
Anatomical Expertise
The facial nerve and its branches traverse the operative field during endoscopic midface and brow procedures. Surgeons performing these procedures should possess detailed knowledge of nerve anatomy, fascial relationships, and the anatomical variations that exist between patients.
Honest Clinical Assessment
Surgeons should demonstrate willingness to recommend against procedures when alternative approaches may better serve patient interests. The most technically sophisticated endoscopic midface lift cannot adequately address advanced neck changes or significant skin excess. Honest acknowledgment of these limitations reflects surgical integrity.
Determining the Right Approach
The appropriate surgical technique depends entirely on individual anatomy, the degree of facial change present, and treatment goals.
Patients experiencing early midface descent without significant skin excess may be candidates for endoscopic approaches. Those with more advanced changes, substantial jowling, or neck concerns may require more comprehensive traditional facelift techniques.
During consultation, your facial anatomy, skin quality, and specific concerns undergo a thorough assessment. Dr Scott J Turner, Specialist Plastic Surgeon, provides honest guidance about which techniques may address your concerns effectively, and equally importantly, which procedures may not be appropriate for your situation.
Arrange a Consultation
If you are considering facial surgery, Dr Scott J Turner offers comprehensive assessments at his clinics in Sydney, Brisbane and Canberra. As a Specialist Plastic Surgeon with experience in facial aesthetic surgery, Dr Turner can evaluate your individual concerns and discuss the most appropriate surgical approach.
For patients travelling from regional areas or interstate, information is available for out-of-town patients.
To arrange your consultation, please contact us.
Disclaimer: This content is intended for educational purposes only and does not constitute medical advice. Individual results will vary from patient to patient and depend on factors such as genetics, age, diet, and lifestyle. All surgical procedures carry risks and require a recovery period. Patients should seek a consultation with an appropriately qualified Specialist Plastic Surgeon before proceeding with any surgical procedure.
