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Let's look at the situations in which endoscopy alone or, conversely, only classical techniques will not be enough

Published at

March 29, 2024

Different from others

The main indications for endoscopic surgery are volumetric changes in the central oval of the face, gravitational tissue prolapse. Endoscopy gives a complex, "shaded" result, similar to the effect of high-quality Photoshop. If you want to model contours and improve facial features, make up for lost "volumes of youth", correct anatomical features, smooth out excessive relief, open your eyes — endoscopy will allow you to solve all tasks taking into account individual characteristics.

Unlike classical techniques, the effect of endoscopic surgery is not related to tension, but to the movement of tissues. The tissues of the facial mask are separated by a single block from the fixed structures of the skeleton, moved and fixed in an aesthetically more advantageous position. The technique makes up for missing and lost volumes, taking into account all the difficulties: three-dimensionality of the facial structure, anatomy, facial activity, changes in surrounding tissues.
Important principles 
Mini-incisions of 1-1.5 cm are performed in inconspicuous places and play the role of technical access points for the introduction (into the required layer of the facial mask) of an endoscope and special tools. The accesses are located in the scalp and/ or in the mouth from the mucosa, that is, the technique avoids incisions on the face. During endoscopic operations, nothing is brought in from the outside, while facial tissues are not removed. In the vast majority of cases, the feeling that there is "extra" skin in the central oval of the face is false. It is enough to restore the volumes so that the skin on them straightens and tightens.
Thanks to an endoscope, a special video camera, the surgeon penetrates into the desired layer and performs tissue detachment with special tools not under direct eye control, but with the help of a monitor. The endoscope displays the image on a large monitor and magnifies it tenfold. The surgeon clearly sees all the structures he works with and controls the entire operation process as much as possible. Due to the deepest possible detachment, scar tissue does not form superficially, which allows you to preserve the naturalness of facial expressions and avoid deformations.
The age of endoscopic patients is from 18 to 70+, since endoscopy adapts to any request: whether it is beatification or rejuvenation. Although endoscopic operations are conditionally divided by impact zones, there are no identical endoscopic operations. In each individual case, their individual issues are solved, unique technical tasks are set and various maneuvers are applied. Endoscopy is a construction kit that is assembled for you. The names only give a general idea of which zones can be adjusted.
The area of influence
Endoscopy of the upper third allows you to change the position of the eyebrow, improve the upper eyelid area, ease its crease, open the gaze, tighten the temporal part, eliminate wrinkles in the forehead, between the eyebrows, around the eyes.
In an isolated form, the technique is most often performed as a beatification for young patients with low eyebrows and puffy eyelids.
For the purpose of rejuvenation, the technique is often combined with other volumes of correction.
Endoscopic periorbitoplasty corrects the intermediate zone between the upper and middle thirds of the face. The operation allows you to move the corner of the eye, eliminate the feeling of excess skin on the upper eyelid, smooth out the relief under the eyes, redistribute fat packages, tighten and smooth the transition zone from the lower eyelid to the cheekbone.
Endoscopy of the middle zone corrects age-related changes in the form of excessive relief, separation and visualization of fat packages of the lower eyelid, gravitational changes in the middle cheek and loss of volumes of the middle zone. The operation eliminates the separation of fat packages, smoothes the boundaries between the lower eyelid, cheekbone, cheek, corrects the "traps" between the cheekbone and cheek when visualizing paint bags and dimpling under it. Removes the feeling of excess skin on the lower eyelid. Straightens nasolabial folds, tightens the zygomatic zone. Moves the volumetric accents from the lower cheek to a higher position. If necessary, endoscopy of the middle zone is combined with endoscopic correction of the upper third.

In the case of correction of gravitational changes in the central oval of the face, that is, in the frontal plane, the endoscopic technique has no analogues. However, it should be understood that older patients with relaxation changes in the lateral parts of the face and neck are shown classic SMAS techniques. SMAS techniques and endoscopy are ideally combined and complement each other. Depending on the indications, SMAS lifting is often combined with endoscopic lifting of the middle zone or two thirds of the face.

SMAS LIFTING is performed under eye control. The main effect is due to the tension of the tissues. Long incisions are hidden in natural reliefs and folds of the skin: around the ear (in front or behind it) with continuation into the scalp. The more skin we remove, the longer we get the incision. More often, the technique is shown to older patients: the first signs of age-related changes relate to the central oval of the face, and the lateral sections change later. The effect lasts 10-15 years.

A classic of the genre: a patient with age-related changes in the face and neck turns to a surgeon, she is offered a "facelift" / SMAS-lifting (a lift with a scar around the ear). Whether it's a "high" SMAS, a "deep" Mendelssohn method, a "circular" or an author's lift — it doesn't matter. Any variation of the SMAS technique will always be aimed at correcting the lateral parts of the face and neck. After surgery, the neck will be perfect, the oval of the face will be clear, but the rejuvenation effect will remain unattainable.

The success of the operation in the patient's understanding is not measured by the amount of skin removed or the degree of tension of the oval. Success is measured by how much and how the overall impression of the face has changed. What determines the overall impression of the face? Depends on the condition of the central oval. Accordingly, we get the opposite situation. The presence of relaxation changes in the lateral parts of the face and neck is not corrected by endoscopy, but it does not mean that working with the central oval of the face will not be relevant. It is the effect on the central department (frontal plane) that allows you to achieve a rejuvenating effect.

Classical SMAS techniques and endoscopic techniques do not replace each other. Each case is unique and inimitable. There is no one solution for everyone.
What combination of techniques is shown to you? Doctors of OLYMPUS CLINICS will select an individual optimal path for consultation.

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