Midface sagging and the loss of midface soft tissue is usually the first sign of aging. The distinct advantage of an endoscopic subperiosteal midface lift is the ability to lift the midface without the need for a preauricular (in front of ear) incision. In addition, the motion attained in the cheek area with this approach allows for the excision of the lower eyelid skin (lower blepharoplasty) with less risk of ectiopion (eyelids turn outward).

As a result of the repositioning of the midface soft tissue in the subperiosteal plane, apart from rejuvenating the sagging midface fat pad, the underlying muscles are lifted up and tightened, which leads to an slightly upturning of the corner of the mouth correcting the down and tight lips of an aging mouth. The approach provides an excellent way of repositioning the soft tissue of the midface that yields a well rested look.

The operation is done through the same incisions of an endoscopic foreheadplasty. It is in fact done in conjunction with a forehead lift. This allows for no conspicuous incision on the face. Because of the better blood supply, this approach may be an alternative for smokers who would otherwise be denied of a facelift. By the same token, there will be more prolonged swelling post-operatively.

This approach is particularly useful in the occasional patient who is seen with cicatricial hemifacial deformity (wasting of one side of the face) due to the ability of subperiosteal undermining of the face to reposition tissue in mass more effectively than extraperiosteal approaches. For cosmetic patients, this approach is excellent for younger patients who have developed eyebrow and midface sagging yet with no significant neck or jowl problems, who wish to have a natural rejuvenation with no visible scars.