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Subperiosteal, vertical and preservation facelifts

A subperiosteal lift raises the facial soft tissue from the bone, under the periosteum, and moves the whole "mask" upward. Vertical and "preservation" facelifts are newer variants that lift in a more upward direction and leave more tissue attached, often through endoscopic or hidden incisions.

Subperiosteal lift

  • Tessier 1989 "mask-lift": complete subperiosteal dissection of the malar bones, zygomatic arches and orbital margins, via coronal or short vestibular incision (PMID 2473674).
  • Ramirez 1991, extended subperiosteal lift: nerve injury was 11% with the Psillakis approach and 20% with the Tessier approach in the authors' first 60 patients; none in 28 with dissection deep to both temporal fascia layers (PMID 1852815).
  • Ramirez 1994: endoscopic full facelift with total subperiosteal dissection; patients up to their late 40s treated without skin excision (PMID 7817884).
  • Hamra 1995 commentary on the subperiosteal face lift (PMID 7624433).
  • Heinrichs 1998, 200 cases over 4 years, all with brow lift: complications 5%; transient frontal branch weakness 2; secondary surgery 1% (PMID 9727455).
  • MASK lift (subperiosteal lift of the upper and middle face), 2024 technique paper (PMID 39060149).
  • ABPS tracer data: subperiosteal lifts were 1% of 3,400 facelifts in 2006-2021 (PMID 38302713).

Subperiosteal midface lifts

  • Concentric malar lift, 342 cases (2010-2016): no secondary eyelid malposition; 10-30 mm of skin recruited into the lower lid (PMID 29464383).
  • Intraorbital fixation midface lift, 82 cases: no fixation failure or relapse in primary patients; no ectropion in 58 primary patients (PMID 36342769).
  • Medial limited subperiosteal midface lift, 569 cases over 16 years, fixation through drill holes in the orbital rim (PMID 42009921).

Vertical approaches

  • MACS: purse-string sutures give a vertical vector (PMID 11994618).
  • MADE vertical facelift: deep-plane release of zygomatico-cutaneous ligaments with a vertical suspension, 153 patients (PMID 22065880).
  • Vector analysis in deep-plane lifts: mean SMAS vector 70.8 degrees (PMID 38657095).
  • V plication facelift, 58 patients: vertical superior suspension of the anterior mobile face (PMID 39843874).
  • Vertical vector face lift under local anesthesia with submentoplasty (PMID 21276163).

Endoscopic deep-plane lifts (no preauricular incision)

  • Ponytail lift, 600 cases over 22 years: no flap necrosis, no permanent nerve injury; touch-up in 20 (PMID 38152870).
  • Endoscopic deep-plane facelift with 5-group classification, 393 patients: no permanent nerve injury; revision 4.8%, mostly in the first 100 cases (PMID 40576459).
  • Transtemporal endoscopic deep-plane lift, 140 patients: temporary frontal neuropraxia 5; revision 6; lower eyelid length reduced 22.45% (PMID 39850537).
  • Endoscopic en bloc composite flap face and neck lift without preauricular incision, 41 cases; results comparable to the same surgeon's open composite lifts (PMID 37931912).

"Preservation" and "conservation" facelifts

  • Preservation face lift with rotating pedicle flap: combines extended deep plane and high SMAS with minimal skin delamination and preservation of deep structures; 134 patients, shorter drainage and fewer complications than extended deep plane (PMID 40104381).
  • Conservation facelift ("mesoface"): deep-plane lift repositioning the mesoface fat pad with limited undermining; 864 facelifts in 5 years, 0 nerve complications, 37 hematomas (PMID 42630822).
  • Limited delamination extended deep plane, 3,964 patients across 6 surgeons (PMID 39072376).
  • Anatomical basis: full release with redraping preserves the deep fascial architecture; no-release lifts drag retaining fibers (PMID 37747400).
  • Prejowl: fat grafting with less skin release corrected jowls more than mandibular ligament release (PMID 39001648).

Glossary

  • Subperiosteal: under the periosteum, the membrane on bone (PMID 2473674).
  • Mask lift: Tessier's subperiosteal lift of the facial soft-tissue envelope (PMID 2473674).
  • Midface lift: elevation of the cheek soft tissue below the eye (PMID 36342769).
  • Vertical vector: lift direction close to straight up (PMID 38657095).
  • Endoscopic facelift: dissection through small hidden incisions with a camera (PMID 40576459).
  • Preservation face lift: tissue-sparing deep-plane/high-SMAS hybrid that minimizes skin delamination (PMID 40104381).
  • Delamination: separation of skin from the SMAS flap (PMID 40104381).

Papers

PMID First author Year Journal Title Finding
2473674 Tessier P 1989 Ann Chir Plast Esthet [Subperiosteal face-lift]. Tessier subperiosteal mask-lift (landmark)
1852815 Ramirez OM 1991 Plast Reconstr Surg The extended subperiosteal face lift: a definitive soft-tissue remodeling for facial rejuvenation. Extended subperiosteal lift; earlier nerve injury 11%-20% (landmark)
7817884 Ramirez OM 1994 Aesthetic Plast Surg Endoscopic full facelift. Endoscopic full facelift, subperiosteal (landmark)
7624433 Hamra ST 1995 Plast Reconstr Surg Subperiosteal face lift. Hamra commentary on subperiosteal lift (landmark)
9727455 Heinrichs HL 1998 Plast Reconstr Surg Subperiosteal face lift: a 200-case, 4-year review. Subperiosteal lift, 200 cases, complications 5% (landmark)
39060149 Jamin C 2024 Ann Chir Plast Esthet [The MASK lift]. MASK lift technique 2024
38302713 Stein MJ 2024 Aesthetic Plast Surg Clinical Practice Patterns in Facelift Surgery: A 15-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery. ABPS: subperiosteal 1% of facelifts
29464383 Le Louarn C 2018 Aesthetic Plast Surg Concentric Malar Lift in the Management of Lower Eyelid Rejuvenation or Retraction: A Clinical Retrospective Study on 342 Cases, 13 Years After the First Publication. Concentric malar lift, 342 cases
36342769 Bitik O 2023 Aesthet Surg J Intraorbital Fixation Midface Lift. Intraorbital fixation midface lift, 82 cases
42009921 Zholtikov V 2026 Aesthetic Plast Surg Medial Limited Midface-Lift-16-Year Experience. Medial limited midface lift, 569 cases
11994618 Tonnard P 2002 Plast Reconstr Surg Minimal access cranial suspension lift: a modified S-lift. MACS vertical purse-string lift (landmark)
22065880 Jacono AA 2011 Aesthet Surg J The minimal access deep plane extended vertical facelift. MADE vertical facelift (landmark)
38657095 Talei B 2024 Aesthet Surg J Vectorial Analysis of Deep Plane Face and Neck Lift. Vector of lift in deep plane
39843874 Kontoes P 2025 Aesthetic Plast Surg Vertical Superior Vector Suspension of the Anterior Mobile Face with the V Plication Facelift: A Volumization and Lifting Technique. V plication facelift, 58 patients
21276163 Somoano B 2011 Dermatol Ther Vertical vector face lift. Vertical vector face lift under local (landmark)
38152870 Kao CC 2024 Aesthet Surg J The Ponytail Lift: 22 Years of Experience in 600 Cases of Endoscopic Deep Plane Facial Rejuvenation. Ponytail lift, 600 endoscopic cases
40576459 Firat M 2025 Aesthet Surg J Endoscopic Deep Plane Facelift: A Classified Approach. Endoscopic deep plane, 393 patients
39850537 Kul Z 2025 Plast Reconstr Surg Glob Open Transtemporal Endoscopic Deep Plane Face Lift. Transtemporal endoscopic deep plane, 140 patients
37931912 Mani M 2025 Facial Plast Surg Endoscopic, "Scarless" Composite Flap Face and Neck Lift. Endoscopic composite face and neck lift, 41 cases
40104381 Sadati K 2025 Plast Reconstr Surg Glob Open Advancements in Face Lift Techniques: Preservation Face Lift With a Rotating Pedicle Flap. Preservation face lift, 134 patients
42630822 Quinodoz P 2026 JPRAS Open Conservation facelift: The mesoface. Conservation facelift, 864 cases
39072376 Roskies M 2024 Facial Plast Surg Aesthet Med Limited Delamination Modifications to the Extended Deep Plane Rhytidectomy: An Anatomical Basis for Improved Outcomes. Limited delamination, 3,964 patients
37747400 Minelli L 2024 Plast Reconstr Surg Anatomy of the Facial Glideplanes, Deep Plane Spaces, and Ligaments: Implications for Surgical and Nonsurgical Lifting Procedures. Glideplanes: release vs no-release
39001648 Talei B 2024 Aesthet Surg J Mandibular Ligament and the Prejowl Sulcus Explained. Prejowl: fat grafting vs ligament release

Open questions / controversies

  • "Preservation facelift" has no standard definition; the 2025 and 2026 papers describe different techniques (PMID 40104381, PMID 42630822).
  • Nerve risk in subperiosteal work fell with technical changes (PMID 1852815), but the approach is rare in practice (PMID 38302713).
  • Endoscopic series report low complications without comparative controls or patient-reported outcomes (PMID 40576459, PMID 38152870).
  • Release against no-release: longevity argument is anatomical, not from long-term trials (PMID 37747400).

Papers cited on this page

Newest first.

2026
Medial Limited Midface-Lift-16-Year Experience
Zholtikov V, Korableva N, Lebedeva Y · Aesthetic Plast Surg · PMID 42009921
2026
Conservation facelift: The mesoface
Quinodoz P, Scampa M, Belhaouari L · JPRAS Open · PMID 42630822
2025
2025
Transtemporal Endoscopic Deep Plane Face Lift
Kul Z, Eryilmaz E, Özer E · Plast Reconstr Surg Glob Open · PMID 39850537
2024
[The MASK lift]
Jamin C, Laure B · Ann Chir Plast Esthet · PMID 39060149
2024
2023
Intraorbital Fixation Midface Lift
Bitik O · Aesthet Surg J · PMID 36342769
2011
Vertical vector face lift
Somoano B, Chan J, Morganroth G · Dermatol Ther · PMID 21276163
2002
Minimal access cranial suspension lift: a modified S-lift
Tonnard P, Verpaele A, Monstrey S, Van Landuyt K, Blondeel P, Hamdi M, et al. · Plast Reconstr Surg · PMID 11994618
1998
1995
Subperiosteal face lift
Hamra ST · Plast Reconstr Surg · PMID 7624433
1994
Endoscopic full facelift
Ramirez OM · Aesthetic Plast Surg · PMID 7817884
1989
[Subperiosteal face-lift]
Tessier P · Ann Chir Plast Esthet · PMID 2473674