Abstract
BACKGROUND: Traditional facelift techniques, although effective in addressing facial aging, are often associated with visible scarring and stigmas. These factors contribute to patient hesitation and a growing preference for nonsurgical alternatives. In recent years, endoscopic approaches have gained popularity by offering scar-concealed access and deep plane dissection, but many techniques lack a standardized framework for patient selection and reproducibility. OBJECTIVES: The aim of this study was to present a systematic endoscopic facelift technique which proposes a 5-group classification system to guide patient-specific surgical planning and optimize aesthetic outcomes. METHODS: A total of 393 patients underwent endoscopic facelift surgery performed by a single surgeon between 2020 and 2024. Patients were categorized into 5 groups based on facial aging patterns and anatomical needs, including brow lift, midface lift, lower facelift, and neck correction. The technique emphasized minimal skin undermining, vertical vector elevation, and cable suture suspension. All patients were followed for a minimum of 12 months postoperatively. Complications, revisions, and outcomes were recorded prospectively. RESULTS: There were no cases of permanent nerve injury. Revision surgery for cosmetic concerns was performed in 19 patients (4.8%), most of whom were among the first 100 cases. CONCLUSIONS: This vertical vector endoscopic facelift technique demonstrates consistent aesthetic results with low complication and revision rates. By combining a classification-based surgical strategy with minimally invasive access and deep anatomical correction, this method offers a reproducible, safe, and natural-appearing alternative to traditional facelift approaches. Future studies will aim to incorporate objective assessments and patient- reported outcome measures. LEVEL OF EVIDENCE: 4: (Therapeutic).