Dr. WorldWide | Frank Agullo, MD

BLOG

Last summer, every red carpet, every Vogue Arabia spread, every grainy paparazzi shot of the Bezos wedding ended with the same question. Who did Kris Jenner’s face? The internet lost its mind. One post asking for the doctor’s name racked up tens of thousands of likes. Some called it the best celebrity facelift in a hundred years. The momager looked, depending on the photo, somewhere between thirty-eight and fifty. Then a year passed. Now the same internet that crowned the result is asking why the magic looks like it is wearing off. Stories of “facelift slipping.” Whispers of revision. Comparisons to other women in the same age cohort, like Denise Richards, whose results held while Kris’s seems to be drifting south. I have been watching this story closely. Not because I love celebrity gossip, but because what is unfolding in public, in real time, is the entire arc of a facelift. The honeymoon. The retouch. The first year. The technique that did or did not go deep enough. And what happens when you do a SMAS-based operation on a seventy-year-old face that needed more.

What her surgeon actually did

Kris Jenner’s surgeon is a respected New York plastic surgeon, well trained, well credentialed, and widely reported to perform a hybrid technique, a lateral SMASectomy paired with a deep neck lift. SMASectomy means cutting out a strip of the SMAS, the muscle and tendon layer that sits just under the skin, and stitching the edges back together. SMAS plication is the close cousin, folding that same layer over itself like a hem and tacking it down. Both are SMAS techniques. Both work on the layer of facial anatomy closest to the skin. Neither dissects underneath the SMAS. Neither releases the four retaining ligaments that anchor the face to the skull. This is not the deep plane facelift. It is also not the endoscopic ponytail lift, which I trained to perform at the Ponytail Academy in Pittsburgh and Santa Monica. It is a respectable, well-executed, brand-name version of an older operation. And in a seventy-year-old face, that distinction matters more than people realize.

The honeymoon phase nobody tells you about

Every facelift looks incredible at three months. I mean every single one. Here is why. Three months out, the swelling has not fully resolved. There is still a layer of inflammatory fluid plumping the face. Skin is still tight from the closure. The deep tissues are healing in a position that is, frankly, slightly tighter than where they will eventually settle. Add professional lighting, a glam team, and a heavy hand in retouching, and you have what I call the honeymoon face. The honeymoon face is not the result. It is a preview of the result, dressed up. The real result lives at twelve to eighteen months out, after the swelling has gone, the skin has relaxed, and the tissues have settled into their new home. That is the face you will see in the mirror for the next decade. If the technique was right for the anatomy, the twelve-month face is barely distinguishable from the three-month face. Rested. Younger. Like the patient on a great day. If the technique was wrong for the anatomy, twelve months is when the gap shows up. Volume that was masking a structural issue retreats. Skin that was tight goes lax. The midface, which is heavier than people realize, starts to fall again. And the patient ends up where Kris is now, in the public square, watching strangers debate her face on TikTok.

The midface, the malar bags, and the golf balls

Look at the recent photos with an honest eye and a working knowledge of facial anatomy. The lower face and the neck are still meaningfully better than they were before surgery. That part of the operation worked. The jawline is cleaner. The platysmal bands are quiet. But the midface tells a different story. The cheeks, which were lifted into position briefly by swelling and a tight skin closure, have descended again. The malar bags, the prominent rounded fullness that sits on top of the cheekbones, are now obvious. Two of them. Round, glossy, and impossible to unsee. Some commenters have, less charitably than I would, called them golf balls. This is not some mystery failing. The midface was never fully addressed in the first place, and what we are watching now is exactly how a midface behaves when you do not address it. A lateral SMAS technique tugs on the side of your face. Lovely for the jowl. Useless for the malar fat pad, which is the cushion of fat that gives a cheek its shape instead of leaving you with a literal pouch sitting on top of the cheekbone. The deep plane operation handles this directly. We release the zygomatic ligament, free the malar fat pad, and reposition the whole thing as one composite piece with the rest of the flap. The endoscopic ponytail lift does the same job, just through small openings tucked inside the hairline. Skip the malar release on a face that needed it, and you get exactly this trajectory. The swelling carries you through the honeymoon. Then the swelling leaves, and the cheekbones still are not where they should be.

A seventy-year-old face is not a fifty-year-old face

Skin at seventy is not the skin you had at fifty. The elastin content has dropped, the collagen network is thinner, and the deep ligamentous support that anchors a face to its skull is no longer doing the job it used to. Run the same operation on a fifty-year-old and a seventy-year-old by the same hands and on the same day, and the fifty-year-old will hold the result longer. Every plastic surgeon I have ever trained with knows this. Most of us, out of politeness, do not say it out loud. So I will. At seventy, the technique you pick is more or less the whole game. SMAS-only buys you maybe a year or two of looking the way you did the day after the bandages came off, then a steady drift back toward where you started. The deep plane gives you ten, twelve, sometimes fifteen years. That is not my opinion, that is what the peer-reviewed longitudinal data shows. Which is why the Denise Richards comparison hits where it does. Richards is fifty-five, fifteen years younger than Kris, and her surgeon took her into the deep plane. Younger tissue, deeper operation, more durable result. A year out, she still looks like she did at three months. Kris is seventy, with a SMAS-based operation. The arithmetic was hard before anyone cut a single stitch.

Quick comparison

One more thing about those reveal photos

Let me be the surgeon who says what other surgeons say in the lounge but not on the record. The reveal photos last summer were heavily retouched. I do not say this with any pleasure. I say it because the gap between the polished cover image and the candid Instagram from the same week was too wide to be lighting alone. That kind of editing helps nobody. The patient walks into a setup, because reality always catches up to a retouched photo. The public walks into a setup too, because they sign up for an operation expecting a result the operation was never on its own going to give them. Worst of all, the patient ends up feeling betrayed by an outcome that, honestly, is doing exactly what that technique does at twelve months on a seventy-year-old face. When I do a facelift on you, the photos you see at twelve months are the actual photos. Not filtered. Not retouched. Usually in black and white, because that is how I prefer to show work and because color photography flatters a result you have not earned. What you see is what you have.

Why I trained where I trained

My plastic surgery fellowship was at Mayo Clinic, where they hammer into you the idea that you choose the operation for the anatomy, never the brand for the marketing. From there I went to Pittsburgh for the intermediate Ponytail Academy course, then back out to Santa Monica for the advanced one, because the deep plane and the endoscopic deep plane are the operations that, year over year, actually hold. And I teach as a Clinical Associate Professor at Texas Tech University Health Sciences Center for one simple reason: if I cannot stand in front of a resident and explain why a maneuver works, I do not understand it well enough to perform it on you. I have been a Castle Connolly Top Doctor for thirteen consecutive years. I have published over forty peer-reviewed papers. I have a global following of over 3.5 million across Instagram, TikTok, and Snapchat. None of that matters if the face I deliver does not hold. The face has to hold.

Why choose Dr. Agullo for a facelift in El Paso?

Double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. Fellow of the American College of Surgeons. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor at TTUHSC. Affiliate Professor at UTEP. Ponytail Academy intermediate (Pittsburgh) and advanced (Santa Monica). Castle Connolly Top Doctor for thirteen straight years. Texas Super Doctors Hall of Fame. Aesthetic Everything Top Plastic Surgeon, 2026. Trained in deep plane facelift, endoscopic deep plane (Ponytail Lift), preservation rhinoplasty, supercharged BBL, and rib repositioning for waistline reduction. About sixty percent of my patients fly in from out of town because the operation, not the city, is what they are choosing.

Ready to talk?

If you are thinking about a facelift, the most useful forty-five minutes of your year is a consultation with the surgeon who would actually do it. Bring photos of yourself from ten years ago. Bring the photos that bother you now. Bring the questions you would not ask your dermatologist. I will tell you whether you need a deep plane facelift, an endoscopic ponytail lift, a neck lift only, or to come back in five years. If filler is the right answer for you today, I will tell you that. If you need surgery, I will not pretend you do not. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

BLOG

Every surgeon has a story about the first time they saw a facelift that actually looked good. Mine was at Mayo Clinic during my plastic surgery fellowship. The patient was about a year out. She looked ten years younger. Not pulled, not waxy, not surprised. Rested. I asked my attending how the result held up over time. He said, “If you do it in the deep plane, it holds up longer than anything else we have.”

That line stuck with me. It’s the reason I went to Pittsburgh for the Ponytail Academy’s intermediate course, and then to Santa Monica for the advanced.

What a Deep Plane Facelift actually does

For decades, the standard facelift worked like this: you pulled on the skin, tightened a thin layer underneath called the SMAS, and closed. It gave a result, but not forever. Skin stretches. And patients who came back for a second facelift often noticed the second one felt a little more “done” than the first.

The Deep Plane Facelift doesn’t pull on skin. It dissects underneath the SMAS, releases the four retaining ligaments that anchor the face to the skull (zygomatic, masseteric, mandibular, and platysma), and repositions the whole composite flap as one unit. Skin, SMAS, fat, muscle. All moving together. Nothing is under tension.

That one detail changes everything. Because the tissue isn’t stretched, the face doesn’t look stretched. Because the anatomy is restored instead of pulled, the result lasts. Peer-reviewed data shows Deep Plane Facelift results holding at ten, twelve, and fifteen years.

The quick comparison:

The Ponytail Lift: same philosophy, hidden incisions

The Ponytail Lift is the endoscopic version of the Deep Plane Facelift. Same tissue release, same ligaments, same composite flap. What’s different is the access. Instead of incisions in front of the ears, the work is done through tiny openings hidden inside the hairline, using an endoscope for visualization.

No pre-auricular scar. No earlobe distortion. The incisions heal inside the hair, which means even a patient pulling their hair back into a ponytail (hence the name) doesn’t reveal anything.

It’s not an easier operation. It’s a more demanding one, because you’re working through small access points with indirect visualization. The benefit is that the right patient gets a deep plane result with no visible scar. Which matters.

Who is (and isn’t) a Ponytail Lift candidate?

The right candidate is usually in their forties or fifties, has early-to-moderate midface and jowl descent, has skin with decent elasticity, and cannot accept any trace of a pre-auricular scar. Patients with thick hair can fully hide the hairline incisions, which is ideal.

The wrong candidate is usually a patient with heavier skin laxity or patients in their mid-sixties and beyond. That anatomy does better with a traditional open Deep Plane Facelift, because the skin itself needs to be redraped and excised, not just the deep tissue repositioned.

Part of the consultation is figuring out which version is right for you. If a traditional deep plane fits your face better, that’s what I’ll recommend. If the Ponytail Lift is the better match, we’ll go that route. I’m not attached to one operation. I’m attached to the result.

Why the Ponytail Academy?

I’ve been doing facelifts my whole career. I could have watched a YouTube video, told my patients I do the Ponytail Lift, and called it a day. A lot of surgeons do exactly that. I didn’t.

The Ponytail Academy is the advanced training program built around this technique. It’s small, it’s cadaver-based, and it’s taught by the surgeons who invented the approach. I took the intermediate course in Pittsburgh first, then returned for the advanced course in Santa Monica. Days in the lab dissecting, releasing, and repositioning, with real-time correction from faculty who do this operation every week. That’s how I learned plastic surgery at Mayo. That’s how I wanted to learn this.

My patients deserve the version of the Ponytail Lift taught by the people who wrote it. Not the version taught by someone who read about it.

One more thing about fillers

I love fillers for the right patient. I use them every day. But fillers are a tax. You pay it every six to twelve months, and when you stop paying it, the face goes back to where it was.

A Deep Plane Facelift is an investment. You pay for it once, and it appreciates over the decade that follows. Patients who chase volume loss with filler for years often arrive in my office with a face that looks fuller, not younger. Puffy cheeks, no jawline, weird upper-lip volume. That’s the filler tax, paid too many times.

If fillers are right for you, we’ll use them. If surgery is right for you, we’ll do it right. The goal is always the same. The face you recognize in the mirror. #StayBeautiful.

Why choose Dr. Agullo for a Deep Plane Facelift in El Paso?

Double board-certified (American Board of Plastic Surgery, American Board of Surgery). Fellow of the American College of Surgeons. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, where I teach the same techniques I use every day. Affiliate Professor at UTEP. Castle Connolly Top Doctor, thirteen consecutive years. Ponytail Academy, advanced endoscopic deep plane training. Over 3.5 million followers across Instagram, TikTok, and Snapchat, because patients want to see the work before they trust someone with their face.

Ready to talk?

The best way to figure out which operation is right for you is an in-person or virtual consultation. I’ll evaluate your anatomy, walk you through the options honestly, and tell you what I’d recommend if you were my sister. If the answer is “not yet, come back in three years,” I’ll tell you that too.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.