Dr. WorldWide | Frank Agullo, MD

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Three Days in Boston: A Surgeon’s Read on The Aesthetic Meeting 2026

The Aesthetic Society’s annual meeting wrapped Sunday in Boston after kicking off on Wednesday. The press releases will tout innovation and “the next big thing.” For me, what actually mattered came out of three days of panels, technique sessions, and lobby-bar conversations with surgeons who do this work every week.

I came home with three things: the rise of the deep plane facelift, the evolution of the rules around endoscopic access, and AI. I am saving AI for last because there is the most to unpack there.

The Deep Plane Was the Room

The entire track devoted to deep plane facelifts was the focal point of the face program this year. Full rooms. I would guess that half the attendees already perform deep plane dissections and were present for subtle refinements rather than basic technique. The other half are clearly contemplating the move. Just five years ago, you would find a deep plane discussion running opposite a SMAS plication panel that would pack the bigger convention center room. Now the SMAS panels are the side rooms, empty except for the hardy few who still rely solely on that dissection.

I had several key takeaways from the deep plane content.

The neck content was tighter than I have seen it in years. Speaker after speaker explained the same idea from different perspectives. Durability in the neckline truly comes from the deep neck. The sub-platysmal compartment, the digastric muscles, the submandibular gland, the deep fat. A platysmaplasty alone, done superficial to that compartment, gets you a decent result at three months and a disappointing one at three years. The data on properly executed direct sub-platysmal work, including selective digastric reduction and partial submandibular gland resection in the right anatomy, is solid enough that the focus of the discussion is no longer “should we do it,” but “on whom, and to what extent.”

The midface release content was stronger than last year. The zygomatic ligament releases that I routinely include in my deep plane were thoroughly confirmed by anatomical talks and by ten-year-plus follow-up photos. The newer development this year was a more aggressive discussion around the masseteric ligaments and the platysma-auricular ligament, with several speakers now strongly recommending full versus partial release. It gave me pause. I am hesitant to adopt much more aggressive ligament releases without firsthand dissection experience on cadavers. Boston was a stark reminder to schedule cadaver lab time before I move my own technique to include deeper and wider releases.

The submandibular gland question turned out to be less about whether to reduce the gland and more about where to put the scar. A vocal subset of surgeons is committing to a longer low cervical incision, almost at the neck crease, to give themselves direct line of sight to the gland. I have a hard time with that. The submental incision under the chin hides beautifully in the natural shadow, and that is the access I prefer for partial gland reduction. For hemostasis I use the LigaSure, which most of the room supported. I also keep a cell saver running as a backup. If we have any meaningful blood loss the patient gets her own red cells back instead of someone else’s. It is an inexpensive safety net for an elective operation and there is no good reason not to have one in the corner of the room.

The opinionated take after the weekend. Deep plane has won. The remaining question is not whether to operate beneath the SMAS. It is how deep, how wide and on which patient.

Endoscopic Access Evolved, Rules Solidifying

The endoscopic facelift track ran parallel to the open deep plane sessions, which was the right organization. The fundamental dissection philosophy and tissue manipulation are the same. The problem lies in the access route and the visualization.

I trained for the endoscopic deep plane, the operation often referred to as the Ponytail Lift, at the Ponytail Academy. The intermediate course was in Pittsburgh and the advanced course was in Santa Monica. I came to Boston wanting a clearer picture of which patients are actually good candidates for this approach versus which ones absolutely need the open operation. This year’s meeting delivered.

The endoscopic deep plane facelift is the right operation for the patient who is beginning to experience descent in the midface and brow, still has robust skin elasticity, and has a firm refusal of any pre-auricular scarring. Hairline incisions simply vanish into the temporal and post-tragal tufts. The surgical dissection plane is exactly the same as my workhorse open deep plane. The outcome is a full deep plane lift without any external signs that surgery happened.

Conversely, the endoscopic deep plane is the worst operation for the patient with significant skin laxity, jowl-dominant aging in the lower third of the face, or a long ear-lobe-to-mandible distance that is clearly going to demand open redraping to get a good twelve-month result. A few speakers were refreshing in their blunt honesty. The conversion-to-open rate when you over-select for the endoscopic lift is a real number, and the twelve-month photos show it on their own, whether you present them or not.

The fixation chatter was useful. Endotines and bone-anchored fixation are not the hardline debate they used to be. Most rooms I sat in are converging on suture fixation to the deep temporal fascia for the temporal and lateral fixation in primary cases. For that part of the operation, my hands look like everyone else’s. The midface is where I split off. In my hands, the endoscopic Ponytail Lift with an Endotine Ribbon at the midface delivers a stronger and more durable lift than any suture-only construct I have tried, and Boston did not show me a long-follow-up photo set that gave me a reason to put the Endotine Ribbon away.

There is one more piece of my technique I want to mention here, because patients ask about it on consult. When the face calls for an open deep plane in 2026, I am running a hybrid. The brows, forehead and midface go through Ponytail Lift access, with the Endotine Ribbon midface fixation. The lower face and the deep neck get the open deep plane. The combination, on the right patient, gives me the lift quality of an open deep plane in the lower face with the scar discipline of the Ponytail Lift across the top of the face. Boston did not invent that operation for me. Boston confirmed that the surgeons whose twelve-month photos I trust are quietly doing the same thing.

AI’s Clinical Relevance? Underwhelming.

So, AI.

I went into those sessions wanting to be impressed. A real-world intraoperative ligament mapping tool. A planning system that shaves time off my deep plane markup without introducing risk. A preoperative simulator that produces an outcome image the patient can actually rely on instead of being fooled by. Anything someone is using on a real patient next Tuesday.

Nobody gave that talk. The clinical AI content at this meeting was, in my honest read, half a letdown. A few academic posters on imaging analysis. One talk on AI-assisted aesthetic ranking that was interesting but unusable in clinic. No one stood up and said “I run this tool in my operating room on a real face, here is the workflow, here is the data on outcomes.” That gap is enormous, and it is the gap our specialty needs to close before the marketing copy stops being embarrassing.

The other half of the AI track, though. That was actually useful, and I had a stake in it. I presented in the practice-management track this year on AI for reputation management in plastic surgery. The practice management content was stronger than I expected. So was the patient communication content. So was the lead handling content. A lot of the practical AI work in aesthetic medicine is happening on the patient experience side and the panels reflected that.

AI front-desk coverage and after-hours support are now a real thing. The good tools handle scheduling, qualify inbound leads against the practice’s actual aesthetic criteria, send tailored pre-op and post-op communication, and escalate the unusual cases to a human at the right moment. A handful of practice owners walked through deployment timelines and conversion numbers. The numbers were credible.

EMR-integrated documentation tools (ambient scribes, structured note generators, post-op summary drafting) are not a demo anymore. Surgeons in private practice are running them on real cases. The hours back per surgeon per week are not trivial.

For my practice in El Paso, this is already in place. The chatbot is live on my homepage, picking up the after-hours inbound that used to sit in a queue until Monday morning. An ambient AI scribe runs in the consultation room so my eyes stay on the patient and not on a keyboard, and the chart is largely drafted by the time she stands up to leave. Neither tool is there to automate away the humans in my office. Both are there because the patient who fires off a text at midnight from Toronto, or who sends a recovery question from Seattle on a Sunday morning, deserves a prompt and accurate first response. The humans on my team are then free to focus on the conversations where a human interaction is the appropriate and beneficial tool.

I will absolutely not overstate the role AI plays in the surgical planning phase. The patient who shows up for a consultation in 2026 expecting a computer algorithm to design her facelift has been oversold something the field has yet to fully develop. I will not be the doctor playing along with that notion.

Why Choose Dr. Agullo

Double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. Fellow of the American College of Surgeons. Plastic surgery fellowship at Mayo Clinic. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine. Affiliate Professor at the University of Texas at El Paso. Castle Connolly Top Doctor for thirteen consecutive years. Texas Super Doctors Hall of Fame, 2025. Aesthetic Everything Top Plastic Surgeon, 2026. Ponytail Academy intermediate (Pittsburgh) and advanced (Santa Monica) training.

Ready to Talk?

If you are seriously considering a facelift, a Ponytail Lift, or a deep neck lift this year, the consultation is where the real work starts. Bring pictures of yourself from a decade or so ago. Bring the current photos that are causing you the most concern. Most importantly, bring the questions that you would only trust asking a surgeon you feel comfortable with. I will assess your anatomy and tell you which surgical approach, if any, it is asking for. If filler is the right answer for now, I will tell you so, plainly. And if it is the right time for a more definitive procedure, I will tell you that just as plainly.

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

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The patient in the photos on this page walked back into her office the day after surgery. Two weeks later she was lifting weights again. Four weeks later she was running. The compression bra came off at three. None of those numbers used to be possible.

For most of my career, the honest answer to “when can I lift my kids” after a breast augmentation was four to six weeks. The honest answer to “when can I lift heavy at the gym” was six to eight. I gave those answers a thousand times. They reflected the real recovery from a traditional submuscular augmentation, where the pectoralis muscle is partially released to make room for the implant. The muscle heals. It just takes the time it takes.

I stopped giving those answers about a year ago. The reason is a technique called Motiva Preservé, and it has changed enough about how I plan a breast augmentation that I owe my patients a longer explanation.

What Preservation Actually Means in the OR

The word “preservation” in Preservé is a commitment. Smaller incision (2.5 to 3 centimeters, inside the natural shadow below the breast). Minimal muscle release. A no-touch funnel so the implant never contacts skin on its way into the pocket. Less tissue dissection overall. The breast and chest wall handed back to the patient as close to their pre-operative state as the operation allows.

What patients feel is less swelling, less tightness, less of the bruised-rib soreness that traditionally defines the first week. The recovery curve compresses. The day-one experience now looks like the week-three experience used to look.

The case in the photos on this page was completed in under an hour in the operating room, under light sedation rather than general anesthesia. She walked out of the surgical suite the same morning and drove home (with someone else at the wheel) before lunch. That is not a marketing claim either. It is the operative report.

That is not a manufacturer claim. That is what every Preservé patient in my practice has told me, with a logbook that backs them up.

The Implant: Motiva Ergonomix Full

The implant in this case is a 315cc Motiva Ergonomix Full. Sixth-generation silicone gel, ProgressiveGel Ultima inside, SmoothSilk surface outside. The shape is what makes the Ergonomix line different from anything else in my OR.

Upright, the implant drapes into a teardrop that looks like real anatomy. Supine, on the back, it flattens and rounds the way breast tissue does. Nothing about its shape is fixed. The implant moves with the body the way tissue would. Patients describe the result as natural in a way I do not hear with older implant designs. That has shown up in my consult conversations and in the reaction shots my own patients send me a year later.

The Full profile is one of three Ergonomix projection options Motiva offers in the United States (Mini, Demi, and Full). For a slim athletic patient who wants visible projection but a natural silhouette, Full is the right end of the range. The 315cc volume was the result of careful sizing in the office. She did not want a striking change. She wanted proportion. For the full breakdown of the technique itself, the Motiva Preservé breast augmentation page on agulloplasticsurgery.com walks through every step.

Why I Stopped Promising Six-Week Recoveries

The single hardest number to defend in breast augmentation is recovery time, because the standard answer has been wrong for a long time. We told patients six weeks because that was the honest answer for the surgery we were doing. We are not doing that surgery anymore.

The Preservé recovery ladder, for a patient with this body type and this implant choice, looks like this. Day one: back to desk work, off the heaviest pain medication, sleeping upright. Day seven: showering, light walking, sleeping however she wants. Week two: back to lower-body gym work and short runs, with a sports bra. Week three: compression bra off. Week four: full upper-body programming, with the surgeon’s clearance.

None of those numbers come from a brochure. They come from the patients themselves, who tell me what they actually did, day by day, in the months after. I keep notes. I update the table I show in consults. The numbers have not slipped.

A Short Comparison

A simple way to see the difference:

The table flattens some real surgical detail. The full nuance lives in the clinical version of this post on agulloplasticsurgery.com (linked at the bottom of this post), where I walk through the operating room in more depth.

Who Is the Wrong Candidate

I will tell you who Preservé is not for. A patient with significant ptosis (drooping) needs a breast lift in addition to an augmentation, and the lift drives a different recovery curve. A patient with very thin tissue or a history of capsular contracture needs a more nuanced breast augmentation revision conversation. A patient who wants a dramatic enlargement well beyond what her frame supports is going to be unhappy with any technique, and I will tell her so before we book a date.

The right candidate is a patient with a reasonable skin envelope, a defined inframammary fold, and goals that lean toward proportion. The patient in the photos on this page is one of the easier candidates to plan for. Not every patient is.

Why I Trained on This System

I have placed thousands of breast implants going back to my plastic surgery fellowship at Mayo Clinic. Castle Connolly Top Doctor thirteen consecutive years. Clinical Associate Professor at Texas Tech University Health Sciences Center, where I teach breast augmentation to the residents I am responsible for. I do not adopt new techniques because a rep walks them in. I adopt them when the data and my own results justify the change.

Motiva earned FDA approval for its silicone gel implants in 2024 after years of leading the implant market in Latin America and Europe. I trained on the system directly before I placed an implant in a patient. I do not place a Motiva implant the way I place every other implant in my OR, because the technique is different and the implant rewards the difference.

One More Thing About Volume

Patients always ask about size in cubic centimeters first. The number matters less than the planning around it. A 315cc implant on the patient in these photos reads as proportional. The same 315cc on a different frame might read as dramatic. The same 315cc on a third frame might read as not enough. Size, projection, profile, the elasticity of the skin envelope, the position of the inframammary fold. All of those drive the answer to “what should the number be.”

The right surgeon will spend the consult walking you through that math. If the conversation starts and ends with a single number, you are in the wrong consult.

See the case on social: originally posted to Instagram and TikTok.

Ready to Talk?

If you are reading this on your phone and thinking “two weeks back to the gym sounds too good to be true,” the right next move is a consultation. I will tell you whether Motiva Preservé fits your anatomy and goals, whether 315cc is the right number for your frame, and whether augmentation alone is the right operation or whether you also need a lift. If the answer is “not the right time,” I will tell you that too. The goal is the face and body you recognize in the mirror. #StayBeautiful.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. For the longer clinical breakdown, see the agulloplasticsurgery.com post on this same case or the swplasticsurgery.com practice version. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.