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:
Aspect |
Traditional SMAS facelift |
Deep Plane Facelift |
| What moves
|
Skin and a thin SMAS layer
|
Skin, SMAS, fat, and muscle together
|
| Ligaments released
|
No
|
Yes (all four)
|
| Skin tension
|
High
|
Low
|
| Typical longevity
|
6 to 8 years
|
10 to 15 years
|
| The “pulled” look
|
Possible over time
|
Rare; tissue isn’t stretched
|
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.