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The Price Nobody Prints: What a Facelift Costs and Why

Black and white profile portrait of a woman in her fifties, jawline and neck lit as a single architectural line.

Search “facelift cost” and you get a national average, a range so wide it is useless, and eleven pages of practices inviting you to call for pricing.

Call for pricing. As though the number were a trade secret rather than the single most common question in aesthetic surgery.

I publish mine. Not because I am cheaper (I am not) but because the alternative is a consultation that opens with sticker shock.

The Numbers, Since You Asked

The full range is $15,000 to $75,000, depending on what combination the result actually requires. The tiers underneath it, published on the fees page:

Procedure Starting Fee
Mid facelift (mini or S-lift) $15,000
Lower facelift (lower face and neck) $19,500
Full facelift $25,750
Endoscopic facelift (the ponytail lift) $30,000
Neck lift alone $15,000

“Those prices are minimums, and they include anesthesia, the surgical facility, medical tests, garments, and recovery products. Because pricing does change, please confirm current pricing at agulloplasticsurgery.com/fees, which is the page we keep updated.

A final quote is only given after a consultation, and it will include everything.”

Two quotes that look thousands apart are frequently the same operation described differently.

The Naming Problem

Deep plane. Extended deep plane. Endoscopic deep plane. Ponytail lift. MACS. SMAS plication.

Patients arrive fluent in this vocabulary and convinced the terminology sets the price. Mostly it does not. Deep plane, extended deep plane, SMAS plication: all map onto the tiers above.

The ponytail lift is the exception. It takes a little bit longer, and it always requires fat grafting in every case, so the graft is bundled rather than optional. Operative time and a second procedure, not a demand premium.

What decides technique is anatomy:

“The differentiator is how much excess skin there is. If there’s substantial excess skin, then we do a deep plane open facelift with an incision in front of the ear. If there’s not a lot of excess skin, we can get away with doing everything through the incisions behind the hairline. Nevertheless, a full facelift is always going to have the endoscopic portion of the forehead and brows.”

Why the First Hour Costs the Most

The economics patients never get told:

“Combining does change the total, but usually in your favor compared to doing things separately. The first hour of operating room and anesthesia time is the most expensive, because of the equipment and the setup, and you only incur that once instead of two or three times. The same goes for medications, moisturizer, scar cream, and lymphatic massages, you only pay for those once.

That said, each additional procedure adds surgical time, and pricing reflects the time and the complexity of the combination. Adding eyelids, a lip lift, an earlobe reduction, fat grafting, or a skin resurfacing treatment will increase the total.”

Not a discount. Arithmetic.

What I Am Actually Charging For

The version patients think and rarely ask:

“Cost varies with the doctor’s experience. Surgeons in high demand consistently deliver good results in a safe environment with top-quality products, and that increases cost. I allow sufficient operating room time to work in a paced fashion, for safety. Low-cost surgeries get compressed to cut anesthesia and operating room fees.

Our patients get direct nurse access 24 hours a day, and all surgeries are done in an accredited surgical center.”

Pace is not a luxury. Compressed surgery is what makes a low quote possible.

What I tell every patient shopping on price:

“I always feel like when things are too good to be true, they usually are. If a price seems far below what everyone else is charging, you have to ask what’s being cut, the surgeon’s experience, the accreditation of the facility, the type of anesthesia, or the follow-up care.”

It is always one of those four.

What Goes With the Lift

“With most facelift procedures we also do fat grafting. We usually recommend Morpheus8 with Iriescence PDGF, or the Sciton MicroLaserPeel with Profractional, depending on your skin type. We can also use exosomes or nanofat. We recommend ELIXIR MD, which is LED light therapy, for almost double the speed of recovery. And a lot of patients will require an upper blepharoplasty, a lower blepharoplasty, a lip lift, or an earlobe reduction. Those all do increase the cost.”

Lifting tissue that has lost volume gives you a tighter version of a deflated face.

Patients Are Arriving Earlier

“I think the deep plane lift and the endoscopic deep plane lift are great procedures, which create very natural and long-lasting results, and we’re seeing patients completely avoid the noninvasive procedures and go straight to the surgical procedures early on.”

They watch the results hold, and they come earlier. I think they are right.

Paying for It

“Patients can finance through PatientFi, AlphaEon, Cherry, or CareCredit. We also offer direct financing through the practice, where you make payments directly to us ahead of your surgery. That lets you schedule the procedure out for the time you need, and make the payments periodically at your convenience.

Beyond that, patients can pay by credit card or cash, or arrange financing through their own bank or another institution.”

Where I Trained on This

Double board-certified. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Castle Connolly Top Doctor thirteen consecutive years. Endoscopic deep plane training at the Ponytail Academy in Pittsburgh, then the advanced course in Santa Monica.

The full clinical detail, including what each tier covers and how the add-ons price, is in the clinical breakdown on agulloplasticsurgery.com.

Ready to Talk?

Come with a budget and a question and leave with a real number that includes everything. Call (915) 590-7900, text 1-866-814-0038, or book online. #StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

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The Facelift With No Visible Scar: Deep Plane, the Neck, and Why I Dissolve Old Filler

Black and white profile portrait of a woman with hair pulled back into a ponytail, jawline catching the light. Ponytail deep plane facelift commentary by Dr. Frank Agullo, MD, FACS.

Most facial consultations begin with the same small gesture. Someone lifts the skin at their cheeks in the mirror, watches the jawline snap into place, and says, “I just want this back.”

Underneath that gesture is almost always the same set of problems. Jowls. A heavy neck. A lower face that sags when they smile. And, increasingly, a face tired of being chased with filler.

Here is how I talk about the fix, candidly.

A Facelift You Cannot See the Scars From

For the right candidate, I use a facelift with no visible scars. The incisions hide in the hairline, which is why it is called a ponytail facelift, and a good portion of the lift is done endoscopically.

It brings the brow up just slightly and lifts the cheek, so that when you smile the lower face softens instead of dropping. You can still wear your hair up.

“Is This Just Pulling the Skin Tight?”

No, and that is the entire point. It is a deep plane facelift, which means I reposition the deeper tissues rather than pulling on skin. That is what makes it look natural and last. You do not end up looking pulled or windswept, because the tension lives in the deep layer, not in your skin.

What the Neck Actually Needs

For the neck, I place a small incision under the chin and behind the ear. Through that I can remove a little of the gland and the deeper fat and build a tight, youthful jawline.

Taking out the deeper fat matters for the long run. Even if your weight changes later, the result will not blur as much, because the fat that tends to come back is more superficial.

And no, most people do not need a chin implant. If you already have a strong chin, the neck lift alone makes it look more pronounced and sharper, because right now it is getting lost.

My Strong Opinion on Old Filler

This is where I will not hedge. Chasing facial aging with more and more filler eventually stops helping and starts distorting, especially stacked over high cheekbones. Old filler often does not fully dissolve. It migrates.

So during the facelift, I can place medication to dissolve some of that old filler, which leaves us working with your own tissues instead of building on top of someone else’s product. I would rather reposition your own anatomy than keep adding to it.

The Add-Ons That Travel With a Facelift

Concern What I Often Add
High forehead, hairline sits high Hairline-lowering incision to move the scalp forward, hair transplant later
Hollow folds, tired upper-eye shadow A little fat grafting, often sparing you an upper eyelid surgery
Old filler over the cheeks Medication to dissolve it during surgery
Slow bruising and swelling ElixirMD LED therapy starting day seven

On the forehead, the rule of thirds says it should measure about the same as the length of your nose. If your hairline sits high, I can make an incision at the hairline and move the scalp forward to close that distance, with a tiny scar in front, and refine it later with a hair transplant. It can be done at the same sitting as the facelift.

For the eyes, I almost always add a little fat to the folds and sometimes the upper eyelid hollows. The fat is permanent and very natural. It is alive, so it shifts a touch with weight, but it erases the tired shadow so you look awake, and it often keeps you away from a separate upper eyelid surgery.

What Recovery Is Really Like

The good news about facial surgery is that it does not really hurt. The pain level is close to zero. What you deal with is swelling and bruising.

Plan on a couple of weeks before you are comfortable being seen, and about six weeks to be ready for a special event. Most people return to work after two weeks, sometimes with a little makeup. We also offer an LED therapy called ElixirMD starting seven days after surgery that roughly doubles the speed of recovery, and Morpheus8 microneedling can refine skin quality later.

Who I Think Is a Candidate

I am candid in the room about who this is for. The ponytail deep plane facelift is for the patient who has real structural change, jowls, a softening jawline, a lower face that drops with a smile, not for someone whose only complaint is fine surface lines that a good skincare plan and a laser would handle. It is ideal for a patient who wants to keep wearing their hair up and who refuses the visible incisions in front of the ears. Healthy patients who do not smoke heal the cleanest, and I will tell a smoker to stop well before I will operate.

The other thing I look for is the neck. So often the neck is the tell, and a beautiful cheek lift over an untreated neck looks unfinished. When I assess a face, I plan the cheek, the jawline, and the neck as one unit, because that is how they age and that is how they should be corrected.

Why I Chose This Approach

I completed my plastic surgery fellowship at the Mayo Clinic and I teach facial surgery as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. I trained for the deep plane and ponytail technique at the Ponytail Academy in Pittsburgh and Santa Monica. I chose this approach because it lasts and because it looks like you, not like surgery.

See the Patient-Facing Versions

For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com. For the treatment menu, see the version on swplasticsurgery.com.

Ready to Talk?

If you are pulling your cheeks up in the mirror, that is your sign to come in.

Call the office at (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.