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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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On the Cover of Women’s Journal: The Scar-Free Facelift

July 2026 Women's Journal cover featuring Dr. Frank Agullo and the scar-free facelift story.

The July issue of Women’s Journal is their Face Issue. The cover is me, arms crossed, in a #StayBeautiful shirt, next to a quote I have said in the operating room more times than I can count: the best results are the ones no one can point to.

Strange feeling, seeing your own sentence printed in serif type on a magazine rack. Also a useful one. Because the story they chose to tell is the story I have been trying to get patients to hear for two years.

Not a new machine. Not an injectable. A facelift you cannot see.

What the Cover Story Actually Covers

The piece, written by Adriana Sinclair, is about the ponytail lift, which is the nickname for what I perform as a total endoscopic deep plane facelift. The name comes from the incision placement. The openings sit so far back inside the hairline that a patient can pull her hair into a high ponytail or a bun without showing a single mark.

No cut in front of the ear. No scar tracing the earlobe. None of the tells that made facelifts recognizable for fifty years.

Instead of lifting skin, I thread an endoscope, a camera thinner than a pencil, beneath the surface and reposition the deeper layers of the face: the brow, the midface, the jawline. The skin comes along because the foundation under it moved, not because I pulled on it.

If you want the full technical walk-through, I wrote it up in April in The Facelift You Can’t See. The Women’s Journal piece is the patient-facing version of that argument.

Tension Is the Enemy

Here is the opinion that runs through everything I do to a face. Tightening skin and adding tension is what creates the pulled, wind-blown look every patient says they are terrified of. Skin is a cover, not a scaffold. Treat it like a scaffold and it tells on you.

The deep plane approach, open or endoscopic, moves the structural layer and lets the skin settle where it belongs. That is why the results read as rested instead of redone. It is also why they hold. Repositioned tissue stays put in a way stretched skin never will.

Surgeons argue about plenty inside this space. How deep, how wide, on whom. I have been in those rooms, including at The Aesthetic Meeting in Boston this spring. But the direction of the field is not really in dispute anymore. Deep plane won.

Training With the Man Who Invented It

The cover story spends time on something I insist on being transparent about: where I learned this.

The ponytail lift was created by Dr. Chia Chi Kao in Santa Monica. I took his intermediate course in Pittsburgh, then applied to the advanced Ponytail Academy, the invitation-only program held at his own operating suite in Santa Monica, and was accepted.

Those days are not lecture-hall days. Cadaver lab on the midface. Live demonstrations of endoscopic tissue elevation. Long arguments about candidacy, because knowing who not to operate on is most of the job.

I brought all of it back to my AAAASF-accredited practice in El Paso, where it joined what Mayo Clinic fellowship training and twenty years of facial surgery had already built. That stack matters. A technique is only as good as the hands and the judgment around it.

Who the Ponytail Lift Is For, and Who It Is Not

Surgeon to reader, candidly: this operation is not for everybody, and any surgeon who tells you otherwise is selling.

The endoscopic version shines for patients who want the brow, midface, and jawline lifted discreetly, typically earlier in the aging curve, before heavy jowling and significant loose skin take over. For a patient with a lot of skin excess, a traditional open deep plane facelift remains the stronger tool, and I offer both, which keeps me honest. When you only own a hammer, every consult looks like a nail.

Recovery between the two is similar. Both rely on repositioning deeper tissue rather than surface tension, which is exactly why both are built to last.

Why a Magazine Cover Matters to Patients in El Paso

There is a line in the piece I want to underline. El Paso used to be a city people left for this kind of surgery. That has reversed. More than eight in ten of my facelift patients now travel to El Paso from out of town, from across Texas and the rest of the country.

A national cover story is not why they come. They come for the work. But the cover is a signal that the work happening on the border is being noticed at the national level, and I am proud of that for my city, not just for my practice. I see patients in English and Spanish, often in the same hour, and that bilingual, binational room is part of what makes this practice what it is.

Thirteen straight years as Best Plastic Surgeon in El Paso. Castle Connolly Top Doctor thirteen consecutive years. Texas Super Doctors Hall of Fame. Those lines have lived on my CV for a while. Seeing the philosophy behind them on a newsstand is new.

The Quote I Will Stand Behind

“The best results are the ones no one can point to.”

That is the whole preservation-first argument in eleven words. If someone can tell you had a facelift, something went wrong: too much tension, too much volume, wrong plane, wrong patient. The win condition is a colleague saying you look well rested and meaning it.

Women’s Journal put that sentence on a cover. My job is to keep making it true one face at a time.

Ready to Talk?

If the cover story raised questions about your own face, let’s answer them properly, in person. Call Southwest Plastic Surgery at (915) 590-7900, text my consult line at 1-866-814-0038, or book through agulloplasticsurgery.com. Find me as @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

Companion reads: the patient-focused version on agulloplasticsurgery.com and the practice story on swplasticsurgery.com.

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Reading the Ambassador Face: A Candid Surgeon’s Breakdown of Layered Aesthetic Work

Black and white editorial comparison of two portraits side by side. Aesthetic analysis commentary by Dr. Frank Agullo, MD, FACS.

Reading a face from photos is one of the more interesting things I do, and influencers make it easier. So much of their work gets documented, especially when they are a brand ambassador for a med spa and probably get a lot of their care in exchange for the publicity. Let me read one of these faces candidly, the way I would talk it through with a colleague. This is an educational read, not a diagnosis. I have not treated her, and a photo is not a consultation.

What We Can Be Fairly Sure About

We know for a fact that she’s had neurotoxin to the upper face, which includes the forehead, crow’s feet, and glabella, in hopes of making her eyes more open. She’s had Sculptra to the temples to fill in her temporal recession, hollowness, or temporal wasting. She’s also had Renuva to the temples, also for volume. This is a fat graft. It’s a donor fat graft that is processed, and it encourages ingrowth of fat in that area.

She also had hyaluronic acid filler in the lips, which it seems she did not like and then had dissolved, even though I still see some hints of more volume than she previously had. There is some filler still there that wasn’t completely removed. She had a Botox lip flip. She’s also had PDGF for the under eyes, which is platelet-derived growth factor, which encourages collagen ingrowth. She’s had various lasers and radiofrequency, including Tixel, a thermal resurfacing device, Moxi, a resurfacing laser, and Agnes RF, which is very similar to Morpheus8.

The Weight Loss Is Doing a Lot of the Work

Judging by her earlier photos and her photos now, she’s definitely lost too much weight. I’m not sure if she’s been using a GLP-1, but this has caused her to lose a lot of the good fat in the face, which is the reason she had to fix the temporal wasting. You can notice in the current pictures that she has a lot less lower cheek fat and a lot more angulated jawline. This could all be from weight loss.

Now she has a lot more anterior malar volume, so she may have had some Sculptra and Renuva in the upper cheek area. I’m sure she maintains the skin also with broadband light, like BBL. And I think she’s probably had neurotoxin also to the masseters and lower face, which you can see from her slimmer jawline. She probably has good skin quality maintenance with medical-grade topicals, so tretinoin, vitamin C, but this has never been disclosed.

Why the “She Had X” Take Is Usually Wrong

When you read a face like this, the honest answer is never one thing. It stacks many small treatments over years, plus a real weight change, plus maybe one well-chosen surgical step. The internet wants “she had a facelift” or “she had buccal fat removal.” The truth is messier, and from a photograph you can only ever offer a careful, hedged read.

The One Thing That Hints at Surgery

Now, what calls my attention the most, and I’m not sure she’s had any surgical work, and she is rather young, under forty, is that her brow position is significantly different from her earlier days. It’s pulled up and laterally, which actually opens her eyes. Although a certain degree of this can be achieved with botulinum toxin, the degree she’s showing looks more pronounced. She may have had an endoscopic brow lift, the ponytail type, which can help with brow shaping, and it’s very effective and looks very natural.

Other than that, I don’t see any other signs of actual surgical work. You can see that her nose is unchanged. Although she may have had a rhinoplasty in her early life, you can see that it is off the midline and could actually use improvements. It does look unchanged from her previous photos to now.

The Credential Behind the Opinion

Double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, American College of Surgeons Fellow, Mayo Clinic plastic surgery fellowship, Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, Editorial Board Member at Aesthetic Plastic Surgery, and Castle Connolly Top Doctor for thirteen consecutive years. The technical read is fair game. The flat “she had X” diagnosis is not.

Ready to Talk?

If there is a look you are chasing, the real question is which of these layers applies to your face, and in what order.

For the patient-facing treatment-by-treatment guide, see the companion post on agulloplasticsurgery.com. For the treatment menu behind this kind of work, see the version on swplasticsurgery.com.

Call (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.

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

Dr. Frank Agullo, MD, FACS, double board-certified plastic surgeon, at The Aesthetic Meeting 2026 in Boston, in front of the The Aesthetic MEET Boston 2026 floral and gold branded backdrop, where he presented in the practice-management track on AI for reputation management.

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 Facelift You Can’t See: Deep Plane and the Ponytail Lift

Black and white editorial portrait of a woman after a Deep Plane Facelift by Frank Agullo, MD, FACS (Dr. WorldWide), El Paso, Texas.

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.