June 25, 2026 | Uncategorized
A patient sat down across from me and did the thing nearly everyone does first. She lifted the skin at her cheeks in the mirror on the wall, watched her jawline tighten, and said she just wanted that back. Underneath were jowls, a heavy neck, a lower face that dropped when she smiled, and years of filler she was tired of.
Here are the answers I gave her, pulled from how I explain a facelift in the room and anonymized.
“Will I Have Obvious Scars?”
No. For the right candidate, the procedure I use is a facelift without visible scars. We hide the incisions 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 a little 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 whole 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 are not going to look pulled or windswept.
“What About My Neck?”
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 create a tight, youthful jawline. Removing the deeper fat matters, because even if your weight changes later, the result will not blur as much.
And if you already have a strong chin, you usually do not need a chin implant. The neck lift alone makes the chin look more pronounced and sharper, because right now it is getting a little lost.
“I Have Had Fillers. What Happens to Those?”
This is where I have a strong opinion. Chasing facial aging with more and more filler eventually stops helping and starts distorting, especially over high cheekbones. Old filler often does not fully dissolve, it just migrates. So during the facelift I can place medication to dissolve some of it, so we are left working with your natural tissues instead of stacking on top of them. I would rather reposition your own anatomy.
“Can You Fix My High Forehead at the Same Time?”
Yes. The forehead should measure about the same as the length of your nose, which is the rule of thirds. If your hairline sits high, I can make an incision at the hairline and move your scalp forward to close that distance, which gives the most density, with a tiny scar in front. Months later we can add a hair transplant to refine it, and the forehead reduction can be done at the same time as the facelift.
“What About the Hollows Around My Eyes?”
I almost always add a little fat when I do a facelift, on the folds and sometimes the upper eyelid hollows. Doing this often keeps you away from needing an upper eyelid surgery. The fat is permanent and very natural. It is alive, so it shifts a little with weight, but it is not much volume, and it erases that tired shadow so you look more awake.
“How Long Is Recovery?”
The good news with facial surgery is that it does not really hurt. The pain level is almost zero. It is mostly swelling and bruising, so 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 go back 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 the skin later.
“Am I a Candidate?”
This is one of the first things I sort out in the room. The ponytail deep plane facelift is for the patient with real structural change, jowls, a softening jawline, and a lower face that drops with a smile, rather than someone whose only concern is fine surface lines that skincare and a laser would handle better. It is an excellent fit if you want to keep wearing your hair up and you do not want incisions in front of your ears. Healthy patients who do not smoke heal the cleanest, and if you smoke I will ask you to stop well before surgery.
I also pay close attention to the neck during your consultation, because it is so often the part that gives age away. I plan the cheek, the jawline, and the neck as one unit, since that is how they age and how they should be corrected.
“What Can I Combine With It?”
A facelift pairs naturally with several things in one recovery. Fat grafting to the folds and eye hollows travels with almost every facelift I do. A forehead reduction or hairline advancement can be done at the same sitting if your hairline sits high. Eyelid surgery, when the upper or lower lids need it, fits the same anesthetic. Combining these means one healing window instead of several, and I will map out what makes sense for your face during the consultation rather than padding the plan.
Why I Do This Procedure
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 Other Versions
For the surgeon’s editorial take, see the companion essay on drworldwide.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. Bring photos of yourself from a few years ago if you have them.
Call the office at (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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