August 12, 2026 | Facelift
A patient sat down across from me last week and slid a magazine over my desk. It was the July issue of Women’s Journal, their Face Issue, with my face on the cover. She tapped the headline and asked the question I suspect a lot of people asked that week.
“Scar-free. Is that real, or is that a magazine talking?”
Fair question. Every surgical incision heals as a scar. What the cover story describes, accurately, is a facelift whose scars are placed so far inside the hairline that nobody, including her hairdresser, will ever see them. Here is the medicine behind the headline.
What the Ponytail Lift Actually Is
The procedure on that cover is the ponytail lift, the popular name for a total endoscopic deep plane facelift. Two terms there deserve plain English.
Endoscopic means I operate through small openings using an endoscope, a thin surgical camera that lets me see under the skin without long incisions. Deep plane means the lifting happens in the anatomical layer beneath the skin and the SMAS, the sheet of muscle and connective tissue that gives the face its structure.
The openings sit within the hairline, behind where a headband would rest. That is the entire trick behind “scar-free.” The scars exist, but they live where hair grows, so a high ponytail shows nothing. No line in front of the ear. No distorted earlobe. No hairline shifted backward.
Lifting Structure Instead of Stretching Skin
For decades, facelifts pulled skin tight. Skin is elastic, so those results faded, and when they were overdone they produced the stretched look everyone fears.
In a deep plane approach, I reposition the brow, the midface, and the jawline as structural units, then let the skin drape naturally over the corrected foundation. Nothing is stretched, so nothing looks stretched. The result reads as rested, and because repositioned tissue heals in place, it is built to hold for years, not seasons.
That philosophy has a name in my practice: preservation-first. Do less damage to tissue, protect long-term health, and aim for a face that looks like you, not like surgery. I wrote more about the technique itself in Inside the Hairline, and the editorial version of this story lives on my Dr. WorldWide blog.
Who Is a Good Candidate
The honest answer, which the Women’s Journal piece included to its credit, is that this operation is not for everyone.
The endoscopic ponytail lift fits patients who want the midface lifted and the brows shaped discreetly, usually in their forties and fifties, with early to moderate aging changes. Good skin quality helps, because the skin needs to redrape on its own.
For significant loose skin and established jowling, a traditional open deep plane facelift is often the stronger option, because it lets me remove excess skin directly. I perform both, so my recommendation in a consultation is based on your anatomy, not on the one technique I happen to own.
| Endoscopic ponytail lift | Open deep plane facelift | |
|---|---|---|
| Incisions | Hidden inside the hairline | Around the ear, closed meticulously |
| Best for | Brow, midface, early jawline changes | Established jowls, significant loose skin |
| Skin removal | None; skin redrapes | Yes, tailored directly |
| Longevity | Years; structure is repositioned | Years; structure is repositioned |
| Visible scarring | None in normal styling | Fine lines, well hidden in folds |
Recovery for the two approaches is similar: most patients are presentable in about two weeks and back to exercise in four to six, with individual variation.
The Training Behind the Technique
The ponytail lift was developed by Dr. Chia Chi Kao. I trained with him directly, first in his intermediate course in Pittsburgh, then in the advanced Ponytail Academy, an invitation-only program at his Santa Monica operating suite. Cadaver dissection of the midface, live endoscopic demonstrations, and hard conversations about patient selection.
That training sits on top of a Mayo Clinic plastic surgery fellowship, board certification by the American Board of Plastic Surgery and the American Board of Surgery, and a teaching appointment as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. I teach residents the anatomy I operate on. That is the standard a facelift deserves.
The Questions Patients Ask After Reading It
The magazine has been in my waiting room for two weeks now, so I can tell you exactly what patients ask after reading it.
Does insurance cover it? No. This is cosmetic surgery, planned and paid for privately, and my coordinators walk every patient through exact pricing at the consultation, away from the exam room.
Will I look like a different person? The opposite. The entire point of repositioning structure instead of stretching skin is that you look like yourself, rested, with the proportions you had a decade ago. If your best friend can tell you had surgery, I did not do my job.
How long does it last? Years. Repositioned deep tissue heals where I place it. Aging continues, gravity continues, but you never lose the head start, and patients rarely need or want a second operation within the first decade.
Am I too young, or too old? Age matters less than anatomy. I have operated on patients in their late thirties with strong genetic sagging and turned away patients in their fifties whose faces only needed skin care and time.
One More Thing the Cover Got Right
The story notes that more than eighty percent of my patients now travel to El Paso from across the country for surgery at my AAAASF-accredited practice. A decade ago, patients from this region traveled the other way, assuming the big coastal cities were the only place for this level of facial surgery.
That reversal is the part of the cover I am proudest of. You should not have to leave West Texas, or the border, to get a facelift that no one can point to. And if you are flying in, my team has the travel logistics down to a routine: consultation, surgery, and follow-up planned around your trip, in English or Spanish.
Ready to Talk?
If the cover story made you curious about your own options, bring me your questions. Call (915) 590-7900, text the consult line at 1-866-814-0038, or book a consultation. Find me as @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful
Companion reads: the surgeon’s editorial on drworldwide.com and the practice story on swplasticsurgery.com.
