Most facial consultations at Southwest Plastic Surgery in El Paso open the same way. A patient lifts the skin at the cheeks in the mirror, watches the jawline tighten, and says some version of, “I just want this back.” Beneath that are usually jowls, a heavy neck, a lower face that drops with a smile, and a history of filler the patient has grown tired of.

Dr. Frank Agullo addresses all of it with the ponytail deep plane facelift. Here is how he explains it.

A Facelift Without Visible Scars

For the right candidate, this is a facelift without visible scars. The incisions are hidden in the hairline, which is the reason for the name, and a good portion of the lift is done endoscopically. It raises the brow slightly and lifts the cheek, so a smile softens the lower face instead of dropping it. Patients can still wear their hair up.

More Than Pulling Skin Tight

The ponytail facelift is a deep plane facelift, which means Dr. Agullo repositions the deeper tissues rather than pulling on the skin. That is what keeps the result natural and lasting, without the pulled or windswept look that worries patients.

What the Neck Needs

For the neck, Dr. Agullo places a small incision under the chin and behind the ear. Through it he removes a little of the gland and the deeper fat to build a tight, youthful jawline. Removing the deeper fat helps the result hold up even if weight changes later. A patient with an already strong chin usually does not need a chin implant, because the neck lift alone makes the chin look more pronounced.

How Old Filler Is Handled

Dr. Agullo has a clear position on filler. Chasing facial aging with more and more filler eventually stops helping and starts distorting, especially over high cheekbones, and old filler often migrates rather than fully dissolving. During the facelift he can place medication to dissolve some of that old filler, leaving the patient’s own tissues to be repositioned rather than building on top of product.

What Often Travels With the Facelift

For a high forehead, the rule of thirds says it should measure about the same as the length of the nose. If the hairline sits high, an incision at the hairline can move the scalp forward to close the distance, with a small scar in front, refined later with a hair transplant, all at the same sitting as the facelift. For tired eyes, a little fat grafting to the folds and upper eyelid hollows is permanent and natural and often spares a separate eyelid surgery.

What Recovery Looks Like

Facial surgery does not really hurt. The pain level is close to zero, and the main events are swelling and bruising. Patients should plan on a couple of weeks before they are comfortable being seen and about six weeks to be ready for a special event. Most return to work after two weeks, sometimes with a little makeup. The practice offers ElixirMD LED therapy starting seven days after surgery, which roughly doubles the speed of recovery, and Morpheus8 microneedling at the Med Spa can refine skin quality later.

Who Is a Candidate

The ponytail deep plane facelift suits a patient who is noticing jowls, a softening jawline, and a lower face that drops with expression, rather than someone whose only concern is fine surface lines. It is a strong fit for patients who want to keep wearing their hair up and who do not want the telltale incisions in front of the ears. Candidates in good general health, who do not smoke or are willing to stop well before surgery, tend to heal cleanest. During the consultation, Dr. Agullo assesses skin quality, the position of the deeper tissues, and the neck together, since the neck is so often the part that gives age away.

Surgery, Skin, and the Med Spa

A facelift repositions structure, but skin quality is a separate question, and the two work best together. After the deeper healing is well along, treatments at the Med Spa such as Morpheus8 microneedling and laser resurfacing can refine tone and texture so the skin matches the rejuvenated foundation underneath. Patients planning a facelift often build a longer skin plan with the team, since investing in the envelope protects the result of the surgery.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He completed a plastic surgery fellowship at the Mayo Clinic and is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and trained for the deep plane and ponytail technique at the Ponytail Academy in Pittsburgh and Santa Monica. He chose this approach because it lasts and because it looks like the patient, not like surgery.

What Recovery Asks of You

Patients are often surprised that the discomfort of a facelift is modest, but the social downtime is real and worth planning for. The first week is the heaviest for swelling and bruising, and most patients prefer to stay close to home. By two weeks, many return to work, sometimes with a little makeup, and by about six weeks they are ready for a special event. Dr. Agullo and the team set expectations clearly at the consultation, schedule ElixirMD sessions to begin around day seven, and build in skin treatments later so the timeline fits the patient’s life rather than the other way around. Planning the calendar before surgery, rather than after, is the single thing that makes recovery feel smooth.

See the Other Versions

For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing question-and-answer version, see the companion post on agulloplasticsurgery.com.

Ready to Talk?

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

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

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