I can spot an old-school facelift from across a restaurant. Pulled temples. Waxy cheek. Earlobe pointing up instead of down. A smile that does not quite reach the eyes. These are the tells I have been trained to notice for twenty years, and once you know them, you cannot unsee them.

The whole point of the operation I do now is that nobody should be able to tell.

I rebuilt my facelift practice at Southwest Plastic Surgery around that single idea. Two operations carry it. The Deep Plane Facelift, and its endoscopic sibling, the Ponytail Lift.

What changed in a decade

The standard facelift in 2010 was, essentially, a skin operation. A surgeon lifted the skin off the face, tightened a thin fascial layer called the SMAS, trimmed the excess, and closed up. Results looked good in the short run. They also faded. Skin has memory. Tension leaks out of it over years. And a patient who came back for a second facelift on a stretched-out first one often walked out looking worse, not better.

The Deep Plane Facelift rewrote the premise. Nothing gets pulled on the skin. The dissection happens beneath the SMAS, releasing the four retaining ligaments that anchor the face to the skull (zygomatic, masseteric, mandibular, and platysma) so the whole composite flap lifts as one block. Skin, SMAS, fat, muscle. Everything moves together. Everything moves without tension. And because it all moves without tension, it does not stretch back out two years later.

That one shift drives everything good about the modern facelift. The peer-reviewed data on deep plane results now runs ten, twelve, and fifteen years.

The quick comparison:

The Ponytail Lift is the same surgery through a different door

The Ponytail Lift is the endoscopic version. Same plane. Same ligament releases. Same composite flap. Different access entirely.

The traditional deep plane incision sits in front of the ear, wraps around the earlobe, and ducks into the hairline behind. Healed well, it fades to a line most people will not register. But a certain kind of patient does not want to gamble on “most people.” For her, I do the same deep plane work through small openings tucked inside the hairline, with an endoscope for visualization. No pre-auricular incision. No tug on the earlobe. Nothing to hide when the hair goes up.

This is a harder operation. The access is narrow. The view is indirect. The margin for error is thinner than it looks. A lot of surgeons advertise it. Far fewer have trained for it.

Who fits which operation

The Ponytail Lift fits a specific anatomy. Forties or early fifties. Early-to-moderate midface descent. A jowl that has started to form but has not taken over. Skin that still rebounds when you pinch it. And a firm line against any visible pre-auricular scar. Thick hair is a bonus, because it hides the hairline incisions completely.

The open Deep Plane is a broader tool. It fits faces in the mid-sixties and beyond, skin with real laxity, heavier volumes in the jowl and the neck. That anatomy needs the skin redraped and excised, not just the deeper tissues repositioned. Try to do all of that through the hairline and the Ponytail Lift under-delivers.

Part of a facelift consultation at Southwest Plastic Surgery is telling you, plainly, which operation suits your face. I perform both. I do not favor one over the other. I favor the right one for you.

Why training matters

I trained at the Mayo Clinic plastic surgery fellowship, and Mayo taught me that an operation worth doing is worth learning from the surgeons who invented it. That is not how you pick up a technique from a YouTube cadaver video on a Saturday.

I took the Ponytail Academy Intermediate Course in Pittsburgh first. Days of cadaver dissection, real-time correction from the faculty who developed the approach. Then I returned for the Advanced Course in Santa Monica. Same lab format, deeper into the technique.

When a surgeon advertises an operation they have not trained in, the person who finds out is the patient on the table.

One more word on fillers

I use fillers every day. They work. They are also a tax. You pay it every six to twelve months, and when you stop paying, the face resets.

A Deep Plane Facelift is not a tax. It is an investment. You pay once, and it appreciates over the decade that follows. Patients who have chased volume loss with filler for years often walk into Southwest Plastic Surgery with a face that looks fuller, not younger. Puffed cheeks. No jawline. Odd lip volume. That is the filler tax, paid too many times.

If filler is right, I will say so. If surgery is right, I will do it right. The goal does not change. A face you still recognize in the mirror. #StayBeautiful.

Why Southwest Plastic Surgery for a facelift in El Paso

Southwest Plastic Surgery is the practice I founded. I am double board-certified (American Board of Plastic Surgery, American Board of Surgery), a Fellow of the American College of Surgeons, Mayo Clinic plastic surgery fellowship-trained, and Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, where I teach the same techniques I use every day. I am an Affiliate Professor at UTEP. Castle Connolly has named me a Top Doctor for thirteen consecutive years. I have completed both Ponytail Academy courses, intermediate in Pittsburgh and advanced in Santa Monica. About sixty percent of my current patients travel in from outside the region, from Canada, Seattle, California, New York, Florida, across Texas, and Mexico, to have their surgery done here.

Ready to talk?

A facelift consultation at Southwest Plastic Surgery starts with your anatomy and your goals, not with a menu of procedures. I look at your face, I listen to what you actually want, and I tell you what a Deep Plane or Ponytail Lift would do for you. If surgery is not the answer yet, I will say so out loud.

For more depth on the philosophy, read my piece on drworldwide.com: The Facelift You Can’t See. For the candidacy and hairline-scar angle, see the companion post on agulloplasticsurgery.com: Inside the Hairline.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow along at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.