I arrived back late Sunday night in El Paso. The Aesthetic Society’s annual conference finished up in Boston that afternoon and I jumped on a flight. By eight a.m. Monday morning, I was at the long table in the front office at Southwest Plastic Surgery with our coordinators and the team from Southwest MedSpa, talking about what was about to change this week, this month and this quarter in our practice.
What I want to cover here is the same thing I covered with my team Monday morning. Three things from Boston that are going to change what you see in our clinic and what we say.
Not “trends.” I am not into trends. I am talking about three concrete updates that our practice is putting into place now on real consults and operating days, and one quiet update to the patient care experience.
Update One: The Facelift Conversation Has Shifted
For years, the work a facelift consult involved was talking to a patient who had been told about a SMAS facelift by a friend. So I would walk her through why a different operation, the deep plane facelift, would look different and last longer. The deep plane goes underneath the SMAS, releases the four retaining ligaments of the face (zygomatic, masseteric, mandibular and platysma) and then lifts the composite of skin, fat, muscle and SMAS as one unit instead of pulling each layer one at a time. That was the conversation.
That conversation is over.
Boston this year had “the deep plane face” as the major highlight of the face portion of the program. Full rooms. The questions coming up were asked by surgeons who already do the operation and were trying to get better at it. The deep plane facelift is now the operation the community agrees best answers the needs of the right patient. The literature supports retention for years, with data published at ten, twelve and fifteen years out, holding.
The deep plane is now the default conversation starter for our facelifts at Southwest Plastic Surgery. We can walk you through alternatives, including a more limited neck lift, the Ponytail Lift (next section) or non-surgical alternatives if you are not a candidate for surgery yet, but we talk about the deep plane as the first option now, based on the data on its long-term durability and on how it looks at year three.
On a note that goes with facelift surgery: there was a lot more neck content this year and it was more advanced, concise and targeted than I have seen in years. The thing about a neck holding up at a year after a facelift has been proven to be less about what we do in the face itself (skin redraping) and more about the underlying neck contour, specifically what we do below the platysma muscle within the deep neck compartment. That is part of my deep plane facelift work, even on patients not requesting an isolated neck lift.
One floor-level debate from the deep neck portion is worth bringing into the open. The question of where to place the incision when a partial submandibular gland reduction is part of the plan. A vocal group of surgeons is choosing a longer scar low on the neck, near the natural crease, because it gives them easier access to the gland. I take the opposite position. I prefer a small incision hidden under the chin, in the natural shadow. The dissection is harder for me, the scar is better for you, and at Southwest Plastic Surgery that is the trade I will make every time. Two safety habits go with this work. I operate with the LigaSure, which seals small blood vessels with controlled energy as I work and keeps the field clean. I also keep a cell saver in the room as a backup, so if there is any meaningful blood loss your own red cells are collected, washed and returned to you, rather than relying on donor blood. It is an inexpensive safety net for an elective operation and I see no reason not to have it running.
Update Two: Clearer Rules for the Ponytail Lift
The endoscopic deep plane facelift is what you have probably seen on social media as the “Ponytail Lift.” It avoids the visible scar in front of the ear, hides every incision within the hairline and delivers the same deep-tissue facelift benefits as the open version. I trained for this operation at the Ponytail Academy, intermediate course in Pittsburgh and advanced course in Santa Monica. I attend meetings like the one in Boston annually to make sure I have the clearest understanding of indications and contraindications. Boston was the most productive meeting on this subject I have attended in three years.
Here is the concise description of who fits the operation.
Right candidate for the Ponytail Lift: a patient in her forties or fifties with moderate laxity in the midface and brow, good skin elasticity, an absolute refusal of any visible scar in front of the ear, and ideally thick hair that would easily hide the small hairline scars. She generally does not have pronounced laxity in the jowls.
Wrong candidate for the Ponytail Lift: a patient with thicker skin laxity, whose predominant sign of aging is located in the lower portion of the face (the jowls), and whose anatomy requires the skin itself to be redraped along with the deeper tissues. She will be better served by a full deep plane facelift performed with traditional incisions tucked in front of and behind the ear, allowing the tailoring and redraping of the skin along with the deeper tissues.
On midface fixation specifically, I want to be clear about how I have settled on my technique. For the midface I no longer rely on sutures alone to hold the lift. I use a small, well-designed surgical implant placed deep beneath the soft tissue (the Endotine Ribbon), which anchors the midface lift more durably than suture alone. In my hands, that combination delivers a stronger and longer-lasting midface lift than what I was getting with suture-only fixation, and Boston did not show me a long-term photo set that gave me a reason to change.
There is also a practical evolution in how I combine these techniques. Increasingly, when an open deep plane is the right operation, I run what I call a hybrid: the endoscopic Ponytail Lift approach (with the Endotine Ribbon midface fixation) takes care of the brows, forehead and midface, while the open deep plane technique handles the lower face and the deep neck. On the right patient, the hybrid gives the lift quality of an open deep plane in the lower face with the scar discipline of the Ponytail Lift across the upper two-thirds.
At Southwest Plastic Surgery, our consults focus on assessing your suitability for the Ponytail Lift, the open deep plane facelift, or the hybrid I just described. It is not one technique versus another. It all hinges on the desired and expected result at twelve months after surgery.
Update Three: AI on the Patient Experience, Not on the Operating Room
The third major theme of Boston was artificial intelligence, which should be approached carefully since it is the hottest, and perhaps the most overrated, subject in plastic surgery currently.
I went into the AI portion of the meeting with a stake in the conversation. I was one of the presenters in the practice-management AI track and spoke specifically on AI for reputation management in plastic surgery. That gives me a closer view of what is real and what is being oversold in this space, which is what I want to bring back to you and to our team.
The simple truth about AI at our practice, or honestly anywhere clinically applicable at the moment, is that it is not designing your facelift. The clinical AI demos shown at the meeting were surprisingly weak. I found zero reliable, ready-to-use, operating room-grade AI tool that would do this. The research is ongoing. The clinical applications are not there. So I am not going to push that angle.
What AI does work well on, and where we are already moving at Southwest Plastic Surgery, is the patient care experience. I want to be specific about what is already running. An AI chatbot is live on our practice homepage, available around the clock to answer your common questions, schedule consultations, and route the unusual concerns directly to the right person on our team. An AI scribe runs during consultations so that my eyes stay on you, not on a screen, and so that your visit summary is largely drafted by the time you walk out of the room. When you reach out through text message on a Sunday afternoon from California, or send a message at midnight with questions about your recovery, the wait until Monday morning is no longer necessary.
The same goes for our MedSpa side as much as the surgical side. Patients on their third session of Morpheus8 treatment, patients who have banked stem cells for YOU by Acorn, patients several visits into a hair restoration program, they all lead complex, multi-visit journeys that require ongoing communication between their appointments. The use of appropriate AI tools removes these bumps from the road while retaining the human touch and the warmth that makes coming to Southwest Plastic Surgery what it is.
What has not changed is who you see in the operating room during surgery. You will be accompanied by a board-certified surgeon, a board-certified anesthesia team, a recovery nurse and our entire team at Southwest Plastic Surgery that knows you by name. The AI sits as a front-end technology for the patient journey, not as an embedded tool that interrupts or replaces it.
Why Choose Southwest Plastic Surgery
As El Paso’s pioneering plastic surgery practice, Southwest Plastic Surgery was founded by me. I am double board-certified by both the American Board of Plastic Surgery and the American Board of Surgery, and I am a Fellow of the American College of Surgeons. I completed my plastic surgery fellowship at Mayo Clinic. I serve as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, and as an Affiliate Professor at the University of Texas at El Paso. Castle Connolly has recognized me as a Top Doctor for thirteen consecutive years, Texas Super Doctors Hall of Fame honored me in 2025, and Aesthetic Everything named me Top Plastic Surgeon for 2026. Southwest Plastic Surgery brings together surgical procedures and MedSpa services under one roof, planning your facial, body and skin care together rather than as separate, isolated concerns.
Ready to Talk?
If you are considering a facelift, the Ponytail Lift, a deep neck lift or one of Southwest Plastic Surgery’s MedSpa programs, your journey starts with a consultation. I will personally review the version of the operation best suited for your facial anatomy, outline the recovery you should prepare for, and clarify how and where AI will (and will not) fit into your experience with our practice.
To read more on this Boston meeting from a surgeon-to-surgeon perspective, see my piece on drworldwide.com: Three Days in Boston: A Surgeon’s Read on The Aesthetic Meeting 2026. For a patient-focused version on my personal practice website, see What I Brought Home From Boston on agulloplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book your appointment online at agulloplasticsurgery.com/appointments. Follow @RealDrWorldWide on Instagram, TikTok and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful
