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

Concern	What Dr. Agullo Often Adds
High forehead, high hairline	Hairline-lowering incision, hair transplant later
Hollow folds, tired eye shadow	A little fat grafting, often sparing an upper eyelid surgery
Old cheek filler	Medication to dissolve it during surgery
Swelling and bruising	ElixirMD LED therapy from day seven

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.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Thursday, June 25th, 2026 at 8:00 am and is filed under Facial Procedures, Plastic Surgery. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

When a patient sits down at the long table in the front office at Southwest Plastic Surgery, the consultation almost always starts with a feature. The eyes. The brows. The cheekbones. Dr. Frank Agullo listens, asks a few questions, and then almost always asks if he can spend a careful moment on the lower third of the face. That is where the story usually lives.

A US national outlet asked Dr. Agullo last week for a technical read on a public figure’s “transformation,” and his answer matched a colleague’s read: the lower half of the face was the part that had changed. The longer version of that conversation belongs here, in the context of the lower-face program at Southwest Plastic Surgery, because the program at the practice is built around the same insight. The lower third tells the real story, and a serious lower-face plan layers consultation, MedSpa biostimulators, microneedling, laser, and the deep plane facelift on a single continuum.

Why the Lower Face Tells the Real Story

The face divides into three thirds. The upper third runs from the hairline to the brows. The middle third runs from the brows to the base of the nose. The lower third runs from the base of the nose to the chin, and it carries the jawline, the jowl, the marionette region, the corner of the mouth, the chin, the submental fat pad, the platysma, and the cervicomental angle. The cheek pad, anatomically a midface structure, slides into the upper lower third as the supporting ligaments lengthen and is therefore best read together with what is happening below it.

The lower third is the part of the face that integrates almost every change that happens above it. Volume loss in the midface drops into the marionette region. Skin laxity above the jaw drops into the jowl. Loss of definition along the mandibular border erases the line that the eye reads as “young.” A small chin makes the whole lower face look heavier than it is.

The patient who books a consultation for her cheekbones often leaves with a plan that addresses her jawline. The patient who books for her lip lines often leaves with a plan that addresses her perioral region as a whole. The cheekbone and the lip line are the symptoms. The lower third is the engine.

The Five Forces That Change the Lower Third

The consultation at Southwest Plastic Surgery sorts five forces in the same five-minute read.

Bone resorption. The mandible and the maxilla both lose bone with age. The jaw narrows. The chin recedes slightly. The soft tissue above the bone has more space to drift downward.

Ligament lengthening. The retaining ligaments that anchor the cheek pad to the zygoma and the jowl behind the mandibular border slowly lengthen. Volume that used to sit high slides into the lower third.

Volume loss in the deep fat compartments. The midface flattens, the nasolabial fold deepens, and the corner of the mouth turns down because the structures behind it have lost volume.

Skin laxity. Collagen and elastin decline, the dermis thins, and the skin loses its grip on the underlying structures.

Weight change and prior treatment. Significant weight loss, especially the rapid loss now common with GLP-1 medications, can age a lower third by a decade in eighteen months. Years of filler placed in the wrong plane can make a lower face look heavier than it would have aged on its own.

The combination of those five forces is what shapes the plan. The plan is never one thing. It is a sequence built into a single program.

The Lower-Face Continuum at Southwest Plastic Surgery

The continuum runs from non-surgical to surgical and back to non-surgical maintenance. The program at the practice covers all of it.

Consultation and assessment. Every plan starts with a careful in-person assessment by Dr. Agullo. The five-minute read of the lower third is what produces the plan that matches the face in front of him.

Biostimulators at the Med Spa. For patients who are not surgical candidates yet, or who would benefit from a slow rebuild of collagen and structural support before a surgical step, the MedSpa offers a thoughtful biostimulator program. The point is not to fill. The point is to stimulate. Placed in the correct plane, by an experienced injector, biostimulators rebuild structure that the face has lost without making the lower face look heavier or fuller than it should.

Microneedling for skin quality. The lower third’s skin envelope responds well to disciplined microneedling, with or without growth-factor or autologous secretome adjuncts. The point is not to lift. The point is to remodel the dermis so that whatever surgical step comes next, or whatever non-surgical lifting follows, sits on a higher-quality envelope.

Laser treatments for tone and texture. The perioral region in particular responds well to fractional resurfacing, and patients who have lived with sun damage along the lower face benefit from a layered laser program that runs alongside the rest of the plan.

The deep plane facelift for patients who need real surgical lifting. For the patient whose cheek pad has dropped, whose jowl has migrated forward of the mandibular border, and whose marionette region has lost its definition, the right operation in 2026 is a deep plane facelift. Dr. Agullo trained the operation through the Ponytail Academy intermediate and advanced courses (Pittsburgh and Santa Monica) and has built the practice around it. The deep plane lifts the cheek pad back to the zygoma, repositions the jowl behind the mandibular border, and restores the line that the eye reads as “young.” It does not stretch the skin to do the work.

Recovery support through ElixirMD and post-surgical massage. Recovery is a layered program built into the practice, with IV vitamin support, peptide protocols on indication, and post-surgical lymphatic drainage from an experienced therapist.

The lower-face program is not a menu. It is a sequence the practice walks the patient through, in the right order, for the right face, at the right time.

What a Lower-Face Consultation at Southwest Plastic Surgery Looks Like

Step	What Happens	Where
Assessment	Five-minute read of the lower third by Dr. Agullo	Consultation room
Photography	High-resolution standardized photographs, including three-quarter and profile	In-office photo studio
Imaging where useful	Chrysalix 3D imaging for selected cases	Consultation room
Plan written	Sequence of surgical and non-surgical steps in the right order	Consultation room
MedSpa step if appropriate	Biostimulator, microneedling, or laser scheduled	Med Spa
Surgical step if appropriate	Deep plane facelift, lower face lift, or combined procedure scheduled	Surgery suite
Recovery support	ElixirMD, peptides, lymphatic drainage, follow-up cadence	Recovery program
Maintenance	Skin-quality plan, periodic biostimulator touch-ups, follow-up assessments	Med Spa and consultation

The columns are designed to work together. The plan is what holds them together.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. He is a Fellow of the American College of Surgeons. He completed a plastic surgery fellowship at the Mayo Clinic. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and an Affiliate Professor at the University of Texas at El Paso. He has been named a Castle Connolly Top Doctor for thirteen consecutive years. He sits on the Editorial Board of Aesthetic Plastic Surgery, the journal of the International Society of Aesthetic Plastic Surgery, and national outlets routinely call on him for facelift commentary, including recent coverage in both UK and US national outlets reading the lower face of a public figure.

Ready to Talk About Your Lower Face?

If a facial procedure is on your mind and you are not sure where the conversation should start, start with a lower-face consultation at Southwest Plastic Surgery. The five-minute read of your lower third is what produces a plan that matches your face. The plan is what produces a result that lasts.

For the surgeon’s editorial version of this conversation, see Dr. Agullo’s drworldwide.com essay, The Lower Third Tells the Story. For the clinical patient-facing version, see The Lower Third Tells the Story: How a Surgeon Reads a Jawline on agulloplasticsurgery.com.

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

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Wednesday, June 17th, 2026 at 9:00 am and is filed under Facelift, Plastic Surgery News. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

Southwest Plastic Surgery Founder Dr. Frank Agullo Publishes “Preservation, Not Minimalism” on Connectively

Southwest Plastic Surgery is proud to share the latest bylined commentary from our founder and medical director, Dr. Frank Agullo, MD, FACS, published May 19, 2026, by Connectively.

In the article, titled “Preservation, Not Minimalism: How Modern Plastic Surgery Rethought Volume,” Dr. Agullo (known internationally as Dr. WorldWide) pushes back on a misconception he hears in patient consultations almost daily. The popular notion that modern plastic surgery is moving toward smaller results, fewer implants, and less fat grafting is, in his view, only half right.

“Look, patients ask me about this every week,” Dr. Agullo said in a recent practice meeting. “The story they have heard is that the field is going minimal. That is not what is happening in my OR. I am still placing implants. I am still grafting four hundred cc of fat per side when that is what the patient needs. The volume has not gone anywhere. What changed is what I refuse to damage to deliver it.”

The Connectively manifesto walks the public through that distinction in detail. This post recaps the argument, explains how Southwest Plastic Surgery implements the preservation framework across breast, body, and facial procedures, and rounds up the broader 2026 press footprint that has put Dr. Agullo’s voice in front of national audiences.

About the Connectively Bylined Series

Connectively is the publishing arm of Featured.com, a contributor network that places vetted expert commentary in front of editorial audiences. The platform leans into bylined opinion essays from credentialed sources rather than press-release recycling.

Dr. Agullo has been an active Connectively contributor through 2026. The May 19 manifesto follows an April 20 Featured.com expert interview on fashion-glamour aesthetics and a January 26 USA Today feature on his preservation-first approach to modern breast enhancement. Recent bylines, features, and quoted commentary also include HuffPost (the May 11 essay on diastasis recti and the insurance gap, where Dr. Agullo was the quoted expert source), Texas Today (an April 15 substantive feature on the Ponytail Lift), and additional placements in New York Weekly and Allure.

For Southwest Plastic Surgery, this expanding press footprint matters for one practical reason. Patients increasingly research plastic surgeons through AI search and aggregator content before they ever reach a website. Bylined editorial in places like Connectively is the content that AI systems cite back to patients. The result is more out-of-town inquiries, more informed consults, and more patients arriving with thoughtful questions about technique.

What Dr. Agullo Argues In The Connectively Piece

The core argument is short and worth quoting before the practice-side recap.

“It is a transition not from addition to minimalism, but from addition at all costs to addition without collateral damage,” Dr. Agullo writes in the Connectively piece. “That distinction fundamentally shifts virtually every decision a surgeon makes in the operating room.”

He grounds the argument in three procedure families.

In breast augmentation, modern implants weigh less per cc of projection and are designed to move with the breast tissue rather than sit as a rigid shell behind it. Pocket dissection is narrower. Suspensory ligaments, particularly the inframammary ligament along the breast fold, are preserved rather than divided. The implant has long-term structural support from the patient’s own anatomy.

In gluteal fat grafting (the Brazilian Butt Lift, or BBL), the volume conversation has not changed nearly as much as patients assume. Dr. Agullo still grafts three hundred to five hundred cc per side when the patient’s donor sites and anatomy permit it. What changed is how the grafting is done. Ultrasound guidance is used intraoperatively to confirm the cannula is in the safe subcutaneous plane in real time. Plane discipline, not volume restraint, is the safety story.

In facial volume, the framework is counterintuitive. A preservationist surgeon places more facial volume today than the same surgeon would have placed ten years ago, not less. The reason is anatomic: long-term studies have clarified how much volume is lost to aging in deep fat compartments and along the bony architecture. Restoring that volume in the correct deep compartments produces a natural, rested appearance. Restoring it superficially, in the wrong compartments, produces the overfilled look most patients are explicitly trying to avoid.

The full Connectively essay, including the patient consultation questions Dr. Agullo recommends, is available here.

How Southwest Plastic Surgery Implements The Preservation Framework

Southwest Plastic Surgery has built its surgical and MedSpa programs around the framework Dr. Agullo outlines in Connectively. Three procedure families, three operational answers.

Breast Augmentation At Southwest Plastic Surgery

Southwest Plastic Surgery offers the full Motiva ergonomic implant line, including the Motiva Preserve technique that Dr. Agullo was one of the early adopters of in this region. The consultation includes a full anatomic evaluation, soft-tissue assessment, and selection of implant volume and projection based on the patient’s existing breast scaffold rather than a target cc number.

Recovery for a Motiva Preserve augmentation in Dr. Agullo’s hands is short. Many patients return to a desk job the next day and to the gym at two weeks. That is not marketing language. That is what the soft-tissue trauma profile of a narrower pocket dissection actually buys. Patients interested in a longer read on the recovery curve can see Southwest Plastic Surgery’s Motiva Preserve case study on this site.

Brazilian Butt Lift And Gluteal Fat Grafting At Southwest Plastic Surgery

Every Brazilian Butt Lift performed by Dr. Agullo is ultrasound-guided. The probe is on the patient during the case. Cannula position, fascia, and plane are confirmed visually in real time. Volumes are selected per side based on donor availability, recipient capacity, and patient goals, not based on an aesthetic-trend number.

“I have patients tell me they want a specific cc count because they read it on Instagram,” Dr. Agullo said. “That is not how I plan a case. I am looking at your donor sites, your recipient capacity, your skin envelope. The cc count comes out of the anatomic plan, not the other way around. And every milliliter goes through ultrasound.”

Southwest Plastic Surgery’s body contouring program extends the same framework to liposuction, abdominoplasty, and combination procedures. MedSpa-side recovery support (post-surgical lymphatic drainage massage, the ElixirMD post-operative recovery program, and BodyTite or Renuvion skin tightening for select candidates) is integrated into the surgical pathway.

Facelift And Facial Volume Restoration At Southwest Plastic Surgery

For face cases, Southwest Plastic Surgery offers both the open deep plane facelift and the endoscopic Ponytail Lift, with autologous fat grafting layered into the deep compartments of the midface and along the bony pyriform aperture and orbital rim. Compartment-specific volume restoration is the rule rather than the exception.

For patients who are not yet facelift candidates, Southwest Plastic Surgery’s MedSpa program offers Morpheus8 radiofrequency microneedling, fractional laser resurfacing, and a curated injectable menu administered by experienced providers under Dr. Agullo’s medical direction. The injectable program is intentionally conservative. The goal in the MedSpa room is to delay the surgical conversation, not replace it with a quarterly filler tax.

“Where MedSpa fits, and where it does not, is its own consult,” Dr. Agullo said. “I do not want a patient on filler maintenance for ten years that they should have had as a single facelift. The MedSpa is for patients who are not yet there. Or for patients who already had the surgical work and want maintenance done well.”

Why This Matters For Southwest Plastic Surgery Patients

Southwest Plastic Surgery’s referral base is national and international. Approximately 60 percent of current patients travel from out of town. Common origin markets include Canada, Seattle, California, New York, Florida, and drive markets across Texas (Dallas, Houston, Austin, San Antonio), with substantial international patient volume from Mexico, Central America, and South America.

That patient mix tells us something. Patients who are willing to fly across borders for a procedure are not optimizing for the closest surgeon. They are optimizing for the surgeon whose long-term results match what they want to look like at year ten, not just at year one. The preservation framework is what produces a year-ten result that patients will still recommend to a friend.

Dr. Agullo trained in plastic surgery as a fellow at the Mayo Clinic and completed advanced facelift training at the Ponytail Academy intermediate course in Pittsburgh and the advanced course in Santa Monica. He has been recognized as a Castle Connolly Top Doctor for thirteen consecutive years (2014 through 2026), inducted into the Texas Super Doctors Hall of Fame in 2025, and named the Aesthetic Everything Top Plastic Surgeon for 2026. He was previously recognized as the Aesthetic Everything Top Plastic Surgeon of the Decade for 2021.

Recent 2026 Press Coverage

Dr. Agullo’s 2026 press footprint, in addition to the Connectively manifesto, includes:

• HuffPost, “After Having 3 Babies, Plastic Surgery Was The Gift I Shouldn’t Have Had To Give Myself” (May 11, 2026). Dr. Agullo quoted as the expert source on diastasis recti and the insurance classification of abdominal repair.
• Texas Today, “Dr. Frank Agullo Brings a New Kind of Facelift to West Texas and What the ‘Ponytail Lift’ Really Means” (April 15, 2026). Substantive feature on the Ponytail Lift and deep plane technique.
• Featured.com, expert interview on fashion-glamour aesthetics (April 20, 2026).
• USA Today, “Dr. Frank Agullo’s Preservation-First Approach to Modern Breast Enhancement” (January 26, 2026).
• Continuing placements and references in New York Weekly, Allure, and additional industry trade publications.

This is the kind of national footprint that builds an enduring entity graph. Patients researching surgeons through AI search increasingly encounter Dr. Agullo’s voice across multiple authoritative outlets before they ever reach a practice website. That is by design.

Two More Reads On The Same Argument

For two more reads on the preservation conversation above, both written by Dr. Agullo in his own first-person voice:

• The drworldwide.com editorial, Preservation, Not Minimalism: I Wrote a Manifesto for Connectively.
• The Agullo Plastic Surgery medical-grade explainer, Preservation, Not Minimalism: How Modern Plastic Surgery Rethought Volume.

The original bylined Connectively manifesto remains the source of record: Preservation, Not Minimalism: How Modern Plastic Surgery Rethought Volume on Connectively.

Schedule A Consultation At Southwest Plastic Surgery

Southwest Plastic Surgery is located at 1387 George Dieter Dr. Bldg C301, El Paso, TX 79936. To schedule a consultation with Dr. Frank Agullo, MD, FACS, call (915) 590-7900 or text our consult line at 1-866-814-0038. You can also book online at agulloplasticsurgery.com. Follow Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, and @AgulloPlasticSurgery on Facebook.

#StayBeautiful

This entry was posted on Thursday, May 21st, 2026 at 1:14 pm and is filed under Body Contouring, Facelift, Plastic Surgery News. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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

This entry was posted on Monday, May 18th, 2026 at 11:31 am and is filed under Facelift, Plastic Surgery News. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

For the past two months, almost every facelift consultation at our El Paso office has begun the same way. The patient pulls out her phone, turns the screen toward Dr. Frank Agullo, and there are Kris Jenner’s two photos. The Vogue Arabia cover from August on the left, and a candid shot from the past few weeks on the right. The patient asks the same thing every time. What happened to her face.

It turns out to be a really useful question to chase down. Because the answer is the same answer that decides every facelift, ours included. Which technique. On whose face. At what age.

We grabbed Dr. Agullo between two surgeries last week and asked him to walk us through it the way he walks his consultation patients through it. The transcript below is lightly cleaned up.

Last summer’s reveal, and the year that followed

Last August, Kris Jenner appeared on the cover of Vogue Arabia and confirmed she had had a second facelift. The before-and-after circulated for weeks. One post on X asking who her surgeon was racked up tens of thousands of likes. Pundits called it the best celebrity facelift in a hundred years. She is seventy. Some of the photos made her look closer to forty.

Twelve months on, the headlines have flipped. Outlets are reporting that her facelift is “slipping” and that she has been asking her team about a revision. The same press cycle that crowned the result has started running comparisons against Denise Richards, who is fifty-five and looks, by any account, terrific a year out from her own facelift.

Asked what he sees in the recent photos, Dr. Agullo doesn’t reach for the gossip frame.

“None of this is unusual,” he told us. “What you’re watching happen to her face in real time, on the internet, is the textbook arc of a SMAS-based facelift on a seventy-year-old. It’s actually the best public-education moment we’ve had on facelift technique in years, and patients should pay attention.”

The question patients should be asking, and almost never do

Walk into any of our facelift consultations and you will hear the same first three questions. How much. How long is recovery. Will I look pulled. All fair, all important. None of them, in Dr. Agullo’s view, is the question that matters most.

“What I want patients to ask me,” he said, “is ‘what plane do you operate in.’ Because the plane decides almost everything else. How long the result lasts. How natural it looks at year five. Whether you’re still happy at year ten.”

There are essentially two planes a facelift can be done in.

A SMAS-based facelift works on a layer just under the skin called the SMAS (short for Superficial Musculoaponeurotic System). The surgeon either folds it on itself (plication) or removes a strip and stitches the cut edges back together (SMASectomy). Done well, it gives a clean three-month result. It has been the workhorse facelift for decades.

A deep plane facelift works underneath that layer. The surgeon dissects beneath the SMAS, releases the four retaining ligaments that anchor the face to the skull (zygomatic, masseteric, mandibular, platysma), and lifts the entire composite of skin, SMAS, fat, and muscle as one piece. Nothing gets pulled on. Nothing closes under tension. And because nothing is stretched out at closure, nothing relaxes back over the next two years. The published longevity data on deep plane results runs ten, twelve, sometimes fifteen years.

Kris Jenner’s surgeon performed a SMAS-based operation. Specifically, a lateral SMASectomy paired with a deep neck lift. Reputable surgeon. Well-executed work. But not the same operation as the deep plane Dr. Agullo performs.

The honeymoon phase

One of the reasons Kris Jenner’s reveal looked as breathtaking as it did, and one of the reasons her current photos look as different as they do, has nothing to do with her surgeon. It has to do with what Dr. Agullo calls the honeymoon phase of every facelift.

“Every facelift looks incredible at three months,” he said, almost cheerfully. “I mean every single one. It’s not a bug, it’s a feature, but patients need to know about it before surgery so they don’t fall in love with a result that isn’t actually their result yet.”

Three months postoperatively, the swelling has not finished going down. The skin is still tight from the closure. The deep tissues are healing in a position that is, frankly, just slightly tighter than where they will end up. Add a Vogue cover team, a top-tier glam squad, and the careful retouching that comes with a celebrity reveal, and you get the honeymoon face. Which, Dr. Agullo says, is real but not durable.

“The face you live with shows up at twelve to eighteen months. Swelling is gone, skin has relaxed, the tissues have settled where they’re going to settle. If your operation was right for your anatomy, the twelve-month face barely differs from the three-month face. Rested. Younger. Still you.”

When the operation isn’t right for the anatomy, twelve months is when the gap shows up. Volume that was masking a structural problem retreats. Skin that was tight relaxes. The midface, which is heavier than people think, starts dropping again. Which, in his read, is exactly what is on display in the recent Kris Jenner photos.

The midface, the malar bags, and what a SMAS technique can’t do

Asked to point at specifics, Dr. Agullo focused us on the midface.

“Look at her lower face and her neck. Both still meaningfully better than they were preop. Her jawline is cleaner. The platysmal bands are quiet. That part of the operation worked, and it’s actually pretty good work for the technique used.”

“Now look at her cheekbones. The malar bags, the rounded fullness sitting on top of the cheekbones, are right there. Two of them. Round, glossy, hard to unsee. They were briefly hidden by swelling and a tight closure at the reveal. Now the swelling is gone, the closure has relaxed, and the bags are back.”

He’s quick to say this isn’t a mystery and isn’t an error in any judgmental sense.

“It’s anatomy. A lateral SMAS technique pulls on the side of the face. It does great work in the lower third. But it does not reposition the malar fat pad, which is the cushion of fat that gives a cheekbone its shape and keeps the area from collapsing into a pouch. The deep plane does. We release the zygomatic ligament, free up the malar fat pad, and lift the whole construct as part of the composite flap. The endoscopic ponytail lift gets to the same anatomy through tiny incisions inside the hairline. If you skip the malar release on a face that needs it, you get exactly the trajectory we are watching.”

Seventy is not fifty

The Denise Richards comparison the press has run with isn’t really a fair fight, in Dr. Agullo’s view.

“Richards is fifty-five. Her surgeon took her into the deep plane. Fifteen years younger plus a more durable operation equals a result that, a year out, still looks like the result. Kris is seventy and had a SMAS-based operation. The math was hard before anyone scrubbed in.”

Why does age matter so much? Because tissue at seventy doesn’t behave like tissue at fifty. Less elastin. Thinner collagen. Less of the deep ligamentous architecture that holds a result in place. Run the same operation on a fifty-year-old and a seventy-year-old by the same surgeon on the same day, and the fifty-year-old will hold longer. Every plastic surgeon knows this. Most of them, out of professional politeness, don’t say it out loud.

Dr. Agullo will say it.

“At seventy, the technique you choose is doing most of the work. A SMAS-only operation might give you a year or two of looking like the day after the bandages came off, then a steady drift back to where you started. A deep plane, on the same patient, holds for ten to fifteen years. Those aren’t my numbers. Those are what the longitudinal studies show.”

Where MedSpa fits, and where it doesn’t

A question that comes up constantly in our consultations, especially with patients in their forties and fifties: can we just keep doing MedSpa treatments instead of surgery? Tox, fillers, lasers, Morpheus, BBL Forever Young.

Dr. Agullo’s answer is honest and a little nuanced.

“Look, our MedSpa side has real tools. Botox, hyaluronic acid fillers, BBL Forever Young, laser resurfacing, Morpheus8 radiofrequency microneedling. They earn their place. For a forty-year-old face they can buy you years before surgery is the answer. But none of them reposition deep tissue. They treat surface, volume, skin tone. So when somebody tries to use them as a permanent stand-in for a facelift on a face that has actually descended, what you get is a face that looks fuller. Not younger. Puffy cheeks, no jawline, an upper lip that nobody asked for. The filler tax, paid one too many times.”

Sequencing matters, in his telling.

“Forties and early fifties, lean MedSpa. Keep the skin in good shape. Be sparing and precise with injectables. When structure starts to slip, that is the moment to have a surgery conversation, and you want it before the slipping gets a head start. After the facelift, MedSpa picks back up. Skin care. Energy-based treatments to keep the result clean. The right cadence of small injectables, not a wall of them.”

That sequencing is something our surgical team and MedSpa team plan out together for facelift patients. It is part of why people fly into El Paso for the long arc of facial aging, not just for one operation.

What to ask any surgeon you consult, anywhere

We asked Dr. Agullo what questions he wishes patients would put to every surgeon they sit with, his own consults included.

He gave us four.

What plane do you operate in. SMAS, deep plane, composite. The honest answer matters more than the polished marketing language on a website.

How often do you do a deep plane facelift versus a SMAS-based operation. A surgeon who does the deep plane every week is a different surgeon from one who does it occasionally.

Where did you train for it. The deep plane and the endoscopic ponytail lift are unforgiving operations with a steep learning curve. A weekend cadaver course is not the same as a structured intermediate-and-advanced program.

Can I see your one-year, two-year, and five-year follow-up photos. Not three-month reveals. Three-month reveals are the honeymoon. The deliverable is the long view.

About Dr. Frank Agullo, MD, FACS

Dr. Frank Agullo is the medical director of Southwest Plastic Surgery in El Paso. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and a Mayo Clinic plastic surgery fellowship alum. He serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center and Affiliate Professor at the University of Texas at El Paso. He has been named a Castle Connolly Top Doctor for thirteen consecutive years. His advanced facelift training includes the Ponytail Academy intermediate course in Pittsburgh and the advanced course in Santa Monica. Roughly sixty percent of his facelift patients fly into El Paso from out of town.

For two more reads on the technique conversation above, both written by Dr. Agullo himself:

The editorial take is on his personal blog, drworldwide.com: After the Honeymoon: Kris Jenner, the SMAS Plication, and the Difference a Decade Makes.

The deeper clinical version is on his medical-grade blog, agulloplasticsurgery.com: After the Honeymoon: What Kris Jenner’s Facelift Actually Tells Us About SMAS, Deep Plane, and Time.

Schedule a facelift consultation at Southwest Plastic Surgery

Southwest Plastic Surgery is the El Paso practice of Frank Agullo, MD, FACS. To schedule a facelift consultation with Dr. Agullo or to talk to our MedSpa team about non-surgical options, call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

This entry was posted on Sunday, April 26th, 2026 at 4:06 pm and is filed under Facelift. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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:

Aspect	Traditional SMAS facelift	Deep Plane Facelift
What moves	Skin and a thin SMAS layer	Skin, SMAS, fat, and muscle together
Ligaments released	No	Yes (all four)
Skin tension	High	Low
Typical longevity	6 to 8 years	10 to 15 years
The “pulled” look	Possible over time	Rare; tissue is not stretched

 

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.

This entry was posted on Friday, April 24th, 2026 at 1:07 pm and is filed under Facelift. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.