This story has been medically reviewed for accuracy by Chevy Chase, MD board-certified facial plastic surgeon Dr. Philip S. Schoenfeld on October 19, 2020.
In the nuanced world of facelifts, the encyclopedic array of buzzwords thrown around—both by surgeons and social media users—can not only overwhelm potential patients but convolute the entire procedure. Deep plane, SMAS, mini lift, full lift, lower facelift… the list goes on. And on. Though one of the latest terms to resurge in popularity is the so-called Ponytail Facelift.
The meaning behind its breezy name is apparently two-fold: First, the lift’s effects are meant to mimic that of fastening one’s hair into a tight, high ponytail, pulling the skin of the scalp and, subsequently, the forehead, cheeks, and brows upward in order to create a more elevated and youthful appearance. Second, the procedure “is designed to give the effect of a facelift without the traditional scars of a facelift,” explains board-certified San Francisco plastic surgeon Dr. Carolyn Chang. And so, because scarring (which would traditionally be in front of the ears) is minimal, the patient is theoretically able to wear their hair in a high ponytail without fear of exposing obvious scars.
After reading that, you’re probably thinking, But isn’t the goal of any quality facelift a more lifted appearance with no visible scarring? You’re not wrong: The Ponytail Facelift is hardly a reinvention of the wheel, in terms of technique or outcomes. Yet Google is flooded with queries about the procedure. We asked surgeons for clarification on what, exactly, the ponytail lift refers to, the specific maneuvers it may or may not entail, and what they want everyone to know before diving down a rabbit hole of trademarked plastic surgeries.
1. Ponytail Facelift is a marketing term, not a medical one.
Unlike the deep plane or the SMAS—two tried-and-true approaches—the Ponytail Facelift procedure is not a textbook technique that plastic surgeons learn about in residency. Nor is it a new or in any way revolutionary facelift technique. Surgeons have been using “ponytail” as a descriptor for their supposedly specialized (read: less invasive) facelifts for decades. One particular surgeon currently owns the trademark for the name, but that hasn’t stopped countless others from adopting it for use on their websites and social accounts.
“The procedure itself is not a traditional standard procedure, such as a breast augmentation or liposuction, that all plastic surgeons are familiar with,” Dr. Chang explains. “It’s a catchy term that was most likely coined for ease of marketing, such as the term mommy makeover,” which refers to a nonspecific combination of surgeries intended to restore a woman’s post-baby body. “That does not necessarily mean that the procedure is unreliable or ineffective, but it does mean that one should do some research and choose [a provider] carefully.”
As with the mommy makeover, there’s no one single formula for a ponytail lift. While the intricacies of the operation should depend entirely on the needs and anatomy of the patient, the overall aesthetic goal remains relatively the same: elevating the midface and cheeks (and, subsequently, the partial jawline along the outer jowls), for a slicked-back look reminiscent of Bella Hadid, sans any visible scarring.
2. A ponytail lift will mean different things to different surgeons.
“Terms used to describe facelift surgery are not consistent or uniform among providers,” explains board-certified New York City plastic surgeon Dr. Lara Devgan, because “marketing terms don’t have a universally agreed upon technical meaning.”
What one surgeon calls a mini facelift, another might refer to as a partial or a lower facelift, though the intended outcome and the methods of achieving it may be similar or almost identical. (Although when it comes to cosmetic surgery, the term identical doesn’t ever truly apply, because there should never be a one-size-fits-all approach.)
“Ultimately, the proof is in the pudding and the kind of surgery that we deliver as plastic surgeons—and it has nothing to do with what we call the procedure,” says New York City board-certified plastic surgeon Dr. Steven Levine, who explains that every facelift he performs is personalized for the individual. “Every patient gets the facelift that they need—and some people need more [work] than others. So if I can deliver a high-quality facelift with shorter incisions and quicker healing time and you want to call that a mini, go for it.”
That said, in general, when you come across the term Ponytail Facelift, it likely refers to a limited endoscopic lift. “The most common elements of a ponytail lift are the elevation of the midface, cheek structures, and jowls using small hidden incisions,” Dr. Chang explains. “Often, an endoscope is employed and suture suspension [is used] to achieve the results” (though some surgeons may skip the camera). It also bears mentioning that it won’t have an effect on the forehead, the way a brow lift would.
Related: Lower Facelift vs. Neck Lift: What’s the Difference?
3. Endoscopic facelifts have limitations.
In the case of a ponytail lift, the endoscopic surgery is typically performed using small instruments, a tiny camera, and small incisions that are made far away from the area trying to be lifted (usually along the temporal hairline). These small incisions allow the surgeon to lift the underlying connective tissues (technically called the SMAS) but not any skin—this would have to be cut out via another larger incision. Like any surgical procedure, the technique has its benefits and drawbacks. On the positive side, it is less invasive, so scarring is minimal, and the downtime and recovery time is also less than that of a traditional face lift. And, as with any type of facelift surgery, the results are long-lasting.
“When you do an endoscopic procedure, it’s great that you can have an incision that’s far away from the area that you want to lift,” Dr. Levine explains, meaning that you can hide the incision within the hair on the scalp. “But the downside is twofold: One, you can’t remove any excess skin… and secondarily, you run the risk of losing hair.” This is because the incision is typically on or near the scalp and if it heals improperly, could damage the surrounding hair follicles.
4. A Ponytail Facelift is most appropriate for younger patients.
Compared to a classic SMAS, traditional face lift, or deep plane facelift, a ponytail lift does not provide complete correction of the saggy neck and jawline. And because “true endoscopic incisions do not allow for skin excision,” adds Dr. Chang, a ponytail lift is really effective only for those with early signs of aging who don’t have a dramatic loss of skin elasticity—in other words, mild volume loss and fallen cheeks but not lax skin and droopy jowls or full-on facial rejuvenation.
5. You should choose a qualified surgeon—not a fad procedure.
“The take-home point ought to be that it’s the surgeon, not the name of the cosmetic procedure [that is important],” Dr. Levine says, because “giving something the same label does not mean that it has the same result.”
In finding the right plastic surgeon, Dr. Levine advises seeking out recommendations from friends, family, and other physicians and then researching the person as if your life depends on it. You’ll want to see consistently great facelift results in standardized before- and after-photos and have an in-depth conversation with the surgeon about your overall goals. Rather than pushing a branded off-the-rack procedure on everyone who walks in requesting small scars, the surgeon you choose should tailor your facial plastic surgery to you. And there’s a term for that, too: legit.
