Your Questions About the Endoscopic Midface Lift, Answered
Not every patient who walks in asking about a facelift needs one. For patients with early facial descent, mild jowling, and good skin elasticity, the endoscopic midface lift—the Ponytail Facelift™—often delivers exactly what they are looking for: a repositioning of descended tissue through incisions hidden in the hairline, with recovery measured in days rather than weeks.
The Ponytail Facelift™ was pioneered by Dr. Chia Chi Kao, with whom Dr. R. Brannon Claytor trained on the technique. Dr. Claytor now teaches it to other surgeons—experience that informs how carefully he evaluates who is truly a candidate. And with over 20 years of experience in facial rejuvenation, Dr. Claytor gives patients options like the endoscopic midface lift, alongside procedures like the endoscopic brow lift and deep plane facelift, and approaches each consultation with one question: which technique fits this patient’s anatomy and goals?
Below are the answers to questions you may have about the Ponytail Lift™ procedure.
What is an endoscopic midface lift?
The endoscopic midface lift is a minimally invasive procedure that addresses facial descent in the midface and cheek area through small incisions hidden within the hairline. A tiny camera guides the instruments, allowing precise repositioning of descended tissues without the longer incisions required by traditional facelift surgery.
Through those same incisions, Dr. Claytor can also access and release the retaining ligaments that tether the descended tissue in place, which allows for more complete repositioning of the midface. The incisions stay up in the hairline, with at most a small one tucked behind the ear, so patients can pull their hair back completely without anything visible.
Who is a good candidate?
The best candidates have volume descent, but without significant loose skin, and are looking for a minimally- invasive solution. Specifically, patients tend to do well with this surgery if they have some malar descent, some jowling, and some loose neck skin that can be pleated and hidden behind the ear.
Patients with a significant amount of loose skin will need an incisional operation like a deep plane facelift, which uses incisions to allow excess skin to be removed. Dr. Claytor sits down with each patient in the consultation to have a conversation about goals, examine the skin, and make that determination.
How does the endoscopic midface lift differ from a deep plane facelift?
With the endoscopic midface lift, Dr. Claytor makes a small incision on the scalp, behind the hairline, and sends tiny cameras and instruments through the temples to the cheek area to lift tissues. He may also use endotines to lift the tissues and promote collagen production for certain patients. Incisions are hidden in the hairline, with no visible scarring.
With the deep plane technique, Dr. Claytor makes incisions along the hairline at the sideburn, in front of and behind the ear, and underneath the chin to gain direct surgical access to the muscles and ligaments. He then dissects beneath the muscles, releases retaining ligaments, and removes excess skin in the neck, cheek, and jowl region. Incisions are placed along the contours of the hairline and ears and gradually disappear as they heal.
For a patient with minimal facial descent, which typically entails some nasolabial fold fullness, some jowling, some looseness in the midface, the endoscopic approach is often the right choice. For a patient with a significant amount of loose skin, a full deep plane facelift is the better option. Both your desires and your anatomy factor into the decision about whether to opt for a deep plane facelift or an endoscopic midface lift.
What are endotines, and how are they used?
Endotines are an absorbable polymer that dissolves over approximately six months. Once deployed into the midface, the small barbs grab the descended malar mound (the soft tissue pad of the cheek) and lift it into position. They are not plastic and not permanent.
Dr. Claytor often uses both endotines and sutures together in the midface lift: the endotines do the lifting and grabbing, while permanent sutures hold the tissue in place for lasting support.
Where are the incisions, and will they be visible?
The primary incision is made on the scalp, in the hairline, and it is completely concealed. There may also be a small incision behind the ear, but the area beneath the sideburn and in front of the ear is left untouched. For patients who are particular about wearing their hair up, i.e. in a “ponytail,” that is an advantage over the traditional approach to a facelift.
Can an endoscopic midface lift address neck concerns?
No, and this is worth understanding clearly before choosing this approach. The endoscopic midface lift addresses malar (cheek) descent, some jowls, and concerns in the periocular region and the upper third of the face.
Addressing the neck directly requires a separate incision. Patients with neck concerns alongside midface descent may be better served by a more comprehensive approach, which Dr. Claytor evaluates during the consultation.
What is the recovery timeline?
Plan for the first week as true recovery time. After that, most patients are comfortable being out in public. For a significant event or important occasion, patients are generally ready by about one month.
Recovery is notably shorter than what a full facelift requires, which makes this approach practical for patients who cannot take extended time away from work or their routine.
How long do results last?
The endoscopic midface lift delivers approximately a 10-year result. The aging process continues, but patients can expect a durable improvement rather than one they will be revisiting in a year or two.
Can an endoscopic midface lift be combined with other procedures?
Yes, and Dr. Claytor frequently approaches it this way. The endoscopic midface lift shares incisions in the hairline with the endoscopic brow lift, making the two procedures a natural pairing for patients whose brow and midface have descended together, which is a common pattern.
He also combines it with upper or lower blepharoplasty when eyelid concerns are part of the picture, since lifting the midface and refreshing the lower eyelid area together produces a more cohesive result than either procedure achieves on its own.
For patients who need more comprehensive rejuvenation, the endoscopic midface lift can be performed as part of a broader surgical plan that includes a deep plane facelift. Combining procedures means one recovery period and a result that addresses the face as a whole rather than in isolated parts.
How do I know which procedure is right for me?
Dr. Claytor evaluates each patient individually in the consultation, and makes recommendations based on your anatomy and goals. Some patients are straightforward candidates for the endoscopic approach; others have more descent or skin laxity than this technique is built for, and a deep plane facelift will serve them better. The goal is always to match the technique to the patient, and not the other way around.
To schedule a consultation at our Bryn Mawr office, call (610) 527-4833 or contact us online.
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