Dr. Renato Calabria Revisits The Ponytail Lift

So, what are the indications of ponytail lift or the mid-face suspension? The indication is a patient in their 30s with little or non-skin laxity and needs a little bit of projection in a tiny little bit of tightening of the skin.

The experience that we all gathered by doing the procedure had reduced the indication. Of course, when the technology was first introduced, we used it in a lot more cases, but then we had seen the result based on those cases and we have selected a smaller number of cases.

Now, some surgeons use the same technique for every patient, and of course if you have only a hammer, the entire word looks like a nail. But I can offer several types of facelift from the ponytail, so-called mid-face suspensions to the one-stitch to the mini to the vertical lift. I have a variety of procedures that I select. It is basically a custom-made decision.

Now, I was one of the first ones to present in the early 2000, the midface technique suspension, and I taught it to a lot of residents, including the surgeon who actually popularized the technique right now, and he’s a very talented surgeon.

Now, the problem I see in my experience is that we tend to use one technique for all the patients, which is wrong. Now, the mid-face suspension, as I said, works well for younger patients with the limited laxity of the skin. Now, remember, the beauty of doing endoscopic surgery is that you don’t leave scars, or leave small scars. In cases with the ponytail lift, a scar in the temporal area, which is not visible, is the positive thing.

Now, the negative thing is obviously that by not removing the excess skin, even in a younger patient in their 30s has excess skin. So, by not removing the excess skin, you are not, in my opinion, getting long-term gain. Again, sacrificing the fact that you’re not doing any incision, and that’s a plus obviously. But remember, the incisions in front, in the ear, are actually very well tolerated by patients and most of the time heal with an almost invisible incision. So, it’s sometimes a gimmick.

So, what I want you to educate yourself and distinguish what is the gimmick and what is the real deal. So, remember, when I see results on social media, I don’t see long-term results. Most of the results are short-term. I see one month, three months, six months post-op, and obviously because of the swelling, everybody looks great at one month, two months, six months. But the success of a procedure is in their long-term result. And in my experience, the long-term result, I’m not rewarding.

So, the ponytail lift is a sub. Let’s say it’s a small part of the options we can deliver to each patient. It has some indications. In my opinion, it’s overdone. It’s used for every patient. 

Sometimes what is kind of nonsense, is to do the ponytail lift and do a separate incision with the neck lift. And basically what happens is you have a clean neck, but the skin of the face is still not tight enough. So you have not created a very harmonic result. So, that’s my opinion.

I actually have done hundreds of these mid-face ponytail suspensions. I have seen results, long-term, and I can offer it and before I’m able to distinguish what is the best procedure for each patient.

Don’t fall for the gimmick. Again, educate yourself. Look at a decent long-term result, not for the… Don’t fall for the one-month social media classic result, in which, wow, or the result in which the pre-op picture has all the markings and it makes it look like the patient is older than his age.

Of course, we all post before and after pictures. Sometimes, I’m at fault myself with different lighting. It is done. It is not done with intention. Sometimes with surgery, you operate in different areas in Italy and in other areas of the world and the lighting is not perfect. It’s not done intentionally. Beware of surgeons, some of the surgeons, they intentionally only show you the one month, three months, six months results. And so I’m trying to be intellectually honest and tell you everything.

Again, so the bottom line is this. Endoscopic facial surgery seems to stay. The endoscopic brow lift has widespread indications and I use it all the time. The midface suspension is sort of a peak and has leveled out to a level in which the indications are limited.

That is my opinion, my honest opinion. I hope you have gathered some information from this video and please be aware again of the shortcomings of this very popular procedure, which is the ponytail lift.

Take care.