Endoscopic (Ponytail) Facelift Surgery
IN SYDNEY
The Endoscopic (Ponytail) Facelift
My approach is considered, curated, and grounded in precise anatomy. Endoscopic techniques allow targeted release and lift of the brow, temple, and midface through small, well‑concealed incisions - prioritising natural vectors and careful tissue handling over tension.
The endoscopic (ponytail) facelift is one of my preferred techniques for younger patients. Using a camera-assisted, subperiosteal/deep plane approach, I elevate and re‑suspend the lateral brow, temporal region, and midface via discreet hairline incisions. For suitable candidates, it offers refinement with minimal visible scarring and a streamlined recovery, and can be combined with lower‑face or neck procedures when broader rejuvenation is indicated.
What is an Endoscopic (Ponytail) Facelift?
An endoscopic (ponytail) facelift is a camera‑assisted, small‑incision approach that elevates the lateral brow, temple, and midface through short cuts hidden in the hairline. The aim is to release and re‑suspend deep soft tissues along natural, upward vectors - without extensive skin undermining..
How does the Endoscopic Facelift actually work?
How it works — in practical terms
Tiny hairline incisions (typically 3–5) within the scalp keep scars discreet.
A slim endoscope provides magnified visualisation beneath the soft tissues.
Using a subperiosteal/deep plane, key retaining ligaments are released so the brow–temple–midface can be repositioned without surface tension.
Tissues are secured to stable deep structures with sutures or bioabsorbable fixation to support the lateral brow, upper cheek (SOOF), and lid–cheek junction.
Because skin is not pulled tight, the focus is on structure and vector, not stretch.
What it addresses best
Lateral brow descent and temporal hooding.
Early midface descent (upper cheek flattening).
Heavy outer‑eye appearance due to soft‑tissue descent rather than excess skin.
What it does not primarily treat
Lower‑face jowls or a heavy neck (better addressed with MACS/SMAS or deep plane techniques, with or without dedicated neck work).
Significant skin redundancy (may require adjunct procedures).
Anaesthesia, setting, and recovery snapshot
General or twilight anaesthesia in an accredited facility.
Short hairline scars designed to be concealed even when hair is worn up.
Recovery is typically streamlined; bruising/swelling around the temples and upper cheeks settles progressively.
Where the Endoscopic Facelift Fits Among Facelift Techniques
Techniques differ in incision pattern, depth, vectors, and target regions. The endoscopic approach is optimised for the brow–temple–midface with small hairline incisions and subperiosteal/deep plane release; it is not a lower‑face/neck operation.
Endoscopic (Ponytail) Facelift — this procedure
Vector/Depth: Vertical-superior; subperiosteal/deep plane release with endoscopic visualisation.
Best for: Lateral brow descent, temporal hooding, early midface flattening; good skin quality and limited laxity.
Limitations: Does not directly treat jowls or heavy necks; limited effect on significant skin redundancy.
MACS Lift
Primarily vertical; SMAS suspension with shorter scars/downtime.
Best for early-moderate lower-face ageing; pairs well with a gliding brow lift.
SMAS Lift
Lateral + vertical vectors via plication/imbrication.
Useful for moderate lower-face ageing; midface effect less than deep plane.
Deep Plane Facelift
Sub‑SMAS ligament release for cheek, jawline, and neck repositioning.
Best for more advanced lower‑face/neck ageing or heavier tissues.
Frequently paired with an endoscopic brow lift when comprehensive rejuvenation is desired.
Neck‑Focused Procedures (Deep Cervical Work)
Platysmaplasty with selected subplatysmal manoeuvres (subplatysmal fat, anterior digastric, selective submandibular gland).
Best for bands, heaviness, or obtuse cervico‑mental angle; often combined with deep plane.
The Bottom Line
An Endoscopic (ponytail) facelift is best chosen for targeted upper/outer‑face elevation with minimal visible scarring; combine with a deep plane lower facelift and deep cervical necklift when lower‑face or neck changes are a priority.
COMBINE YOUR ENDOSCOPIC FACELIFT
A Complete Facial Rejuvenation
Balanced rejuvenation often pairs upper‑face lifting with lower‑face and neck contouring, eyelid refinement, volume restoration, and skin quality care.
Structural Partners (Lower Face & Neck)
Deep plane lower facelift - repositions the cheek–jawline complex without surface tension.
Deep cervical necklift - may include platysmaplasty and selected subplatysmal manoeuvres to sharpen the cervico‑mental angle.
Periocular Refinements
Upper and/or lower blepharoplasty - complements lateral brow elevation.
Profile & Proportion
Chin augmentation or reduction - harmonises projection and the jaw–neck transition.
Closed, preservation rhinoplasty (when indicated) - often staged to streamline recovery.
Volume & Skin Quality
Facial fat grafting (micro/nanofat) - restores soft‑tissue support; nanofat may improve skin quality.
Skin resurfacing (laser or chemical peel) - targets texture, fine lines, and dyschromia.
Same‑Session vs Staged
Same‑session: efficient single recovery when combining deep plane lower facelift and/or deep cervical necklift.
Staged: periocular work is often performed concurrently; rhinoplasty, chin augmentation and resurfacing are frequently timed after initial swelling resolves (commonly around 6–12 weeks) to optimise precision and comfort.)
WHY CONSIDER A ENDOSCOPIC FACELIFT?
Who Is the Ideal Candidate?
Lateral brow descent or temporal hooding with good skin quality and limited laxity.
Preference for short, hidden hairline incisions and a streamlined recovery.
Non‑surgical treatments with diminishing benefit; desire for a structural lift.
Good general health and clear, realistic goals.
When another approach may be better
Primary concerns are jowls or a heavy neck - favour deep plane lower facelift and/or deep cervical necklift.
Significant eyelid/midface skin redundancy - consider blepharoplasty or alternative facelift strategy.
Marked midface descent, revision cases, or substantial laxity - deep plane techniques provide more robust repositioning.
WHAT TO EXPECT
From Consultation to Recovery - Endoscopic Facelift Surgery
Undergoing facelift surgery is a detailed and personalised process. From your first consultation to your final review, every stage is carefully planned to support your comfort, safety, and optimal healing.
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Your Initial Consultation
Vector analysis, hairline pattern, review of prior treatments; discuss alternatives and risks; planning photography.
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Preoperative Planning
Medications, supplements, skincare, smoking cessation, anaesthetic review/testing.
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Surgery Day
Accredited facility; general or twilight anaesthesia; typically 1.5–3 hours; short hairline incisions; endoscopic subperiosteal/deep plane release; secure fixation; same‑day discharge typical.
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Week 1 Post-Op
Review 24–72 h; swelling/bruise peak 48–72 h; staples/sutures (if used) removed day 7–10; head elevation and gentle walks.
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Week 2–3 Post-Op
Return to desk work/social settings days 7–14; resume gentle skincare; hair colouring after clearance (≥2–3 weeks).
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6 Weeks+ Post-Op
Refinement continues; full exercise by 4–6 weeks as advised; staged procedures commonly 6–12 weeks post‑op.
YOUR RECOVERY
Postoperative Care & Follow-up
Most patients experience swelling, tightness, and mild numbness - typically improving within weeks. Pain is minimal and managed with oral medication.
Swelling/bruising at temples/upper cheeks; tightness or scalp tenderness; temporary patchy numbness.
Activity: head‑elevated sleep; avoid bending/heavy lifting initially; gradual return to activity by 4–6 weeks.
Incisions/scalp: gentle shampoo after first review; avoid heat styling over incisions until healed; colour/chemical services after clearance (≥2–3 weeks).
Follow‑up: 24–72 h; day 7–10; 2–3 weeks; 6–12 weeks; contact urgently for sudden painful swelling, persistent bleeding/fever, or chest pain..
SURGICAL RISKS
Risks of Endoscopic Facelift Surgery
All surgery carries risk. Possible complications include:
Haematoma; infection.
Nerve effects: temporal branch (motor) - transient brow weakness (rarely persistent); sensory nerves - temporary forehead/scalp numbness or tingling.
Hair/incision issues - localised alopecia at portals; widened/raised scars; minor hairline irregularity.
Asymmetry or under/over‑correction; contour tethering (usually settles).
Fixation‑related palpability or discomfort until integration/resorption.
Prolonged swelling/bruising; general anaesthetic risks.
Risks can be minimised through proper planning, patient selection, and adherence to postoperative instructions.
Why Choose Dr Karagiannis for your Endoscopic Facelift?
1. Younger Candidates
Preferred technique for younger candidates seeking discreet upper/outer‑face elevation.
2. Experienced Surgeon
Advanced fellowships in facial aesthetics; procedure selection across endoscopic, MACS/SMAS, and deep plane methods.
3. Discreet Hairline Placement
Hairline‑aware portal planning and anatomy‑first vector control.
4. Continuity of Care
Measured aesthetics and compliant, evidence‑based counselling, continuity of care in accredited facilities.
Endoscopic Facelift FAQS
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Tightness/pressure at the temples and scalp tenderness are more common than sharp pain; oral analgesia is usually sufficient.
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Short hairline incisions within the scalp (typically 3–5); no shaving required - minor trimming at portals only if needed.
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Bruising/swelling peak 48–72 h and improve over 7–14 days; many return to desk work and light social settings by days 7–14.
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Gentle shampoo after the first review; colouring/chemical treatments after clearance (≥2–3 weeks).
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No. This targets the brow–temple–midface. For jowls/neck laxity, consider deep plane lower facelift and deep cervical neck lift.
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Common with deep plane lower facelift, deep cervical necklift, blepharoplasty, fat grafting, and resurfacing; rhinoplasty/chin augmentation are often staged 6–12 weeks later.
Request a Consultation
If you're considering an endoscopic facelift, I invite you to schedule a private consultation. Together we’ll explore your goals, assess your anatomy, and tailor a plan to suit your needs.