By Dr Scott J Turner, Specialist Plastic Surgeon (FRACS) | Bondi Junction, Sydney
If you search “ponytail facelift Sydney,” what comes up is a mixed bag. Some results describe a clinic treatment done in an hour under local anaesthetic. Others are describing something very different — a proper surgical procedure in hospital, under general anaesthesia, with dissection into the deep layers of the face. They share a name. They are not the same procedure.
That distinction matters, and it’s worth getting clear on before you book anything or start comparing quotes.
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Ponytail Facelift at a Glance
| Procedure time | 3–4 hours |
| Anaesthesia | General |
| Incisions | Concealed within temporal scalp |
| Best suited to | Early midface descent, good skin elasticity |
| Initial downtime | 10–14 days |
| Longevity | Approximately 7–10 years |
What Is the Endoscopic Ponytail Facelift?
The name comes from what happens when you pull hair up into a ponytail — the tension works upward and backward, lifting the face against gravity rather than letting it continue its descent. That directional effect is essentially what the surgery aims to recreate, but through careful anatomical work rather than anything as blunt as pulling skin.
The “endoscopic” part means a small camera is used throughout. Rather than making a long incision to directly view the tissue, the surgeon works through a short opening within the temporal scalp — roughly 2–4 centimetres — while watching a magnified feed on a monitor. No incisions on the face itself. Nothing around the ears. The scarring sits entirely within hair-bearing scalp.
Where people get confused is around the depth of the procedure. The endoscopic ponytail facelift, done properly, involves releasing the fibrous retaining ligaments that anchor the face to the underlying bone — then repositioning the deeper tissue structures. That’s fundamentally different from thread lifts or any clinic-based tightening treatment where a suture is placed without any real dissection. One produces durable structural change. The other doesn’t, and the results reflect that difference.
Ponytail Facelift Sydney: Is It Right for You?
Honestly, it’s not right for everyone — and the patient selection question is where I spend a lot of time in consultations, because getting this wrong is how people end up with underwhelming results.
This approach works well for patients who are starting to notice the early signs of facial change but haven’t yet developed the kind of significant laxity that would require a more extensive operation. We’re generally talking about people in their late twenties through to their early forties. Mild to moderate midface descent — the cheek beginning to flatten, the nasolabial folds starting to deepen, the lateral face losing a little height. Skin that still has reasonable elasticity. No significant jowling yet, no loose neck skin, no platysmal banding.
That last point matters more than people sometimes realise. Because this procedure doesn’t involve skin excision and doesn’t address the lower face through extended access, it can’t correct what it can’t reach. If you’ve got visible jowling or significant neck changes, the deep plane facelift, SMAS facelift, or Vertical Restore Facelift will serve you much better — as will a neck lift if that’s the primary concern. Applying a limited-access technique to a patient who needs more won’t produce a good result, and it’s not something I’d recommend.
Age is a guide, not a threshold. A facelift consultation is always the right starting point — it’s where we can actually look at your anatomy and figure out what makes sense.
How the Surgery Is Performed
The procedure takes approximately three to four hours under general anaesthesia, performed at an accredited hospital facility in Bondi Junction. Here’s how it unfolds.
Access and Initial Dissection
Before anything else, dilute local anaesthetic with adrenaline is infiltrated into the area. This reduces bleeding — which matters a great deal when you’re working with a camera, because even minor haemorrhage can compromise visibility quickly. The main incision, roughly 2–4 centimetres, is placed within the temporal scalp about two centimetres behind the hairline. Everything stays within hair-bearing tissue from the outset.
Dissection works downward through the layers until the deep temporal fascia is reached. This deeper layer becomes the surgical floor — the reference plane for everything that follows.
Navigating Toward the Midface
Tracking toward the cheekbone, the anatomy gets interesting and requires care. There’s a small perforating vein — surgeons call it the sentinel vein — that marks a critical zone. The frontal branch of the facial nerve runs within about a centimetre of this vessel. That proximity is exactly why endoscopic magnification is so important here; you need to see clearly to navigate safely. Once past this point, dissection transitions over the zygomatic arch and into the midface proper.
Ligament Release
This is the step that separates meaningful facial surgery from surface-level procedures. In the deep plane above the zygomaticus major muscles, the zygomatic retaining ligaments come into view — firm, white fibrous bands that tether the cheek tissue directly to the malar bone. These are the same structures responsible for midface descent as we get older. They hold the tissue down, and until they’re fully divided, nothing above them can be repositioned in any lasting way.
Once cut, the change is immediate. The malar fat pad and overlying skin release as a single unit — there’s a distinct give in the tissue that confirms the dissection has been adequate. Dissection then continues laterally along the masseter to address the masseteric ligaments and free the lateral cheek.
Tissue Suspension
With the midface genuinely mobile, a heavy-gauge suture is introduced through the temporal incision and used to capture the malar fat pad and the sub-orbicularis fat below it. The direction of pull matters enormously here — a vector of roughly sixty degrees superolaterally, chosen to recreate the upper cheek fullness that’s characteristic of a younger facial shape. It’s not about pulling sideways. It’s about restoring a vertical dimension that gravity has slowly taken.
The suture anchors to the deep temporal fascia under tension, which then becomes the fixed point against which healing consolidates the new tissue position.
Facial Fat Grafting
Lifting repositions existing tissue. It doesn’t replace what’s no longer there — and that distinction matters. Facial ageing involves two separate processes happening simultaneously: descent of the soft tissues, and deflation of the deep fat compartments. The ponytail facelift addresses the first. Facial fat grafting addresses the second, and for that reason it’s an integral part of the procedure rather than an optional add-on.
Fat is harvested from a donor site — typically the abdomen or inner thighs — processed, and placed precisely into the areas most affected by volume loss: the deep medial cheek, the sub-malar hollow, and the temporal region. The temporal fat pad in particular tends to deflate with age, and the dissection required for the ponytail technique can occasionally accentuate this. Grafting here provides structural support and helps prevent the hollowed temple appearance that can result from the procedure without it.
Together, repositioning and volume restoration produce a more complete result than either approach could achieve on its own. The lifted cheek sits on a properly supported foundation rather than over a deflated one.
Skin and Incision Closure
No skin comes off the cheek. The redundancy created by lifting the underlying structures simply redistributes upward into the temporal region. Good skin elasticity means the cheek skin contracts down over the new contour on its own — no excision needed. Sometimes a small amount of skin is trimmed at the temporal site, and the incision is closed in layers, entirely within the hairline.
Additional Procedures
Beyond fat grafting, the temporal access point also sits adjacent to several other structures that may be worth addressing in the same sitting. A brow lift is the most natural pairing — elevating the brow and cheek together avoids an imbalanced result. If the cheek goes up and the brow doesn’t move, the crowded appearance around the upper lid can actually worsen rather than improve.
Where needed, a lip lift addresses philtral proportions that can shift when the midface is elevated. And upper or lower blepharoplasty may be worth including if the periorbital area is a separate concern.
Risks and Potential Complications
Every surgical procedure carries risk — the ponytail facelift is no different. What follows reflects complication rates seen in experienced surgical practice; individual risk depends on your anatomy, health history, and other factors specific to you. The risks and complications page covers the broader picture.
Frontal nerve neuropraxia: The most discussed risk with this procedure. Temporary forehead weakness from minor nerve stretching occurs in roughly one to five percent of cases — usually resolving within three to six months. Permanent injury is rare in experienced hands.
Temporal hollowing: If dissection disrupts the temporal fat pad, a slightly sunken appearance can develop in the temple area. Careful technique and fat grafting where needed reduce this.
Alopecia: Hair thinning around the incision site is possible. It’s usually temporary; permanent hair loss is uncommon.
Asymmetry: Small differences in suspension tension between sides can leave one cheek sitting slightly higher than the other. Most of this settles as swelling resolves, though secondary correction is occasionally needed.
Contour irregularity: Where skin elasticity is poor, the surface may not smooth down evenly over the repositioned tissue. This is partly why patient selection — specifically around skin quality — is so important.
Choosing an experienced Specialist Plastic Surgeon with specific endoscopic training significantly reduces these risks across the board.
Recovery
Because there are no incisions around the ears and no skin excision from the face, recovery after the endoscopic ponytail facelift is generally less involved than after traditional facelift procedures. That said — it’s still surgery, performed under general anaesthesia, and planning two to three weeks of genuine downtime is sensible rather than optimistic.
The first week tends to look worse than it feels. Swelling and bruising gather around the temples, cheeks, and eyes — but discomfort is typically manageable with oral pain relief. Most of the visible bruising clears by the end of week two. Desk-based work is generally feasible from day ten to fourteen; most social activities resume by weeks three to four. Anything physically strenuous should wait at least four weeks.
The result itself takes time to declare. Deeper swelling can persist for several months, and the skin continues to settle and refine well beyond that point. Three to six months is when things really start to look like the final outcome. Our facelift recovery page walks through what to expect week by week.
Frequently Asked Questions
Arrange a Consultation at Bondi Junction, Sydney
If you’re researching a ponytail facelift in Sydney and want a realistic assessment of whether it suits your anatomy, Dr Scott J Turner offers comprehensive consultations at FacePlus Aesthetics in Bondi Junction. As a Specialist Plastic Surgeon focused exclusively on facial surgery, Dr Turner will evaluate your concerns, explain what’s achievable, and outline the approach most suited to your situation.
To arrange your consultation, contact us online or call 1300 437 758.
