What is an Endoscopic Midface Lift?

The Endoscopic Midface Lift (Ponytail  Facelift)?

At Unveil Plastic Surgery, we provide clarity on the endoscopic midface lift (sometimes referred to as a “ponytail lift” or “ponytail facelift”). This is not a separate operation but a variation of the broader endoscopic facelift. It involves small incisions hidden in the hairline and is most often considered for patients with early facial changes. The technique repositions the brow, temples, and cheeks to create an elevated effect, often likened to the pull of a high ponytail. An endoscope is used for visualisation, and in some cases the procedure is combined with fat transfer (fat grafting) to restore volume and support facial contouring. Careful patient selection remains an important factor in achieving appropriate outcomes.

Is the Endoscopic Midface Lift (Ponytail Lift) Right for You?

Many people first hear the term “ponytail lift” or “ponytail facelift” when looking for a subtle way to refresh their appearance around the eyes and upper cheeks. In surgical terms, this usually refers to an endoscopic midface lift. Understanding whether this procedure is right for you depends on the specific changes you have noticed and the outcomes you are seeking.

Common indications of the endoscopic lift include:

• Early descent of the cheeks (flattening of the midface)

• Subtle drooping of the eyebrows or outer corners of the eyes

• Hollowness at the temples

• Early laxity in the upper eyelids caused by changes in the support structures

• A general sense that the upper face looks tired or less supported than before

This procedure is usually best suited to patients with early changes in the upper and midface who would like a modest, natural lift without the more extensive dissection required in traditional facelifts.

When an endoscopic facelift may not be suitable:

• Significant skin laxity or heaviness in the lower face or neck

• Prominent jowls or advanced sagging along the jawline

• Poor skin elasticity or advanced sun damage

• When more comprehensive lifting or skin removal is required, in which case a meloplasty with a deep plane facelift or neck lift may be more appropriate

Deep Plane Facelift vs. Endoscopic Midface Lift in Meloplasty: What’s the Difference?

Not all faces age in the same way. The most suitable approach depends on where changes are most noticeable (upper/midface vs lower face/neck), how much skin laxity is present, tissue quality, and personal goals. Two useful categories are comprehensive procedures (e.g., deep plane facelift, neck lift) and short scar procedures (e.g., endoscopic midface lift/mini facelift).

Deep Plane Facelift / Neck Lift

• Best when main concerns are: jawline blunting, jowls, deeper folds, banding or excess skin in the neck; can also be appropriate for some patients at a younger age when the lower face is heavier or the jawline is less defined.
• What it addresses: repositions the deeper layers of the midface and lower face and, when indicated, the neck; allows meaningful skin removal.
• What it doesn’t typically target alone: subtle changes limited to the outer brow/temple or early cheek descent without lower‑face concerns.

Endoscopic Midface Lift / Mini Facelift

• Best when main concerns are: early changes of the upper and midface—outer brow descent, temple hollowing, cheek descent, or upper‑eyelid heaviness related to support changes. Suitable for patients across age groups when concerns are localised and skin excess is limited.
• What it addresses: support and contour of the brow–temple–cheek complex through small hairline incisions under endoscopic guidance; may be combined with fat transfer (fat grafting) to restore volume.
• What it doesn’t address: significant jowls, pronounced neck laxity, or situations where skin removal is required—these often call for a comprehensive technique.

Facial Surgery