900 Wilshire Boulevard at golden hour: the second-floor glass of the three-story building reflects the sunset, the Santa Monica Pier and its Ferris wheel. Below, the sign reads KAO Aesthetics, Plastics, Regenerative.

Plastic Surgery in Los Angeles & Santa Monica Look past
the reflection.

The Ponytail Lift^™

Not a thread lift, and not a smaller facelift under a new name. A stepwise system of endoscopic deep-plane facial rejuvenation, developed by Dr. Kao and adapted to the anatomy of each face.

Four principles. One method.

What makes the Ponytail system different from a conventional facelift, one principle at a time.

Principle 1 of 4
Endoscopic
A small camera and fine instruments work through limited access points, so deeper structures can be repositioned without long, visible incisions.
Principle 2 of 4
Deep-plane
The deeper support layers are released and repositioned, rather than relying on tension placed on the skin.
Principle 3 of 4
Vertical vectors
Tissues are restored upward instead of pulled back toward the ears, avoiding the flattened, operated look of lateral tension.
Principle 4 of 4
Discreet incisions
Placed where the anatomy allows: within the scalp for Ponytail Lift I, with small additions behind the ear or beneath the chin as the level rises.

Four levels. One system.

Dr. Kao assigns the level after examining the face. It follows anatomy and the pattern of aging, not age alone, and each level builds on the one before it.

Endoscopic · no skin removed
Ponytail Lift™ I
PTL-I
Suited to
Early descent of the brows, temples, eyes or cheeks.
What is done
These areas are lifted endoscopically, through incisions hidden within the scalp.
Endoscopic · no skin removed
Ponytail Lift™ II
PTL-II
Suited to
Early jowls, with little loose skin on the neck.
What is done
Level I, extended to the lower face and jowls, with deeper neck contouring where there is fullness beneath the chin.
Deep-plane · limited skin removal
Ponytail Facelift™ I
PTFL-I
Suited to
Jowls, with mild to moderate loose skin on the neck.
What is done
The lower face and neck are lifted at the deep plane and a limited amount of skin is removed, without incisions in the temple hairline or directly in front of the ear.
Deep-plane · limited skin removal
Ponytail Facelift™ II
PTFL-II
Suited to
Heavier jowls, more loose skin on the neck, reduced elasticity.
What is done
Level III, extended to greater laxity of the face and neck, still preserving the temple hairline and sideburn.

Aging happens in three layers. So does the plan.

Treating only the skin can leave deeper descent untouched. Treating only volume can make a fallen face look heavier. The plan follows the anatomy through every layer.

Surface layer
Skin quality and excess
Skin loses collagen, elasticity and evenness. Some faces benefit from resurfacing; meaningful lower-face or neck redundancy may call for skin removal.
Middle layer
Facial volume
Some regions lose volume while others expand. Regenerative fat transfer restores support and shape where indicated, never as indiscriminate filling.
Deep layer
Structural support
As the SMAS and deep-plane tissues descend, cheeks flatten and the jawline softens. These are repositioned, rather than the skin being tightened over them.

600 patients, in print.

Dr. Kao and Dominik Duscher published a retrospective study of 600 consecutive patients treated with the Ponytail Lift™ and Ponytail Facelift™, each followed for at least twelve months.

The published cohort
Patients	600 consecutive
Follow-up	12 months or longer
Mean age	50.9 years
Age range	17–82 years

Kao CC, Duscher D. Read the study in Aesthetic Surgery Journal (opens in a new tab).

A retrospective study of one surgeon’s experience. Individual results vary.

Chia Chi Kao, MD

Board-certified plastic surgeon and the creator of the Ponytail Lift™ and Ponytail Facelift™.

Born in Taipei and raised in Seattle, Dr. Kao trained in general surgery at the University of Washington, where he taught video endoscopic surgery to residents and fellow surgeons. He completed plastic surgery training at the University of Southern California and a fellowship in craniofacial surgery in Taipei. That endoscopic lineage is the root of the Ponytail system.

“It is not about making someone simply look younger, but giving them the gift of feeling attractive and vibrant. Beauty is timeless.”
Chia Chi Kao, MD

Meet Dr. Kao

Board certification: American Board of Plastic Surgery; American Board of Surgery
Medical degree: University of Washington
Training: General surgery, University of Washington; chief resident; Plastic surgery, University of Southern California; International fellow in craniofacial surgery, Chang Gung Memorial Hospital, Taipei
Endoscopy: Clinical professor, University of Washington Center for Video Endoscopic Surgery
Societies: ASAPS · ASPS · ISAPS · IFATS; California Society of Plastic Surgeons
Licensure: California · New York
Hospital: Staff surgeon, Providence Saint John’s; 20th Street Surgery Center