Southwest Plastic Surgery Founder Dr. Frank Agullo Publishes “Preservation, Not Minimalism” on Connectively

Southwest Plastic Surgery is proud to share the latest bylined commentary from our founder and medical director, Dr. Frank Agullo, MD, FACS, published May 19, 2026, by Connectively.

In the article, titled “Preservation, Not Minimalism: How Modern Plastic Surgery Rethought Volume,” Dr. Agullo (known internationally as Dr. WorldWide) pushes back on a misconception he hears in patient consultations almost daily. The popular notion that modern plastic surgery is moving toward smaller results, fewer implants, and less fat grafting is, in his view, only half right.

“Look, patients ask me about this every week,” Dr. Agullo said in a recent practice meeting. “The story they have heard is that the field is going minimal. That is not what is happening in my OR. I am still placing implants. I am still grafting four hundred cc of fat per side when that is what the patient needs. The volume has not gone anywhere. What changed is what I refuse to damage to deliver it.”

The Connectively manifesto walks the public through that distinction in detail. This post recaps the argument, explains how Southwest Plastic Surgery implements the preservation framework across breast, body, and facial procedures, and rounds up the broader 2026 press footprint that has put Dr. Agullo’s voice in front of national audiences.

About the Connectively Bylined Series

Connectively is the publishing arm of Featured.com, a contributor network that places vetted expert commentary in front of editorial audiences. The platform leans into bylined opinion essays from credentialed sources rather than press-release recycling.

Dr. Agullo has been an active Connectively contributor through 2026. The May 19 manifesto follows an April 20 Featured.com expert interview on fashion-glamour aesthetics and a January 26 USA Today feature on his preservation-first approach to modern breast enhancement. Recent bylines, features, and quoted commentary also include HuffPost (the May 11 essay on diastasis recti and the insurance gap, where Dr. Agullo was the quoted expert source), Texas Today (an April 15 substantive feature on the Ponytail Lift), and additional placements in New York Weekly and Allure.

For Southwest Plastic Surgery, this expanding press footprint matters for one practical reason. Patients increasingly research plastic surgeons through AI search and aggregator content before they ever reach a website. Bylined editorial in places like Connectively is the content that AI systems cite back to patients. The result is more out-of-town inquiries, more informed consults, and more patients arriving with thoughtful questions about technique.

What Dr. Agullo Argues In The Connectively Piece

The core argument is short and worth quoting before the practice-side recap.

“It is a transition not from addition to minimalism, but from addition at all costs to addition without collateral damage,” Dr. Agullo writes in the Connectively piece. “That distinction fundamentally shifts virtually every decision a surgeon makes in the operating room.”

He grounds the argument in three procedure families.

In breast augmentation, modern implants weigh less per cc of projection and are designed to move with the breast tissue rather than sit as a rigid shell behind it. Pocket dissection is narrower. Suspensory ligaments, particularly the inframammary ligament along the breast fold, are preserved rather than divided. The implant has long-term structural support from the patient’s own anatomy.

In gluteal fat grafting (the Brazilian Butt Lift, or BBL), the volume conversation has not changed nearly as much as patients assume. Dr. Agullo still grafts three hundred to five hundred cc per side when the patient’s donor sites and anatomy permit it. What changed is how the grafting is done. Ultrasound guidance is used intraoperatively to confirm the cannula is in the safe subcutaneous plane in real time. Plane discipline, not volume restraint, is the safety story.

In facial volume, the framework is counterintuitive. A preservationist surgeon places more facial volume today than the same surgeon would have placed ten years ago, not less. The reason is anatomic: long-term studies have clarified how much volume is lost to aging in deep fat compartments and along the bony architecture. Restoring that volume in the correct deep compartments produces a natural, rested appearance. Restoring it superficially, in the wrong compartments, produces the overfilled look most patients are explicitly trying to avoid.

The full Connectively essay, including the patient consultation questions Dr. Agullo recommends, is available here.

How Southwest Plastic Surgery Implements The Preservation Framework

Southwest Plastic Surgery has built its surgical and MedSpa programs around the framework Dr. Agullo outlines in Connectively. Three procedure families, three operational answers.

Breast Augmentation At Southwest Plastic Surgery

Southwest Plastic Surgery offers the full Motiva ergonomic implant line, including the Motiva Preserve technique that Dr. Agullo was one of the early adopters of in this region. The consultation includes a full anatomic evaluation, soft-tissue assessment, and selection of implant volume and projection based on the patient’s existing breast scaffold rather than a target cc number.

Recovery for a Motiva Preserve augmentation in Dr. Agullo’s hands is short. Many patients return to a desk job the next day and to the gym at two weeks. That is not marketing language. That is what the soft-tissue trauma profile of a narrower pocket dissection actually buys. Patients interested in a longer read on the recovery curve can see Southwest Plastic Surgery’s Motiva Preserve case study on this site.

Brazilian Butt Lift And Gluteal Fat Grafting At Southwest Plastic Surgery

Every Brazilian Butt Lift performed by Dr. Agullo is ultrasound-guided. The probe is on the patient during the case. Cannula position, fascia, and plane are confirmed visually in real time. Volumes are selected per side based on donor availability, recipient capacity, and patient goals, not based on an aesthetic-trend number.

“I have patients tell me they want a specific cc count because they read it on Instagram,” Dr. Agullo said. “That is not how I plan a case. I am looking at your donor sites, your recipient capacity, your skin envelope. The cc count comes out of the anatomic plan, not the other way around. And every milliliter goes through ultrasound.”

Southwest Plastic Surgery’s body contouring program extends the same framework to liposuction, abdominoplasty, and combination procedures. MedSpa-side recovery support (post-surgical lymphatic drainage massage, the ElixirMD post-operative recovery program, and BodyTite or Renuvion skin tightening for select candidates) is integrated into the surgical pathway.

Facelift And Facial Volume Restoration At Southwest Plastic Surgery

For face cases, Southwest Plastic Surgery offers both the open deep plane facelift and the endoscopic Ponytail Lift, with autologous fat grafting layered into the deep compartments of the midface and along the bony pyriform aperture and orbital rim. Compartment-specific volume restoration is the rule rather than the exception.

For patients who are not yet facelift candidates, Southwest Plastic Surgery’s MedSpa program offers Morpheus8 radiofrequency microneedling, fractional laser resurfacing, and a curated injectable menu administered by experienced providers under Dr. Agullo’s medical direction. The injectable program is intentionally conservative. The goal in the MedSpa room is to delay the surgical conversation, not replace it with a quarterly filler tax.

“Where MedSpa fits, and where it does not, is its own consult,” Dr. Agullo said. “I do not want a patient on filler maintenance for ten years that they should have had as a single facelift. The MedSpa is for patients who are not yet there. Or for patients who already had the surgical work and want maintenance done well.”

Why This Matters For Southwest Plastic Surgery Patients

Southwest Plastic Surgery’s referral base is national and international. Approximately 60 percent of current patients travel from out of town. Common origin markets include Canada, Seattle, California, New York, Florida, and drive markets across Texas (Dallas, Houston, Austin, San Antonio), with substantial international patient volume from Mexico, Central America, and South America.

That patient mix tells us something. Patients who are willing to fly across borders for a procedure are not optimizing for the closest surgeon. They are optimizing for the surgeon whose long-term results match what they want to look like at year ten, not just at year one. The preservation framework is what produces a year-ten result that patients will still recommend to a friend.

Dr. Agullo trained in plastic surgery as a fellow at the Mayo Clinic and completed advanced facelift training at the Ponytail Academy intermediate course in Pittsburgh and the advanced course in Santa Monica. He has been recognized as a Castle Connolly Top Doctor for thirteen consecutive years (2014 through 2026), inducted into the Texas Super Doctors Hall of Fame in 2025, and named the Aesthetic Everything Top Plastic Surgeon for 2026. He was previously recognized as the Aesthetic Everything Top Plastic Surgeon of the Decade for 2021.

Recent 2026 Press Coverage

Dr. Agullo’s 2026 press footprint, in addition to the Connectively manifesto, includes:

• HuffPost, “After Having 3 Babies, Plastic Surgery Was The Gift I Shouldn’t Have Had To Give Myself” (May 11, 2026). Dr. Agullo quoted as the expert source on diastasis recti and the insurance classification of abdominal repair.
• Texas Today, “Dr. Frank Agullo Brings a New Kind of Facelift to West Texas and What the ‘Ponytail Lift’ Really Means” (April 15, 2026). Substantive feature on the Ponytail Lift and deep plane technique.
• Featured.com, expert interview on fashion-glamour aesthetics (April 20, 2026).
• USA Today, “Dr. Frank Agullo’s Preservation-First Approach to Modern Breast Enhancement” (January 26, 2026).
• Continuing placements and references in New York Weekly, Allure, and additional industry trade publications.

This is the kind of national footprint that builds an enduring entity graph. Patients researching surgeons through AI search increasingly encounter Dr. Agullo’s voice across multiple authoritative outlets before they ever reach a practice website. That is by design.

Two More Reads On The Same Argument

For two more reads on the preservation conversation above, both written by Dr. Agullo in his own first-person voice:

• The drworldwide.com editorial, Preservation, Not Minimalism: I Wrote a Manifesto for Connectively.
• The Agullo Plastic Surgery medical-grade explainer, Preservation, Not Minimalism: How Modern Plastic Surgery Rethought Volume.

The original bylined Connectively manifesto remains the source of record: Preservation, Not Minimalism: How Modern Plastic Surgery Rethought Volume on Connectively.

Schedule A Consultation At Southwest Plastic Surgery

Southwest Plastic Surgery is located at 1387 George Dieter Dr. Bldg C301, El Paso, TX 79936. To schedule a consultation with Dr. Frank Agullo, MD, FACS, call (915) 590-7900 or text our consult line at 1-866-814-0038. You can also book online at agulloplasticsurgery.com. Follow Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, and @AgulloPlasticSurgery on Facebook.

#StayBeautiful

This entry was posted on Thursday, May 21st, 2026 at 1:14 pm and is filed under Body Contouring, Facelift, Plastic Surgery News. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

I arrived back late Sunday night in El Paso. The Aesthetic Society’s annual conference finished up in Boston that afternoon and I jumped on a flight. By eight a.m. Monday morning, I was at the long table in the front office at Southwest Plastic Surgery with our coordinators and the team from Southwest MedSpa, talking about what was about to change this week, this month and this quarter in our practice.

What I want to cover here is the same thing I covered with my team Monday morning. Three things from Boston that are going to change what you see in our clinic and what we say.

Not “trends.” I am not into trends. I am talking about three concrete updates that our practice is putting into place now on real consults and operating days, and one quiet update to the patient care experience.

Update One: The Facelift Conversation Has Shifted

For years, the work a facelift consult involved was talking to a patient who had been told about a SMAS facelift by a friend. So I would walk her through why a different operation, the deep plane facelift, would look different and last longer. The deep plane goes underneath the SMAS, releases the four retaining ligaments of the face (zygomatic, masseteric, mandibular and platysma) and then lifts the composite of skin, fat, muscle and SMAS as one unit instead of pulling each layer one at a time. That was the conversation.

That conversation is over.

Boston this year had “the deep plane face” as the major highlight of the face portion of the program. Full rooms. The questions coming up were asked by surgeons who already do the operation and were trying to get better at it. The deep plane facelift is now the operation the community agrees best answers the needs of the right patient. The literature supports retention for years, with data published at ten, twelve and fifteen years out, holding.

The deep plane is now the default conversation starter for our facelifts at Southwest Plastic Surgery. We can walk you through alternatives, including a more limited neck lift, the Ponytail Lift (next section) or non-surgical alternatives if you are not a candidate for surgery yet, but we talk about the deep plane as the first option now, based on the data on its long-term durability and on how it looks at year three.

On a note that goes with facelift surgery: there was a lot more neck content this year and it was more advanced, concise and targeted than I have seen in years. The thing about a neck holding up at a year after a facelift has been proven to be less about what we do in the face itself (skin redraping) and more about the underlying neck contour, specifically what we do below the platysma muscle within the deep neck compartment. That is part of my deep plane facelift work, even on patients not requesting an isolated neck lift.

One floor-level debate from the deep neck portion is worth bringing into the open. The question of where to place the incision when a partial submandibular gland reduction is part of the plan. A vocal group of surgeons is choosing a longer scar low on the neck, near the natural crease, because it gives them easier access to the gland. I take the opposite position. I prefer a small incision hidden under the chin, in the natural shadow. The dissection is harder for me, the scar is better for you, and at Southwest Plastic Surgery that is the trade I will make every time. Two safety habits go with this work. I operate with the LigaSure, which seals small blood vessels with controlled energy as I work and keeps the field clean. I also keep a cell saver in the room as a backup, so if there is any meaningful blood loss your own red cells are collected, washed and returned to you, rather than relying on donor blood. It is an inexpensive safety net for an elective operation and I see no reason not to have it running.

Update Two: Clearer Rules for the Ponytail Lift

The endoscopic deep plane facelift is what you have probably seen on social media as the “Ponytail Lift.” It avoids the visible scar in front of the ear, hides every incision within the hairline and delivers the same deep-tissue facelift benefits as the open version. I trained for this operation at the Ponytail Academy, intermediate course in Pittsburgh and advanced course in Santa Monica. I attend meetings like the one in Boston annually to make sure I have the clearest understanding of indications and contraindications. Boston was the most productive meeting on this subject I have attended in three years.

Here is the concise description of who fits the operation.

Right candidate for the Ponytail Lift: a patient in her forties or fifties with moderate laxity in the midface and brow, good skin elasticity, an absolute refusal of any visible scar in front of the ear, and ideally thick hair that would easily hide the small hairline scars. She generally does not have pronounced laxity in the jowls.

Wrong candidate for the Ponytail Lift: a patient with thicker skin laxity, whose predominant sign of aging is located in the lower portion of the face (the jowls), and whose anatomy requires the skin itself to be redraped along with the deeper tissues. She will be better served by a full deep plane facelift performed with traditional incisions tucked in front of and behind the ear, allowing the tailoring and redraping of the skin along with the deeper tissues.

On midface fixation specifically, I want to be clear about how I have settled on my technique. For the midface I no longer rely on sutures alone to hold the lift. I use a small, well-designed surgical implant placed deep beneath the soft tissue (the Endotine Ribbon), which anchors the midface lift more durably than suture alone. In my hands, that combination delivers a stronger and longer-lasting midface lift than what I was getting with suture-only fixation, and Boston did not show me a long-term photo set that gave me a reason to change.

There is also a practical evolution in how I combine these techniques. Increasingly, when an open deep plane is the right operation, I run what I call a hybrid: the endoscopic Ponytail Lift approach (with the Endotine Ribbon midface fixation) takes care of the brows, forehead and midface, while the open deep plane technique handles the lower face and the deep neck. On the right patient, the hybrid gives the lift quality of an open deep plane in the lower face with the scar discipline of the Ponytail Lift across the upper two-thirds.

At Southwest Plastic Surgery, our consults focus on assessing your suitability for the Ponytail Lift, the open deep plane facelift, or the hybrid I just described. It is not one technique versus another. It all hinges on the desired and expected result at twelve months after surgery.

Update Three: AI on the Patient Experience, Not on the Operating Room

The third major theme of Boston was artificial intelligence, which should be approached carefully since it is the hottest, and perhaps the most overrated, subject in plastic surgery currently.

I went into the AI portion of the meeting with a stake in the conversation. I was one of the presenters in the practice-management AI track and spoke specifically on AI for reputation management in plastic surgery. That gives me a closer view of what is real and what is being oversold in this space, which is what I want to bring back to you and to our team.

The simple truth about AI at our practice, or honestly anywhere clinically applicable at the moment, is that it is not designing your facelift. The clinical AI demos shown at the meeting were surprisingly weak. I found zero reliable, ready-to-use, operating room-grade AI tool that would do this. The research is ongoing. The clinical applications are not there. So I am not going to push that angle.

What AI does work well on, and where we are already moving at Southwest Plastic Surgery, is the patient care experience. I want to be specific about what is already running. An AI chatbot is live on our practice homepage, available around the clock to answer your common questions, schedule consultations, and route the unusual concerns directly to the right person on our team. An AI scribe runs during consultations so that my eyes stay on you, not on a screen, and so that your visit summary is largely drafted by the time you walk out of the room. When you reach out through text message on a Sunday afternoon from California, or send a message at midnight with questions about your recovery, the wait until Monday morning is no longer necessary.

The same goes for our MedSpa side as much as the surgical side. Patients on their third session of Morpheus8 treatment, patients who have banked stem cells for YOU by Acorn, patients several visits into a hair restoration program, they all lead complex, multi-visit journeys that require ongoing communication between their appointments. The use of appropriate AI tools removes these bumps from the road while retaining the human touch and the warmth that makes coming to Southwest Plastic Surgery what it is.

What has not changed is who you see in the operating room during surgery. You will be accompanied by a board-certified surgeon, a board-certified anesthesia team, a recovery nurse and our entire team at Southwest Plastic Surgery that knows you by name. The AI sits as a front-end technology for the patient journey, not as an embedded tool that interrupts or replaces it.

Why Choose Southwest Plastic Surgery

As El Paso’s pioneering plastic surgery practice, Southwest Plastic Surgery was founded by me. I am double board-certified by both the American Board of Plastic Surgery and the American Board of Surgery, and I am a Fellow of the American College of Surgeons. I completed my plastic surgery fellowship at Mayo Clinic. I serve as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, and as an Affiliate Professor at the University of Texas at El Paso. Castle Connolly has recognized me as a Top Doctor for thirteen consecutive years, Texas Super Doctors Hall of Fame honored me in 2025, and Aesthetic Everything named me Top Plastic Surgeon for 2026. Southwest Plastic Surgery brings together surgical procedures and MedSpa services under one roof, planning your facial, body and skin care together rather than as separate, isolated concerns.

Ready to Talk?

If you are considering a facelift, the Ponytail Lift, a deep neck lift or one of Southwest Plastic Surgery’s MedSpa programs, your journey starts with a consultation. I will personally review the version of the operation best suited for your facial anatomy, outline the recovery you should prepare for, and clarify how and where AI will (and will not) fit into your experience with our practice.

To read more on this Boston meeting from a surgeon-to-surgeon perspective, see my piece on drworldwide.com: Three Days in Boston: A Surgeon’s Read on The Aesthetic Meeting 2026. For a patient-focused version on my personal practice website, see What I Brought Home From Boston on agulloplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book your appointment online at agulloplasticsurgery.com/appointments. Follow @RealDrWorldWide on Instagram, TikTok and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

This entry was posted on Monday, May 18th, 2026 at 11:31 am and is filed under Facelift, Plastic Surgery News. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

Patients walking through the doors at Southwest Plastic Surgery this year have started asking a question the practice did not get six months ago. “Is that the implant that gets you back to the gym in two weeks?”

The implant they mean is the Motiva Ergonomix, placed using a technique called Motiva Preservé. The two together represent the most significant change in breast augmentation that the practice has adopted in more than a decade. Dr. Frank Agullo, MD, FACS, the medical director at Southwest Plastic Surgery and a double board-certified plastic surgeon with a Mayo Clinic plastic surgery fellowship, has been placing the system for the past year. We sat down with him to walk through what it is, what it changes, and who the right candidate is.

What Preservation Means When a Plastic Surgeon Says It

“Look, preservation isn’t a marketing word in this context,” Dr. Agullo said. “It’s a commitment in the operating room. The breast tissue, the muscle attachments, the lymphatic drainage, the neural anatomy. All of it gets handled like it matters, because it does. The technique was designed around minimizing what we touch.”

In practical terms, that means a smaller incision (2.5 to 3 centimeters, hidden in the natural fold under the breast), minimal release of the pectoralis muscle, and a no-touch funnel that allows the implant to drop into its pocket without contacting skin on the way in.

The result is a recovery curve that the practice’s patients have described, somewhat sheepishly, as “weirdly easy.” Less swelling. Less tightness. Less of the bruised-rib soreness that defines the first week of a traditional submuscular augmentation.

Worth noting on the anesthetic side: the case in the photos on this page was performed under light sedation rather than general anesthesia, and the operation itself was completed in under an hour. The patient was discharged from our accredited surgical suite the same morning. The shorter anesthetic exposure is part of why the recovery profile compresses.

“The day after a traditional submuscular augmentation, patients describe themselves as wrecked,” Dr. Agullo said. “After Preservé, they describe themselves as sore. Two different words, two different recoveries. Honestly, that single change in how patients answer the post-op day-one question has been the most striking part of adopting this technique.”

The Implant: Motiva Ergonomix Full, 315cc in This Case

The Motiva Ergonomix is a sixth-generation silicone gel implant produced by Motiva (a division of Establishment Labs), the company that earned FDA approval for its silicone implants in 2024 after years of leading the implant market in Latin America and Europe. The implant uses ProgressiveGel Ultima inside the shell and a SmoothSilk surface on the outside that has been shown in published data to lower the rate of capsular contracture compared to older textured surfaces.

The shape is what differentiates the Ergonomix line. The gel inside is engineered to behave the way breast tissue does. Upright, the implant takes on a teardrop drape that reads as natural anatomy. Supine (lying on the back), it flattens and rounds the way real tissue would.

“That’s what patients react to when they see results,” Dr. Agullo said. “It’s not the volume. It’s how the volume behaves when she sits up, when she lies down, when she walks. The implant moves with her. Older implants don’t.”

The Full profile is one of three Ergonomix projection options Motiva offers in the United States (Mini, Demi, and Full). For a slim athletic patient who wants visible projection but a natural silhouette, Full sits at the upper end of the range. The patient in the photos on this page received 315cc, sized in the office before surgery using the Motiva Sizers and a long conversation about her goals. The practice’s full breast augmentation procedure page covers the broader category and the consultation process.

A Recovery Ladder That Holds Up

The recovery numbers patients keep asking about are, in Dr. Agullo’s words, the part that drove him to adopt the system. “I kept hearing the manufacturer claims and I didn’t believe them. So I went and trained on the technique, placed it in my own practice, and started keeping notes. The recovery profile is real.”

For a patient with this body type and implant choice, the Preservé recovery ladder at Southwest Plastic Surgery looks like this:

Time	Activity
Day 1	Back to desk work, off the heaviest pain medication, sleeping upright
Day 7	Showering normally, light walking, sleeping however she wants
Week 2	Back to lower-body gym programming and short runs, with a sports bra
Week 3	Compression bra off
Week 4	Full upper-body lifting with surgical clearance
Week 6	Implant in final pocket position, surgical recovery complete

“None of those numbers come from a brochure,” Dr. Agullo said. “I keep notes on every Preservé patient I place. The recovery times have not slipped. That’s the difference between a marketing claim and a real change in the operating room.”

How Preservé Compares to a Traditional Submuscular Augmentation

For patients comparing options, the short version:

Question	Traditional Submuscular	Motiva Preservé
Incision length	4 to 5 cm	2.5 to 3 cm
Muscle release	Significant	Minimal
Insertion technique	Direct hand placement	No-touch funnel preferred
Back to desk work	5 to 7 days	1 to 2 days
Back to upper-body lifting	6 to 8 weeks	2 to 3 weeks
Compression bra	4 to 6 weeks	2 to 3 weeks
Implant surface	Smooth or textured (varies by brand)	SmoothSilk
Implant shape behavior	Round or shaped, fixed	Ergonomic, position-responsive

Patients should understand that the technique is more demanding than a traditional submuscular augmentation, and the surgeon’s volume with the specific Motiva system matters. “I trained directly on the technique before I placed an implant in a patient,” Dr. Agullo said. “I would not place a Motiva implant the way I place every other implant in my OR. The technique is different and the implant rewards the difference.”

Where MedSpa Fits, and Where It Does Not

Southwest Plastic Surgery operates a clinic and a MedSpa under one roof. The MedSpa side handles Botox, fillers, Morpheus8 RF microneedling, BBL Forever Young, ElixirMD post-procedure recovery, laser resurfacing, hair restoration, and a regenerative aesthetics line that now includes YOU by Acorn.

For Preservé patients, the MedSpa intersects the surgical recovery in a specific way. ElixirMD post-procedure recovery is the practice’s structured early-recovery program. Lymphatic drainage massage and topical recovery support are layered in for patients who want the smoothest possible swelling curve. Patients who want their decolletage skin in optimal condition before surgery often start a Morpheus8 or microneedling protocol on the chest weeks or months in advance.

“What MedSpa is not, in the breast augmentation conversation, is a replacement for surgery,” Dr. Agullo said. “Filler in the breast isn’t a thing we offer here. We do real anatomy with real implants, and we use the MedSpa side to support the surgical recovery and the long-arc plan.”

Who Is the Right Candidate

The patient profile shown in the photos on this page is, in Dr. Agullo’s framing, one of the easier candidates to plan for. A young woman with adequate skin envelope, a defined inframammary fold, and goals that lean toward natural proportion rather than dramatic enlargement.

Patients with significant ptosis (drooping) may need a breast lift in addition to the augmentation. Patients with a history of prior augmentations and capsule issues need a more nuanced revision conversation. Patients with very thin tissue may need a different planning approach, with implant size and pocket choice tailored to their anatomy.

“Preservé is the default I now reach for first,” Dr. Agullo said. “But the planning is still individual. The right answer for the patient in front of me is the only answer that matters.”

About Dr. Frank Agullo

Dr. Frank Agullo is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. He is a Fellow of the American College of Surgeons, completed his plastic surgery fellowship at Mayo Clinic, and is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center as well as an Affiliate Professor at the University of Texas at El Paso. He has been named a Castle Connolly Top Doctor for thirteen consecutive years, was inducted into the Texas Super Doctors Hall of Fame in 2025, and was named Aesthetic Everything Top Plastic Surgeon for 2026. Southwest Plastic Surgery is an early adopter, in West Texas, of the Motiva Preservé breast augmentation system.

Two More Reads From Dr. Agullo Himself

For a more editorial take on Motiva Preservé, see his piece on drworldwide.com: Back to the Gym in Two Weeks: Motiva Preservé and What Preservation Surgery Actually Means.

For the longer clinical breakdown of the technique, the implant, and the recovery ladder, see his post on agulloplasticsurgery.com: What Preservation Breast Augmentation Looks Like on a Slim Athletic Body: A Motiva Preservé Case Study at 315cc.

See the case on social: originally posted by Dr. Agullo to Instagram and TikTok on @RealDrWorldWide.

Schedule a Motiva Preservé Consultation at Southwest Plastic Surgery

If you are weighing breast augmentation and want to understand whether Motiva Preservé is right for you, book a consultation. Dr. Agullo and the Southwest Plastic Surgery team will walk you through whether the technique fits your anatomy and your goals, whether the volume you have in mind makes sense for your frame, and where the MedSpa side of the practice can support your recovery on either side of surgery.

Call (915) 590-7900, text 1-866-814-0038, or book a consultation online. Follow Dr. Agullo on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

This entry was posted on Wednesday, May 13th, 2026 at 7:20 pm and is filed under Breast Augmentation. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

Last week HuffPost ran a personal essay from a mother of three who paid out of pocket to repair what three pregnancies had done to her abdominal wall. The headline did the heavy lifting. The story underneath it landed because the experience is common, the operation that fixes it is well understood, and the reason it gets paid out of pocket has very little to do with medicine.

The editor reached out to Dr. Frank Agullo, the medical director at Southwest Plastic Surgery and a double board-certified plastic surgeon in El Paso, for a surgeon’s read on why these repairs are so often denied. His answer, as he puts it, is the one he gives every postpartum patient who walks into his consult room with a soft belly, a sore lower back, and a primary-care note that says “core work.”

“The word cosmetic is doing a lot of work in that sentence,” Dr. Agullo says. “Most of it is wrong.”

This piece walks through what diastasis recti actually is, how the team at Southwest Plastic Surgery diagnoses it, what the operation involves, where physical therapy fits, where the MedSpa fits, and why insurance still treats a structural problem as if it were a vanity one.

What Diastasis Recti Actually Is

The rectus abdominis is the long paired muscle running down the front of the torso, one belly on each side of the midline. The thin sheet of connective tissue between them, the linea alba, is what keeps the two bellies tethered at the midline so the abdominal wall behaves as a single pressurized box. Pregnancy stretches that sheet. Sometimes it stretches and recovers. Sometimes it stretches and stays stretched. When it stays stretched, the two rectus bellies sit further apart than they did before. The abdominal wall has lost the closed front it had.

That is diastasis recti. The muscles are not injured. The wall between them is.

“Look, the rectus muscles are fine,” Dr. Agullo tells patients on the table during the exam. “The tissue between them is what gave. And tissue that has lost its length does not get it back from a workout.”

The Symptoms That Are Not Cosmetic

When the abdominal wall loses its tension, the lower back takes more of the load. Pelvic floor symptoms get worse, because the abdomen and pelvic floor work as a coordinated pressure system, and the box only holds pressure if every side of the box is doing its job. Some patients develop a visible dome when they sit up from lying flat, where the contents of the abdomen push into the space between the separated muscle bellies. Some develop a true umbilical or ventral hernia.

“I’ll see a patient who’s been on muscle relaxants and anti-inflammatories for years,” Dr. Agullo says. “She’s been to a chiropractor. She’s been to pelvic floor PT. She’s leaking when she runs with her kids. Her primary care doctor never put her flat on the table and asked her to lift her head. So nobody ever told her that her abdominal wall is open.”

That last sentence is, by his read, the central clinical failure. Diastasis is a bedside diagnosis. It is not subtle once you look for it. And it almost never makes it into the postpartum visit.

How the Team Tells Diastasis Recti From the Things It Gets Confused With

There are three different problems that all show up as a soft belly after pregnancy. They get conflated constantly. Southwest Plastic Surgery uses a quick comparison to separate them:

	Diastasis Recti	Loose Skin Only	Soft Postpartum Belly
What is separated	Linea alba is stretched, rectus muscles sit apart	Nothing structural	Nothing structural
Visible sign	A dome or ridge when sitting up from lying flat	Skin laxity, stretch marks	Soft fullness that responds to weight loss
Back pain pattern	Common, often years of it	Uncommon	Uncommon
Pelvic floor symptoms	Common	Uncommon	Uncommon
Hernia risk	Real	Low	Low
Helped by core PT alone	Sometimes, sometimes not	No	Yes
What a real repair requires	Plicating the rectus muscles back to midline, surgically	Skin excision	No surgery at all
Typical insurance label	“Cosmetic”	“Cosmetic”	N/A

“PT works for the patient who has a small residual gap and good motor control,” Dr. Agullo notes. “It does not work for the patient whose linea alba is permanently stretched. PT cannot close a hernia. It cannot reattach a sheet of collagen that has lost its length. When PT is the answer, we send the patient to PT. When it is not, we say so.”

How Dr. Agullo Plans a Repair

The consultation starts with the patient supine, head off the table, like she is mid curl-up. Dr. Agullo measures the inter-rectus distance at three levels: above the navel, at the navel, and below. He notes the depth of the gap as well as the width. He looks for a coexisting hernia at the umbilicus, because a small one is easy to miss and changes the operation.

For complex cases (prior abdominal surgery, very obese patients, atypical pain), he orders an abdominal ultrasound or a CT before he books anything. He wants to know whether what he is feeling is a pure diastasis or a diastasis hiding a hernia inside it.

“Different operation, different conversation,” he says. “I want to know before I plan, not in the OR.”

When repair is the right answer, it is most often done as the muscle component of a tummy tuck. The skin and subcutaneous tissue of the lower abdomen are elevated off the muscle layer. The rectus sheath is exposed from the xiphoid all the way to the pubis. The plication runs the full length of the diastasis. The closure is layered: long-acting absorbable suture on the inner layer, permanent suture on the outer layer. A hernia, if there is one, is repaired in the same operation, with mesh in selected cases. The umbilicus is released and reset through the new midline.

“Tension balance is the whole game,” Dr. Agullo says. “Close it too tight in one segment and that segment fails. Close it correctly across the full length and it holds for decades. The peer-reviewed durability data is on the side of the technique. The technique just has to be right.”

What Recovery Looks Like (Honestly)

The first week is the hardest. The repair is tight, the patient is flexed at the waist to protect the closure, and pain management is the main job. Walking starts day one (short flat-footed steps) and expands every day. Drains, if used, typically come out somewhere in week two. By week three the swelling has peaked and is starting to come down. By weeks four to six, the patient is on light cardio. Core work waits until Dr. Agullo clears it, usually around eight to twelve weeks, and resistance training expands from there.

Pelvic floor symptoms often improve within the first three months. Some patients report immediate relief from urinary leakage on the first cough after waking up from anesthesia. Back pain driven by the lost abdominal tension generally improves on the same schedule as the closure heals.

“By a year, the scar has matured and the result is the result,” he says. “A repair done well lasts. A repair done poorly is a redo with a scar she did not have before.”

Where the MedSpa Fits, and Where It Does Not

The MedSpa team at Southwest Plastic Surgery does not treat diastasis recti. Nothing at the MedSpa closes an open midline. There is no laser, no radiofrequency device, no peptide that reattaches a sheet of stretched collagen. Patients who hear otherwise are being misled.

Where the MedSpa is genuinely useful is around the surgery, not instead of it.

• Stretch marks. Patients who have stretch marks across the lower abdomen often want them addressed at the same time. Most of the obvious stretch marks are excised along with the lower-abdominal skin during the tummy tuck itself. Residual marks above the umbilicus are candidates for fractional laser or RF microneedling (Morpheus8) at the MedSpa once healing is complete.
• Scar care. Once the tummy tuck scar matures, usually six months out, RF microneedling can soften it and improve texture. Topical silicone and a few months of disciplined scar care from the post-op nursing team usually does most of the work, and the MedSpa picks up the rest.
• Skin tone and texture. Patients who want their abdominal skin to look like the rest of their body book the occasional radiofrequency or laser session at the MedSpa. None of this is required. All of it is optional.
• Post-op recovery support. The practice offers structured post-op recovery protocols, post-surgical lymphatic massage where indicated, and access to the in-house nursing team for the first six weeks. The ElixirMD regimen is available for patients who want a structured post-op skincare protocol layered on top.

“The MedSpa cannot fix a diastasis,” Dr. Agullo puts it flatly. “Anyone who tells you it can is selling you something. What it can do is take care of the patient after the repair, so the result feels complete. That is its job. We do not blur the two.”

Why Insurance Still Calls It Cosmetic

The pattern is consistent. Insurance pays for years of physical therapy that did not solve the problem, for the medications that managed the back pain instead of treating the cause, for the pelvic floor consults, and eventually for the hernia repair when the umbilical hernia finally herniates badly enough that the structural argument is impossible to dismiss.

What insurance will not pay for is the single operation that closes the wall before all of that.

“That is not medical sense,” Dr. Agullo told HuffPost. “That is accounting. The word cosmetic is being used as an exclusion code, not a clinical description. There is a real peer-reviewed body of work on the functional outcomes of diastasis repair. A handful of insurers are catching up. Most are not. And so the patient pays out of pocket for the operation that should have been covered the day she presented with documented symptoms.”

The practice does not pretend insurance will pay for these repairs. It quotes the surgery transparently up front, finances responsibly through the practice’s standard programs, and makes sure the patient understands the operation she is signing for. Where there is a clear hernia component, the team does help patients document the medical case for partial coverage. Sometimes that works. Often it does not.

Two More Reads, Both Written by Dr. Agullo Himself

For a shorter editorial take on the same HuffPost conversation, see Dr. Agullo’s piece on drworldwide.com: The Repair Your Insurance Calls Cosmetic: Diastasis Recti After Three Babies.

For a longer clinical walkthrough (diagnosis, surgical technique, recovery week by week), see the agulloplasticsurgery.com version: Diastasis Recti Repair: What Pregnancy Stretches, What PT Can and Cannot Fix, and Why Insurance Still Calls It Cosmetic.

Why Southwest Plastic Surgery

Dr. Frank Agullo is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. He completed his plastic surgery fellowship at Mayo Clinic. He is a Fellow of the American College of Surgeons, a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, and an Affiliate Professor at the University of Texas at El Paso. He has been named a Castle Connolly Top Doctor for thirteen consecutive years, from 2014 through 2026. Southwest Plastic Surgery is the practice he founded in El Paso, with a busy surgical practice and a full-service MedSpa under the same roof.

Schedule a Tummy Tuck Consultation at Southwest Plastic Surgery

If you have been carrying around five years of “just being a mom” and a primary-care file that never mentioned the words diastasis recti, come in. Dr. Agullo and the Southwest Plastic Surgery team will examine you, document what they find, and tell you honestly whether you need surgery, whether physical therapy is still your best move, or whether the answer is somewhere in between.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow along at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful.

This entry was posted on Tuesday, May 12th, 2026 at 4:23 pm and is filed under Body Contouring, Mommy Makeover, Recovery, Tummy Tuck. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

The weight loss conversation has changed. Five years ago, a patient asking for help with the last thirty pounds left with a meal plan, a workout routine, and a follow-up booked at three months. Today she’s asking about a vial. Most of the time, she wants to know whether to start a GLP-1, which one, and who’s actually going to supervise her on it. The answers she gets online aren’t the answers a real medical practice would give her.

Southwest Plastic Surgery has launched a medically supervised GLP-1 weight loss program in El Paso. Dr. Frank Agullo, MD, FACS, is the medical director. The practice’s nurse practitioner runs day-to-day clinical care. The program offers three different compounded GLP-1-class medications: semaglutide, tirzepatide, and retatrutide. The choice between them is clinical, made at intake, with both the prescribing NP and Dr. Agullo on the case.

We sat down with Dr. Agullo to walk through how the program works, who it’s for, and why a plastic surgery practice ended up running one in the first place.

Why a plastic surgery practice runs a weight loss program

The first question patients tend to ask is why a body contouring surgeon would build a medically supervised weight loss program when there are pharmacies, online platforms, and standalone clinics already offering GLP-1 prescriptions all over El Paso.

The answer, Dr. Agullo says, is partly about who’s walking into his office now, and partly about what happens to those patients downstream.

“Eighteen months ago, almost none of my body contouring consults involved weight loss medication. Today, more than half of them do. Either she’s already on a GLP-1, or she’s asking whether she should be. Which drug, what dose, what supervision: those are real medical decisions, and I want them made by people who have eyes on the surgical plan, not just the medication.”

The supervised structure is what the practice considers non-negotiable. Online ordering, weekend telehealth services, and Instagram-based brands have flooded the GLP-1 space, often with no meaningful clinical oversight at all. The Southwest Plastic Surgery model is built the other direction. Labs at intake on every patient. Dosing changes reviewed clinically, every time. Anyone with a complication has the office on speed dial.

“This is medicine,” Dr. Agullo told us. “Pancreatitis is real. Gallbladder problems are real. Gastroparesis is real. These drugs are mostly very well tolerated, but they aren’t vitamins, and the patients on them deserve a clinical team that picks up the phone.”

Three medications, three different mechanisms

Program patients have access to three different compounded GLP-1-class medications. They aren’t interchangeable, and the choice between them is clinical.

Semaglutide is a single-receptor GLP-1 agonist. Mimics the gut hormone GLP-1, which signals satiety to the brain. Trial data shows roughly fifteen percent body weight loss at twelve months. For most program patients, this is the first-line drug.

Tirzepatide is a dual-receptor agonist. It mimics GLP-1 and a second hormone called GIP. The added receptor appears to spare lean mass while pushing weight loss further. Trial data lands closer to twenty percent at twelve months. The program moves patients to tirzepatide when sema plateaus, when a larger loss is needed, or when the clinical picture suggests it’s the right starting drug.

Retatrutide is the newest. A triple-receptor agonist hitting GLP-1, GIP, and glucagon. Early-phase data shows weight loss closer to twenty-five percent at a year. The program offers it as a compounded formulation for select candidates, with a higher level of supervision than the other two.

“Patients sometimes assume the newest drug is the right drug for them,” Dr. Agullo says. “Sometimes it is. Often it isn’t. The right answer is the one that fits her medical history, her goal, and her trajectory. It’s a conversation, not a checkout cart.”

Who the program is for, and who it isn’t

The program fits three patient archetypes the practice sees most often.

First is the surgical-readiness patient. She wants body contouring surgery, often a tummy tuck or a BBL, and her current weight puts her at the margin of candidacy. The program serves as a structured on-ramp, often three to five months long, that takes her into a stronger surgical candidacy zone before her surgery is scheduled. (For more on this case, see the post on agulloplasticsurgery.com.)

Second is the postpartum or perimenopausal patient. Thirties, forties, fifties. Working hard at the same diet and exercise that used to work in her twenties. Watching the scale not move. The program offers a medically appropriate medication option to break the plateau, and a supervised structure to do it inside.

Third is the general wellness patient. She doesn’t want surgery, has no specific cosmetic goal, and just wants to lose twenty to fifty pounds in a way that’s medically real and not based on an internet protocol. We run her with the same level of care as everyone else.

The program doesn’t enroll everyone. Personal or family history of medullary thyroid carcinoma is a hard exclusion. So is MEN type 2. So is active pancreatitis or significant pancreatic disease. Severe gastroparesis. The intake screen catches contraindications before the first dose is prescribed.

Where MedSpa fits, and why it matters after weight loss

The Southwest Plastic Surgery MedSpa side becomes meaningfully more useful for patients who have lost weight on a GLP-1, in part because rapid weight loss reveals laxity that the underlying weight had been hiding.

Patients in the program often pair their medication arc with non-surgical treatments timed to address what shows up after the weight comes off. Morpheus8 radiofrequency microneedling for skin tightening on the lower face, neck, and abdomen. BBL Forever Young for skin tone and texture. Renuvion (J-Plasma) for selected candidates with looser tissue. Strategic injectables for the volume changes that show up in the face after a thirty-pound loss.

“The MedSpa is not a substitute for surgery, and surgery is not a substitute for the MedSpa,” Dr. Agullo said. “The honest answer is that they sit on top of each other in different parts of a patient’s arc. A weight loss program is one of those parts, and the MedSpa is another, and a body contouring procedure is a third. We plan all three together when that is what the patient needs.”

The cost question, briefly

The program is structured as a month-over-month medical service that includes the prescribing visit, the medication, the labs at intake, and the follow-up cadence the patient’s case requires. Specific pricing is reviewed at the intake visit and is dependent on which compound is selected and which dose the patient is on. The practice does not publish month-by-month pricing online because pricing is, in most cases, a clinical decision rather than a fixed-tier decision.

What the program does not do is sell a vial-of-the-month subscription with no oversight. The price reflects medical care, not a shipping schedule.

What new patients should expect at intake

A new patient’s first visit involves a medical history review, an examination, intake labs (a standard panel including comprehensive metabolic, lipid, A1C, and thyroid function), and a clinical conversation about goals, contraindications, and which compound is the appropriate first-line drug. Most patients leave the intake visit with a prescribed first dose. A small number of patients leave with a referral elsewhere because the program is not the right fit for their case, and the practice considers honest screening at this stage to be the most important step in the process.

About Dr. Frank Agullo, MD, FACS

Dr. Frank Agullo is the medical director of Southwest Plastic Surgery and the medical director of the practice’s GLP-1 weight loss program. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and a Mayo Clinic plastic surgery fellowship alum. He serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center and as an Affiliate Professor at the University of Texas at El Paso. He has been named a Castle Connolly Top Doctor for thirteen consecutive years. Roughly sixty percent of his body contouring patients fly into El Paso from out of town.

Read more on the broader GLP-1 conversation

For an editorial perspective on the cultural and aesthetic side of GLP-1 therapy, see Dr. Agullo’s piece on his personal blog: The Vial in the Vanity: A Plastic Surgeon’s Honest Read on the GLP-1 Glow-Up.

For a deeper clinical view of GLP-1 therapy as a path to body contouring surgery, see the post on the practice’s medical-grade blog: Dropping the Weight Before the Tummy Tuck: How GLP-1 Therapy Is Reshaping Who Qualifies for Body Contouring.

Schedule a consultation at Southwest Plastic Surgery

Southwest Plastic Surgery is the El Paso practice of Frank Agullo, MD, FACS. To schedule a consultation for the GLP-1 weight loss program, body contouring, or any of the practice’s MedSpa services, call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

This entry was posted on Monday, May 11th, 2026 at 7:17 pm and is filed under Med Spa, Medical Weight Loss. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

If you have walked through the doors at Southwest Plastic Surgery in the last few months, you may have noticed a small refrigerated case at the MedSpa station that was not there a year ago. Inside are personalized vials, each labeled with a single patient’s name, holding a serum that did not exist on the United States market until very recently.

The product is called YOU by Acorn. Each patient’s vials are made from the growth factors and proteins produced by their own hair follicle mesenchymal stem cells. The cells are collected at our MedSpa, shipped to Acorn Biolabs (a Canadian company that runs its lab in California), expanded and stressed in culture for fifteen days, and the secretome they produce is what comes back as that patient’s personal serum. Our medical director, Dr. Frank Agullo, MD, FACS, has been using it on his patients (and on himself) since the start of the year. We sat down with him to walk through what the product actually is, where it sits among the regenerative options on the market, and why the practice has folded it into our MedSpa programs alongside Morpheus8, microneedling, and hair restoration.

So What Does Secretome Mean, Really?

“Look, the first generation of stem cell hype got the basic idea wrong,” Dr. Agullo said. “People thought you’d put stem cells in someone and they’d turn into the tissue you wanted. They don’t, mostly. What they actually do, when they’re alive in the body, is read the room. They sense what the surrounding tissue needs, and they secrete the signals to make that tissue healthier. That secretion, the whole package of it, is the secretome.”

Concretely, that package includes growth factors, cytokines, collagens, proteins, and exosomes (the carriers). All in the proportions a patient’s own cells produced when they were stressed in a lab.

A point Dr. Agullo wants to be very clear on, because patients keep asking: the bottle is the secretome, not the cells. “The vial doesn’t contain stem cells. It contains everything those cells made when we put them to work. The cells themselves are banked separately, frozen, stored as the patient’s property. Two different products from one collection.”

The signal that matters is autologous. “It’s yours. It comes from cells we collected from you. There’s no donor. There’s no rejection risk. Your body already recognizes everything in the bottle as part of you.”

Where the Cells Come From (and Why Fifty Hairs Is Enough)

There are three ways clinicians have historically tried to harvest mesenchymal stem cells. Aspirating the iliac crest, which is painful. Pulling them out of liposuctioned adipose tissue, where they are surrounded by oils and difficult to isolate. Or, more recently, plucking them from the base of hair follicles. That third option is the one Acorn built its platform around.

“There are roughly 1,500 to 4,500 mesenchymal stem cells at the base of every one of your follicles,” Dr. Agullo said. “We pluck about fifty hairs from the back of the scalp, where the nerve density is forgiving. The lab needs about twenty-seven viable follicles to bank a patient. Fifty gives the lab enough cushion to get a clean run.”

Patients keep telling us, somewhat sheepishly, that the collection is the easiest part of the visit. Dr. Agullo agreed, with a laugh: “Honestly, this is the least painful thing that happens at our clinic. Let’s be real.”

What Ends Up in Each Vial

A first-time YOU by Acorn collection produces a personalized batch of twelve 2cc vials, refrigerated, ready for use over multiple visits. (For patients who are not sure they want to commit to the full course, the lab also offers a six-vial entry option.)

The published characterizations Acorn shares with prescribing clinicians:

• About 5 billion exosomes per vial
• Approximately 34 times the concentration of the best platelet-rich plasma a patient could draw on a healthy day
• 18-month shelf life refrigerated, no preservatives
• FDA-cleared use today: topical application onto skin after microchannels are made by microneedling, Morpheus8 RF microneedling, or fractional laser resurfacing, and topical application onto the scalp after microneedling for hair

That is the full FDA-cleared use case as of this writing. YOU is not an injectable. The product is delivered into the brief few-hour window after a procedure has opened thousands of microchannels into the dermis or scalp.

How It Stacks Up Against PRP, PRF, Recombinant PDGF, and Generic Exosomes

This is the table the team uses with patients in MedSpa consults. It is also the cleanest way to see why Dr. Agullo changed his mind about generic exosomes.

What it is	Source	Blood draw?	Dose consistency	Where it fits at SWPS in 2026
PRP (platelet-rich plasma)	Patient’s own blood, single spin	Yes	Drops measurably with age and patient health on the day of draw	Reasonable for younger, healthier patients. We still use it.
PRF (platelet-rich fibrin)	Patient’s own blood, slower spin	Yes	Slightly more consistent than PRP. Less age-dependent.	Useful scaffold for under-eye and orthopedic indications.
Recombinant pure PDGF (Ariessence pure PDGF+)	Recombinant rhPDGF-BB in HA	No	Identical dose every kit	Excellent post-microneedling topical when one specific signal at a controlled dose is the goal.
Generic donor exosomes	Cultured donor stem cell media, often filtered to exosomes only	No	Rarely characterized. Carriers without published payload.	Not used at SWPS.
YOU by Acorn secretome	Patient’s own follicle-derived mesenchymal stem cells, expanded and stressed in lab. Bottle is the secretome only; cells are banked separately.	No (one painless follicle pluck)	The same biology the patient’s body produces, concentrated, characterized	Default for patients who want the broadest, most personalized regenerative signal currently available, applied through microneedling, Morpheus8, or fractional laser channels.

“Honestly, the generic exosome conversation is the one I’m happiest to retire,” Dr. Agullo said. “An exosome by itself is a carrier. An empty Easter egg unless you actually know what’s loaded inside it. Most exosome bottles ship the carriers without the surrounding signal, and without published assays of the payload. With YOU, we have both. The carriers, the cargo, and the data.”

Where It Fits in Our MedSpa, Treatment by Treatment

YOU is a topical that requires microchannels in the skin or scalp to reach the compartment that responds to it. The currently FDA-cleared applications are post-microneedling, post-Morpheus8 RF microneedling, post-fractional laser, on the face, and post-microneedling on the scalp for hair. That is where most patients first encounter the product.

For Morpheus8 RF microneedling, the team typically reconstitutes two YOU vials with the topical-grade hyaluronic acid that ships with the kit, and the secretome solution is applied immediately after the radiofrequency pass and rolled or microneedled into the freshly opened channels. Patients can take a small dropper home and continue topical application twice a day while the channels are still open. The recovery window has been visibly shorter for patients on this protocol.

For fractional laser resurfacing and decollete work, twelve vials disappear quickly, and the post-procedure recovery profile has been consistent with what we see on Morpheus8.

For hair restoration, we use YOU for Hair as a microneedled scalp treatment in series. Patients already invested in PRP or PRF for hair do not have to choose between regimens. We layer the secretome into their existing schedule for one or two sessions and let them tell us what they prefer once they have seen both.

A Surgical Sidebar: Dr. Agullo’s Own Experiment

For patients curious about what the protocol actually looks like in practice, Dr. Agullo has been candid about running it on himself before recommending anything to patients.

“I’m fifty-two,” he said. “I’ve been on GLP-1s for about a year. Lost roughly thirty pounds. There’s no question my skin would have lost more elasticity than it has if I hadn’t been keeping up with my MedSpa protocol. So I scheduled a Morpheus8 session in my own clinic, microneedled two cc of YOU by Acorn into the freshly channeled tissue, and went home. One week later, my wife noticed. She said my face looked better than it had a week earlier. Morpheus8 alone is good. Morpheus8 with YOU was different. The recovery was visibly faster, and the skin quality at one week looked like what I would have expected at three weeks.”

Cell Banking, and Why Patients Are Signing Up at Any Age

Every YOU by Acorn collection cryopreserves one quarter of the patient’s mesenchymal stem cells. Those cells are stored at the age the patient was on the day of collection, and they remain the patient’s property. Acorn’s banking subscription includes individual and family options.

For patients reading this who are wondering whether they are too old, Dr. Agullo’s clinical answer is encouraging: “We’ve banked patients as old as eighty-two. As long as the lab confirms viable stem cells in the collection, age is not a hard limit. The product isn’t reversing the biological clock. But the secretome we generate from the youngest banked version of you is, by definition, the youngest version of your own signaling we can still get our hands on.”

Acorn’s lab can also induce banked mesenchymal stem cells back into a pluripotent state and derive lineages including bone, cartilage, pancreatic cells, neurons, and natural killer cells. The clinical translation of that work is years away. The bank, in the meantime, gives patients the option to make their own cells available, with their consent, to future therapies derived from their own biology.

Where MedSpa Fits, and Where It Does Not

YOU by Acorn lives in our MedSpa programs, paired with Morpheus8, microneedling, fractional laser, ElixirMD post-procedure recovery, and our hair restoration protocols. It is not a substitute for sunscreen, a retinoid, or the procedure itself. And it is not, in Dr. Agullo’s framing, a turn-back-the-clock product.

For the patient whose conversation needs to start with surgery rather than MedSpa (a deep plane facelift, a Ponytail Lift, a breast preservation program, a body contouring plan), YOU is a complement on the recovery side rather than the answer. The team will tell you that directly in the consult.

About Dr. Frank Agullo

Dr. Frank Agullo is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. He is a Fellow of the American College of Surgeons, completed his plastic surgery fellowship at Mayo Clinic, and is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center as well as an Affiliate Professor at the University of Texas at El Paso. He has been named a Castle Connolly Top Doctor for thirteen consecutive years, was inducted into the Texas Super Doctors Hall of Fame in 2025, and was named Aesthetic Everything Top Plastic Surgeon for 2026. Southwest Plastic Surgery is an early West Texas adopter of the Acorn Secretome, which won a 2026 NewBeauty Award; Acorn Biolabs was named to Fast Company’s list of Most Innovative Companies of 2026.

Two More Reads From Dr. Agullo Himself

For a more editorial take on YOU by Acorn, see his piece on drworldwide.com: Fifty Hairs From the Back of My Head: YOU by Acorn and the End of the Exosome Hype Cycle.

For the longer, clinical breakdown comparing YOU to PRP, PRF, recombinant pure PDGF, and generic donor exosomes, see his post on agulloplasticsurgery.com: From Your Scalp to Your Face: A Plastic Surgeon’s Look at YOU by Acorn Vs. PRP, PDGF, and Generic Exosomes.

Schedule a YOU by Acorn Consultation at Southwest Plastic Surgery

If you are scheduling Morpheus8, microneedling, fractional laser, or one of our hair restoration protocols, and you want to know whether YOU by Acorn fits your plan (and whether banking your stem cells now is the right call for your decade), book a consultation. Dr. Agullo and the Southwest Plastic Surgery team will walk you through whether the secretome belongs in your protocol, whether PRP, PRF, or recombinant pure PDGF is a better match for the procedure you are considering, and where the MedSpa side of our practice supports the surgical side over the long arc of facial aging.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow Dr. Agullo on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

This entry was posted on Wednesday, May 6th, 2026 at 9:09 am and is filed under Med Spa, Non-surgical Procedures, Skin Treatments. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

May is on the board at our Med Spa, and my team built three specials around the same idea. Renew. Restore. Revive. One per word. All three running at our Eastside office on George Dieter and our Westside office on Silver Springs, all month.

I want to spend a few minutes telling you who each one is for, because they are not interchangeable, and the most useful thing I can do for somebody scrolling our practice site this week is help her figure out which of the three is actually meant for her.

Renew. Laser tattoo removal at 20 percent off per session.

Of the three on the May board, this one is the longest commitment, and I want patients to hear that part of it before they hear the discount.

Tattoo removal is never one appointment. It is a course. Six to ten sessions on most tattoos, six to eight weeks between each one. Most patients hate hearing that, and I do not blame them. The reason for the spacing is not a sales tactic. It is the physiology. The laser fragments the ink. Your own immune system carries the broken pigment away. Stack the sessions too tight and the skin pays for it. Space them right and the tattoo lifts cleanly.

The 20 percent applies per session. So a patient who locks in the full course in May rides the discount for the whole run. On a sleeve that adds up to hundreds of dollars. On a back piece, more. If you have been postponing tattoo removal because of the price, this is the month.

A few honest notes on candidacy. Black ink and dark blue ink are easy. Reds and warm yellows take more sessions. Cosmetic eyebrow tattoos and amateur ink are usually quick. Old, multi-layered professional work is the long road. We will tell every patient at the consult what a realistic course looks like for the specific tattoo on the specific skin in front of us. If a clinic anywhere is promising you three-and-done on a real tattoo, walk out.

Two things I am rigid on. One. Sun avoidance between sessions. Sunscreen every day on the treated area for the entire course. The patient who hits the laser, then goes to the pool, then comes back six weeks later asking why her skin looks unhappy is a story I have watched more times than I want to admit. Two. Respect the spacing schedule. Compressing the timeline does not get the tattoo off faster. It gets the skin angry.

Restore. The Mother’s Day Radiance Facial, $125.

I am picky about facials. Most facials are not medical. They are pleasant. Skin looks slightly better for forty-eight hours and then nothing has actually changed.

The Mother’s Day Radiance Facial my team built for May is structured differently. It is medical-grade exfoliation, deep cleansing, and active serums chosen by our aesthetician based on what your skin is doing the day of the appointment. It is not a fixed protocol. It is a treatment facial that adjusts to the patient.

At $125, this is one of the easier yes’s I can give a patient.

I am seeing three different people book this one.

A daughter buying for her mom. The card prints cleanly. The mother walks out with skin care she would not have bought for herself. Best $125 you can put on a Mother’s Day card and we both know it.

A patient buying for herself, no apology, no permission. A forty-something or fifty-something woman who decides on a quiet Tuesday to drop $125 on her own face. I see this more every year and I approve of every one of those bookings.

A pre-event patient. Wedding next month. Reunion. A photographed thing on the calendar somewhere. The window is twelve to fourteen days before the event. Far enough that any treatment redness has settled. Close enough that the glow is still on the skin in the photographs. I am rigid about that timing.

What this facial is not. Not a chemical peel. Not a laser. It will not undo a decade of sun damage in a single afternoon, and any clinic that pretends otherwise is selling you a story. It is the maintenance layer of a real skin program. Used as such, it earns its $125.

Revive. The Mother’s Day Refresh, $3,650.

This is the special on the May board worth reading carefully, because the structure of the package is the part that makes it interesting.

A standard injectable package is sold by the syringe. One syringe of this. Twenty units of that. Same numbers on every face that walks in the door. Convenient for billing. Not great for outcomes. Faces are not standardized.

The Refresh is built the other way around.

The package combines dermal filler with an upper-face neuromodulator, the wrinkle relaxer used in the forehead, between the brows, and around the crow’s feet. The phrase the flyer uses is “nurses’ discretion.” That phrase is the whole point.

What it means is this. My injecting nurse has the budget, in the room, to spend product where the face actually needs it. If the upper face is dominant, the toxin moves there. If the cheekbones are flat, the filler concentrates in the malar area. If the lower face is intact and your real complaint is fine perioral lines, the package goes there. The nurse is looking at the whole face and allocating accordingly. Not counting units off a price list.

This is how I want injectables done.

I should also make my standard speech about filler.

Filler is a tax. A facelift is an investment. I keep saying that line because it keeps being true. The patient who has been getting filler every six months for ten years is the patient who often cannot tell where her face ended and where the filler began. The Refresh, used correctly, is the right kind of filler appointment, balanced, not run on a quota. But it does not replace a face that has structurally changed. If your face has dropped, the conversation needs to be a surgical one with me, not another injectable package. My team will route you to that consult before they will sell you the Refresh under the wrong premise. That is not bad for business. That is how a real practice operates.

Two cautions I want every Refresh patient to walk in with.

A first-time injectable patient should know that the result is a quieter, more rested version of the same face. Not a different face. Patients who confuse those two outcomes are the patients who are unhappy at follow-up regardless of how technically clean the work was.

A patient with a face that has changed materially in the last decade should book a surgical consult with me before booking the Refresh. We can use the package after surgery, not in place of it.

A clean side-by-side

Special	What it is	Investment	Best for
Renew	Laser tattoo removal	20 percent off per session	Patients ready for a real course of removal, lock in the discount across the run
Restore	Mother’s Day Radiance Facial	$125	A meaningful gift for mom, or a maintenance reset for the patient herself
Revive	Mother’s Day Refresh	$3,650	Dermal filler plus upper-face wrinkle relaxer, balanced across the face by my injecting nurse

Where to come, East or West

The Med Spa at Southwest Plastic Surgery runs out of two El Paso locations and the May specials are valid at both.

The Eastside office is at 1387 George Dieter Drive, Building C, El Paso, Texas 79936.

The Westside office is at 5925 Silver Springs Drive, Suite C, El Paso, Texas 79912.

My Med Spa team works across both sites. Same protocols, same products, same supervising physician. Pick the side of town that fits your week and your commute.

Who is supervising the work

I am Frank Agullo, MD, FACS, double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and a Mayo Clinic plastic surgery fellowship alum. I serve as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center and Affiliate Professor at the University of Texas at El Paso. I have been named a Castle Connolly Top Doctor for thirteen consecutive years. The Med Spa runs under my license and on protocols I have written. That is the bar.

For two more reads on the same three specials.

The editorial take is on my personal blog, drworldwide.com: Renew, Restore, Revive: The May Med Spa Specials I’d Actually Book.

The longer clinical version is on my medical-grade blog, agulloplasticsurgery.com: Mother’s Day at the Med Spa: A Plastic Surgeon’s Read on Three May Specials Worth Booking.

Schedule a Med Spa appointment at Southwest Plastic Surgery

To book any of the May specials at our Eastside (1387 George Dieter Building C) or Westside (5925 Silver Springs Suite C) Med Spa, call (915) 590-7907. For surgical or combined consults with me, call my main practice line at (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

This entry was posted on Monday, May 4th, 2026 at 4:22 pm and is filed under Med Spa, Tattoo Removal. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

Three weeks after surgery, a deep plane facelift patient sat down across from me at her two week visit. She lifted the hand mirror she had brought, looked at her own face, and asked the question I get more often than any other in that chair. “Why do I feel this good already?” The bruising she had braced for never really showed up. The fatigue lasted four days. She had slept the night of surgery and every night since.

I told her the truth. Part of it is the operation itself. A well-executed deep plane facelift releases the four retaining ligaments and repositions the soft tissue without tension, which means less swelling and less bruising than a traditional skin-tightening lift. Part of it is anesthesia and a meticulous closure. And part of it, increasingly, is what I add on the back end. A short, supervised peptide protocol that I have been refining for several years and that we now offer almost every surgical patient at Southwest Plastic Surgery.

More and often than not, when patients request I write peptide protocols, this is why. The recovery benefit is only one application for these molecules. Many patients use these molecules as part of an enhanced fitness and wellness program, for instance, they’ll use these peptides exclusively for support on their skin health, boost their immune and energy systems and ward off aging, which have nothing to do with post-surgery support. This specific article addresses only surgical recovery. If you wish to read my article concerning these peptides as a standalone benefit within a wellness program, please refer to the hyperlink found at the end of the document.

What a peptide actually is

A peptide is a short string of amino acids. The body makes thousands of them every day to send signals between tissues. Insulin is a peptide. Oxytocin is a peptide. Growth hormone is a peptide. The peptides I prescribe for surgical recovery are synthetic versions of molecules the body already makes, manufactured under cGMP pharmaceutical conditions, dosed precisely.

That is the part that matters. These are not herbal supplements. They are not hormones in the testosterone or estrogen sense. They are signaling molecules. The dose tells the body to do something it already knows how to do, just faster and more completely. Lay down collagen. Recruit fibroblasts to a sutured edge. Build new microvasculature. Restore mitochondrial energy.

Used well, with a physician selecting the dose and the duration, peptides accelerate the work the body was going to do anyway. Used poorly, with patients shopping the gray market on Instagram, they are a waste of money or a real safety problem. The peptides we prescribe at Southwest Plastic Surgery come from a US-based, cGMP-certified pharmacy with a certificate of analysis on every batch.

GLOW for face, KLOW for body

I prescribe two related peptide blends, depending on the operation. GLOW is a three-peptide blend (GHK-Cu, BPC-157, TB-500). KLOW is the same three peptides plus a fourth, KPV. The reason the menu has two versions is that face and body procedures call for different emphasis on the recovery side, and the right blend tracks the operation. The pharmacy compounds the peptides together in one vial, which makes it a single daily injection rather than three or four.

GHK-Cu is a naturally occurring copper tripeptide found in human plasma. The concentration drops as we age. It’s the same active compound in the copper peptide cosmetics you see at Sephora, with one important difference: injected, the peptide reaches the dermis directly at a controlled dose, instead of having to fight through the stratum corneum. Mechanistically, GHK-Cu activates more than three hundred genes involved in tissue repair. It signals fibroblasts to lay down new collagen and elastin. For a facelift patient, it is the part of the blend that helps a fresh incision heal flat and helps the skin in the operated zone look better six months out. The blue color of the solution comes from the copper. It is normal.

BPC-157 stands for Body Protection Compound. It is a fifteen amino acid peptide derived from a protein in human gastric juice. The mechanism that matters most for recovery is angiogenesis, the formation of new blood vessels at injury sites. New tissue cannot survive without blood supply. The body builds that supply slowly. BPC-157 accelerates it. The peptide also dampens local inflammation and supports tendon, ligament, and muscle repair. For a body procedure, this is the workhorse of the blend.

TB-500 is a synthetic analog of Thymosin Beta 4. It regulates a cellular protein called actin, which is essentially the rail system cells use to crawl across tissue. The simple way to put it: BPC-157 builds the new blood vessels, and TB-500 mobilizes the repair cells to use them. The two are synergistic, and the original published research on the pair came out of sports medicine, where elite athletes used the combination to come back from soft tissue injuries faster.

KPV’s a tripeptide (lysine-proline-valine) derived from alpha-MSH, and the job it does is anti-inflammatory. It works by inhibiting NF-kB, which is the master switch in the body for inflammatory gene expression. BPC-157 and TB-500 already dampen inflammation as a side effect of their main jobs, but KPV is the dedicated anti-inflammatory anchor sitting on top of that. For face procedures, where the inflammatory load is small and the priority is incision quality and skin remodeling, GHK-Cu’s doing most of the heavy lifting and GLOW gets the job done. For body procedures (BBL, gluteal fat grafting, tummy tuck, mommy makeover, breast surgery), the inflammatory field is much bigger, so I add KPV. That’s KLOW. Same once-daily injection from the same compounding pharmacy. The surgical field just gets broader anti-inflammatory coverage where it needs it.

I dose both blends subcutaneously, abdomen or thigh, once daily for the first three to four weeks after surgery. Most patients self-inject at home with a 30 gauge insulin syringe. We adjust at each post-op visit.

NAD plus, the mitochondrial side

NAD+ is a different molecule for a different problem. Technically it is a coenzyme rather than a peptide, but it sits next to peptides on the same prescribing menu and pairs with them well. The “nicotin” in Nicotinamide Adenine Dinucleotide is from vitamin B3 etymology. It has nothing to do with cigarettes, a clarification I make at the start of every consultation.

NAD+ powers the mitochondria, the cellular machinery that makes energy. It also fuels sirtuins, a family of enzymes involved in DNA repair. Levels drop with age, with stress, and with illness. Surgery is a stress. Recovery is a period of accelerated cellular work. Adequate NAD+ is the cofactor that work needs.

We primarily use at-home self-injections. Patients can go home with one month total supply. You’re supposed to split the doses evenly between morning and night in two separate injections a week apart. I usually inject patients two times per week for a total of eight doses. A total of 62.5 mg each time to recover nicely over the four weeks post surgery. Patients typically have minimal discomfort and it’s convenient for at-home self use. The constant infusion will ensure constant mitochondrial support throughout this crucial period in your healing.

If you do decide that you want to add an IV option in addition to the self injections, Southwest Plastic Surgery does offer a NAD+ and Glutathione drip. One IV infusion a few days before surgery and another one about a week after the surgery. One before surgery primes the body’s mitochondria so that we can have as much support as possible for the body going through stress from the surgical trauma. One after surgery helps the body as we head into the critical phase in the healing and repairing processes of the body’s cells. Glutathione is added slowly over time as the IV infusion slows. Glutathione is an antioxidant peptide which is useful in liver Phase 2 cleansing and it also helps clear leftover anesthesia and metabolites that come from the surgery.

One IV complication to note: Run the NAD+ infusions too quickly, the NAD+ will cause chest tightening, nausea, flush and a hot burning sensation. The reaction to IV NAD+ is dose and speed related. Run the NAD+ drip at the recommended rate, the NAD+ (500 mg) will usually be administered at over two to three hours followed by 1000-1500 mg of Glutathione at a push rate of five to 15 min, the entire time the infusion is happening is comfortable for the patient. Our medspa nurses are excellent in titrating rate to patient comfort. Asthma patients should be watched carefully during the glutathione push as we’ve had a patient or two experience bronchospasm.

How the protocol matches the procedure

The recovery protocol is not a single template. It shifts with the operation.

Procedure	Blend	Cycle	NAD plus
Facelift, neck lift, blepharoplasty	GLOW	3 to 4 weeks daily	250-500 mg SQ/IM monthly, divided 2x/week. Optional IV pre-op + post-op.
BBL, gluteal fat grafting, body contouring, tummy tuck, mommy makeover	KLOW	4 to 6 weeks daily	Same SQ/IM schedule, sometimes extended through month two. Optional IV pre-op + post-op.
Breast surgery, including Motiva Preserve augmentation	KLOW	3 to 4 weeks daily	250-500 mg SQ/IM monthly, divided 2x/week. Optional IV pre-op + post-op.
Combination procedures (face plus body, multi-site)	KLOW	Longer cycle, individualized	Standard SQ/IM schedule, IV often included.
Isolated minor procedures (lip lift alone, blepharoplasty alone)	Often none	Patient-specific	Patient-specific

Where the MedSpa fits, and where it does not

The Southwest Plastic Surgery MedSpa runs the IV NAD+ plus glutathione infusions, the subcutaneous NAD+ refills, and the peptide pickup and education for patients on a GLOW or KLOW protocol. The MedSpa nurses also handle the technique training for self-injection at the post-op visit, including site rotation and disposal.

Two things the MedSpa does not do, and that I want to be plain about. The MedSpa does not adjust the prescribed dose without me. The MedSpa does not add additional peptides on top of GLOW or KLOW based on something a patient read online. Both of those decisions live with me as the prescribing physician. That is not a service limitation. That is a safety floor.

We integrate the peptide protocol with the rest of what the MedSpa offers in the same recovery window. Lymphatic massage, ElixirMD post-op recovery, scar protocols. The peptide piece is not a replacement for any of those. It is an addition.

Who is a candidate, and who is not

The starting question is whether the patient wants the smoothest possible recovery, will tolerate four to six weeks of daily self-injection, and has a medical history that supports the protocol. Most do.

Active malignancy is a contraindication for growth-factor-adjacent peptides because we do not want to support an undiagnosed tumor. Pregnancy and breastfeeding are off the protocol. Active infection is a temporary contraindication and we delay until cleared. Patients on therapeutic anticoagulation receive adjusted dosing in coordination with their cardiologist. Patients with a personal cancer history, even if treated and clear, get a longer conversation and often an oncology clearance before we proceed.

The cautious side

Peptides aren’t actually FDA-approved new drugs, as most physicians use compounded peptides from US 503A pharmacies. This practice is legal and valid, however, it also contributes to a black market rife with peptides of unspecified origin, unverified dosage and questionable sterility. As a peptide is an injectable sterile medication, purchasing it from a source on Telegram represents a risky decision about one’s well-being and is a lawsuit waiting to happen. I personally use a U. S. -based, cGMP-certified pharmacy, which provides a certificate of analysis with each prescription. The price is higher than that of the black market. You’re paying for the quality differential that this represents.

The second rule, and the one patients sometimes struggle with: a compounded peptide blend is calibrated. Adding random fourth and fifth peptides on top of GLOW or KLOW because of a podcast is not optimization. It is a way to give yourself an unintended hormonal or hematologic problem. If a patient wants to expand the protocol, that conversation happens in my office, with new prescriptions written for the new molecules.

Two more reads

For the editorial, shorter version of this post, with the Vogue-side voice rather than the practice-side voice, see After the Operating Room: The Peptide Stack My Patients Recover On on drworldwide.com.

For the longer, more clinical version, with deeper mechanism, dosing, and contraindications, see Peptides for Plastic Surgery Recovery: A Clinical Guide to GLOW and NAD Plus on agulloplasticsurgery.com.

Why choose Dr. Agullo for a peptide-supported recovery?

Double board-certified, American Board of Plastic Surgery and American Board of Surgery. Fellow of the American College of Surgeons. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, teaching the same techniques I use every week. Affiliate Professor at UTEP. Castle Connolly Top Doctor for thirteen consecutive years. The peptide protocol is prescribed by me, sourced through a US cGMP-certified compounding pharmacy, and integrated into a recovery plan refined operating on local, national, and international patients for the last fifteen years.

Ready to talk?

The right time to start the recovery conversation is during the surgical consultation, not the day before surgery. Schedule a consultation at Southwest Plastic Surgery and we will review your anatomy, the operation you are considering, your medical history, and we will decide together whether peptides belong in your plan. If they do not fit, I will say so. If they do, you will leave the consultation with a written protocol, a price, and a timeline. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful.

This entry was posted on Friday, May 1st, 2026 at 12:39 pm and is filed under Recovery. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

For about five years, every Morpheus8 appointment at our El Paso MedSpa started the same way. Patient checks in. Vitals. A small tube of blood drawn from the inside of the elbow. The tube goes into a centrifuge. Twelve minutes later, our team paints platelet-rich plasma onto freshly microneedled skin. Patient leaves with a small bandage on the inner arm and (usually) a glow.

Then, sometime around the start of the year, the routine changed. The blood draw disappeared. The bandage on the arm disappeared. Patients started asking the obvious question. What happened to the PRP.

We took the question to Dr. Frank Agullo, the medical director of Southwest Plastic Surgery. He has been running this MedSpa long enough to remember when PRP was the new exciting thing nobody had heard of. He gave us the long answer.

The shorthand version

“PRP works,” Dr. Agullo told us. “It still works. We did not stop because PRP failed. We stopped because something cleaner showed up. Recombinant pure PDGF, in a controlled dose, with no blood draw. The brand we use is Ariessence pure PDGF+.”

The longer version of that explanation is worth a few minutes. The MedSpa team has been getting a version of this question every week since the change, and the answer is genuinely interesting once a patient takes the time to hear it.

What is PDGF, in plain English

The body has a small set of proteins it relies on to handle injury. When tissue gets cut, scraped, microneedled, lasered, or otherwise irritated, platelets release a cocktail of proteins called growth factors. PDGF is one of the leaders of that cocktail. It calls in the cells that lay down new collagen. It helps the body build the new blood vessels healing tissue needs. It is, in a real sense, the molecule the dermis is asking for at the exact moment it just got injured.

For most of the past decade, the way clinicians delivered PDGF to skin in an aesthetic context was indirect. They drew a tube of patient blood, spun it down in a centrifuge, and applied platelet-rich plasma on freshly microneedled or lasered skin. PDGF rode along, mixed with several dozen other proteins, in concentrations that varied with the patient and the technician.

Recombinant pure PDGF is what you get when a lab makes only the PDGF molecule itself. The protein is produced in cultured cells from a human gene, then purified to a single active species. The dose is the same in every patient. There are no human-derived components in the formulation. The Ariessence product pairs the recombinant PDGF with a hyaluronic acid serum and is mixed in the treatment room in under a minute.

“Same idea as PRP,” Dr. Agullo said. “Just a cleaner version of the same idea. The thing the body was asking for, in a controlled amount, every time.”

Why right after a microneedling session, and not as a take-home serum

Patients ask if Ariessence is something they can buy and apply at home. The answer is no, and the reason is mechanical.

PDGF on intact skin sits on top of the stratum corneum. The stratum corneum is the skin’s outer barrier. It is highly effective at keeping large molecules out. A growth factor in a jar at home is mostly a moisturizer with an interesting label.

The post-procedure window changes that. After Morpheus8, RF microneedling, fractional laser, or a medium-depth peel, the skin has thousands of microchannels open into the dermis for a finite period. The treatment area is briefly ready to receive what gets applied to it.

“That window closes inside a couple of hours,” Dr. Agullo said. “Whatever I put on the skin in the first ten minutes is the second half of the procedure. We do not waste it on water.”

The study patients keep asking about

In September 2025, Michael Gold and colleagues published a randomized controlled trial in the Journal of Cosmetic Dermatology. Healthy adults between thirty and sixty got a single Morpheus8 RF microneedling session. They were randomized to receive either bland Aquaphor or topical recombinant pure PDGF-BB immediately after. A blinded evaluator graded them at seven and thirty days using a global aesthetic score, the Canfield Visia imaging system, and patient experience surveys.

The PDGF group did better on the global aesthetic score at thirty days. The result was statistically significant. The PDGF group came out ahead on six of the seven Visia metrics. Patient experience favored the PDGF group across the experience measures. No serious adverse events were reported.

We asked Dr. Agullo for his read.

“Two reads at the same time,” he said. “Patients deserve both.”

He started with the honest read. Topical recombinant pure PDGF after RF microneedling beat a bland emollient on the measures that matter for skin rejuvenation. The margin was not subtle.

Then the careful read. The manufacturer puts a disclaimer in writing. The exact formulation tested in the trial is not identical to the marketed Ariessence bottle.

“So I do not tell my patients the trial proves the bottle,” he said. “I tell them the science of the category is real, the trial supports the approach, and the bottle on our shelf is the closest commercial expression of that science right now. Both things are true. Better they hear it from me than from a Reddit thread at 2 in the morning.”

Where Ariessence sits next to PRP, PRF, and exosomes

The MedSpa team is asked about all of these in roughly the same week. Here is the comparison Dr. Agullo had us put together.

Modality	Source	Blood draw	Dose predictability	2026 role at our MedSpa
Aquaphor	Petroleum jelly	No	Total, but no biological signal	Default barrier, used after most procedures
PRP	Patient blood, single-spin	Yes	Variable patient to patient	Available on request, not the default
PRF	Patient blood, slower spin	Yes	Slightly more consistent than PRP	Not currently in rotation
Exosomes	Stem cell conditioned media (donor)	No	Manufacturer-dependent, regulatory uncertainty	Not in rotation
Ariessence pure PDGF+	Recombinant rhPDGF-BB in HA serum	No	Identical dose every kit	Default after Morpheus8, RF microneedling, fractional laser, or medium-depth peel

“That table changed in our practice this year,” Dr. Agullo told us. “It will change again. The right answer to a patient’s question is whatever the most current science supports. I am not married to a tray.”

Where MedSpa fits, and where it does not

A version of one question shows up in our consultations every week, particularly with patients in their forties and fifties. How far can MedSpa take me, the question goes, before I really do need to think about surgery.

Dr. Agullo’s answer has been more or less the same for years.

“Our MedSpa has real tools, not props,” he said. “Botox, hyaluronic acid fillers, BBL Forever Young, laser resurfacing, Morpheus8 RF microneedling, chemical peels, and now Ariessence on top of all of those for cleaner recovery. Every one of them earns its keep. On a forty-year-old face the whole toolbox can buy years before surgery is the right move. The catch is that none of those tools repositions deep tissue. They treat surface, volume, and tone. Try to use them as a permanent stand-in for a facelift on a face that has actually descended, and what you get is not a younger face. You get a fuller one. Puffy cheeks, no jawline, an upper lip nobody asked for. We call that the filler tax.”

He spends almost as much time on sequencing.

“In your forties and early fifties, lean into MedSpa. Be sparing and precise with injectables. The day structure actually starts to slip is the day to be sitting at a surgery consultation. Earlier than later. After the facelift heals, MedSpa picks back up. Skin care, energy-based treatments, growth factors after each procedure for faster recovery, and small injectables on a careful cadence. Not a wall of syringes.”

That arc is something the surgical team and the MedSpa team plan together for facelift patients. It is one of the reasons our practice draws patients from out of state for the long view, not just one operation.

What patients should ask about Ariessence specifically

We asked Dr. Agullo what questions he wishes patients would put to any provider who is offering Ariessence, or for that matter any other growth-factor adjunct.

He came back with four.

First, what procedure are they pairing it with? The right answers are Morpheus8, RF microneedling, fractional laser, or a medium-depth peel. If the provider tells you “oh, you can just take it home and apply it daily,” he says, walk out.

Second, how fast is it going on after the procedure ends, and how is the kit being mixed in front of you? Within roughly ten minutes is what you want. Hours later is past the point where it does much.

Third, what is the dose, and where does the protein come from? Recombinant pure PDGF-BB, controlled concentration, no human-derived material, is the standard he wants you to ask the provider to confirm. Vague answers there are a red flag.

Fourth, is the product being marketed and used as a topical cosmetic, or is somebody quietly offering to inject it? Topical cosmetic is the entire regulatory category for this product. A provider offering to inject it has decided to operate outside that category, and that is not a position you want a stranger making on your face.

What it is not, said cleanly

Ariessence pure PDGF+ is sold as a topical cosmetic. It is not an FDA-approved drug. It is not approved to diagnose, treat, cure, or prevent any disease or condition. It is not for injection. The four FDA-approved drug products that contain PDGF (GEM 21S, Augment, Augment Injectable, Regranex) are unrelated formulations approved for non-cosmetic medical indications. Their long safety record informs the molecule’s general safety profile, but does not transfer regulatory approval to the cosmetic.

The MedSpa is clear about this with every patient. So is Dr. Agullo. So is the manufacturer.

About Dr. Frank Agullo, MD, FACS

Dr. Frank Agullo is the medical director of Southwest Plastic Surgery in El Paso. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and a Mayo Clinic plastic surgery fellowship alum. He serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center and Affiliate Professor at the University of Texas at El Paso. He has been named a Castle Connolly Top Doctor for thirteen consecutive years, was inducted into the Texas Super Doctors Hall of Fame in 2025, and was named Aesthetic Everything Top Plastic Surgeon for 2026. Roughly sixty percent of his patients fly into El Paso from out of town.

For two more reads on the topic above, both written or co-developed with Dr. Agullo himself:

The editorial take is on his personal blog, drworldwide.com: After the Needles: The Growth Factor That Earned Its Spot Next to My Morpheus8.

The deeper clinical version is on his medical-grade blog, agulloplasticsurgery.com: Pure PDGF After Microneedling: A Clinical Read on Ariessence and the Gold Trial.

Schedule a Morpheus8 consultation at Southwest Plastic Surgery

Southwest Plastic Surgery is the El Paso practice of Frank Agullo, MD, FACS. To book a Morpheus8 session, an RF microneedling course, a chemical peel, or to talk to our MedSpa team about the right post-procedure protocol for your skin, call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

This entry was posted on Tuesday, April 28th, 2026 at 4:43 pm and is filed under Noninvasive Skin Treatments. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

For the past two months, almost every facelift consultation at our El Paso office has begun the same way. The patient pulls out her phone, turns the screen toward Dr. Frank Agullo, and there are Kris Jenner’s two photos. The Vogue Arabia cover from August on the left, and a candid shot from the past few weeks on the right. The patient asks the same thing every time. What happened to her face.

It turns out to be a really useful question to chase down. Because the answer is the same answer that decides every facelift, ours included. Which technique. On whose face. At what age.

We grabbed Dr. Agullo between two surgeries last week and asked him to walk us through it the way he walks his consultation patients through it. The transcript below is lightly cleaned up.

Last summer’s reveal, and the year that followed

Last August, Kris Jenner appeared on the cover of Vogue Arabia and confirmed she had had a second facelift. The before-and-after circulated for weeks. One post on X asking who her surgeon was racked up tens of thousands of likes. Pundits called it the best celebrity facelift in a hundred years. She is seventy. Some of the photos made her look closer to forty.

Twelve months on, the headlines have flipped. Outlets are reporting that her facelift is “slipping” and that she has been asking her team about a revision. The same press cycle that crowned the result has started running comparisons against Denise Richards, who is fifty-five and looks, by any account, terrific a year out from her own facelift.

Asked what he sees in the recent photos, Dr. Agullo doesn’t reach for the gossip frame.

“None of this is unusual,” he told us. “What you’re watching happen to her face in real time, on the internet, is the textbook arc of a SMAS-based facelift on a seventy-year-old. It’s actually the best public-education moment we’ve had on facelift technique in years, and patients should pay attention.”

The question patients should be asking, and almost never do

Walk into any of our facelift consultations and you will hear the same first three questions. How much. How long is recovery. Will I look pulled. All fair, all important. None of them, in Dr. Agullo’s view, is the question that matters most.

“What I want patients to ask me,” he said, “is ‘what plane do you operate in.’ Because the plane decides almost everything else. How long the result lasts. How natural it looks at year five. Whether you’re still happy at year ten.”

There are essentially two planes a facelift can be done in.

A SMAS-based facelift works on a layer just under the skin called the SMAS (short for Superficial Musculoaponeurotic System). The surgeon either folds it on itself (plication) or removes a strip and stitches the cut edges back together (SMASectomy). Done well, it gives a clean three-month result. It has been the workhorse facelift for decades.

A deep plane facelift works underneath that layer. The surgeon dissects beneath the SMAS, releases the four retaining ligaments that anchor the face to the skull (zygomatic, masseteric, mandibular, platysma), and lifts the entire composite of skin, SMAS, fat, and muscle as one piece. Nothing gets pulled on. Nothing closes under tension. And because nothing is stretched out at closure, nothing relaxes back over the next two years. The published longevity data on deep plane results runs ten, twelve, sometimes fifteen years.

Kris Jenner’s surgeon performed a SMAS-based operation. Specifically, a lateral SMASectomy paired with a deep neck lift. Reputable surgeon. Well-executed work. But not the same operation as the deep plane Dr. Agullo performs.

The honeymoon phase

One of the reasons Kris Jenner’s reveal looked as breathtaking as it did, and one of the reasons her current photos look as different as they do, has nothing to do with her surgeon. It has to do with what Dr. Agullo calls the honeymoon phase of every facelift.

“Every facelift looks incredible at three months,” he said, almost cheerfully. “I mean every single one. It’s not a bug, it’s a feature, but patients need to know about it before surgery so they don’t fall in love with a result that isn’t actually their result yet.”

Three months postoperatively, the swelling has not finished going down. The skin is still tight from the closure. The deep tissues are healing in a position that is, frankly, just slightly tighter than where they will end up. Add a Vogue cover team, a top-tier glam squad, and the careful retouching that comes with a celebrity reveal, and you get the honeymoon face. Which, Dr. Agullo says, is real but not durable.

“The face you live with shows up at twelve to eighteen months. Swelling is gone, skin has relaxed, the tissues have settled where they’re going to settle. If your operation was right for your anatomy, the twelve-month face barely differs from the three-month face. Rested. Younger. Still you.”

When the operation isn’t right for the anatomy, twelve months is when the gap shows up. Volume that was masking a structural problem retreats. Skin that was tight relaxes. The midface, which is heavier than people think, starts dropping again. Which, in his read, is exactly what is on display in the recent Kris Jenner photos.

The midface, the malar bags, and what a SMAS technique can’t do

Asked to point at specifics, Dr. Agullo focused us on the midface.

“Look at her lower face and her neck. Both still meaningfully better than they were preop. Her jawline is cleaner. The platysmal bands are quiet. That part of the operation worked, and it’s actually pretty good work for the technique used.”

“Now look at her cheekbones. The malar bags, the rounded fullness sitting on top of the cheekbones, are right there. Two of them. Round, glossy, hard to unsee. They were briefly hidden by swelling and a tight closure at the reveal. Now the swelling is gone, the closure has relaxed, and the bags are back.”

He’s quick to say this isn’t a mystery and isn’t an error in any judgmental sense.

“It’s anatomy. A lateral SMAS technique pulls on the side of the face. It does great work in the lower third. But it does not reposition the malar fat pad, which is the cushion of fat that gives a cheekbone its shape and keeps the area from collapsing into a pouch. The deep plane does. We release the zygomatic ligament, free up the malar fat pad, and lift the whole construct as part of the composite flap. The endoscopic ponytail lift gets to the same anatomy through tiny incisions inside the hairline. If you skip the malar release on a face that needs it, you get exactly the trajectory we are watching.”

Seventy is not fifty

The Denise Richards comparison the press has run with isn’t really a fair fight, in Dr. Agullo’s view.

“Richards is fifty-five. Her surgeon took her into the deep plane. Fifteen years younger plus a more durable operation equals a result that, a year out, still looks like the result. Kris is seventy and had a SMAS-based operation. The math was hard before anyone scrubbed in.”

Why does age matter so much? Because tissue at seventy doesn’t behave like tissue at fifty. Less elastin. Thinner collagen. Less of the deep ligamentous architecture that holds a result in place. Run the same operation on a fifty-year-old and a seventy-year-old by the same surgeon on the same day, and the fifty-year-old will hold longer. Every plastic surgeon knows this. Most of them, out of professional politeness, don’t say it out loud.

Dr. Agullo will say it.

“At seventy, the technique you choose is doing most of the work. A SMAS-only operation might give you a year or two of looking like the day after the bandages came off, then a steady drift back to where you started. A deep plane, on the same patient, holds for ten to fifteen years. Those aren’t my numbers. Those are what the longitudinal studies show.”

Where MedSpa fits, and where it doesn’t

A question that comes up constantly in our consultations, especially with patients in their forties and fifties: can we just keep doing MedSpa treatments instead of surgery? Tox, fillers, lasers, Morpheus, BBL Forever Young.

Dr. Agullo’s answer is honest and a little nuanced.

“Look, our MedSpa side has real tools. Botox, hyaluronic acid fillers, BBL Forever Young, laser resurfacing, Morpheus8 radiofrequency microneedling. They earn their place. For a forty-year-old face they can buy you years before surgery is the answer. But none of them reposition deep tissue. They treat surface, volume, skin tone. So when somebody tries to use them as a permanent stand-in for a facelift on a face that has actually descended, what you get is a face that looks fuller. Not younger. Puffy cheeks, no jawline, an upper lip that nobody asked for. The filler tax, paid one too many times.”

Sequencing matters, in his telling.

“Forties and early fifties, lean MedSpa. Keep the skin in good shape. Be sparing and precise with injectables. When structure starts to slip, that is the moment to have a surgery conversation, and you want it before the slipping gets a head start. After the facelift, MedSpa picks back up. Skin care. Energy-based treatments to keep the result clean. The right cadence of small injectables, not a wall of them.”

That sequencing is something our surgical team and MedSpa team plan out together for facelift patients. It is part of why people fly into El Paso for the long arc of facial aging, not just for one operation.

What to ask any surgeon you consult, anywhere

We asked Dr. Agullo what questions he wishes patients would put to every surgeon they sit with, his own consults included.

He gave us four.

What plane do you operate in. SMAS, deep plane, composite. The honest answer matters more than the polished marketing language on a website.

How often do you do a deep plane facelift versus a SMAS-based operation. A surgeon who does the deep plane every week is a different surgeon from one who does it occasionally.

Where did you train for it. The deep plane and the endoscopic ponytail lift are unforgiving operations with a steep learning curve. A weekend cadaver course is not the same as a structured intermediate-and-advanced program.

Can I see your one-year, two-year, and five-year follow-up photos. Not three-month reveals. Three-month reveals are the honeymoon. The deliverable is the long view.

About Dr. Frank Agullo, MD, FACS

Dr. Frank Agullo is the medical director of Southwest Plastic Surgery in El Paso. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and a Mayo Clinic plastic surgery fellowship alum. He serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center and Affiliate Professor at the University of Texas at El Paso. He has been named a Castle Connolly Top Doctor for thirteen consecutive years. His advanced facelift training includes the Ponytail Academy intermediate course in Pittsburgh and the advanced course in Santa Monica. Roughly sixty percent of his facelift patients fly into El Paso from out of town.

For two more reads on the technique conversation above, both written by Dr. Agullo himself:

The editorial take is on his personal blog, drworldwide.com: After the Honeymoon: Kris Jenner, the SMAS Plication, and the Difference a Decade Makes.

The deeper clinical version is on his medical-grade blog, agulloplasticsurgery.com: After the Honeymoon: What Kris Jenner’s Facelift Actually Tells Us About SMAS, Deep Plane, and Time.

Schedule a facelift consultation at Southwest Plastic Surgery

Southwest Plastic Surgery is the El Paso practice of Frank Agullo, MD, FACS. To schedule a facelift consultation with Dr. Agullo or to talk to our MedSpa team about non-surgical options, call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow Dr. Agullo at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

This entry was posted on Sunday, April 26th, 2026 at 4:06 pm and is filed under Facelift. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.