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
