The pre-op call at Southwest Plastic Surgery follows a script. The post-op calls do not.
Every week the practice’s nurse practitioner gets on the phone or on video with patients who are two weeks, six weeks and three months out, and those patients text in photos that drop straight into their chart. The work on those calls is triage: separating what looks alarming and is completely normal from the short list of things that need Dr. Agullo.
Several of those calls were transcribed. Staff names and every patient detail have been removed. What follows is the nurse practitioner in her own words.
This is one practice’s protocol. Patients who had surgery elsewhere should follow their own surgeon’s instructions.
Seroma or Fibrosis
At ten to twelve weeks this is the most common question there is.
Nurse practitioner: “If it was more like a seroma, it would have been getting bigger in size and it would be painful. You would have discomfort, even some redness or even some warmth, like warm to touch, where there’s a big pocket underneath of fluid that would need to be drained. But at this point, at 12 weeks post-op, it’s very unusual that you would have that.”
The far more likely explanation:
Nurse practitioner: “If it’s more like a hard area that feels a little hard to touch, like a little lump, then it could be more like fibrosis, swelling of the tissue that is still present at the time. And the only thing to remove that would be with lymphatic massage, continue massage in the area to soften up the tissue.”
A third possibility patients rarely consider is that they are feeling the repair itself:
Nurse practitioner: “Where you’re pointing, it could be also your suture, your plication in the area of your obliques, that you might be feeling. Those tend to take about 2 years for them to be completely dissolved.”
Nurse practitioner: “If it gets to a point that it’s bothering you, it’s uncomfortable, or it’s growing, you let me know and I could definitely send you for an ultrasound just so that we could make sure that everything looks good.”
Spitting Sutures
Routine, with instructions that depend on location.
Nurse practitioner: “Probably your body’s not absorbing them, and it happens. We just want to make sure we leave it until they’re exposed and we’re able to remove with tweezers, and then you just trim to where you’re able to get to the skin.”
One exception:
Nurse practitioner: “The only one that I would be very cautious with would be the one around your areola, because that’s what’s keeping the areola in place at the size of it. That’s the Gore-Tex suture around. So if it’s really deep, I would just leave that one alone.”
Scabs
Nurse practitioner: “The scar, it looks much better from last week to now where you have that little scab. It’s white, but remember, it’s healing from the inside out. Now, if we remove the scab, of course it’s going to open and you’re going to have an open wound. So I would just leave the scab. As long as it’s not red, it’s not draining, it doesn’t smell foul, then it’s not an infection. It just means it’s healing from the inside out. And eventually the scab will fall off.”
Red, draining, foul smelling. That is the three-part test.
Nurse practitioner: “Sometimes it could be the suture, sometimes it could be a scab. If the scab looks like it’s coming, you could ask your massage therapist, because sometimes you might have a little suture underneath it and it just needs to be removed so that way it could completely heal.”
Numbness and Hypersensitivity
This distresses patients more than the pain does.
Nurse practitioner: “There was trauma, there were nerves that were cut, so now your nerve endings are starting to reconnect. You’re going to start getting some more of that sensation as we go on.”
Nurse practitioner: “The nerve endings, remember, they’re starting to reconnect. You’re going to feel more hypersensitivity as far as restless leg syndrome. You could feel more like the numbness, tingling, sharpness everywhere.”
Two low-cost suggestions come up repeatedly:
Nurse practitioner: “You could take some vitamin B complex. That tends to kind of help repair more of those nerve endings.”
Nurse practitioner: “You might want to touch your face all along, just so that you could bring back some of that sensory back to your nerves. And it could help regulate more of that sensation so you’re not so sensitive as well.”
The same principle for the body: “Have your husband kind of touch you in the back, massage, because with the feeling you’re kind of regulating your body with the nerve endings with that sensation as well.”
Hair Loss After a Facelift
Nurse practitioner: “The hair loss too sometimes could be a little bit more abundant because of the trauma that it just went through. And then eventually your hair should start growing back within about 3 months. You should start seeing that cycle coming back again.”
Early Asymmetry and Angry-Looking Scars
Nurse practitioner: “You’re always gonna have that one side that’s gonna be a little different than the other depending on the asymmetry of your face. But then again, it’s just so premature right now, because everything’s very swollen, everything’s very irritated. They just removed sutures, so it’s gonna look very red. So we have to let it heal, let the swelling continue to subside.”
Nurse practitioner: “Since it’s pretty raised, we still have to wait until it heals completely, because it’s going to start to fade off where you hardly are going to be able to see it. Trust me, it’s going to get much better. But right now, because they removed the sutures, it’s more visible. We have to trust the process, let the swelling go down, and then you see how it starts to heal. It’s going to be very fine.”
Why Facial Swelling Behaves Differently
Nurse practitioner: “In your abdomen, for the most part, you’ll create like a seroma, like a pocket of fluid, and those are very easy to just go in there and remove. With the face, since there’s not enough room, most of it is just in your soft tissue. So it really just comes down to compression and then also the massage, you continue massaging the area to drain that fluid out. But it will get better. I’ve had some patients that had that swelling on the temples. Within the 3 months, you’ll notice a huge difference.”
Compression morning and night, a facial roller for patients recovering out of town, and light therapy.
Nurse practitioner: “If you also have access to red light therapy, that tends to help a lot with the swelling in the face. That tends to help our patients a lot with the bruising and the swelling of the face. Even if you get in those red light therapy beds, that tends to help a lot too.”
Returning to the Gym
Four to six weeks, gated on the incisions rather than the calendar.
Nurse practitioner: “We’re 4 weeks out, so at this point, if all incisions are healed and closed correctly, there’s no openings, pretty much we could go and resume back to normal activities.”
Nurse practitioner: “You’re not going to be able to go back to where you left off. You’re going to have to start in slowly. What I recommend is stretching, loosening up a little bit more, and seeing your limitations as far as how far you’re able to stretch, starting off there first.”
She repeats it on nearly every call: “That’s why I always say focus on your stretching and the flexibility first before we introduce any weight.”
Nurse practitioner: “And then if you do, if you’re reaching or doing something, you might feel a little strain. If that happens, it feels like a sharp pain in your abdomen, it tends to happen that time. Yeah, and that’s normal, that can happen. If that happens, you take a couple days without doing any heavy lifting, take a little bit of ibuprofen, and that should help improve the discomfort.”
The rule that overrides the rest: “And your body will tell you if it’s something that it feels uncomfortable, then you know that, okay, you’re overdoing.”
Breast patients have a longer restriction:
Nurse practitioner: “I would try to refrain, stay away from any chest exercise as far as pull-ups, push-ups, anything that can disrupt the pocket of the breast for now, not until maybe around 6 months. Then you can start introducing more of those exercises.”
Scar Care, and How Long It Runs
Nurse practitioner: “We’ll go ahead and remove the tape. I would give yourself at least a week, let your skin kind of air, kind of breathe a little. And then after a week from now, we could start the scar gel and the silicone tape.”
Nurse practitioner: “Usually we continue using the scar gel and the silicone tape for at least a year to see any improvement. Usually at the 1-year mark, that’s when we see the difference as far as your scar.”
For pigment that lingers at six months: “If it’s still very hyperpigmented, then maybe we could try a little bit of hydroquinone, which is a little stronger, and that will help lighten up the scars.” And: “If it’s more the pigmentation, you could also incorporate maybe microneedling.”
Microneedling and the rest of the longer-term skin work run through the med spa. Revision comes last: “At that point, if you notice that it’s something you’re not satisfied with, then either one, we could do revision.”
“I Feel Like I Look Worse Than Last Week”
Nurse practitioner: “I could see the difference from last week to this week. There is change. The thing is, since you see yourself every day, it’s very hard for you to notice some of these changes. But I could see a huge difference, as far as the right side looks not as swollen as it did last week. So we just have to stay positive. I’ll keep you on the schedule for next week so I could continue to follow up with you, making sure that we’re going on the right path. But if anything changes in between, feel free to give me a call at any time.”
Photos, and How Remote Follow-Up Works
Many Southwest Plastic Surgery patients fly into El Paso, have surgery, and fly home.
Nurse practitioner: “Just send me pictures when you get a chance. Just send pictures of the front, the side, and the back. And then in between your incision. That way I could make sure that the incisions are healing well, or anything that I see abnormal. And that goes directly into your profile, your chart. As soon as you text them to that number that I sent you, it’s gonna go directly to your file.”
The escalation path is stated plainly on the call: “And if at any point doctor needs to get involved, we need to bring her, we’re going to have to have her come in.”
What Actually Triggers a Call to the Surgeon
Across months of these calls the short list is consistent: a breast that is bruising and getting firm with a lot of pain, fever or chills, an incision that is red and draining and smells wrong, a wound opening rather than closing, or a fluid collection that keeps growing.
Nurse practitioner: “If there’s a bleed, you’re gonna notice more of a lump, a bruise. It’s gonna start bruising the whole breast, a lot of pain. Any fever, any chills, make sure you give us a call. Now that you’re on your antibiotics, that’s good. That’s the one medication I want you to make sure that you complete.”
Why the Follow-Up Is Part of the Operation
Dr. Agullo’s position is that a technically excellent operation can still end with an unhappy patient if nobody picks up the phone at week four. For patients who fly in and fly home, the follow-up is the back half of their care rather than a formality.
Dr. Agullo is a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and a Clinical Associate Professor of plastic surgery at Texas Tech University Health Sciences Center.
Ready to Talk?
Call Southwest Plastic Surgery at (915) 590-7900, text the consult line at 1-866-814-0038, or book a consultation at swplasticsurgery.com.
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
