It was seven years after surgery, the last of many operations but the most important one at Southwest Plastic Surgery, and her deep plane facelift had held the way a properly executed deep plane face holds: subtly, perfectly, beautifully. She was not asking about another operation, another lift, another scar. She sat forward in her chair and asked, “Doctor, what do you think about NAD+? What about GHK-Cu? My friend has been on this thing called the GLOW blend. Is any of it real? Is it just marketing? What would you take yourself, assuming it all passed FDA approval?” Those kinds of questions were coming my way often, so we started building a program around them. This post is about what it is, who it is for, and its limits, written by a double board-certified plastic surgeon, not an influencer. This is the serious take. I have a separate piece that describes our approach for post-operative recovery, and you can find links to both companion pieces at the end.
What a Peptide Is
A peptide is merely a small string of amino acids, the building blocks of proteins. Our own bodies create hundreds of thousands of them daily to function and communicate between cells: insulin is a peptide, oxytocin is a peptide, growth hormone is a peptide. The therapeutic peptides we offer under a peptide wellness menu are synthetic copies of molecules your body already makes. They are synthesized under strict cGMP pharmaceutical conditions, measured and given in prescribed amounts to elicit a response. They are signaling molecules, telling your body to do things it already knows how to do: lay down collagen, repair DNA, build new micro-vessels, restore mitochondrial energy. Your own cells perform the work, the peptide is just the message. This has profound implications for understanding their limitations. Peptides are not substitutes for surgery when the need for surgery exists. No peptide will restore 20 pounds of lost facial volume or rebuild the worn ligaments supporting a youthful face, that is where surgery comes in. But they can prepare your cellular environment beforehand and help you recover afterward. For patients who do not need surgery yet, they extend the cellular runway, buying them time.
NAD Plus at Southwest Plastic Surgery
NAD+ (nicotinamide adenine dinucleotide) is not a peptide but a technically different coenzyme, though it finds its way onto many peptide wellness menus due to its well-established scientific rationale. The “nicotin” is derived from B3’s etymology and bears no relation to tobacco. I make that crystal clear for every patient. It fuels the mitochondria (the energy-producing cell organelles) and is the substrate for the sirtuins, enzymes implicated in DNA repair and gene regulation. NAD+ levels fall with age, and the decline correlates with a decrease in mitochondrial efficiency, the visual signs of aging, and the underlying cellular factors. Supplementing NAD+ in animal models reverses some of the signs and functional deficits of aging, and while the human data is younger, it trends that way too. At Southwest Plastic Surgery, we offer NAD+ as an IV infusion, the one most people are aware of and the source of those ecstatic online “I felt amazing afterward” stories. Run too quickly, it can be uncomfortable: chest tightness, flushing, a hot burning feeling, but that is rate-dependent, predictable, and totally preventable. Run over two to three hours, it is entirely painless and relaxing. We only run IV infusions slowly, and our medspa team is rigorously trained in titration for patient comfort. For maintenance purposes, I recommend one monthly IV infusion combined with subcutaneous NAD+ treatments in between. While the immediate post-IV energy boost is the most obvious reason patients book a second infusion, I am prescribing it for the less dramatic but more significant longer-term cellular work it performs over months.
GHK-Cu, the Skin Investment
GHK-Cu (copper tripeptide-1) occurs naturally in your plasma. Your levels peak in your twenties and steadily decline thereafter. It is the same active ingredient found in copper peptide serums and lotions on the dermatology counter, but with a critical difference. Topical GHK-Cu must pass through the stratum corneum, an efficient skin barrier that excludes large molecules like GHK-Cu. The injectable form, conversely, delivers the molecule directly to the dermis in a measured amount, with no battle against your skin barrier. The mechanisms of action read like the reverse of skin aging. It activates over three hundred genes that promote tissue repair, stimulates fibroblasts to produce collagen and elastin, supports basal stem cells in the epidermis, exhibits anti-inflammatory properties, and acts as an antioxidant. Preclinical and initial clinical research has demonstrated notable benefits on hair growth, skin density, and the visible effects of photoaging. None of this is a myth. What is misleading is that topical formulations generally deliver only a fraction of the dose used in these study protocols. As for lifestyle and wellness use, I typically recommend GHK-Cu for women in their early to mid-forties, women who are on top of external care (like excellent skincare and sunscreen), are not yet candidates for surgery, and want to get some real work happening in the underlying cellular layer of their regimen. I will typically start a patient on 1 to 2 mg subcutaneously daily in cycles of ten to twenty-one days, repeating periodically depending on their response. The bluish tint of the solution comes from the copper, and it is completely normal.
GLOW and Where the MedSpa Fits
GLOW is our three-peptide blend (GHK-Cu, BPC-157, and TB-500), formulated by a special compounding pharmacy. All three components play a vital role in surgical recovery, but I assess their lifestyle wellness use differently. For routine lifestyle and anti-aging wellness, I usually opt to prescribe GHK-Cu in cycles rather than the full GLOW blend. The skin and hair benefits patients often seek are primarily GHK-Cu’s contribution. While BPC-157 and TB-500 are renowned for their roles in tissue repair (which is their purpose), injecting them long-term for general wellness in healthy patients without an injury pushes the boundaries of evidence-based benefit. I prefer to reserve them for periods of actual recovery when the need is clear and the treatment duration is finite. The exception is a patient who suffers from chronic soft-tissue issues, persistent inflammation, or is in rehabilitation following a serious injury. In those cases, the full GLOW blend delivered in cycles can be a sensible approach.
Our Southwest Plastic Surgery MedSpa is equipped to administer IV NAD+ infusions, provide subcutaneous NAD+ refills, and dispense GHK-Cu to patients on a wellness plan after proper instruction. The MedSpa nurses provide training in self-injection technique, including advice on rotating injection sites to minimize bruising and irritation. They administer slow-rate, comfortable NAD+ infusions in our tranquil recliner-equipped infusion room, and they handle the scheduling and tracking of wellness cycles. The MedSpa does not adjust the dosage of any prescribed peptide without my approval, nor do they add other peptides to a regimen based solely on something a patient encountered online. Both of those decisions rest with me as the ordering physician. That is not a limitation of the service, that is the safety floor distinguishing a genuine medical program from a transient wellness trend. Beyond their specific benefits, we often integrate peptides into a broader spectrum of MedSpa treatments in synergistic ways. For instance, patients undergoing a GHK-Cu cycle might time it to coincide with their microneedling or laser treatments, taking advantage of the skin’s enhanced remodeling capacity following those procedures.
Who Is a Candidate, and What Peptides Do Not Replace
A good candidate for peptide wellness is usually between their late thirties and sixties, has no active cancer or infection, is in generally good health, and is committed to a multi-month treatment plan with regular follow-up appointments. Our consultations involve a thorough medical history, a review of all medications, frequently up-to-date lab results, and an open discussion about your cosmetic and wellness objectives and the projected timeline. Active malignancy is an absolute contraindication for any growth-factor-related peptides. Pregnancy and breastfeeding immediately place a patient off protocol. A personal history of cancer, even if treated and resolved, warrants an extended conversation and often clearance from an oncologist before proceeding. Patients on chronic anticoagulant medication will have their peptide doses adjusted accordingly.
Peptides are not a substitute for SPF protection. They cannot replace sleep. They cannot replace an adequate intake of protein, resistance training, healthy blood pressure, or any other pillar of standard preventive medicine. When stacked on top of those fundamentals, a peptide protocol can be meaningful. If it replaces them, it is merely an expensive way to deplete your wallet. Nor do peptides obviate the need for surgery when the patient’s facial anatomy calls for it. A patient who has lost the youthful support of their cheeks and jawline will not regain that structure through any peptide on offer. The correct answer for that individual is a deep plane facelift, with peptides serving as a support system for recovery and long-term aging maintenance, not as a replacement for the foundational surgery itself.
The Cautious Side
Peptides are not on an FDA new drug approval pathway. Instead, they are typically compounded for physician prescription at 503A pharmacies within the United States. While perfectly legal, this regulatory space is precisely why the gray market is saturated with vials of uncertain origin, potency, and sterility. The pharmacy I partner with is US-based, cGMP-certified, and provides a certificate of analysis with every batch. The price tag will be higher than buying off a vendor on Instagram. The discrepancy in cost highlights the distinction. To directly answer the question of buying peptides on social media: unequivocally, no. Without exception. A compounded peptide blend is carefully balanced. Throwing additional peptides onto the mixture after seeing something on a podcast is not optimizing your regimen, it is a potential way to inflict an unanticipated hormonal or hematological issue on yourself. If you are interested in adding to your peptide protocol, that discussion must take place in my office, with new prescriptions issued for those additional molecules.
For an edited, shorter version of this article, see The Quiet Way I Treat Aging: NAD Plus, GHK-Cu, and the Peptides I Stand Behind on drworldwide.com. For the more comprehensive and in-depth clinical discussion of mechanisms, dosing, and contraindications, see Peptides for Anti-Aging and Wellness: A Plastic Surgeon’s Clinical Read on NAD Plus and GHK-Cu on agulloplasticsurgery.com.
Why Choose Dr. Agullo
Double board-certified in plastic surgery (American Board of Plastic Surgery) and surgery (American Board of Surgery). Fellow of the American College of Surgeons. Completed a plastic surgery fellowship at the Mayo Clinic. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, where I train the next generation of surgeons in the techniques I use daily. Affiliate Professor at UTEP. Named a Castle Connolly Top Doctor for thirteen consecutive years. Every peptide I prescribe is sourced exclusively through a US-based cGMP-certified compounding pharmacy, precisely dosed by me, and fine-tuned during your follow-up appointments.
Ready to Talk?
If you are interested in whether a peptide protocol aligns with your individual goals, the first step is a personalized wellness consultation at Southwest Plastic Surgery. We will review your entire medical history, discuss your aesthetic aspirations, assess your current routine, and explore what you envision for the coming decade. If peptides are a suitable fit, we will create a tailored protocol. If they are not, I will honestly tell you so. Call us at (915) 590-7900, text 1-866-814-0038, or book an appointment online at agulloplasticsurgery.com. Connect with us on social: @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful.
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