Southwest Plastic Surgery

Some of the most rewarding consultations at Southwest Plastic Surgery are with patients who have lost sixty, eighty, even a hundred pounds, whether through bariatric surgery, a GLP-1 medication, or sheer discipline. They did the hard part. What remains, Dr. Frank Agullo explains, is skin that lost its elasticity and will not bounce back, no matter how much they exercise.

Here is how he talks patients through it, offered as education rather than a plan for any one person.

Why the Skin Will Not Go Back

Once skin has been stretched that far for that long, Dr. Agullo says, the elastic fibers are spent. A patient can be at a great weight with a tiny waist and still have skin hanging from the breasts, the abdomen, the inner thighs, and the arms. That is not a discipline problem, it is a tissue problem, and the only thing that removes loose skin is surgery. That is exactly what body contouring after major weight loss is built to address.

The Breasts After Weight Loss

After massive weight loss the breast usually still has volume, Dr. Agullo notes, it is just hanging very low. Most of the time a lift alone gives a beautiful result, without an implant. He brings the nipple up, removes the excess skin, and places a mesh on the inside so the result does not rely on skin that has lost its elasticity. When the breasts are extremely low, he often advises against an implant in the same operation, because moving the nipple a long way up while adding an implant can compromise its blood supply. An implant is an easy second step later.

Tummy Tuck or All the Way Around?

With a standard tummy tuck, Dr. Agullo makes a low incision, removes the excess skin, pulls everything down tight, and repairs the muscles up the middle and along the sides for a corset effect and a smaller waist, combined with liposuction.

After massive weight loss, a lot of the looseness wraps around the sides and the back, so he often recommends the circumferential procedure, also called a lower body lift. The incision continues all the way around, letting him pull the skin down in front and lift the outer thigh and buttock at the same time. It is the most complete option when the laxity is not just in the front.

If the laxity is	Dr. Agullo usually recommends
Mostly in the front	A tummy tuck with liposuction
Wrapping around the sides and back	A circumferential lower body lift
At the breasts	A lift, often with internal mesh
On the inner thighs	A thigh lift, staged carefully

The Honest Tradeoffs

Dr. Agullo is upfront about the limits. The circumferential lift pulls everything down and in, but heavy side-to-side laxity can leave some looseness up top, and removing that completely requires a vertical scar most patients prefer to avoid. He almost always leaves that as an optional second stage.

The thigh lift, he tells patients, is the hardest of these to recover from. Right where the tension pulls upward, the incision tends to open a little, almost every time. It is simply kept covered with gauze, closes on its own in about two to three weeks, and often needs no scar revision at all.

A procedure like this removes roughly ten pounds, so Dr. Agullo advises patients to reach a stable weight first, then maintain it for the best, longest-lasting result.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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 is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years. Body contouring after massive weight loss, he says, is not one operation for everyone. It is a plan.

Ready to Talk?

If you have lost the weight and you are ready to deal with the skin, the team at Southwest Plastic Surgery will help you build a plan together.

For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing version, see the companion post on agulloplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Sunday, July 19th, 2026 at 8:00 am and is filed under Body Contouring, 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 arrive at Southwest Plastic Surgery focused on the nose, or the neck, or the jawline. Very often, Dr. Frank Agullo says, the real issue is a chin that sits a little too far back. A small, well-placed chin implant can bring an entire profile into balance, and it is one of the fastest, most underrated procedures he performs.

Here is how Dr. Agullo talks patients through it, offered as education rather than a recommendation for any one face.

How Dr. Agullo Knows If a Chin Implant Is Needed

He reads the profile from the side. Ideally, he explains, there is a straight line from the nose to the lips to the chin. When the chin sits behind that line, everything else looks off. The nose can look bigger and the neck heavier than they really are.

A lot of the time the patient is almost there and just needs a touch of projection. In many cases the chin only needs about a quarter inch to a half inch to come into balance.

Narrow or Wide, It Is the Patient’s Call

Dr. Agullo asks whether a patient would rather keep the chin narrow or carry it a little wider, because the implant shape can do either. He uses an anatomical implant shaped to follow the patient’s natural bone. If there is a small indentation on either side of the chin, the anatomical shape fills it in, and when it does not fill it completely, a little filler or fat can smooth the transition later.

Why an Implant Instead of Filler

Consideration	Filler	Chin Implant
How long it lasts	Months	Permanent
Best use	Preview, refinement	Lasting profile change
Material	Injectable gel	Solid silicone
Maintenance	Repeat treatments	None once healed

Filler is fine for a temporary look, Dr. Agullo says, but for a real, lasting change to the profile the implant is the better tool. The implant he uses is solid silicone, so it is permanent. It does not need changing and cannot rupture or leak. When the sides need refining afterward, fat is the more permanent touch-up, though he waits for the swelling to settle before deciding.

How Big a Deal the Surgery Is

It is fast. A small incision goes right underneath the chin where it cannot be seen, and the procedure takes about thirty minutes. It can be done under local anesthesia for patients who feel they can get through it, or with a little IV sedation. Recovery, Dr. Agullo tells patients, is a lot like a dental visit. There is some swelling, the smile can feel slightly off at first from minor nerve irritation, and there is no long downtime.

Where the Chin Implant Earns Its Keep

The procedure makes its biggest difference in combination. When a patient is already addressing the neck or jawline, perhaps alongside a facelift, a small chin implant is easy to add and pulls the whole lower face together. The lighter refinements, fillers and small touch-ups, live at the Med Spa. Instead of a much bigger jaw surgery, a small chin implant is far easier to recover from and still gives a balanced result.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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 is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years. The chin is a place where a millimeter or two changes everything, so his goal is balance rather than a brand-new face.

Ready to Talk?

If your profile has always bothered you and you cannot quite say why, the team at Southwest Plastic Surgery can take a look and tell you whether the chin is the answer.

For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing version, see the companion post on agulloplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Friday, July 17th, 2026 at 8:00 am and is filed under Facial Surgery, Plastic Surgery News. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

A decade ago, most patients who came to Southwest Plastic Surgery about their breasts wanted to go bigger. Today, a striking number want the reverse. They have carried their implants ten or twelve years, they have read something online, and they want a clear answer about whether to remove, exchange, or simply go smaller.

Dr. Frank Agullo walks each of them through the same honest framework. What follows is that conversation, offered as education rather than a verdict on any one case.

What Dr. Agullo Tells Patients About Breast Implant Illness

If you have lived with your implants for years and felt fine, Dr. Agullo says, you are most likely never going to develop a problem. It is uncommon. Across the thousands of augmentations he has performed, only ten or twelve women have asked to have them removed because they felt the implants were affecting them, and most of those women did feel better afterward.

He is candid about the uncertainty. A lot of the time, he explains, it is hard to know whether the implants caused it or whether ordinary aging did, since aches and fatigue arrive on their own as the years pass. The science is still developing, so he will not hand a patient a certainty the evidence does not support, and he will not talk anyone out of removal who genuinely wants it.

Why Textured Implants Get a Closer Look

Textured implants have been linked in a small number of patients to a specific type of lymphoma. The risk is low, on the order of one in a few thousand, and it is tied to the textured surface rather than to smooth implants.

For that reason, Dr. Agullo tells patients with textured implants that exchanging them for smooth ones is reasonable even when everything feels fine. If a risk can be sidestepped, he would rather sidestep it.

What Removal Does to the Shape

This is the part that surprises patients most. Remove an implant of any real size, Dr. Agullo explains, and the breast drops a cup size or more and tends to sag, because the implant was holding up volume the skin had stretched to accommodate.

That is why removal alone is rarely the full plan. Most patients get a better result with a breast lift at the same time, which raises and tightens everything. If a patient still wants a little fullness on top, fat grafting can be added a few months later, once the pocket has closed off.

The Options at Southwest Plastic Surgery

What the Patient Wants	The Path at the Practice
Implants out, simplest plan	Removal, often paired with a lift
Smaller but still shaped	Remove, lift, small implant
Soft, natural fullness	Lift now, fat grafting later
Textured shell, no symptoms	Exchange to a newer implant
Touch-ups over time	Injectables and follow-up at the Med Spa

Going Smaller, on Purpose

Many patients choose the middle path. Dr. Agullo removes the large old implant, performs the lift, and places a small one, sometimes only 150 or 200 cc, mostly to hold a little cleavage and shape. A small implant is more predictable than fat, gives a reliable size, and does not change when a patient’s weight goes up and down.

The Motiva implants Dr. Agullo places now carry a very low rupture rate, under half a percent, and a very low rate of capsular contracture, also around half a percent, compared with ten to fifteen percent for some older implants. Because of that, he no longer tells patients they must swap every ten years, and he often adds an internal mesh to hold the result in place.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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 is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years. Removal and exchange is more involved than a first-time augmentation, which is why he examines each patient, reviews imaging, and is honest about how the shape will change before making a plan.

Ready to Talk?

If you are weighing whether to remove, exchange, or downsize your implants, the team at Southwest Plastic Surgery will help you build a plan around what you actually want.

For the surgeon’s editorial take on this topic, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing version, see the companion post on agulloplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Wednesday, July 15th, 2026 at 8:00 am and is filed under Breast Surgery, Plastic Surgery News. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

Plenty of appointments at Southwest Plastic Surgery are not about a whole region of the body. They are about one spot: a raised scar on the ear after a piercing, a mole on the cheek, a lesion a patient just wants gone.

Dr. Frank Agullo tells patients that the difference between a plastic surgeon doing these and someone simply removing the spot is that he is thinking about the final scar the entire time. The spot is temporary. The scar is permanent. The questions below are from real consultations, anonymized.

Can a Keloid on the Ear Be Removed?

Yes, and Dr. Agullo says it is one of the more straightforward things he does. Ear keloids almost always trace back to a piercing. He numbs the spot, cuts the keloid out, and re-closes it, then lays in a little Kenalog, a steroid, to discourage it from returning. The procedure runs about twenty minutes under local anesthesia, and the only real ask afterward is that the patient skip the gym for roughly ten days.

Will the Keloid Come Back?

There is always some risk, and Dr. Agullo gives patients the actual numbers rather than a vague reassurance. Across the board, recurrence sits around ten to twenty percent. But once the keloid is cleaned up and closed well, most people are simply done with it, so the odds of it coming back the way it was probably drop under five percent. The moment it starts to feel hard or look like it is trying to return, the patient comes straight in and a touch more steroid is placed to shut it down early.

Where Do Keloids Actually Form?

This matters, Dr. Agullo notes, because patients worry about keloids in places they almost never occur.

Common Keloid Sites	Rare or Essentially Never
Ears	Face (rare)
Shoulders	Eyelids (he has never seen one)
Sternum and chest	Genital area (different tissue, never seen one)
Joints, like knees and ankles

Keloids set up shop wherever there is tension and movement. They are genuinely rare on the face, and on the eyelids Dr. Agullo has never seen one. The genital area is a different material entirely, more mucosa than skin and not under tension, so he has never seen one there either. So a patient bracing for a keloid before eyelid surgery or a labiaplasty can set that worry down.

What About a Mole or Spot on the Face?

Here is where having a plastic surgeon do it earns its keep. Anyone can take a lesion off, Dr. Agullo says. The reason to have him do it is that he is building toward the final scar the whole time, choosing where the incision sits and how it closes so that what remains is as close to invisible as possible, instead of just lifting the spot and moving on.

Med Spa Scar Care After the Procedure

Careful closure is only the first half. At Southwest Plastic Surgery, old or healing scars can be softened with microneedling using PDGF, a platelet derived growth factor that is like PRP but more powerful and helps renew collagen. It takes a few sessions and is done at the Med Spa. For certain marks and discoloration, laser treatments can refine the result further. The surgery sets up the scar, and the Med Spa work polishes it over time.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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, completed a plastic surgery fellowship at the Mayo Clinic, and has been named a Castle Connolly Top Doctor for thirteen consecutive years. A keloid or a mole is a small thing, he tells patients, but the scar it leaves is permanent, so it is worth doing right the first time.

For the surgeon’s candid editorial take, see Dr. Agullo’s essay on drworldwide.com, and for the full patient walkthrough, see the companion post on agulloplasticsurgery.com.

Ready to Talk?

If there is a spot, a bump, or a keloid you want handled with the scar in mind, the team is ready. Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Monday, July 13th, 2026 at 8:00 am and is filed under Med Spa, Plastic Surgery, Skin Procedures. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

A surprising number of tummy tuck conversations at Southwest Plastic Surgery start with a patient who is not even sure she needs surgery. She has been told she just needs liposuction, or she has had a tummy tuck elsewhere and cannot get a straight answer about a bulge that will not go away. The practice was built to give that straight answer.

Dr. Frank Agullo tells patients the tummy tuck is the operation people most often confuse with liposuction, and the difference matters enormously. He also sees a steady stream of second opinions. The questions below are from real consultations, anonymized.

Will Liposuction Flatten the Stomach, or Is a Tummy Tuck Needed?

Dr. Agullo explains that when the abdominal muscles split apart during pregnancy or weight swings, liposuction does nothing for it. Liposuction only addresses what can be pinched. Relax those muscles and the bulge from the separation is still there, and a tummy tuck is the only thing that resolves it. The procedure flattens and tightens the abdomen and repairs the muscle wall, like building a corset on the inside. It delivers far more than liposuction alone, with the trade-off of a scar across the lower abdomen.

What a Tummy Tuck Repairs

Two problems liposuction and dieting cannot reach: loose, excess skin, and separated abdominal muscles, which Dr. Agullo calls rectus diastasis. He takes out the extra skin and stitches the muscles back together down the midline. That midline repair is what produces the flat, supported result.

The Second-Opinion Question: Is It a Seroma?

Few questions bring more patients to Southwest Plastic Surgery for a second opinion, and Dr. Agullo’s first move is always to look rather than guess. He uses an in-office ultrasound that color-codes the tissue.

Color on Ultrasound	What It Means
Yellow	Fat
Red	Muscle
Blue	Fluid

No blue on the screen means no fluid, which means no seroma. For patients who have been aspirated again and again with no real answer, that single image is a relief on its own. What is usually going on instead is residual diastasis. The scan shows the muscle on each side and the gap running between them. Up high, where the muscles nearly touch, that is normal. Lower down, where they stayed separated, the abdominal wall goes slack and pushes outward, and that is the fullness patients keep feeling.

How Residual Diastasis Is Repaired

If it is a true diastasis, Dr. Agullo explains, there is one real fix: go back in, open it up, and re-suture the muscles tighter. When a patient’s tissue is very elastic, he may add a mesh to back up the repair, an internal version of the binder worn after surgery. His preferred option is a mesh that dissolves and gets replaced by the patient’s own collagen, about as biocompatible as it gets. The alternative is traditional sutures laid down with a few extra reinforcing layers.

On the upper abdomen, Dr. Agullo notes that he does not aggressively liposuction it during the initial tummy tuck, because removing too much fat there can compromise the blood supply to the skin. Once everything is healed, a little liposuction later can safely refine that area.

Recovery and Med Spa Support

Recovery is where Southwest Plastic Surgery does a lot of its quiet work. As swelling settles, post-surgical massage can help the abdomen feel more comfortable and move fluid along, and the team builds the aftercare plan around each patient. If the bulge a patient is worried about turns out to be no hernia, no seroma, and no fluid collection, Dr. Agullo tells her plainly that it is not a health risk, and he would rather she decide with clear information than be rushed into surgery. For patients thinking about the whole post-pregnancy picture, the mommy makeover page covers the combined approach.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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, completed a plastic surgery fellowship at the Mayo Clinic, and teaches as a Clinical Associate Professor at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. With abdominal surgery, he tells patients, the honest answer usually comes from imaging and an exam, not assumptions.

For the surgeon’s candid editorial take, see Dr. Agullo’s essay on drworldwide.com, and for the full patient walkthrough, see the companion post on agulloplasticsurgery.com.

Ready to Talk?

Whether it is a first tummy tuck or a worry about one done elsewhere, the team will look together. Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Saturday, July 11th, 2026 at 8:00 am and is filed under Body Surgery, Med Spa, Plastic Surgery. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

When a national outlet asked Dr. Frank Agullo for a technical read on Katie Miller’s transformation, he agreed with a colleague that the lower half of the face was where the change was. This is the longer version of that read, offered as an educational assessment from photographs rather than a diagnosis. Dr. Agullo has not treated her, and a photo is not a consultation.

The Before and the After

In her earlier pictures, Dr. Agullo says, we can see that Katie has pretty full cheeks and fullness in the lower face, making her face very rounded, giving her a tired appearance. There’s also a lack of definition of the jawline. Since then, a combination of things has occurred. She does look younger and more refreshed. Her face is more triangulated, and her jawline is more defined.

What Could Explain the Change

In Dr. Agullo’s read, she’s likely had a combination of botulinum toxin around the forehead, the glabella, and crow’s feet. He thinks she’s had some weight loss, probably aided by GLP-1, but the lower face change is rather significant.

He believes this would only be achievable either with liposuction, with the aid of something like FaceTite for skin tightening and Morpheus8, both of which are radiofrequency treatments, and removal of the buccal fat pad. If she truly has had weight loss, she may be keeping the upper cheek fullness with fillers or biostimulators like Sculptra. Or if she actually had the liposuction and buccal fat removal, she may have had some fat injections to the cheek and zygomatic area. He thinks it would be a little bit too far-fetched to think that she’s had a lower face lift, although it’s not out of the question.

The Lower-Face Options at Southwest Plastic Surgery

What Dr. Agullo Sees	The Option at the Practice
Botulinum toxin, upper face	Injectables at the Med Spa
Skin tightening	FaceTite and Morpheus8 radiofrequency
Lower-face fullness	Liposuction, buccal fat assessment
Upper cheek volume	Fillers, biostimulators, fat grafting
Real lifting if needed	Deep plane facelift

Why the Lower Face Tells the Story

The lower third integrates almost everything happening above it. Volume that drops, skin that loosens, and weight that comes off all collect along the jawline and the lower cheek. So when a face moves from rounded and tired to triangulated and defined, the lower third is where the work shows up, which is exactly why Dr. Agullo and his colleague both landed on the lower half of the face.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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, completed a plastic surgery fellowship at the Mayo Clinic, and sits on the Editorial Board of Aesthetic Plastic Surgery, the credential national outlets cited when they asked him to read this face. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years.

Ready to Talk?

If your own before-and-after is what is on your mind, bring the photos to Southwest Plastic Surgery. The team will read your lower face the same careful way and map a plan to the right options.

For the surgeon’s editorial take on reading public figures, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing version, see the companion post on agulloplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Friday, July 10th, 2026 at 12:22 pm and is filed under Aesthetic Analysis, Med Spa, Plastic Surgery News. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

By the time many women reach Southwest Plastic Surgery for a breast reduction, they have tried everything else. Better bras. Physical therapy. Strength work for the back. The pain in the neck and shoulders keeps coming back, because none of those things change the weight that is causing it.

Dr. Frank Agullo tells patients this is one of the most satisfying operations he performs, because it fixes a genuine physical problem and not only a cosmetic one. It also carries a few honest limits that the practice makes sure every patient understands before scheduling. The questions below are from real consultations, anonymized.

How the Reduction Works

Dr. Agullo explains that a reduction is really a lift and a reduction happening together. The patient ends up with a scar around the areola, one dropping down to the fold, and one along the fold itself. Working through those, he raises the breast and removes tissue, usually a few hundred grams per side. A simulation shows the smaller, lighter result beforehand, with less weight tugging at the neck and back. That lighter load is what eases the pain more than anything else.

How Much Can Be Removed

There is a ceiling, and Dr. Agullo tells patients the reason is worth understanding. The nipple and areola have to keep their blood supply, so he cannot take out an unlimited amount. Remove too much and the blood stops reaching the nipple. So he works in a safe middle zone, aiming for the most relief he can responsibly provide.

The Weight Question

Patients often ask whether they should lose weight first. Dr. Agullo explains that the breast has two tissues that behave very differently.

Tissue Type	Behavior With Weight Loss
Fat tissue	Shrinks with diet and weight loss
Glandular tissue	Does not shrink with weight, and is sometimes still growing

If a patient’s BMI is in the obese range, losing weight first helps her feel lighter on top and can reduce the breast a little. But if she has a lot of glandular tissue, her breast size will not change much with weight loss, which is exactly why surgery is the answer for many women. And if a patient plans to lose a significant amount, Dr. Agullo prefers to operate when she is close to her goal, because reducing first and then losing a lot of weight can let things sag again.

Adding Arm Contouring

Patients frequently ask about treating the arms at the same time. Dr. Agullo often does this with liposuction plus BodyTite to tighten the skin, blending into the side of the chest and the back so the patient does not look heavy on top. When the skin is healthy, it responds very well.

The Risks Dr. Agullo Always Discusses

Two, every time. There is a risk of losing some nipple sensation, less than ten percent but possible. And there is a small risk that the nipple and areola do not get enough circulation, in which case some of that tissue can be lost. That risk is under one percent, very low, but patients should always know it is possible. On breastfeeding, the breast tissue stays connected to the nipple, so in theory it should remain possible, though even women who have never had surgery cannot always know in advance.

Surgery, Recovery, and Med Spa Support

The full procedure runs about four to four and a half hours under general anesthesia, and the patient goes home the same day. Plan on roughly a week to return to calm activity and four weeks before exercise, lifting, running, or swimming. For comfort and swelling as the body settles, post-surgical massage at Southwest Plastic Surgery can help during recovery, and the team builds the aftercare plan around each patient. If a patient turns out to need a lift more than a reduction, that lives on the breast lift page.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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, completed a plastic surgery fellowship at the Mayo Clinic, and is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Breast reduction changes lives, he tells patients, but it has real anatomic limits, and he would rather a patient understand the trade-offs up front than be surprised later.

For the surgeon’s candid editorial take, see Dr. Agullo’s essay on drworldwide.com, and for the full patient walkthrough, see the companion post on agulloplasticsurgery.com.

Ready to Talk?

If the weight of your breasts is wearing on your back and neck, relief is a real option. Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Thursday, July 9th, 2026 at 8:00 am and is filed under Breast Surgery, Med Spa, Plastic Surgery. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

Some appointments at Southwest Plastic Surgery start with the door closing a little more deliberately than usual. The patient wants privacy before she even sits down, and the team gives it to her without making a thing of it. That is by design. Labiaplasty is one of the most private procedures Dr. Frank Agullo performs, and the practice is built to make it an ordinary, judgment-free conversation.

It also comes up far more often than patients assume. Dr. Agullo tells patients that almost everyone walks in nervous and walks out wondering why they waited so long to ask. The questions below are drawn from real consultations and anonymized.

Is It Cosmetic, or Can It Help With Discomfort?

Dr. Agullo tells patients it is frequently both, and both reasons are legitimate.

Excess labial tissue can cause discomfort with certain clothing and with activity, and some patients also deal with recurrent irritation. When it bothers a patient physically and she does not love the appearance, those are two valid reasons that do not have to be ranked against each other. No one at the practice asks a patient to justify which one matters more.

How Dr. Agullo Performs the Procedure

He trims the excess tissue so everything is smooth and deliberately leaves some behind, rather than chasing the smallest possible result.

There is one detail he makes sure every patient hears first. When the labia are trimmed, the clitoral hood can end up looking like it protrudes, because it is no longer in proportion with the tissue around it. To avoid that, Dr. Agullo usually recommends reducing the clitoral hood a little at the same time, so everything sits flush. For a patient who starts with very little tissue, a small amount may still show afterward, but far less than before.

What About Sensation?

This is the question patients ask most, and Dr. Agullo addresses it directly. He is removing tissue, and although small nerves are cut in the process, the nerve stays on the surface right where the cut is made, so loss of sensation is not something his patients report afterward. Patients keep the sensation they had. And because the clitoris ends up with a little less tissue around it, full sensation is often actually heightened.

Anesthesia and Recovery, at a Glance

The procedure can be done under IV sedation, similar to a colonoscopy. An IV is placed, the patient is brought into a deep sleep, the area is numbed with local anesthesia, and the procedure is performed. The patient does not feel or remember anything. General anesthesia is available on request but is not necessary. The procedure itself is quick, under forty-five minutes.

Recovery Point	What to Expect
Pain	Most patients report little; some soreness
Comfort aid	Exparel numbs the area about three days
Spotting	A little, for a couple of days
Back to work	About five days, nothing strenuous, under fifteen pounds
Exercise	Four weeks
Intercourse	Four weeks while everything heals
Final result	Visible right away; settles by four to six weeks

Will a Keloid Form There?

Patients worry about this, often because they keloid elsewhere on the body. Dr. Agullo reassures them that he has never seen a keloid form in this area. Keloids tend to appear on the ankles, shoulders, ears, and chest, where there is tension and movement. The genital area is different tissue, more mucosa and skin, and is not under tension, so it is simply not where keloids form.

How the Med Spa Supports Healing

Recovery from a private procedure is still recovery, and Southwest Plastic Surgery treats it that way. The Med Spa and laser services support skin quality and overall healing, and for patients combining labiaplasty with body work, post-surgical massage can ease swelling in those other areas. The team builds an aftercare plan around the whole patient, not just the surgical site.

On symmetry, early unevenness is usually just swelling, since one side tends to swell differently than the other. Like breasts, there are always slight natural differences, and Dr. Agullo makes them as even as he can. He does not finish a case until he is satisfied with it, and his revision policy means he does not charge for a touch-up itself, only the operating room and anesthesia time.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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, completed a plastic surgery fellowship at the Mayo Clinic, and has been named a Castle Connolly Top Doctor for thirteen consecutive years. With a private procedure like this, he tells patients, the two things that matter most are an honest conversation about what is realistic and a result that feels comfortable and natural.

For the surgeon’s candid editorial take, see Dr. Agullo’s essay on drworldwide.com, and for the full patient walkthrough, see the companion post on agulloplasticsurgery.com.

Ready to Talk?

If this is something you have quietly wondered about, you can ask privately at Southwest Plastic Surgery. Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Tuesday, July 7th, 2026 at 8:00 am and is filed under Female Procedures, Med Spa, Plastic Surgery. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

At Southwest Plastic Surgery, Dr. Frank Agullo tells patients something they do not always expect to hear: a good result is half operation and half aftercare. The patients who do their massages, wear their garments, and call early when something feels off are the ones who heal beautifully. That is why the practice builds recovery support into every plan rather than leaving patients to figure it out alone.

These are the recovery questions the team answers most, drawn from real follow-up visits.

Is This Firmness Normal?

Usually, yes. After surgery, firm or hard areas are fibrosis and edema, a normal part of healing. Dr. Agullo has patients massage these areas, and the firmness keeps softening over about three months. It is far better at three months than at three weeks. What is not routine is new, painful, red, or rapidly changing firmness, which is a reason to call the practice.

A Stitch Is Poking Out

That is usually a suture working its way to the surface, which is common and minor. If a small area opens where a suture extruded, the team keeps it covered, sometimes with a silver antimicrobial dressing, and it heals. It does not mean something went wrong. Rarely an incision needs a few extra sutures, about one patient in fifty.

How the Massages Work

Aftercare Step	What the Practice Provides
Lymphatic massage	In-house tech, 2 to 3 times a week for ~4 weeks
Abdominal drain	Clears trapped fluid during massage
Compression	Two Marena fajas, sized down as swelling drops
Facial recovery	ElixirMD LED therapy from day seven

For body work, the lymphatic massages are how the practice keeps fibrosis from becoming a problem. An in-house tech sees patients two or three times a week for about four weeks. In the abdomen, Dr. Agullo leaves a small drain so trapped fluid clears quickly during massage, because trapped fluid is what creates lumpiness.

Garments and Showering

The practice provides two Marena fajas with clips so the team can size patients down as swelling drops. They are worn four weeks, off twice a day to shower and let the skin breathe. If a standard post-op bra is uncomfortable, a supportive alternative is often fine, because comfort that keeps a patient in compression beats a “correct” garment they refuse to wear. Patients shower the next day, and a nurse visits to help with that first shower, check healing, give IV fluids if needed, and answer questions.

Nausea, Pain, and Who Is in the Room

If a patient tends to get nauseous from anesthesia, a pill called Emend taken the night before usually prevents it. Facial procedures barely hurt. Liposuction feels like going back to the gym after a long break, sore with movement but tolerable, and easier than a C-section.

The anesthesia is run by CRNAs who are army and combat trained and have been with Dr. Agullo over ten years. The surgical techs are certified first assist and have been with the practice since 2012. After surgery, patients get a wristband with a 24-hour line to the nurses or nurse practitioner.

What Speeds Healing

Several recovery supports are available through the practice and its Med Spa. NAD infusions with glutathione before and after surgery help clear the anesthesia. Post-op peptides, GLOW for face work and GLOK for body, help with inflammation and tissue regeneration. Arnica and bromelain help with bruising. And for facial recovery, ElixirMD LED therapy starting seven days out roughly doubles the speed of healing.

The Three Habits Behind a Smooth Recovery

Dr. Agullo sums up the patient’s role in three habits: do the massages, wear the garment, and call early. The patients who keep up with their post-surgical massage are the ones whose tissue stays soft and even, while skipping it is what leads to fibrosis that has to be broken up months later.

The garment is the mold the new contour sets into, not a fashion choice, which is why the practice provides two and sizes them down as swelling drops. And calling early matters because nearly everything that worries a patient in the first weeks is normal, and the rare exception is easiest to address when caught quickly.

Preparing Before Surgery Day

The smoothest recoveries start before surgery. The team coaches patients to set up at home in advance: loose clothing that does not require raising the arms overhead, water and easy meals stocked, elevation arranged if the procedure calls for it, and help lined up for the first few days. Arranging support ahead of time is far easier than scrambling for it afterward, and it lets the patient focus on healing.

When Can a Patient Travel or Return to Work?

This is a per-patient answer rather than a fixed timeline. Dr. Agullo prefers to clear patients based on how they are actually healing, not a generic chart. Patients are encouraged to mention upcoming trips early so the team can plan around them, including precautions for long flights. After surgery, every patient receives a wristband with a 24-hour line to the nurses or nurse practitioner, so questions never have to wait.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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 completed his plastic surgery fellowship at the Mayo Clinic. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years.

Ready to Talk?

Recovery questions deserve real answers from the surgeon, not the internet. For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Sunday, July 5th, 2026 at 8:00 am and is filed under Med Spa, Recovery. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

At Southwest Plastic Surgery, the mommy makeover consult often starts with Dr. Frank Agullo subtracting from the patient’s list rather than adding to it. “Mommy makeover” is a marketing name, he explains, not a single operation. His first job is to figure out which procedures actually serve a patient’s goals, and which ones they can skip. Sometimes the most useful thing he does is talk someone out of part of it.

Here is how Dr. Agullo walks patients through the decision.

What the Mommy Makeover Bundles

It is a list of procedures combined into one plan, not a fixed package. It can include a breast augmentation or whatever the breasts need, liposuction 360, a BBL (fat injections to the buttocks), and a tummy tuck. The team picks from that menu based on the individual. No one has to do all of it. The full overview lives on the practice’s mommy makeover page.

Being Unsure Is Normal

Dr. Agullo tells patients that walking in certain about one part and nervous about another is completely normal. Many are sure about the tummy tuck and anxious about implants, or the reverse. Being scared is not a reason to rush or to skip. It is a reason to slow down and go through each piece, one at a time, and patients are allowed to leave undecided.

Implant, Lift, or Both?

What Dropped	What Dr. Agullo Considers
Mostly lost volume	An implant may be enough
Nipple and tissue descended	A lift, often with a modest implant
Somewhere in between	A donut lift plus a modest implant

It depends on what dropped. If it is mostly lost volume, an implant can be enough. If the nipple and tissue have descended, an implant alone can make it look worse, and a lift enters the conversation. A donut lift, a small circle of skin around the areola, raises the nipple about an inch and re-centers it, and Dr. Agullo can place a modest implant through that same incision for upper fullness. The result is perkier and natural, with the scar hidden at the edge of the areola.

Liposuction or Tummy Tuck?

This is the conversation Dr. Agullo never lets a patient skip. Liposuction removes the fat that can be pinched. But if the abdominal muscles separated during pregnancy, a bulge remains when the muscles relax, and the only thing that repairs it is a tummy tuck. A tummy tuck flattens and tightens the abdomen and repairs the muscle, like a built-in corset. It is a bigger improvement than lipo alone, and it comes with a scar, a trade-off he lays out clearly.

Should a Patient Lose Weight First?

Stable matters more than low. If weight is still swinging, settling it first usually gives a better, longer-lasting contour. But a tummy tuck removes loose skin and repairs separated muscle, and dieting fixes neither, so the answer depends on what is actually bothering the patient. The team sorts that out at the exam.

One Surgery or Several?

Often it can be done in one, and that is usually the smarter choice: one anesthesia, one recovery, one block of time off. When planning combined surgery, Dr. Agullo weighs overall health and total operative time rather than stacking a wish list. If a list runs past the safe ceiling on operative time, he stages it into two calmer surgeries rather than one marathon, and he tells patients plainly when that is the safer route.

What Recovery Looks Like

At Southwest Plastic Surgery, patients are coached to expect the tummy tuck to drive the recovery in most mommy makeovers. It asks the most, with a real adjustment in the first week or two as the repaired muscle settles. The breast and liposuction portions ride alongside it without adding much.

The practice builds recovery support into the plan. In-house post-surgical massage keeps fibrosis from setting in, two Marena compression garments are provided and sized down as swelling drops, and a nurse helps with the first shower the next day. Most patients return to normal daily life sooner than they feared, with full exercise later. The advantage of combining procedures is doing this recovery once.

When Is the Right Time?

There is no universal answer, but there are good signals. A patient is done having children, or confident they are. Weight is stable. Help is lined up at home for the first week. And the reasons are the patient’s own, not a deadline someone else set. Dr. Agullo never wants a patient rushing a permanent decision to make an event, and he will say so if the timing is not right.

Recovery and Med Spa Support

Beyond the operating room, the practice’s Med Spa rounds out the mommy makeover journey, from skin care that complements the body work to maintenance treatments once healing is complete. The goal is a result that lasts, supported well after surgery day.

Talking Patients Out of What They Do Not Need

One thing that distinguishes Dr. Agullo’s approach is his willingness to remove items from a patient’s list. If liposuction alone will address a concern, he does not add a tummy tuck. If an implant will restore volume without a lift, he does not recommend longer scars. The practice measures a successful consult not by how many procedures get booked, but by how well the plan fits the patient. For many, the most reassuring part of the visit is hearing what they can safely skip.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. 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 completed his plastic surgery fellowship at the Mayo Clinic. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years.

Ready to Talk?

Let the team build the plan that fits you, not a template. For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Friday, July 3rd, 2026 at 8:00 am and is filed under Body Contouring, Med Spa. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.