Southwest Plastic Surgery

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.

There is a growing demand for lifting and contouring of the face without surgery, and Dr. Frank Agullo sees it every week at Southwest Plastic Surgery. It actually extends to the breast, body, even the buttocks. He says the demand has accelerated due to GLP-1 treatments, where patients undergo rapid weight loss and the appearance of aging shows up much more accelerated, along with a tendency for maintenance early on in order to avoid bigger procedures later.

Because the practice offers both the nonsurgical work at the Med Spa and the surgery, the whole continuum lives under one roof. Here is how Dr. Agullo lays it out.

Why Aging Shows Up Faster Now

As Dr. Agullo explains, aging is a combination of two things, skin laxity and volume loss. In weight loss patients, the skin has already been stretched out. The volume loss shows up as aging, and the skin that had previously been stretched out is now sagging, so the aging shows up much, much faster than in regular patients.

The Volume Side at the Med Spa

The practice has used fillers underneath the eyes and the temples for a long time, but the newer volume replacement materials are where the interesting work is. Sculptra is a biostimulator. After it is injected, the body tries to absorb the material and produces collagen.

There are more exciting biostimulating and regenerative treatments now, including PRP, protein-rich plasma, and PDGF, a platelet-derived growth factor. PDGF has not been cleared for injection, but it is a great adjunct to any procedure that performs microneedling or resurfacing. It regenerates the tissues quicker, and with the growth factor the result is a younger appearance and more protection of collagen.

Lipoderma is one of the newest available fillers. It is a donor-derived fat graft with a framework that allows the ingrowth of your own fat cells. This is a more permanent solution, more natural and more like the actual fat we have in our face, rather than scar tissue or collagen.

The Tightening Side

For skin tightening, the best therapies at the moment are radiofrequency. Morpheus8, which is microneedling with radiofrequency, is one of the most sought-after treatments in the practice. The team also uses FaceTite in the face, a more invasive radiofrequency treatment that treats under the skin and above it, and is usually combined with even liposuction of the neck. The laser program still relies on fractionated lasers, with extra care taken for darker skin types, which tend to create hyperpigmentation or scarring.

Step	Treatment	Best For
Volume, gentle	Sculptra, biostimulators	Early volume loss, collagen rebuild
Volume, regenerative	PRP, PDGF, Lipoderma	Adjunct to microneedling, longer-lasting fill
Skin quality	Microneedling, laser	Texture, tone, sun damage
Tightening	Morpheus8	Early laxity, radiofrequency tightening
Deeper tightening	FaceTite	Neck and jawline, often with liposuction
Real lifting	Deep plane facelift	When the mirror test calls for surgery

What the Practice No Longer Leans On

Dr. Agullo is candid about thread lifts. He thinks they had a peak in the last two years, but patients found they’re really not long-lasting. The threads can behave differently on one side of the face than the other and create asymmetries, and sometimes they are not completely absorbed and can be palpated. The practice has really almost diverged away from thread lifts and started to do more minimally invasive surgical procedures instead.

Honest Expectations

All these treatments are good in the early stages of aging, or weight-loss-related aging, and they usually give subtle improvements. They can correct specific areas like temporal wasting, hollowness underneath the eyes, or nasolabial lines. Longevity depends on the therapy. Regular fillers can last up to a year. Sculptra tends to last longer. The new regenerative treatments will be longer-lasting, if not permanent. But aging continues once the clock is set back, even with surgery.

Dr. Agullo is firm that expectations have to be toned down in nonsurgical procedures and well communicated, especially with radiofrequency skin tightening, because a lot of the tightening depends on the patient’s own response and cannot be foreseen.

The Mirror Test, and When It Is Time for Surgery

There is a rule of thumb Dr. Agullo uses. If a patient reaches up to their face and pulls with their fingers upwards, bringing their brows and cheeks and jowls up, or even tightening their neck back, that is a sign they need a surgical procedure and not a noninvasive one. The deep plane facelift and the endoscopic deep plane lift create very natural and long-lasting results, and the practice now sees patients skip the noninvasive procedures and go straight to surgery early on. Recovery is supported through ElixirMD, peptides, and post-surgical lymphatic drainage.

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 a 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, trained the deep plane technique through the Ponytail Academy intermediate and advanced courses in Pittsburgh and Santa Monica, and has been named a Castle Connolly Top Doctor for thirteen consecutive years.

Ready to Talk?

Whether you are in the early-maintenance stage or you already know the mirror test points to surgery, the first step is an in-person assessment at Southwest Plastic Surgery. Because the practice offers the full continuum, you will get an honest recommendation rather than a sale.

For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the clinical patient guide, 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 Monday, June 22nd, 2026 at 12:06 pm and is filed under Facial Procedures, 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.