When a patient sits down at the long table in the front office at Southwest Plastic Surgery, the consultation almost always starts with a feature. The eyes. The brows. The cheekbones. Dr. Frank Agullo listens, asks a few questions, and then almost always asks if he can spend a careful moment on the lower third of the face. That is where the story usually lives.
A US national outlet asked Dr. Agullo last week for a technical read on a public figure’s “transformation,” and his answer matched a colleague’s read: the lower half of the face was the part that had changed. The longer version of that conversation belongs here, in the context of the lower-face program at Southwest Plastic Surgery, because the program at the practice is built around the same insight. The lower third tells the real story, and a serious lower-face plan layers consultation, MedSpa biostimulators, microneedling, laser, and the deep plane facelift on a single continuum.
Why the Lower Face Tells the Real Story
The face divides into three thirds. The upper third runs from the hairline to the brows. The middle third runs from the brows to the base of the nose. The lower third runs from the base of the nose to the chin, and it carries the jawline, the jowl, the marionette region, the corner of the mouth, the chin, the submental fat pad, the platysma, and the cervicomental angle. The cheek pad, anatomically a midface structure, slides into the upper lower third as the supporting ligaments lengthen and is therefore best read together with what is happening below it.
The lower third is the part of the face that integrates almost every change that happens above it. Volume loss in the midface drops into the marionette region. Skin laxity above the jaw drops into the jowl. Loss of definition along the mandibular border erases the line that the eye reads as “young.” A small chin makes the whole lower face look heavier than it is.
The patient who books a consultation for her cheekbones often leaves with a plan that addresses her jawline. The patient who books for her lip lines often leaves with a plan that addresses her perioral region as a whole. The cheekbone and the lip line are the symptoms. The lower third is the engine.
The Five Forces That Change the Lower Third
The consultation at Southwest Plastic Surgery sorts five forces in the same five-minute read.
Bone resorption. The mandible and the maxilla both lose bone with age. The jaw narrows. The chin recedes slightly. The soft tissue above the bone has more space to drift downward.
Ligament lengthening. The retaining ligaments that anchor the cheek pad to the zygoma and the jowl behind the mandibular border slowly lengthen. Volume that used to sit high slides into the lower third.
Volume loss in the deep fat compartments. The midface flattens, the nasolabial fold deepens, and the corner of the mouth turns down because the structures behind it have lost volume.
Skin laxity. Collagen and elastin decline, the dermis thins, and the skin loses its grip on the underlying structures.
Weight change and prior treatment. Significant weight loss, especially the rapid loss now common with GLP-1 medications, can age a lower third by a decade in eighteen months. Years of filler placed in the wrong plane can make a lower face look heavier than it would have aged on its own.
The combination of those five forces is what shapes the plan. The plan is never one thing. It is a sequence built into a single program.
The Lower-Face Continuum at Southwest Plastic Surgery
The continuum runs from non-surgical to surgical and back to non-surgical maintenance. The program at the practice covers all of it.
Consultation and assessment. Every plan starts with a careful in-person assessment by Dr. Agullo. The five-minute read of the lower third is what produces the plan that matches the face in front of him.
Biostimulators at the Med Spa. For patients who are not surgical candidates yet, or who would benefit from a slow rebuild of collagen and structural support before a surgical step, the MedSpa offers a thoughtful biostimulator program. The point is not to fill. The point is to stimulate. Placed in the correct plane, by an experienced injector, biostimulators rebuild structure that the face has lost without making the lower face look heavier or fuller than it should.
Microneedling for skin quality. The lower third’s skin envelope responds well to disciplined microneedling, with or without growth-factor or autologous secretome adjuncts. The point is not to lift. The point is to remodel the dermis so that whatever surgical step comes next, or whatever non-surgical lifting follows, sits on a higher-quality envelope.
Laser treatments for tone and texture. The perioral region in particular responds well to fractional resurfacing, and patients who have lived with sun damage along the lower face benefit from a layered laser program that runs alongside the rest of the plan.
The deep plane facelift for patients who need real surgical lifting. For the patient whose cheek pad has dropped, whose jowl has migrated forward of the mandibular border, and whose marionette region has lost its definition, the right operation in 2026 is a deep plane facelift. Dr. Agullo trained the operation through the Ponytail Academy intermediate and advanced courses (Pittsburgh and Santa Monica) and has built the practice around it. The deep plane lifts the cheek pad back to the zygoma, repositions the jowl behind the mandibular border, and restores the line that the eye reads as “young.” It does not stretch the skin to do the work.
Recovery support through ElixirMD and post-surgical massage. Recovery is a layered program built into the practice, with IV vitamin support, peptide protocols on indication, and post-surgical lymphatic drainage from an experienced therapist.
The lower-face program is not a menu. It is a sequence the practice walks the patient through, in the right order, for the right face, at the right time.
What a Lower-Face Consultation at Southwest Plastic Surgery Looks Like
| Assessment |
Five-minute read of the lower third by Dr. Agullo |
Consultation room |
| Photography |
High-resolution standardized photographs, including three-quarter and profile |
In-office photo studio |
| Imaging where useful |
Chrysalix 3D imaging for selected cases |
Consultation room |
| Plan written |
Sequence of surgical and non-surgical steps in the right order |
Consultation room |
| MedSpa step if appropriate |
Biostimulator, microneedling, or laser scheduled |
Med Spa |
| Surgical step if appropriate |
Deep plane facelift, lower face lift, or combined procedure scheduled |
Surgery suite |
| Recovery support |
ElixirMD, peptides, lymphatic drainage, follow-up cadence |
Recovery program |
| Maintenance |
Skin-quality plan, periodic biostimulator touch-ups, follow-up assessments |
Med Spa and consultation |
The columns are designed to work together. The plan is what holds them together.
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. He is a Fellow of the American College of Surgeons. He 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 and an Affiliate Professor at the University of Texas at El Paso. He has been named a Castle Connolly Top Doctor for thirteen consecutive years. He sits on the Editorial Board of Aesthetic Plastic Surgery, the journal of the International Society of Aesthetic Plastic Surgery, and national outlets routinely call on him for facelift commentary, including recent coverage in both UK and US national outlets reading the lower face of a public figure.
Ready to Talk About Your Lower Face?
If a facial procedure is on your mind and you are not sure where the conversation should start, start with a lower-face consultation at Southwest Plastic Surgery. The five-minute read of your lower third is what produces a plan that matches your face. The plan is what produces a result that lasts.
For the surgeon’s editorial version of this conversation, see Dr. Agullo’s drworldwide.com essay, The Lower Third Tells the Story. For the clinical patient-facing version, see The Lower Third Tells the Story: How a Surgeon Reads a Jawline 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, June 17th, 2026 at 9:00 am and is filed under Facelift, Plastic Surgery News.
You can follow any responses to this entry through the RSS 2.0 feed.
Both comments and pings are currently closed.
