Southwest Plastic Surgery

“Anything you do like that with your finger, it means you needed a scar. To pull up the skin. Because that’s what you’re doing. You’re pulling up the skin.”

That is Dr. Frank Agullo, the founder of Southwest Plastic Surgery, and he tends to say it early in a consultation rather than late in one. There is a mirror on the wall of every consultation room here, and the staff has learned to watch what patients do in front of it rather than listen to what they say about it, because a patient who reaches up, catches the skin at her cheek with two fingers and lifts has already answered the question she is about to ask.

He puts it a second way for patients who want a rule they can take home with them:

“Anything you wanna lift, or to take out skin, it’s a scar.”

It is a blunt thing to hear on a first visit, and it is also the most useful three seconds in the whole appointment, because it can save somebody several years of paying for the wrong thing.

The Med Spa Is Not the Enemy of the Operating Room

This is worth saying up front, because posts like this one usually turn into an attack on injectables and that is not the position here.

Filler, neuromodulators, microneedling, and laser resurfacing all do real work, and the Med Spa at Southwest Plastic Surgery is busy for good reasons. Injectables even have a job after surgery:

“It’s not gonna look wrinkled right after surgery, but your muscles will start working again. So we do need to put a little bit of Botox here just to soften that so you don’t make that many wrinkles.”

Running those treatments inside a surgical practice changes how they get done, too. Dr. Agullo has been dissolving under-eye filler for a patient whose first attempt at it somewhere else did not accomplish much:

“I wonder if they used enough of the enzyme that breaks it up, and which brand they used. We use the top brand and give pretty high doses so you see it a lot faster. Sometimes places put very little because it’s costly, but you have to do a good amount to start seeing results. Sometimes they don’t know the anatomy as well, so they’re hesitant to go a little deeper where it’s needed.”

What the practice will not do is sell somebody a fourth round of something that did not solve her problem the first three times, and having a surgeon and a Med Spa under one roof means there is always somebody in the building qualified to say out loud that she has outgrown it.

Two Problems, One Complaint

Almost everyone walks in saying a version of the same sentence, which is “I look tired.”

Underneath that sentence are two different mechanical problems that need opposite treatments. The first one is volume loss. Fat compartments deflate over the years, the temples hollow out, the area under the eyes sinks, the cheek flattens, and the hip develops a visible depression between the hip bone and the upper thigh. Nothing in any of those areas has fallen anywhere, there is simply less of it than there used to be. The second problem is laxity, which is a stretched skin envelope sitting over deeper structures that have descended, and in that case the volume is mostly still present. It has just moved south.

Filling fixes the first one and cannot touch the second, and Dr. Agullo describes the physics without softening any of it:

“It’s gonna fill this in, so you would have more, you wouldn’t have the dips. It will fill in and give you a shape, but it’s not gonna tighten the skin. You understand? So it’s not gonna pull anything up. It’s just, we’re blowing it up a little… it does get to be just like with implants, when we put in implants, the skin looks a little tight.”

When a patient asked what it would take to get the shape she was making with her own hands on her buttock, the answer moved to a different room in the building:

“If we just want volume, then it will fill it in. But it’s not gonna do this. If you wanna do that, we need to do a buttock lift. So you would have an incision that goes like this… in the groin area, and it goes towards the back, and it lifts this up.”

A cushion that has lost its stuffing needs stuffing. A fitted sheet that has stretched off the corners of the mattress does not need stuffing, it needs to be taken in. Two problems, two entirely different fixes, and the mirror test tells you which one you have.

Fill Versus Lift, at a Glance

	Filling	Lifting
Treats	Volume loss, hollows, hip dips, flat midface	Ptosis, loose skin, descended deep tissue
Delivered at	Med Spa or minor procedure room, often under local	Operating room, usually under general anesthesia
What it will not do	Tighten skin or reverse descent	Restore lost volume on its own
Downtime	Hours to a few days	Weeks, planned in advance
Leaves behind	Puncture sites	A planned scar, placed where it hides
The mirror tell	Fingers press into a hollow	Fingers pull skin upward

Where the Practice Sends Patients to Filling, Happily

Hip dips are the example Dr. Agullo reaches for most often, because they are the cleanest case of a problem that filling actually solves.

“In your case, you have pretty prominent hip dips. So if we fill them in with the allograft, this is gonna look nicer. Right now you have the waist, you have this prominence, you have a dip, and then you have this prominence. So if we fill this in, then you’re gonna have a waist. And hips.”

Filling that dip produces a waist without lifting anything at all, and it works because the waist was never the problem in the first place.

For patients who do not want a traditional fat transfer, or who do not have donor fat to spare, the practice offers an allograft adipose matrix, which is a processed donor fat product that the body gradually populates with its own cells.

“Allograft works really well. It’s a donor fat. Whatever I inject stays… So sometimes we start with, like, 100 ccs and then start building up if we need to do more sessions. The good thing is that we can do it just with local anesthesia, so it doesn’t require going to the OR or anything like that.”

“I wouldn’t do it all at once because we want your body to replace that with its own fat, and then we can always repeat the sessions.”

There is also none of the sitting restriction that comes with fat transfer to the buttocks, which is usually the first thing a patient asks about: “With allograft there’s no, you know, when we do fat, we say no sitting and things like that. With the allograft, you can sit and everything, so it’s not an issue.”

The face is handled differently, with the patient’s own fat rather than the donor product. “I do need to put a little bit of fat here, and here, and a little bit even on your eyes that are a little bit hollow here and in your temples. And I can get that from your inner thighs. The allograft is too thick for the face.”

The Honest Ceiling on Energy Devices

Skin tightening technology is where the conversation gets slippery in a lot of practices, so here is the version patients get at Southwest Plastic Surgery.

Renuvion J-Plasma uses helium plasma with radiofrequency energy delivered under the skin through the same tiny access sites used for liposuction, and it makes the connective tissue underneath contract. Morpheus8 delivers radiofrequency through microneedles from above. Both are real tools, and Dr. Agullo has used Renuvion J-Plasma since 2019, runs it most operating days, and is counted by the manufacturer, Apyx Medical, among the ten highest-volume users of the device in the world. This is how he offers the pair of them for loose skin around the knees:

“The only thing you can do that’s noninvasive without any scars would be to do some Morpheus and J-Plasma just through a little incision. And that does tighten the skin around the knees, but a lot of it is gonna depend on how your body reacts to that radiofrequency and how tight it gets. For that we just make a tiny, tiny incision here, just to put in a probe to do the radiofrequency.”

His caveat carries weight for exactly that reason. Asked whether the devices could deliver what the patient was showing him with her hands, he said:

“It will, but in that area it’s a lot looser. So it may not give you as much. It’s gonna give you some result, but it’s not gonna be what you’re doing in the mirror.”

That is the ceiling, stated plainly. Energy devices work up to the line where the mirror test starts, and past that line they give you some result rather than the result your fingers just demonstrated, and no number of additional sessions changes it.

When the Answer Is an Incision, the Practice Says So

For a loose abdomen the answer is a tummy tuck, and here is how that conversation usually goes when a patient asks whether the skin can be tightened without a scar:

“Your abdomen is not bad, but you do have loose skin. The only way to get rid of the loose skin on the abdomen would be an incision like this, and that’s where we pull everything down and even tighten your muscle to make them flat. But it’s a tummy tuck.”

The length of that incision is tied directly to how much can actually be corrected, which is why it is not something to negotiate down:

“If you make it short, then we can only do a little bit like that. It’s not doing anything up here. If we make it long, then we can really pull everything down.”

Arms after significant weight loss need a brachioplasty, and most of the body contouring conversation at the practice turns out to be a conversation about scar placement, with patients shown exactly where the scars will sit before anything gets scheduled. The neck is worth spelling out too, because so little of a neck lift is actually about skin:

“The scars for the neck are behind the ear, right on the edge of the hair and the ear, so you really can’t see them, and one right underneath the chin, which you can’t see either, but it makes a difference. It’s actually the muscle, the platysma. We’re fixing the muscle, removing the deep structures here so this is nice and flat, then putting the muscles together and pulling them this way. We pull the skin a little, but the effect is more from the muscle. Then I put a special suture from the muscle to the bone right here, and that’s what gives us a really tight sling.”

On the face, the deep plane facelift with endoscopic brow and temple work is the operation Dr. Agullo believes in most, and he still tells patients the truth about the incision:

“The scar’s gonna be here, so they’re gonna be behind the hair, so you’re not gonna see those. But you are gonna have one scar here, and then it’s gonna go behind the ear, and hug in the hairline. So everything hides really, really well. I can’t do it without any scars in front of the ear. I’m afraid, because we do have to lift significantly, you’re gonna have these wrinkles here if I don’t take out your skin.”

The scar is not a failure of technique. It is the price of the lift.

Which brings up the line he has been saying publicly for years, that fillers are a tax and a facelift is an investment. A tax recurs on a schedule that never gets shorter, and an investment gets paid once and then works for a decade or more. Filler also has a habit of overstaying, which is worth knowing before the fourth syringe rather than after it:

“Filler is going to make your nose bigger. All we do with filler is we cheat by adding to other places.”

“And the problem is that filler, what we see now, is that it doesn’t really go away. It spreads. So then in the end, it’s going to end up on the sides and make you look wide.”

None of that is an argument against ever having filler. It is an argument against paying the tax on a problem the tax was never designed to solve.

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 and a Fellow of the American College of Surgeons. He completed his plastic surgery fellowship at Mayo Clinic and trained in the endoscopic deep plane technique through the Ponytail Academy intermediate course in Pittsburgh and the advanced course in Santa Monica. 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?

Come in, stand in front of the mirror, and do the thing with your fingers. The team will tell you honestly which side of the line you are on, and whether the Med Spa or the operating room is the right room for you.

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

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

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Companion Reads

• Editorial version on drworldwide.com: Filling Is Not Lifting: The Mirror Test Every Patient Runs Without Knowing It
• Clinical patient-facing version on agulloplasticsurgery.com: The Fingers in the Mirror: Why Filling and Lifting Are Not the Same Operation

This entry was posted on Sunday, July 26th, 2026 at 8:00 am and is filed under Facelift, Injectable Fillers. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

There was a question around the table during Thursday lunch at the front office of Southwest Plastic Surgery. Someone had read an article that day about an influencer nearly dying from a facial infection and asked about the dramatic-sounding region, the “triangle of death.” Well, it is real. And it is one of the oldest admonitions in the medical books. Dr. Agullo happens to be the plastic surgeon the Daily Mail called for the answer to this exact story last April, so he brought the answer home to El Paso.

What the Triangle of Death Is

Draw on your face an outline of a triangle with the corner pointing upward to your forehead at the bridge of the nose and the base corners extending to the outer points of your mouth. You have marked your nose and the skin around it, which has been called the “triangle of death” in anatomical diagrams for more than a century.

The title is not chosen to be morbid. It comes from an anatomical quirk with real implications. As Dr. Agullo describes it, this is the one part of the face that must be handled with more gentleness than a mirror and ten extra minutes of morning ritual.

Why This Zone Is Different: Veins Without Valves

Here is the part you have most likely never known. Veins deliver blood in one direction, toward the heart, and almost all of them have small valves inside to stop the blood from reversing direction. These valves are one reason an infection does not spread across your body from a minor lesion.

But most veins around the triangle of death do not have them. What is worse, they empty into the ophthalmic and facial veins, which carry blood back toward a large cistern at the base of the skull, behind the eye: the cavernous sinus. This is a great big pool of blood that sits just behind the eyes and nestles right next to the brain. Because there are no valves to restrict their direction, blood in these veins can flow in reverse instead of out.

So in the case of picking a pimple there or using an unsterile needle in the region, there is a rare path that will carry the infection backward along those veins, toward the eye and the cavernous sinus, instead of up and out. It is that pathway that has given this region its grim special status.

How Worried Should You Be

The good news: most patients infected here recover without lasting problems. The single most dangerous complication is a clot known as cavernous sinus thrombosis, forming inside that cavernous sinus. Before the advent of antibiotics, it almost invariably brought death, earning it the ominous nickname.

It is exceedingly uncommon nowadays, with fewer than a 1 percent chance (0.2 to 0.5 percent) that a triangle infection would proceed that far, and effective treatment available in the form of modern antibiotics. Because it is treatable, patients usually make a full recovery even if cavernous sinus thrombosis does take hold. So yes, while rare, the triangle of death warrants cautious consideration, not panic with every stray pimple or mark on the bridge of the nose.

The Habits That Cause Trouble

A triangle infection is rare in careful patients. Usually, an infection of the triangle region means something more forceful happened. Mostly it means picking pimples from the dead center of your face with your nails, yanking an ingrown hair from your upper lip, digging at a blackhead beside the bridge of your nose, or popping a cyst into your sink. Newer sources of infection are DIY tools from online, lancing devices, comedone extractors, derma-rollers, or injectables administered by non-physicians.

These all end the same way: pushing bacteria down into the tissue in an unsafe manner, rather than letting the body push the bacteria up and out or letting it resolve on its own.

The Safer Alternative: Let the Med Spa Do the Extractions

The entire point of a med spa, especially a medical med spa run by surgeons, is to close this exact gap. Professional acne extractions, medical-grade acne care, and chemical peels and skin treatments happen safely and in sterile environments, under a physician’s guidance and at a level of cleanliness a patient working at home cannot reach.

These are not marketing platitudes; this is surgical discipline. Dr. Agullo performs facelifts, both deep plane and endoscopic deep plane, right across the triangle of death area all the time. Why is that safe? The skin is prepped with an antiseptic solution, the instruments he uses are sterile, and the procedure itself is designed to keep bacteria from entering the tissue beneath the skin in the first place. That standard was drummed into him during his plastic surgery fellowship at the Mayo Clinic, and he has taught it for years as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. When this section of your face demands care, these standards apply.

The Warning Signs to Never Ignore

Almost all blemishes in the triangle area resolve rapidly without intervention. The warning signs start when a blemish does not follow its usual predictable path toward healing. Contact your nearest emergency room immediately if you notice redness spreading beyond the boundaries of the blemish and into surrounding tissue, especially toward your eye, swelling that keeps increasing over hours, a fever, a headache far worse than normal, any change in vision or double vision, or an eye that begins to bulge, droop, or stop moving normally.

When these symptoms arise, it is an ER-level, same-day emergency, not a wait-and-see, and it is the rapid application of antibiotics that often saves the day. Simply stated: leave the triangle alone, use a plan for acne rather than blunt force, keep the skin clean, and defer any extractions or invasive interventions to a professional.

A Home Routine That Works With the Triangle, Not Against It

For most patients, taking care of the triangle at home does not involve more products. In fact, it involves doing a bit less. Twice-daily cleansing with a mild, neutral-pH cleanser, followed by daily moisturizer and then sunscreen, will do far more good than ever attempting to squeeze out a pore. Acne, when it occurs consistently, calls for a specific strategy and, if indicated, a prescription rather than a nightly brawl in the mirror.

The single hardest reflex to break is the temptation to attack a pimple the minute it shows up. Blemishes generally resolve without intervention. The pimples that have been squeezed, jabbed with an unsterile needle, or poked into submission are more often the cause of serious complications. If anything in the triangle is stubborn, painful, or recurring, it is time to get help rather than do damage at home.

Our med spa works hand in hand with Dr. Agullo. The med spa team can safely handle all routine skincare and any necessary extractions, and any problem that is clearly beyond a blemish is referred straight to Dr. Agullo or one of his partners. Bottom line: you do not have to be the judge of how hard to press on the most delicate area of your face.

Ready to Talk?

If you have been fighting acne, a lesion, or scarring in this zone on your own, let our team look at it properly and build a safe plan, whether that is a med spa treatment or a consultation with Dr. Agullo. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

Companion reads: Dr. Agullo’s editorial take is on drworldwide.com, and the clinical exam-room version is on Agullo Plastic Surgery.

This entry was posted on Friday, July 24th, 2026 at 12:31 pm and is filed under Face. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

A lot of people think Botox is only for forehead lines and crow’s feet. One of Dr. Frank Agullo’s favorite uses sits lower, in the masseter, the chewing muscle at the angle of the jaw. When that muscle is strong, he explains, it widens and squares the lower face. Relax it, and the jaw narrows, softens, and looks more feminine. No incision, no downtime.

Here is how Dr. Agullo talks patients through it at the Southwest Plastic Surgery Med Spa, offered as education rather than a recommendation for any one face.

What Masseter Botox Actually Does

It relaxes the big chewing muscle along the back of the jaw, Dr. Agullo says. When that muscle is overdeveloped, often from clenching or grinding, it makes the lower face look wide and square. Softening it lets the jaw narrow over the following weeks, so the face reads more oval and more feminine. Patients get that tapered lower third without anyone being able to tell they had something done. These injectables live at the Med Spa.

How Long It Lasts

The masseter is different from regular Botox. When Dr. Agullo treats the forehead or the eyes, that lasts about three to four months. The masseter holds much longer, usually around six months, because of how the muscle responds.

Area Treated	Typical Duration
Forehead, glabella, crow’s feet	About three to four months
Masseter (jaw)	Around six months

How the Dose Is Decided

It depends on the strength of the muscle, Dr. Agullo explains. The first time, if the masseter is strong, he may treat it more fully, an even split on both sides. Once the muscle has already been softened from a prior round, he can do less, maintaining rather than starting from scratch. The goal is a balanced, even result on both sides so the jaw narrows symmetrically, and he would rather build the effect gradually than overdo it in one sitting.

Softening a Square Jaw

Narrowing the jaw, Dr. Agullo says, is a big part of softening a masculine or very square lower face. When the angle of the jaw comes in, the face looks more heart-shaped and more feminine, in a way that looks natural rather than surgical. People notice the patient looks better, not that they had work done.

How the Chin Completes the Look

The chin works together with the jaw. Sometimes after the sides are narrowed, a little projection in the middle of the chin finishes the look, so it stays pointed and feminine rather than reading wide. That can start as a small amount of filler. For a permanent change, Dr. Agullo uses a button-style chin implant, which projects the chin straight forward instead of widening it, making the chin look narrower and giving that nice shadow underneath the jawline. Filler previews the look, and the implant is the lasting tool. The two pair naturally with masseter Botox. When a patient needs true lifting instead of reshaping, that is closer to a facelift, a different conversation entirely.

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. He treats the lower face as one connected unit, the masseter, the jawline, and the chin together.

Ready to Talk?

If your jaw has always looked wider or squarer than you would like, the team at Southwest Plastic Surgery can tell you whether masseter Botox is the simplest fix.

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 Tuesday, July 21st, 2026 at 8:00 am and is filed under Injectables, 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.

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.

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.