Southwest Plastic Surgery

The terminology at the front desk has morphed in recent years. A few years ago, a new patient would typically ask, “What makes me younger by Friday?” Today, she is saying, “I want to talk about longevity,” or “I am interested in my health span,” or “How can I preserve collagen,” rather than, “How can you fix my fine lines?” One recent patient stated, “Dr. Agullo, please future-proof my skin.” There is really no better three-word way to describe the longevity movement.

Dr. Frank Agullo could not be more thrilled about the shift. “Anti-aging was a lost bet from the beginning. Anti-aging, by definition, promised to roll back time and as you can imagine, time does not always wish to be rolled back. Longevity asks a better question: how do we help skin maintain health and function for the long haul? This is a bet that can and will be won.”

From Correction to Preservation

This transition stems from a fundamental change in medicine, as doctors increasingly prioritize not just how long patients live, but how healthily they live those years (i.e., their health span). This same thinking is now being applied to skin care, as patients now reallocate their money and focus away from undoing the damage of the past and toward protecting skin against the damage of the future.

“Aging starts at the cellular level. It is mitochondrial function, the level of inflammation in the skin, metabolic health, cellular repair mechanisms,” Agullo said. “What you see on the surface is just a report card on all of those things. This is why skin care truly begins much earlier in life than a wrinkle cream. It needs to work on a cellular level and needs to be treated in a more profound way than topical anti-wrinkle ingredients.”

With collagen levels starting to drop in the mid-20s and women losing an estimated 25 to 30 percent of their collagen in the first five years post-menopause, preservation will always beat rescue hands down.

The Foundation Comes Free

“Before I recommend one single ingredient or topical product,” Agullo said, “we start with the fundamentals. We want our patients to wear a daily sunscreen (the El Paso sun, in particular, means this is the one step that cannot be skipped), consume enough protein, include strength training in their weekly schedule, get real, sustained sleep and work to maintain a steady, relatively flat blood sugar line, thus limiting the glycation of collagen. Patients sometimes try to bypass the basics to leapfrog ahead to the new gadgets. This is something I tell every patient that I meet with in the MedSpa: An infusion or a device simply cannot fix five hours of sleep. Nothing can make up for not applying a sunscreen on a daily basis. The fundamentals are the treatment itself. Everything else is an amplifier that helps maximize your results when it is added to this consistent, daily and disciplined foundation.”

The Shelf: Why We Carry Alastin and SkinCeuticals

When you walk into the MedSpa at Southwest Plastic Surgery, you will notice two distinct skincare lines lining our shelf: Alastin and SkinCeuticals. That was a choice and an important one. Both Alastin and SkinCeuticals are known for their high quality and their evidence-based approach to skincare development. Every one of their formulations undergoes extensive testing and both brands publicly share their published scientific data, focusing on ingredients that are proven to support skin function, repair and protection. Here is the skin longevity routine our team builds around those two brands, from morning to night.

Step	Product	The Longevity Job
Morning defense	SkinCeuticals C E Ferulic	Antioxidant shield against UV and pollution damage
Morning protection	Alastin HydraTint Pro Mineral SPF 36	Tinted mineral sunscreen patients wear every day
Night signal	SkinCeuticals Retinol 0.5	The most studied collagen-stimulating topical class
Night repair	Alastin Restorative Skin Complex	TriHex peptides support new collagen and elastin while clearing damaged fragments
Targeted add-on	SkinCeuticals A.G.E. Interrupter Advanced	Formulated for glycation-stiffened, mature skin
Procedure support	Alastin Regenerating Skin Nectar	Preps skin before treatments, supports recovery after

“Longevity rewards consistency,” Agullo notes. “A shelf stacked with 30 different products from numerous brands suggests a hobby, not a treatment plan. The six products used consistently each day are a strategy designed for long-term benefits.”

Treatments That Build Collagen, Not Just Polish Skin

“You absolutely must first defend the collagen you have before building more,” says Agullo. The treatments at our MedSpa actively encourage new collagen formation. Procedures like microneedling and radiofrequency microneedling involve controlled micro-injuries that encourage the skin’s natural repair response and stimulate the production of fresh collagen over the next several months. Different types of laser treatments are used to address accumulated sun damage, improving skin tone, texture and radiance. Injectable biostimulators such as Sculptra work internally by prompting the body to produce more collagen. In this longevity approach, these treatments are used earlier, applied lightly and scheduled regularly for maintenance, rather than waiting until damage occurs and attempting more aggressive, restorative treatments. This is analogous to servicing your car regularly to keep it running well versus rebuilding the engine after it has seized up due to neglect. And when a patient’s concerns are related to structure or the actual pulling down and loss of volume of tissue rather than the quality of the skin, the MedSpa team is honest about referring those conversations to the surgical side of Southwest Plastic Surgery. Dr. Agullo completed his plastic surgery fellowship training at the Mayo Clinic, is board-certified by the American Board of Plastic Surgery and the American Board of Surgery and has been named a Castle Connolly Top Doctor for 13 consecutive years. When patients consult the MedSpa, they will be directed to the right tool for their needs, not the nearest one in the tool kit.

Start Before You Think You Need To

The unspoken message of the skin longevity revolution is that timing is critical. The best candidates for skin preservation today are the ones who may not yet think they need any interventions. If your current skin plan involves simply waiting to see what happens, consider reaching out. We would be happy to assess your skin’s actual condition, develop a tailored routine to protect it and outline a schedule for any treatments that fit into your overall strategy. #StayBeautiful

Dr. Frank Agullo shares his editorial opinion on the anti-aging movement at drworldwide.com, while his comprehensive patient protocol is available at agulloplasticsurgery.com.

Ready to Talk?

Visit agulloplasticsurgery.com to book your consultation, text 1-866-814-0038 or call (915) 590-7900. @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

This entry was posted on Monday, July 27th, 2026 at 11:25 am and is filed under MedSpa, Skincare. 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.

“So much of their work gets documented, especially when they are a brand ambassador for a med spa and probably get a lot of their care in exchange for the publicity.” That is how Dr. Frank Agullo describes reading an influencer’s face from photos, an educational exercise rather than a diagnosis. He has not treated her, and a photo is not a consultation. But the read is a useful tour of the real menu of treatments behind a polished look.

What He Can Be Fairly Sure About

In Dr. Agullo’s read, we know for a fact that she’s had neurotoxin to the upper face, which includes the forehead, crow’s feet, and glabella, in hopes of making her eyes more open. She’s had Sculptra to the temples to fill in her temporal recession, hollowness, or temporal wasting. She’s also had Renuva to the temples, also for volume, which is a processed donor fat graft that encourages ingrowth of fat in that area.

She also had hyaluronic acid filler in the lips, which it seems she did not like and then had dissolved, even though there are hints of more volume than before. She had a Botox lip flip. She’s also had PDGF for the under eyes, platelet-derived growth factor, which encourages collagen ingrowth. And she’s had various lasers and radiofrequency, including Tixel, a thermal resurfacing device, Moxi, a resurfacing laser, and Agnes RF, which is very similar to Morpheus8.

The Weight Change Behind the Contour

Judging by her earlier photos and her photos now, she’s definitely lost too much weight. Dr. Agullo is not sure if she’s been using a GLP-1, but it has caused her to lose a lot of the good fat in the face, which is the reason she had to fix the temporal wasting. You can notice in the current pictures that she has a lot less lower cheek fat and a lot more angulated jawline.

Now she has a lot more anterior malar volume, so she may have had some Sculptra and Renuva in the upper cheek area. He thinks she maintains the skin with broadband light, like BBL, and has probably had neurotoxin to the masseters and lower face, which you can see from her slimmer jawline, plus good skin quality maintenance with medical-grade topicals like tretinoin and vitamin C.

The Treatments, Mapped to the Practice

Influencer’s Likely Treatment	At Southwest Plastic Surgery
Neurotoxin (upper face, masseters)	Injectables at the Med Spa
Sculptra, Renuva (temples, cheeks)	Biostimulators and fat grafting
PDGF, growth factors	Regenerative adjuncts with microneedling
Lasers and radiofrequency	Laser and microneedling with RF
Brow shaping	Endoscopic brow lift, ponytail type
Skin quality	Medical-grade topicals and BBL

The One Thing That Hints at Surgery

What calls Dr. Agullo’s attention the most, even though he’s not sure she’s had any surgical work and she is rather young, under forty, is that her brow position is significantly different from her earlier days. It’s pulled up and laterally, which actually opens her eyes. A certain degree of this can be achieved with botulinum toxin, but the degree she’s showing looks more pronounced. She may have had an endoscopic brow lift, the ponytail type, which can help with brow shaping and looks very natural. Other than that, he doesn’t see signs of surgical work, and her nose looks unchanged from her earlier photos.

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. 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 there is a look you are chasing, bring the photos to Southwest Plastic Surgery. The team will read your own face the same careful way and map a plan to the right menu, in the right order.

For the surgeon’s editorial take on why public-figure reads are tricky, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing treatment-by-treatment 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 Wednesday, July 8th, 2026 at 10:42 am 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.

“A shrunken follicle can still be revived with growth factors, medications, or therapies, but a lost follicle cannot be brought back.” That is the line Dr. Frank Agullo keeps coming back to with every patient who notices her hair thinning, and it is why he tells women not to wait. Plenty of them see more hair in the brush than they used to and worry, and at Southwest Plastic Surgery the first thing he sorts out is whether it is normal shedding or true hair loss.

Normal shedding is between fifty and a hundred hairs a day, which is usually unnoticeable. True hair loss is different. It exceeds the regrowth potential, and the hair that comes in is thinner, with worse texture and worse density, a process he calls miniaturization. The hair grows in three cycles, Dr. Agullo explains. There is anagen, when the hair is growing, catagen, which is a transition, and telogen, when the hair is resting or shedding. At the conclusion of each cycle, the hair sheds some.

The Common Causes the Team Looks For

The most common cause is female pattern hair loss, which is also called androgenic alopecia, the same major cause of hair loss in men. It has to do with genetics and a follicle sensitivity to DHT byproducts, which make the follicles shut down. In a woman, we don’t see a receding hairline like the one typically seen in males. Instead it happens at the top of the scalp and almost gives us a Christmas tree pattern.

Another common cause is emotional or physical stressors, which can push a large share of follicles into the resting phase. Right after a trigger like childbirth, surgery, major illness, rapid weight loss, or significant stress, the hair follicles go into this resting phase, and a few months later they all shed together. Third is hormonal imbalances, like low thyroid, where hair growth slows and shedding increases across the whole scalp. The fourth is nutritional deficiencies, like low iron, which is very common in many women, especially with heavy menses, and vitamin D deficiency can affect hair growth too. And the fifth is a physical reason, like when women pull their ponytails back too hard, which is called traction alopecia.

Menopause deserves its own mention. Estrogen is a very hair-friendly hormone. It keeps hair in its growth phase longer and supports healthy blood flow in the scalp. During menopause the production of estrogen falls dramatically, and as the estrogens drop, the androgens become more dominant. Those androgens then act on the genetically sensitive follicles at the top of the scalp, the same mechanism we see in female pattern hair loss, which is why so many women notice thinning right around midlife.

The Regenerative Scalp Program

The practice approaches the scalp the way it approaches the rest of the skin, by improving the environment the follicles live in. Microneedling of the scalp improves the microcirculation of blood flow to the hair follicles and has been shown scientifically to improve hair growth, often paired with regenerative growth-factor protocols. ElixirMD supports the nutritional side, addressing reversible contributors like iron and vitamin D.

A Candid Word on TCM-Inspired Approaches

Patients often ask Dr. Agullo about traditional Chinese medicine, and he treats it seriously. Several TCM-inspired approaches line up with what the evidence supports, and they tend to share one mechanism: scalp circulation.

Approach	What It Does	Evidence Note
Ginseng	Promotes scalp blood circulation	Well-researched, encouraging results
Angelica sinensis	Blood tonic, moves circulation	Lab studies show anti-inflammatory, circulatory benefit
Scalp acupuncture	Improves follicle microcirculation	Behaves much like microneedling
Scalp massage	Improves circulation	Proven to increase hair thickness and count
Polygonum multiflorum	Targets DHT, cells, circulation	Caution: a top reported cause of herbal liver injury

Dr. Agullo is direct about Polygonum multiflorum. Most studies on it are in vitro and in animals, the risk of liver damage is real, and the reaction is unpredictable, especially with the raw root. As he puts it, a remedy being all natural does not mean it is automatically safe.

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 member of the International Society of Hair Restoration Surgery. 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?

The most important step, Dr. Agullo says, is to see a physician as soon as hair loss begins, when therapies can actually help and reversible causes can be ruled out. Start with a scalp and hair assessment at Southwest Plastic Surgery.

For the surgeon’s editorial take on the evidence behind TCM and hair, 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 Friday, June 26th, 2026 at 12:07 pm and is filed under Hair Restoration, 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.

When patients sit down at the long table in the front office at Southwest Plastic Surgery to discuss a planned operation, the question of the scar comes up almost every time. “What will it look like?” The answer is honest, layered, and based on a real program that runs from the first decision in the operating room to the last MedSpa treatment a year later.

Dr. Frank Agullo served as a principal investigator alongside Michael Sanchez, PhD on a 114-patient clinical study of the Planatome surgical blade, featured in MPO Magazine under the headline “Significant Reduction in Hypertrophic Scarring Seen With Planatome’s Surgical Blades.” The findings are part of the broader scar management program at Southwest Plastic Surgery, and the longer version of how that program runs in practice belongs here.

Why Scar Quality Is a Series of Decisions

Scar quality is decided at six moments and shaped by one variable nobody controls.

The variable nobody controls is the patient. Genetics, skin type, ancestry, and personal scar history all enter the room with her. Honest pre-operative counseling sets the realistic expectation.

The six decisions are the surgeon’s. The incision location. The orientation of the incision. The length of the incision. The blade. The closure plan, layered, with the right suture choice. And the post-operative scar care plan, including silicone, compression, sun protection, and any post-op laser or microneedling at the right interval.

A scar program that controls all six decisions and supports the patient on the seventh variable produces a measurably better final scar than a program that controls only one or two.

The Six Decisions, in Order

Incision Location

Where the scar is going to live is the first decision. Inframammary fold for breast augmentation. Suprapubic crease for tummy tuck. Periareolar for selected breast operations. Submental for selected facial procedures. The location is chosen for surgical access, for the geometry of the planned operation, and for the position where the scar will be least conspicuous in the patient’s natural clothing and posture.

Incision Orientation and Length

A scar that runs along a natural skin tension line heals quieter than a scar that runs across one. A scar of the right length, neither over-engineered for the operation nor compromised by an attempt to be artificially short, heals better than a scar of the wrong length.

Blade Geometry

This is the decision the field has been quietest about, and the one the Planatome study addressed directly. A polished, sharper cutting edge produces a cleaner cut, a quieter inflammatory response at the wound edge, and, on the data, a measurable reduction in hypertrophic scarring. Dr. Agullo incorporates the Planatome blade into the operations where scar quality is most consequential, including tummy tuck, breast augmentation, mommy makeover, facelift, and any operation on a patient at elevated risk for hypertrophic scarring.

Closure Plan

A layered closure with deep-dermal sutures that absorb the tension before it reaches the skin, fine subcuticular sutures that approximate the dermal edges without strangulating them, and meticulous wound edge eversion is the foundation of a fine-line scar. The suture choice, the spacing, the depth, and the technique all matter. A great incision with a poor closure is a poor scar.

Post-Operative Silicone, Compression, and Sun Protection

The first three to six months are the active phase of scar formation. Daily silicone gel or sheeting, gentle compression where the anatomy allows, and disciplined sun protection are the patient-side variables that have been shown, repeatedly, to influence the final scar. The patient handout at Southwest Plastic Surgery is specific about products, timing, and frequency.

MedSpa Laser and Microneedling on Indication

For selected patients, the MedSpa layers in post-operative scar-management modalities at the appropriate intervals. Fractional non-ablative laser for early hypertrophic scar redness and pigmentation. Microneedling at the right interval to remodel the dermis along the scar line. Pulsed-dye laser for persistent vascularity. The MedSpa team coordinates the cadence with Dr. Agullo’s office, and the patient does not have to assemble the program from three separate providers.

How the Program Runs in Practice

Phase	Setting	What Happens	Why
Pre-op	Consultation	Realistic scar expectation set	Genetics, skin type, anatomy, prior scars
Pre-op	Planning	Incision location, orientation, length set	Long-term scar geometry
Intra-op	Surgery suite	Planatome blade incision	Cleaner cut, quieter inflammatory response
Intra-op	Surgery suite	Layered closure with tension-balanced sutures	Foundation of a fine-line scar
Weeks 1 to 4	Recovery	Silicone, compression, sun protection	Active phase scar modulation
Weeks 6 to 12	Follow-up	Scar assessment, plan refinement	Catch early hypertrophy
Months 3 to 12	MedSpa	Laser, microneedling on indication	Address vascularity, pigmentation, texture
Year 1+	Final assessment	Long-term scar quality reviewed	Document the result and adjust as needed

The phases run together as a single program. No part of the program is exotic. All parts of the program have to be done correctly to produce the final scar the patient hoped for at the consultation.

What the Planatome Study Showed, in Plain Terms

A 114-patient study evaluating the Planatome surgical blade showed a measurable reduction in hypertrophic scarring in the arm using the polished blade. Dr. Agullo served as a principal investigator on the study alongside Michael Sanchez, PhD. The trade industry coverage in MPO Magazine framed the reduction as significant. The result is internally consistent and clinically meaningful, and other investigators will be replicating it across other populations and operations in the years ahead.

The study is one input into the longer scar conversation, not the only input. The Southwest Plastic Surgery scar management program incorporates the finding at the first decision, the blade itself, and continues through the closure, the silicone, the MedSpa cadence, and the long-term follow-up.

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 served as a Principal Investigator on the 114-patient Planatome surgical-blade clinical study, picked up by MPO Magazine and other trade outlets in early 2025.

Ready to Talk About a Planned Operation?

If a planned operation is on your mind and the scar is part of what you are weighing, the first conversation is a consultation at Southwest Plastic Surgery. The scar management program runs from the first decision in the operating room to the last MedSpa treatment a year later, and the program is part of the plan from the beginning.

For the surgeon’s editorial version of this conversation, see Dr. Agullo’s drworldwide.com essay, A Sharper Edge: A Surgeon’s Read on Blade Geometry and Scarring. For the clinical patient-facing version, see A Sharper Edge: How Blade Geometry Reduces Hypertrophic Scarring 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, June 19th, 2026 at 9:00 am and is filed under Body Contouring, Plastic Surgery News, Recovery. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

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

Step	What Happens	Where
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.