Southwest Plastic Surgery

“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.

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 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.