DR. WORLDWIDE GETS SOCIAL
DR. WORLDWIDE GET TO KNOW HIM
Frank Agullo, MD, FACS — known globally as Dr. WorldWide — is a double board-certified plastic surgeon in El Paso, Texas. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center and Affiliate Professor at the University of Texas at El Paso. Specializing in preservation-based aesthetic surgery and the Deep Plane Facelift, he has been named a Castle Connolly Top Doctor for thirteen consecutive years and has a global social following of over 3.5 million across Instagram, TikTok, and Snapchat. He is the founder of Southwest Plastic Surgery and Plastic Surgery Studios.
Meet Dr.WWDR. WORLDWIDE GET TO KNOW HIM
Frank Agullo, MD, FACS is the plastic surgeon the world watches. Known globally as Dr. WorldWide, he has built one of the largest followings of any surgeon on the planet (over 3.5 million on Instagram @RealDrWorldWide) by pulling back the curtain on plastic surgery and showing what extraordinary results actually look like. Celebrities, influencers, and patients from across the United States and around the world make the trip to El Paso, Texas, because when you have seen the work up close, there is nowhere else to go. More than 80% of his patients travel from outside El Paso. The practice handles every detail of their journey.
Dr. Agullo is double board-certified, Mayo Clinic fellowship-trained, and a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. But credentials only tell part of the story. What sets him apart is a philosophy built on preservation: enhancing, restoring, and elevating what is already there rather than changing who you are. Not cookie cutter. Every plan is molded around the individual patient's desires, their anatomy, their life.
That philosophy drives every decision in the operating room. His Motiva Preserve breast augmentations deliver results that feel as natural as they look. His deep plane and endoscopic deep plane facelifts turn back time without announcing themselves. His Supercharged BBL has been refined, published, and presented on international stages. And his ability to combine face and body procedures in a single operative session is a capability few surgeons in the world can offer safely at his level.
The same philosophy applies outside the OR. Forget synthetic fillers. Dr. Agullo restores volume with regenerative grafts including Alloclae, Lipoderma, exosomes, and platelet-derived growth factors. Recovery is treated as part of the result: lymphatic massages, scar management, and Elixir MD LED light therapy ensure that what happens after surgery is as intentional as what happens during it.
Castle Connolly Top Doctor for eleven consecutive years. Texas Super Doctors Hall of Fame. Best Plastic Surgeon in El Paso for thirteen consecutive years. Aesthetic Everything Top Plastic Surgeon 2026. Founding Vice President and President of the World Association of Gluteal Surgeons, where he helped write the global safety standards for gluteal surgery.
The results are daily. The standard is uncompromising. The philosophy is simple: #MakeItHappen. #HappyIsBeautiful. #StayBeautiful.
#PlasticSurgeryIsMyPassion
GLAMOUR SHOTS
Plastic Surgery is a very personal choice and a unique experience for every individual who chooses to undergo a change, be it a discreet or major surgery. The one thing in common for my patients though is that they experience an inner transformation which ultimately shines through as confidence in themselves. Confident is Beautiful!
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- Posted on: November 1st 2026
- Category: Celebrity, Commentary, Skin Tightening
The video is forty seconds long. Barry Keoghan in a treatment chair, a facialist, a handpiece, and the line that made the story: “I feel better about myself. I look better.” Then the number, about $6,000 for two sessions. I run every rung of the RF ladder, from the needle-free end to the probe under the skin, so here is what that money buys, what it cannot, and why the reason he gave matters more than the device.
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- Posted on: November 1st 2026
- Category: Celebrity, Commentary, Skin Tightening
Barry Keoghan sat down for his second needle-free skin tightening session last week, and his facialist filmed it. “I feel better about myself. I look better,” he says in the video. “I think it’s important to look after yourself inside and outside.”
Two sessions, about $6,000, according to the Daily Beast. The device is called Xerf. No needles, no numbing cream, no downtime. In March he had told a radio host, “There’s a lot of hate online. There’s a lot of abuse of how I look.”
It bought heat, carefully delivered
I have not examined him, and no doctor is named in the story. What I can say is what the money bought. Every RF device does the same thing in principle, from the gadget on a nightstand to the probe I use with liposuction, and the gadgets stay mild for one reason:
“The main reason being that these devices do not deliver the same energy as medical grade office devices, and do not heat the dermis up to the 40 to 45 degrees Celsius range, which is what actually remodels collagen. This is also the reason why the results are very mild.”
A needle-free office device like the one in his video does reach the dermis, from the surface, with cooling on the way in. NewBeauty describes Xerf as a dual-frequency device that heats at two depths. Real treatment. Also, by design, the gentlest real treatment there is.
It did not buy much more than that
Comfort is the pitch. For years the trade was real: more tightening, more pain. Morpheus8 Cool ended that at my practice. I was the first patient.
“When I tried it, it was night and day. The pain level I perceived was a one or two out of ten, without any topical anesthesia or medications on board. This made the treatment a lot faster. I noticed less swelling of the tissues because of the cooling technology. I did feel a little, almost needle-like sensation every so often, but very tolerable.”
“Morpheus8 Cool changes that dramatically. The treatments are the same, the depth of treatment is the same, the power is the same. It just makes the procedure so much more comfortable.”
“You will feel the cool head of the applicator on your face. You will feel some vibration, and every now and then you may feel a small needle prick, similar to when you get Botox.”
“In terms of recovery, you may have some redness depending on how aggressive the treatment is and the depth of the treatment, and you may feel some itchiness or mild burning on the skin. Depending on the depth and aggressiveness of the treatment, the recovery could be anywhere between 24 and 48 hours, at which time you’ll start noticing the results. You will see the skin is smoother and tighter, the pores are smaller, and the skin looks refreshed.”
So the gap between “no needles” and “tiny cooled needles” is now a one or two out of ten. The gap in results is not small.
And for the body, nothing from the surface competes with going underneath:
“QuantumRF treats the deep subcutaneous tissue and skin, creating contracture using higher delivery powers in a safe fashion. So far, we’ve seen far greater contracture with QuantumRF than with any other device.”
“If I had to pick just one, I would pick QuantumRF over all the other devices, mainly because it delivers more power, and does so much faster, in a safe and controlled fashion.”
“It is performed through a small incision, about four millimeters, the same incision we use for liposuction. The probe is inserted through the incision on a long cannula, and the radiofrequency treats the tissues under the skin.”
The paragraph the video leaves out
I say this to every RF patient, needle-free or not, before they pay for anything:
“Radiofrequency is going to give us mild to moderate improvement in skin laxity. It is important to note that every patient is going to react differently to the radiofrequency energy, and the amount of skin contracture can really not be predicted, but will tell itself over the following three months.”
“Radiofrequency energy is going to work well for mild to moderate cases where the skin is still good quality. By good quality, I mean that the skin has good elasticity and is usually absent of stretch marks. In more severe cases, or when the skin quality cannot give us predictable contracture, then surgical excision is indicated.”
“Massive weight loss patients will rarely respond to radiofrequency by itself, and although it can still be used, excisional surgery is necessary.”
Mild to moderate. Unpredictable. Three months to know. No jawline comes back from the surface.
What lasts, and what does not
“With some of the radiofrequency technologies, we can repeat the treatments for further tightening. And the results that you obtain really are permanent. We create contracture, and we keep going in that timeline from that result. So obviously, as time passes, the skin can begin to lax again, but the actual contracture obtained sets the clock back.”
His treatment set the clock back a little. The reporting says the effect is expected to show for a year or so, about what I would expect from the surface rung. Under the skin, the clock moves a lot further.
The social media problem
“I think the biggest misconception is that on social media, practitioners only show their best results. This gives patients a certain expectation which may not actually happen to them.”
A celebrity in a treatment chair is that misconception with a famous face on it.
The reason he gave
Months of abuse over his looks, then a chair and a handpiece. I hear that every week. Start with what the face needs, not with what strangers said. Low risk, yes. Low yield too, and no caption mentions that part.
Why choose Dr. Agullo
I am certified by the American Board of Plastic Surgery and the American Board of Surgery, completed my plastic surgery fellowship at the Mayo Clinic, and serve as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly has listed me as a Top Doctor every year from 2014 through 2026. I run the whole RF ladder, from Morpheus8 Cool in the med spa to QuantumRF, BodyTite and Renuvion in the operating room, and I say no to the rung that will not reach the problem.
Ready to talk?
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
- Posted on: November 1st 2026
- Category: Ask Dr. Agullo, Breast, Commentary
Nobody learns the words bottoming out, double bubble, lateral slide or waterfall before their first augmentation. They learn them after, at two in the morning, on a forum. Here are five of those questions as they reached me on RealSelf this year, paraphrased, with my answers lightly edited for the page, and the one rule that decides every revision I do.
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- Posted on: November 1st 2026
- Category: Ask Dr. Agullo, Breast, Commentary
Nobody studies bottoming out, double bubble, lateral slide, waterfall, or capsule before breast augmentation. They study them afterward, at 2am, on a forum, with a photo of their own chest open in a separate tab.
And by the time those patients get to me on RealSelf, they’ve already picked one of the words for themselves. Sometimes it’s the right one.
Five RealSelf Q&As from this year, paraphrased and de-identified. My answers, lightly edited for the page.
“Have my implants bottomed out again? My nipples look high now.”
Answered on RealSelf, Jun 2026.
Bottoming out and high nipples are the same thing. When the implant bottoms out and moves below the breast fold it takes the volume with it and this will make your nipple/areola complex appear higher than expected. I can see this in your side picture as well with most of the volume sitting low and the nipple sitting high. Going from 200 and 250 cc implants to 320 and 350 cc implants likely added more weight to an already weakened lower pole that bottomed out in the past and this allowed the breast fold to stretch down again.
In order to correct this issue it would require going back in and performing a breast fold plication (capsulorrhaphy) to tighten up the pocket and move the implant back up to the appropriate position. I would perform this with mesh support (GalaFlex or dermal matrix) considering your breast pocket/tissue has already bottomed out in the past. I would also discuss maintaining your implant size or potentially going slightly smaller to take as much stress off of the breast fold plication as possible. A lift revision, without moving the nipple is likely necessary.
“Six months after augmentation with a small lift, what has gone wrong?”
Answered on RealSelf, May 2026.
The deformity you have developed is called a “waterfall” deformity. The implant position looks good. It’s your breast tissue that has fallen off of the implant, which you are feeling when you lay on your side. The small areola lift that you had will not adequately address your breast tissue falling off of the implant. The suture spitting is a wound healing issue that is separate from your deformity.
Revision surgery could help improve your waterfall deformity. Based on the degree of your deformity and amount of extra skin a Benelli/donut lift revision (larger than what you have already had) or more likely a traditional vertical/anchor lift revision may be performed to help move your breast tissue back up on top of your implant. I will often use a mesh product (GalaFlex Lite) to place over the top of the implant to try and maintain the position of the implant. You are healed enough (6 months) to consider revision surgery.
“My implants have slid out to the sides. Is that my chest or the surgery?”
Answered on RealSelf, May 2026.
I realize you are concerned about lateral slide, however it appears that you actually have 2 different issues going on. First you have a wider chest wall. The second issue is most likely an overly dissected implant pocket laterally by your original surgeon.
With wider chest walls there is more surface area for the implant to slide onto. I’m actually reassured with your photos that you have good cleavage formation when standing which suggests to me that your anatomy is likely not the issue here. Instead I’m concerned that you have some lateral slide of the implant where the implant is migrating too far laterally in the implant pocket causing a larger gap between the breasts. In this scenario I would consider revision surgery with a capsulorraphy using permanent sutures to plicate the implant pocket medially. This would likely also require a mesh material (P4HB or GalaFlex) to help support the capsule contract medially over time. If the implant profile/base width is too wide this may also need to be addressed at time of revision by exchanging for a smaller implant. Subfascial placement may also help with patients that have wider chest walls, however it’s likely in your scenario that addressing the implant pocket would be the main procedure needed to improve this.
It’s good to hear you have no pain at 2 years post-op. And aesthetically this issue can be improved.
“I want more upper fullness. Can I avoid a lift?”
Answered on RealSelf, Jun 2026.
It’s good that 2 out of 3 of your doctors in person do not think you need a lift as I would side with their comments over mine since mine would be based off of educated guessing through photos. I do agree that your upper poles are flat, this can happen with saline implants placed above the muscle that have been in for 14 years. I do think that your nipple areola complex is positioned a little low and there is breast tissue hanging below the nipple areola complex. Whether you need a lift or not will really depend on how high your nipple sits in relationship to your breast fold. Yours appears to be right on the fold. If it’s lower than this then getting larger implants would just end up giving you more ptotic breasts with a larger implant that the breast tissue slides off of and more tissue below the nipple, ie “waterfall” effect. I think you could do well with a small circumareolar lift.
As far as getting fullness I think a cohesive gel implant with a higher profile would help here more than deciding if its above or below the muscle. I understand you do not want it below the muscle as you are active and do not like the way it moves when you contract your pec. You can get fullness above the muscle you just will sacrifice a little coverage and accept a little more palpable/visible implant edge.
“My implants look like disks on my chest. What makes them look natural?”
Answered on RealSelf, May 2026.
From your photos yes you do look a bit like there are disks sitting on your chest. This can happen with subfascial placement since the implant is placed above the pec muscle, it can’t slip underneath like a submuscular implant. Combined with your previous lollipop incision and thinner tissue in the upper breast I can see how this may occur. I don’t think this will change over time.
If I was operating I would perform a:
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Medial capsulorrhaphy, this is basically using permanent sutures to narrow the inside aspect of the implant pocket so the implants can’t migrate medially
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Lateral implant pocket release, this would allow the implant to fall more laterally on the chest wall
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I would recommend a smaller implant size with a width smaller than the ergo mini 220 and a lower profile implant so that you don’t flatten out as much when you lay down
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Fat grafting, using lipofilling to the upper pole to help hide the implant contour especially superior medially. This can help camouflage the implant in patients with thinner tissues.
It would all be done in one surgery. You should discuss all of this with your surgeon.
Depending on if your skin envelope continues to thin out you should discuss possibly converting to a dual plane as well. Don’t pass on the lipofilling. It’s not a lot of fat, but it can make a world of difference.
The rule
- The implant pocket is key, support the pocket with mesh if necessary. Don’t believe tissue that has been expanded can be trusted to not do so again.
- The implant is the last thing I change, not the first!
- A lift is a lift… it’s just not called a “fold revision.”
Ten of these, with the full table, are on my surgical site.
Why choose Dr. Agullo
I am certified by the American Board of Plastic Surgery and the American Board of Surgery, completed my plastic surgery fellowship at the Mayo Clinic, and serve as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly has listed me as a Top Doctor every year from 2014 through 2026. Breast revision is a large part of my practice, and most of it is other people’s augmentations.
Ready to talk?
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. More of my answers are on RealSelf. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
