Dr. WorldWide | Frank Agullo, MD

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I recently did surgery on a woman three weeks ago. When she got seated in the examination room two weeks after surgery, looked in the mirror at her hands and asked the single question that I’ve been asked 100 times over by every patient in that room: “Why do I feel so good already? ” She was doing so with a deep plane facelift. The bruising she had anticipated just didn’t manifest, the post-op fatigue warning she had been issued only seemed to last maybe four days, and, oddly enough, she slept the entire first night of surgery-a feat she was sure she’d be incapable of.

In a lot of ways, I told her the truth: It’s a combination of the right technique (a true deep plane lift lifts ligaments and layers tissue, it’s not skin tightening, which will always cause more swelling and more bruising), good anesthesia and precise closure and a post-op peptide regimen I developed over the past few years, now an option for practically all my surgery patients.

This is the post on what those peptides are, why I use them, and what I think every patient considering plastic surgery should know about them. Not the version a wellness influencer would write. The version a double board-certified plastic surgeon writes.

What a peptide actually is

A peptide is a short chain of amino acids. Examples include insulin, growth hormone, and oxytocin. These signal molecules are synthesized by your body every day to enable communication between tissues. The peptides used for surgical recovery are bioidentical copies manufactured pharmaceutically, dosed precisely.

That’s the part that matters. Peptides aren’t herbal supplements. They aren’t hormones in the testosterone or estrogen sense either. They’re signaling molecules. Inject a small dose of BPC-157 subcutaneously (250 to 600 micrograms daily, in my protocols) and your body responds the way it already knows how. It heals a wound. It lays down new collagen. It recruits cells and growth factors to a sutured edge. It restores mitochondrial energy. The dose is the signal. Your own cells do the work.

Used well, they speed up what the body was going to do anyway. Used poorly, or by patients shopping on the gray market, they are a waste of money or a real safety problem. The version I prescribe comes from a US-manufactured, cGMP-certified pharmacy, with a certificate of analysis, on a dose I selected for the patient and the procedure.

GLOW for face, KLOW for body

I prescribe two related peptide blends, depending on the operation. GLOW is a three-peptide blend: GHK-Cu, BPC-157, and TB-500. KLOW is the same three peptides plus a fourth, KPV. The reason the menu has two versions is that face and body procedures call for different emphasis on the recovery side, and the right blend tracks the operation.

GHK-Cu (glycyl-L-histidyl-L-lysine copper) is a copper tripeptide that exists naturally in human blood. As a person ages, the level of GHK-Cu in the body naturally declines. The same active compound is in many topical copper peptide anti-aging products you’ll find at Sephora, but injected GHK-Cu skips the struggle of the stratum corneum and reaches the dermis directly. This copper peptide activates more than three hundred genes associated with tissue repair. It signals fibroblasts to lay down new collagen and elastin. It also supports basal stem cells in the skin. In plain terms, it’s the piece of the blend that helps a fresh facelift incision heal flat and undisturbed, and that improves the surrounding skin six months down the road.

BPC-157 stands for Body Protection Compound. It is a fifteen amino acid peptide derived from a protein in human gastric juice. The mechanism people care about for recovery is angiogenesis, which is the formation of new blood vessels at injury sites. Healing tissue needs new microvasculature, and the body builds it slowly without help. BPC-157 accelerates that process. It also dampens local inflammation and supports tendon, ligament, and muscle repair. For a body procedure, where I am separating tissue planes and closing layers, this is the workhorse of the blend.

TB-500 is a synthetic analog of Thymosin Beta 4. It regulates a cellular protein called actin, which is the rail system cells use to crawl across tissue. The simple way to put it is that BPC-157 builds the new blood vessels, and TB-500 mobilizes the repair cells to use them. The two are synergistic. The original published research on the pair came out of sports medicine, where elite athletes were using them to push back from soft tissue injuries faster. The same biology applies to a surgical site.

KPV is a tripeptide (lysine-proline-valine) derived from alpha-MSH. Its job is anti-inflammatory. KPV inhibits NF-kB, the master switch for inflammatory gene expression in the body. For a face procedure, where the inflammatory load is comparatively small and the priority is incision quality and skin remodeling, the GHK-Cu story does most of the work, so I run GLOW. For a body procedure, where the inflammatory field is large (BBL, gluteal fat grafting, tummy tuck, mommy makeover, breast surgery), I add KPV to the same three peptides. That is KLOW. Same once-daily injection, same compounding pharmacy, broader anti-inflammatory coverage where the surgical field calls for it.

I dose both blends subcutaneously, in the abdomen or thigh, once daily for the first three to four weeks after surgery. Most patients self-administer at home. Adjustments happen at the post-op visits. The blue tint of the solution is the copper in GHK-Cu. It is normal and not a sign of contamination.

NAD+, the mitochondrial side of recovery

NAD+ is a different molecule for a different problem. It stands for Nicotinamide Adenine Dinucleotide. It is technically not a peptide, but it sits next to peptides on the same prescribing menu, and it pairs well with surgical recovery. The “nicotin” in the name is from vitamin B3 etymology. It has nothing to do with cigarettes.

NAD+ drives our power generators: the mitochondria. And it powers sirtuins, proteins that repair DNA and generally keep the cell tidy. NAD+ levels decrease with age, stress, and illness. Surgery is a stress. The body has to work hard to heal and recover. Adequate NAD+ is the cofactor that work needs.

The default protocol I prescribe is at-home, subcutaneous or intramuscular. Patients go home with a one-month supply, 500 mg total, divided into two doses per week for four weeks. Eight injections, sixty-something milligrams each, spaced through the recovery window. It is well tolerated, easy for patients to self-administer, and it keeps mitochondrial support steady through the period when the body is doing the most cellular work.

For patients who want the IV layer on top, we offer a NAD+ plus glutathione infusion. One before surgery, one after. The pre-op infusion primes mitochondrial reserves before the stress of the operation. The post-op infusion replenishes during the highest-demand recovery week. Glutathione is added as an IV push at the end of the NAD+ drip; it is an antioxidant tripeptide that supports phase 2 liver clearance and helps clear the residual metabolites of anesthesia.

A note on the IV experience. Run too fast, NAD+ causes chest tightness, nausea, and a hot burning sensation. That is rate-dependent and expected. Run slowly, over two to three hours, the patient is comfortable for the entire session. We always run it slowly. The glutathione push that follows takes another five to fifteen minutes.

Who is a candidate

Almost every elective plastic surgery patient is a candidate, with a small number of caveats. Active cancer is a contraindication for most growth-factor-adjacent peptides because we do not want to fertilize a tumor we do not know about. Active infection is a temporary contraindication. Pregnancy and breastfeeding are off the protocol. Patients on therapeutic anticoagulation get adjusted dosing.

Beyond that, the question I ask is whether the patient wants the smoothest possible recovery and is willing to do daily self-injections for a few weeks. If yes, we talk about which blend fits which procedure. A facelift patient gets the skin and incision benefit of GHK-Cu more than anything else, so I prescribe GLOW. A BBL or tummy tuck patient gets more out of the angiogenesis, cell migration, and especially the anti-inflammatory benefit of KPV across a large surgical field, so I prescribe KLOW. Breast surgery and combination cases default to KLOW because the inflammatory load is meaningful. Isolated minor procedures (lip lift, blepharoplasty alone) sometimes do not need a peptide cycle at all, and I will tell a patient that.

The cautious side

Peptides are not on FDA approval pathways the way a new pharmaceutical is. They are compounded by US 503A pharmacies under physician prescription. That is legal. That is also why they are easy to find on the gray market in versions of unknown identity, unknown dose, and unknown sterility.

Two rules I tell every patient. First, do not buy peptides off Instagram, Telegram, or any vendor that ships in unmarked vials. The pharmacy I use issues a certificate of analysis with every batch. The price is higher. The peace of mind is the entire point. Second, do not stack peptides without a physician. The blends are calibrated. Adding random fourth and fifth peptides on top of GLOW because someone on a podcast said to is how you give yourself a problem.

I love fillers for the right patient. I use them every day. But fillers are a tax. Peptides are different. They support the work the body is already doing, and when you stop, the body simply continues at its own pace. There is no rebound. There is no dependency. Used during a defined recovery window, they are a high-leverage tool. Used as forever therapy, they are something else, and we will get into that on a separate post.

Why choose Dr. Agullo for a peptide-supported recovery in El Paso?

Double board-certified, American Board of Plastic Surgery and American Board of Surgery. Fellow of the American College of Surgeons. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, where I teach the same techniques I use every day. Affiliate Professor at UTEP. Castle Connolly Top Doctor for thirteen consecutive years. The peptide protocols I prescribe are dosed by me, sourced through a US cGMP-certified compounding pharmacy, and integrated into the same surgical recovery plan I have built operating on out of town and international patients for the last fifteen years.

Ready to talk?

The right time to start the recovery conversation is during the initial consultation, not the day before surgery. We will look at your anatomy, the operation you are considering, your overall health, and we will decide together whether peptides belong in your protocol. If they do not fit, I will tell you. If they do, you will leave the consultation with a clear plan, a price, and a timeline.

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

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

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After the Needles: The Growth Factor That Earned Its Spot Next to My Morpheus8

Last month a longtime patient sat down on my Morpheus8 table, looked at the small kit on the tray, and asked me where the blood draw was. We had done platelet-rich plasma after every one of her treatments for the past five years. Tube, centrifuge, twelve-minute wait, supernatant painted onto freshly needled skin, small bandage on the inner arm at the end. That was the rhythm of the visit.

I told her we were doing something different this time. A small kit, mixed in a minute, no needle in the arm. Same idea as PRP. A cleaner version of the same idea.

The product is called Ariessence pure PDGF+. The molecule inside is recombinant platelet-derived growth factor BB. I have been using it on a subset of my Morpheus8 patients since the start of the year, and over the past few months it has quietly replaced PRP in my MedSpa for most post-procedure protocols. This is the long version of why.

What PDGF actually is

Platelet-derived growth factor is one of the body’s lead first-responder proteins at any tissue injury. When platelets release at a wound site, PDGF recruits fibroblasts to lay down collagen, calls in the cells that build new microvasculature, and helps coordinate the rest of the early healing response. It is the most studied tissue growth factor in regenerative medicine. Four FDA-approved drug products contain it. Over the past twenty-eight years, more than five and a half million patients have been treated with PDGF-containing FDA-approved products in non-cosmetic medical indications such as periodontal regeneration and diabetic foot ulcer healing. The molecule has a long safety record.

For most of the past decade, the way clinicians delivered PDGF to skin in an aesthetic context was indirect. We drew the patient’s own blood, spun it down, and applied platelet-rich plasma to freshly microneedled skin. PDGF was in there. So were dozens of other proteins, in concentrations that varied with the patient and the centrifuge run.

Recombinant pure PDGF is the next step. The protein is produced in cultured cells from a human gene sequence and purified to a single active species. The label calls it sh-Polypeptide-59 Dimer. There are no human-derived components in the formulation. The dose is controlled by the manufacturer and is the same in every kit.

Why topical, and why right after a microchanneling procedure

Topical PDGF on intact skin is a moisturizer with an interesting label. The protein is too large to cross an intact stratum corneum in a meaningful concentration. Healthy skin keeps macromolecules out. That is the barrier doing its job.

Topical PDGF in the brief window after Morpheus8, RF microneedling, fractional laser, or a medium-depth peel is a different story. The procedure has just opened thousands of microchannels into the dermis. The growth factor reaches the compartment that is asking for it. The window closes within hours.

That is why this product is sold to clinicians, not on a shelf at Sephora. Without a procedure to pair it with, you have an expensive serum.

The Gold 2025 study

In September 2025, Gold and colleagues published a randomized, evaluator-blinded, controlled trial in the Journal of Cosmetic Dermatology. Subjects between thirty and sixty years old got a single Morpheus8 session and were randomized to receive either bland Aquaphor or topical recombinant pure PDGF-BB immediately after. Patients were graded at seven and thirty days using the Clinical Global Aesthetic Improvement Score and Canfield Visia objective imaging.

The PDGF group did better. The difference on the global aesthetic score at thirty days was statistically significant. The PDGF group performed favorably on six of the seven Visia metrics. Patient-reported outcomes were better on the experience measures. No serious adverse events were reported.

The manufacturer is explicit about one caveat in the published reprint, and I will repeat it. The exact formulation in the Gold trial is not identical to the marketed Ariessence product. The trial supports the use of topical recombinant pure PDGF-BB after RF microneedling as a category. It is not a label claim for a specific commercial bottle. I tell patients this clearly. They appreciate it.

Where it sits next to PRP, PRF, and exosomes

The regenerative aesthetics category is crowded. Here is how I sort the actual contenders in my room.

The table is not exhaustive. Topical recombinant epidermal growth factor preparations also exist, for instance. But it captures the choices a patient is realistically being offered today.

Who is the right candidate

Anyone scheduled for Morpheus8, RF microneedling, fractional laser resurfacing, or a medium-depth chemical peel who wants the cleanest possible thirty-day skin. Anyone who has always disliked the blood draw side of PRP. Anyone who has had wildly different PRP results over the years and wants to know whether a controlled dose evens out the experience.

It is not a stand-alone serum. It is not an injectable. It is not a substitute for sunscreen, a retinoid, or the procedure itself. Patients with active facial infection, active inflammatory dermatoses on the treatment area, or any contraindication to the underlying procedure are not candidates until those issues resolve.

What it is not

Ariessence pure PDGF+ is sold as a topical cosmetic. It is not an FDA-approved drug. The Cosmetic Product Listing number is on file with the agency. Cosmetics in the United States do not require FDA pre-market approval. The agency does require honest labeling, prohibits drug-style claims, and oversees safety and adverse-event reporting. Ariessence operates within those constraints.

The product is not approved to diagnose, treat, cure, mitigate, or prevent any disease or condition. It is not for injection. The four FDA-approved PDGF-containing drug products (GEM 21S, Augment, Augment Injectable, Regranex) are unrelated formulations approved for non-cosmetic indications. Their decades of safety data inform the molecule’s general safety profile. They do not transfer regulatory approval to the cosmetic.

I tell patients all of this before we add it to a treatment plan. The Ariessence label does the same.

Why I added it to my MedSpa stack

PRP after microneedling has earned its place over the years. I am not knocking it. A controlled, recombinant dose of the lead growth factor in the platelet release is, on the data we have today, a little better.

Workflow is the second piece. PRP requires a draw, a centrifuge, a twelve-minute wait, and a patient who is okay with a needle in her arm before a needle in her face. Ariessence is mixed in under a minute on the same tray as everything else. My MedSpa team prefers it. My patients prefer not having to roll up a sleeve.

The third piece is consistency with how I think about aesthetic medicine. Preservation, precision, controlled dosing, predictable outcomes. PDGF is the most studied tissue growth factor in regenerative medicine, with more than a hundred clinical trials and a twenty-eight-year FDA-approved drug heritage in non-cosmetic indications. Bringing the recombinant pure version into the cosmetic side of the practice fits.

From Vampire Facials to recombinant pure PDGF

If you have followed me for a while, the throughline matters. The 2019 piece on this blog argued for PRP after microneedling. The science was right then. The recombinant era is a refinement, not a refutation. The molecule is the same lead actor in the platelet release. The vehicle is cleaner and the dose more dependable. I would rather a patient be reading a 2026 update than a 2019 piece pretending to still be current.

Why choose Dr. Agullo for skin in El Paso?

Double board-certified by the American Board of Plastic Surgery and the American Board of Surgery. Fellow of the American College of Surgeons. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Affiliate Professor at the University of Texas at El Paso. Castle Connolly Top Doctor for thirteen consecutive years. Texas Super Doctors Hall of Fame, 2025. Aesthetic Everything Top Plastic Surgeon, 2026. Morpheus8 in active rotation in our MedSpa, paired with Ariessence pure PDGF+ as the post-procedure topical when the indication fits.

We run a clinic and a MedSpa under one roof for one reason. The arc of facial aging is decades long, and you should not have to drive across town to handle it.

Ready to talk?

If you are thinking about Morpheus8, an RF microneedling course, fractional laser, or a peel, and you want to understand what your skin care protocol should look like in the thirty days after, the most useful forty-five minutes of your year is a consultation with the surgeon who would actually plan it. I will tell you whether Ariessence pure PDGF+ is the right add-on for your treatment, whether you are better off with a different combination, or whether the procedure you are asking for is not the one you actually need.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful