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: October 27th 2026
- Category: Breast, Breast Revision, Commentary
Cardi B told X Spaces she wants her breasts done again and is “very scared” to do it, and that her kids are the reason they changed. She is describing the most common breast revision consultation I have. Here is what pregnancy and breastfeeding do to an augmented breast, why bottoming out, sagging and rippling show up afterward, what a revision fixes, and my answer to the woman who wants implants before she is done having children.
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- Posted on: October 27th 2026
- Category: Breast, Breast Revision, Commentary
Cardi B got on X Spaces last week and said the thing half my revision patients say in the exam room. “I’m not gonna lie, I want to get my titties done already.” Then: “For some reason, I’m very scared of getting my boobs done. I don’t know why.” Eighteen years with the implants, four kids since. “I’ve had these titties for a really long time and they’re sagging really bad.” Billboard ran the whole thing.
I will not diagnose a woman from an audio clip. I do not have to. What she described is the breast revision consult I have more than any other.
Here is what happens, in my words from the exam room.
What Four Kids Do to an Implant
“It really depends on what happens during pregnancy. If there are big changes in weight, the breasts also get much larger and the skin and tissues get stretched.”
“Once pregnancy and breastfeeding are done, the breast shrinks back in size and the skin somewhat retracts, but not always to the same extent as pre-pregnancy. That is where bottoming out, ptosis or sagginess, and rippling can happen. Those are the reasons for a revision.”
The implant did not change. Everything over it did.
Why the Implants Look High and the Breast Looks Low
“The level of droopiness determines whether the patient will require a lift or not. If the nipple areola complex is below the inframammary fold, then a full lift, anchor type incision, will be necessary. If the nipple areola complex is at or slightly above the inframammary fold, I will often recommend a circumareolar lift or donut lift. The ideal sternal notch to nipple areola distance is anywhere from 19 to 22 centimeters. Any number greater than that should consider some type of lift. If the lift is not performed during the augmentation and there is considerable sagging, then the implants will appear to be higher up, even though they are in the right place, and the nipple areola and breast tissue will hang over it.”
That last sentence is the one to reread. The implant is where I put it. The breast slid off it. Patients call that sagging; I call it the lift that was skipped, or the lift that pregnancy wrote into the plan later.
The Rule I Use, Not the Feeling
| Nipple position | What it usually means |
|---|---|
| Above the fold, sternal notch to nipple 19 to 22 cm | Swap or reposition the implant, donut lift at most |
| At or slightly above the fold | Donut (circumareolar) lift |
| Below the fold, or the distance runs past 22 cm | Full lift, anchor pattern |
“So when a patient comes in for a lift, usually they do need a full breast lift, unless the nipple areolar complex is above the inframammary fold, in which case we can offer a circumareolar, or donut, lift. Once we’ve identified that a lift is necessary, we ask the patient whether they want to stay the same size or slightly smaller, or if they want to be larger. Of course, if they want to be larger, we will need an implant or a fat transfer to the breast.”
“I generally don’t recommend a lollipop type lift because it has a high incidence of bottoming out. Nevertheless, it is a good procedure on very select patients.”
The longer version is in what nobody tells you about a breast lift.
Why I Put a Bra on the Inside
“In a breast augmentation, the mesh helps support the weight of the implants and creates a tight capsule, to prevent lateral and inferior displacement.”
“In a breast lift and a breast reduction, it actually helps reshape the breast tissue and support it, just like a push-up bra, to gain more upper pole fullness and avoid bottoming out and lateral displacement.”
“The mesh supports the tissues for a period of up to two years. As it dissolves, it leaves behind collagen deposits, so the support remains there even well after the mesh has gone.”
And on the rippling that shows up after the kids, when the tissue over the implant has thinned:
“It is important to also realize that there are risks involved with not using a mesh. These risks include rippling, implant palpability, and implant displacement.”
“One of the ways to make this better is to put some fat here, to make it thicker so that there is more between the skin and the actual implant. I inject it under the skin so it pumps that layer up and it gets thicker.”
The rest of the rippling story is in breast implant rippling.
The Expectation I Set Every Time
“I think a lot of patients are afraid of this surgery because they feel like they’re going to need the full anchor type incision. By offering the circumareolar, or donut, lift for patients whose nipple and areola are above the inframammary fold, this can be a game changer. Also, expectations need to be handled. A lot of patients having a breast lift with implants are expecting a lot of upper fullness and a very high implant placement, which is just not possible at the same time as a breast lift. A breast lift will always give a perkier look, more upper fullness, and cleavage, but it’s going to have usually a natural slope on top.”
Why the Fear Is Usually Misplaced
Cardi B has had two operations on her buttocks to remove injected polymers and says the breasts are the one thing that scare her. I get it. The first operation is the one you remember. A revision after kids is not a bigger operation than the first one. It is a more precise one, because I already know what your tissue did under load.
“If a patient just wants to have a breast lift, then they have to understand that they may be the same size or slightly smaller, maybe half a cup size to a cup size, because we are removing that excess skin. The breast will be perkier, but it’ll also be tighter, and it may appear smaller. Regardless of the combination of procedures we perform, I do recommend using an internal bra with mesh support, with GalaFLEX or DuraSorb, to give us that support of the breast weight, so that we’re not just relying on skin, which has lost all its elastin and is not reliable long term.”
“Should I Wait Until I’m Done Having Kids?”
This is the question under Cardi B’s story.
“Patient who wants augmentation before she is done having kids: go ahead. There are still going to be changes in the breast with or without implants. Surgery may be necessary after pregnancy even without implants, for a more cosmetic and aesthetic look.”
Pregnancy changes every breast, augmented or not. Waiting buys you nothing but years without the result you wanted. For the first-timer who wants the light version, the numbers are in the breast lift beat the implant at ISAPS. The surgical version of this post, with the options side by side, is on agulloplasticsurgery.com; the consultation version is on the Southwest Plastic Surgery post.
Why Choose Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026. Breast revision, including fold repair with internal mesh support, lift with implant exchange and fat grafting over thin tissue, is a core part of his practice in El Paso.
Ready to Talk?
If your implants changed after the kids, bring the old photos and come in. The exam takes ten minutes and the plan is usually simpler than you fear.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
- Posted on: October 27th 2026
- Category: Body Contouring, Commentary
She had a BBL two years ago and a second fold under each buttock that no fat transfer fixed. What I told her about the Miami thong lift, the hidden scar, and the pear shape she wanted, nearly as I said it.
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- Posted on: October 27th 2026
- Category: Body Contouring, Commentary
A patient in her late twenties came to me on video. She had a lipo 360 with fat transfer to the buttock two years ago with another surgeon. Good projection. But under each buttock there was a second fold, and she wanted her hips lower and rounder, a pear instead of an hourglass. I am publishing the exchange nearly as it happened, identifiers removed, because almost nobody knows this operation exists.
The visit
Her: I gained about forty pounds in the last two, three years. I’m working hard on losing that weight, but I’m scared it will get worse with weight loss. Do you think it’s best to do the surgery now?
Me: “Let’s talk about what we want to achieve. I know that you want to get rid of the, kind of like this double butt crease, this area right here.”
Her: Yeah, that area stresses me out a lot.
Me: “So for this, we would do the thong lift, the Miami thong lift. It’s an incision that goes right here. I do a little bit of lipo here, and then we tuck that in so it kind of does a circle inside. So that would be the fix for that.”
Me: “You wanted to reduce the size here a little bit? The upper hips? Yeah, so we could do lipo here to take that out.”
The crease question
Her: Could we, like on the bottom of my butt, make it more round? Could we move fat around? Because I have no crease. You know this crease? I don’t have that, so I was wondering if we could put fat here.
Me: “So the crease here is actually good, it’s good when it’s short. If you look at very sexy buttocks, this crease is short. When it gets long, it’s because the buttock has fallen down, so it folds. So you actually, you’re good with that. I think that part’s fine.”
Me: “I do see that this is a little flat, like here, and you’re full here. Your projection is good. So really it’s just giving it a little bit of shape. So maybe removing a little here, adding a tiny bit here, and the rest for projection. And then lifting this up would make it look really nice.”
Me: “There’s a lot of different ways to describe it. Some people say like frog butt or elephant because of this, but we can fix that. I’m one of the few surgeons that does this procedure, the Miami thong lift. So where are we going to get fat from? Your back and your arms? Okay.”
The pear shape question
Her: Would it be possible to add fat to my outer thighs? I want to look like a pear rather than an hourglass.
Me: “I just don’t think you have enough, because we’re taking from your upper back and your arms. So we can add whatever fat we get there, or if we don’t have enough, we can use the allograft, which is the donor fat, and we can inject that into the saddlebag area to create more curviness lower down. So more like a heart shape.”
Her: A lot of other BBL doctors I asked, they declined to do that area, to inject fat in there.
Me: “We do it routinely because sometimes, you know, I get patients that have very skinny thighs. And if we just do the buttock, it looks funny, it looks like a chicken. So routinely we add to that area.”
Her: Oh, like to the thighs, not just the hips. And I can do everything at once?
Me: “You could, yeah.”
The fibrosis question
Her: I have pretty bad fibrosis on my stomach from my second round of lipo. What is fibrosis caused by?
Me: “So a lot of times it’s, number one, when they do too much lipo. Number two, if any of the fluid gets caught and it doesn’t come out, it creates like a capsule and scar tissue. So that’s why I really recommend doing lymphatic massages after the liposuction.”
Her: I didn’t also wear my faja. Is that also why?
Me: “That’s another one, yeah. It’s a lot of the aftercare. Number one, if you do too much lipo, then you get that really bumpy look. And number two is the aftercare. It really prevents the fibrosis.”
Her: Thank you, doctor. I learned a lot today.
My exam note that day: a double butt crease deformity, flat hips with fuller saddlebags, mild cellulite, good buttock projection.
What I tell everyone about the scar
To another patient the same year who had hip implants placed elsewhere and the same second fold: “On the posterior view, you do have a little bit of a double butt crease deformity. So to make this kind of go up and look more rounded instead of having that second bump, it would be the Miami thong lift. The incision goes right in the middle, on either side, but it hides completely when you are standing in the nude.”
“It is actually gonna pull up almost like a wedgie, so it will pull up everything and make it up and rounded. And it usually ends right about here, so you really don’t see any scars on the outside.”
And on why she had never heard of it: “That’s a procedure that very few surgeons do and very few people know about. And sometimes the surgeons just don’t know how to make it better.”
Surgery is about three to three and a half hours under general anesthesia, and you go home the same day. No drains. Five to seven days to light activity and driving, about four weeks to exercise, a compression garment for four weeks, and two weeks of sitting on your thighs with a cushion instead of on the buttock. In about four to six weeks you should be able to put on a bathing suit.
That is the whole subject. The second crease is not a volume problem, it is a position problem, and more fat makes it worse. A short hidden incision, a little lipo above it, and fat moved to where the shape needs it.
I am a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and I teach plastic surgery as a Clinical Associate Professor at Texas Tech University Health Sciences Center.
Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at drworldwide.com.
#StayBeautiful
