Dr. WorldWide | Frank Agullo, MD

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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

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Last summer, every red carpet, every Vogue Arabia spread, every grainy paparazzi shot of the Bezos wedding ended with the same question. Who did Kris Jenner’s face? The internet lost its mind. One post asking for the doctor’s name racked up tens of thousands of likes. Some called it the best celebrity facelift in a hundred years. The momager looked, depending on the photo, somewhere between thirty-eight and fifty. Then a year passed. Now the same internet that crowned the result is asking why the magic looks like it is wearing off. Stories of “facelift slipping.” Whispers of revision. Comparisons to other women in the same age cohort, like Denise Richards, whose results held while Kris’s seems to be drifting south. I have been watching this story closely. Not because I love celebrity gossip, but because what is unfolding in public, in real time, is the entire arc of a facelift. The honeymoon. The retouch. The first year. The technique that did or did not go deep enough. And what happens when you do a SMAS-based operation on a seventy-year-old face that needed more.

What her surgeon actually did

Kris Jenner’s surgeon is a respected New York plastic surgeon, well trained, well credentialed, and widely reported to perform a hybrid technique, a lateral SMASectomy paired with a deep neck lift. SMASectomy means cutting out a strip of the SMAS, the muscle and tendon layer that sits just under the skin, and stitching the edges back together. SMAS plication is the close cousin, folding that same layer over itself like a hem and tacking it down. Both are SMAS techniques. Both work on the layer of facial anatomy closest to the skin. Neither dissects underneath the SMAS. Neither releases the four retaining ligaments that anchor the face to the skull. This is not the deep plane facelift. It is also not the endoscopic ponytail lift, which I trained to perform at the Ponytail Academy in Pittsburgh and Santa Monica. It is a respectable, well-executed, brand-name version of an older operation. And in a seventy-year-old face, that distinction matters more than people realize.

The honeymoon phase nobody tells you about

Every facelift looks incredible at three months. I mean every single one. Here is why. Three months out, the swelling has not fully resolved. There is still a layer of inflammatory fluid plumping the face. Skin is still tight from the closure. The deep tissues are healing in a position that is, frankly, slightly tighter than where they will eventually settle. Add professional lighting, a glam team, and a heavy hand in retouching, and you have what I call the honeymoon face. The honeymoon face is not the result. It is a preview of the result, dressed up. The real result lives at twelve to eighteen months out, after the swelling has gone, the skin has relaxed, and the tissues have settled into their new home. That is the face you will see in the mirror for the next decade. If the technique was right for the anatomy, the twelve-month face is barely distinguishable from the three-month face. Rested. Younger. Like the patient on a great day. If the technique was wrong for the anatomy, twelve months is when the gap shows up. Volume that was masking a structural issue retreats. Skin that was tight goes lax. The midface, which is heavier than people realize, starts to fall again. And the patient ends up where Kris is now, in the public square, watching strangers debate her face on TikTok.

The midface, the malar bags, and the golf balls

Look at the recent photos with an honest eye and a working knowledge of facial anatomy. The lower face and the neck are still meaningfully better than they were before surgery. That part of the operation worked. The jawline is cleaner. The platysmal bands are quiet. But the midface tells a different story. The cheeks, which were lifted into position briefly by swelling and a tight skin closure, have descended again. The malar bags, the prominent rounded fullness that sits on top of the cheekbones, are now obvious. Two of them. Round, glossy, and impossible to unsee. Some commenters have, less charitably than I would, called them golf balls. This is not some mystery failing. The midface was never fully addressed in the first place, and what we are watching now is exactly how a midface behaves when you do not address it. A lateral SMAS technique tugs on the side of your face. Lovely for the jowl. Useless for the malar fat pad, which is the cushion of fat that gives a cheek its shape instead of leaving you with a literal pouch sitting on top of the cheekbone. The deep plane operation handles this directly. We release the zygomatic ligament, free the malar fat pad, and reposition the whole thing as one composite piece with the rest of the flap. The endoscopic ponytail lift does the same job, just through small openings tucked inside the hairline. Skip the malar release on a face that needed it, and you get exactly this trajectory. The swelling carries you through the honeymoon. Then the swelling leaves, and the cheekbones still are not where they should be.

A seventy-year-old face is not a fifty-year-old face

Skin at seventy is not the skin you had at fifty. The elastin content has dropped, the collagen network is thinner, and the deep ligamentous support that anchors a face to its skull is no longer doing the job it used to. Run the same operation on a fifty-year-old and a seventy-year-old by the same hands and on the same day, and the fifty-year-old will hold the result longer. Every plastic surgeon I have ever trained with knows this. Most of us, out of politeness, do not say it out loud. So I will. At seventy, the technique you pick is more or less the whole game. SMAS-only buys you maybe a year or two of looking the way you did the day after the bandages came off, then a steady drift back toward where you started. The deep plane gives you ten, twelve, sometimes fifteen years. That is not my opinion, that is what the peer-reviewed longitudinal data shows. Which is why the Denise Richards comparison hits where it does. Richards is fifty-five, fifteen years younger than Kris, and her surgeon took her into the deep plane. Younger tissue, deeper operation, more durable result. A year out, she still looks like she did at three months. Kris is seventy, with a SMAS-based operation. The arithmetic was hard before anyone cut a single stitch.

Quick comparison

One more thing about those reveal photos

Let me be the surgeon who says what other surgeons say in the lounge but not on the record. The reveal photos last summer were heavily retouched. I do not say this with any pleasure. I say it because the gap between the polished cover image and the candid Instagram from the same week was too wide to be lighting alone. That kind of editing helps nobody. The patient walks into a setup, because reality always catches up to a retouched photo. The public walks into a setup too, because they sign up for an operation expecting a result the operation was never on its own going to give them. Worst of all, the patient ends up feeling betrayed by an outcome that, honestly, is doing exactly what that technique does at twelve months on a seventy-year-old face. When I do a facelift on you, the photos you see at twelve months are the actual photos. Not filtered. Not retouched. Usually in black and white, because that is how I prefer to show work and because color photography flatters a result you have not earned. What you see is what you have.

Why I trained where I trained

My plastic surgery fellowship was at Mayo Clinic, where they hammer into you the idea that you choose the operation for the anatomy, never the brand for the marketing. From there I went to Pittsburgh for the intermediate Ponytail Academy course, then back out to Santa Monica for the advanced one, because the deep plane and the endoscopic deep plane are the operations that, year over year, actually hold. And I teach as a Clinical Associate Professor at Texas Tech University Health Sciences Center for one simple reason: if I cannot stand in front of a resident and explain why a maneuver works, I do not understand it well enough to perform it on you. I have been a Castle Connolly Top Doctor for thirteen consecutive years. I have published over forty peer-reviewed papers. I have a global following of over 3.5 million across Instagram, TikTok, and Snapchat. None of that matters if the face I deliver does not hold. The face has to hold.

Why choose Dr. Agullo for a facelift 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 at TTUHSC. Affiliate Professor at UTEP. Ponytail Academy intermediate (Pittsburgh) and advanced (Santa Monica). Castle Connolly Top Doctor for thirteen straight years. Texas Super Doctors Hall of Fame. Aesthetic Everything Top Plastic Surgeon, 2026. Trained in deep plane facelift, endoscopic deep plane (Ponytail Lift), preservation rhinoplasty, supercharged BBL, and rib repositioning for waistline reduction. About sixty percent of my patients fly in from out of town because the operation, not the city, is what they are choosing.

Ready to talk?

If you are thinking about a facelift, the most useful forty-five minutes of your year is a consultation with the surgeon who would actually do it. Bring photos of yourself from ten years ago. Bring the photos that bother you now. Bring the questions you would not ask your dermatologist. I will tell you whether you need a deep plane facelift, an endoscopic ponytail lift, a neck lift only, or to come back in five years. If filler is the right answer for you today, I will tell you that. If you need surgery, I will not pretend you do not. 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