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: August 11th 2026
- Category: Body, Editorial
RibX, Ribella, Invisarib, the Barbie waist: all one procedure. A surgeon explains scarless rib repositioning, the real numbers, and who should consider it.
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- Posted on: August 11th 2026
- Category: Body, Editorial
Scroll aesthetic TikTok for ten minutes and you will meet the same operation wearing six different outfits. RibX. RibXcar. Ribella. WASP. RIBOSS. H-Curve rib remodeling. The nicknames are even better: the Barbie waist, or Invisarib.
These are all the same procedure with different names, due to marketing or surgeon preference. We tend to call it rib repositioning. It can also be referred to as rib remodeling or minimally invasive rib contouring.
Whatever you call it, the interesting part is not the branding. It is the anatomy, because the anatomy explains why some waists will not shrink no matter how disciplined the diet is.
Your Waist Has a Floor, and It Is Made of Bone
The waist is defined, or restricted, by the distance between the superior crest of the pelvis and the last rib. In some patients, this last rib almost touches the pelvis, which means that there really can be no further reduction in the waistline. You can lose fat. You can build obliques. The bones do not care.
To create a smaller waist, what we do is cut the outer portion of the last two floating ribs so that we can reposition them in a narrower configuration. That’s the way we create a smaller waistline. We move the floor.
What Changed: From Rib Removal to a Needle
This used to be done by removing the ribs in their entirety, which required a large incision, had an increased risk of injury to the lung or nerves, and sometimes led to chronic pain. That version earned its bad reputation.
The way this procedure is done now is through a small needle incision, using a device called a Piezotome, which is an ultrasonic needle device that helps us cut the outer portion of the rib with ultrasound guidance, and then the ribs are fractured into their new position. Today it is a scarless procedure with substantially fewer risks and complications.
I think this was a controversial procedure when we were removing entire ribs and accepting large scars and increased risks. With this new scarless technique, the risks are minimal. There is no scar. And if we only treat the two floating ribs, it’s an easy recovery. It’s not controversial at all.
The Real Numbers
| Two floating ribs | Adding the two false ribs | |
|---|---|---|
| Waist reduction | About 3 to 4 inches | 6 to 7 inches |
| Complication rate | Under 1 percent | Around 1 to 2 percent |
| Extra requirement | None | CT scan before surgery |
| How it works | Outer portion cut, ribs repositioned | Ribs cut at the cartilage in front and in back, converted into floating ribs, then repositioned |
Not every patient is a good candidate for the false rib extension, which is why it starts with imaging rather than a wish list.
Who Actually Books This
The ideal candidate is somebody who wants to reduce their waistline and get a more feminine figure. This is very common in women who have an athletic body build and do not have much waist. It is also very common in male-to-female transgender patients. And it’s very common in women who are already curvy but want to reduce their waist further.
Other times, I see patients who have already had liposuction and tummy tucks and just want even more waist definition, and this would be the last option for them to achieve it.
The Ultimate Waist, Assembled
Rib repositioning rarely works alone in my practice. Liposuction is a very strong tool for the waist contour, and I often combine the two: if you’re able to pinch excess fat in the waistline area, liposuction there buys more definition.
The way I perform a tummy tuck also gives a lot of waist definition, because I plicate the rectus muscles and the oblique muscles. It’s like an internal corset, a triple plication, which brings in the waistline further. (That triple plication deserves its own article, and it will get one.)
And corset training is not a gimmick here, it is the recovery. We actually use the waist trainer for three months to help heal the ribs in their new position. Many patients notice their waist trainer can be placed tighter and tighter as they heal, and they often have to downsize to a smaller waist trainer toward the end of the three months. Watching your own recovery require smaller equipment is a satisfying way to convalesce.
So the ultimate waist definition procedure would be a combination of liposuction, rib repositioning, a triple plication internal corset through a standard or mini tummy tuck, and then the waist trainer for recovery. For some patients this folds into a larger body contouring or mommy makeover plan.
Pain, Risk, and the Three-Month Rule
The risk of injury to the lung, if we’re only targeting the floating ribs, is minimal, probably less than one percent. I inject Exparel in the area prior to the procedure, a local anesthetic that lasts for three days and numbs the area for a much smoother recovery. Most patients describe the pain as mild to moderate, and they feel the waist trainer helps them through it.
The non-negotiable: abstain from strenuous exercise and activity for three months while the ribs heal in their new position.
Why Me, for This
This technology did not come into development until about two or three years ago, so be careful who you let near your ribs. I am a board-certified general surgeon and plastic surgeon, and I have experience with rib fractures and rib removal procedures from both careers. I use the ultrasound to identify the ribs and visualize while I’m cutting the outer table before repositioning, and this decreases the risk of injury to other structures. The Mayo Clinic fellowship taught me many things, and one of them was respect for what sits behind a rib.
Ready to Talk?
If your waist has stopped responding to everything you throw at it, the limiting factor may be bone, and that is now a solvable problem. Call (915) 590-7900, text 1-866-814-0038, or book online. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Companion reads: the clinical candidate guide on agulloplasticsurgery.com, and the practice overview at swplasticsurgery.com.
- Posted on: August 10th 2026
- Category: Injectables, Surgeon Take
I have injected Kybella, operated on hundreds of necks, and taken the needle in my own chin. From all three chairs, here is what the fat-dissolving shot really buys you.
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- Posted on: August 10th 2026
- Category: Injectables, Surgeon Take
It surprises people every time: the plastic surgeon telling you to think twice about Kybella has had Kybella under his own chin.
I remember the first time turkey neck started creeping into the mirror, a few years back. So I took my own advice: one session, my own central pocket, my own experiment. This means I am not reviewing a brochure. I have been the injector, the surgeon who performs the more definitive operation, and the guy sitting in the chair.
The Three-Chair Review
It looks elegant. Your body already produces a form of deoxycholic acid. It is how your gut processes fat in your food. If you make a more concentrated version, inject it into the submental fat pad, and it kills the cells. The cells will burst and then be cleared out. Fat-cell-killing fact. Destruction is permanent, those cells do not come back.
Lying back, less glamorous. You get a bunch of injections that really burn. That is where the “unseen part” of this whole trend begins. You get swollen up to where you have a more janky turkey neck than the one you paid to fix up and it will be a while before the effect starts showing. Two to four weeks is how long you can expect, or even longer. Now remember, that was after just one treatment and people generally get three sessions.
Looking at it from the doctor’s standpoint, it is a basic sum: Twenty percent of the central fat compartment is eliminated with Kybella. CoolSculpting likewise eliminates about twenty percent, except it freezes the fat instead of dissolving it, and I like it even less. In terms of effectiveness, even on a strong candidate, twenty percent of the single center compartment reads as a subtle change at best. On the wrong candidate, it reads as nothing.
Who the Shot Actually Fits
My peers and I may squabble a lot on many of the above issues, but Kybella candidature has little debate among people performing these procedures daily.
You want superficial subcutaneous fat, directly underneath the skin, not below the platysma muscle. The needle is too short to reach that far and the ads do not mention it, which is one of the reasons why it makes some people look worse. It needs to be mostly in the mid neck region. Lateral neck fat and jowls are off the map. The skin quality must be of good elasticity to take the deflation of fat within; if you just remove the fat below loose skin, you will have a worse neck.
A younger individual with elastic skin has one specific, isolated fat pocket right in the middle. That patient does exist, and for that person the Kybella program at our med spa is a legitimate option.
What I Do for Every Other Neck
In most necks walking into the office, the fat has migrated beyond being a simple neck issue and has already wrapped around the jawline, spilled onto the sides, or the skin has been relaxed for a long time. So for that patient, for many years, my solution has been neck liposuction combined with FaceTite.
It is not even close. Liposuction takes out up to 80% of the excess fat and treats the entire aesthetic unit (lower face, jawline, center neck, sides of neck). FaceTite runs RF underneath the skin through the same 3 little entries, one behind each ear and one below the chin, and tightens the envelope up as the volume drops. A real neck lift is the choice when the problem is larger than a single energy device will help, point-blank!
Plus, it all costs about as much as three sessions of Kybella. It is not like people were choosing cheap versus expensive. They are deciding between 20% off of one pocket versus 80% of the entire neck for the same price.
The Part I Trained For
The Mayo Clinic taught us that the diagnosis IS the surgery. The neck is our classic teachable moment. Is the fullness fat or gland? Is it above the platysma muscle or below? Is the neck fullness a narrow strip down the front or has it completely encircled it? Is the overlying skin a bystander or the focus of pathology?
They all swap out the correct tool, not that these questions could possibly be found on a spa menu, nor that 90 seconds’ worth of exam would not find the best tool. Ninety seconds is the most important part of every consultation on necks, even mine. This is precisely the reason I keep both the needle and cannula within arm’s reach of the procedure, rather than deeming one “king”.
My Bottom Line
Kybella is real. The science is sound, the fat it kills stays dead, and my own neck carries the proof years later.
However, in a one-pocket room, the shot has a ceiling of 20 percent, and most necks need more than that. When someone only talks about a particular needle treatment that is the only thing a clinic is willing to offer, they are not telling you what a treatment is supposed to be; they are telling you about an ingredient they offer.
Ready to Talk?
Bring me your neck and ninety seconds. I will tell you which chair you actually belong in.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments.
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Cross-links
- Med spa version on swplasticsurgery.com: “Kybella in El Paso: What the Fat-Dissolving Shot Can and Cannot Do” (link once live)
- Surgical version on agulloplasticsurgery.com: “Why I Still Reach for Liposuction and FaceTite Over Kybella” (link once live)
