Dr. WorldWide | Frank Agullo, MD

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There are two types of plastic surgeons when talking about aging. They are the loudest type and the quietest type. The loud type says fillers, then more fillers, then a surgery. The quiet type takes a longer view and plays the game on a cellular level. Better mitochondria, better collagen, better skin, better sleep. Less for the surgeon to do eventually, as the patient ages more slowly.

My career took the loud road. Deep plane facelifts, breast preservation, body contouring. These are real operations on real anatomy you can see from across the room. I am not going anywhere near quitting those. In recent years, though, I have found myself thinking more about the quiet road as well, because the science is finally at a level where I can stand up and discuss it. This is a post on my take on peptides outside the operating room. NAD+ as a tool for daily energy and longevity, GHK-Cu as a skin-quality investment, and the GLOW blend used on patients who are not recovering from surgery but would like to see a bit more of their thirties in their forties.

What a Peptide Is, in Plain English

Peptides are small amino acids in a chain. Insulin is one, oxytocin is another, and human growth hormone is a peptide. Your body makes tens of thousands of peptides each day, sending signals between tissues. The therapeutic peptides we offer on the wellness menu are the man-made counterparts to molecules that your body produces every single day, made at a cGMP pharmaceutical standard and dosed by the milligram.

The dose simply tells the body to do something it already knows how to do: lay down collagen, repair damaged DNA, build new microvasculature, or restore mitochondrial energy. Peptides do not perform the chemistry to do this work, the peptides signal cells to do so. The work is done by the patient’s own cells.

This is the crucial distinction that tells you what peptides cannot do. Peptides cannot bring back a face that has lost over 20 pounds of its volume along with all of its supportive ligaments and muscles. They cannot make a 45-year-old neck look like one at 30. Surgery does this. Peptides cannot replace surgery when surgery is what your body needs. However, they can build the cellular foundation around surgery stronger, both before and after it. And for the patients who do not need surgery just yet, they can extend the length of the runway.

NAD Plus, the Molecule I Take Seriously

NAD+ is the chemical that means nicotinamide adenine dinucleotide. Technically, it is a coenzyme, and it sits on the menu next to peptides as the longevity molecule with the highest evidence. The “nicotin” component refers to its link to the etymology of vitamin B3. This is not related to smoking. I discuss this with patients on every visit.

NAD+ is the cofactor required for the operation of mitochondria, the part of a cell that produces its energy, and it is used by sirtuins, an enzyme family important in DNA repair and cell maintenance. Longevity researchers care about NAD+ because the levels drop as we get older, correlating with visible signs of aging and even hidden ones, and restoring the NAD+ levels in animals restored cellular function. Human studies are younger, more chaotic, but on track in the same direction.

NAD+ infusions are the more common NAD+ formulation patients have heard of. It is what is responsible for the “I felt so amazing after my infusion” posts online. An infusion run too fast will make patients uncomfortable with chest pain, hot flushing, and burning around the neck and head. That is dose and infusion-rate dependent and normal. An infusion run more slowly over 2 to 3 hours will make patients comfortable throughout. We use the slow rate for all of our infusions. The low-dose subcutaneous injection taken at home is maintenance therapy.

When speaking with patients about NAD+, I suggest they look at two separate timeframes: the acute and noticeable lift in energy and mental clarity immediately after an infusion, and the slower, less noticeable cellular improvements over months and years. Patients book their NAD+ infusion because of the former. I prescribe it because of the latter.

GHK-Cu, the Skin Investment That Runs Deeper Than Topical

GHK-Cu, or copper peptide, is glycyl-L-histidyl-L-lysine copper, a three-amino-acid string normally present in human plasma in high concentration, peaking in one’s twenties with a concentration decrease following that point in life. GHK-Cu is the same active compound in many topical copper peptide skin-quality products available on shelves at any dermatology or beauty counter. However, topical GHK-Cu must penetrate the skin’s outermost barrier (the stratum corneum), designed specifically to keep molecules such as this from entering the skin at high enough concentrations to start cell repair and regrowth. Injectable GHK-Cu delivers the peptide at a controlled dose directly to the dermis. It does not have to fight the skin barrier.

GHK-Cu has been shown to trigger more than 300 gene functions related to repair of injured tissue, and to stimulate fibroblasts (skin cells) to create new collagen, new elastin, and support the survival of stem cells of the epidermis (basal stem cells). Copper peptide also demonstrates anti-inflammatory properties and holds results through preclinical research and some early clinical data on hair regrowth, wound healing, the dermal density of skin, and photoaging. There is not a single part of this story that has been fabricated out of thin air by a skincare brand. What has been misrepresented, and is essentially a lie, is the implication that the topical version of GHK-Cu achieves anything remotely similar to the concentrations proven beneficial in studies of GHK-Cu as a treatment.

When GHK-Cu is ordered for wellness (not surgery), it is most often a woman in her early-to-mid forties who follows best practices about sun exposure, knows surgery is not for her at this time, but wishes for her aesthetic plan to use meaningful cellular improvements as well. The blue color is normal, caused by the copper. It is also injected subcutaneously, most often with injections done at home by the patient.

GLOW, Used Outside the Operating Room

GLOW is a mixture of three peptides: GHK-Cu, BPC-157, and TB-500. I covered these peptides in my post on surgical recovery, where their ability to work synergistically to bring about healing (collagen, angiogenesis, and cell migration) is best leveraged. On a wellness, non-surgical front, the thinking is a little different.

In terms of using the blend on an ongoing basis in wellness settings, I most frequently prescribe only GHK-Cu on a cycle basis, rather than the full blend. The effects and benefits attributed to GHK-Cu, namely improved skin and hair quality, are largely a story on its own. The two peptides BPC-157 and TB-500 show literature to be most beneficial for tissue repair, which is exactly what these peptides were designed for. Dosing them as a permanent maintenance medication for a healthy patient without any particular illness is, to me, dosing the patient far past marginal benefit. It would be better to keep the peptides available to be utilized for a genuine wound, injury, tendinopathy, or surgical recovery, where the effects of higher doses are more easily evaluated.

The only exception that would justify use in a wellness, non-surgical patient would be one dealing with a chronic soft-tissue problem, significant chronic inflammation, or who is recovering from a previous injury. In this scenario, the GLOW blend can be of benefit when cycled and used over a fixed course of time. It is important that this discussion take place with the patient on a case-by-case basis.

What Peptides Do Not Replace

Peptides cannot replace the use of SPF, can never replace adequate and consistent sleep, and can never replace what any given individual uses to maintain themselves day to day, such as some combination of sleep, protein consumption, resistance training, sun protection, and not engaging in behavior that will age you faster (such as drinking your liver and face into early aging). A peptide protocol can be layered on top of this foundation. However, peptides cannot be used as substitutes for it. The attempt at the latter will be a waste of money.

Peptides also are incapable of replacing surgery when the actual physical structure and tissue of your face need it. A patient who has experienced loss of volume along the cheeks and jawline in a way that takes decades off their appearance is not going to achieve a return of these areas with a peptide treatment, regardless of what it may offer. In this scenario, the appropriate course of action is a deep plane facelift, done well, and peptides can serve as support for the recovery process and longevity afterward, not as an outright replacement for it.

The Cautious Side, in Plain Language

It is essential to note that peptides are not under the regulatory process known as FDA new drug approval. Instead, they are compounded at US 503A pharmacies by a licensed and registered physician, and, as I said, there are gray-market options for peptides with questionable identities and origins. This is because a great percentage of the time, such products have not been formulated in a sterile and consistent environment. My clinic partners exclusively with a US-based pharmacy that adheres to cGMP regulations and provides a certificate of analysis with each batch. While my costs will likely be higher than many other sources of peptides you may encounter (on places like Instagram or Telegram), that extra expenditure is, without a shadow of a doubt, why you should stick to a trustworthy source. Do not buy peptides from Instagram. Ever.

For peptides such as growth-factor peptides (a related category of growth factors and signaling molecules), active malignancy is a contraindication to treatment. Pregnancy and breastfeeding are also off the protocol. For patients with a prior personal history of cancer, we will have an extended conversation, and in most instances we will request that an oncologist sign off on treatment. For patients who are anticoagulated for medical reasons, doses will be adjusted in coordination with their cardiologist to maintain patient safety.

Fillers are a tax. That is the way I think of them when it comes to cosmetic procedures. I like and use fillers all the time for the right patient, but the comparison stops there. Peptides differ, in that they do the work that the body already knows how to do, and once you stop peptides, your body just continues on with its own pace of aging. There is no rebound effect, no dependency, and no need to keep dripping peptides for the remainder of time. Used judiciously for specified periods, with a physician defining the dosage and the length of treatment, these can indeed be a valuable longevity tool. However, for patients who wish to continue with the peptides forever, with no rhyme or reason to their prescription, the situation is far more murky.

Why Choose Dr. Agullo for a Peptide Wellness Protocol 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. Affiliate Professor at UTEP. Castle Connolly Top Doctor for thirteen consecutive years. Every single peptide I prescribe is sourced through a US cGMP-certified compounding pharmacy, personally dosed and monitored to ensure effective and appropriate treatment. Wellness peptide visits at Southwest Plastic Surgery take the same care and level of medical attention as surgical consultations. Complete medical histories are established and a thoughtful treatment plan is curated to monitor patients over time.

Ready to Talk?

If you are curious about whether a peptide protocol fits your goals, the starting point is a wellness consultation. We will review your medical history, your aesthetic goals, your current routine, and what you actually want out of the next decade of your face and body. If peptides fit, we will write a protocol. If they do not, I will tell you. The point of the visit is not to sell you a vial.

For two more reads on the same subject, see the longer clinical version, Peptides for Anti-Aging and Wellness: A Plastic Surgeon’s Clinical Read on NAD Plus and GHK-Cu on agulloplasticsurgery.com, and the practice program version, NAD Plus, GHK-Cu, and the Peptide Wellness Program at Southwest Plastic Surgery.

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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Saturday night, Stephanie Han defended her WBA lightweight world title against Holly Holm at the El Paso County Coliseum, live on ESPN, and won by decision. She is 13-0. About four months earlier, she was on my operating table for a breast augmentation, and nobody in her camp knew.

We sat down together to talk through how that was possible. Our conversation is below, in her words and mine.

Your Body Is Your Livelihood. Why Did You Decide to Do This?

Stephanie: “It’s something I’ve wanted to do for a very long time, and I always held back because of the stigma, that you shouldn’t do it because it’s going to affect your performance as a professional fighter. But I did my own research and realized I can still perform at an elite level. Most importantly, I’m doing it for myself. I don’t ask for a lot of things in life. This is personal.”

You’re a Mom of Two Who Breastfed Both. How Did That Factor In?

Stephanie: “I’m a mom of two beautiful kids, and I breastfed both of them. No one tells you your breasts won’t be the same afterward. I could train, I could do a million push-ups, and it would not change this. This was probably my biggest insecurity. I knew if I got it done, it would boost my confidence and make me feel comfortable in my own skin again.”

What Makes Motiva Preservé Recover So Differently?

Dr. Agullo: It comes down to where the implant sits and how we get there. We make a small incision in the fold, about two and a half centimeters, and we open the pocket above the muscle, behind the breast gland. There is no cutting and no electrocautery. We use a balloon to create the space, so we are just pushing the tissues outward and letting the breast’s own ligaments hold the implant. We preserve the nerves and the arteries, and because the muscle is never released, the recovery is fast. We do not even need a mesh. Most patients are back to work the next day and back in the gym in about two weeks.

Her Implants Were Not a Matched Pair, Were They?

Dr. Agullo: No, and that is part of the artistry. Stephanie had a meaningful difference between the two sides, which is very typical, since we all have an asymmetric side. On the 3D simulation we planned a 265cc Demi Ergonomix on the right, with a little less projection, and a 315cc Full Ergonomix on the left. The Ergonomix implants move with the body, so they fill in beautifully and read as symmetric, even when she cuts weight for a fight.

What Was the Recovery Actually Like?

Stephanie: “Dr. WorldWide told me I’d be fully recovered in two weeks, and honestly I didn’t believe it until it happened. I had maybe a little discomfort for about three days, and after that it felt amazing. It’s been about four months and it truly feels like I didn’t get them done.”

Back in Camp Four Months Later. How Did Your Body Hold Up?

Dr. Agullo: I was surprised she never told her coach, but it made for a perfect test, because he was blinded to it. He watched her spar and train for the whole camp and thought she was in the best shape he had ever seen. That tells me the augmentation did not get in the way of her performance, her strength, or her range of motion, which is exactly the point of Preservé.

Stephanie: “Today I sparred 12 rounds and there was no pain. I can run seven miles, no problem. It feels like nothing, like they’re not even there. It’s maybe a pound of extra weight, and it feels like part of my body.”

Does That Mean the Surgery Helped Her Performance?

Dr. Agullo: No. The implants did not make her a better fighter. They boosted her confidence enormously, she does not stop talking about them, but they did not change her fighting. The whole point is that they did not affect it. They did not make her worse. That is what makes this such a good illustration of what the procedure can do for athletes, and really for all women.

How Do You Feel About the Result?

Stephanie: “They’re so symmetrical, so nice and perky. It’s taken my confidence from probably a six to a ten. I feel beautiful, I feel strong, I feel confident. And at the end of the day, I’m still Stephanie Han. I’m still a world champion boxer, still a police officer, still a mother of two, still a woman of God. This doesn’t change who I am. It’s just something I wanted for myself.”

Is This the Recovery Every Patient Should Expect?

Dr. Agullo: It is realistic for most women having Preservé on its own. Back to work within one to three days, back in the gym at about two weeks, the way I have seen with many patients. If a patient also needs a lift, or is having liposuction or a mommy makeover with a tummy tuck, that changes everything, and the recovery is dictated by those other procedures. For the full breakdown of the technique, the implant, and the recovery ladder, I wrote that up in Back to the Gym in Two Weeks: Motiva Preservé and What Preservation Surgery Actually Means. The technique itself is on the Motiva Preservé page at agulloplasticsurgery.com, and the broader breast augmentation overview is on swplasticsurgery.com.

What Would You Tell a Woman Who Has Been Holding Back?

Stephanie: “This is one of the things I do not regret at all, and I honestly wish I’d done it sooner. Don’t listen to the stigma. You can still be strong, you can still be beautiful, and you can still perform at 100 percent. To every mom and every athlete, especially the women champion boxers and the moms who breastfed, if you have two weeks, you can do it.”

Ready to Talk?

If Stephanie’s story sounds like the version you want, the next move is a consultation. I will tell you whether Motiva Preservé fits your anatomy and your goals, and I will give you a recovery timeline I can actually defend. The goal is the body you recognize in the mirror, and a recovery you can plan your life around. #StayBeautiful.

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