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Keloids, Moles, and Small Lesions, Off the Record: The Scar Is the Whole Point

Black and white editorial portrait, soft studio light. Keloid and mole removal commentary by Dr. Frank Agullo, MD, FACS.

Not every patient who sees me wants a whole region of the body changed. A lot of them walk in about one specific spot.

A raised scar on the ear after a piercing. A mole on the cheek that has been there for years and finally bothers them. A lesion they just want gone. These are small procedures, the kind a lot of doctors treat as a quick in-and-out. Here is my whole argument for why they are not.

When I do one of these, I am thinking about the final scar the entire time. That is the difference between a plastic surgeon doing it and someone simply removing the spot. The spot is temporary. The scar is permanent. So the scar is what I am actually operating on. These answers are from real consultations, anonymized.

“I Have a Keloid on My Ear. Can You Remove It?”

Yes, and honestly it is one of the more straightforward things I do.

Ear keloids almost always trace back to a piercing. I numb the spot, cut the keloid out, and re-close it cleanly. Then I lay in a little Kenalog, a steroid, to discourage it from coming back. Start to finish it runs about twenty minutes under local anesthesia, and the only real ask afterward is that you skip the gym for roughly ten days. That is the whole commitment.

“Will the Keloid Come Back?”

There is always some risk, and rather than hand you a vague reassurance, I will give you the actual numbers.

Across the board, recurrence sits somewhere around ten to twenty percent. But once we clean it up and close it well, most people are simply done with it, so the odds of it returning the way it was probably drop under five percent. The real protection is what happens next. The moment it starts to feel hard or look like it is trying to come back, you come straight in and we put in a touch more steroid to shut it down before it builds. Caught early, it almost always backs off.

“Where Do Keloids Actually Happen?”

This matters, because people worry about keloids in places they almost never occur. Here is the honest map.

Common Keloid Sites Rare or Essentially Never
Ears Face (rare)
Shoulders Eyelids (I have never seen one)
Sternum and chest Genital area (different tissue, never seen one)
Joints, like knees and ankles

Keloids set up shop where there is tension and movement. The face is genuinely rare. On the eyelids I have never seen a single one, and the genital area is a different material entirely, more mucosa than skin and not under tension, so I have never seen one there either. So if you are heading into eyelid surgery or a labiaplasty and you are bracing for a keloid, you can let that worry go. That is not where they grow.

“What About a Mole or Other Spot on My Face?”

Here is where having a plastic surgeon do it actually earns its keep.

Anyone can take a lesion off. The reason to have me do it is that I am building toward the final scar the whole time, choosing where the incision sits and how it closes so that what remains is as close to invisible as I can make it, instead of just lifting the spot and moving on. On a face, the gap between those two approaches is something you look at in the mirror for the rest of your life.

“How Do You Keep Scars Looking Good Afterward?”

Beyond careful closure, old or healing scars can be softened with microneedling using PDGF, a platelet derived growth factor that is like PRP but more powerful and helps renew collagen. It takes a few sessions, and you can have it done at the Med Spa. The surgery sets up the scar, and the skin work refines it over time.

The Credential Behind the Small Stuff

I am a double board-certified plastic surgeon, certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, with a plastic surgery fellowship from the Mayo Clinic. A keloid or a mole is a small thing, but the scar it leaves is permanent, so it is worth doing right the first time, with a plan to prevent recurrence and protect the final result.

For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com, and for the scar-refinement menu, including microneedling and laser options, see the version on swplasticsurgery.com.

Ready to Talk?

If there is a spot, a bump, or a keloid you want handled with the scar in mind, come see me. 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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The Tummy Tuck, Off the Record: Muscle Repair, Smooth Results, and the “Is This a Seroma?” Panic

Black and white editorial portrait, soft studio light. Tummy tuck commentary by Dr. Frank Agullo, MD, FACS.

A patient came in last month convinced she had a fluid pocket that three other offices had been draining with a needle for the better part of a year. She had been stuck. Aspirated, told to wait, aspirated again, no real answer.

I put an ultrasound on her belly for ninety seconds and the whole story changed. There was no fluid. There never had been.

That moment is half of why I wanted to write this. A tummy tuck is the operation people most often confuse with liposuction, and the difference matters enormously. The other half is the steady stream of second opinions I see from patients worried about a bulge after a tummy tuck done somewhere else. Here is how I explain all of it, from real consultations, anonymized.

Liposuction Will Not Do What a Tummy Tuck Does

This is the most common mix-up I run into, so let me clear it up before anything else.

When the abdominal muscles split apart during pregnancy or big weight swings, liposuction does nothing for it. Liposuction handles what we can pinch, and that is all. Relax those muscles and the bulge from the separation is still right there, and the only thing that touches it is a tummy tuck. A tummy tuck flattens everything, tightens it, and repairs that muscle wall, like building you a corset on the inside. It buys you a lot more than liposuction can, and the cost of admission is a scar across the lower abdomen. That trade is the entire decision.

What a Tummy Tuck Actually Repairs

Two things liposuction and dieting cannot touch.

Problem What Fixes It
Loose, excess skin Removed during the tummy tuck
Separated muscles (rectus diastasis) Sutured back together down the midline
Pinchable fat Liposuction (often added to the tummy tuck)

I take out the excess skin and stitch those separated muscles, the rectus diastasis, back together down the midline. That midline repair is what hands you a flat, supported abdomen, not just a thinner layer of fat sitting over the same loose wall.

“I Had a Tummy Tuck Elsewhere and Still Have a Bulge. Is It a Seroma?”

This is one of the most common second opinions to land in my office, and my first move is always to look rather than guess.

I reach for an ultrasound right there in the room. It color-codes the tissue for you. Yellow is fat. Red is muscle. Fluid lights up blue. No blue on the screen means no fluid, which means no seroma. For a patient who has been stuck under a needle over and over with no real answer, that single image is a relief in itself.

What is usually going on instead is residual diastasis. On the same scan you can see the muscle on each side and the gap running between them. Up high, where the muscles nearly touch, that is normal. Drop lower, where they stayed separated, and the abdominal wall goes slack and pushes outward, and that is the fullness people keep feeling. Now and then someone has a connective tissue disorder, and a perfectly correct repair simply stretches back out over time. Nobody’s fault.

“How Do You Fix Residual Diastasis?”

If it is a true diastasis, there is only one real fix: go back in, open it up, and re-suture the muscles tighter.

When a patient’s tissue is very elastic, I will sometimes add a mesh to back up the repair, an internal version of the binder you wear after surgery. My preference is a mesh that dissolves and gets replaced by your own collagen, about as biocompatible as it gets. The alternative is traditional sutures laid down with a few extra reinforcing layers. Which way I go comes down to your tissue, not a rulebook.

“Why Was My Upper Belly Not Liposuctioned During the Tummy Tuck?”

On purpose, and it is a safety decision, not an oversight.

When we do the tummy tuck initially, we do not aggressively liposuction the upper abdomen, because removing too much fat there can compromise the blood supply to the skin, and the skin can die. Once everything is healed, a little liposuction later can safely make that area look less bloated. The staged approach protects the result.

“If the Bulge Does Not Hurt, Do I Have to Do Anything?”

Not necessarily, and I will tell you that honestly even though it is not the answer that books surgery.

If there is no hernia, no seroma, and no fluid collection, then nothing is a health risk. At that point a small residual bulge is more about how it looks than a physical problem, and it is not something I would rush to fix. I would rather you make that decision with clear information than be scared into an operation you do not need.

The Credential Behind the Imaging

I am a double board-certified plastic surgeon, certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, with a plastic surgery fellowship from the Mayo Clinic, and I teach as a Clinical Associate Professor at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. With abdominal surgery, the honest, useful answer usually comes from imaging and an exam, not assumptions.

For the full patient walkthrough, see the tummy tuck page at agulloplasticsurgery.com and the El Paso version at swplasticsurgery.com. If your concern is the whole post-pregnancy picture, that lives on the mommy makeover page.

Ready to Talk?

Whether it is a first tummy tuck or a worry about one you already had, let us actually look together. 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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Breast Reduction, Off the Record: Relief, Real Limits, and the Weight Question

Black and white editorial portrait, soft studio light. Breast reduction commentary by Dr. Frank Agullo, MD, FACS.

Most of my patients do not cry in a consultation. The breast reduction ones sometimes do, and it is not sadness.

It is relief, arriving early. They have been carrying this for years. Back, neck, and shoulder pain. Grooves carved into the shoulders by bra straps. Breasts that just kept growing no matter what they did. And the first time someone tells them the pain is fixable, the weight does not have to stay, the body softens a little. I get it. This is one of the most satisfying operations I do, precisely because it solves a physical problem and not just a cosmetic one.

But it comes with honest limits, and I would rather hand them to you up front than have you discover them later. Here is the candid version, from real consultations, anonymized.

It Is a Lift as Much as a Reduction

People picture this operation as scooping volume out. It is more than that. You are getting a lift and a reduction in the same sitting.

The scars trace a familiar pattern: one around the areola, one running down from the areola to the fold, one along the fold itself. Working through them, I lift the breast up where it belongs and take tissue out, usually a few hundred grams a side for most women. Before any of that, a simulation lets you stand in front of a screen and see the smaller, lighter version of yourself, with less load hanging off your neck and back. That drop in weight is the thing that does the heavy lifting on your pain.

There Is a Ceiling, and Blood Supply Sets It

Here is the limit nobody wants to hear, so I will not dress it up. I cannot take out an unlimited amount.

The nipple and areola have to stay alive, which means they have to stay connected to their blood supply. Take too much and the blood does not reach the nipple, and that is a far worse outcome than landing a cup size above your dream. So I work within a safe middle ground and chase the most relief I can responsibly give you. For most women that is still dramatic, still life-changing. But if you came in picturing a very large chest shrunk to tiny in one operation, your anatomy may not cooperate, and I would rather say so to your face than pretend otherwise.

The Weight Question, Answered Straight

Patients ask me constantly whether they should drop weight first. The answer is often yes, and the reason is more interesting than most people expect.

A breast is built from two different tissues, glandular and fat, and they could not behave more differently from each other.

Tissue Type What It Does With Weight Loss
Fat tissue Shrinks; this is the part that responds to diet and weight loss
Glandular tissue Does not shrink with weight, and is sometimes still growing

If your BMI sits in the obese range, dropping weight first will help you feel lighter up top and can trim the breast a little. But if yours run mostly glandular, the scale barely touches their size, and that is precisely why surgery, not dieting, is the real answer for so many women. One more piece of timing advice: if you have a big weight-loss goal, get close to it before we operate. Reduce first, then shed a lot of weight, and things can sag all over again.

Yes, I Can Usually Do the Arms Too

This request comes up often, and the answer is usually yes. For arms I lean on liposuction with BodyTite to tighten the skin, frequently feathering it into the side of the chest and the back so you do not end up looking heavy on top once the breasts are smaller. Healthy skin responds beautifully, and the whole upper body finally reads as one result instead of a reduced chest bolted onto an unchanged frame.

The Two Risks I Never Skip Over

I put both of these on the table every single time.

The first is losing some nipple sensation. Under ten percent, but real. The second is more serious and far rarer: a small chance the nipple and areola do not get enough circulation, in which case some of that tissue can be lost. That one sits under one percent, very low, but you deserve to know it exists before you sign anything. I would rather you carry the small risks knowingly than be ambushed by them later.

“Will I Still Be Able to Breastfeed?”

You keep breast tissue connected to the nipple, so in theory it should remain possible. Here is the honest caveat, though. Even women who have never had a single operation do not always know in advance whether they can nurse, so I cannot hand you a clean percentage. What I can promise is that the connection is preserved, not cut.

The Credential Behind the Honesty

I am a double board-certified plastic surgeon, certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, with a plastic surgery fellowship from the Mayo Clinic. Breast reduction changes lives, but it has real anatomic limits, and I would rather you walk in understanding the trade-offs, the weight question, and the small risks than walk out surprised.

For the full patient walkthrough, see the breast reduction page at agulloplasticsurgery.com, and for the El Paso practice details and recovery support, see the version at swplasticsurgery.com. If a lift is more what you need, that lives on the breast lift page.

Ready to Talk?

If the weight of your breasts is wearing on your back and neck, relief is a real option, with honest limits attached. 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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Labiaplasty, Off the Record: The Quiet Question I Answer Every Week

Black and white editorial portrait, soft studio light, calm tone. Labiaplasty commentary by Dr. Frank Agullo, MD, FACS.

The voice drops. That is the tell.

A patient will be five confident minutes into talking about a lift or some liposuction, and then there is a pause, and the volume comes down half a notch, and the real reason she booked finally arrives. It is almost always some version of the same thing. She has been thinking about labiaplasty for a while. Sometimes years. And she has never said it out loud to a single soul.

So let me put the unglamorous part first. In my practice this is one of the most ordinary requests there is, and there is nothing to be embarrassed about. I run it like a rhinoplasty consult. Anatomy, options, honest limits, zero theater. What follows is the candid version, drawn from real consultations and stripped of anything that could identify anyone.

Stop Trying to Sort It Into One Box

Patients walk in already braced for me to ask which it is. Vanity, or a real problem? They have an answer rehearsed, as if the wrong one disqualifies them.

It does not work that way. For most women it is both at once, and both count. Extra tissue tugs under leggings. It chafes on a bike seat. It gets in the way at the gym and it can drive recurrent irritation. If that is your life and you also do not love how things look down there, you do not owe me a single justifying reason. The discomfort is legitimate. So is the preference. Either one, by itself, is plenty to start the conversation.

The Detail Nobody Warns Patients About

Here is the part I refuse to let anyone leave the room without hearing, because it is where a lot of results go wrong.

When I trim the labia minora, I leave tissue behind on purpose. I am not chasing the smallest possible version of you. But trimming the labia alone creates a problem that surprises people: the clitoral hood can suddenly look like it is poking out, simply because the thing that used to balance it is now smaller. Not a flattering trade. And patients are rarely told it is coming.

That is why, in most cases, I reduce the hood a little at the same time. Everything settles flush and proportionate instead of lopsided. If you began with very little tissue, a small amount may still show. Far less than before, though. The goal is the whole picture, not one isolated piece of it.

The Sensation Worry, Answered Like an Adult

This is the fear that keeps women from ever booking, so I will be blunt about it. Will you lose sensation?

Look at the anatomy. I am taking tissue away, and yes, I cut through small nerves to do it. But the nerve stays put on the surface right at the line where I cut. In all my years, loss of sensation simply is not something my patients circle back to complain about. You keep what you walked in with.

There is even a quiet upside. With a little less tissue crowding the clitoris, full sensation often goes up rather than down. The opposite of the thing people are scared of on the way in.

Asleep, Numb, Out in Under an Hour

You do not need general anesthesia for this. I usually use IV sedation, the same deep sleep you would get for a colonoscopy. We place the IV, you drift under, I numb everything with local, and I do the work. No memory of it, no feeling of it. If you would genuinely rather have general, it is available, but it is overkill here.

The procedure itself runs under forty-five minutes. Here is the day and the weeks after, side by side.

Question The Honest Answer
Anesthesia IV sedation, like a colonoscopy (general optional)
Procedure time Under forty-five minutes
Pain Usually minimal; Exparel numbs the area about three days
Spotting A little, for a couple of days
Back to work About five days, nothing strenuous, under fifteen pounds
Intercourse Wait four weeks
Exercise Four weeks
Final look Visible right away, settles by four to six weeks as swelling fades

No, There Will Not Be a Keloid

People ask this constantly, usually because they keloid on an ear or across the chest and assume every incision behaves the same. It does not.

I have never once seen a keloid form here. Not in all my years. Keloids live on ankles, shoulders, ears, the sternum, places that stretch and pull and stay under tension. The genital region is a different material altogether, more mucosa and skin, and it is not yanked around the way those high-tension spots are. It is just not where keloids show up.

Why I Take My Time on the Symmetry

Early on you may catch some unevenness in the mirror. Almost always that is swelling, because one side likes to puff up more than the other for a while. Underneath it, like breasts, the two sides were never perfectly identical to begin with. My job is to get them as even as the anatomy honestly allows, and I will not close a case until I am satisfied with what I am looking at.

If a touch-up is ever called for down the road, my revision policy means I do not charge for the revision itself, only the operating room and anesthesia time.

The Credential Behind the Candor

I am a double board-certified plastic surgeon, certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, with a plastic surgery fellowship from the Mayo Clinic. None of that buys you a fancier technique here. What it buys you is a straight conversation. I will tell you plainly whether removing more is realistic for your anatomy, and I will not sell you a result I cannot actually deliver.

This is a private decision, and it deserves a surgeon who treats it as a perfectly normal one. For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com. For skin and recovery support after intimate procedures, the team lays it out on swplasticsurgery.com.

Ready to Talk?

If this is something you have quietly wondered about, you can ask me directly and privately. There is no wrong way to start. 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.