Posted on

The 60-Minute Window: What Actually Happens When At-Home Filler Goes Wrong

Black and white editorial close-up of a syringe and vial on a sterile surface, illustrating DIY injectables safety commentary by Frank Agullo, MD, FACS.

Daily Mail called last month asking about a Reddit community of 70,000 people trading at-home Botox, filler, and peels. They wanted the clinical reality behind it, and I was the only surgeon they quoted, so I’ll give the fuller version here.

Why Filler Is the Dangerous One

Filler is by far the riskiest thing to do to your own face, because it’s a blind injection into tissue loaded with arteries. You can’t see the vessels you’re threading a needle around. A trained injector knows the danger zones by anatomy, uses technique that reduces the odds of hitting one, and keeps hyaluronidase in the room to dissolve a blockage within minutes if it happens anyway.

Someone injecting alone in a bathroom has none of that. If filler goes into a vessel, it can stop blood flow to skin or to an eye, and that can mean tissue death or permanent vision loss. There’s a window, somewhere around 60 to 90 minutes, where dissolving the blockage can still prevent lasting damage. After that, the odds get much worse. That window is the whole argument for doing this in a place where someone recognizes what’s happening and has the antidote already on the shelf.

Botox Carries a Different Risk

Self-injected Botox isn’t a vascular emergency the way filler is, but it has its own problem: you don’t actually know what’s in the vial. Product bought online is sometimes counterfeit or never went through FDA approval, so you don’t know the real dose or the real substance. Misplaced toxin, from bad dosing or bad placement, causes drooping eyelids, double vision, and trouble swallowing. Those aren’t rare fringe outcomes on the r/DIYaesthetics threads I read for this piece, they’re common enough to be a recurring theme.

Skin Boosters and Microneedling Are Lower Risk, Not No Risk

These sit at the safer end of the spectrum, but “safer” isn’t “safe.” Without sterile technique, both can produce infection, nodules, and permanent scarring. The forum has real examples: a 50 percent glycolic peel that burned for an hour and left white patches, an under-eye toxin injection that caused fluid pooling, a self-described “witch chin” from over-injected chin filler, and a woman who woke with an eye swollen shut after self-injected cheek filler and was told by commenters to go to the emergency room over the risk of blindness.

What a Discounted Vial Is Actually Costing You

Real Botox and filler are expensive to buy wholesale, and a legitimate practice carries real overhead: sterile supplies, trained staff, emergency drugs on hand, and a follow-up visit built into the price. A heavily discounted offshore vial skips all of that, and it comes with no guarantee it’s genuine, sterile, or properly stored. You’re not saving money. You’re paying with risk instead of dollars, and the bill can come due as a trip to the emergency room.

About Dr. Frank Agullo

Frank Agullo, MD, FACS, is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery and a Fellow of the American College of Surgeons. He completed his plastic surgery fellowship at Mayo Clinic and serves as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. He has been named a Castle Connolly Top Doctor for thirteen consecutive years.

Ready to Talk?

If you’re weighing a discounted vial against an office visit, talk to someone first. It’s a five-minute conversation that can save you a much worse one later.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

  • Patient-facing version on agulloplasticsurgery.com: “Why At-Home Filler and Botox Are Riskier Than the Price Tag Suggests” (link once live)
  • Practice version on swplasticsurgery.com: “Southwest Plastic Surgery on DIY Injectables” (link once live)
  • Source: Daily Mail, “Inside DIY Aesthetics: The community where women share their at-home Botox ‘hacks’ and horror stories,” Margaret Abrams, July 27, 2026. https://www.dailymail.com/lifestyle/beauty/article-15991213/diy-aesthetics-reddit-home-botox-fillers.html
Posted on

I Had Kybella Myself: A Surgeon’s Honest Read on the Fat-Dissolving Shot

Moody greyscale photograph of a woman in profile examining her jawline and under-chin in a handheld mirror. Kybella fat-dissolving injection review by Frank Agullo, MD, FACS, Dr. WorldWide.

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.

  • 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)
Posted on

The Last Stretch of Summer: The August Med Spa Specials I’d Actually Book

August Med Spa Specials flyer, Renew Restore Revive promotions at The Med Spa at Southwest Plastic Surgery, Frank Agullo, MD, FACS, double board-certified plastic surgeon in El Paso, Texas

The Last Stretch of Summer: The August Med Spa Specials I’d Actually Book

I put together this month’s Med Spa board in late July, sitting at my desk after clinic, and I kept coming back to the same thought while I looked at what my team had lined up. August in El Paso still has the pool open, the sun is still doing real damage between about ten in the morning and five in the afternoon, and by this point in the summer most of my patients are not asking me about sunspots anymore. They are asking about their eyes. Tired eyes, puffy eyes, the kind of look that concealer does not really fix because concealer was never built to fix skin that is worn out.

So the board this month has three things on it, and honestly two of them are going after that same eye problem from two different angles, while the third one is about getting ahead of your own body before summer runs out. I want to go through all three the way I would if you were sitting in the chair across from me, because a flyer with a percentage sign on it does not tell you much on its own.

Renew. Laser Hair Removal, 15% Off Bikini and Underarms Packages.

I tell people August is actually a smarter month to start laser hair removal than January, and most people do it the other way around because January is when the resolutions hit.

The way the laser works is not complicated once somebody walks you through it. The device is tuned to a wavelength of light that gets absorbed strongly by melanin, which is the pigment sitting inside your hair. That light turns into heat once it hits the follicle, and if there is enough heat the follicle gets damaged, and damaged follicles either grow back thinner and sparser or, for a good number of them over time, stop growing hair at all. None of that is controversial and it has been understood for a long time.

The part that trips people up is that your hair is not all on the same clock. Every individual follicle has its own cycle, an active growing phase and then a resting phase, and it goes through that cycle more or less on its own schedule, not in sync with the follicle next to it. The laser can only damage a follicle that happens to be actively growing right when you are being treated, which means a follicle that is resting that day walks away untouched and will need to be caught on a later visit once it wakes back up. That is the actual reason this is sold as a series of appointments spread a few weeks apart rather than as one visit that finishes the job. You are not buying one treatment, you are buying enough visits to eventually catch most of your follicles somewhere in their growth phase.

Bikini and underarms get bundled together as a starter package mostly because they are both areas that cycle relatively quickly and respond well, so pairing them tends to be a better deal than paying for each one on its own schedule.

I will also say, because I think every patient deserves to hear it before they book, that skin tone changes how this has to be done. Darker skin has more melanin in the skin itself and not just in the hair, and that changes both the risk of a burn or a lingering pigment change and the settings the device needs to be run at. That is a judgment call for trained staff working under a physician, not something that should be run the same way for every single patient who walks through the door regardless of skin type.

Restore. Morpheus8 Under Eye, $800 for a Package of Three.

Morpheus8 has been part of my practice for a while, and I have mostly used it on the body for tightening skin. Using it specifically under the eye is a more targeted application of the same machine, and it tends to be the first thing I bring up when a patient’s problem is really about their skin and not about lost volume.

Here is where I slow down with patients, because this is the part that gets confused constantly and the two things genuinely look almost identical staring back at you in a mirror. Tired under-eyes can come from losing volume, meaning fat under the eye that has thinned out or shifted with age, and that reads as a hollow spot or a shadowed groove that makeup cannot fill in. Or the tiredness can come from the skin itself, crepey texture, a little bit of sag, fine lines, none of which has anything to do with volume and everything to do with the collagen underneath getting thinner with time. Morpheus8 is not going to put volume back where it used to be. If a patient’s real issue is a hollow from lost fat, I say that to their face and point them somewhere else, because pretending otherwise would just waste their money. What Morpheus8 does handle well is that second category, the actual skin.

Mechanically, the device pushes a grid of very thin, insulated needles just under the surface of the skin and sends radiofrequency energy through them at a controlled depth. The needling by itself starts a healing response in the tissue. The radiofrequency energy on top of that adds heat at a specific depth under the skin, which is what remodels the collagen and tightens things from underneath, with no incision and without touching the visible surface of the skin at all. Around the eye, where the skin is thinner and more delicate than almost anywhere else on the face, that lets us treat crepiness and mild sagging in a spot where a lot of other energy-based devices are simply too aggressive to use safely.

The reason it comes as a package of three rather than one appointment is that collagen does not remodel itself overnight. On the body, where I have used this device for years, patients see part of the result right away and then watch it keep improving for about two months as new collagen forms, and the same general timeline holds under the eye. Downtime is minimal, we numb the area with a topical anesthetic first, and most patients deal with some mild redness or sensitivity for a few days afterward rather than anything that keeps them off work. A single session softens things a bit. A full series of three is closer to the change most people are actually picturing when they ask me about this.

Revive. EZ Gel, 20% Off Per Session.

Anyone who has read my writing for a while has probably seen me write about PRP and PRF before, platelet-rich plasma and platelet-rich fibrin, both made from a patient’s own blood, usually in the context of microneedling and what people call the vampire facial. EZ Gel takes that same underlying biology one step further, and by coincidence it is aimed at the exact same tired-eye problem as the Morpheus8 special above, just coming at it from the opposite side.

The prep work starts out the same way PRF prep always starts. We draw a small amount of blood and spin it down to isolate the platelet-rich fibrin, and for EZ Gel specifically we also pull albumin out of that same sample. What we end up with is a gel made entirely of the patient’s own material, loaded with growth factors and proteins that tell the body to start laying down new collagen wherever we place it. The areas people use it on most tend to be the same spots where both volume and skin quality fade first as we age, which is under the eyes, around the mouth, and at the temples.

That overlap is exactly why it pairs well with Morpheus8 instead of competing with it for the same appointment slot. Morpheus8 works on the collagen scaffold that is already sitting there under your skin. EZ Gel adds a small amount of your own biological material into a spot that has genuinely thinned out, which edges closer to replacing lost volume than Morpheus8 ever will. One is a quality treatment, the other is closer to a volume treatment, and neither one involves putting something synthetic into your face.

I ask for the same patience here that I ask for with any biostimulator. It takes weeks after each session for your own collagen response to build, a maintenance visit once or twice a year keeps the result going, and nobody walks out of the office that same afternoon looking noticeably different. If a med spa somewhere is telling you otherwise about a treatment like this one, it is worth asking exactly what they are injecting.

A Clean Comparison

Special What it is Investment Best for
Renew Laser hair removal, bikini and underarms package 15% off Getting ahead of your own hair growth cycle for the rest of summer
Restore Morpheus8 under eye $800 (package of 3) Crepey, lax under-eye skin, not volume loss
Revive EZ Gel, PRF-based bio-stimulator 20% off per session Building the patient’s own collagen and volume under the eyes, mouth, and temples

Where to Come, East or West

The Med Spa at Southwest Plastic Surgery runs out of two El Paso locations, and all three August specials are valid at both of them.

The Eastside office is at 1387 George Dieter Drive, Building C, El Paso, Texas 79936.

The Westside office is at 5925 Silver Springs Drive, Suite C, El Paso, Texas 79912.

The same team and the same protocols run at both sites, so pick whichever side of town works better with your schedule. If you want to see the fuller menu before you call, the Med Spa page on our practice site is a good place to start.

A Note on Who Is Doing the Work

When you book at my Med Spa, it is worth knowing whose name is actually on the room. Mine. I trained in plastic surgery at Mayo Clinic, I am double board-certified, I teach residents at Texas Tech as a Clinical Associate Professor, and Castle Connolly has named me a Top Doctor for thirteen years running now. The Med Spa runs on that same standard, not on a slogan painted on the wall.

Ready to Talk?

Call our Med Spa at (915) 590-7907 to book any of the August specials at the Eastside (1387 George Dieter Building C) or Westside (5925 Silver Springs Suite C) office, or text 1-866-814-0038. For surgical or combined consults, call my main office at (915) 590-7900 or book online at agulloplasticsurgery.com/appointments. Follow me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

Posted on

Hands Don’t Lie: Inside the Filler Trend Everyone’s Suddenly Asking About

Black and white editorial close-up of a hand resting on a sterile drape beside a fine cannula. Hand filler safety commentary by Frank Agullo, MD, FACS.

Not too long ago, a reporter from the Daily Mail called asking about hand filler. Hand filler, not face filler. Of all things.

That didn’t surprise me. I’ve been getting the question in consult rooms for over a year now, usually as an afterthought right at the end of a facelift consultation. “Also, can you do anything about my hands?” Almost always said a little sheepishly, like it’s a strange thing to ask a plastic surgeon.

They aren’t. Hands are the most honest part of the body there is. A facelift can buy your face a decade back in the mirror. Your hands don’t get that same deal. They still tell the truth.

Why Hands Age Faster Than Most People Expect

Under the thin skin on the back of the hand sits a layer of fat that cushions the tendons and veins. That fat pad thins with age, the same process that hollows out the face, except faster, because your hands take more sun, more friction, and more daily wear than your cheeks ever do.

Once that padding thins, the tendons and veins that were always there start to show. Add years of unprotected sun exposure and you get sunspots and uneven pigment layered on top. None of this is disease. It’s just wear, in the one spot nobody remembers to put sunscreen on.

The Daily Mail piece I was quoted in framed the current spike in demand around video calls and phones, and I think that’s exactly right. A decade ago, almost nobody spent hours a day staring at their own hands on a screen. Now it’s a Zoom call, a phone held up in front of your face, a ring light for the selfie: your hands are on camera constantly, the same way “Zoom face” made people suddenly notice their neck. Hands got their own version of that.

Three Ways I Actually Treat a Hand

There are three separate problems in an aging hand, and you can’t treat them all the same way. Each one needs its own approach.

Problem What I use Why
Lost volume, visible tendons and veins Hyaluronic acid filler, calcium-based biostimulators, or Lipoderma fat grafting HA is temporary and reversible; biostimulators build the patient’s own collagen; Lipoderma or a patient’s own fat grafting lasts the longest
Thin, crepey skin texture Laser resurfacing, IPL, microneedling with PDGF Rebuilds texture and quality, not just volume
Sunspots and uneven pigment IPL and laser, paired with daily sunscreen Treats existing damage; sunscreen is the only thing that prevents the next round

Most patients need some mix of the three, and I say so upfront instead of just selling whichever one happens to be in my hand that day. A hand with good fat padding but bad sun damage doesn’t need filler. A hand with thinning padding and clean skin doesn’t need a laser. Matching the treatment to the actual problem is most of the job.

Why I Won’t Touch a Hand Without a Cannula and an Ultrasound Probe

Here’s the part that matters most, and the part I told the Daily Mail directly: hands are safe to treat in experienced hands, but anatomy is everything and unforgiving.

The skin is thin. The tendons sit right under it. The veins run closer to the surface than almost anywhere else I inject. There’s no fat padding, no muscle bulk to hide a mistake the way there sometimes is on a face. Poor technique shows immediately, and it shows on a body part your patient looks at fifty times a day.

That’s why I inject hand filler with a cannula, a blunt-tipped instrument, instead of a sharp needle. A cannula is far less likely to puncture a vessel as it moves through the tissue. I also treat ultrasound guidance as a genuinely vital safety tool here, not an optional upgrade. It lets me see the vessels I’m working around in real time instead of relying on landmarks alone.

The common side effects are ordinary and expected: swelling, bruising, and a few days of stiffness that makes gripping things uncomfortable. Lumps or small nodules can form if the filler isn’t massaged correctly right after injection, which is a technique issue, not a product issue. The rare but serious risk is injecting into or compressing a blood vessel and cutting off circulation. That’s the one cannula technique and ultrasound guidance exist to prevent, and it’s why I don’t consider this an entry-level injectable.

Who I Turn Away

Not everyone who asks for hand filler is a candidate, and I say so before I ever pick up a syringe.

I won’t inject over an active skin infection, and I’m cautious with patients who have uncontrolled autoimmune or connective-tissue disease, a history of severe filler reactions, or blood thinners that can’t safely be paused for the appointment.

There’s a subtler category too. Some patients are bothered by prominent joints or visible bones on the back of the hand, not lost volume between them. Filler doesn’t fix that. It sits in the soft tissue; it doesn’t camouflage a joint. I turn those cases away rather than inject anyway, because a patient who leaves disappointed is a worse outcome for both of us than a patient I was honest with in the consult room. Taking the case isn’t the win. The right outcome is.

Why This Sits in a Surgical Practice, Not a Med Spa Menu

I did my plastic surgery fellowship at Mayo Clinic, and I’m a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, where hand and upper extremity anatomy is part of the curriculum. Castle Connolly has named me a Top Doctor for thirteen straight years running.

None of that is a hand-filler credential specifically. It’s the reason I think about vascular anatomy the way I do before I ever pick up a cannula, on a hand or a face. The same caution that keeps a facelift safe belongs in a fifteen-minute hand appointment.

There’s no gown, no operating room, and realistically no downtime built into the schedule. I check the skin under good light, feel for how much padding is left over the tendons, and ask about decades of sun: driving with a hand on the wheel, gardening without gloves, none of it dramatic, all of it cumulative. If filler or a biostimulator is the answer, the injection itself runs fifteen to twenty minutes across both hands under topical numbing. Ice, then back to normal life the same day. I’d rather spend the extra ten minutes on the exam than the extra syringe on the wrong problem.

If your hands turn out fine and the concern is really your face, that’s a different conversation, and it usually starts with Botox or a look at the broader Med Spa and Laser menu.

Ready to Talk?

If your hands have been bothering you longer than your face has, say so. It’s a five-minute exam and an honest answer about which of the three problems you actually have.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

  • Patient-facing version on agulloplasticsurgery.com: “The Hand Filler Question: What I Tell Patients Before I Touch a Cannula” (link once live)
  • Practice version on swplasticsurgery.com: “Hand Rejuvenation, Explained: How We Approach the Newest Anti-Aging Trend” (link once live)
  • Source: Daily Mail, “‘Hand filler’ is the latest anti-aging trend sweeping America… but experts are urging caution,” Jane Herz, July 23, 2026.
Posted on

Slimming the Jaw Without a Scalpel: My Favorite Use of Botox Is the One Nobody Expects

Black and white editorial portrait illustrating masseter Botox for jaw slimming. Commentary by Dr. Frank Agullo, MD, FACS.

Ask most people where Botox goes and they point at the forehead. Frown lines, crow’s feet, the eleven between the brows. Fine.

My favorite spot is lower, and it has nothing to do with wrinkles. The masseter, the chewing muscle anchored at the angle of the jaw. When that muscle is strong, it widens and squares the lower face. Relax it and the jaw narrows, softens, reads more feminine. No incision. No downtime. Nothing for anyone to notice but the result.

For the right person, it is a small treatment that quietly reshapes the whole face.

What Masseter Botox Actually Does

It relaxes the big chewing muscle along the back of your jaw. Overdevelop that muscle, usually from clenching or grinding, and it bulks the lower face out wide and square.

Soften it, and over the following weeks the jaw draws in, so the face reads more oval and more feminine. You get that tapered lower third, and nobody can tell you had a thing done. That is the part I love. A surgeon-level result delivered through a needle.

Why It Lasts Longer Than Forehead Botox

The masseter behaves differently from regular Botox, and that surprises people.

Treat the forehead or the eyes and you get about three to four months. The masseter holds far longer, usually around six, because of how that muscle responds to being relaxed. So you are not chasing it as often. We treat it, you enjoy it for half a year, then we touch it up.

Area Typical Duration
Forehead, glabella, crow’s feet About three to four months
Masseter (jaw) Around six months

How I Decide the Dose

It rides on the strength of your muscle. First time, if the masseter is strong, I may treat it more fully, an even split across both sides. Once a prior round has already softened it, we back off, because now we are maintaining rather than starting cold.

What I am after is a balanced, even result so the jaw narrows symmetrically. I would rather build the effect gradually than overdo it in one sitting. You can always add more. Subtracting is the hard part.

Can It Feminize the Face?

Yes, and this is one of the things I love most about it. Narrowing the jaw does a lot of the work in softening a masculine or very square lower face. Bring the angle of the jaw in and the face turns more heart-shaped, more feminine, and it does it in a way that reads natural rather than surgical. People notice you look better. They do not notice why.

Where the Chin Comes In

The chin works in concert with the jaw. Sometimes, once we have narrowed the sides, a little projection in the middle of the chin finishes the look, keeping it pointed and feminine instead of wide. That can start as a small amount of filler.

For something permanent, I reach for a button-style chin implant. A button projects the chin straight forward rather than widening it, so the chin reads narrower and you get that clean shadow underneath the jawline everyone is after. Filler previews the look first. If you want it to last, the implant is the better long-term tool. The two pair naturally with masseter Botox. Relax the jaw to draw the sides in, add projection out front, and the whole lower face settles into balance. I think about the lower face the same way I think about a facelift, as one connected unit rather than a set of separate parts.

The Credential Behind the Approach

I am double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Mayo Clinic plastic surgery fellowship alum, and a Castle Connolly Top Doctor for thirteen consecutive years. I treat the lower face as one connected unit, the masseter, the jawline, and the chin together. A few units of Botox in the right muscle, sometimes paired with a little chin work, can reshape a face more than people expect. Done well, it looks like you, just more refined. The in-office injectable side of all this lives at our Med Spa.

Ready to Talk?

If your jaw has always looked wider or squarer than you would like, masseter Botox may be the simplest fix, no surgery required.

For the patient-facing version, see the companion post on agulloplasticsurgery.com. For the El Paso treatment menu, see the version on swplasticsurgery.com.

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.

Posted on

The Many Uses of Botox: A Surgeon’s Tour From the Well-Established to the Experimental

Black and white editorial close-up of a fine syringe held in gloved hands in soft side light. The many uses of botulinum toxin, by Dr. Frank Agullo, MD, FACS.

Before we talk about the different uses of Botox, which is a very exciting topic, it’s important to understand how botulinum toxin works. In essence, it inhibits the release of acetylcholine, which is the chemical signal that nerves send to the tissue on the other side. In the traditional use of botulinum toxin for the prevention of wrinkles, the nerves are sending acetylcholine to the muscles to contract the muscle, and the botulinum toxin is preventing that release so that the muscle doesn’t contract and create a wrinkle. In the same fashion, it can work on other targets, like sweat glands.

Once you understand that one mechanism, the whole long list of uses makes sense. So here is the tour, from the well-established to the experimental.

Excessive Sweating

Botulinum toxin can be used for excessive sweating, in medical terms, hyperhidrosis. This is what a fitness audience tends to care the most about. The FDA has actually approved botulinum toxin for excessive underarm sweating. In this case, the toxin is injected into the skin every half an inch to cover the area of the sweat glands that produce the sweat. A single underarm treatment usually lasts anywhere between four to six months, and it does have to be repeated.

Off-label, we can use it in the same fashion for sweaty palms, the soles of the feet, a sweaty scalp, and even the forehead. It doesn’t change how much you’re going to sweat in other places that aren’t treated, but it is very effective. I’ve had patients whose excessive sweating is disabling, and for them these treatments are life-changing.

Chronic Migraine and Headaches

The FDA has approved the treatment of chronic migraines and headaches with botulinum toxin for more than fifteen years now. There is a very specific protocol, and it consists of about thirty injection points in the forehead, scalp, and neck. This is considered a preventative treatment, which means it prevents the onset of new headaches. It would not cure an active headache at the time of injection.

I’ve had a lot of patients who just routinely get botulinum toxin for cosmetic reasons, to prevent wrinkles in the forehead, crow’s feet, and glabella, and they tell me that they’ve had fewer headaches since they started using the botulinum toxin.

Jaw Clenching, Tics, and Symmetry

Botulinum toxin is also used for jaw clenching and teeth grinding. It’s injected into the masseter muscle, which decreases the strength of the bite. As a side effect, it can be used to slim a heavy jawline by decreasing the size of the masseter muscle, creating that shadow effect that a lot of women aspire to.

It can also be used for spasms or continuous nervous tics around the eyes, to soften them. We use it often in patients with facial nerve palsy to create more symmetry between the non-paralyzed and paralyzed sides. It can be used in neck muscle spasms and even in overactive bladders.

The Less Traditional Uses

Less traditional uses of Botox include TrapTox, which is injected into the trapezius muscle, and sometimes it’s called the Barbie. It reduces the mass of the trapezius muscle, which creates a more slender neck, and a longer, more slender neck. Some people use it for comfort in this area, as they feel they carry significant stress in their shoulders, and this can help alleviate that.

We use it around the mouth to correct gummy smiles. We inject it into the muscles that elevate the upper lip excessively, and it reduces the gum show, or gingival show, when smiling. Another area where it’s injected into muscles to decrease their mass is the calf muscles, which is very common in the Asian population. It can also be used to treat the pebbly chin, or orange peel appearance of the chin. Relaxing the mentalis muscle smooths this area of skin.

The Skin Itself

There are applications where we do microdroplets of botulinum toxin over the skin. These are very superficial injections, and overall they decrease oil production and smooth out the skin over time. It’s something we’ve noticed just in treating patients aesthetically for the prevention of frown lines and wrinkles, that the area where the Botox is injected, the skin quality improves over time and looks younger. It is also used for rosacea flushing, where microdroplets are injected into the skin to decrease facial flushing and redness, which is considered off-label. It pairs naturally with skin-quality work like microneedling.

The Experimental Frontier

Depression is actually being studied at the moment, but some studies already suggest that relaxing the glabellar frown muscles influences emotional feedback mechanisms and pathways in a way that improves depression. It’s not FDA-approved for depression, but it remains an active area of research.

There is a nonstandard indication where botulinum toxin can be injected into the clitoris, which relaxes the capillaries and promotes engorgement during sexual stimulation, which can increase sensitivity. In the same manner, it can be injected around the vagina to prevent vaginismus, sexual pain, and pelvic floor spasms. And some physicians actually use it in places you would never imagine, like the vocal cords, the salivary glands to decrease saliva production, the pelvic floor for problems in women, and the hands for circulation disorders.

One of the side effects of injecting into areas for decreased sweat production is that there’s also a decrease in body odor production, since the smell is produced by the same glands that produce the excessive sweat.

The Credential Behind the Opinion

Double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, American College of Surgeons Fellow, Mayo Clinic plastic surgery fellowship, Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, and Castle Connolly Top Doctor for thirteen consecutive years. The reason I keep a long mental map of these uses is that the same molecule, in the right hands and the right plane, solves a surprising range of problems.

Ready to Talk?

If a use on this list speaks to something you have lived with, the conversation is worth having.

For the patient-facing clinical guide, see the companion post on agulloplasticsurgery.com. For the MedSpa toxin menu at the practice, see the version on swplasticsurgery.com.

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.

Posted on

Collagen Season: The June Med Spa Specials I’d Actually Book

June Med Spa Specials flyer at The Med Spa at Southwest Plastic Surgery East and West, El Paso Texas, supervised by Frank Agullo, MD, FACS, double board-certified plastic surgeon

Collagen Season: The June Med Spa Specials I’d Actually Book

Here is something nobody at a med spa will tell you in June. This is the worst month of the year for your face.

The sun is brutal right now. The pool is open. Half of El Paso is outside between ten and four, which is the exact thing that ages skin faster than any birthday. And what does the wellness world sell you in response? A glow facial for the wedding next weekend.

I want to argue for the opposite. Skip the quick fix. June is when you start the slow stuff, the treatments that compound across the summer, so the face you have in September is better than the one you have right now. I think of it as collagen season.

Three things are on our June board. These are the three I would book if it were my money and my face. Here is the honest version of each, the read you would get if you were sitting across the desk from me.

Renew. The Sculptra package, three vials, $1,725.

I have written before that fillers are a tax. I stand by it. So it should mean something that the first special on this list is, in my opinion, the best non-surgical money on the board, and it is not a filler.

Sculptra is a collagen biostimulator. The active ingredient is poly-L-lactic acid, and it does not work the way a hyaluronic acid syringe works. A traditional filler sits under your skin and takes up space on day one. You leave the office full. Sculptra does almost nothing visible on day one. It triggers your own body to lay down new collagen over the following weeks and months, and the result builds slowly, from your own tissue, on your own scaffolding.

That difference is the entire point.

A filler is a thing in your face. Sculptra is your face making more of itself. One of them you have to keep buying to maintain. The other one is, in the most literal sense, an investment in your own collagen.

Why three vials, and why as a package. Sculptra is a series. You spread the vials across a couple of sessions, a few weeks apart, and the collagen builds in layers. The package at $1,725 just locks you into finishing the protocol at a better price. The most common way I see people waste money on this product is paying vial by vial and quitting after the first one, before their own collagen has done much of anything.

Two honest cautions.

One. This is slow. If you want to look different for an event in two weeks, Sculptra is the wrong tool and I will tell you so. The payoff shows up around the eight to twelve week mark and keeps improving after that. Start in June, peak in fall. That is the trade.

Two. Technique is everything with this product. Sculptra has to be reconstituted correctly, given time to sit, and injected in the right plane by someone who understands biostimulators, or you get nodules instead of a result. That is exactly why the package runs under my supervision and not at a strip-mall injectables bar.

Restore. Microneedling with PRP/PRF, $1,500.

If you have read this blog for any length of time, you know I once wrote a post about vampire facials. It is still one of the most-read things I have ever published, and the science behind it is the second special on the June board.

Microneedling with PRP/PRF is the grown-up version of that treatment.

Here is the mechanism, in plain English. We draw a small amount of your blood and spin it down to concentrate the platelets and the growth factors they carry. That is the PRP, platelet-rich plasma, or PRF, platelet-rich fibrin, which is the newer preparation that releases those growth factors more slowly and over a longer window. Then we use a microneedling device to create thousands of microscopic channels in the skin, and we drive your own concentrated growth factors down into them.

The needling alone triggers a wound-healing and collagen response. The growth factors pour fuel on that response. The result, over a series, is better texture, smaller-looking pores, softened fine lines, and the kind of glow that is actually new collagen and not just a temporary flush.

What I like about this one for June specifically. It is your own biology, so there is nothing foreign going in. It pairs beautifully with the Sculptra patient who wants surface quality and deep collagen working at the same time. And the $1,500 package price is built around a series, because one session is a nice afternoon and a series is what actually changes the skin.

One rule I will not bend on, and June makes me say it twice. Stay out of the sun. Freshly needled skin that hits the pool the next afternoon is begging for a pigment problem, and an El Paso summer punishes that mistake harder than almost anywhere else in the country. Sunscreen and shade between sessions. Every time.

Revive. A complimentary gift with the purchase of three skincare products.

This is the quiet one on the board and the one I most want patients to actually take.

The deal is simple. Buy three medical-grade skincare products and the gift comes with it. No drama. But the reason I am putting my name behind a skincare promotion at all is that skincare is the foundation under everything else on this list, and it is the part patients skip.

You can biostimulate collagen with Sculptra and resurface with microneedling, and then undo a good chunk of it by washing your face with whatever was on sale and skipping sunscreen. Medical-grade skincare is not the drugstore product with a nicer label and a worse price. It is higher actual concentrations of the ingredients that do the work, a real retinoid, a real vitamin C, a real medical sunscreen, formulated to get through the skin barrier instead of sitting on top of it.

Three products, chosen for your skin, used every day, is the cheapest anti-aging on this entire page. The gift is just the nudge to finally build the routine.

A clean comparison

Special What it is Investment Best for
Renew Sculptra collagen biostimulator $1,725 (3 vials) Building your own collagen over the summer, the long game, not a quick fix
Restore Microneedling with PRP/PRF $1,500 Texture, pores, fine lines, and a real glow from your own growth factors
Revive Gift with 3 skincare products Complimentary gift Committing to the daily medical-grade routine that protects all of it

Where to come, East or West

The Med Spa at Southwest Plastic Surgery runs out of two El Paso locations, and the June specials are valid at both.

The Eastside office is at 1387 George Dieter Drive, Building C, El Paso, Texas 79936.

The Westside office is at 5925 Silver Springs Drive, Suite C, El Paso, Texas 79912.

You can book at either. My Med Spa team works across both sites, the protocols are the same, and you should pick the side of town that fits your week. If you want to see the full menu, the Med Spa page and the microneedling page on our practice site are the place to start.

A note on who is doing the work

When you walk into my Med Spa, you should know whose name is on the room. Mine. I trained in plastic surgery at Mayo Clinic, I am double board-certified, I teach the residents at Texas Tech as a Clinical Associate Professor, and Castle Connolly has named me a Top Doctor thirteen years running. None of that is decoration. The Med Spa is the non-surgical half of my surgical practice, and I write the protocols myself.

That is the only reason I will attach my name to a Sculptra package or a vial of your own platelets. If the standard slips, I do not put my name on it.

Ready to talk?

Call our Med Spa at (915) 590-7907 to book any of the June specials at the Eastside (1387 George Dieter Building C) or Westside (5925 Silver Springs Suite C) office. For surgical or combined consults, call my main office at (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

Posted on

Renew, Restore, Revive: The May Med Spa Specials I’d Actually Book

May Med Spa Specials flyer, Renew Restore Revive promotions at The Med Spa at Southwest Plastic Surgery East and West, supervised by Frank Agullo, MD, FACS, double board-certified plastic surgeon in El Paso, Texas

May is the month of Mother’s Day, hot weather creeping back, and somebody in the group chat asking, again, what I think she should get done before her sister’s wedding.

So this is my answer in writing. Three things on the May board at our Med Spa. Three I would actually book. Honest read on each.

If you have read me before, you know how I feel about wellness specials. Most of them are spa theater. Pretty room, candle, tiny outcome. The point of writing this post is the opposite. The three on this list move skin or move ink, and they move it in ways I can defend with a straight face the next morning when I scrub in.

Renew. Laser tattoo removal at 20 percent off per session.

Tattoo removal is the special on this list that earns its 20 percent discount the loudest, because tattoo removal is not one appointment. It is a course. Most patients need somewhere between six and ten sessions, spaced out about six weeks apart so the body has time to clear the broken pigment.

That spacing matters more than people realize. Stack the sessions too close and the skin punishes you. Space them right and the pigment lifts cleanly, with no scarring, on most colors and on most skin types.

Twenty percent off, applied across a full course, is real money. On a sleeve or a back piece it is the difference between thinking about it and doing it. May is also a strategically smart time to start. By the time the first holiday party season hits, a patient who started in May has three or four sessions in and is well past the point where the tattoo is the loudest thing on her arm.

What I want a tattoo removal patient to know going in.

We use medical-grade laser tattoo removal. The pigment, broken into smaller particles by the laser, is then cleared by your immune system, which is why the spacing between sessions exists. Color matters. Black is the most cooperative. Reds and warm yellows take more work. Cosmetic eyebrow tattoos and amateur work are usually the fastest cases. Old, deep, layered ink is the longest road. Whatever the case, sun avoidance between sessions is non-negotiable.

If you have been postponing it, this month is the time.

Restore. The Mother’s Day Radiance Facial, $125.

I am picky about facials. Most of them are smell-good and feel-good and do not actually change anything that I, as a surgeon, would be able to see two weeks later.

The Mother’s Day Radiance Facial my Med Spa team built for May is the exception. It is a real treatment facial, structured around exfoliation, deep cleansing, and active serums chosen by the aesthetician based on what your skin is actually doing that day. It is not a candle and a vibe. It is a $125 piece of skin care that earns its slot.

Who I would book this for.

A daughter buying for her mom. A mom buying for herself, which I am increasingly seeing and approving of, because a $125 facial bought without permission from anyone is a healthy line item in the budget.

The patient who has been working too hard, in too much sun, and whose skin looks duller than her actual age. This facial is a reset.

The pre-event patient. Wedding next month. Reunion. Big trip. A radiance facial twelve to fourteen days out is the right window. Long enough for any redness to settle, close enough that the glow is still on the skin when the photos happen.

What this facial is not. It is not a chemical peel. It is not a laser. It is not going to undo a decade of sun damage in one sitting. It is the maintenance layer of a real skin program. Used as such, it is excellent.

Revive. The Mother’s Day Refresh, $3,650. Nurses’ discretion.

This is the special I would have written off as marketing copy if I were not the one signing off on the protocol.

The Mother’s Day Refresh is a $3,650 facial balancing package. Dermal filler plus upper-face neuromodulator (the wrinkle-relaxer in the forehead, brows, and crow’s feet area), with the specific products and quantities chosen at the appointment by the injecting nurse based on the patient’s actual face, in the room, that day.

The phrase “nurses’ discretion” is the part I want to talk about, because that is what makes this package interesting.

Most filler-and-tox packages are sold by the syringe. One syringe of this, twenty units of that, on every face that walks through the door. That is convenient for billing. It is not great for outcomes. Faces are not standardized. A patient with a heavy lower lid and a flat midface needs a totally different distribution of filler than a patient with deep nasolabial folds and a strong cheekbone.

The Refresh package solves that by giving the nurse the budget to spend where the face actually needs it. If your forehead lines are loud, more goes there. If your cheekbones are flat, more filler in the malar area. If your upper lip is fine and your jaw is what is bothering you, the package goes where the work is.

This is how I want injectables done. By a nurse who has been trained to look at the whole face and to allocate product accordingly, not to count units off a price list.

Two real cautions.

One. This is a refresh, not a redesign. If your face has changed materially in the last decade, what you actually want is a surgical conversation with me, not a filler package. Filler is a tax. A facelift is an investment. I have written that line before and I will keep writing it, because it keeps being true.

Two. If you have never been injected before, the Refresh is a good first step but go in with realistic expectations. The result is a quieter, more rested version of you. Not a different face.

A clean comparison

Special What it is Investment Best for
Renew Laser tattoo removal 20 percent off per session Anyone with old or unwanted ink, ready for a real course
Restore Mother’s Day Radiance Facial $125 A reset for tired skin, or a thoughtful gift for mom
Revive Mother’s Day Refresh $3,650 Filler plus upper-face wrinkle relaxer, nurse-curated, full-face balance

Where to come, East or West

The Med Spa at Southwest Plastic Surgery runs out of two El Paso locations.

The Eastside office is at 1387 George Dieter Drive, Building C, El Paso, Texas 79936.

The Westside office is at 5925 Silver Springs Drive, Suite C, El Paso, Texas 79912.

You can book at either. The Med Spa team works across both sites and the protocols are the same. Pick the side of town that is easier for you that week.

A note on who is doing the work

I want every patient who walks into my Med Spa to know who is supervising the room. I do. I am Frank Agullo, MD, FACS, double board-certified, Mayo Clinic plastic surgery fellowship alum, Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, Castle Connolly Top Doctor for thirteen consecutive years. The Med Spa is not a side hustle. It is the non-surgical arm of my surgical practice, and the protocols are written and overseen by me.

That is the only way I would put my name on a $125 facial or a $3,650 refresh package. The standard is the standard.

Ready to talk?

Call our Med Spa at (915) 590-7907 to book any of the May specials at the Eastside (1387 George Dieter Building C) or Westside (5925 Silver Springs Suite C) office. For surgical or combined consults, call my main office at (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. Follow me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful

Posted on

The House That Never Changes

Aging

Three boys and three girls, loving (but firm!) parents, a live-in maid/nanny, a HUGE house!  The Brady house didn’t seem to ever change: the wide open staircase, the formal living and dining room, the eat-in kitchen that seemed like it was much bigger than the space should allow. The house pictured on the opening credits hasn’t changed at all since filming, and it’s been put up for sale.  The owners are looking for a serious buyer who will preserve the traditions of the “second most photographed home in America.”

Is Your “Home” Aging?

If you grew up watching the Bradys on television, you’ve probably changed more than the house has! After all, the show is close to fifty years old! A home may need a new coat of paint, a new roof, or new siding. But at the end of the spruce, it may look the same as it did when it was new. Not so with the fifty-year-old human! Time shows on your face and your neck in smile lines and sagging.  The skin on your hands and feet show the years of working and walking. Pregnancies and injuries and surgeries have all left their marks. There’s no way you’ll ever look again the way you did when you were twenty. But with the help of Dr. Agullo, you can look younger, smoother, and more toned!

With various techniques available to eliminate deep lines and freeze the muscles that create wrinkles, you’re living in a time when it really is possible to get an age-defying look. Come try out the selection of injectables we offer like Botox and Juvederm. Consult with Dr. Agullo about other ways to tone your skin and body. Get social with us so you can see the big picture: @RealDrWorldWide on Snapchat and Instagram, @Agullo on Twitter, or @AgulloPlasticSurgery on Facebook.