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The Year the Lift Beat the Implant: A Surgeon Reads the 2025 ISAPS Numbers

Black and white photograph of four women of different backgrounds in long satin evening gowns facing the camera on a marble terrace above city lights at night. Illustrative image, generated, not patients. Commentary by Frank Agullo, MD, FACS.

“In my practice, I have seen breast lifts as one of the most common procedures performed.”

I dictated that in September. On September 29 the International Society of Aesthetic Plastic Surgery published its 2025 global count:

Worldwide, 2025 Count One-year change
Breast lift 1,143,862 plus 48.1 percent
Breast augmentation 1,622,639 minus 2.2 percent
Implant removal 360,594 plus 42 percent since 2021
Secondary breast surgery 592,965 28 percent ended with no implant

Eighth most common operation in the world last year. Fourth this year.

What I See in the Room

“Where the nipple sits relative to the IMF is the entire question. Above the fold leans aug alone, or aug plus a small doughnut lift for better symmetry and perkiness. BodyTite if skin is borderline. At or below the fold leans an honest mastopexy, and an implant alone in that setup will make the heaviness worse.”

That is how I answered a woman on RealSelf this spring, and it is the exam the implant was sold around for years.

What Changed

The first is the incision. “I think a lot of patients are afraid of this surgery because they feel like they’re going to need the full anchor type incision. By offering the circumareolar, or donut, lift for patients whose nipple and areola are above the inframammary fold, this can be a game changer.”

The second is what holds the lift up. “Regardless of the combination of procedures we perform, I do recommend using an internal bra with mesh support, with GalaFLEX or DuraSorb, to give us that support of the breast weight, so that we’re not just relying on skin, which has lost all its elastin and is not reliable long term.”

“The mesh supports the tissues for a period of up to two years. As it dissolves, it leaves behind collagen deposits, so the support remains there even well after the mesh has gone.”

A lift that lasts is a different product from the lift of ten years ago. The world ordered 370,000 more of them.

The Look Women Are Choosing

“A breast lift will always give a perkier look, more upper fullness, and cleavage, but it’s going to have usually a natural slope on top.”

“An implant is very predictable,” and 1.6 million women still chose one. I wrote about where the implant still belongs after Forbes asked whether one of them was the Rolls-Royce. The full read on the lift, with the exam and the cost, is on my practice site, and what nobody tells you about the lift itself is here.

Ready to Talk?

Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at agulloplasticsurgery.com/appointments. #StayBeautiful

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

Statistics: International Society of Aesthetic Plastic Surgery, ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2025.

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A Lift Alone Can Make You Smaller. Somebody Should Say That First.

Black and white torn-paper collage of two cut-out portraits of poised women with engraved magnolia beside a large numeral reading 4th.

Breast lift was the fourth most common cosmetic operation in the country last year. It is also the one where expectations most often go wrong, and usually in two specific ways.

First: a lift on its own does not add size

“If a patient just wants to have a breast lift, then they have to understand that they may be the same size or slightly smaller, maybe half a cup size to a cup size, because we are removing that excess skin. The breast will be perkier, but it’ll also be tighter, and it may appear smaller.”

If you want to be larger, that is a different operation.

“Of course, if they want to be larger, we will need an implant or a fat transfer to the breast. The biggest difference here is that an implant is very predictable, and fat transfer to the breast is going to be a slight change, very natural, and a little bit unpredictable in terms of how much of the fat actually stays, but we can usually count on about a cup size increase.”

Second: the upper pole

“A lot of patients having a breast lift with implants are expecting a lot of upper fullness and a very high implant placement, which is just not possible at the same time as a breast lift. A breast lift will always give a perkier look, more upper fullness, and cleavage, but it’s going to have usually a natural slope on top.”

A natural slope is the result, not a failure of the result.

The incision people are afraid of

“I think a lot of patients are afraid of this surgery because they feel like they’re going to need the full anchor type incision. By offering the circumareolar, or donut, lift for patients whose nipple and areola are above the inframammary fold, this can be a game changer.”

That is an anatomy question, settled at the consultation, not a preference.

Why I put mesh in

“Regardless of the combination of procedures we perform, I do recommend using an internal bra with mesh support, with GalaFLEX or DuraSorb, to give us that support of the breast weight, so that we’re not just relying on skin, which has lost all its elastin and is not reliable long term.”

Skin that stretched once will stretch again. It is not a load-bearing structure.

What the price actually depends on

“Using an implant and/or internal bra support mesh will increase the cost. If a procedure is going to take longer, that can increase the surgical and operative time cost. And any other procedures that we add on, like sometimes liposuction of the lateral chest with Renuvion J-Plasma, or the axilla and upper back, can increase the cost as well.”

On size

“I think the bulk of patients still use the three hundred to four hundred CC implants, which give them one to two and a half cup sizes depending on their starting point.”

Some want far more, and I offer the Mentor MemoryGel Enhance line, which runs up to 1,445cc. Others want less, under 300cc, sometimes with Motiva Preserve for a faster recovery.

“So really, I have a wide range of patients, and I like to help them achieve what they desire in a safe framework, and have a good conversation about how we can get them there.”

Consultations at Southwest Plastic Surgery in El Paso.

Call (915) 590-7900 or text 1-866-814-0038.

#StayBeautiful

Source: Commentary from Dr. Agullo’s 2026-09-07 dictation. Mentor MemoryGel Enhance ceiling of 1,445cc confirmed by Dr. Agullo 2026-09-07.

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One Surgery, Many Decisions: What Actually Goes Into a Mommy Makeover

Greyscale editorial photograph for a mommy makeover essay by Frank Agullo, MD, FACS.

Mommy makeover is a misleading name. It sounds like a single procedure. It is not. It is a name given to a decision tree that every patient is faced with.

Most mommy makeovers are the same, except where they are customized. In general, they come 360 around the torso, with a tummy tuck and breast work. Breast work can be a reduction and lift, an augmentation, or an augmentation with a lift. We offer fat grafting to the buttock and people like to call that an extreme mommy makeover, but the truth is that it is often just a further decision-making addition.

Is It Actually Safe

As you will see in the next paragraph, we safely perform this combination of breast, abdominal, and buttock work several times a week. Often patients ask, are the results lasting? So long as the patient does not have more children after the mommy makeover, the results often remain the same. The liposuction performed with the tummy tuck removes most patients of five to ten pounds. You will notice the effect of the shape change more through that than through the change in your weight directly.

People come in asking us: is it safe to combine surgery, and what is included in my mommy makeover? What is even safer is your experience. We do this combination of surgeries three to four times a week. I would not be doing as many mommy makeovers if I had any reservation about the safety of combining them. All mommy makeovers typically run under six hours, with the patient in compression socks and sequential compression devices, walking that same day, following a blood thinner.

What Breast Surgery You Need Depends Entirely on Your Body

The breast has the biggest variety of factors. All we do is look at the patient and decide what we can do to make it better. Maybe you experienced volume loss after nursing, and we repair that with an implant. Some patients even combine a breast implant with fat transfer for extra volume. After you have decided on the fat transfer and or implant, then a conversation about the nipple becomes relevant depending on the change you experienced from nursing.

When planning a breast lift we examine both how much your breast droops and the shape that drooping has taken. Where your nipple ends up is perhaps our most prominent visual guide to an ideal outcome. The other option is a smaller circumareolar lift. Regardless of whether you pursue an extreme mommy makeover, a mini mommy makeover, or somewhere in between, most patients get a mesh that holds the breast result in place, GalaFLEX or DuraSorb.

In contrast to most cosmetic clinics, it is impossible for me to give a price on a mommy makeover when a patient first asks. I do not give a quote until your anatomy is sitting in front of me, so we can have a personalized discussion. My entire purpose as a Mayo Clinic fellowship-trained, double board-certified plastic surgeon is making sure patients feel confident in breast, abdomen, and buttock work without losing their natural looks or jeopardizing their bodies while pursuing a higher level of confidence.

Tummy Tuck Decisions

When making an inquiry into a tummy tuck, the options are generally pretty easy. It entirely boils down to how much skin is loose. Minimal laxity calls for a mini tummy tuck, roughly the length of a C-section incision. A higher amount of skin laxity signals a standard tummy tuck. If the skin rolls are pronounced, we are probably looking at an extended abdominoplasty, or a circumferential body lift when there is more extensive sagging around the back and buttock.

Typically, 360-degree liposuction across the torso pairs with our Renuvion J-Plasma tightening technique. Arms and inner thighs, when treated, get BodyTite for that same skin-tightening effect.

As a Castle Connolly Top Doctor for thirteen consecutive years and a double board-certified plastic surgeon, I have got your back.

Ready to Talk?

Bring your anatomy, not a checklist. We will build the plan together.

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.

  • Full surgical guide on agulloplasticsurgery.com: “What Really Goes Into a Mommy Makeover, and Why It’s Safe as One Surgery” (canonical)
  • Med spa side on swplasticsurgery.com: “Built Around You: How Southwest Plastic Surgery Customizes a Mommy Makeover” (link once live)
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You Lost a Hundred Pounds. The Skin Did Not Get the Memo: A Surgeon on the Body Lift

Black and white editorial portrait illustrating body contouring after major weight loss. Surgical commentary by Dr. Frank Agullo, MD, FACS.

Some of the most rewarding consultations I have are also, for the patient, some of the most maddening.

Sixty pounds gone. Eighty. A hundred. Bariatric surgery, a GLP-1, or sheer stubborn discipline, it does not matter which. They finished the part most people never do. And then they are sitting across from me genuinely upset, because the skin will not play along.

Here is the truth I hand them, pulled from real consultations and anonymized. The skin is not a willpower problem. It is a tissue problem. Willpower does not fix tissue.

Why the Skin Will Not Go Back

Stretch skin that far for that long and the elastic fibers give out. You can hit a beautiful weight, carve out a tiny waist, and still have skin hanging off the breasts, the belly, the inner thighs, the arms.

No squat program reverses that. The only thing that removes loose skin is surgery. I say it bluntly because I have watched too many people blame themselves for something that was never theirs to fix at the gym in the first place. That is precisely the work body contouring after major weight loss was built for.

What I Do for the Breasts

After massive weight loss the breast usually still has volume. It is just hanging very low. Most of the time a lift alone gives a beautiful result, no implant needed. I bring the nipple up, take out the excess skin, and because your skin has lost its elasticity, I lay a mesh on the inside so the result no longer leans on skin that cannot hold. Skip that mesh and everything drifts back down over the years.

When the breasts hang extremely low, I usually hold off on the implant during the lift. Moving the nipple a long distance up while adding an implant in the same sitting can choke the blood supply to that nipple, and that is not a gamble I take. The implant is an easy second step later. One breast almost always outsizes the other, so I trim the bigger side to match.

Standard Tummy Tuck or All the Way Around?

With a standard tummy tuck I make a low incision, pull out the excess skin, draw everything down tight, and repair the muscles up the middle and along the sides for that corset effect and a smaller waist. Liposuction goes with it.

After massive weight loss, though, the looseness rarely stays in front. It wraps around the sides and the back. So I often steer toward the circumferential procedure, also called a lower body lift. The incision carries all the way around, which lets me pull the skin down in front while lifting the outer thigh and the buttock in the same pass. When the laxity is not just frontal, this is the most complete option on the table.

If your laxity is I usually recommend
Mostly in the front A tummy tuck with liposuction
Wrapping around the sides and back A circumferential lower body lift
Hanging low at the breasts A breast lift, often with internal mesh
Loose on the inner thighs A thigh lift, staged thoughtfully

The Honest Tradeoff on Stubborn Laxity

The circumferential lift pulls everything down and in. But carry a lot of side-to-side laxity and you may still have some looseness up top when it heals. Erasing that completely takes a vertical incision, one that gathers everything in like a corset.

Most people would rather not wear that scar, because it is harder to hide. So I almost always park it as an optional second stage, done later only if the looseness truly bothers you. I am not in the habit of talking patients into scars they do not need.

And the Inner Thighs

Real excess skin on the inner thighs? Liposuction alone will not touch it. I run an incision in the groin crease that continues just below the buttock and pull everything up. Want it tighter still? That means a vertical scar down the inner thigh, which I again hold in reserve.

Let me be upfront. The thigh lift is the hardest of these to recover from. Right where the tension pulls upward, the incision tends to open a little, almost every single time. The good news is we just keep it covered with gauze, it closes on its own in about two to three weeks, and more often than not we never even have to revise the scar.

Why I Stage It This Way

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 Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Body contouring after massive weight loss is never one operation that fits everyone. It is a plan. I would rather hand you a safe, powerful result today and keep the more aggressive scars in my back pocket than chase perfection in a single marathon surgery and gamble with your healing.

Ready to Talk?

If you have lost the weight and you are ready to deal with the skin, let us build a plan together.

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.

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The Mommy Makeover Is a Marketing Name: How I Build the Right List, Not the Longest One

Black and white editorial portrait study. The mommy makeover read by Dr. Frank Agullo, MD, FACS.

Let me say the quiet part first. “Mommy makeover” is a marketing name, not a single operation. It is a label that bundles several procedures under one friendly phrase, and the phrase sells better than the parts.

That is fine, as long as we are honest about what is happening underneath it. When someone books that consult with me, my first job is not to schedule the longest list. It is to figure out which procedures actually serve their goals and which ones they can skip.

Sometimes the most useful thing I do all day is talk someone out of part of it.

What “Mommy Makeover” Actually Bundles

It is a menu we combine, not a fixed package. It can include a breast augmentation or whatever your breasts need, the liposuction 360, the BBL (fat injections to the buttocks), and the tummy tuck. We pick from that list based on you. You do not have to do all of it, and most patients should not.

Being Scared of Part of It Is Normal

Almost everyone walks in certain about one thing and nervous about another. Sure about the tummy tuck, anxious about implants. Or the exact reverse. That is not a reason to rush, and it is not a reason to skip.

It is a reason to slow down and go through each piece on its own. We talk through the parts you are unsure about, one at a time, and you are completely allowed to leave my office undecided. The decision keeps until you are ready.

Implant, Lift, or Both?

This depends entirely on what dropped. If you mostly lost volume, an implant can be enough. If the nipple and tissue have descended, an implant alone can actually make it look worse, and a lift enters the conversation.

Often the answer sits in between. A donut lift, a small circle of skin removed around the areola, raises the nipple about an inch and re-centers it, and I can place a modest implant through that same incision to restore the upper fullness. You get a perkier, natural result without the longer scars of a full lift, and the scar hides at the edge of the areola.

Liposuction or Tummy Tuck? The Key Conversation

This is the one I never let a patient gloss over. Liposuction removes the fat we can pinch. But if your abdominal muscles separated during pregnancy, you will still see a bulge when you relax, and the only thing that fixes that is a tummy tuck.

A tummy tuck makes everything flat and tight and repairs the muscle, like a built-in corset. It is significantly more improvement than lipo alone, but it comes with a scar. I would rather you choose with that clearly in front of you than feel cheated later.

Should You Lose Weight First?

Stable matters more than low. If your weight is still swinging a lot, settling it first usually gives a better, longer-lasting contour.

But a tummy tuck removes loose skin and repairs separated muscle, and no amount of dieting fixes either of those. So the answer depends on what is actually bothering you, and we sort that out at the exam, not by a rule.

What Belongs on Your List vs. What Doesn’t

If Your Concern Is The Honest Recommendation
Lost breast volume only Implant may be enough
Dropped nipple and tissue Lift, often with a modest implant
Pinchable belly fat Liposuction
Bulge when muscles relax Tummy tuck repairs the separation
Loose skin after pregnancy Tummy tuck, not dieting

Can It All Be Done at Once?

Often yes, and it is usually the smarter choice. One anesthesia, one recovery, one block of time off work. When I plan combined surgery I am weighing your overall health and the total operative time, not just stacking a wish list. Adding something small, like the breast portion, frequently does not add much to your recovery.

There is a ceiling, though, and I respect it. Operative time has a relationship to safety, and at some point a longer list stops being convenient and starts being a risk I am not willing to take. When a wish list runs past that line, I stage it. Two calmer surgeries beat one marathon, every time, and I will tell you honestly when that is the smarter plan for your body.

The Recovery You Are Actually Signing Up For

People focus on the surgery and underestimate the recovery, so let me set expectations. The tummy tuck is the dominant part of the recovery in most mommy makeovers. It is the one that asks the most of you, with a real adjustment for the first week or two as the repaired muscle settles.

The breast portion and the liposuction ride alongside it without adding much. Lymphatic massage, the compression garment, and patience carry you the rest of the way. Most patients are back to normal daily life faster than they feared, with full exercise coming later. The point of planning it together is that you do this recovery once, not three separate times.

When Is the Right Time to Do This?

There is no universal answer, but there are good signals. You are finished having children, or confident that you are. Your weight has settled. You have help lined up at home for the first week, because you will genuinely need it. And the reasons are yours, not a date someone else circled on a calendar.

I will not rush a patient into a permanent decision to make an event. If the timing is wrong, I will say so, and we will plan for when it is right. The body you are restoring took years to change, and getting the timing right is worth more than getting it fast.

The Credential Behind the Plan

Double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, 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 best mommy makeover is not the longest list. It is the right list for your body and your goals, planned safely.

Ready to Talk?

Let us build the plan that fits you, not a template. For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com. For the practice’s mommy makeover overview, 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.