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He Came In With a Plan: A Surgeon on the Young Men Who Research Their Own Faces

Black and white photograph of a young man's jawline in hard side light, head turned fully away so the face is in shadow and no features are identifiable, dark crew neck against a dark wall. Illustrative image, not a patient. Commentary by Frank Agullo, MD, FACS.

The men do not arrive with a question anymore. They arrive with a list.

“The patient is a man in his late twenties who came in asking for buccal fat pad removal and improvement in his jawline. He really didn’t come in for recommendations. He had already done a lot of research. He had seen a video about buccal fat removal, how it made the face more triangulated, but he also wanted to have jawline filler and a chin implant to strengthen his lower face contour.”

I have written before about these consults. Here is one, every identifying detail removed.

The intake form first.

“On his pre-op intake form, I saw what I see often on this type of patient. No medical problems, but a long list of supplements, including peptides, peptide stacks, an LED home device, protein powders, and retinoid cream.”

Then the exam, the part a video cannot do.

“When I examined him, he was already an attractive fellow. His chin projection was actually in line with the norms, lining up with the mouth and the nose. So he had a normal chin projection for his frame. Mild asymmetry, as expected, between the left and right side of the face and jawline. A slight amount of cheek fullness. And good jawline definition.”

Normal chin. Good jawline. The video got the cheek right.

I did not say no. I said look.

“The procedures he was asking for were not inappropriate. We did a 3D simulation, which did show improvement in his facial balance and contours, which he liked. In the end, he decided on buccal fat pad removal with chin augmentation and fat transfer to the jawline, rather than jawline fillers, for a more permanent result. Of course, we stopped all supplements two weeks before surgery.”

The chin stayed. The filler went, replaced by his own fat. Fillers are a tax you pay forever; the specialty’s own numbers agree.

Three months later.

“It’s been three months since his surgery and he is very satisfied. I am surprised he has brought up his upper eyelids and his nose at post-op appointments, and I’ve asked him to wait at least six months to a year to allow this surgery to completely heal and give us a good idea of his facial features.”

What I took from it is not about buccal fat.

“What I took away from this case is that these patients are very motivated. They have done their research and they understand the procedure they’re going to go through. Sometimes they do have unrealistic expectations. Tools like 3D imaging help the patient visualize what can actually be done and help them decide whether to undergo the procedure. I was happy to see that this patient, unlike many others, was obtaining his peptides and supplements through another doctor’s oversight and through a legitimate pharmacy.”

Unlike many others. Underline that.

The clinical version, with the exam-to-plan table and the FAQ, is on agulloplasticsurgery.com. The men in my waiting room can bring me a plan. I reserve the right to improve it.

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

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

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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.

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The Profile Fix Nobody Talks About: Why a Chin Implant Beats the Nose Job You Were Planning

Black and white editorial profile portrait illustrating chin implant facial balance. Surgical commentary by Dr. Frank Agullo, MD, FACS.

She booked the consultation about her nose. Convinced, the way patients usually are, that the nose was the villain. So we pulled up her side profile, I laid my thumb over the nose, and she went quiet.

The nose was fine. It was the chin, sitting too far back, throwing off everything in front of it.

That moment happens far more than you would guess. Here is what I reach for when it does, and why I will argue the chin is the most underrated fix on the whole menu.

How to Tell If Your Chin Is the Real Problem

I read the profile from the side. What I want is a clean line dropping from the nose to the lips to the chin. Let the chin fall behind that line and the whole face tips out of balance. The nose looks bigger than it is. The neck looks heavier than it is. Neither one is the real problem.

Most of the time the patient is almost there, needing only a touch of projection. A quarter inch, maybe half an inch, and the profile clicks into place. Small change, outsized payoff.

Will It Make My Face Look Wider?

Only if you want it to.

I always ask the question up front. Narrow, or a little wider? The implant shape goes either way. The one I use is anatomical, meaning it is carved to follow your own bone instead of sitting on top of it like a block. Got a slight indentation on either side of the chin? The anatomical shape fills it. And if it does not fill it all the way, a touch of filler or a little fat down the road smooths the transition.

Why an Implant Instead of Filler

Filler has its place. For previewing a look, for a temporary lift, it does the job. But a real, lasting change to the profile calls for the implant, and I will say so plainly.

Mine is solid silicone. Permanent. Nothing to change out down the line, and it cannot rupture or leak the way people fret about. Need to refine the sides later? Fat is the more permanent touch-up there, though I do not rush to it. We let the swelling settle first, so we are working with what is actually there rather than guessing through the puffiness.

Question Filler Chin Implant
How long it lasts Months Permanent
Best use Preview, small refinement Lasting profile change
Predictability Varies with product Reliable, fixed shape
The procedure A few minutes, a needle About thirty minutes, tiny hidden incision

How Big a Deal Is the Surgery?

Small. The incision tucks right underneath the chin where nobody will spot it, and the whole thing runs about thirty minutes. Local anesthesia works fine if you feel you can sit through it. Prefer it to go quicker? We add a little IV sedation.

Recovery, honestly, reads a lot like a dental visit. Swollen for a while. Your smile might feel slightly off at first from some minor nerve irritation, and then it settles right back to normal. No long downtime on this one.

The Best Place to Use It: In Combination

This is where a chin implant earns its keep. Someone already addressing the neck or the jawline? Adding a small chin implant is easy, and it amplifies the whole result. You can read how I think about the jaw and neck together on the facelift side, and how the smaller in-office refinements fit in at the Med Spa.

A small chin implant beats a much bigger jaw surgery on recovery and still lands a balanced result. I would rather do the smaller thing well than overcorrect and chase it.

The Credential Behind the Restraint

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. The chin is a place where a millimeter or two changes everything, so the goal is balance, not a brand-new face. Done right, no one knows you had anything done. They just think your profile looks good.

Ready to Talk?

If your profile has always nagged at you and you cannot quite name why, your chin may be the answer.

For the patient-facing version of this read, 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.