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The Gynecomastia Quote Nobody Explains: Why $7,050 Is Just the Starting Line

Black and white editorial photograph of a man seen from behind, looking at his own reflection in a mirror, hand resting on his chest. Gynecomastia surgery cost commentary by Frank Agullo, MD, FACS.

Every gynecomastia forum has the same number floating around, usually quoted with more confidence than the person posting it has any right to. A flat price, no exam, no distinction between the patient who needs a few minutes of liposuction and the patient who needs an actual excision. I understand the appeal of a single number. I just can’t defend one in a consult room, and neither should anyone else who’s being honest about this operation.

Our own starting price is real and published: $7,050, all-inclusive of anesthesia, facility, testing, and garments, prescription medications excluded. I’ll defend that number. What I won’t defend is pretending it’s the final number for every chest that walks in.

Three Words That Get Collapsed Into One

Clinically, “gynecomastia” is doing the work of three different diagnoses. True glandular tissue is firm, fibrous, disc-shaped under the nipple. Pseudogynecomastia is fat with no gland involvement at all. Most chests I see are a blend. The word on the intake form is the same regardless. The operation is not, and neither is the price.

The Patient Nobody’s Price List Accounts For

Most of my gynecomastia patients could have had this corrected during puberty. Almost none of them did. What I actually see, over and over, is a patient who waits until he’s financially independent and can take care of it himself, sometimes a decade or more after the fullness first showed up, carrying real self-consciousness about it the entire time.

Anabolic steroids, testosterone replacement therapy, and a handful of medications can also trigger genuine glandular growth. Here’s the myth I correct on repeat, regardless of cause: weight loss shrinks the fatty component of an enlarged chest. It does not shrink the gland. The gland grows on its own signaling, independent of body weight, and assuming diet and exercise will eventually take care of it is simply wrong.

What Actually Moves the Number

The $7,050 starting fee covers gland removal, and it’s actually pretty rare that gland removal alone is the whole job. That’s mostly reserved for athletic patients with well-developed pectoral muscles and no real excess fat, just fullness behind the nipple. Everyone else needs more, and it’s worth naming the additions instead of burying them in a “final price may vary” disclaimer:

  • Liposuction of the breast with Renuvion J-Plasma, clearing the excess subcutaneous fat (often driven by the gland’s own signaling) and tightening the skin that goes loose afterward, the same way a balloon goes slack when you let the air out.
  • Liposuction of the lateral chest wall and axilla with Renuvion, because the fullness frequently extends past the central chest and blunts pectoral definition.
  • A donut lift, a circumareolar incision, for the more severe cases with real breast ptosis or a stretched areola that needs reducing.

Every one of those has a clinical reason to exist, not just a billing reason. An exact number only comes after an exam, and I say that plainly instead of hiding behind it.

The Scarless Claim, Examined Honestly

Patients read “scarless gynecomastia surgery” online and assume it’s marketing. Here’s the actual answer, not the marketing version. We no longer have to put a scar underneath the areola to remove the gland behind the nipple and areola. I use a method where a small incision is made inferior and lateral to the breast or chest. It’s about four millimeters long, and it’s used for the liposuction of the lateral chest and the breast area. Through that same incision, I insert an arthroscopic shaving device and shave down the gland, no large incision needed.

The reason an incision was ever necessary is that the breast gland is rubbery, more indurated than the soft fat around it, so a liposuction cannula cannot suction it out. The arthroscopic shaver is what lets me shave the gland down and remove it instead. With this technique there’s less risk of contour irregularities. After an old-style excisional gland surgery with a scar, a large divot behind the nipple and areolar complex was common. That’s avoided here, and I guard against it further by injecting fat into the area after gland removal. The exception is the patient with true ptosis or a badly stretched areola, who needs a donut lift, a real incision, just a well-hidden one.

Why I Publish a Fee I Know Will Climb

I’d like to think our practice distinguishes itself by providing excellent patient service, pre- and postoperative care, and the latest current techniques and innovations. Because of this, a lot of our fees run on the higher end. We publish them anyway, so patients know before a consultation what it may entail financially, and whether it works for them. That way we avoid surprises after a consultation, and we have better-educated patients. It’s the same philosophy behind everything we do on social media and the website: educate patients as much as possible, so by the time they come in for a consultation, they already know a lot about the procedure itself. The consultation becomes about determining the best technique for that patient specifically, what their expectations are, whether those expectations can be met, and whether there’s the kind of rapport between us that will carry us through the next six months to a year of recovery and results.

What the Waiting Actually Costs

The men who end up in my consult room have usually carried real weight over this, not financial weight, the other kind. Bullying. Years of swimming with a shirt on, or not swimming at all. Locker rooms avoided outright. I tell them plainly that it’s common, and that a lot of people have stood exactly where they’re standing. It’s also true, and worth saying, that longstanding gynecomastia tends to fibrose further with time. The wait doesn’t show up on an invoice, but it isn’t free either.

Why This Sits in a Surgical Practice, Not a Price Comparison Chart

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 I teach the anatomy this operation depends on. Castle Connolly has named me a Top Doctor for thirteen straight years. None of that is a gynecomastia-specific credential. It’s the reason I’d rather quote honest additions to a real number, and a real technique, than one flat figure I can’t stand behind.

Ready to Talk?

Skip the forum number. Come in, and I’ll tell you which of the three chests you actually have, and what an honest quote looks like for it.

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.

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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.

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.
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Sepsis Lives in the Trends: The Boring Signs Are the Ones That Kill

Black and white photograph of a bedside monitor and a clipboard chart in a quiet hospital room. Commentary on postoperative infection by Dr. Frank Agullo, MD, FACS.

What are the earliest signs of infection after surgery? This question was posed to me for the Malpractice Monitor series at MDLinx. My response became the sentence that anchors their article. The boring, early warning signs, the ones easily rationalized and dismissed by medical providers, are the most critical ones to catch.

Here I expand slightly on that quote. The sentence is easily understood and difficult to practice, and its simplicity belies its gravity.

I do not know the facts of the malpractice case or the individuals involved. What I do know is a pattern, one that plays out in hospitals around the country, even at leading institutions.

Every Sign You Can Name Is a Late One

Ask a room full of seasoned clinicians to name the recognizable signs of sepsis and the list is exhaustive. Low blood pressure. Narrowing pulse pressure. Cold, clammy skin. Elevated lactate. An abnormal white cell count. High creatinine.

These are all legitimate. They are also all indicative of a patient who is already ill.

By that point, the window for the easiest intervention has slammed shut. A simple recheck, a phone call, one perfectly timed consultation will not turn the clock back. You are playing catch-up against a destabilizing physiology that moves faster than a hurried clinician.

The early warning signs are subtler. A pulse that sat at 78 yesterday reads 96 in the morning and 108 by evening. A temperature that rises slightly above the patient’s average but is not officially a fever. Urine output that declines inexplicably. Breathing that picks up a little. A patient who is slightly disoriented, a little sluggish, just not himself. After abdominal surgery, pain that increases without resolving, plus new bloating, nausea, or no passage of gas.

Individually, none of these would raise much of an alarm. Taken together and moving consistently in the same direction, they are the whole warning.

That is what I gave MDLinx, and it is what I would emblazon on the ward board of every surgical unit in the country.

The most egregious failure is dismissing a vital sign as a single isolated value rather than reading it as one point on a moving line. Heart rate of 104? Just a number. Heart rate of 82 turning to 91, then 98, then 104 across four sets of vitals? That is a story, and it tells a clear direction.

Our focus narrows to the current number because the current number is the only thing the chart makes easy. The chart is great at providing a value and terrible at providing trajectory. The nurse sees the elevated heart rate. A resident looks. A covering physician looks. One at a time, each person reasonably concludes that 104 is acceptable.

Each of them, individually, is not technically wrong. All of them together are demonstrably wrong.

Fragmented Care Kills the Curve

The problem is not intent or a lack of caring. It is a broken process.

Care is fragmented. At the next shift rotation, the nurse who saw the patient looking sickly at midnight is replaced by the nurse present for rounds at eight in the morning. The surgeon who operated is not always the one rounding afterward. The handoff, which is the critical moment to transfer a patient’s trajectory, often degenerates into a list of tasks.

Handoffs are where the trend dies. “Vitals stable overnight” can be factually accurate and clinically ruinous. Stable from what level? Stable compared with when?

There is no complicated or flashy fix for this. Call the direction out loud. Say instead: “Her heart rate has climbed thirty points since yesterday evening and her urine output is down.” That handoff communicates the trend. The extra five seconds are the price of knowing a patient instead of a chart.

Why I Take This Personally

I completed my general surgery residency at Texas Tech University Health Sciences Center and my plastic surgery fellowship at the Mayo Clinic, and I am board certified in both general surgery and plastic surgery. I trained and worked on wards where perforation, peritonitis, and postoperative sepsis are not abstractions.

The drama of sepsis arrives abruptly in some patients and subtly in others.

It is the subtle ones I still think about.

People assume aesthetic surgeons exist in a pleasant vacuum, far removed from all this. Not true. Infection after an elective operation is rare, and rarity, if anything, makes people less vigilant rather than more. When you expect a clean result every time, your mind subconsciously learns to rationalize the one odd finding. She is tachycardic because she is nervous. He feels warm because the room is too hot. Her pain is up because she missed a dose.

Each of those explanations is usually right. That is exactly what makes them dangerous.

What I Do In My Own Practice

I follow my patients closely and early, and I do not hand them to autopilot. A form gives me a value. A patient standing in front of me gives me a trajectory, and the trajectory is what I need.

My patients can call the office directly and they can text. Send me ten messages that turn out to be nothing so that I do not miss the one that was something. That is not customer service. It is clinical care. The patient is the only person present for every single data point, which makes their trend line the most complete one in the building.

So do not ask “is the pain bad.” Ask “is the pain worse than yesterday.” Do not ask “do you have a fever.” Ask “is your temperature climbing.” I care very little about the number on any given day. I care where it is going.

What a Patient or Family Member Should Escalate On

If someone you love is recovering from surgery, at home or in a hospital bed, be loud about these:

  • Pain that is steadily worsening, or spreading instead of staying focal
  • A heart rate that keeps climbing, even when any single reading looks acceptable
  • A fever, or a temperature whose trend line is heading the wrong way
  • Confusion, abnormal drowsiness, or simply not acting like themselves
  • Passing far less urine than they should
  • Breathing faster or more labored than expected
  • After abdominal surgery, bloating, nausea, vomiting, or an inability to pass gas

You are not trying to be right. Your burden is to be loud.

Use the word trend. Ask what the numbers were last night. Put the direction in front of the team, not just the value. A spouse who says “she has gotten worse every day for three days” has handed over the one piece of information nobody in the institution managed to preserve.

That is not impolite. In the right moment, it is the only actionable thing anyone says all day.

The Point

No one misses sepsis because nobody knows what sepsis looks like. It gets missed because each of the early signs looks uneventful on first pass, each one can be explained away, and the points land on the shoulders of four different people who will only ever know their own piece.

Read the curve. #StayBeautiful.

For the patient-facing version of this post, see the companion on agulloplasticsurgery.com. For the way we follow up with postoperative patients in the practice, see the version on swplasticsurgery.com.

Ready to Talk?

Planning surgery and want the follow-up routine explained to you in detail? Ask. Any surgeon worth choosing will give you an exact answer.

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

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

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A Surgeon’s Read on the Katie Miller Before and After: The Lower Face Did the Talking

Black and white editorial comparison of two portraits side by side. Before-and-after read by Dr. Frank Agullo, MD, FACS.

A national outlet asked me for a technical read on Katie Miller’s transformation, and I agreed with my colleague that the lower half of the face was where the change was. Here is the longer, candid version. It is an educational read from photographs, not a diagnosis. I have not treated her, and a photo is not a consultation.

The Before

In her earlier pictures, we can see that Katie has pretty full cheeks and fullness in the lower face, making her face very rounded, giving her a tired appearance. There’s also a lack of definition of the jawline.

The After

I think a combination of things has occurred since then. She does look younger and more refreshed. Her face is more triangulated, and her jawline is more defined.

What Could Explain It

I think she’s had a combination of botulinum toxin around the forehead, the glabella, and crow’s feet. I think she’s had some weight loss, probably aided by GLP-1, but the lower face change is rather significant.

I think this would only be achievable either with liposuction, with the aid of something like FaceTite for skin tightening and Morpheus8, both of which are radiofrequency treatments, and removal of the buccal fat pad. If she truly has had weight loss, she may be keeping the upper cheek fullness with fillers or biostimulators like Sculptra. Or if she actually had the liposuction and buccal fat removal, she may have had some fat injections to the cheek and zygomatic area. I think it would be a little bit too far-fetched to think that she’s had a lower face lift, although it’s not out of the question.

Why “She Had X” Is the Wrong Read

This is what I want colleagues and readers to take from it. From a photograph, the honest read is a hedged read. The lower-face change here could be a real procedure, a real GLP-1 weight loss, or a combination, and telling those apart from press photos is hard. The technical read is fair game. The flat “she had a buccal fat removal” headline is not, because the same look can be produced more than one way.

Why the Lower Face Did the Talking

The lower third integrates almost everything that happens above it. Volume that drops, skin that loosens, and weight that comes off all collect along the jawline and the lower cheek. So when a face moves from rounded and tired to triangulated and defined, the lower third is where I look first, because that is where the story almost always is. That is exactly why my colleague and I both landed on the lower half of the face.

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, Editorial Board Member at Aesthetic Plastic Surgery, and Castle Connolly Top Doctor for thirteen consecutive years.

Ready to Talk?

If your own before-and-after is what is on your mind, the read on your face is the place to start.

For the patient-facing version of this read, see the companion post on agulloplasticsurgery.com. For the lower-face 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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Reading the Ambassador Face: A Candid Surgeon’s Breakdown of Layered Aesthetic Work

Black and white editorial comparison of two portraits side by side. Aesthetic analysis commentary by Dr. Frank Agullo, MD, FACS.

Reading a face from photos is one of the more interesting things I do, and influencers make it easier. So much of their work gets documented, especially when they are a brand ambassador for a med spa and probably get a lot of their care in exchange for the publicity. Let me read one of these faces candidly, the way I would talk it through with a colleague. This is an educational read, not a diagnosis. I have not treated her, and a photo is not a consultation.

What We Can Be Fairly Sure About

We know for a fact that she’s had neurotoxin to the upper face, which includes the forehead, crow’s feet, and glabella, in hopes of making her eyes more open. She’s had Sculptra to the temples to fill in her temporal recession, hollowness, or temporal wasting. She’s also had Renuva to the temples, also for volume. This is a fat graft. It’s a donor fat graft that is processed, and it encourages ingrowth of fat in that area.

She also had hyaluronic acid filler in the lips, which it seems she did not like and then had dissolved, even though I still see some hints of more volume than she previously had. There is some filler still there that wasn’t completely removed. She had a Botox lip flip. She’s also had PDGF for the under eyes, which is platelet-derived growth factor, which encourages collagen ingrowth. She’s had various lasers and radiofrequency, including Tixel, a thermal resurfacing device, Moxi, a resurfacing laser, and Agnes RF, which is very similar to Morpheus8.

The Weight Loss Is Doing a Lot of the Work

Judging by her earlier photos and her photos now, she’s definitely lost too much weight. I’m not sure if she’s been using a GLP-1, but this has caused her to lose a lot of the good fat in the face, which is the reason she had to fix the temporal wasting. You can notice in the current pictures that she has a lot less lower cheek fat and a lot more angulated jawline. This could all be from weight loss.

Now she has a lot more anterior malar volume, so she may have had some Sculptra and Renuva in the upper cheek area. I’m sure she maintains the skin also with broadband light, like BBL. And I think she’s probably had neurotoxin also to the masseters and lower face, which you can see from her slimmer jawline. She probably has good skin quality maintenance with medical-grade topicals, so tretinoin, vitamin C, but this has never been disclosed.

Why the “She Had X” Take Is Usually Wrong

When you read a face like this, the honest answer is never one thing. It stacks many small treatments over years, plus a real weight change, plus maybe one well-chosen surgical step. The internet wants “she had a facelift” or “she had buccal fat removal.” The truth is messier, and from a photograph you can only ever offer a careful, hedged read.

The One Thing That Hints at Surgery

Now, what calls my attention the most, and I’m not sure she’s had any surgical work, and she is rather young, under forty, is that her brow position is significantly different from her earlier days. It’s pulled up and laterally, which actually opens her eyes. Although a certain degree of this can be achieved with botulinum toxin, the degree she’s showing looks more pronounced. She may have had an endoscopic brow lift, the ponytail type, which can help with brow shaping, and it’s very effective and looks very natural.

Other than that, I don’t see any other signs of actual surgical work. You can see that her nose is unchanged. Although she may have had a rhinoplasty in her early life, you can see that it is off the midline and could actually use improvements. It does look unchanged from her previous photos to now.

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, Editorial Board Member at Aesthetic Plastic Surgery, and Castle Connolly Top Doctor for thirteen consecutive years. The technical read is fair game. The flat “she had X” diagnosis is not.

Ready to Talk?

If there is a look you are chasing, the real question is which of these layers applies to your face, and in what order.

For the patient-facing treatment-by-treatment guide, see the companion post on agulloplasticsurgery.com. For the treatment menu behind this kind of work, 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 Patient Has Changed: What Looksmaxxing Really Wants From My Consult Room

Black and white editorial photo of a young man in a modern aesthetic consultation setting. Commentary by Dr. Frank Agullo, MD, FACS.

This past April, a twenty-year-old viral streamer named Clavicular collapsed at a Miami mall, sparking discussions across the entire industry for weeks. He represents the public face of the looksmaxxing movement, an online community dedicated to maximizing male attractiveness through any means necessary. His fall from grace suddenly shone a harsh light on the trend my practice has watched approaching.

MedEsthetics contacted me to feature a piece written by Joshua Eferighe about the phenomenon, and my truthful version will now serve as an expansion here.

The statement I keep returning to is this. The patient has changed.

Five Years Ago Versus Now

Five years ago, men visited my clinic with the desire to look less tired. Their only request was simple. Remove the fatigue from their eyes, soften the two frown lines etched between their brows, and prevent them from looking exhausted in photos.

Today they present themselves to my clinic with specific requests about their canthal tilt, their gonial angle, and the eye shape they refer to as the “hunter eye.” They have internalized the lingo, have their ideal reference photos saved on their phones, are typically in their early twenties, and have spent hours on looksmaxxing forums before ever making contact with my staff.

This marks a dramatic shift from the initial consultation framework that guided plastic surgery from its inception.

What the Requests Look Like

One intriguing aspect is that looksmaxxing requests tend to occur in clusters rather than in isolation. When a young man enters my office with such a clearly defined concept in his mind, his list of desired modifications rarely deviates from that of other patients.

Chin augmentation and jaw implants are common, often coupled with genioplasty to bring the chin forward or downward, buccal fat removal to slim the cheeks, a narrowed rhinoplasty, and a lateral canthoplasty to achieve the aforementioned “hunter eye.” Hair restoration is often part of the package too.

The language used is precise and the references are entirely photo-based. These patients are not reticent about their desires. They can articulate every angle, a level of specificity that is genuinely new to my experience.

Where I Think It Comes From

Aesthetic medicine did not originate the idea of looksmaxxing. I do acknowledge, though, that we played a role in laying the groundwork. We established injectables as a norm in the 1990s, endured the subsequent explosion of filler popularity, and ultimately witnessed how filters and social media turned the results of these procedures into an objective checklist.

Online communities embraced these clinical guidelines, stripped out the medical context, and reframed them as optimization objectives. A canthal tilt is an anatomical feature with specific medical implications. It transforms into something entirely different when it is reinterpreted as a metric to be assessed and compared against other men in a comment section.

The Part That Matters: Reading Motivation

This is where my profession fundamentally changed, and it is not the surgical aspect that was transformed.

I now devote more time to understanding a patient’s motivation than to the requested modification itself. There is a significant distinction between a man seeking to subtly blend his nose into the rest of his face and a man who aspires to become the transformed individual he encountered in a viral before-and-after post. The former is a good candidate. The latter is not, at least not at present.

When the desired outcome continues to evolve because it is tethered to an online ideal, the responsible approach is to slow down the planning process. I prioritize the reversible and less invasive steps first, and I am willing to refuse certain requests. Not every desire warrants a scalpel, and the most beneficial outcome is occasionally a recalibration of expectations rather than an irreversible procedure.

This is not about being overly precious. Body image distress is a real and significant issue, and screening for it is an integral part of responsible patient care today, a concept that was far less prominent a decade ago.

The Credential Behind the Opinion

I hold double board certification from the American Board of Plastic Surgery and the American Board of Surgery, am a Fellow of the American College of Surgeons, and completed a plastic surgery fellowship at the Mayo Clinic. I am currently a Clinical Associate Professor of Plastic Surgery at the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, serve on the Editorial Board for Aesthetic Plastic Surgery, and am now a member of the Editorial Board for PRS Global Open. Castle Connolly has recognized me as a Top Doctor for thirteen consecutive years.

I perform a considerable volume of male aesthetic procedures. I have also increased the rate at which I say no, and I believe that is the critical point of this whole discussion.

Ready to Talk?

If you are a man considering this type of procedure, the crucial question is not which angle you should chase. It is whether the intended change aligns with your facial features and your life, or whether it is simply a pursuit of someone else’s photograph.

For the patient-facing perspective on this, see the companion post on agulloplasticsurgery.com. For the treatment menu behind male aesthetics, 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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Red Light Therapy: Why the Wound-Healing Science Is the Reason to Take It Seriously

Black and white editorial portrait of a face lit by a soft directional light. Red light therapy commentary by Dr. Frank Agullo, MD, FACS.

Patients ask me whether red light therapy is real or just a nice glow. The reason the wound healing research gives us confidence in red light for skin rejuvenation is that the mechanism for wound healing is the same as for skin rejuvenation.

The Mechanism Is Pretty Well Established

The mechanism for LED red light therapy is pretty well established. That’s the mechanism of action on the wound healing side. The light at red and near-infrared wavelengths is absorbed by the mitochondria of the cells. This raises ATP, or energy production, and drives the proliferation of specific cells active in wound healing, like fibroblasts and keratinocytes. It increases collagen synthesis and local blood flow. This has been described in peer-reviewed publications.

And the same mechanism of action is activated in aesthetic applications. So when I use it on skin, I am not hoping for a vague glow. I am running the same cellular cascade that closes a wound.

What the Studies Show

There are randomized controlled trials showing reduction in the wrinkles around the eyes up to thirty percent. There’s also a controlled trial that showed increased intradermal collagen density, which in turn reduces the appearance of fine lines and wrinkles in the skin. And there have been other multicenter randomized studies that have shown measurable crow’s feet improvement.

Where I Put It in the Hierarchy

I am not going to pretend red light replaces a facelift or resurfacing. As an adjunct, though, it earns its place. After surgery it supports the healing the body is already doing. For skin, it supports collagen, and it stacks well with microneedling.

The Catch Nobody in the Gadget Aisle Mentions

Now, it’s important to know that results do vary by wavelength, dose, and device, and many home consumer units are weaker than the devices used in clinical trials. I personally use Elixir MD, which is an FDA-cleared LED device, which builds credibility for plastic surgeons to cut post-surgical downtime. This device uses a spectrum of wavelengths: red for mitochondrial stimulation and blood flow, infrared for deeper tissue repair, blue to reduce bacterial load, and yellow for cellular repair.

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. I never write a confident claim that is not grounded in peer-reviewed evidence or my own practice experience, and red light clears that bar.

Ready to Talk?

If you want red light to do real work, the device and the dose matter as much as the idea.

For the patient-facing guide, see the companion post on agulloplasticsurgery.com. For the LED program 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.

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Patients Used to Come in Ready to Book. Now They Come in to Plan.

Black and white editorial still of a printed surgical quote and a calendar on a desk in soft side light. Aesthetic planning commentary by Dr. Frank Agullo, MD, FACS.

Before, patients used to come in ready to book and asking for the next available date, using credit for the payments or financing. That has definitely changed over the last five years. Now I see patients in their early twenties and thirties who come in for a consultation without any intention of booking, but rather to learn about the procedure, the recovery times, and the cost of the surgery, so that they can start saving up for it.

It is one of the more interesting behavior shifts I have watched across the desk, and I think it is worth writing down.

What the New Patient Looks Like

I see it in patients in their forties and fifties who are thinking about a facelift or facial rejuvenation procedure in three to five years. I also see the patients who just want to avoid credit debt, so they bypass financing or paying with their credit cards. Although they may have an earlier timeline for their procedure, maybe within a year, they prefer to save once they learn the cost and pay it off before surgery. Or some of them actually start making payments directly here at the clinic, without any interest, before they have their procedure.

It is surprising that a lot of patients are coming in this way.

Why the Planning Makes Sense

The planning actually makes sense, because aesthetic treatments fall into two buckets. The first bucket is the treatments that are performed routinely, like botulinum toxin every four months, fillers every year or every two years, facials every one or two months, and skin tightening procedures once or twice a year. These are expenses that patients have already learned and can foresee. The other bucket is the surgical procedures, which obviously have a larger sticker price, and they do require financial planning, whether it’s done beforehand or by budgeting for payments afterwards.

The Part I Find Most Encouraging

What I do see is that the patients who are planning ahead are actually making better decisions and choices, rather than looking for the latest bargain or deal. They’re looking for the most qualified surgeons for their procedures. They’re looking for board-certified plastic surgeons. They’re doing their research. And although many times these providers are on the more expensive side, they’re planning for that expense and that quality.

Patients who haven’t planned for these financial expenses tend, a lot of times, to look for the least expensive option, which sometimes is a non-board-certified provider, or they choose to travel abroad. And these are the patients who usually run into trouble or complications. That is the part that matters. The planning behavior is not just financially smart. It correlates with better, safer choices.

The GLP-1 Driver

This trend has become more evident with the GLP-1s, like Ozempic, or semaglutide-like treatments. These patients see a quick weight loss, which a lot of times transforms into accelerated aging and changes in their body contour. And as they’re seeing this, they’re starting to plan ahead toward when they will achieve their weight loss goal.

While they’re getting some treatments to slow the changes and restore some of the lost volume, they are planning toward more long-lasting and effective solutions like facelifts, breast lifts or augmentations, tummy tucks, buttock lifts, or even Brazilian butt lifts. And these patients really stem from twenty-year-olds to patients in their sixties and seventies. There is not one age-specific sector in the GLP-1 population.

Why This Is Good for the Field

A patient who plans is a patient who shops on quality instead of price. That is good for them and good for the field. The bargain hunt is where the complications come from, and a planning culture pushes patients toward board certification, real research, and a sequence that makes sense, rather than the cheapest available date. The routine maintenance treatments hold the line while the patient saves for the surgical step that actually solves the concern.

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. I would rather a patient plan for two years and choose well than book tomorrow and choose badly.

Ready to Talk?

If you are planning rather than booking, that is exactly the right instinct. Come learn the procedure, the recovery, and the real cost.

For the patient-facing version with the two buckets in detail, see the companion post on agulloplasticsurgery.com. For the practice’s planning and financing resources, 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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Tired Eyes, Honestly: Eyelid Surgery, Eye Bags, and the Under-Eye Filler I Keep Dissolving

Black and white close study of a woman's eyes in soft light, rested and open. Eyelid surgery commentary by Dr. Frank Agullo, MD, FACS.

The eyes are where people notice age first. They are also where the smallest, best-hidden procedures in my whole practice live.

Patients point at the same things. Heavy upper lids. Puffy lower bags. Hollows that read as exhaustion no matter how much they sleep. And, very often, old under-eye filler that simply never went away.

Here is how I talk about the eyes, candidly.

“Heavy, Uneven Upper Lids. Is That a Muscle Problem?”

Usually not. A true lazy eye is a muscle issue, but in most cases both lids line up the same distance from the pupil, which tells me the problem is the fold and the weight of extra skin, not the muscle.

The fix for the upper lid is surprisingly minor. I remove the fold of skin, and the scar sits inside the new crease. When you open your eyes, you do not see it.

“Will Surgery Change the Shape of My Eye?”

No, and this is the worry I hear most. I am only removing the fold. In most cases I do not extend out to the side, I finish right at the crease, and that is what avoids the pulled, changed look. Your crease is already drawn by your own anatomy, so I follow it. The goal is more symmetric, not different. Faces are always a little different side to side, so I make it better, not identical.

What Eye Bags Actually Are

Lower eyelid surgery removes the fat bag. If you keep your face still and roll your eyes up, you will watch the bags pop out more. Those are what come out.

I do it through an incision on the inside of the lid, so there is no scar on the outside and no external stitches. I add a little fat to blend the transition, and I often pair it with Morpheus to tighten the skin.

Hollows Are a Volume Problem, Not a Bag Problem

If the issue is hollowness rather than bags, I add volume with your own fat. The face has essentially no pain, and fat grafting under the eyes is very safe. I do it routinely, on facelifts and on younger faces that simply have less tissue.

It looks a little full at first, because you absorb about thirty to forty percent of grafted fat, so I slightly overfill. As it settles, it looks completely natural, because it is your own tissue.

My Strong Opinion on Under-Eye Filler

I am cautious about filler in that area, and I have seen what it does. Filler under the eyes can hold water and stay puffy for years, and it tends to migrate rather than fully dissolve.

Fat is the safer, more natural way to address true hollowing. If you already have problem filler there, dissolving it is often the first step before we do anything else.

Eyes, At a Glance

What You See What It Usually Is What I Do
Heavy upper lid Fold and extra skin Remove the fold, scar hidden in the crease
Puffy lower bag Fat bag Remove from the inside, no external scar
Hollow, tired shadow Volume loss Fat grafting, slightly overfilled
Puffy for years Old migrated filler Dissolve first, then reassess

“Will I Have Stitches Across My Lid? Will It Scar?”

Not visible ones. On the upper lid I place the sutures under the skin, so they do not leave the track marks you see in some photos. You might have two or three small ones that fall out on their own. On the lower lid, done from the inside, there are no external stitches at all.

As for keloids, on the eyelids and face they are almost unheard of. Keloids happen on the ears, shoulders, sternum, and joints. On the eyelids, I have never seen one.

What Recovery Is Really Like

The procedure takes under two hours. You are back to normal in three or four days, with some swelling and bruising. If you bruise, it can take up to two weeks, but usually after a week you can cover it with a little makeup. Exercise at four weeks.

To soften any old scars elsewhere, microneedling with PDGF, a growth factor stronger than PRP, works well over a few sessions at the Med Spa. ElixirMD LED therapy can speed the early healing.

Who I Think Should Have It, and Who Should Not

I am as quick to talk a patient out of eyelid surgery as into it. The right candidate can point to one specific thing, heavy upper lids, a lower bag, a tired shadow, rather than asking me to remake the eye. This is refinement, and patients who want transformation are usually asking the wrong procedure for the wrong reason.

The harder conversation is the patient whose tired look is really coming from the cheek dropping or the brow descending. In that face, an eyelid surgery alone chases the symptom. Sometimes the honest answer is a little fat, a brow that needs addressing, or a facelift, and I would rather say that than hand someone a procedure that will not fix what bothers them. Healthy non-smokers heal cleanest, and I am direct about that too.

Why I Work This Way

I am a double board-certified plastic surgeon with a plastic surgery fellowship at the Mayo Clinic, and I teach as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Eyelid work rewards restraint. The goal is for you to look rested, not operated on, and that comes from removing exactly what needs to go and hiding every incision.

See the Patient-Facing Versions

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

Ready to Talk?

If people keep asking why you look tired, your eyes may be the answer. Come in and let me take a look.

Call the office at (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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Traditional Chinese Medicine and Hair Loss: What the Evidence Actually Supports, and What to Be Careful With

Black and white editorial still of dried botanical herbs beside a mortar in soft side light. Traditional Chinese medicine and hair loss, by Dr. Frank Agullo, MD, FACS.

He shou wu. People take it for their hair, and most of them have no idea it is one of the most reported causes of herbal liver injury in the world.

I get a lot of questions about Chinese medicine for hair. I never dismiss it out of hand, because some of it actually has studies behind it. But the he shou wu story is why I always say the same thing first. All natural does not mean automatically safe. So here is my plain version, the parts that work and the parts to watch.

Before grading any remedy, I want to be precise about what we are even treating. Normal shedding is fifty to a hundred hairs a day. True hair loss is more than that. The hair that grows back comes in thinner, with worse texture and worse density. We call that miniaturization. Here is the part that matters most. A shrunken follicle can still be revived with growth factors, medications, or therapies. A lost follicle cannot be brought back. So any herb that claims to help has to be judged against that line.

So What Is Traditional Chinese Medicine, Really?

It is a compounding of various treatments and diagnostic principles developed in China. Like a lot of Eastern medicine, it treats the body as one connected system and cares a lot about balance across that whole network. Herbs, acupuncture, diet, massage. On hair specifically, the thinking ties hair health to blood circulation and the kidneys. Hair is something you can see, so when it declines, they read that as the person’s vitality declining.

The Herb to Be Careful With

Polygonum multiflorum is a plant used in Chinese medicine to support the health and growth of hair. It can even counteract hair whitening. It acts on three mechanisms at the same time: DHT damage inhibition, cellular protection, and circulatory improvement of the scalp.

Here is the candid part. Most of the studies have been in vitro, which means in the lab, and in animals, and there hasn’t really been a strict comparison against Western medical treatments. There have been some cases of liver damage using this herb. Worldwide, it is one of the most reported causes of herbal liver injury. The risk is higher when using the raw root rather than the processed version. The reaction is really unpredictable. And since this is a dietary supplement, it’s not regulated by the FDA in the same way that traditional medication is.

That is exactly the kind of thing patients need to hear before they order a supplement off the internet because it is natural.

The Ones the Evidence Treats More Kindly

Ginseng is among the most well-known and most extensively researched traditional Chinese medicine herbs. It promotes scalp blood circulation, and the existing research shows promise and encouraging results.

Angelica sinensis was traditionally known as a blood tonic. It is an herb they believe moves blood, or prevents stagnation. Some of the published studies include laboratory research showing anti-inflammatory properties and improved circulatory blood flow.

Scalp acupuncture is the one that interests me most as a surgeon. If we think about it, it almost behaves like microneedling, which we’ve shown scientifically to improve hair growth. It improves the microcirculation of blood flow to the hair follicles.

Scalp massage is perhaps the simplest recommendation, and it has been scientifically proven to work. It improves circulation, which seems to be a recurring theme here, and studies have shown it can increase hair thickness and the number of hairs.

The Recurring Theme

Notice the pattern across the items that hold up. Ginseng, acupuncture, massage, and even the microneedling we do in clinic all improve the same thing, which is scalp circulation. It seems to be a recurring theme, and it is probably why the modern regenerative tools and the older traditions sometimes land in the same place.

The Two Things to Take Away

Well, I think the most important thing to know is that a remedy being all natural does not mean that it is automatically safe. There are dangers, like we spoke about previously with Polygonum multiflorum. And second, the most important thing is to visit a physician for consultation as soon as hair loss begins. This is the time when therapies can be initiated and actually help, and it’s also helpful to rule out any reversible causes.

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, member of the International Society of Hair Restoration Surgery, and Castle Connolly Top Doctor for thirteen consecutive years. I am happy to talk about the traditions seriously, and just as happy to tell you which herb has a liver-injury problem.

Ready to Talk?

If you want a read on what is worth trying and what is worth avoiding for your hair, that is a consultation.

For the patient-facing guide to the hair cycle and the five most common causes, see the companion post on agulloplasticsurgery.com. For the scalp-health and hair-restoration program 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.