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After the Shelf: What a BBL Reversal Actually Involves

Black and white photo of Dr. Frank Agullo in black scrubs making pre-operative markings on a BBL reversal patient's hip in an exam room. BBL reversal editorial by Dr. Frank Agullo, MD, FACS.

A patient called me from the East Coast for a virtual consultation. Years ago I had done her BBL myself, a supercharged one, implants plus fat. Since then she had babies, started her family, and moved somewhere more conservative. She wanted her body back, or at least a quieter version of it. More discreet. More athletic.

She is not an outlier. She is a wave.

I wrote earlier this year about how beauty standards keep moving, and the buttock is where that pendulum is swinging hardest right now. So let me explain what a BBL reversal actually is, because it is more interesting, and more surgical, than the headlines suggest.

Why They Come Back

The most important reason is time. A BBL is a procedure where liposuction is done in the trunk, including the upper back, lower back, lateral chest, abdomen, and sometimes the thighs and arms, and that fat is transferred to the buttock. Once liposuction is done in those areas, they do not increase in volume as much when the patient gains weight. The buttock becomes the one area that increases the most.

So a patient gains weight years later, and the proportions run away from her. The buttock is no longer proportionate, or has developed cellulite or even droopiness. Some patients develop a double butt crease deformity, which patients themselves call elephant butt or frog butt. Their words, not mine, and they are not wrong about the shape.

Another portion of patients have not gained anything. They just want a more natural, less aggressive body contour. And a certain percentage were never happy in the first place: exaggerated hips, too much projection, a lower back scooped too aggressively, a buttock that doesn’t transition well into the thighs.

The Reversal Toolkit

Reversal surgery can involve a combination of a lot of procedures, and the plan is assembled per patient.

Tool What it does
Liposuction Reduces buttock volume and recontours
Renuvion J-Plasma Radiofrequency with helium plasma for skin contraction
Morpheus8, stacked on top Microneedling with radiofrequency, more contraction
Buttock lift, lateral thigh lift Removes loose skin and lifts when volume loss is significant
Miami thong lift Corrects the double butt crease deformity
Implant removal For the supercharged BBLs of the 2010s

The honest caveat: when we perform liposuction, the skin often becomes looser, and the buttock can droop more. Renuvion and Morpheus8 help create skin contraction, but the amount of contraction is hard to predict, as each patient reacts differently to these technologies. If we’re removing a significant amount of fat, then oftentimes a buttock lift, and even a lateral thigh lift, is necessary. Skin quality work continues afterward with microneedling when needed.

I prefer to do the surgery all at once, which gives the best results. The exception is the patient trying to avoid scars, who declines the lifts in hopes that the energy devices create enough contracture. Those patients know that at three or six months, if they develop buttock ptosis or loose skin, the lift conversation returns.

Can You Get Your Old Body Back?

We can get patients to their pre-BBL body, although most patients don’t really want to go that far back. They’re looking for a result in between: tighter contours, tighter skin, sometimes a more athletic look. That target gets set at consultation, along with an honest answer about whether it is achievable given which procedures they are willing to undergo.

How the East Coast Case Went

Her plan: buttock implant removal, liposuction of the lateral thighs, saddlebags, and buttock, a buttock lift with a lateral thigh lift, and a Miami thong lift to correct the double crease and create a sweeping curve where the lower buttock meets the thigh.

Four and a half hours under general anesthesia. Hotel the same day. My nurse saw her the next morning with IV fluids, helped with her first shower, got her into her garments. Lymphatic massages every other day. Drains out on day seven, and she flew home. No complications, and at four months she is mostly healed and very pleased with the new contour. Most of my reversal patients fly in exactly like this; the majority had their original surgery out of town or in another country, usually more than five years ago. This kind of travel case is routine in my body contouring practice.

Recovery in general runs about a week to get back to normal activity and driving, and about four weeks to return to the gym, running, and jumping. The risks specific to reversal are asymmetries, development of cellulite, and buttock ptosis if a lift is not performed at the same time.

No, the BBL Era Is Not Over

The BBL era is far from over. Patients’ desires have shifted, but it really depends on their culture and each person’s definition of beauty. I still perform minimal BBLs, or skinny BBLs. I also still perform some exaggerated ones.

The tendency is toward a reduced size: maybe only the hip dips and a little projection, more of an upside-down heart shape than a shelf, some reduction in hip width. And still, plenty of patients want a very small waist with larger hips.

My tool for keeping everyone honest: photographs. The buttock is a hard anatomical place to describe with words, so I have patients bring pictures of what they want to the consultation, and again on the day of surgery, so that we’re both on the same page.

I served as founding vice president of the World Association of Gluteal Surgeons. I have watched this pendulum from the front row, in both directions. The surgeons who did the shelf era well are the ones patients now trust to quiet it down.

Ready to Talk?

If your BBL no longer fits your life, there is a surgical path back, and it can usually be planned from a virtual consultation. Call (915) 590-7900, text 1-866-814-0038, or book online. #StayBeautiful

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

Companion reads: the clinical reversal guide on agulloplasticsurgery.com, and the destination-patient overview at swplasticsurgery.com.

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Lie Down, Now Stand Up: Why Your Tummy Tuck Did Not Hold, and the Revision That Will

Black and white editorial photo of a tummy tuck revision patient standing in profile before a gold antique mirror, hands framing her waist. Tummy tuck revision editorial by Dr. Frank Agullo, MD, FACS.

“From your photos, it seems that you still have abdominal wall laxity, and when you lay down, this looks like it’s corrected. It also seems like you still have some excess subcutaneous fat between the skin and the muscle.”

That is me, on a virtual consultation last week, reading two photos a patient sent through my tummy tuck revision page. She had her tummy tuck a few years ago in another city. Standing, the abdomen still pushes forward. Lying down, flat.

She asked me if her first surgery failed. Not exactly. It stopped short.

The Part Nobody Repaired

Here is what I told her next, word for word:

“I see patients like you routinely, where the diastasis was repaired, that’s just the separation between the rectus muscles. But during pregnancy, or when patients gain weight and then lose it, the fascia is stretched throughout the abdomen, not just between the rectus muscles.”

The first surgeon fixed the midline. The stretch was everywhere. That is the whole story of most revision consultations, and it is why the bulge survives a technically successful operation.

She had also been working her core for two years on a trainer’s advice. “Performing core exercises will strengthen the muscle, but will not tighten the fascia.” I have written about that trap before, the sit up lie. Revision patients are its most frustrated victims, because they already did everything right once.

The Retightening

“That’s why I often recommend performing a triple plication, where I plicate from the sternum to the pubis, bringing together the fascia of the rectus, and I also plicate the obliques to the lateral edge of the rectus. This is called a triple plication, which in essence creates an internal corset, or waist trainer.”

Regular readers know my analogy for the triple plication. If you look at any waist trainer at any store, you’ll see that there are multiple seams in the waist trainer. Essentially, most surgeons are just making a waist trainer with one seam, versus using multiple seams, in this case three, to bring in the waistline.

In a revision, those two extra seams retighten the fascia the first operation never touched, laterally over the obliques, and they add something the patient did not have even on her best day after the first surgery: a waistline.

The triple plication is something I have published on. I can’t take the credit for inventing it, as it is something the Brazilian plastic surgeons described many years ago. But somehow, a lot of plastic surgeons did not implement it into their procedures. I’ve been performing it for more than seventeen years, which is exactly how long revision patients have been finding their way to my office after one-seam operations.

The Fat, the Skin, the Scar

Remember the second finding in her photos, the excess subcutaneous fat between the skin and the muscle. The wall repair alone does not fix that. All my tummy tucks include liposuction, especially of the anterior abdomen, waistline, and lower back, and I often combine it with Renuvion J-Plasma for skin tightening. A scar that healed wide or rides too high gets revised in the same operation.

So the revision is really three corrections in one: retighten the wall, remove the residual fat, and improve the scar.

Recovery, Second Time Around

Patients brace for a worse recovery than the first surgery. Then I tell them my numbers. I use Exparel injected into what we call a TAP block, which numbs the area for three days, and I’m happy to say that fifty percent of my patients experience no pain whatsoever. Most patients recover in two weeks to get back to normal activity, and six weeks for exercise, running, jumping, and heavy lifting.

Patients do feel a tighter abdomen after surgery. This time it stays tight standing up, which is the entire point.

The Two-Photo Test

Standing, then lying down. If the bulge disappears when you lie flat, the wall is the likely problem, and a wall problem has a surgical answer. If it does not disappear, the answer may be liposuction, or skin, or something else, and I will tell you which.

I trained at the Mayo Clinic and I teach plastic surgery at Texas Tech. Revisions are where that training earns its keep, because the first operation already spent the easy options.

Ready to Talk?

If your tummy tuck left you flatter lying down than standing up, send me the photos. Call (915) 590-7900, text 1-866-814-0038, or book online. #StayBeautiful

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

Companion reads: the clinical revision guide on agulloplasticsurgery.com, and the practice overview at swplasticsurgery.com.

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The Rhinoplasty Price Nobody Explains: What $15,000 Actually Buys You

Black and white editorial side-profile silhouette emphasizing the nose line, illustrating rhinoplasty cost commentary by Frank Agullo, MD, FACS.

Rhinoplasty has a reputation as one of the more expensive procedures I perform, starting at $15,000 in my practice, and revision starts at $18,000. I’ll give you the honest version of what that number includes, why it varies so much from surgeon to surgeon, and why I think searching for the cheapest rhinoplasty surgeon is the wrong way to go about it.

What the Price Actually Includes

The published price on my web page, on the fees page, includes everything you need to undergo a rhinoplasty. This is the surgeon’s fee, the anesthesia fee, and the operating room fee. It includes the vitamins you’ll take preoperatively and after surgery, as well as supplements like Arnica and Bromelain for bruising and swelling. I give you ice packs and everything you need to recover, as well as your follow-up appointments. The only thing you’ll be responsible for is picking up your prescription medications at the pharmacy.

Why the Price Varies So Much From Surgeon to Surgeon

There are several things that increase the cost of a rhinoplasty with certain surgeons. Location affects the price, due to overhead and the fees related to anesthesia and the operating room, which are more expensive in certain cities. When you seek a board-certified plastic surgeon, they often charge more than a non-board-certified physician, because of their experience and additional training. Other factors include how much demand a surgeon has for rhinoplasties, the expertise and consistent before-and-after results, and patient testimonials and satisfaction.

Sometimes you’ll see too-good-to-be-true prices, and they usually are. When this happens, surgeons usually cut down on surgical time, or rush through the procedure to decrease the cost of anesthesia and the operating room. Also, surgeons who aren’t as experienced, or want to get more experience with rhinoplasty, may charge less to attract new patients.

What Actually Changes the Cost

Factor How it moves the price
Primary rhinoplasty, standard Baseline, $15,000+
Open technique with significant tip work Longer procedure, more controlled contours, cost rises with time
Weir incision (ala width reduction) Adds time, increases cost somewhat
Revision rhinoplasty $18,000+, grafts often needed from other parts of the body or a donor graft, much longer surgery
Rhinoplasty plus chin implant $18,000+

Most primary rhinoplasties are standard. If there’s significant tip work, I usually recommend an open rhinoplasty for the best results, and more controlled, longer-lasting contours. But cost is really determined by how long the procedure takes and the number of maneuvers and techniques needed, including grafting. Most rhinoplasties are done in two to two and a half hours. When a patient also wants to reduce the width of the ala, a Weir incision, the time runs a little longer, and that increases the cost somewhat. What increases the cost the most is revision rhinoplasty, where grafts need to be taken from other parts of the body, or using a donor graft. These surgeries run much longer, and multiple revisions make them exponentially longer.

Insurance, Deviated Septum, and the Cosmetic Portion

I have a holistic approach to rhinoplasty. I don’t take insurance myself, but I still take care of the problem. If I encounter a deviated septum, or diagnose it before surgery, I take care of that at the same time as the rhinoplasty itself, which is usually cosmetic in nature. If a septoplasty or turbinate resection is necessary and a patient wants to run that portion through insurance, the insurance will require the procedure be done at a Medicare-certified surgery center or hospital. Some surgeons do it this way, but the patient still gets charged for the cosmetic portion in terms of OR time and anesthesia, and that ends up much higher than if the entire procedure is performed at the surgeon’s own cosmetic surgery center.

Why I Think It’s Worth the Investment

Rhinoplasty is a very technically demanding procedure, and it requires vast experience and great communication with the patient, to find out what the patient is truly looking for. I find 3D imaging systems help communicate better, so patients can visualize the changes that are technically feasible, and that makes certain the surgeon and the patient are on the same page. A rhinoplasty also isn’t something that can be easily hidden after surgery. It’s in the middle of your face. Everybody else is going to be looking at it, and you’re going to be looking at it in the mirror every day. It’s important to get it right, and it’s really important to get it right the first time, because that’s the best chance at the best result.

I do a lot of revision surgeries, and I can say a revision will never get it as good as the first time around. Revisions are far more expensive than an initial rhinoplasty. That’s why I think cost-cutting, or searching for the cheapest rhinoplasty surgeon, isn’t the right way to go about it.

Smart Questions Beyond “How Much”

The most important things to look at are the surgeon’s reviews, the number of reviews, their before-and-after photos, the number of before-and-after photos, the consistency in results, and whether the surgeon is using an accredited facility. Make sure you’ll have proper follow-up and access to the clinic twenty-four hours a day after surgery. Make sure your surgeon is board-certified. And make sure you have good rapport with the surgeon during the consultation, since you’ll be seeing them for a while, rhinoplasties take about a year for their final outcome.

Financing

Making a rhinoplasty affordable is something I take seriously, so my practice offers several financing options, including PatientFi, AlphaEon, Cherry, and CareCredit. Beyond those, I also offer direct financing through the practice itself, where a patient can make payments toward their surgery ahead of time, scheduling the procedure around a timeline that works for them. Patients are always welcome to use a credit card, pay in cash, or finance through their own bank.

What About Non-Surgical Filler Rhinoplasty?

Non-surgical rhinoplasty, the liquid filler option, costs significantly less than surgery, usually around fifteen hundred dollars, and it’s done without anesthesia or an operating room. It’s a temporary fix, and what you’re really doing is creating an optical illusion by adding volume to the nose, so you’re making it bigger. If your goal is to make your nose smaller, this isn’t the right treatment. But if you have a small hump, it can be hidden by adding filler above the hump, below the hump, and to the tip.

Filler doesn’t really go away, it migrates. I see a tendency in some patients where the bridge of the nose, or even the tip, starts getting wider over time as the filler dissipates. If you’re seriously considering a rhinoplasty down the road, you’ll likely need the filler dissolved first with Hylenex, a hyaluronidase that dissolves fillers. You shouldn’t have any other materials injected into the nose, since they’re not dissolvable and can interfere with future treatments.

Hidden Costs and My Revision Policy

The idea behind a primary rhinoplasty is to get it all done correctly the first time. There’s a chance that after surgery there are things a surgeon can’t control, like how an individual scars, how fast swelling resolves, and whether the cartilage’s memory wants to return to its previous shape or deviation. So sometimes revisions are necessary. I always give it at least a year before jumping to any revision, to allow all the swelling to go down. If a revision is requested and I believe the result can be improved, I won’t charge any surgeon’s fees. The patient is only responsible for the operating room and anesthesia.

About Dr. Frank Agullo

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

Ready to Talk?

Bring the real questions, not just the number. I’ll walk you through exactly what goes into your quote.

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: “What Rhinoplasty Actually Costs in El Paso” (link once live)
  • Practice version on swplasticsurgery.com: “Southwest Plastic Surgery on Rhinoplasty Pricing” (link once live)
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The Breast Augmentation Quote Nobody Explains: Why $7,000 Is Just the Starting Line

Black and white editorial photograph of a confident woman in a bikini, viewed from behind, looking at her own reflection in a mirror. Breast augmentation cost commentary by Frank Agullo, MD, FACS.

Breast augmentation is the most searched procedure I perform, and the price is the first thing anyone looks for. Fair enough. I publish mine. Starting at $7,000 for saline, $8,000 for silicone, $8,500 to $9,000 for a gummy bear implant. What I won’t do is pretend that starting number is the only number, because it isn’t, and any surgeon who tells you otherwise before an exam is guessing.

Here’s what I’d want to know if I were the one asking.

What the Starting Price Actually Includes

Our published price is real, and it’s genuinely inclusive. It covers the surgery center, the operating room, anesthesia, and an anesthesiologist. It covers my fee. It covers a pair of implants. It covers the post-surgical bra, scar treatments, moisturizer, and vitamins. It covers your pre-op workup and every post-op visit. The only thing it doesn’t cover is your prescription medications, which you pick up at the pharmacy like anyone else.

That’s a longer list than most patients expect, and it’s exactly why I publish it. Better-educated patients walk into a consultation already knowing what they’re buying instead of getting surprised by it afterward.

Why the Number Moves From One Surgeon to the Next

Location changes the number. Overhead is higher in some markets than others, for the surgeon and for the surgery center both. What the anesthesia team charges changes it. What a surgeon can negotiate on implants, antibiotics, and supplies changes it. Experience changes it too. Surgeons in high demand are usually the ones who deliver consistent results safely, and that reputation carries a cost.

When a price looks too good to be true, it usually is. Somewhere, a corner is getting cut. I use a Keller funnel for a no-touch technique when I insert implants, which drives up cost but lowers infection risk. I use Exparel to create a chest block, injecting long-lasting anesthesia between the ribs, which keeps patients more comfortable after surgery. I schedule enough OR time to work at a paced, careful speed instead of rushing to save on anesthesia minutes. Patients get direct access to our nursing staff twenty-four hours a day. Every case happens in an accredited surgical center built for real emergencies, not just routine ones. None of that is free, and none of it should be.

Saline, Silicone, or Gummy Bear: The Implant Sets the Floor

Implant type Where it lands Why
Saline Least expensive Simplest implant, adjustable fill volume
Silicone Mid-range More natural feel, higher material cost
Gummy bear Highest of the standard options Cohesive gel, lowest rupture profile
Mentor enhanced oversized (800cc+) Highest overall Premium sizing tier, priced accordingly

I recommend the gummy bear category, and Motiva specifically, more than any other option. Motiva carries the lowest capsular contracture rate and the lowest rupture rate of any implant I place, with one of the strongest warranties in the industry, one that can even cover surgical costs if a complication like contracture or rupture happens down the road, or if a patient simply changes her mind.

What Actually Pushes a Quote Higher

A revision that needs more OR time and a more involved technique costs more than a straightforward first surgery. A donut lift or a full lift added to the augmentation costs more. Mesh support, GalaFLEX or DuraSorb functioning as an internal bra, adds cost. A premium implant, especially the Mentor enhanced oversized line, costs more than a standard Motiva or Mentor silicone implant. A longer anticipated surgery time costs more. A transaxillary approach, through the armpit, takes longer than an inframammary or periareolar incision and prices accordingly.

Past that list, there really isn’t a hidden fee. We offer package discounts when a patient combines procedures, but nothing is required. If a case runs long or hits a complication, the patient still pays what was quoted. That’s the deal.

What I Tell a Patient Who Feels Priced Out

Think long-term. You’re paying for reduced complications, a better result, and a surgeon who’s board-certified specifically in plastic surgery rather than someone practicing outside their training. Cheaper packages skip the parts that actually protect you: the better warranty, the internal mesh bra, Exparel, triple antibiotic irrigation, a no-touch technique. Financing exists for a reason. We work with PatientFi, AlphaEon, Cherry, and CareCredit, plus a direct payment plan through the practice itself, paid at your own pace before surgery.

Eighty percent of our patients travel from other cities to have this done here. Not because it’s cheaper. It usually isn’t. They come for the reviews, the before-and-afters we post almost daily, and the fact that so many of our patients come back for something else once they’ve experienced the practice firsthand.

Consultation, 3D Imaging, and Insurance

There’s a separate consultation fee to see me, in person or virtually, and it’s applied toward your procedure if you move forward. That consultation includes 3D imaging with Crisalix, where you can see different implant sizes and brands on your own body before committing to anything, plus time with real sizers in the room. It also lets us catch volume asymmetry between breasts early, and flag whether a lift should happen at the same time.

I no longer take insurance, since I perform these as cosmetic procedures. Reconstruction after breast cancer or for congenital asymmetry is a different category, and I’ll refer you to a colleague who handles that. Some patients with a medical reason still choose to see me on a cash-pay basis, for the results and the experience, and that’s their call to make.

Why This Sits in a Surgical Practice, Not a Price 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. Castle Connolly has named me a Top Doctor for thirteen straight years. Breast augmentation, including the preservation technique with Motiva Preserve, is one of the procedures I do most. That’s the reason I’d rather explain a real number honestly than quote a flat one I can’t stand behind.

Ready to Talk?

Skip the forum number. Come in, and I’ll tell you what actually goes into your quote, implant by implant.

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: “What Breast Augmentation Actually Costs in El Paso (And Why the Number Moves)” (link once live)
  • Practice version on swplasticsurgery.com: “What Breast Augmentation Costs at Southwest Plastic Surgery” (link once live)
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Sunscreen, Not Syringes: What Actually Slows Hand Aging

Black and white editorial close-up of a hand with a dropper of serum, illustrating hand skincare prevention commentary by Frank Agullo, MD, FACS.

Last month, a producer over at GB News got in touch and posed a simple question: What is one change you would recommend to keep your hands from aging?

Sunscreen. And the talking did not stop, for the obvious reason that you do not fix 100 percent of life in a $15 tube of moisturizer. I wanted them to remember how completely ridiculous it was.

Here’s what I actually tell patients, in the order I tell them.

Why Your Hands Age Faster Than Your Face

I spend most of a facelift consultation talking about fat pads, retaining ligaments and skin quality on the face. Nearly no patient will ask me the same question about their hands even though it is exactly the same biology occurring on their hands, only more quickly.

Back of your hand skin is much thinner than the skin on your face anyway; the fat pad on it is smaller and thinner, thinning out faster over time. Over a lifetime your hands get a good amount more sun exposure than your face will get because NOBODY remembers sunscreen while they are at a car steering wheel, pulling a shopping cart, working on a computer laptop, etc.

Brown spots and thin, crinkled texture on the backs of hands often show up years before similar changes on patients’ faces. This phenomenon is a normal aging process rather than a disease and occurs because years of unprotected sun damage take their toll on the delicate, less pliant skin of the hands.

The Habit That Actually Works

Sun protection is the single most important habit, and I stand by that answer. Most of the brown spots and crepey texture I see on the backs of hands trace back to sun exposure, not age by itself.

The fix is boring and that’s exactly why it works. Broad-spectrum SPF 30 or higher, every morning, on the backs of both hands. Reapply after you wash your hands, because soap and water strip it off faster than most people expect. That’s it. No serum, no device, no appointment required.

The Four-Step Routine I Give Patients

Sunscreen buys you prevention. It doesn’t rebuild what’s already thinning or fade a spot that’s already there. So I layer three more habits on top of it.

Step What to do Why
1. Protect Broad-spectrum SPF 30+ every morning, reapplied after washing hands Prevents most new brown spots and crepey texture; the single highest-leverage habit
2. Repair the barrier A thick cream with ceramides, glycerin, and hyaluronic acid after every hand wash Rebuilds the moisture barrier that soap and sun both damage
3. Build collagen A retinoid two or three nights a week Stimulates collagen production, smooths texture, softens the crepey look over time
4. Fade what’s there Vitamin C and niacinamide topicals Gradually fades existing age spots and helps prevent new ones from forming

Be upfront with the timing as I do not want to give a false impression with a claim. Both retinoid and vitamin C need to be applied 2-3x weekly and titrated upwards as tolerated, and no patient of mine has really seen significant changes from these before 8-12 weeks. That is not marketing hyperbole; that is an educated estimate on observed effects using either/both of those ingredients on the face; hand skin works on pretty much the same biological timescale as skin on your face.

What the Sunscreen Evidence Actually Shows

I get skepticism about sunscreen more than almost anything else in my practice, usually some version of “does it really matter that much?” It does, and hands are actually the cleanest proof I have.

Cumulative UV exposure breaks down collagen and triggers the pigment changes that show up as brown spots. Hands take that exposure in a way faces mostly don’t anymore, because most of my patients already wear a facial sunscreen or a moisturizer with SPF built in and have for years. Almost nobody extends that same habit past the wrist. The result is a natural experiment running on every patient who drives, gardens, or works outdoors: protected face, unprotected hands, and a visible gap in aging between the two by the time they’re in their forties or fifties.

Sunscreen applied every single day is the main contributor to collagen decline. No other part of a regimen, be it ceramides, retinol or vitamin C, will be as effective without it; the latter two work as helpers to the skin’s underlying support system. It is of no use to treat the problem if the problem source remains unchecked.

When Home Care Isn’t Enough

A consistent routine can preempt many of those future problems, as well as improving skin that has begun showing such changes. Of course, it has limits.

Deeper pigment, more established crepey texture, and visible tendons and veins from real volume loss are not things a cream alone will reliably clear. That’s when I bring in-office tools into the conversation: laser resurfacing and IPL for spots and skin quality that creams can’t touch, chemical peels for texture, and microneedling for texture that’s further along, the same in-office menu the Med Spa and Laser team runs. If the issue is actual lost volume rather than skin quality, that’s a different conversation entirely, and I’ve written about it separately, because filler and biostimulators solve a different problem than sunscreen and retinoids do.

Why I Think About Hands Like a Face

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. Castle Connolly has named me a Top Doctor for thirteen straight years running.

Yet, the above points do not make me a dermatologist by trade. My process for the hands is just the same as my approach to the face: 1) assess what is truly the underlying cause (UV damage/texture changes, compromised moisture barrier, loss of hyaluronic acid/collagen, fat loss). 2) Once that is defined, reach for the correct skincare or tool to address that specific concern. Basically, do what you do with your face for your hands.

One More Thing About Filler

A variety of fillers and biostimulators can be considered for hands; these are both regularly utilized in my practice. However, I will caution that neither is a substitute for an effective skincare routine.

A patient who’s been sun-damaging their hands for thirty years and shows up asking for filler still needs the sunscreen, the barrier repair, and the retinoid, whether or not they add volume on top. Filler restores what’s missing underneath the skin. It doesn’t fix the skin quality sitting on top of it. Skip the routine and you’re paying to maintain a result the sun is actively working against.

Why Choose Dr. Agullo for Hand Skincare in El Paso

Patients come to me from across Texas and beyond, and roughly sixty percent of my current patients travel in from outside El Paso. I think about hand aging the way I think about facial aging: as a structural problem with a preventable component and a treatable component, not as a single product decision.

Ready to Talk?

A hand-skincare consult is short. I check the skin, the barrier, the pigment, and tell you honestly whether a routine will do the job or whether you need something more.

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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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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You Cannot Unstretch an Ear: What Gauge Repair Actually Rebuilds

Black and white editorial still life of a black ear gauge plug retired beside fine surgical sutures on a linen surface. Ear gauge repair editorial by Dr. Frank Agullo, MD, FACS.

Half the gauge repair consultations in my office start with a job application on somebody’s phone.

Most of the people who show up for an ear gauge reversal or earlobe repair do so because they’re joining the workforce. Jobs like the military, police, and border patrol require the earlobes to not be gauged. This is usually due to the risk of the earlobes getting caught or torn. I practice in El Paso. Border Patrol hires a few miles from my office. You can guess how often I see this.

A lot of patients are also joining professional jobs and have decided to clean up their look, so they appear more appropriate for their job position. It is rare, but sometimes it is in preparation for weddings or other special events. Grandma has opinions.

Whatever the reason, they almost all arrive with the same wrong assumption. They think I am going to close the hole.

We Do Not Close Gauges. We Rebuild Earlobes.

Here is the part nobody explains at the piercing shop. We really don’t close your gauges. What we do is reconstruct the earlobe with the skin and fatty tissue that’s left after stretching out the gauge.

Essentially, any size gauge can be reconstructed, even if it has been torn. The bigger the gauge, the more the remaining tissue has been thinned and draped into a hanging loop, and the more sculpting it takes to turn that loop back into something that reads as an earlobe.

This is also why gauge repair is different from an earlobe tear repair, which is usually just trimming the edges and bringing the tissues together. With a gauge, we usually discard some of the tissue, and we actually have to reshape the skin into an earlobe. One is a seam. The other is a rebuild.

There is not one standard technique. The repair is planned for each individual case, depending on how much tissue is left, how much skin, and the quality of the skin and tissues. I have never drawn the same plan twice.

The Timeline, From Chair to Uniform

Milestone When
The procedure About 30 minutes, local anesthesia
External sutures out 7 to 10 days
Eligible to join military or law enforcement As early as 7 to 10 days after suture removal
Back to exercise About 2 weeks
Re-piercing possible 4 to 6 weeks
Hard to tell the ear was ever gauged About 3 months

That third row matters most to my recruits. For military and law enforcement applicants, it is usually a requirement that the ears are not gauged, for safety reasons. We treat these patients very often, and they can join the forces as early as seven to ten days after we remove the sutures. If you have a ship date, tell me at the consultation and we will work backward from it.

Yes, You Can Wear Earrings Again

You can re-pierce your ears after a gauge repair. We usually wait at least four to six weeks, and we can do it in the office. We just need an earring stud that we can keep in place for at least a month, and we sterilize it before placing it so the new piercing heals.

A normal stud, through a normal lobe, that you put there on purpose. Full circle.

What It Costs and How It Heals

The cost range usually starts at fifteen hundred dollars, and it depends on how much the ear has been gauged, how much tissue is left, and the complexity of the reconstruction. Like my earlobe tear repair and in-office excisions, this is cash based with one upfront quote, and a photo is usually enough to price it.

It heals very well. Usually, after three months, it would be difficult for anybody to tell that the patient had a gauged ear before. The scars are very difficult to identify or see. If skin texture needs a final polish, laser treatments can refine it, but most patients never need that.

The Part Where I Am Blunt

I don’t think a lot of surgeons in other specialties actually know how to repair gauged ears. It’s really something that plastic surgeons have been trained for, as we take care of a lot of ear deformities and trauma. Congenital ear differences, torn lobes, cancer reconstructions, keloids. The earlobe is small, but it sits next to your face in every conversation you will ever have.

So for a procedure like this, I would look for a board-certified plastic surgeon. I trained at the Mayo Clinic and I teach plastic surgery at Texas Tech. I can tell a closed hole from a rebuilt earlobe across a room. Everyone else can too.

Ready to Talk?

If a gauged ear is in the way of a job or a uniform, send me a photo and we will quote it, usually the same week. Call my office at (915) 590-7900, text the consult line at 1-866-814-0038, or book online. Sutures out in a week. Uniform shortly after. #StayBeautiful

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

Companion reads: the clinical walk-through on agulloplasticsurgery.com, and the practice overview at swplasticsurgery.com.

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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.

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

Ready to Talk?

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

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

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

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

Black and white editorial close-up of a single pearl drop earring resting beside fine suture material on a linen surface. Earlobe repair editorial by Dr. Frank Agullo, MD, FACS.

A bride-to-be sat in my office earlier this year with a problem no one warns you about. She had lost about fifty pounds with Ozempic in a four-month period, and noticed that her earrings didn’t sit the same way anymore. Her earlobe had become empty and wrinkly.

She was young. In her thirties. The weight loss was a win. Her ears did not get the memo.

Nobody thinks about earlobes until theirs stop cooperating, and then they think about them constantly. Wedding photos have a way of accelerating that timeline.

The Earlobe Has a Rough Job

The most common cause of earlobe tears, or elongated piercings that haven’t torn quite yet, is the chronic use of heavy earrings. It’s a gradual stretching that happens over time.

And as we age, we also lose some of the fat and collagen in the earlobes, which decreases the tissue strength, and the stretching or tearing can speed up. Then there is trauma: the earring getting stuck on something and pulling, or a baby pulling on the earring. Every mother of a grabby infant knows exactly the moment I am describing.

The GLP-1 era added a new chapter. Aging earlobes have actually increased in demand, not just because of aging, but also because of the GLP-1s like Ozempic and tirzepatide. Patients lose the good fat in the earlobes, and these become deflated or elongated. Everyone talks about Ozempic face. The earlobes deflate right along with the cheeks.

The Repair Is Simpler Than You Think

The repair itself is rather simple. The first step is to do it in a sterile fashion, so we sterilize the area to decrease the risk of any infection. Then we use local anesthesia, which is infiltrated into the earlobe. This is the part that can sting a little bit, but it’s very quick. After that, the whole area is anesthetized, and you don’t feel anything.

Depending on how big the tear or stretch is, we cut out that area, and then we suture it in a layered fashion, approximating the deep tissue coming all the way up to the superficial skin layer. The procedure usually takes fifteen to thirty minutes. And to keep the ear natural, we rearrange the tissues so there’s no puckering or indentations. That last sentence is where the plastic surgery training earns its keep. Anyone can close a tear. The art is a lobe that looks like nothing ever happened, the same philosophy I bring to my in-office excisions.

A partial tear versus a complete split changes less than people expect. The approach is about the same. The only thing that’s affected is the length of the incision, and whether it goes all the way to the edge or can be repaired within the tear itself.

And a fact that surprises patients: not all tears happen on the earlobe. They can happen anywhere there is a piercing, including the belly button, genitalia, nose, and the helical rim of the ear. We repair those too.

Refilling the Deflated Lobe

For the empty, wrinkly earlobe, we can do various things that involve filling the earlobe back.

Option What it is How long it lasts
Hyaluronic acid filler (Juvederm, Restylane) Injectable gel, done in minutes Temporary, repeat about every year
Lipoderma Donor fat injected into the lobe Longer lasting, what I used for the bride
Your own fat Harvested and injected Long lasting, requires a small harvest
Trim and tuck Surgical reduction of redundant skin Permanent reshaping for elongated lobes

For the bride, we used Lipoderma, one syringe on each earlobe. That filled in the void of the earlobes, plumped the skin, and actually reduced the size of her piercings, so that the earrings were now sitting like they used to. The whole procedure took about thirty minutes or less. She went back to work the next day, and back to the gym in five days. She was very happy overall, and I suspect the wedding photographer never knew.

Maintenance for filler options lives at the med spa at Southwest Plastic Surgery, alongside the laser treatments we use when skin quality needs help too.

Re-Piercing: Yes, You Can

The question every patient asks before I finish the first sentence: when can I wear earrings again?

To re-pierce, we usually wait three to six weeks depending on the area. For ears, it’s usually three weeks, and we can re-pierce right here in the office. We sterilize the earring or stud that you’re going to use, which will need to remain in place for about a month before it can be taken out. Then wear what you want. Maybe rotate the chandelier earrings to special occasions this time.

What It Costs

The cost range usually starts around a thousand dollars, and the final cost depends on the type of anesthesia, the location, and the size of the defect. Like the rest of my minor procedure practice, this is cash based with a single upfront quote, no insurance and no preauthorization. A photo by email is usually enough to quote it.

I trained at the Mayo Clinic and have spent two decades repairing tissue far more complicated than an earlobe. This is one of the smallest operations I do, and one of the most quietly satisfying. Patients hide torn ears behind their hair for years. Fifteen to thirty minutes later, they stop.

Ready to Talk?

If your earlobes are torn, stretched, or deflated, send a photo and we can usually quote the fix without a visit. Call (915) 590-7900, text 1-866-814-0038, or book online. #StayBeautiful

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

Companion reads: the clinical step-by-step on agulloplasticsurgery.com, and the practice overview with med spa options at swplasticsurgery.com.

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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.