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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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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.