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Reading the Reddit Threads About My Own Practice

Black and white photograph of a packed carry-on bag and a folded compression garment on a hotel bed. Commentary by Frank Agullo, MD, FACS.

There is a subreddit where people who have had tummy tucks post their twelve-day photos, their twelve-week photos, and exactly what they paid. Some of those posts are about my practice. I did not ask for them and I cannot edit them.

The number that travels is $17,600, all in, for an abdominoplasty with liposuction 360, a hernia repair, oblique plication, mons work, and a new belly button. I was asked whether it is accurate.

“This article is talking about a certain patient’s experience, so that figure would be correct for her and for her particular combination of procedures.

“As of this writing, our published range for a tummy tuck is $16,000 to $26,000, depending on the combination. For the most updated figures, readers should go to agulloplasticsurgery.com/fees, which is the page we keep updated.”

A hernia repair is not a line item everybody needs. Neither is oblique plication.

What I like about the thread it appeared in is that nobody let it sit there. “That’s extremely expensive just for a tummy tuck,” came the reply from u/Yelenablanka1987 in Who in the US can give me results like this?. “Respectfully for Texas too.”

The patient answered: “A coworker of mine went more local last year, only paid 6k and unfortunately her results are not pleasing. I wasn’t going to let that happen. You get what you pay for.”

I am not going to referee that. It is my fee they are arguing about, which disqualifies me. I will say the argument itself is the right one, and I would rather a prospective patient read those two strangers going back and forth than scroll my before-and-afters.

She also flagged something I should have said louder myself: “He usually does BBLs with his TTs, so if that’s not want you want, make sure you tell him. Most of his patients do. When I got my quote, it included the BBL, so had to ask for a new quote without it.” Her first number was $25,000 with a BBL in it. Ask for a quote for your operation, not the popular one.

What my quoted fee covers: the surgeon’s fee, the operating room, anesthesia, garments, and the pre-op and post-op supplements, which means SinEcch for bruising and swelling, Skinuva scar cream, a moisturizer, and Exparel for long-acting pain control. Every lymphatic drainage massage and every post-op visit is included. The patient pays for prescriptions at the pharmacy and nothing else.

I told Yahoo Finance something this year about patients flying overseas that applies to anyone driving in from Phoenix. Two quotes are often not measuring the same service. One covers the operation. The other covers the operation, the facility, the anesthesia and the follow-up.

On travel, in his words: “So for this one, we need you seven days minimum. Some people stay two weeks, but seven days is the usual.” And: “You can fly after seven days, that’s not a problem.” Day seven is when the sutures come out; the drain usually comes out on day fourteen, so a patient flying at a week often travels with it still in. Two weeks to easy activity, six weeks to unrestricted exercise, and lymphatic drainage “two or three per week for four weeks.”

I was asked whether the threads got anything wrong that I wanted corrected.

“I don’t think so. This is all a patient’s opinion.”

Those posts are unsolicited. They are not testimonials, I did not commission them and I cannot edit them. What I have quoted is excerpted and linked back to the original threads, disagreements included. Read them, then check the fees page for the current number rather than a post from last spring.

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

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The Destination Nose: Why My Rhinoplasty Patients Fly In

Greyscale editorial photograph for a destination rhinoplasty essay by Frank Agullo, MD, FACS.

In most such visits, the patients begin by apologizing for the commute. “I am sorry that it is far away,” they begin from their homes on screens in Seattle, Toronto, or, on one occasion I still recall, Dubai.

This is what I tell them: the nose does not care what city it is in. Eighty percent of my patients come from out of town now. Texas and New Mexico send the most, then New York, California, Florida, and Seattle, a whole contingent from Canada, and international patients from as far away as Japan.

Your travel time is nowhere near the barrier to be, but there are specific factors you will need to assess before committing to travel for your surgery. Let us be clear: honesty wins out.

What Travel Does Not Change

When you look, every checklist you see is the exact same. Board-certified plastic surgeon, either in general plastics or facial plastics, that specializes in rhinoplasty (this is key; they do them over and over, unlike a plastic surgeon that rarely works on noses). Make sure it is an accredited surgery center. You want to look for a long string of before-and-after photos of noses just like yours and to see happy patients whose problems look just like your potential problem. If you can talk to any former patients, then you will really get good information.

I published the full checklist, plus how our process works step by step, in the complete Texas rhinoplasty guide on the practice site.

What Travel Actually Changes

Logistics. Solely logistics. The patient will consult from her country. 3D simulation of the case will be completed entirely in my virtual office. By the time she boards an airplane, we have worked through the Surgical Plan piece by piece and agreed on the plan. Pixel by pixel.

From there, your personal coordinator handles the remaining details, such as arranging your hotel, surgery booking, nurse visit after your surgery, post-op appointments and virtual check-ins after you return to your home country. My patients are actually scheduling their rhinoplasty similar to scheduling their vacation with one mandatory and the most crucial meeting in the middle.

And the framing’s not inaccurate. It would take about a week, no matter where you went, to recover at home after a rhinoplasty. And again, this comes down to bias on my end, if I were going to hide out for a week, West Texas sun and Texas cuisine sound as good a place to do it as any.

The Simulation Is the Contract

Here is the part of my process I would defend to any colleague: nobody gets on a plane until the simulation is settled.

My patient and I edit using VECTRA 3D and Crisalix, determining their goals, what they find undesirable, and what is realistic for their particular body type. By the time we agree on a plan, we are entirely in accord and the image will then be utilized over the coming year as our visual guideline through the healing process.

This is even more important in ethnic rhinoplasty, which is 30 to 40 percent of what I do. Some patients prefer a more Western profile; others just want a refined version of their own nose.

The simulation forces that conversation to happen before surgery, where it belongs. And the image bypasses language differences entirely, which matters in a bilingual border practice where my patients move between Spanish and English.

The Year After

Distance is irrelevant; it generally takes one full year for rhinoplasty to heal. The residual swelling will dissipate and the nasal tip will relax as the healing process reaches its final stage, which takes one year to become apparent.

That should be a check on the vetting list. You will have spent more hours on your surgeon than on virtually anyone else over the year; pick someone you are willing to see more than one more time. Do not pick someone whom you barely tolerated in one single visit.

It really is not too hard; I wrote the rough range prices I had down on paper in there: real-deal prices for plastic surgery and what makes them so.

Ready to Talk?

The consultation is virtual. The simulation is virtual. The only thing that has to travel is you, once.

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.

“Rhinoplasty in Texas: Why Patients Cross the State (and the Border) for a Nose” can be found on agulloplasticsurgery.com. Southwest Plastic Surgery also offers an out-of-town program, which will be linked here once it goes live.