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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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The Vial in the Vanity: A Plastic Surgeon’s Honest Read on the GLP-1 Glow-Up

Three vials of compounded semaglutide, tirzepatide, and retatrutide on a vanity, greyscale editorial image, GLP-1 weight loss program at Southwest Plastic Surgery overseen by Frank Agullo, MD, FACS, double board-certified plastic surgeon in El Paso, Texas

A patient came in last week and put her phone on my desk. Photo of her vanity drawer. Serum she couldn’t pronounce. Her mother’s old YSL lipstick. A small fridge pouch with a vial of compounded semaglutide. Which of the three, she asked me, was actually doing the work.

Keep all three. Probably not for the reasons she thought.

This kind of question hits my office a lot now. Several times a week. Eighteen months ago it was once a month. And the women asking aren’t the ones with a hundred pounds to lose. They eat clean. They do Pilates. They’re stuck on the last fifteen before a wedding, a fiftieth, or a surgery date already on my books. Ozempic. Mounjaro. Now, more and more, the third one. The one their trainer keeps name-dropping. Retatrutide.

So let me answer the way I’d answer across the desk, without the marketing copy.

Three vials, three generations

The brand names dominate the popular conversation. The compounds underneath are not the same drug.

Semaglutide is the one everyone started with. Single receptor. Mimics GLP-1, the gut hormone for satiety. Translation: walks into your brain and tells you you’re not hungry, and means it. Trial data puts loss around fifteen percent of body weight by twelve months. Life-changing for plenty of people. On some faces, it also produces the hollow look the wellness columns have been calling Ozempic face. I’ll get to that.

Tirzepatide added a second receptor. GLP-1 plus GIP, an insulinotropic peptide. What the GIP receptor does, on the data we have, is two things. It spares a bit more lean mass. And it pushes loss past where sema usually stalls. Twenty percent at twelve months is where good responders are landing in the trials. In my program, tirz is where I move someone after sema plateaus and the scale stops moving.

Retatrutide is the newest. Three receptors. GLP-1, GIP, and glucagon. Early-phase data is striking. Patients pushing toward twenty-five percent loss at a year, which is a number that didn’t exist in this category two years ago. We offer it as a compounded formulation. Not casually. The patients we put on it are screened with a level of caution that the popular coverage hasn’t, frankly, been encouraging.

Compound Receptors Typical loss at 12 months Where it fits in our program
Semaglutide GLP-1 ~15% Default for most patients
Tirzepatide GLP-1 / GIP ~20% Plateaued patients, or larger loss goals
Retatrutide GLP-1 / GIP / glucagon ~25% Specific candidates, closely supervised

These are not interchangeable shots. Choosing among them is a clinical call. Not a pricing decision.

The face the internet noticed

So about that hollow look.

Weight comes off the face first. Cheeks lose volume. Temples sink. The jawline appears, but the skin that draped over a fuller face is now draping over nothing. People call it Ozempic face. A surgeon calls it volume loss layered on top of skin laxity that the weight had been hiding.

Not a reason to skip a GLP-1. A reason not to take one in a vacuum.

The fix, when needed, is the kind of thing I do every week. Filler done by someone who actually does faces. A deep plane facelift if the laxity is real. A skin program in any case. What I do not want is the patient who spent six months losing weight and only realizes at month seven that no one on her care team was thinking about her face. Body and face are one conversation. They have to be.

Where this gets interesting

This is the side of the GLP-1 story I find more fascinating than anyone else seems to. The wellness press isn’t writing about it. The trainers aren’t. The patients usually haven’t put the pieces together yet.

A patient drops thirty to forty pounds in three months on one of these drugs (a number we see week in and week out now) and walks into my body contouring consult a meaningfully different person than she’d have been at her starting weight. The fat is gone. The skin envelope she’s wearing was sized for the fat. That gap is where my side of the work begins.

I lay hands on an abdominal wall that, three months earlier, would’ve been hidden under a layer of subcutaneous fat thick enough to bury the rectus muscles. I feel the diastasis through skin. A real triple plication is suddenly on the table. So is a waist reduction I used to reserve for thinner patients. The BBL I’d have offered her at her starting weight isn’t the BBL I’d offer today. Proportions changed. Canvas changed. What I can build on it changed.

The GLP-1 didn’t produce that result. It let me do the operation I’d have done anyway, except now the operation hits twice as hard.

That’s the quiet thing nobody’s writing about. The aesthetic ceiling on body contouring went up the day this drug class went mainstream. Every plastic surgeon I know who’s been operating on bodies for fifteen-plus years is having some version of this realization, mostly in private, mostly over coffee at the annual meetings.

How our program runs

Patients ask less than they should about how a weight loss program is supervised. So here is ours.

I am the medical director. My nurse practitioner runs day-to-day. I stay in the loop on dosing, intake, and any patient who needs a second medical opinion before we change anything. Labs at intake, no exceptions. Nobody on my team hands a vial to a patient who has only filled out a form.

That sounds heavier than the GLP-1 you can have shipped after a five-minute online questionnaire from an Instagram brand. The point is that it is. Pancreatitis is the side effect that should make patients nervous about how they get their drug. A flare on a shot you ordered yourself becomes a 2 a.m. trip to an ER where a stranger has to figure out what you took and at what dose. The same flare on the same drug, prescribed in our program, is a phone call to my office, where your chart is already open.

One more thing about the glow

A patient asked me last month, half-joking, whether the program would make her glamorous. I told her it would not.

What it will do is hand her back a body she can dress, photograph, and walk into a room in without the internal commentary that comes with the wrong size of denim. That is what patients are pointing at when they say glow. The rest of glamour, the part the wellness press is trying to bottle, is built out of unsexy fundamentals nobody puts on a billboard. Sleep. Skin care. The correct surgery if and only if. A stress level somewhere south of catastrophic.

I have been doing plastic surgery long enough to watch four or five “miracle” technologies arrive and underdeliver. The GLP-1 class, on the evidence so far, is the rare one doing more than it advertised. That deserves real respect, and respect means running it like medicine, not a cosmetic line.

Why this lives inside a plastic surgery practice

A weight loss program in 2026 isn’t an isolated medical service. It’s a step inside a longer arc. Face, body, skin, recovery, sometimes surgery. Pretending otherwise is how patients end up disappointed by the result they paid for.

I’ll say it. The Mayo Clinic fellowship taught me, above everything else, to treat volume, skin envelope, and structural support as one system. Not three. One. The thirteen straight years on the Castle Connolly list, the Texas Tech academic appointment I’ve held since 2011, the peer-reviewed work, all of it points the same direction: stay close to what actually moves a patient’s outcome, and let the rest go. None of that overlapped with weight loss medicine until the medicine started visibly reshaping who walks into a body contouring consult. Once that happened, sending the program to a med spa across the parking lot was never going to be my answer.

So I run it. With my NP. With my chart open in front of me on the days a patient needs an actual physician on the line.

Ready to talk?

A GLP-1 is a medication. The first move should be a conversation, not a prescription. Bring your goals. Bring any recent labs. Bring a photo of the version of yourself you are trying to come back to. If surgery is also on your mind, we plan the arc together. If the only goal is to drop fifteen pounds and feel like yourself again in clothes, that is a real goal too, and we run that program with the same care.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook. #StayBeautiful