Frank Agullo, MDBoard Certified Plastic Surgeon

2016 Plastic Surgery Trends

Category: Breast Reduction

2016 Plastic Surgery Trends

shutterstock_207094993Cosmetic Culture

It shouldn’t come as a surprise that plastic surgery, from the minor to the major procedures, is becoming more of a social norm. The use of elective cosmetic procedures rose 20% last year. What’s surprising is the type of work people are getting done.

Natural Nip-tuck

As of last year, The American Society for Aesthetic Plastic Surgery’s (ASAPS) annual report concluded there was a 7% growth in surgical procedures and a huge 22% growth in non-surgical procedures. This has a lot to do with trends. In the past, plastic surgery was more recognizable and obvious. Silicone implants were big and round, and facial work could leave you looking like a Cheshire cat. Today, the big trend is to get work done that doesn’t make you actually look like you’ve had work done.

Subtle adjustments are the trend right now. I often see patients in my office who want more natural-looking transformations; less is more.

Changing Demographics

The evolution of plastic surgery has brought us from the stereotypical young ladies wanting their nose done or older women yearning to rewind the clock. Now both women and men of all ages and backgrounds are searching for a way to work with what they’ve already got.

The Trend List

The number one most requested procedure for women is fat-transfer, where fat from an area of your body (your belly, for instance,) is moved to another (like your rear or your breasts). Reflecting this craving for more natural appearances, these types of procedures are rapidly growing as a trend.

Injectables, such as Botox for wrinkle prevention and Juvederm to plump around the face, were in second place. Butt lifts and implants were third, skin tightening methods fourth, tattoo removal fifth. Liposuction was in sixth place.

Expansion of Possibilities

The newest types of technology link makeup with surgery, giving women permanent, beautiful eyeliner, lip liner, and more. They are one of the biggest reasons there has been a big leap in cosmetic procedures. Many of these procedures have decreased in average cost over the years, which is yet another reason for their boost in popularity.

Motivation Makes a Difference

Like so many other things, just because you can have cosmetic procedures done, doesn’t mean you need to. There are times where I may not want to perform a plastic surgery procedure because I feel the patient will regret their decision.

I want to know what your motivation is, and if you feel you are being honest with yourself about what the procedure will address. Your procedure should be something to help, not mask, the situation. Some of the reasons when I might ask a patient to reconsider a procedure is if they are having it done due to pressure from friends or a significant other.

Cosmetic surgery isn’t a “quick fix.” Your life is the same as it was before the surgery. Someone who is depressed because of their appearance, may still find a reason to be troubled afterward, despite excellent surgical outcomes. But at the same time, plastic surgery can help you overcome barriers that get in the way of your self-confidence.

Before and After Breast ReductionI recommend plastic surgery for those who have significant personal reasons or barriers that they want to overcome. Those with an obvious physical issue that can be surgically repaired are usually the most pleased. A pattern can be seen with breast reductions, for example. So many women will say it is something they’ve wanted for years! It can make them feel so much more comfortable and confident.

It’s not magic, but it is a science that can improve your life!

If you are interested in cosmetic surgery and would like to learn more about your options, make an appointment with Dr. Agullo today! You can contact our office by calling (915) 590 – 7900 or by filling out our online contact form

The Benefits of Looking Your Best

Looking Your BestA familiar misconception is the idea that cosmetic surgery isn’t beneficial past the surface of the skin. But that’s not true! Investing in aesthetic treatments by a board-certified plastic surgeon can help you boost your confidence, improve your appearance, and change your lifestyle.

Not only that, but cosmetic treatments can also be beneficial to your health and well-being. Here are just a few examples:

Breast Reduction

It’s not uncommon for women with larger breasts to experience pain or discomfort in their back, shoulders, or neck. Reducing the size of the breasts to one that is lighter can improve posture, reduce spinal problems, and even make it easier to workout at the gym. Some women also experience frequent skin irritation or infection under their breast tissue, so a reduction makes it much easier to reduce the likelihood of these conditions.

Breast Augmentation

For women who experienced tuberous growths, or asymmetry to the point that it interferes with their posture, breast augmentation can create a healthy fit for your profile and reduce your risk of back pain.

Rhinoplasty

Getting a “nose job” could actually help you breathe easier, due to correcting a deviated septum or other anatomical irregularities that reduce oxygen flow. Rhinoplasties offer straightforward results to my patients with obstructed nasal passages.

Eyelid Surgery (Blepharoplasty)

If droopy eyelids (ptosis) interfere with your line of vision, a simple lift can improve your eyesight.
Suddenly you’ll see better again, without having to wear glasses!

Abdominoplasty

A tummy tuck reduces the excess fat and skin along the waistline – decreasing your risk of diabetes, reduce certain types of incontinence, and relieve back pain as the muscular positions are corrected. Enjoy a flatter, more toned stomach that diet and exercise alone haven’t achieved.

Body Lift

After significant weight loss, reducing excess skin in the arms, lower body, thighs, or breasts can improve posture, reduce your risk of diabetes, and even reduce incontinence caused by stress. Say goodbye to the “waving” skin when you walk or raise your arm, and hello to tighter fitting clothes.

Liposuction

Liposuction can be used to reduce the amount a person sweats under their armpits – something that can interfere with everyday social relationships. The procedure can also bone completed using a laser. Liposuction is often used for men who need breast reduction due to excessive fatty tissues in their chest.

Vaginal Rejuvenation

After childbirth, many women experience scar tissues caused by tearing, looseness of the vaginal walls, or chafing because of naturally large labia. Plastic surgery can reshape and recontour the vaginal tissues for greater comfort in your favorite clothes (or with the person you love.) Through vaginal rejuvenation you can achieve your desired look.

Of course, the psychological benefits of plastic surgery are significant. Being able to overcome the embarrassment of specific anatomical irregularities can give my patients a new-found freedom that literally changes their life for the better. If you’ve been thinking about having some type of cosmetic procedure performed, and you just can’t justify it for looks alone – it’s time to look even deeper, and see how treatments can improve things other than just your appearance.

To learn more about your options in plastic surgery, you can make an appointment at the office of Dr. Agullo by calling (915) 590-7900 or filling out our online contact form.

Is a Mommy Makeover the Best Way to Get Your Pre-Baby Body Back?

If you’re done having children and have made it a mission to get your body back to the way it was pre-kids, you’re not alone. Each year thousands of women enjoy the thrill of becoming a mother, but then face the daunting task of getting their bodies back into shape.

While some women bounce right back, others endure more physical tolls on their body. For instance, a very stretched tummy due to abdominal growth during pregnancy can leave saggy, folded tissues years after childbirth. For others, the breastfeeding process has caused stretching or droopiness of the breast, resulting in loss of fullness.

A rigid diet and exercise program may do the trick, but if saggy tissues are to blame, then a Mommy Makeover could be exactly what you were looking for.

What’s Involved in a Mommy Makeover?

Each time I meet with a woman to discuss a Mommy Makeover; I want to know what her goals are. Is it just the breasts? The tummy? Both? Something else? Buttock augmentation? A Mommy Makeover isn’t just one treatment in particular. Rather, it is a series of aesthetic procedures that are all performed at once – giving you great results that return your pre-baby body back to a reality!

Mommy Makeover Before and After

Depending on the actual physical needs of each woman, I will typically recommend combining treatments such as:

Breast Augmentation or Lift – Stretched or saggy breasts are a common side effect of pregnancy and nursing. Breasts may be much smaller and droopier than they were before you became pregnant. You would be amazed at what a simple augmentation or lift can do to restore natural breast fullness and contour. It’s a key to just about every Mommy Makeover that I perform.

Breast Reduction – Unlike women who experience shrinkage of their breasts during nursing, some women feel like their breasts are too large after having a baby. Reducing some of the fullness and lifting the breasts can create a fuller, more youthful appearance.

Abdominoplasty Excessive abdominal fat or stretched tissue can make your stomach appear saggy and increase your waistline. In most cases, I recommend a tummy tuck to reduce the skin in the area, remove fatty tissues, and tighten the abdominal wall. This leaves your stomach much flatter, and eliminates the “baby belly” that even daily trips to the gym can’t get rid of.

What to Expect

In most cases, you can expect to spend a bit more time recovering from a Mommy Makeover than you would just a breast augmentation or single procedure. Why? Because we complete everything at one time. Women who are physically active and have a strict workout routine do typically tend to recover quicker, as their bodies handle the stress much easier. I usually recommend taking at least two weeks off of work. If you still have small children, you will definitely need someone to help you care for them at home, as you will not be able to pick them up during recovery.

You’ll be thrilled with the results of your procedure! The makeover process allows us to refine your waistline, restore fullness to your breasts, and make up for what exercise can’t.

Consultations

During your consultation at my office, we’ll discuss the varying characteristics of your body that have changed since childbirth, and what you want to change. Then I will present a series of realistic plans that we can implement to give you both your body and your confidence back. If you’ve been embarrassed for far too long about the beating that motherhood has taken on your body, then you owe it to yourself to schedule a consultation.

You can make an appointment at the office of Dr. Frank Agullo by calling (915) 590-7900 or filling out an online contact form.

Does the Perfect Breast Size Exist? Science Says ‘Yes!’

Does size really matter? While society has often told us “size isn’t the issue” as far as men are concerned, women’s breasts seem to be an entirely different mindset. If you’re too big, or too small, finding the perfect cup size may seem like an obsession in order to feel confident in your everyday clothing or trip to the beach.

Fortunately, natural breast sizes and shapes are making a comeback for women. A survey published in the Plastic and Reconstructive Surgery journal showed that of over 1,000 people surveyed, most men and women preferred cup sizes that were in the larger-B to smaller-C size range. Not the larger, fuller, more prosthetic versions we see most of Hollywood sporting on everyday media.

This offers a bit of wiggle room for women who have been considering breast augmentation or implants.Breast Augmentation Before and AfterA Natural Contour

Another factor to take into account is the shape of the breast itself. In the previously mentioned study, participants were also asked to identify the most aesthetically pleasing breast contour. It wasn’t the round, saline-filled shape that used to be so popular. Instead, it was a 45:55 ratio. What does that mean? It means that 45% of the breast tissue fell above the nipple line, while 55% fell below it. Most people are more drawn to the contour of a natural breast, as opposed to a rounder one with more fullness above the nipple line.

Creating Beautiful Profiles for Every Patient

Each time I conduct a breast augmentation consultation, I feel that it is important to discuss the various types of implants available and how they will help my patients achieve their aesthetic goals. While certain types of implants have various advantages, others allow me to achieve a closer resemblance to natural tissue.

Automatically assuming that a rounder, fuller breast is best, is not always the right choice. The trend seems to be on a spiraling downward cycle that leaves many women torn as to which type of implant to choose. In my professional opinion, most women are extremely comfortable with naturally shaped breasts, as long as the cup size borders between a full B or C.

The same can be said for breast reduction patients and women who are undergoing reconstructive surgery after having cancer treatment. Creating the right fullness and shape is just as important as our emphasis on cup size. That’s right – being bigger doesn’t always make it better! Size doesn’t matter, size and contour are what matters!

Finding Your Right Shape

At Southwest Plastic Surgery, I’m able to meet privately with each patient to discuss her concerns and expectations regarding their breast augmentation surgery. Together, we’ll look through before and after photos and discuss how various types or sizes of implant treatments can help you achieve your personal goals when it comes to breast fullness.

I encourage women to bring photos with them to their consultation, so that we can compare different types of options and select the most appropriate. It also gives me an idea for your personal preferences as far as treatment expectations.

Some women still prefer the rounder breast even though they are not quite so naturally shaped. Ultimately, your personal preferences will determine the treatment plan that we choose to take. With the right vision, I can help you create a beautiful contour that will help you feel more confident about the way your body looks and feels.

To learn more about breast augmentation and your options, contact the office of Dr. Frank Agullo by calling (915) 590-7900 or filling out an online contact form.

The Top Cosmetic Procedures for Generation X’ers

Let’s face it; the forever-young-at-heart Generation X is beginning to see the impact of life on their bodies. And they’re starting to do something about it! Over 40% of 35-50 year olds have gotten some type of cosmetic procedure done to improve the way they look and feel about themselves.

As middle age starts rearing its ugly head, Generation X’ers aren’t taking it sitting down. With more aesthetic options available than ever before, it’s no wonder why the American Society for Aesthetic Plastic Surgery has seen a surge in elective cosmetic procedures. I’m seeing the very same thing in my own office, as women are becoming more comfortable with the idea of body rejuvenation and skin treatments.

Which ones are the most popular, you ask? Most of my new patient consultations and completed treatments with Gen X’ers involve procedures like:

Breast Augmentation / Lifts / Reduction

You’re at the age where you know what you want. Maybe it’s finally having something to fill out your bra, or regain the confidence you had before “sagging” became a problem. You don’t have to be in your 20s to get your breasts fuller, higher, or the right shape and size. My Gen X female patients know that they’ll be with them for several more decades, and they’re taking steps to feel better about themselves in the future.

Tummy Tucks

Haven’t been able to get rid of that sagging belly skin since you had a baby or finally lost a few pounds? You’re not the only one. The stretching and swelling that your stomach experienced in younger years can really put a toll on your waistline – but a tummy tuck is an excellent fix!

Tummy Tuck Surgery Before and After

Liposuction

If diet and exercise haven’t caught up with your decreasing metabolism, liposuction is an excellent way to rid yourself of excessive fatty or cellulite tissues in those troublesome places that bother us all – love handles.

Eyelid Procedures

The delicate skin around your eye can be one of the first places to show signs of aging. Especially when you see yourself in photos or the mirror – and don’t expect to see what you’re looking at. An eyelid procedure, or blepharoplasty is a great way to erase signs of crow’s feet, circles under the eyes, or excessive wrinkling.

Mommy Makeovers

Our “mommy makeover” packages are extremely popular, especially for our late 30s and 40s women who are done having children. While a mommy makeover isn’t one procedure alone, it’s a combination of various treatments like breast augmentation, body contouring, and vaginal rejuvenation to help them get their entire body back to a slimmer, fitter, more youthful shape.

Somebody You Know Has Had Cosmetic Surgery

How many women are we talking about, here? Nearly 50%! Chances are, out of you and three other girlfriends, at least two of you have had aesthetic surgery. The procedures are becoming more advanced, less invasive, and help you get your younger body back with minimal down time.

Now’s Your Chance

Are you a Generation X’er who is starting to see time and life wear down parts of your body before you’re ready? Tired of seeing fine lines and wrinkles in the mirror each morning? Call to set up a complimentary, private consultation so that my team can help you feel better about the way you look and feel each day!

To contact the office of Dr. Frank Agullo, you may call (915) 590-7900 or fill out an online contact form.

 

Why Men Should Consider Plastic Surgery?

Male Plastic Surgery Before and After PhotosTraditionally, women have been more likely to undergo plastic surgery than men. However, body issues and aging concerns are common for many individuals, irrespective of gender. Many of the procedures available today can benefit both men and women, and over the past few years we have indeed seen a steady rise in men undergoing plastic surgery. If you don’t think that plastic surgery is for you, it may be time to reconsider, as there are many benefits that men stand to gain from male plastic surgery procedures.

Becoming More Competitive in the Job Market

It’s a dog-eat-dog world out there, and every day it gets harder to stay ahead of the competition in the job market. You may find that after a successful interview for a job you’re well-qualified for, you’ve been passed up in favor of a man who is slightly younger or more attractive than you. Younger and more attractive men are often perceived as more capable in the job market, and even if you think you have a stable job, it may be only a matter of time before you’re phased out. While you can’t stop the clock, there are all kinds of plastic surgery procedures that can help you to look fitter, younger, and more attractive, from liposuction and pectoral implants to facial augmentation, eyelid surgery, and rhinoplasty. These procedures can help you maintain a competitive edge in the job market with a more youthful, attractive, and confident look.

Becoming More Desirable to Potential Partners

If it is difficult to stay ahead of the game in the workforce, it is likely even more difficult in the dating realm. Physical chemistry and sexual attractiveness are significant factors in choosing a partner. Potential partners are often looking for a man who they find sexy, attractive, and masculine. Plastic surgery procedures can improve your body contour, your face, and your overall appearance so that you become more desirable to potential partners.

Feeling Confident About Yourself

Confidence is one of the most desirable qualities in any man. A man who is confident in himself and his abilities will go far in life. If you are self-conscious or embarrassed about your appearance, it is difficult to maintain confidence in yourself. Plastic surgery can enhance your appearance so that every time you look in a mirror or look down at your body, you get an extra boost of confidence due to your attractive and masculine physique.

Plastic Surgery Procedures That Are Great for Men

There are many plastic surgery procedures that are specifically designed to benefit men or both genders. Men can improve their body contour with liposuction, male breast reduction, pectoral implants, and buttock implants. These procedures can help your body to look and feel fit, toned, firm, and youthful. Additionally, men can restore a more youthful appearance with procedures such as facelift surgery, rhinoplasty, and eyelid surgery. These procedures can help to define the face with more masculine contours and a fresh, youthful look.

Men have much to gain from male plastic surgery procedures. To learn more about the types of procedures that could benefit you, schedule your consultation with Dr. Frank Agullo today. To book your appointment now, call our El Paso office at (915) 590-7900. You may also fill out our online contact form for more information.

Wait at Least Six Months After Having a Baby to Get a Mommy Makeover

Mommy Makeover El Paso Las CrucesMore than ever women are focused on their bodies, especially after pregnancy. The comparisons not only begin with friends and family but also can be exacerbated by the media stories of the rich and famous. Of course, no one notes the private chefs, coaches, etc. that they have at their disposal.

A lot of women tend to put pressure on themselves to quickly get back to pre-pregnancy shape, often not considering all their bodies have done to prepare them for childbirth. During your pregnancy, not only do your hormones change, but your body changes shape to allow your baby to grow healthily and be delivered. Your mid-section stretches, your breasts increase in size, and certain areas may even swell due to retaining water.

Once your pregnancy is over and hormones return to normal, your skin and muscles will begin to tighten once again. How much a woman’s body will return to “normal” varies from person to person and depends on her overall health, diet, and exercise plan.

There are a large number of women who find no matter what they do physically and with their diets, they simply can’t get back to their pre-pregnancy shape. There may be loose skin around the midsection and potentially sagging breasts once milk production has ceased.

What Is A Mommy Makeover?

Usually a “Mommy Makeover” includes a tummy tuck, liposuction in the mid-section and hips, and either a breast lift, reduction, or augmentation, depending on the woman’s specific needs. In Dr. Agullo’s practice, mommy makeovers often include buttock enhancement via a Brazilian Butt Lift with fat injections or a buttock implant. It’s important to note that the procedures are not intended to speed weight loss, they are to help with areas that diet and exercise simply cannot alter.

How Long Should You Wait?

From birth, this can be several months to a couple years, depending on your family, feeding, diet, and exercise plan. However, it’s never recommended to have a tummy tuck before you are done with childbearing. This is to prevent you from having to redo surgeries in the future.

The most important thing to remember is that your body is different from everyone else’s. Your body will heal and return at a different rate and shape than others. Discussing your body goals with your physician can help create a plan with attainable goals that can then be further defined with surgery if desired.

When you are ready, board-certified plastic surgeon Dr. Frank Agullo of Southwest Plastic Surgery in El Paso and Las Cruces can help you prepare for a Mommy Makeover. Call our office in El Paso (915) 590-7900 or our office in Las Cruces at (575) 520-5041 to schedule your consultation. We encourage you to come in and see our before and after pictures even before you make a decision.

Using Internal Silk Bras to Enhance Mastopexies

A beautiful woman from the waist up with her arms in the air in a red swimsuit top on a sky backgroundAlthough still a fairly new method used to improve the results of breast lifts and reductions, the SERI silk scaffold can give patients an extra level of perkiness that they would otherwise struggle to achieve. Some patients ask if adding the SERI sling will increase the life span of the breast lift.

That’s a great question! From what we have seen at Southwest Plastic Surgery in El Paso, there are very promising results. The mesh silk is an FDA-approved soft tissue support that is inserted internally. It then slowly absorbs into your body over the course of a year to eighteen to twenty-four months. After that time, a new layer of collagen will remain, which offers continued support.

Although SERI silk bras are not designed to prolong the life of the implants, it does assist in the healing process by strengthening the tissue. So in a way, it does have the ability to lengthen the life span of a breast lift. It also helps the breasts to facilitate a more appealing shape and implant position. It lowers the likeliness of needing a revision due to the breasts not having enough tissue to sustain the implants. This is especially true in middle aged women, who have less skin elasticity and tone.

Some things that tend to make breasts less apt to heal to the fully desired effect include: post-pregnancy, larger volume implants, dramatic weight loss or weight gain, and the type of implants used (silicone or saline). In essence the silk scaffold enhances the support, especially under these circumstances. Not every patient needs the SERI internal bra, but this is just another great tool that Dr. Agullo of Southwest Plastic Surgery can use for those patients who do need extra support and comfort.

Using the VECTRA® 3D System for Breast Augmentation

If you have ever wondered about getting breast augmentation, implants or reduction, but are fearful of whether you would like the way it looks after surgery, then fear not! Through the marvel of new technology, Southwest Plastic Surgery of El Paso, TX uses an innovative Vectra 3D system to show patients exactly what their breasts will look like “after” their breasts fully heal!VECTRA 3D

See the “After” Pictures “Before” Breast Surgery

The Vectra 3D system is part of our consultation process and is used to help you determine whether breast augmentation is right for you. It can also be used to show you different sizes, so that you can decide whether you want a “Big C” or “Small D” cup, for example. Everyone’s body type and shape is unique, so a woman who is petite might look rather extreme if she goes through a breast augmentation that is too large to meet the size proportions of her build. However, a woman with a curvy, voluptuous physique might prefer getting breast implants that complement her proportions accordingly.

How Does the VECTRA® 3D Work?

The Vectra 3D image and simulation machine illustrates your prospective outcome on a computer monitor. The results can also be printed, so that you can take home the pictures to think about the decision of whether to go through breast augmentation or not. The Vectra 3D system has an amazing accuracy ratio of 100% and has helped hundreds of patients to decide the best cosmetic procedures even before going through them. They are very useful in the decision process because of their visual interpretation, even more so than wearing a bra with the desired implant sizes.

Come try the Vectra 3D technology for yourself and visualize a breast augmentation at Southwest Plastic Surgery today! You never know until you see it in person, so set up an appointment today with Dr. Frank Agullo.  

Check out the Vectra 3D’s use with Rhinoplasties.

*Photo courtesy of Canfield Scientific 




Can Breast Reduction Surgery Reduce the Risk of Breast Cancer?

There is no doubt that women of all age groups and ethnic backgrounds have a common battleground, and that is with breast cancer. Unfortunately, breast cancer has become one of the leading causes of death among women and now a major front line medical concern. We are now learning the causes of breast cancer can be linked to stress and unhealthy lifestyle choices. Of course, women are more educated than they were twenty years ago, therefore a larger percentage of women get mammograms than even a decade earlier. This has helped in diagnosing breast cancer patients earlier to prevent the progression of breast cancer, but it hasn’t stopped the massive number of new cases.Breast cancer graphic design, silhouette of woman with a ribbon on her chest and "Fight Against Breast Cancer" written below her

Dr. Agullo from Southwest Plastic Surgery of El Paso, Texas has been studying this very issue, which he recently wrote about in an article for “The El Paso Physician”: Vol. 36, No. 4. Among other notable plastic surgeons, Dr. Agullo concluded that women who underwent breast reductions had significantly fewer chances of getting breast cancer than those with larger breasts. The conclusion was based on a recent study of women throughout the U.S., Canada, Sweden and Denmark whose risk was lowered by as much as 50 – 70% over those who had not received breast reduction surgery.

Why is this? Most cases of breast cancer arise from dead cells in the fatty tissue of the breast that manifest into cancer. By reducing the fatty tissues in the breast, you also reduce the potential for getting breast cancer. In fact, today many women are opting to remove the fatty tissue altogether replace their breasts with implants, which seems like an extreme measure, but not without just cause for those women who have a higher hereditary predisposition for breast cancer.

For those who suffer from breast cancer already, there are plenty of options for you. Once the breast cancer has been treated, there are several methods for breast reconstruction that will become an option, if you choose to go through with a breast implant reconstruction. Breast reconstruction is just one method which involves replacement of a tissue expander. After a few months’ time and a few visits, a silicone gel is then inserted to complete the process of expansion. Later on, a final surgery will be needed to remove the expander. Voila! Your new breasts will be complete.

Another type of method used by Southwest Plastic Surgery is called Latissimus Dorsi Myocutaneous Flap. This technique also uses a tissue expander or implant, but is known for giving women a natural look to their reconstructed breasts. This complex procedure also gives Dr. Agullo an ability to reconstruct any part of the breast, including the nipple. Although this particular procedure may not be a solution for every breast cancer patient, it has clear advantages for qualified recipients. These are only a few different types of procedures that can have a positive impact on your breast reduction at Southwest Plastic Surgery of El Paso, Texas.

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