September 08, 2026 | Plastic Surgery News
Every year my specialty publishes its numbers and roughly two hundred outlets publish the top five list. Liposuction won again. You have read that article already.
Almost nobody reads to page 26. That is where the American Society of Plastic Surgeons breaks the country into five regions, and it is where the 2025 report stops agreeing with itself.
On five procedures, the eight-state region I practice in moved the opposite way from the national number. Region 4 is Alabama, Kentucky, Mississippi, Tennessee, Arkansas, Louisiana, Oklahoma and Texas, so I cannot tell you what El Paso did on its own. Nobody publishes that. But here is what the regional table says, and here is what I see on my own schedule.
| Procedure | National | Region 4 |
|---|---|---|
| Nose reshaping | down 5% | up 16% |
| Brazilian butt lift | down 5% | up 4% |
| Male breast reduction | down 8% | up 2% |
| Breast reduction | up 7% | down 1% |
| Lower body lift | up 4% | down 14% |
Rhinoplasty grew here while it fell nationally
Does that match what you see?
“This does match what I see. I’ve seen an increase in surgical rhinoplasty procedures in both men and women. In many places, people are turning to injectable fillers for a liquid rhinoplasty, or non-surgical nose job. But many patients have noticed that when this is done, the nose actually becomes bigger, because filler is volume. We’re adding volume to hide the dorsal hump and maybe push the tip up. But with time, the filler flattens out and migrates to the sides, making the nose look wider and the tip more bulbous.”
“For a real reduction, surgical rhinoplasty reshapes the structure of the nose and reduces its size, removing the dorsal hump, refining the tip, and even narrowing the nose, and it can also remove old filler. A surgical rhinoplasty is a permanent procedure.”
The BBL number is the one I watch
The BBL fell 5 percent nationally and rose 4 percent here.
“There is a tendency toward the more natural look, so there has been a decrease in the number of BBLs nationally. But at the same time, a lot of patients are turning to fat transfer or donor grafts like alloClae instead. In the Southwest, there’s still a demand for the bigger hips and greater projection.”
“Although there may be a decrease nationwide, it may be that patients are seeking out experts in the field and coming to the South and Southwest for these procedures. They’ve done their research. They’re also seeking physicians who use ultrasound for the fat transfer to avoid the gluteal complications.”
These numbers only count board-certified plastic surgeons. In a border city, how much never shows up?
“Even though El Paso is a border city, there really aren’t that many other providers performing these procedures. I do think this changes in some areas, like Florida, where non-board-certified practitioners are performing them. But as patients have become more educated, and as they learn there’s a high risk of pulmonary embolism when this procedure isn’t done correctly, they are seeking board-certified plastic surgeons, especially the ones who use ultrasound guidance, like myself.”
Gynecomastia went up here and down everywhere else
“I was really surprised to see this number, because it’s still a very high-demand surgery among men. Gynecomastia is a condition that creates a lot of psychological and self-image issues. Even very fit men can have it, and it’s a big factor in their self-image, so they seek to have it resolved.”
The lower body lift is the one that bothers me
Nationally this grew 4 percent. Here it fell 14, in the year that was supposed to belong to post-weight-loss surgery. Eighty-two percent of ASPS surgeons reported consultation requests tied to GLP-1 medications.
“I’m also surprised at this number, since we perform it quite often. The lower body lift is the key surgery after massive weight loss, and I’ve been seeing a high volume of this procedure in our practice.”
“The number of patients seeking body contouring procedures has continued to increase since the GLP-1s. What I’ve seen in my practice is a lot more patients coming in for facial surgeries after massive weight loss with GLP-1 medications like semaglutide and tirzepatide. The lower body lift numbers may have decreased because patients are more concerned with the facial aspect first and may pursue the body contouring later.”
That is the most interesting idea in this whole report, and it is not in the report. Face first, body later. If that is right, the body contouring numbers are not gone. They are queued up behind a wave of facelifts.
What I take from this
Be suspicious of national trend pieces, including the ones quoting me. A number describing 1.5 million procedures across fifty states does not necessarily describe your city or you.
I trained at Mayo Clinic, I teach as a Clinical Associate Professor at Texas Tech University Health Sciences Center, and I have been named to Castle Connolly’s Top Doctors list for thirteen consecutive years. None of that makes me right about why rhinoplasty grew 16 percent across eight states. It does mean I read past page 8.
Ready to talk?
If you are weighing a procedure and want the numbers behind it rather than the headline, come in and ask. Call the office at (915) 590-7900, text 1-866-814-0038, or book a consultation at agulloplasticsurgery.com. Current pricing is always on the published fee schedule.
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Source: American Society of Plastic Surgeons, 2025 Procedural Statistics Report, Region 4 table. All percentages recomputed from the published 2025 and 2024 counts. Commentary from Dr. Agullo’s dictation of 2026-09-07, Q&A Transcriptions/Procedure-Trends-Commentary.md.
