November 03, 2026 | Patient Resources, Skin Care Regimen
Real Simple recently reached out to two derms and one plastic surgeon (hi) to share some drugstore recommendations when it comes to anti-aging skincare. My recommendations and the rationale can be found in the article, and a breakdown of each step in my AM and PM routine can be found on Southwest Plastic Surgery.
Today I wanted to share some additional thoughts that are important to me as a surgeon when it comes to topical anti-aging products, and why I ask my patients to incorporate them into their routines even when we’re planning on doing surgery.
The Line I Draw in Every Consult
When it comes to topical anti-aging skincare (think a nightly retinoid, AM vitamin C plus SPF) these products can do a lot. Specifically when it comes to improving skin texture and tone, targeting fine lines and brown spots and generally helping to prevent aging. When Real Simple asked me which category earns its place I said, “Retinoids are the only topical category with decades of evidence for collagen, fine lines, and texture, and the encapsulation releases it slowly so the peeling and redness are milder. Use it at night, two or three nights a week to start, and build from there.”
However, topical anti-aging products cannot address sagging jowls, laxity in the neck, temple hollowness, cheek deflation, or the fold that forms between your nose and mouth. These are all structural concerns that cannot be addressed with a topical product. “There’s no topical that really produces lifting.”
So which serum will fix the jowls? None of them. The serum still matters, just for a different reason.
What Topicals Do for Skin That Is Going to Be Operated On
So what can topical products do for aging skin that will be undergoing surgery to correct structural aging? I discussed this on a podcast recently after seeing a number of patients who had recently undergone weight loss, but the concept can be applied to any patient who is interested in undergoing a facelift: “The topicals have two functions: barrier and attracting moisture, and then the antioxidants, which keep the skin looking younger, and retinoids, which can speed up turnover. So the skincare helps with fine lines and wrinkles, makes the skin appear firmer, helps with texture, helps with comfort”.
In other words, I like my skin primed and ready before performing a facelift. A facelift addresses aging by lifting and repositioning deeper structures in the face and neck and removing excess skin; it does not improve skin quality. Therefore, performing a facelift on someone with dry, crepey, sun damaged skin will result in less saggy dry, crepey, sun damaged skin. Performing a facelift on someone who has been using a nightly retinoid and AM antioxidant for three months prior to surgery will result in a facelift patient whose one year post-op photos look years younger.
This concept also applies to other areas of the body. “Skincare is part of any surgery I do. Even for a breast augmentation or a tummy tuck, I put my patients on a special moisturizer, because when there’s inflammation and recovery you lose that moisture, and that really hurts you in the end.”
The Timeline, and Why It Is Three Months
How long should topical anti-aging skincare be used prior to undergoing surgery? Ideally at least three months. Why? “In terms of timelines, hydration can show in a few days. It is something that you will notice very quickly. But collagen change takes 8 to 12 weeks, and it’s going to be subtle.”
I typically start patients on a retinoid during their consultation visit if they are not currently using one. This allows their skin to adjust to using a retinoid, turn over a few times and improve skin barrier function prior to undergoing surgery. Retinoids are discontinued a few days prior to surgery and restarted after wounds have healed. Vitamin C and SPF are continued throughout.
Skincare, Energy-Based Devices, Surgery
If topical anti-aging skincare is tier one for rejuvenating aging skin, energy-based devices are tier two and surgery is tier three. Each level builds upon the last to provide the best possible outcome.
| Tier | What it treats | What it is |
|---|---|---|
| Cream | Texture, tone, fine lines, spots, prevention | Retinoid at night, vitamin C and sunscreen in the morning, niacinamide and a peptide moisturizer |
| Energy | Early laxity, crepe, acne scars, sun damage below the surface | Morpheus8 Cool radiofrequency microneedling, IPL, laser resurfacing |
| Surgery | Jowls, neck, deep folds, volume loss, true excess skin | Deep plane facelift, ponytail lift, neck lift, fat grafting |
Patients who use a retinoid tend to get better results from Morpheus8 Cool, patients who use a retinoid plus Morpheus8 Cool tend to have better quality skin after a facelift, and so on. Some indications for tier two energy-based skin rejuvenation: poor skin tone or texture, sun damage, acne scarring, early jowls or skin laxity. Morpheus8 Cool (radiofrequency microneedling), IPL and laser skin resurfacing are the options I reach for most.
The Mistake I See Most
My most common anti-aging skincare advice? Don’t spend more money than you need to spend. When it comes to anti-aging skincare, more expensive does not necessarily mean more effective. “I would definitely advise a patient to buy a good retinol rather than an expensive collagen serum.” And on peptides, which get sold hard: “a peptide is a reasonable addition to a product where a sunscreen and a retinoid are doing the real work. It is not a replacement for either one.”
For the record, I don’t make or sell anti-aging skincare products.
When the Answer Is Surgery
If sagging jowls or neck, deeper folds, volume loss or true skin excess are your primary concerns, no amount of anti-aging skincare will improve these issues. I would much rather let you know this during your consultation instead of having you waste two years and a bathroom cabinet full of anti-aging skincare products to figure this out on your own. In terms of the face, this would be an indication for a deep plane facelift or ponytail lift. In terms of the body, this may be an indication for body contouring after weight loss. Current surgical fees are published at agulloplasticsurgery.com/fees, as of this writing, so you can read them before you call.
My wider take on why a surgeon ended up in a drugstore skincare story is over on drworldwide.com.
Why Choose Dr. Agullo
I’m a double board-certified plastic surgeon who completed a plastic surgery fellowship at the Mayo Clinic. I’m also a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. I’ve been named a Castle Connolly Top Doctor 13 years in a row. All of my surgical procedures are performed in our QUAD A accredited surgical center here in El Paso. Pre and post-op skincare is part of the plan for every patient, and this isn’t something I tack on as an add-on.
Ready to talk?
Interested in learning more about anti-aging skincare or which level of treatment (topical skincare, energy-based devices, surgery) may be right for you? Start the retinoid tonight, then come see me.
Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at agulloplasticsurgery.com/appointments. Find me @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
#StayBeautiful
