October 04, 2026 | Plastic Surgery Consultation, Recovery
Most patients arrive having done one kind of homework: photos. Right homework, easy to get wrong. A podcast host asked me about it last week. Four steps.
Step One: The Feed Test
What do you most want people to understand about before-and-after culture?
“I would stay away from anybody that has one or two or three amazing before and afters and that’s it. You want to see a surgeon that’s posting before and afters every day, and they’re all consistent, and they’re all getting good results. They’re not going to all be home runs, because it depends how the patient comes in. You can’t get a home run out of everybody, but you can definitely get them to a better place as long as the expectations are set.”
Scroll past the pinned posts. Three photos is a portfolio. A daily feed is a track record.
Step Two: The Wish Photo Test
Bring it. Then:
“Some patients bring wish photos and you have to coach them. You have to tell them, this patient you’re showing me is 20 years old, you’re 40. Or this patient’s BMI is 20 and you’re still at 30. You look much better than you did before, but we can’t compare apples to oranges.”
Your age? Your BMI? If not, the photo shows me your taste. It does not set the target.
Step Three: What the Photo Cannot Show
“The before and after doesn’t tell the whole story. It doesn’t tell you about the patient’s psychology, if they’re happy or not. You don’t know that from a photo. Some patients get amazing results and they’re still not happy; they have these little things they want to perfect. It doesn’t tell you about the recovery, everything they had to go through, or any complications there could have been. And of course the cost the patient had to undergo, what it cost the family, just getting through the whole procedure. The before and after is a quick fast-forward through all of that.”
Psychology, recovery, complications, cost. None of it is in the picture. That is what the consult is for.
Step Four: Know That the After Moves
Weight-loss patients, especially.
“Patients who have lost a lot of weight, we do these surgeries and we’re pulling as tight as we can, but the skin, because it’s lost that elastin, is going to give again. We lose some of the result over the first six months. Another realistic expectation is that a lot of times, six months later, we have to do a little nip and tuck to tighten things up and get them right.”
The after photo is usually the early after. Six months later some of it has settled, and sometimes a small revision follows. That is a normal part of post-weight-loss contouring and part of the plan I lay out in the timing post. It is not on anyone’s feed because a small revision does not photograph.
Why I Post Anyway
“Before, I would have a consultation with a patient in front of me and they were so anxious and worried, and I was giving them all this information, and I think it just went in one side and came out the other. At the end of the consultation they were more confused than before. Now they come in and they know what’s going on. They’re telling me what they want.”
“But it is an important part of choosing a surgeon, because you want to see somebody that can consistently deliver good results.”
The feed, read correctly, is the best preparation for a consult that exists. It just is not a promise.
Before the Feed: The License Check
None of this matters if the surgeon is not who they say they are. The five-minute board and license check is in my plastic surgery in Texas post. Do that first, then read the feed. The full commentary on this subject is on drworldwide.com, and the rest of what I told the podcast, on loose skin and timing, is here.
Why Choose Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026. He has shared his results publicly since 2014.
Ready to Talk?
Bring the wish photo. Bring the feed you have been reading. We will go through both.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
