June 22, 2026 | Uncategorized
There is a moment in a lot of my consultations that tells me almost everything I need to know before the patient has finished talking. The patient reaches up to their own face and pulls the skin upward with their fingers, bringing their brows and cheeks and jowls up, or even tightening their neck back. That is a rule of thumb for me. When a patient does that, it is a sign they need a surgical procedure and not a noninvasive one.
There is a growing demand for lifting and contouring of the face without surgery. This actually extends to the breast, body, even the buttocks. So let me lay out honestly what the nonsurgical options can do, what they cannot, and how I decide which patient is which.
Why the Demand Has Accelerated
I think the demand has accelerated due to GLP-1 treatments, where patients undergo rapid weight loss and the appearance of aging shows up much more accelerated. There is also a tendency for maintenance early on, in order to avoid bigger procedures later.
As we know, aging is a combination of two things, skin laxity and volume loss. In weight loss patients, the skin has already been stretched out. The volume loss shows up as aging, and the skin that had previously been stretched out is now sagging, so the aging shows up much, much faster than in regular patients.
The Volume Side: Fillers, Biostimulators, and Regenerative Treatments
We’ve been using fillers underneath the eyes and the temples for a long time, but the newer volume replacement materials are more interesting. Sculptra is a biostimulator. After it is injected, the body tries to absorb the material and produces collagen in response.
There are more exciting biostimulating and regenerative treatments now, including PRP, protein-rich plasma, and PDGF, which is a platelet-derived growth factor. PDGF has not been cleared for injection, although some practitioners are using it off-label, but it is a great adjunct to any procedure that performs microneedling or resurfacing. It regenerates the tissues quicker, and with the growth factor we get a younger appearance and more protection of collagen.
Lipoderma is one of the newest available fillers. It is a donor-derived fat graft with a framework that allows the ingrowth of your own fat cells. This is a more permanent solution, more natural and more like the actual fat we have in our face, rather than scar tissue or collagen.
The Tightening Side: Radiofrequency and Lasers
For skin tightening, the best therapies at the moment are radiofrequency. The use of Morpheus8, which is microneedling with radiofrequency, is one of the most sought-after treatments in our practice. We also use FaceTite in the face, which is a more invasive radiofrequency treatment that treats under the skin and above it, and is usually combined with even liposuction of the neck.
We haven’t seen a lot of new technology in laser, but the fractionated lasers are still the most used. One has to be careful with skin types, as darker skin types tend to create hyperpigmentation or scarring.
| Treatment | What It Targets | What to Expect |
|---|---|---|
| Sculptra | Volume loss, collagen | Gradual, longer-lasting than regular filler |
| Regular fillers | Hollow areas, lines | Up to about a year |
| PRP / PDGF | Regeneration, collagen | Best as an adjunct to microneedling or resurfacing |
| Lipoderma | Volume, more permanent fill | Longer-lasting, ingrowth of your own fat |
| Morpheus8 | Skin tightening | Results vary by the patient’s own response |
| FaceTite | Deeper tightening, neck | More invasive, often with liposuction |
A Word About Thread Lifts
I think thread lifts had a peak in the last two years, but patients have found that they’re really not long-lasting. The threads can behave differently on one side of the face than the other and do create asymmetries. Sometimes these threads are not completely absorbed by the body and can be palpated, or give other problems. We’ve really almost diverged away from thread lifts, and we’ve started to do more minimally invasive surgical procedures instead.
What These Treatments Can Realistically Do
All these treatments are good in the early stages of aging, or weight-loss-related aging, and they usually give subtle improvements. They can correct specific areas like temporal wasting, hollowness underneath the eyes, or nasolabial lines. Treatment longevity really depends on the therapy itself. Regular fillers can last up to a year. Sculptra tends to last longer, as the collagen that’s generated stays around. The new regenerative treatments will be longer-lasting, if not permanent. But aging continues once we set the clock back, even in surgical procedures.
I think the expectations have to be toned down in nonsurgical procedures and well communicated to the patient. This is especially true with the skin tightening procedures using radiofrequency. A lot of the tightening depends on the patient’s own response to the treatment and cannot be foreseen. Every patient reacts differently and gets different tightening results.
Back to the Mirror Test
That brings me back to the patient in front of the mirror. If you reach up and pull your face upward to see the result you want, that is the result a surgical procedure gives you, not an injectable or a radiofrequency device. The deep plane facelift and the endoscopic deep plane lift are great procedures that create very natural and long-lasting results. We’re seeing patients completely avoid the noninvasive procedures and go straight to the surgical procedures early on.
Why Choose Dr. Agullo
Double board-certified, American Board of Plastic Surgery and 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. Affiliate Professor at UTEP. Castle Connolly Top Doctor for thirteen consecutive years. Trained at the Ponytail Academy intermediate course in Pittsburgh and the advanced course in Santa Monica. Because I do both the nonsurgical work and the surgery, I have no incentive to sell you the wrong one.
Ready to Talk?
If you are in the early stages and want to maintain, or if you have done the mirror test and you already know the answer, the first step is the same. Come in, let me look at your face, and I will tell you honestly which side of the line you are on.
For the surgeon’s editorial take on where this field is heading, see the companion essay on drworldwide.com. For the MedSpa-to-surgery continuum at the practice, see the version on swplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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