Honors and Awards:

Most Compassionate Doctor Award, Vitals.com, 2012

Best Scientific Exhibit Award by a Candidate or Resident in 2007, American Society for Aesthetic Plastic Surgery and the Aesthetic Surgery Education and Research Foundation, 2008.

 

Outstanding Performance in Research Award, Texas Tech University Health Sciences Center at El Paso, 2007.

 

Steve H. Dougherty, MD Academic Excellence Award, Texas Tech University Health Sciences Center at El Paso, 2005.

 

Special Licenses/Certifications:

Certified by the American Board of Plastic Surgery

Certified by the American Board of Surgery

Professional Activity:

Clinical Associate Professor of Plastic Surgery, Texas Tech University Health Sciences Center, Paul Foster School of Medicine

Community Service:

Volunteer at Smile Network for cleft lip and palate repairs abroad.

Publications, Lectures and Presentations:

BACKGROUND: : Several flaps have been described to provide autologous

augmentation to the gluteal area. Since the authors' original description of a

dermal fat flap for buttock augmentation during lower body lift in 2005, the

procedure has been refined considerably. Unique to previously described flaps,

the technique results in maximum projection of the buttock at its midportion. A

decrease in fatty necrosis and greater mobility has been achieved by

transitioning to a split gluteal musculocutaneous flap.

METHODS: : In a retrospective review from January of 2004 to August of 2010, 200

patients, aged 24 to 57 years, underwent autologous buttock augmentation. The

last 50 patients of the series underwent an incorporation of a split section of

gluteus maximus muscle. Patients were followed for 6 months to 4 years.

RESULTS: : Of the 200 patients, 30 had the buttock flap as an isolated buttock

lift and augmentation; the remainder of the procedures were performed in

conjunction with a circumferential body lift. Incorporation of the split gluteus

maximus muscle facilitated the rotation of the flap caudally and increased the

vascular supply to the flap. Ten percent of the patients had minor complications,

which included small areas of delayed wound healing and partial fat necrosis of

the dermal flaps. In the group with split musculocutaneous flaps, there was no

fatty necrosis. Results were maintained over time.

CONCLUSIONS: : This is a reliable, versatile, and efficient flap for autologous

buttock augmentation. With recent modifications, the incidence of fatty necrosis

has been substantially decreased. CLINICAL QUESTION/LEVEL OF EVIDENCE::

Therapeutic, IV.

Split gluteal muscle flap for autoprosthesis buttock augmentation., Plast Reconstr Surg. 2012 Mar;129(3):766-76., 2012

Gynecomastia is a condition with increase prevalence and the advent of new developments and techniques require a dynamic update to deliver the best possible outcome. Several options are available today to address the different degrees of gynecomastia. The careful analysis of individual patients will permit the selection of the appropriate treatment method to deliver the best result. Psychological guidance plays an important role in the treatment of the condition.

 

Gynecomastia and Liposuction, Current Concepts in Plastic Surgery, Dr. Frank Agullo (Ed.), ISBN: 978-953-51-0398-1, InTech, 2012

INTRODUCTION: The eyelid of a young person can be distinguished by the lateral

fullness of the upper eyelid. With aging, lateral fullness decreases. Volume

restoration in the periorbital area has been previously addressed by fat draping

and grafting. More recently, techniques for regaining lateral fullness of the

upper eyelid have focused on fat grafting, although effective graft take,

reabsorption, and irregularities have been a concern. To address these issues,

the concept of pedicled fat draping in the upper eyelid was explored.

METHODS: In a retrospective study from June 2006 to August 2008, 31 patients

underwent upper blepharoplasty with augmentation of the lateral fullness with a

pedicled fat flap from the central fat pad. The fat from the central compartment

was elevated, dissected, and then transposed to the lateral upper eyelid below

the orbicularis muscle.

RESULTS: All patients were women ranging in age from 43 to 68 years. Pre- and

postoperative picture comparison demonstrated a more youthful appearance with

increased lateral fullness of the upper eyelids. There were no cases of fat

necrosis encountered. Increased volume remained stable over an average of

one-year follow-up. No complications were recorded.

CONCLUSION: Transposing a pedicled fat pad from the central compartment laterally

has proven to be an effective technique for achieving predictable upper lateral

eyelid fullness and thus achieving a long-lasting, more youthful appearance.

 

Pedicled fat flap to increase lateral fullness in upper blepharoplasty., Aesthet Surg J. 2010 Mar;30(2):161-5., 2010

In performing bowel flaps for voice reconstruction, it is common practice to

delay skin grafting to allow for swelling and monitoring. Harvesting the skin

graft at the time of reconstruction and banking it at its donor site allows for

later transfer at bedside. Ten patients between January and July of 2006 had skin

harvested from their thigh at the time of intestinal transfer and banked at the

donor site. Transfer of the graft from donor to recipient site was carried out at

bedside between the third and eighth postoperative day with sedation and

analgesia. Elevation of the graft was well tolerated and take was over 95% in all

cases without related complications. At follow-up between 5 and 12 months all

grafts had healed. This is a reliable technique for skin storage in diverse

clinical applications or when traditional skin banking cannot be performed

because of tissue banking regulations.

 

Delayed skin grafting utilizing autologous banked tissue., Ann Plast Surg. 2009 Sep;63(3):311-3., 2009

BACKGROUND: Buttock contouring represents a surgical challenge, particularly when

both ptosis and volume deficit are present. Isolated buttock lifts may cause a

flattened buttock contour, whereas augmentation with implants or fat injections

alone my not correct the ptosis.

OBJECTIVE: We describe a buttock lift with a dermal fat flap that provides

correction of the buttock contour in such cases.

METHODS: A retrospective review was conducted of 10 patients, aged 26 to 57

years, who underwent a buttock lift with autologous dermal flap augmentation.

Patients were followed up between 6 months and 2 years.

RESULTS: A comparison of preoperative and postoperative photographs indicated

improved buttock contour and maximum augmentation at the midlevel of the

buttocks. There were no major or minor complications. Patient satisfaction was

high.

CONCLUSIONS: Autologous dermal flap gluteal augmentation is a versatile technique

that addresses both buttock ptosis and volume deficit. Drawbacks include an

extended incision line that, however, is easily concealed by underwear or a

bikini.

 

Autologous augmentation gluteoplasty with a dermal fat flap., Aesthet Surg J. 2008 Jan-Feb;28(1):70-6., 2008

BACKGROUND: Patients with a pear- or guitar-shaped body contour deformity are not

frequently encountered, but represent a surgical challenge. Traditionally, these

patients have been treated with belt lipectomies, lower body lifts, medial thigh

lifts, and liposculpture because liposuction alone often is insufficient. This

article describes an alternative method for performing a medial, anterior, and

lateral thigh lift with a buttock lift and autoprosthesis augmentation through a

single spiral incision easily concealed by underwear.

METHODS: A retrospective study of patients treated for body contour deformities

from January 2004 to June 2006 was conducted. The inclusion criteria for spiral

lift were lipodystrophy and excess skin and subcutaneous tissue of the thighs,

flanks, and buttocks without contour deformities of the abdomen. The incision

extends from the inferior crease of the buttocks along the inguinal crease and

continues just inferior to the anterior iliac spine, spiraling above the buttocks

and meeting the contralateral incision at the sacrum. A dermal fat flap is

rotated to function as an autologous buttock implant. Pre- and postoperative

views, patient satisfaction, complications, and operative details are analyzed

and described.

RESULTS: Of the 253 consecutive patients treated for body contour deformities, 5

met the inclusion criteria for the spiral lift. All the patients were women

ranging in age from 30 to 43 years. Comparison of pre- and postoperative views

demonstrated improved contour and firmness of the thighs and gluteal region with

easily concealed scars. The inferior gluteal sulcus became less evident, and the

buttock mass was elevated and augmented with maximum projection at midlevel.

Patient and surgeon satisfaction was high. One patient experienced delayed wound

healing. Stability in the body contour repair was demonstrated at the 1-year

follow-up assessment.

CONCLUSIONS: A reliable, versatile, and effective technique is described.

Applicability and experience with the procedure are limited due to infrequent

presentation of patients seeking correction for such a body contour deformity.

 

Spiral lift: medial and lateral thigh lift with buttock lift and augmentation., Aesthetic Plast Surg. 2008 Jan;32(1):120-5., 2008

BACKGROUND: Improvements and variations in abdominoplasty techniques have

complicated patient and procedure selection. The authors describe their

guidelines for selecting the ideal procedure to be used with patients by

stratifying them into treatment groups according to the presence and location of

excess skin and subcutaneous tissue, lipodystrophy, and abdominal wall laxity.

METHODS: A prospective study analyzed 151 female patients treated for abdominal

contour deformities from January 2004 to July 2005. The patients were

systematically classified into five treatment groups: mini-abdominoplasty (5%),

standard abdominoplasty (42%), abdominoplasty with liposuction and minimal

midline undermining (10%), standard abdominoplasty with removal of deep fat

(13%), and circumferential abdominoplasty (30%).

RESULTS: The patients had a mean age of 42 years and a mean body mass index (BMI)

of 26 kg/m(2). The prevalence of overweight (BMI, 25.0-29.9) was 37%, and that of

obesity (BMI > 30.0) was 19%. Comparison of pre- and postoperative photographs

included improved tension of the entire abdominal wall, enhancement of the

waistline, and increased uniformity of the contour of the abdomen. There was a

significant difference in mean BMI between preabdominoplasty (26 kg/m(2)) and

postabdominoplasty (24 kg/m(2)) (p = 0.01). The prevalence of overweight and

obesity decreased by 8% and 9%, respectively (p = 0.01), and a decrease in BMI

occurred within each abdominoplasty subgroup (p = 0.01). The prevalence of

complications was 11%. Seroma (4%) and delayed wound healing (4%) were the most

common. One case of pulmonary embolus was encountered. Although there was a

positive trend in complications with higher BMI, no statistically significant

difference was found (p = 0.74). Half of the patients had additional procedures

performed without a significant increase in complications (p = 0.5).

CONCLUSIONS: The described algorithm for abdominoplasty selection is safe,

effective, and flexible, with long-term improvement in abdominal contour and BMI.

 

Decision making in abdominoplasty., Aesthetic Plast Surg. 2007 Mar-Apr;31(2):117-27., 2007

A novel method for plication of the abdominal fascia in miniabdominoplasty

addresses abdominal laxity and improves the waistline. The design comprises a

vertical plication of the rectus fascia from xiphoid to pubis and fusiform

plication of the oblique fascias with limited undermining and scars, all in the

setting of a miniabdominoplasty. The procedure was performed for 10 women

undergoing surgery between January and December 2004. The technique resulted in

improved tension of the entire abdomen, a decreased perimeter of the waist, and

improved uniformity in the contour of the anterior and lateral view, avoiding the

epigastric bulking generated when infraumbilical vertical plication is used

alone. There were few minor and no major complications. At the follow-up

assessment 6 months to 2 years after surgery, there was no loss of the improved

muscle-aponeurotic tension or abdominal contour. Triple plication of the fascia

provides a good method for improving both the waistline and abdominal laxity in

the setting of a miniabdominoplasty.

 

Triple plication in miniabdominoplasty., 2006

With the increasing popularity of bariatric surgery, patients with multiple body

contour deformities have become more common in plastic surgery practice. Most of

the deformities involving the abdomen, thighs, and buttocks can be effectively

corrected with belt lipectomy and lower body lift. A common problem with this

procedure is postoperative loss of gluteal projection and resulting flattened

buttock contour, which is directly proportional to the extent of lower body lift

achieved. The use of local myocutaneous flaps to provide coverage for the

lumbosacral defects is a common plastic surgery procedure. The authors have used

these techniques to create an autologous buttock implant for additional

projection during a lower body lift. A local myocutaneous flap originating within

the regularly excised supragluteal tissue is rotated caudally to function as an

autologous buttock implant. This flap has reliable circulation, can be custom

designed for each patient, requires minimal additional operating time, and allows

the creation of more than one flap if necessary. This article describes the

results of this procedure used for 20 consecutive women. There were no major

complications, and the most common minor complications included delayed wound

healing and local hardness in the area, suggesting fat necrosis, which resolved

without intervention in a few months. High patient satisfaction combined with a

low complication rate suggests that this reliable, versatile technique nicely

complements the lower body lift procedure.

 

Autoprosthesis buttock augmentation during lower body lift., Aesthetic Plast Surg. 2005 May-Jun;29(3):133-7, 2005

Video:

Frank Agullo, MD. Introduction and welcome video.