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Plastic surgery techniques have never been better. So why is patient satisfaction at an all-time low? Dr. Sam Jejurikar and Dr. Sal Pacella take on the uncomfortable answer: social media. In a 2024 survey of hundreds of plastic surgeons, roughly two-thirds named social media as the single biggest driver of patient dissatisfaction in their practices. Filters and AI-generated images now promise results no operation could deliver, and patients are arriving at consultations holding those images up as the standard. Sam and Sal trace the line from body dysmorphia to Zoom dysmorphia to Snapchat dysmorphia, why facelift and neck lift consults jumped tenfold in the years after the pandemic, and what Sal calls "the Instagram expectation": the belief that recovery is as instant as tapping a filter. They also get honest about the bind this puts surgeons in. Telling patients the truth about recovery is the right thing to do, and it can also cost you the patient. In this episode: - Why better surgery has not produced happier patients - The 2024 survey where two-thirds of plastic surgeons pointed at social media - Filtered rhinoplasty requests, and noses that only exist in an app - Body dysmorphia, Zoom dysmorphia and Snapchat dysmorphia - Why every surgeon shows their best results, and how that compounds the problem - Where AI morphing and simulated results help, and where they backfire - How both surgeons set expectations for recovery, and what it costs them (00:49) Best techniques ever, lowest satisfaction ever (01:15) Nobody knows what's real anymore (03:11) The survey: two-thirds of surgeons blame social media (04:36) Body dysmorphia to Zoom dysmorphia to Snapchat dysmorphia (06:37) Bare knuckles: good for your practice, bad for your life? (07:43) "The Instagram expectation" (08:11) Telling the truth when the truth costs you patients (10:08) AI morphing and rhinoplasty (12:13) Final thoughts Beauty and the Beasts is hosted by board-certified plastic surgeons Dr. Sam Jejurikar of Dallas, Texas and Dr. Sal Pacella of San Diego, California. Two plastic surgeons. No filter. New episodes every other Tuesday. This podcast is for educational purposes only and is not medical advice. Every patient is different. Please consult a board-certified plastic surgeon about your own situation.

Neck lifts are exploding in popularity, and it's one of the few areas of facial rejuvenation where men show up as often as women. In this episode, Dr. Sam Jejurikar and Dr. Sal Pacella break down the aging neck layer by layer: skin, fat, muscle, and glands, and get honest about which treatments actually deliver. They dig into why radiofrequency devices like Morpheus8 and SoftWave impress at first but often disappoint later, and who's genuinely a good candidate. Dr. Jejurikar shares his own Kybella disaster story involving a transatlantic flight and a very swollen neck, and both surgeons explain why they've moved on from fat dissolvers. From there it's into the deep end: submandibular gland reduction, digastric muscles, and the real risk-reward conversation behind deep neck surgery. Then the big one: is a "deep plane neck lift" a real operation or a marketing term? Two surgeons who actually do this work give it to you straight, along with why an isolated neck lift can be a great operation for men but almost never works for women, and the sleeper procedure Dr. Pacella loves for guys with short hair: the neck Z-plasty. If you're researching a consultation or just tired of the buzzwords on social media, this one gives you the anatomy, the honest opinions, and the questions to ask.

What actually helps you recover faster after plastic surgery, and what's just hype? Board-certified plastic surgeons Dr. Sam Jejurikar (Dallas, TX) and Dr. Sal Pacella (San Diego, CA) separate the evidence from the wishful thinking, including their own self-experiments with the "Wolverine stack." In this episode: - ERAS protocols: staying ahead of pain and nausea before surgery even starts - Aprepitant (Emend), the one-pill prescription that prevents postoperative nausea - The truth about "clear liquids" and hydration before surgery - Journavx, the first truly new class of pain medication in decades: how it works, the trial data, and why it's replacing opioids in our practices - Nerve blocks, TXA, Exparel, and old-school pain pumps - Peptides like BPC-157, TB-500, and sermorelin: what the evidence really says - The Wolverine stack: our honest results after trying it ourselves - Hyperbaric oxygen therapy (HBOT): faster healing or hopeful thinking? Watch the video version on YouTube: https://www.youtube.com/@BeautyandtheBeastsPodcast All episodes: https://www.beautyandthebeasts.com DISCLAIMER: This podcast is for informational and entertainment purposes only and does not constitute medical advice. The discussion of any medication, peptide, or therapy is not an endorsement or recommendation. Always consult your own physician before starting, stopping, or changing any treatment.

One of the most common consults in breast surgery today isn't augmentation, it's downsizing. Dr. Sam Jejurikar (Dallas Plastic Surgery Institute) and Dr. Sal Pacella (San Diego / La Jolla) sit down for another candid, no-filter conversation, this time on why so many women who got bigger implants in their 20s and 30s come back 10, 20, even 30 years later wanting something smaller and more natural. They cover: Why cup sizes (C, D, double D) mean something different from every implant manufacturer, and why that confuses the consult from day oneThe anatomy problem: what happens when a patient chooses an implant wider than her own breast base, and why that choice catches up with her later"Internal bra" mesh support: what it actually does, what it doesn't, and where Sam and Sal disagree on how well it holds up over timeWhen downsizing requires a full breast lift versus a smaller scar option, and why patients often want to skip the lift they actually needThe ethical question both surgeons wrestle with after two-plus decades in practice: how much responsibility does a surgeon carry for an implant choice made years agoWhether you're considering your first augmentation or thinking about going smaller after years with implants, this episode lays out the physics, the anatomy, and the honest tradeoffs nobody tells you about upfront. Hosted by:  Dr. Sam Jejurikar, MD, Dallas Plastic Surgery Institute  https://dallasplasticsurgery.pro/ Dr. Sal Pacella, MD, MBA, San Diego, CA  https://drpacella.com/ Beauty and the Beasts: two plastic surgeons, no filter.

Every surgery leaves a scar. There is no such thing as scarless surgery. But there is a lot you and your surgeon can do to make a scar as imperceptible as possible. Dr. Sam Jejurikar (Dallas) and Dr. Sal Pacella (San Diego) cut through the marketing and break down what the evidence actually supports for scar care: why every scar looks thick and red at three to four weeks (and why that's normal), how scars keep remodeling for one to two years, and why patience is half the battle. They cover silicone sheets vs. gels and why total wear time matters more than anything, how to do scar massage correctly (firm pressure, not a spa day), the real difference between a keloid and a hypertrophic scar, and when microneedling, retinoids, lasers, or steroid and 5-FU injections make sense. Plus: when a scar revision is the right call, when it's too soon, and the one popular remedy the evidence says to skip. Sorry, vitamin E. Two plastic surgeons. No filter. Dr. Sam Jejurikar: https://www.drjplasticsurgeon.com Dr. Sal Pacella: https://www.drpacella.com This episode is for educational purposes only and is not medical advice. Always consult your own physician about your specific situation.

Dr. Sam Jejurikar and Dr. Sal Pacella cut through a two hundred billion dollar industry to answer a simple question: what actually works? In this episode of Beauty and the Beasts, Dr. Sam Jejurikar explains why "medical grade" skincare is not a category the FDA recognizes, why a fifteen dollar sunscreen applied every day beats a two hundred dollar one applied occasionally, and how a genuinely effective regimen can be built for around a hundred dollars a month. The two surgeons walk through the four pillars they recommend to patients: daily broad spectrum sunscreen at SPF 30 or higher, retinoids stepped down to retinols for maintenance, an antioxidant such as vitamin C, vitamin E, or niacinamide, and a moisturizer. Dr. Pacella makes the case for physical blockers containing zinc oxide and titanium dioxide, and argues that what you put in your body matters as much as what you put on it. They also cover why the peeling and redness from tretinoin is a sign the product is working rather than an allergic reaction, why exosomes are heavily marketed and thinly supported by evidence, and how to think about laser resurfacing for sun damaged skin. Ablative versus non-ablative. Fractionated versus full field. CO2 versus erbium. Plus a blunt rule of thumb: the effectiveness of a laser treatment tends to track with its downtime. The episode closes on the sun protection blind spots almost everyone misses. The eyelid margins. The light reflecting off pavement, right under the brim of that hat. The sunglasses that focus ambient sun back onto the skin. The ears. As Dr. Pacella puts it, it is the only skin you have. Dr. Sam Jejurikar is a board certified plastic surgeon in Dallas, Texas. Dr. Sal Pacella is a board certified plastic surgeon in San Diego, California. Beauty and the Beasts is available on Apple Podcasts, Spotify, YouTube, and everywhere you get your podcasts. New episodes every other Tuesday. #SamJejurikar #DrJejurikar #BeautyAndTheBeasts #Skincare #PlasticSurgery

Lip filler has been responsible for some of the biggest aesthetic failures in cosmetic medicine. That is the bold claim that kicks off this episode, and both hosts agree it is true. Board-certified plastic surgeons Dr. Sam Jejurikar (Dallas) and Dr. Sal Pacella (San Diego) dive into the most visible topic in plastic surgery: the lips. They trace the evolution of lip aesthetics from the thin lips of old Hollywood through the J.Lo gloss era to the overfilled Kylie Jenner years, and explain why the pendulum has finally swung back toward natural results. Along the way they cover the permanent scarring that years of filler can leave behind, the silicone lip implant disaster that should have never happened, who is (and is not) a good candidate for a lip lift or corner lift, why fat grafting to the lips so often disappoints, and Dr. Pacella's preferred technique of using the patient's own SMAS tissue during a deep plane facelift for longer-lasting augmentation. For anyone considering their first syringe of filler, the advice is simple: less is more. And for patients with years of built-up, scarred filler, the hosts walk through the "lip rehab" approach of dissolving old product over multiple sessions before starting fresh. Plus, a cautionary tale about Botox around the mouth that involves one of the hosts, a missing front tooth, and nine months of talking funny. New episodes every other Tuesday.

Dr. Sam Jejurikar and Dr. Sal Pacella dig into Preservé, the new breast augmentation technique built around the Motiva ergonomic implant, and ask the question dividing plastic surgery right now: is it a real breakthrough or just great marketing? Dr. Jejurikar makes the case for why Preservé may be changing breast augmentation in a way the field has not seen before. Rather than cutting the tissue behind the breast, the technique uses fluid infiltration and a balloon dissector to gently separate the natural plane between the breast gland and the muscle, preserving the circumareolar ligament that locks the implant in place. The payoff is a smaller incision, no tissue cutting, and an implant that sits remarkably stable. He shares what he is seeing across more than 100 Motiva cases and why he has become a believer, while staying candid about what the data does and does not yet prove. Dr. Pacella brings the skeptic's eye, drawing on the technique he has watched performed in Costa Rica and pressing on pocket tightness, capsular contracture, and whether the balloon dissector is truly necessary or whether this is simply a small implant through a small incision. Together they land on the points patients need to hear, including the local anesthesia marketing, the micro-texturing and capsular contracture debate, and the key caveat that Preservé is a retroglandular procedure without the long term track record we have for subfascial and subpectoral placement. In this episode:  The embryology behind breast preservation surgery  How the Preservé balloon dissection actually works  Local versus general anesthesia for augmentation  Micro-texturing and the capsular contracture data  Why the implant may matter as much as the technique  Does Preservé just mean using a smaller implant? Whether you are researching your own options or you work in the field, this is the honest, two sided breakdown the Beauty and the Beasts audience comes for.

Perimenopause is finally getting the attention it deserves, and it shapes cosmetic surgery results far more than most people realize. In this episode of Beauty and the Beasts, Dr. Sam Jejurikar of Dallas and Dr. Sal Pacella of San Diego break down how the hormonal shifts of perimenopause and menopause change the face, the breast, and the way patients heal. Two board-certified plastic surgeons explain why estrogen and progesterone start declining in the 40s, how that drives collagen loss, thinning skin, and facial deflation, and why women can lose one to two percent of their collagen every year leading up to menopause. They dig into how low estrogen can undercut fat transfer results, why radiofrequency skin tightening loses its punch after menopause, and the underrated roles of sleep, cortisol, and growth hormone in surgical recovery, including the emotional dip so many patients feel a few days after surgery. They also tackle the practical questions patients actually ask. Should you stop hormone replacement therapy before surgery? How does blood clot risk factor into that decision, and how do the Caprini score and the type of procedure guide their approach? And why do breast changes like lower pole thinning and the waterfall deformity matter so much for augmentation and lifts? The takeaway is honest and clear, including why your plastic surgeon is not the one who should be prescribing your hormones. If you are navigating perimenopause or menopause and thinking about your skin, your breasts, or a future procedure, this is a grounded, judgment-free conversation worth your time. In this episode:  Why perimenopause matters to plastic surgeons and not just gynecologists. The collagen and elasticity changes that accelerate after menopause. How hormones affect fat transfer, facelifts, and breast surgery results. Sleep, cortisol, and recovery. The blood clot conversation around hormone therapy and surgery. What to expect emotionally after a procedure. Beauty and the Beasts is hosted by Dr. Sam Jejurikar and Dr. Salvatore Pacella, two board-certified plastic surgeons sharing honest, behind-the-scenes conversations about aesthetic surgery, wellness, and the topics that matter most to their patients. This episode is for educational and informational purposes only and is not medical advice. It does not create a doctor-patient relationship. Always consult a qualified, board-certified physician about your individual situation.

Celebrity plastic surgery is everywhere right now, and the Kris Jenner and Denise Richards facelift stories have quietly touched off a real debate inside the plastic surgery world. In this episode of Beauty and the Beasts, Dr. Sam Jejurikar of Dallas and Dr. Salvatore Pacella of San Diego go past the headlines and talk through what is actually going on. Two board-certified plastic surgeons explain why a third facelift at 70 is a completely different operation than a first facelift in your 50s, why the safest technique is often the smartest choice on a revision, and why almost everyone looks phenomenal at three months postop, a phenomenon one surgeon calls the siren of swelling. They get candid about how GLP-1 weight loss medications can quietly undo facelift and fat transfer results, the realistic healing timeline every patient should expect, how age and skin elasticity change the outcome, those six-figure price tags, and the uncomfortable trend of surgeons piling on one another online. If you have ever wondered what a facelift really looks like as it ages, or how much of what you see on social media is filtered, swollen, or simply too good to be true, this is the honest conversation you have been looking for. In this episode:  The two very different stories behind Kris Jenner and Denise Richards. Why filtered photos and early swelling make results look better than they will hold. The real timeline of recovery from three weeks to six months. First facelift versus third facelift and the risk to the facial nerve. Why GLP-1 medications matter more than most patients realize. What you are actually paying for when a facelift costs more than a car. Beauty and the Beasts is hosted by Dr. Sam Jejurikar and Dr. Salvatore Pacella, two board-certified plastic surgeons sharing honest, behind-the-scenes conversations about aesthetic surgery, the industry, and the stories making headlines. This episode is for educational and informational purposes only and is not medical advice. It does not create a doctor-patient relationship. Always consult a qualified, board-certified physician about your individual situation.

One in eight Americans is now on a GLP-1 medication like Ozempic, Wegovy, or Zepbound. The weight loss can be life-changing, but there is a side of this story that rarely gets talked about openly: what these medications are doing to your face, your skin, your muscle mass, your bone density, and your body contour. In this episode, board-certified plastic surgeons Dr. Sam Jejurikar (Dallas, TX) and Dr. Sal Pacella (San Diego, CA) bring a combined four decades of surgical experience to one of the most pressing topics reshaping their practices today. They break down the predictable patterns of facial volume loss they are seeing, including hollowing of the cheeks, temporal wasting, dark circles from mid-face descent, and loss of skin elasticity that goes beyond what you would expect from weight loss alone. They discuss why fat grafting results in GLP-1 patients may not be as durable as expected, and why GLP-1 receptors expressed on fat cells themselves may be to blame. The episode features a lively disagreement on Sculptra: Dr. Pacella is firmly in the skeptic camp, calling it a reverse ATM machine, while Dr. Jejurikar makes the case that conservative, layered treatments delivered every six to eight weeks can serve as an effective volumizing foundation for the right patient. They also explore the promise and limitations of AlloClae cadaveric fat grafting, currently FDA approved for the breast and body but generating serious interest for facial applications. The conversation then shifts to the body, covering the underappreciated impact of GLP-1s on muscle mass and bone density, why resistance training is now a clinical conversation happening in plastic surgery offices, and why brachioplasty and thigh lift volumes have increased fivefold in recent years. They also tackle Ozempic butt directly, explaining the combined role of fat loss, muscle atrophy, and pelvic structural changes, and why excisional lifting procedures are increasingly replacing the Brazilian Butt Lift for this growing patient population. GLP-1 medications are not going anywhere. Newer agents, oral formulations, and triple-mechanism drugs like Retatrutide are already in the pipeline. For patients and surgeons alike, understanding the downstream effects is no longer optional. Dr. Sam Jejurikar is a board-certified plastic surgeon and President of Dallas Plastic Surgery Institute. Dr. Sal Pacella is a board-certified plastic surgeon in private practice in San Diego, California. Together they host Beauty and the Beasts, a podcast dedicated to honest, unfiltered conversations about plastic surgery, aesthetics, and the science behind looking and feeling your best. Follow Dr. Jejurikar on Instagram: @samjejurikar Follow Dr. Pacella on Instagram: @sandiegoplasticsurgeon

In this episode, Dr. Jejurikar and Dr. Pacella tackle one of the most underappreciated operations in cosmetic plastic surgery: the brow lift. Most patients never come in asking for one. They come in saying they look tired, they want something done about their eyes, and the brow is the hidden culprit. The guys break down why the high, pulled look of the 1990s coronal brow lift is outdated, why endoscopic brow lifts tend to disappoint over time, and why the subcutaneous sliding brow lift has become their preferred approach. They also get into the role of fat grafting in brow rejuvenation, the hemostatic net technique, and how Botox fits into the picture long-term. For male patients, the conversation shifts to brow stabilization rather than elevation, including the direct brow lift and the scarless trans-palpebral approach. If you've ever wondered why your upper eyelid surgery didn't give you the result you hoped for, this episode might explain why.

The Plastic Surgery Consultation What Patients Should Expect In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella focus on one of the most important parts of plastic surgery that often gets overlooked: the consultation. For many patients, the first visit with a plastic surgeon can feel intimidating. Most people arrive having done extensive online research and often come in asking for a specific procedure. Dr. Jejurikar and Dr. Pacella explain why the best consultations are not about requesting an operation, but about clearly explaining concerns, goals, and what truly bothers the patient. The conversation explores how experienced surgeons structure a consultation, beginning with open ended questions and careful listening. The hosts emphasize the importance of rapport and trust, noting that plastic surgery is often a concierge style relationship that requires strong communication before, during, and after surgery. A major focus of the episode is the physical examination and why it remains essential in plastic surgery. Dr. Pacella discusses the value of face to face interaction, hands on examination, and tissue evaluation, and why these elements cannot be replaced by electronic medical records or imaging alone. The episode also covers the questions patients should expect to have answered during a consultation, including safety, recovery, and implant related concerns. The surgeons discuss how they address breast implant associated conditions, including lymphoma and breast implant associated illness, and why transparency about what is known and unknown is critical. Financial considerations are addressed as well, including third party financing and how patients can prepare in advance to understand costs and options. The role of three dimensional imaging is discussed, with insight into how modern tools are best used for communication and assessment rather than exact prediction of results. The episode concludes with a discussion on board certification and recovery planning, explaining why training, qualifications, and a clear understanding of postoperative recovery are essential before moving forward with surgery. This episode is ideal for anyone considering plastic surgery, preparing for a first consultation, or wanting a clearer understanding of how to choose a surgeon and get the most out of the consultation process.

Revision Breast Surgery Why Secondary Breast Operations Are So Common In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella discuss secondary and revision breast surgery and explain why it is one of the most common procedures in modern breast surgery. Many patients are surprised to learn that breast implants are not lifetime devices. Over time, changes in breast tissue, aging, pregnancy, weight fluctuation, implant wear, and personal preferences often lead patients to require revision surgery. In many practices, secondary breast operations are performed as frequently as primary breast augmentation. The conversation covers the most common reasons patients seek breast revision, including capsular contracture, implant rupture, malposition, bottoming out, asymmetry, and changes in desired implant size. Dr. Jejurikar and Dr. Pacella explain what capsular contracture is, why it occurs, and how it can affect both comfort and appearance. The episode highlights why revision breast surgery is significantly more complex than primary breast augmentation. Unlike first time surgery, revision cases often require pocket reconstruction, correction of the breast fold, reinforcement of tissue support, and frequently a breast lift to restore proper shape and nipple position. Dr. Pacella explains the role of internal support systems, often referred to as internal bras, and why tissue that has supported implants for many years is often unreliable on its own. The surgeons clarify that internal support does not replace the need for a breast lift and discuss how physical exam findings determine the surgical plan. Implant technology and capsular contracture prevention are discussed, including Motiva implants, acellular dermal matrices, and bioresorbable meshes. The surgeons explain what the current medical literature supports and where data is still lacking. The episode also addresses ruptured breast implants, how they are diagnosed using ultrasound or MRI, whether ruptures pose health risks, and why addressing them sooner rather than later can simplify revision surgery. This episode is ideal for patients with breast implants, those considering revision breast surgery, and anyone who wants a realistic understanding of why secondary breast operations are common and how they are approached safely and effectively.

Rhinoplasty - Form, Function, and Natural Results In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella explore rhinoplasty, one of the most technically demanding and misunderstood procedures in plastic surgery. Rhinoplasty is often thought of as cosmetic nose reshaping, but the surgeons explain why it is just as much about structure and breathing as it is about appearance. The discussion highlights why rhinoplasty requires a unique skill set, why experience matters, and how small changes can have a major impact on both aesthetics and airflow. Dr. Jejurikar and Dr. Pacella compare open and closed rhinoplasty techniques and explain why the choice depends on surgical goals rather than patient requests. They discuss cartilage support, tip shaping, and why the small scar associated with open rhinoplasty is usually insignificant. The episode addresses common patient misconceptions, including the desire to copy celebrity noses. The surgeons explain why nasal skin quality, facial proportions, and individual anatomy make this unrealistic and why the goal should always be for the nose to fit the face while preserving identity and character. Male and female rhinoplasty differences are discussed, with a focus on subtlety in male patients and the risks of over reduction. The surgeons explain how masculine nasal features differ from feminine ones and why preserving these differences is critical. A significant portion of the conversation focuses on functional rhinoplasty and breathing. Dr. Pacella explains how airway evaluation, septal alignment, and internal nasal valve support are essential parts of planning surgery. Dr. Jejurikar discusses how cosmetic maneuvers can unintentionally affect breathing if not carefully managed. Recovery is covered in detail, including what patients can expect in the first few weeks, why swelling resolves gradually, and why final results continue to refine over a full year. Dr. Pacella also shares his personal experience undergoing rhinoplasty for breathing issues and how it shaped his approach to patient care. This episode is ideal for patients considering rhinoplasty, those researching cosmetic or functional nose surgery, and clinicians interested in the intersection of aesthetics and airway preservation.