S01E14 3 Plastic Surgeons and a Microphone - Top 10 Myths of Aging
Dr. Sam Rhee: [00:00:00] Hello, and welcome to Three Plastic Surgeons and a Microphone. We are on show number 14 with my costars as always Dr. Salvatore Pacella. From LA Jolla, California. His Instagram handle is @SanDiegoplasticsurgeon. Dr. Sam Jejurikar from Dallas, Texas. His IG handle is @samjejurikar and I am Sam Rhee from Paramus New Jersey.
And my Instagram handle is @Bergencosmetic. Good morning. 
Dr. Sam Jejurikar: [00:00:30] Good morning. How are you doing on the moon? Dr. Pacella?
Dr. Salvatore Pacella: [00:00:38] Yeah, 
Dr. Sam Jejurikar: [00:00:40] you have come along where we can see people from such a great distance. 
Dr. Salvatore Pacella: [00:00:45] I apologize. So here's the promoter behind this. I got a new laptop and I neglected to test the webcam until today. And it's right at the bottom of the screen. So if I adjust my screen, you could see my keyboard. It's terrible laptops.
Great. But the one thing I like about the one thing I like about it, despite the fact that I'm looking up at you, my neck looks fancy. Fantastic.
Dr. Sam Jejurikar: [00:01:14] Nice. Very nice. 
Dr. Salvatore Pacella: [00:01:18] I got to do one on Amazon, so I don't have to hear you.
Dr. Sam Jejurikar: [00:01:27] There'll always be something free. 
Dr. Salvatore Pacella: [00:01:30] Free one day shipping.
Alright, jokers, let's get started. 
Dr. Sam Rhee: [00:01:37] All right. So as always, this show is not a substitute for professional medical advice, diagnosis, or treatment that shows for informational purposes, only treatments and results may be a very based on circumstances, situation and medical judgment after appropriately.
Okay. Always seek the advice of your surgeon or other qualified health provider with any questions you may have regarding medical care. I never disregard professional medical advice or delay seeking advice because of something in this show. And with that, we are going to talk about the top 10 myths about aging.
This is a great topic. We're all very excited to talk about all of these, whether they are actually myths or not. So let's just get straight into it. 
Dr. Salvatore Pacella: [00:02:23] Remember it's myth, let's start with myth. Number 11, you, you age less in space.
Dr. Sam Rhee: [00:02:28] Never Looked  better. Sal
Dr. Sam Jejurikar: [00:02:35] very youthful.
Dr. Sam Rhee: [00:02:40] All right. Number 10, skin creams. Keep your skin looking young. 
Dr. Sam Jejurikar: [00:02:46] Now I cannot see the presentation. Are we supposed to be able to say, 
alright, there we go.
What well already. All right. I'm not sure this is entirely a myth in my, in my estimation. I do think that a appropriate skincare regimen is important to prevent aging, for sure. And so usually, in my practice, I'll tell patients that involves a healthy dose of sun protection as they get into their. You know, early forties, a retinol is really important.
Moisturizers exfoliation. I think skin creams have a huge role as, as we'd like to tolerate patients to protect their investment. patients are going to have surgery, to make them solvable younger. They're going to get fillers and make themselves look younger, but there is a huge role for skincare, but I agree there is no fountain of youth, skin creams do not make you look younger, but they can preserve what you have.
Right. 
Dr. Salvatore Pacella: [00:03:41] I think, you know, I think the key in here is the, is a sun protection factor. I mean, clearly, you know, we're all in areas that can have tremendous amount of sun and exposure to the world. so exposure to the solar system, 
Dr. Sam Jejurikar: [00:03:54] particularly without an ozone layer in space,
Dr. Salvatore Pacella: [00:04:04] obviously you're a 
Dr. Sam Jejurikar: [00:04:05] Dallas,
Dr. Salvatore Pacella: [00:04:08] New Jersey busy. There's a lot of sun. I mean, your, your Jersey, Jersey folks, you know, you're getting a lot of sun exposure on the Jersey shore, July to September, right? So the SPF. SPF factor is key, particularly here in San Diego, La Jolla, but, you know, when I, when I go out, when I traveled to outer space, I usually usually use about a 200 SPF.
So ridiculous. A lot of good sound bites. This episode.
Dr. Sam Rhee: [00:04:45] my audio cut out for about a 60 seconds there. So I missed a little bit of what Sam said, but, I heard the topical stuff and, yes, there's nothing that totally eliminates wrinkles, but I agree absolutely that all of these things, can be very helpful in pro maintenance. That's the key. anything else?
Let's move on. number nine, my face gets fatter as I age. 
Dr. Sam Jejurikar: [00:05:12] Well, this is a myth or provided you stay at the same way. Now my face actually. Is getting fatter as I age, but it turns out my whole body is getting fatter and my space is not being spared. However, this is a very, very, very true in terms of the fact that it's a myth as we get older.
One of the biggest telltale signs of facial aging.: It's loss of facial  fat. And so whenever we are talking to our patients about how they get a more youthful look, it may involve facial fillers to actually add volume to the cheeks, to these folds, the nasal labial folds are marrying outlines, to the jawline.
So, so addition of fat can actually make you look. Or addition of filler can make you look more youthful. So this is a huge myth. I completely agree with this. 
Dr. Salvatore Pacella: [00:05:56] Yeah, I agree. You got to tell my patients since in San Diego here is it's, you know, I give this analogy. If you look at a baby's face, a baby who's two years old, you see a tremendous amount of facial fat.
That's a sign of youth. But if you look at somebody who's close to a hundred, their face is very skeletonized, particularly around the orbit and the, and the eye region. So that, that can be very problematic. So one of the key concepts here is as we get older, we lose a lot of fat and we want to add that in add additional fat and for facial rejuvenation, 
Dr. Sam Rhee: [00:06:31] it's actually paradoxical. When you see older patients lose weight and get fitter. they actually, they complain their face looks older, 
Dr. Salvatore Pacella: [00:06:40] older. yeah, absolutely
Dr. Sam Rhee: [00:06:41] Yeah. And, that's, one of those weird things that people complain about as they get healthier, that they look older and then that's where we come in, where we help to try to rejuvenate that for them.
All right. Number eight older patients, older patients should stick to facial procedures, not Fati procedures. 
Dr. Sam Jejurikar: [00:07:03] Well, I guess we're going to stick with the pattern of me answering first. So, what, what I will say is, yeah, that that's not remotely true in the 21st century, patients are living older.
you know, the longevity of people is just extending as, as, as everyone's people seem to be taking better care of themselves and, Patient, you know, many of my patients in their sixties, even seventies are fit and they're healthy. And they, they live the way that people did in their forties and fifties years ago.
And if they are concerned about the way that their overall appearance looks, 
the body is obviously a very important part part of it. So it's not uncommon to do. Liposuction, breast procedures, tummy talks, body lifts. All of these things on patients that are in their sixties and seventies, age is not a contraindication at all to having surgery.
It's the existence of health problems, which are diminishing with increasing frequency in our older patients. 
Dr. Salvatore Pacella: [00:07:57] Right now, I think, I think the key thing to keep in mind here is, from the petition of the patient, you know, as, as we age, excuse me, as we age, we, our skin tends to lose a lot of elasticity. So a, a procedure that's very heavily dependent on skin health.
And skin elasticity. Let's say something like tummy tuck or breast lift. That's going to be a markedly different procedure in somebody who's 30 compared to somebody who's 70. So I think the key here to understand is although body procedures can be very helpful in older patients, the expectation is different because the skin's not going to lie as. As, as, as well as potentially someone who's 30. So I think, although you could certainly still be a candidate for body procedures, we have to, we have to take those with a grain of salt. And that goes for the face as well. I think those are set points. 
So are you saying that you, you tell your patients in their sixties and seventies to not have high expectations for them?
No. No. I think, I think we have to understand. So for example, a common discussion we had is, is around tummy tuck. And, you know, in San Diego, we have a lot of fit, older patients as well, but sometimes when you're super fit, You don't have a lot of subcutaneous fat and you don't have a lot of elasticity in the skin.
And so many times, if we do say people suction that can create a situation where the skin may not retract as well as say somebody who's in their thirties. And so that can lead to some redundancy of skin. And so I think, you know, we have to understand that there's it, that liposuction is not going to do everything, particularly as you get older when, when your skin is not as elastic.
I think it's just, it's just a matter of, 
Dr. Sam Jejurikar: [00:09:45] yeah. 
Dr. Salvatore Pacella: [00:09:45] a Plastic surgeon really looking at the patient's skin and understanding with the patient, just how much, how much can be accomplished. So. 
Dr. Sam Jejurikar: [00:09:55] Yeah, I think that's very, very true. You know, I do find that in those older patients going to stick with the liposuction example, I am more likely to use ancillary technologies with them.
where, I don't know if you guys are big fans of radio-frequency in combination with your liposuction, but we use body tight, a fair amount in our patients as they get a little bit older. we're finding that. At least with our patients here in Dallas, that if you can combine radio-frequency with liposuction on some of these older patients, assuming they're not massive weight loss patients, or have huge issues with their elasticity, we can get pretty good results.
And I'm not sure if you guys have that same experience or if you're more likely to use that or ultrasound or something with those patients or, or do you, do you not, do you just tell them? I don't think our results are going to be as good. Just curious what your, what your personal approach 
Dr. Salvatore Pacella: [00:10:38] is. Yeah, we don't, we don't use a lot of ancillary technology in my office.
It's just, we don't, we don't have the ability to do that. Yeah. So it's, it's, 
Dr. Sam Rhee: [00:10:49] that's a good point. I might, offer more of a skin excision technique type of procedure. Say if I like, for example, someone who is just interested in arm liposuction, and if they're say 65 versus 30, I might say maybe if there's a lot of skin laxity, we should consider a brachioplasty.
I think older patients, their scars tend to heal very nicely in a lot of cases. And, that might be something that I would consider as well. 
Dr. Sam Jejurikar: [00:11:16] I think you guys are so right though. And I think this has been a really interesting conversation in the sense that older patients, terrible skin allows to compared to younger patients and everyone has their own individualized approach in terms of how they deal with it.
But, but they can still get body contouring procedures as they get older. I think that's, that's really the key. 
Dr. Sam Rhee: [00:11:33] Absolutely. Number seven, the older I get the less sleep I need.
Dr. Salvatore Pacella: [00:11:43] I mean, I think, I think that's a true myth. I mean, I've, as I get older, I feel like I need more sleep and sometimes I need a little nap. In the middle of the day, just like I did in kindergarten. I don't know. What do you think? 
Dr. Sam Jejurikar: [00:11:57] Well, the older I get the less sleep I get, I will say that, you know, I think there again, there's a lot of good, Good empiric evidence out there that at least from an aging standpoint, sleep is very important.
you know, in terms of reserving a less tired appearance, you, you obviously need to get more sleep, but, I actually think that, older patients in general do get less sleep than younger patients, but they're not, they, they feel good about it as a totally different issue. 
Dr. Salvatore Pacella: [00:12:23] I agree 
Dr. Sam Rhee: [00:12:24] with you. I think one of the biggest issues as older.
For older patients is, is that we may have a harder time. I put myself in the older category, older, harder time falling asleep. and also a lot of us have insomnia. which is very common. and, but it is also true that we tend to go to sleep earlier and wake up earlier than say when we were twenties.
but I think the studies have shown adults. Older adults still need the same amount of sleep every night, seven to nine hours. That's that's typical, but you're right, Sam, whether we actually get that, it's sometimes more difficult for us 
Dr. Salvatore Pacella: [00:13:00] to achieve. Yeah, I think, I'm gonna, I'm going to turn this into a little bit of a PSA here, which is, you know, I think one of the undiagnosed or underdiagnosed, problems that we have.
As we get older is the presence of sleep apnea. And that's really a silent killer. And, you know, if I think it's important to understand as a patient, if you're having issues with sleep, you're waking up in the middle of night, you're gasping for air. You know, as we get older, our neck gets thicker, our muscles get looser, and that can lead to a phenomenon of your jaw collapsing on itself.
And that can cut off oxygen in the middle of the night, undiagnosed sleep apnea. can lead to heart failure disease. It can lead to other issues. So if you're having issues with sleep, as, as you're aging, really a good idea to chat with your primary care doctor, consider getting a sleep test. There are some small maneuvers, even if you diagnose with a little bit of sleep apnea, things that that can help with maintaining sleep mouthpieces, C-PAP things that, you know, things around sleep hygiene, setting your phone down, avoiding blue light, et cetera.
Dr. Sam Rhee: [00:14:11] Absolutely. 
Dr. Sam Jejurikar: [00:14:12] Yeah, for sure. 
Dr. Sam Rhee: [00:14:13] All right. Number six, plastic surgery accelerates aging, 
Dr. Sam Jejurikar: [00:14:20] bad plastic surgery can accelerate aging. and I think, if you look at how we did, let's say facelifts. 20 or 30 years ago where it was all about tightening and we're moving facial fat. That was a true statement. I think as we get smarter and we learn more about how to, that we learn more about how people age and we're adding fat to people.
Plastic surgery does quite the opposite. I think you guys probably agree with that. 
Dr. Salvatore Pacella: [00:14:45] you know, obviously my, my big interest in San Diego and Southern California is eyelid surgery. And, and I think no other area of the face illustrates this the very much the flavor of. Eyelid surgery and cosmetic blepharoplasty back even.
So, so, so short, like 15, 20 years ago is aggressive removal of fat in the house, the upper eyelid and the lower eyelid. And what we're seeing now is we've created a situation where a lot of these patients look really overdone over resected. The eyeball is hollowed out. You could see the bone around the orbit and that's a, that's a real.
Bad looking plastic surgery job. That's a, that's something that certainly is going to accelerate aging. So I can't agree more. I think when it comes to, fat in the face and around the eyelid, the key is manipulation of that fat and not necessarily, removal. 
Dr. Sam Rhee: [00:15:40] I agree with both of you it's, natural results will help you in the long term.
As Sam said exactly bad plastic surgery over tightening, a gaunt. Look as dr. Patella said it doesn't play well in San Diego, it doesn't play well in Dallas. It doesn't play well in New Jersey. All right, the next one. Number five, the older you are, the less sex is important, 
Dr. Sam Jejurikar: [00:16:06] boy, who's going to 
Dr. Salvatore Pacella: [00:16:09] edit what you're gonna, I know what you're gonna say, dr. Sam, what is sex? 
Dr. Sam Rhee: [00:16:17] Give me the definition of sex. 

Dr. Sam Jejurikar: [00:16:20] you know what I think, And I think as you get older, human contact intimacy, and all of that is still very, very important and personal body image issues that go along with that are obviously very important as well. And so I think, yeah, for all of my patients, intimacy is a very, very important thing in their lives.
The frequency of it be the same. it may not be at the foremost aspect of their minds as a, you know, as they were in their twenties and thirties. And maybe what they're trying to get out of. It's a little bit different. body image issues, overall appearance issues become very important and they're very much tied into those intimacy factors.
Dr. Salvatore Pacella: [00:16:56] What was that line from that? What was that movie years ago? Austin Powers sex. Yes, please.
Yeah. So, you know, it's sex and intimacy is obviously a, a, a part of, you know, our health as human beings. And we don't want to ignore it as we age. 
Dr. Sam Jejurikar: [00:17:17] How many, just out of curiosity, how many of your patients starting in New Jersey with, with Dr. Sam in, New Jersey? How many of your patients come in are on some form of hormone supplementation or pellets men and women, which in many ways is geared towards their, their sex drive?
Is it a high percentage that you're seeing? 
Dr. Sam Rhee: [00:17:37] I think for the ones that disclose, I think a lot of patients feel uncomfortable sometimes talking about that sort of thing. I would say, with the older men, more, I would say more than 50% of them are on some sort of hormone supplementation, I would say for the women.
It, it's hard to say, I would say a substantial percentage of them for sure. but there's no doubt. My older patients, they're the ones that are the most uncomfortable talking about it after a surgery, but they always, will come up to me and say, you know, Oh, by the way, Dr. Rhee, when can I start, you know, doing that again after my procedure.
And so clearly for a lot of patients, it's something that is a big part of their lives. 
Dr. Salvatore Pacella: [00:18:23] Yeah. Yeah. I would say that, You know, a good, a good proportion of older men. I see older being over 50 or 60 are on some sort of, assistance regimen, Viagra, Cialis, things like that. and, I'd say a good percentage of those that.
That are on those medications are also on some sort of testosterone supplementation. And, but the broader picture is that, I think it's really related to understanding your, your own healthcare. If you have a, a primary care doctor or an endocrinologist, that's tuned into these types of issues. Chances are you're going to be on those medications, but quite honestly, many, many primary care doctors are not necessarily tuned in sometimes, you know, my experience.
They don't even really order the correct test or breakdown testosterone, you know? So I think it's important thing for health, for sure. 
Dr. Sam Jejurikar: [00:19:18] Yeah, I have a similar experience in Dallas, men and women are, you know, I see a lot of hormone pellets, a lot of men on testosterone supplementation. And I think it just illustrates that even when there isn't that natural endogenous hormone drive, there's a lot of recognition from patients and, and, and their healthcare providers that these, that intimacy is very important, even as we get older.
And so, there's, and you know, you turn on the TV and you. You see all of the, you know, all of the, the, get Roman and, I've got, I can't remember the other ones, but there's just, it's such a big deal as we get older, that it just really illustrates that sex is very important later in life.
Dr. Sam Rhee: [00:20:00] Number four, the nose grows bigger with age. 
Dr. Salvatore Pacella: [00:20:04] All right, I'm going to, I'm going to take this one because. Arguably, I have the biggest schnoz on, on our podcast here. 
Dr. Sam Jejurikar: [00:20:11] there's no arguing.
Dr. Salvatore Pacella: [00:20:16] I must be the oldest. So obviously, so this, this is a myth. we, we stopped growing, at about age 18, 19. But that doesn't mean our bodies won't change and that's not true. Attributed to growth. It's attributed to just the changes of aging. So for example, In the nose. We commonly see older patients that have a long gated nose or an elongated tip.
Why does that occur? It's not because the nose is actually growing like Pinocchio. There is an attachment of bone to cartilage, right at the base of the nose somewhere right. Mid nose. And as we get older, That loosens up substantially over time. And so you're actually seeing what you're seeing here is you're seeing the cartilage separate from the bone of the nose.
And that's what gives the appearance of the nose growing. This also occurs in the ear, believe it or not. So in the ear we have, cartilage on the inside of the year, but the bottom portion of the year is not a cartilage. And so you might see older patients that have these elongated lobes. So coupled with wearing a heavy, I have an earring and the loss of elasticity of skin coming off of that cartilage that gives the appearance of your ears growing.
So, yeah, couldn't agree with dr. Patella more. This is a technical myth. the noses stopped growing, but it definitely gets bigger because gravity is an inexorable unyielding force. It pulls everything down over, over time, whether it's your nasal tip, whether it's your breasts, whether it's your ear lobe, whether it's your tummy, everything.
It stretches out over time. So the nose is not growing, but it does get bigger with 
age 
Dr. Sam Rhee: [00:21:55] with that depressing note. Let's move on. 
Dr. Sam Jejurikar: [00:21:59] Thank God. There are plastic surgeons. 
Dr. Sam Rhee: [00:22:03] Number three. It's too late to start exercising. 
Dr. Sam Jejurikar: [00:22:07] Not a myth next.
Dr. Salvatore Pacella: [00:22:11] Yeah. 
Dr. Sam Jejurikar: [00:22:12] I'm going to I'll let the exercise fanatics. cause every time I turn on my social media feed, I see Dr. Pcella doing pushups. and Dr. Rhee looks like he gets incredible more and more every day. 
Dr. Salvatore Pacella: [00:22:24] So Dr. Rhee in New Jersey, I'm curious to know your thoughts on, on this and more specifically, what type of exercise as we age.
Dr. Sam Rhee: [00:22:37] Well, all right, so I'll get on my, a crossbar, a CrossFit, a soapbox, and talk a 
Dr. Salvatore Pacella: [00:22:44] little bit. Remember the first rule 
Dr. Sam Jejurikar: [00:22:47] never stopped talking 
Dr. Salvatore Pacella: [00:22:48] about CrossFit.
Dr. Sam Rhee: [00:22:53] All right. The first thing I want to say for everyone out there is that 
Dr. Salvatore Pacella: [00:22:57] I'm very, 
Dr. Sam Rhee: [00:22:59] it sounds like I know what these guys, I pushed CrossFit all the time, but I don't. in fact, I never talk about. Extra like certain types of exercise with my patients. and I, and I do that because I realized that everyone is in a different stage of their life.
if you talk to me, say 20 years ago about doing, you know, high intensity exercise, I would, Thought you had a hole in your head. There's no way. I mean, everyone is at different phases of their lives and it, you don't have to do anything if you don't want to, but there is good science out there that does suggest that no matter what age you work at, work out at, or begin working out at, you can find benefits.
So maybe you never exercised in your twenties or thirties or forties. It's not too late to start in your fifties or sixties or seventies. they did a study. I'm with you? Well, men and women with an average over 80 years old, who began working out, they started with weights and they increased their muscle strength by over a hundred percent, over three months.
And. You know, there's no doubt that major medical issues such as hypertension, heart disease, stroke, cancer, they're all reduced with exercise even regardless of what age you start at. for me, I do, I believe that high intensity, exercise, similar to CrossFit can provide a lot of benefit and doing a multiple.
You know, doing multiple types of exercises. So not just cardio, but weightlifting, you know, you know, things that are constantly challenging, you can be very helpful, but I also realized with people's lifestyles, that can be a problem. So. I'm trying to fit that in. So regardless of it's, if it's just walking a couple of flights of stairs a day, just to try to get started or doing P90X in your basement or whatever it is, doing something, not only helps, but it makes you look better.
And, I, I can tell you that I've had a lot of patients that had never exercised before. They didn't like their appearance. They came and saw me and. Plastic surgery, plus their lifestyle changes, including exercise made a big difference. 
Dr. Salvatore Pacella: [00:25:15] So, I think that's, that couldn't be said better. That's fantastic.
I mean, there's a huge benefit, not only to your health, to your physical health, but to your mental health as well with exercising. So I think that's, that's key. now let me ask you this question, guys. You all, are you both are very active people and, you know, I'm in my late forties and, I definitely feel my body more than, than I did in my late thirties.
And I I've noticed this phenomenon for, for most of my friends about my age. It seems that. You know, most, most of my friends have been athletes their entire life. I was a rugby player for a good chunk of my life. And, what I've noticed is somewhere around your mid thirties, early forties, almost every single one of my friends that has been active has had a major orthopedic injury being the Achilles tendon, the knee back injury, et cetera.
And that just tells me that our bodies. Our, our, our minds are writing checks that our bodies can't cash. Right. And so I think an important concept here is understanding the risk of injury with exercise. So your body at age 47 is not going to be able to do the things you did at 27. So, CrossFit is a fantastic fitness regimen.
But it can also lead to injury. If you don't know what you're doing and you're not, you're not, you know, under the right guidance. So I just want to counsel our patients listening here, you know, listen to your bodies, be careful, you know, do things that are not going to overly stress your joints. 
Dr. Sam Rhee: [00:26:48] I think when you can incorporate it into your lifestyle, it works best.
I know Sal, you were just talking about it. You surf three, four times a week, couple hours a day. That is, you know, Amazingly strenuous exercise. I mean, I'm sure that if I try, you know, if anyone tries to serve several times, you know, a couple hours a day, that's going to wipe them. So if you incorporate that sort of stuff into your life, it can be any kind of activity.
I think the biggest thing as we get older is recovery. So as we get into our thirties and forties, There, the check writing that our bodies are doing is that we're not giving our time, our upsells time to recover. we don't build muscle and we don't gain fitness in the gym. We gain it outside the gym when we're resting and recovering.
So one of the biggest things that I do and I do coach CrossFit is for my, older athletes. I tell them, you need to watch out for everything else in your life. If you're going to stress yourself out in the gym. Make sure your sleep is on point. Make sure you're getting your rest, make sure you're doing all of your recovery and mobility stuff.
And that's the only way. And, and for some types of activity, you can keep up with the 20 year old for a short period of time. Just don't expect to do that every day or, or at the same level of, you know, frequency, that they can 
Dr. Salvatore Pacella: [00:28:04] do. 
Dr. Sam Jejurikar: [00:28:06] Yeah, totally agree with both of you gentlemen. I think, yeah. Now one of my older partners or one of my partners, who's a really well known plastic surgeon and is in his mid, mid sixties.
It's interesting to see how his exercise routine has changed over time. Yoga is the biggest focus of his entire exercise regimen is now because you know, our bodies do change as we get older, that doesn't change the importance of exercising and taking care of ourselves. But, you know, we do need to.
Protect our, our, you know, we're, we're a machine just like any other machine. And when we've been around for a while, we can break down. And so you got a tree, a tree, our bodies, gently. 
Dr. Salvatore Pacella: [00:28:39] Namaste
Dr. Sam Jejurikar: [00:28:44] boy. That's not, that's a really good, 
Dr. Sam Rhee: [00:28:48] like you almost do yoga. number two, I am too old to have plastic surgery. 
Dr. Sam Jejurikar: [00:28:55] Yeah. I mean, I think this is, this is going to build on many other things that we've talked about. It's not about an absolute age, 
Dr. Salvatore Pacella: [00:29:02] it's about health. 
Dr. Sam Jejurikar: [00:29:03] And as there is creasing longevity in our population, there is a bigger desire to not look our 
Dr. Salvatore Pacella: [00:29:09] stated age.
Dr. Sam Jejurikar: [00:29:10] And so I have many patients in Dallas, just like you guys do in New Jersey and San Diego who weren't in their sixties, in their seventies, maybe even a few in their eighties who are the picture of health, ultimately. it's about. How you feel and how you want to look, not your absolute age. 
Dr. Salvatore Pacella: [00:29:26] Right. And, you know, for my older patients, particularly, you know, there's a larger elderly population in LA Jolla here in San Diego.
And you know, a lot of them are interested in plastic surgery and they come in exactly what this question, which is, am I too old for this? And the short of it is, what I tell them is, you know, as long as your heart is healthy and your lungs are healthy and you're generally healthy, You know, the age is not necessarily a factor, but to keep that in mind, we want to have patients understand that they have to be healthy going into surgery.
So, yeah. Every patient that I have that mostly every patient, that I have, that's going, yeah. For a facelift or a, or a larger procedure, I'm going to send to the primary care doctor. I may want a cardiac evaluation or a stress test to make sure they're going to be healthy enough to get through that surgery.
and I think that's where, we separate ourselves as board certified plastic surgeons compared to, some of the other providers that may not be necessarily in tune to this. I mean, we want to. You know, first we want to do no harm. We're doctors, first plastic surgeons. Second. 
Dr. Sam Rhee: [00:30:34] Absolutely. I think, studies have shown that older patients, do not suffer an increased risk for complications versus younger patients.
except actually interestingly, maybe for tummy tucks, maybe it was like a, like a 1% increase in complications, but everything, you know, like one, like two point something versus one point something, But for everything else, as Sam said, it's really about your health, You know, I would much rather have a 65 or 70 year old patient who was very healthy and fit, versus a 35 year old who was a heavy smoker who, you know, obese or had some other, you know, major health issues.
It's really, you know, there's that whole thing about chronologic age versus physiologic age. And there's a little bit of a misnomer with that, but I think a lot of that is actually very, very true.
Alright. And the last one, people fear aging. 
Dr. Sam Jejurikar: [00:31:33] I don't see how this is a myth. People shouldn't fear aging, because you can, you can look right. You can be very healthy. You can have a very. More fulfilling life than you did when you were younger, because you have the experience of you have experience and you, but it doesn't mean people don't fear it.
So I'm not really, I'm gonna, I'm gonna, I think you guys may have a better answer for this one than me, 
Dr. Salvatore Pacella: [00:31:56] right? I think, you know, I just, because something is intimidating. In fact, I was just having this discussion with my nine year old son yesterday. Just because something is intimidating doesn't mean you have to necessarily fear it, but you have to respect it.
And we were having this discussion about the ocean. I took him out surfing yesterday. We, he hit a couple of big waves. He was freaking out, he was scared out of his mind. And I said, no, you just have to. Respect the ocean. You don't have to fear it. Okay. And I think the same thing goes with aging. how do you respect aging?
You keep yourself healthy. You keep seeing the doctor, you, you get tests that are appropriate. Okay. You eat the right things. You stay healthy that you don't have to fear aging, but there's a lot of good things that come with aging. Knowledge comes with aging. Experience comes with aging, you know, 
Dr. Sam Rhee: [00:32:49] I think, most of the patients that I see are actually very happy and satisfied with their lives and maybe even more so as they get older, because as Sam says more experience, and they like, they wouldn't trade their experiences for anything.
I think most of the people who are older are very positive. What they don't like is. There are physical signs of aging where their appearance does not match how they feel about themselves inside. So it's not necessarily that they fear aging, but they just don't like. That they don't look the way they feel.
And, but I will say that most of my patients, are very, very, very happy in their fifties, sixties, seventies. they're very positive. I don't think they fear anything. They just want to look better about it. 
Dr. Sam Jejurikar: [00:33:38] You're here now that well said. And I think that is so true, so true. Yeah. And with that, we are at the 35 minute Mark gentlemen, perfectly timed show is always, 
Dr. Sam Rhee: [00:33:53] it would have been faster if we didn't have three minutes of a ragging on Sal for a space.
Dr. Sam Jejurikar: [00:33:59] Well, I'm just happy to hear that he's going to have a new webcam. By the time we film another episode, that's going to be great.
Dr. Sam Rhee: [00:34:12] Well, thank you much. thank you again, as always for you guys and, have a great day and enjoy wherever you are. 
Dr. Salvatore Pacella: [00:34:19] Take care. 
Dr. Sam Jejurikar: [00:34:20] Stay safe in zero gravity. Dr. Pacella.

DR.PACELLA & FRIENDS DISCUSS SURGICAL VOLUNTEERISM WITH FRESH START CEO SHARI BRASHER AND NFL HALL OF FAMER MARCUS ALLEN

Uncategorized - November 19, 2020

CLICK HERE TO WATCH VIDEO WITH MARCUS ALLEN

Dr. Sam Jejurikar: [00:00:00] Good morning, everyone. And welcome to our
latest edition of Three Plastic Surgeons in a Microphone. I’m Dr. Sam Jejurikar
Instagram handle @samjejurikar and as always happy to be joined by my
compatriots, Dr. Sam Rhee Paramus, New Jersey, whose Instagram handle is
@Bergencosmetic. And Dr. Sal Pacella in San Diego who goes by
@SanDiegoplasticsurgeon.
And, just a brief bit of legal stuff before we get into the meat of the program, the
show is not a substitute for professional medical advice, diagnosis or treatment.
The show is for informational purposes, only treatment and results may vary
based upon the circumstances, situation, and medical judgment after appropriate
discussion, and always seek the advice of your surgeon or other qualified health.
Provider with any questions you may have regarding medical care, never
disregard medical professional medical advice, or delay seeking advice because
of anything you may see on this show. And today we have different sort of show,
a very special show. We’re very, gratified what we’re going to be able to do.
We’re going to talk about charitable endeavors and plastic surgery, and, talking
about a project that dr. South the cello of San Diego has been working with
extensively. So with that, I’m going to turn it over to dr. Patel and he can give us
some intro.
Dr. Salvatore Pacella: [00:01:12] Thanks gents. Once again, everybody
welcome to our podcast this morning.
I’m super excited to be talking about, an organization that’s very close to my
heart called Fresh Start Surgical Gifts. I was, introduced to fresh starts by one of
my colleagues dr. Mike Rucker, who’s a local plastic surgeon, a very good friend
here in San Diego, about 12 years ago when I first moved here.
and it’s a, it’s an organization that, donated plastic surgery services, cosmetic, or
reconstructive services to underserved children’s all over the world, including the
domestic United States. And, we, this organization is just a fantastic organization
as a slightly different model than a lot of, other volunteer surgical organizations.
and we’re gonna dive into that in a little bit here. so just to, to intro here, Jen, you
are both involved in some charitable endeavors and plastic surgery, correct?
Sam, Jersey, Sam, Dr. Rhee from Paramus. Tell me a little bit about what you’re
involved with.
Dr. Sam Rhee: [00:02:11] All of us at Michigan all started, with Dr. Bob Gilman,
when we were residents, a lot of us traveled to Columbia, South America, and,
worked with him on a cleft palate and lip, repair trips. And after that, I’ve traveled
with Sam and other people to Bangladesh, and I’ve been to China. I’ve been to
North Korea, a couple of different places, but I think we all have had a long
history of charitable care and giving back in surgery.
Dr. Salvatore Pacella: [00:02:42] Yeah. Yeah.
Dr. Sam Jejurikar: [00:02:43] I’ve been fortunate enough, as dr. Rhee alluded
to, several years ago, he actually took me on a trip to Bangladesh and I hit it off
well with that organization, Smile Bangladesh. So every year I go to Bangladesh
to do cleft lip and palate surgery that actually Dr. Rhee was on the board of
directors.
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And when his time is up, they asked me to take his place. So I’m currently on the
board of directors to that organization. it’s a huge part of what we do. It’s so
incredibly gratifying as Dr. Pacella.
Dr. Salvatore Pacella: [00:03:10] All right. without any further delay, I wanted to
introduce, a colleague and very good friend of mine , Sherry Brasher. She is the
CEO, of Fresh Start Surgical Gifts. I’ve known her for 12 years and she’s just a
wonderful personality. Runs the organization. And she’s going to come on and
tell us a bit about a fresh start. So Sherry.
Shari Brasher: [00:03:32] Hi everybody. Thank you for having me. I’ve been
around Fresh Start for over almost 30 years now, but we do provide plastic and
reconstructive surgery.
Very similar to all of you, but we do it in the U S hospitals in San Diego. Congo.
So we bring the kids, us, which allows us to be able to do some really difficult
procedures, which include followup and sometimes hosting the kids, having them
live in a home, here nearby so that we can, I have more than several, sometimes
several procedures done at different times within the year.
Dr. Salvatore Pacella: [00:04:09] So Sherry, thanks for coming on. We really
appreciate it. So tell us a little bit about how fresh start started. What was the
beginning of the organization?
The organization was Dr. Dennis Nigro. He had a private practice and he was
helping kids who came in that couldn’t afford the surgeries that he was talking to
them about.
And he had a hard time saying no to anybody. So he started doing them on a
Saturday. And his office, like every three months or so he picked Saturday and
have five or six patients. And our staff was a voluntary time. And at that point in
time, I was working for him as his business manager. Yeah. And that turned into
a partnership, with another freestanding surgical site.
And then finally, it’s been several years about 12 that we’ve been working at
Rady children’s hospital and have a right relationship with them and partner on
doing these surgeries at their facilities.
That’s great. So how is, how exactly is this? Maybe describe a little bit about how
the surgery weekend runs and how we go about prepping patients for surgery.
what’s the process for applying for surgery that patients may have.
Shari Brasher: [00:05:18] Yep. So we are mostly through the internet or verbally
referrals from people. And if you go to our website fresh start gone, or there’s an
application for patients that we make everybody fill out because we have a very
sophisticated eight week process where we have, several doctors who get
together and.
Dr. Pacella is certainly one of the leads on that to discuss the applications and
only the physicians are making the decisions it gets into the program and what
surgeon would be best to lead on the procedures. And then we’ll figure out a
game plan for their surgical. care. And then of course we work in our offices to
schedule them get, sometimes they come from other countries, so we need to do
travel lodging, visas.
We take care of all of that. We pay for all of that. there is no cost to anybody for
it, and we house them, feed them, give them there. Pre surgical, it consultations
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and help. And then of course all the surgery and it’s more than just surgery. We
also do, dental care and sometimes laser adolescents, scars, speech therapy, if
they have something done in their mouth.
So it’s completely comprehensive and very, complicated really over the,
sometimes kids have been patients with us for 10, 15 years, depending on how
complicated their cases are.
Dr. Salvatore Pacella: [00:06:33] That’s great. Yeah. so tell us a little bit about
the medical program committee. what, what does that, so just to start off it’s, this
is the larger group of doctors and coordinators that were together to prep
patients. So tell us a little bit about that process. What does that involve?
Shari Brasher: [00:06:51] We have a meeting every seven weeks and it’s about
16 surgeons and nurses that come together and we are able to look at and go
over the. Applications of the patients see their pictures. We often write the
highlights of their stories, why they want the surgery and how it’s going to change
their lives.
in the office, we’ve already done the background checks to make sure that they
can’t, it’s something that they can’t afford so that we are therefore able to help
them. And then the surgeons are all sitting around the table collaboratively,
which is really incredible to me because I see plastic surgeons as fairly
competitive.
which makes them, makes you as successful as you are. and, it’s just amazing to
see them in one room talking about these patients, collaborating and deciding,
have you tried this procedure? Have you tried this? and then oftentimes we, I
have more than one surgeon in a room.
And so what’s that. Incredibly exciting to me is honestly, these kids fresh start.
Kids are getting better care than even my kids would get because you go and
see one surgeon. And I’m not saying that one plastic surgeon wouldn’t do as
good of a job, but honestly, when you have collaboration amongst some of the
greatest in one room, I, that, our kids, even though it’s free, it’s actually better
than what the average patient is paying for.
Dr. Salvatore Pacella: [00:08:09] Yeah. That’s and, just to, to comment on that
is a really fun process for me. I, I would say medical director running that
committee for a number of years. And, when we’re out in the community as a
plastic surgeon in private practice, it’s not often you get to collaborate with your
colleagues.
guys like dr. Dr. Jejurikar in Texas or Dr. Rhee in New Jersey, it’d be. Super fun
to operate, or take care of patients together. and this is one of the only
opportunities I have in my career to really do a team approach to the surgery and
taking care of patients. And it’s really fun. We have a lot of comedy at the,
medical program committee, a lot of, joking.
It’s really a lot of fun. now after the patients are prepped in the medical program
committee, tell me what happens on the surgery weekend. what’s that all about?
How does it run and what’s the structure.
So the structure is such that at Rady children’s, we’re able to use up to 10
operating rooms.
I think we’ve only used eight at this point. We’ve used several rooms there. We
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have the first right of refusal on a Saturday. And the surgeons are giving up their
time for free and donating their time and expertise to these patients. And they
are coming in and just like any normal patient would they check in, they go
through preop, they have their surgery and they are, and they have the recovery
and oftentimes we have nurses, they with them in a hotel room or at their
wherever host whoever’s home, they’re staying at.
Host home to get the aftercare. They have followup treatments and also follow
up appointments. So honestly it is just like any other patient that you would see
in your own practices.
Okay. Great. And then how has the actual weekend run for surgery? Like what,
when is the surgery done?
When is the followup done? Who volunteers?
Shari Brasher: [00:09:54] it’s everybody, who’s there as a volunteer, not a single
person is paid. And, they literally will come in and have surgery and it, depending
on what the surgeons, I have decided, as far as their care plan, that we follow
that very specifically, we need drive them to the offices or afterwards they get all
that care afterwards.
And often times the surgeon will suggest, they need this next procedure and we
provide and put them on the schedule. So it’s never, it really is rarely ever a
onetime, a procedure. And then they go home. A lot of times, they. Come back
for, like I had mentioned before, for laser treatments or, any other things, our
revisions.
So it’s up to the surgeons to dictate what it is that they need, but we make sure
that whatever it is that they require, we provide that.
Dr. Salvatore Pacella: [00:10:40] That’s great. and from what I understand, and
from what I’m, involved with, the patients stay in town until they’re ready to
recover, correct?
Shari Brasher: [00:10:48] That’s correct. We don’t send them back until the
surgeons say that they’re ready to be on a plane and flying back. And oftentimes
if they’re going to need several procedures, then we’ll just keep them at a host
family’s home. And we’ve had some patients live here, off and on, for a good
couple years.
Depending on what, how difficult the cases are.
Dr. Salvatore Pacella: [00:11:07] And that’s a slightly the different model than a
lot of the other, organizations that donate plastic surgery. Sam and Sam, you
guys, you go into country is do what you need to do, and then you have take off.
And, just with your experience, gents, how do you manage that?
If you have a complex case or something like that?
Dr. Sam Jejurikar: [00:11:24] it’s a challenge for sure. it’s, I’m listening to your
guys’ compensation and it’s amazing. You guys can offer so much more than a
weekend when we go into another country, we are limited in what we can do and
have someone recovering and just within the few days that we’re there.
And then when we, when we, we can’t. We can’t undertake big cases that are
potentially life altering changes. Sometimes if it’s going to pose the patient at an
undue risk. So listening to what you guys are doing here, it’s quite remarkable
and it offers a whole different level of service and what we’re able to do when we
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go abroad.
Dr. Salvatore Pacella: [00:11:56] Oh, that’s great. yeah, so Sherry, obviously it
takes a lot of, support, donor support and volunteer support to run a charity like
this. So tell us a little bit about how financially, you’re able to create all this value
for patients that are on a charity. we’re very,
Shari Brasher: [00:12:17] we have, again, I’ve been involved for 29 years and it
started out as just, a plastics, the plastic surgeon, Dr nigro, and his staff that
donated their time, then fresh start, started having their own staff. And of course,
I was a volunteer at the very beginning. So for 14 years I was a volunteer. And
now for 15 years I’ve been an employee. and now we have 11 employees in San
Diego and two in Chicago when we.
Partner with the American society of plastic surgeons and they provide a
references to us and they helped us with our site where it’s actually a partnership
with the, ASP S over there in Chicago with Comer Children’s. And we do the
same thing there. And, we obviously couldn’t do any of this without the generous
donors that we have.
And, not only is it some amazing companies like EDCO and, big companies like
that. Provide the support for us, but Audrey Geisel and Jim Goddess and all
these, law firms, et cetera, a lot of people, it takes a huge community. For
example, on surgery weekend, it’s over a hundred volunteers on a weekend that
come in to provide surgery to anywhere from, usually six to 18 kids. So the it’s
like when you go on a cruise line and they say, Oh, you get two people for every,
one of you as a guest. this is significantly more. And they’re getting like, again,
the best care possible, but it wouldn’t be possible with the financial help. And, we
have several celebrities involved and, we it’s all donor based.
We don’t get any government funds. We write grants. We put on two events a
year or a golf tournament and gala, and the rest there’s people who are
generous enough over these 29 years to support us through the thick and thin
even with COVID. We have people writing checks, thankfully, because we’re still
providing these surgeries because they’re necessary to the kids.
Dr. Salvatore Pacella: [00:13:57] With that, you were talking about some of the,
celebrity donors out there. And I wanted to bring on a very special guest, and
Sherry, I’ll give a little bit of his resume here. He was, a Heisman trophy winner in
1981, a national champion for college football in 1978.
He was a six time Pro Bowler Super Bowl champion times two and Hall of
Famer. Correct.
So smidgen of his resume. So ladies and gentlemen, I just want to introduce
you, Mr. Marcus Allen who’s kindly joined us today for a broadcast. Marcus, are
you there? All right. We’ve got them online. Mr. Marcus Allen Marcus. Thanks for
joining us.
HOFer Marcus Allen: [00:14:39] Good morning guys. How are you? I’m great
guys. I’m doing great, man.
I’m honored to be on the online with you guys and hello, Sherry. You look
beautiful as always wonderful people in the entire world guy. So it’s a, it’s an
honor to be on with guys. I think who. A believer as I do, you’re rich by what you
give and you’re poor, but what you keep. So I appreciate you guys a great deal
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and all the people with fresh start, frankly, and all the doctors that, donate their
time and, their services.
So it’s great.
Dr. Salvatore Pacella: [00:15:11] Now, Marcus, tell us a little bit about how you
got involved with fresh starts and what your, what you do with them currently.
HOFer Marcus Allen: [00:15:18] I gotta tell you why. I was just thinking about
that and go, Mike, I guess I was just caught up in the charisma of a cheerier
story in which he was doing.
And I just said before he even, was able to go to the, the opposite is, and see
some business, some of the kids that were, about to, or have surgery. I just, I
said, yes. I, first of all, I think. there’s a lot of great stories out there, but most
often it’s the people that are involved with it.
And she’s such a great and wonderful and dynamic person that I basically just
said, yes, whatever you want me to do. I went down and I had an opportunity in
San Diego to visit some of the kids. And I was just really, touch by, what these
doctors, do and the kids that were there.
I remember there was one really rare case. I think you remember this young lady
she may have been from, Latin America. I’m not quite sure, but she, had a rare
disease that, she couldn’t be out. And
Dr. Salvatore Pacella: [00:16:17] yes. Yeah. And
HOFer Marcus Allen: [00:16:18] it was just remarkable, to see her and. And
they’re really look at her life and really say, if anybody could add to give her or
some sort of sunshine well in her life, it would be great.
You know what I mean? So there were so many cases like that guys, and I just, I
really, from then on, I’ve been very small way been a fundraiser, and a
spokesperson. I’m always talking about Sherry every time I haven’t even been
involved. Which I donate. Idonated personally for many years and, this recent
year, even though we didn’t have a golf tournament and I was able to, I, we didn’t
have one, but I was able to give, I think some significant funds.
So Sherry and I partnered with her now I used to be just to, donate, but now I’m,
I’m part of the team. If you will. Raising money for Fresh Start, because I think it’s
such a wonderful organization. Again, that always looked at athletes as heroes
and I go man, you guys are the heroes.
You guys are actually transforming. Live aesthetically, these kids come in and
they look a certain way, but you guys not only change that, but you change them
internally to maybe feel better about themselves. They actually get a fresh start
on life. in a small way, I’m just doing my part. It makes me feel good.
It makes me feel good that I’m helping people. And it makes me feel good that
I’m working with a wonderful person like sharing what she’s trying to accomplish.
And we may accuse the can’t afford. services like this. And when you have
people that donate their time and Sherry, basically covered it. it’s not just, they
do surgery and they send you home. Now it’s followup and it’s, it’s
comprehensive. it is the full package. And to be a part of that, again, give kids a
fresh start on life. They can’t afford it. Is it makes you feel pretty good. Yep.
Dr. Salvatore Pacella: [00:18:06] Now one, one aspect of it organization. that’s
pretty fantastic is not only does fresh starts take care of international patients
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that have no insurance, but we take care of domestic patients, the kids from the
U S that may be under-insured. So for example, patients who may have geared
deformities that just are on the border of cosmetic surgery, but you can imagine
as a young boy or a young girl, Going through grade school and being ridiculed
for your ears or your nose or your teeth, and you know how that can
psychologically affect someone.
it’s just really special. And when these kids come in and we have, we’re in the
Sunday clinic and we have a, hall of fame athletes coming and helping us
change our dressing, that’s pretty fantastic,
HOFer Marcus Allen: [00:18:51] No, it’s better than fantastic, but I listen to, I got
to tell you guys, obviously you guys, as football players or athletes supposed to
be big strong, and, but every time I see a video.
It’s very place where it transformed a kid’s life. I’m actually, I got to turn away
cause I always start crying, man.
This is what life’s all about. This is the best of America right here, guy.
Dr. Salvatore Pacella: [00:19:14] Yeah. that’s a good segue Marcus. So what I’d
like to do is I’m going to share my screen here for a second. I just want to show
some photographs of some patients in cases that I’ve been involved with over
the years here. here we go.
All right, Sam, we got that going.
Sam Rhee, can you see that?
So a few of these are from Instagram. I just downloaded them here. So I’m on
the left. We have a wonderful young lady. Her name is Florence. And she’s, she
was adopted from a couple in Montreal, I believe. Is that true?
And where is she from? She’s from Indonesia and she had a congenital eyelid
deformity and this one wonderful couple, sought us out to assist with.
Get a good fit for a, some eyelid reconstruction and the eyelid prosthesis. I
worked, on floor ranch with, one of my colleagues, dr. who’s an ophthalmologist,
and we did some work around her mouth to restore her smile. She had some
facial paralysis and, just a wonderful child.
on the right here is a young gent, I believe he’s from Texas. his name is jr. And,
two little guy, he had a little, congenital, hemangioma and eyelid deformity where
it was obstructing his vision. And we did a pretty quick little surgery on him to
remove some of this hemangioma that I get is just a great
Marcus. Sounds like you got your hands full there.
Probably one of our most fantastic young gentlemen, just an absolute success
story is this gentleman on the left. His name is beloved. Jeff Petty and beloved is
a young boy who formerly was a young boy who was from Africa. And
unfortunately picked up a landmine. And it caused severe destruction to his face.
And at the time he didn’t have any access to medical resources. He was, seen at
another institution that did a large procedure for a debris movement and a free
flap and to reconstruct his jaw. And then he came to us, I think, close to about
eight or nine years ago. And we’ve done work on him, almost every year.
to restore a bit of a smile on his face. And he is just a wonderful guy. He was
adopted by a family. the tinnies in San Diego here and beloved is just an
absolute American success story. He, came, just came here with minimal
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education, went to school, got his, high school diploma.
And now currently is in college and I was applying for it, us citizenship. He’s just
a beautiful young gentlemen, we’re starting. Recently got engaged. That’s right.
Oh, wow. I’m still just a wonderful guy. here is our, on the right side is our latest,
procedure. We did just this past, two Saturdays ago.
So this is my, my, my colleague, dr. Jeff Shumanski, who I operate with. And, we
did, a bilateral gynecomastia case on this young gentleman. Who’s from the
United States. here’s another, the guy on the left Ricard. No, Ricardo is, also
from Texas, under insured. He had, a congenital ear deformity here.
So this is him on the lower left, right the day of surgery. we performed a surgery.
He came out looking fantastic. This is him a few weeks later, sitting next to me
on the right and he’s just ecstatic and. His little brother I think is going to come
and see us at some point, as well.
He’s got some ears there too. So I’m on the left here. These are a few of our
volunteers. This is, dr. Victor Chung and, one of our, excuse me, one of our older
surgeons, who’s, who’s been operating with us for a number of years. this is
Georgianna. One of our patients who. was born with a congenital eyelid
deformity and some loss of bone on her nose.
And you can see her on the right side. she was just having some difficulty closing
her eyes. And I did a procedure on her where we took a risk tendon and
reconstructed her eye to maintain the position of her eyelid. So another fantastic
success story, here. I’m going to stop sharing.
We’ll go back here. as a surgeon, it’s just been, Really fantastic to be involved
with the organization. the beauty of the way fresh start is structured is I can
continually donate my services every six weeks. And throughout that time without
really leaving out of the country or disrupting, my.
My life or my family’s life, for a period of time. And, with COVID, this is even
much more important that we’re able to touch so many lives without, really
relocating or going to another country. and I think one of the, one of the most
fantastic things is as I’m sure the two other surgeons on the call will agree.
we as plastic surgeons, as doctors, we’re, our life is sometimes confused with
patients and insurance companies. And it’s very, it’s very easy to lose that
doctor, patient connection, many times throughout the Workday and the beauty
of fresh start is this is just a pure connection of patients.
And physician and helping others without any of the trauma of anything else
surrounding the patient’s care. and that’s just, what’s really special here.
Dr. Sam Jejurikar: [00:24:34] Yeah, I
Shari Brasher: [00:24:35] did want to add that, in the third, almost 30 years,
we’ve provided, 8,000, almost 8,000 kids with fresh starts. It represents about
$42 million of a surgery.
That’s measured by CPT codes. it’s really incredible. And I did also want to
mention that every dollar that’s donated. A 100% of the funds go to the kids. we,
I was fortunate enough to meet this woman with our founder who donated a very
large sum of money to us, which sets in a separate account.
We knew only draw 4% off of it per year to pay for all of our overhead so that I
go out and fundraise one to $2 million every single year, which covers everything
8
else that we need and all that money. whenever you donate, literally goes
directly to the kids, not one single penny pays for any overhead.
Dr. Salvatore Pacella: [00:25:21] Wow. That’s fantastic.
we, it’s not all hard work. we do have a lot of fun too. The, every year fresh start
throws this butterfly. Butterfly gala, which is a big donor, gala. We have a big
auction. We, we own some, fantastic, weekends and products and, even
gorgeous paintings from surgeons and others.
and, it’s really a fantastic evening. Marcus. you’ve been to the gala before, right?
Yes. Yes, that’s a fun time. They’re great time.
HOFer Marcus Allen: [00:25:51] So everything that they do is a is, and I think
you certainly believe in having a good time while raising, money. So it’s it’s
exciting again, guys. I, my hats off to all you guys and Sherry too, for creating
such an environment that we can go out and raise money and you doctors,
provide such care for these young people, in their situation again, it’s good to be
a part of such a great thing.
Shari Brasher: [00:26:13] And if you want to meet Marcus in person, he puts on
a tournament, a golf tournament every year in June, first weekend in June. And
it’s hosted at Pelican Hill and he gets all of his, a list celebrities and they come
out and there’s a person who plays in every single group.
the names are huge and, everybody just has a great time racing well into the six
figures for these kids. And. Oh, I just can’t thank Marcus enough for what he
does. He’s our new newest advisory board member and we are so blessed to
have him. And yeah, I was really
HOFer Marcus Allen: [00:26:46] it’s really, I was really happy because we had
to cancel our event. like so many events out there have been canceled, but we
were still able to get money out this year. So we were thrilled by that guy
because, it’s important to us again, we like having a good time where we like
raising money to help others.
Dr. Salvatore Pacella: [00:27:01] Yep. That’s great. That’s fantastic. so Marcus,
we would be, we’re awestruck football fans here.
We’re just gonna, we’re just gonna shift gears a little bit. It would be, we would
be remiss if we didn’t pick your brain a little bit while we still had your odd about
your NFL career, if you don’t mind.
So I’m gonna hand it over to dr. Reed from, from New Jersey here.
Dr. Sam Rhee: [00:27:22] it was funny when I told my wife that Marcus Allen
was going to be on our podcast.
She’s not a football fan, so she didn’t really understand, she knew and then I
said, listen, this is the only guy to put it in her terms. I said, he won the Heisman,
national, NCAA national champion, a super bowl, NFL MVP, and super old
Superbowl MVP. And no one else has ever done that.
And she’s Oh, okay. So that’s wow. so she, at her level, not only realize how elite
you were and to me, Like Sal says, we just, it would be wrong for us not to take
advantage of being able to talk to someone who’s performed at such an elite
level, such a long time.
HOFer Marcus Allen: [00:28:00] Appreciate that. I just, I’m just glad you didn’t
say I fell off my big wheel was when you play,
9
Dr. Sam Rhee: [00:28:08] you looked like you could still play right now. It’s
amazing.
So one of my questions is I do coach athletes at a local gym CrossFit Bison in
New Jersey. And. I asked some people what they wanted to know and want to,
and one of the questions was out as an elite athlete like you after so many years
of competing at such a high level, just turn it off because suddenly, like as
surgeons, we can see kind of Peter out, we can slow down, we can change our
workload, but suddenly you’re going from competing at the highest level to
stopping what you’ve done for decades in your case.
So what is that transition like?
HOFer Marcus Allen: [00:28:46] the transition was easy for me because I, the
day that I entered football, I always said this, and I have to attribute this to
Ronnie Lott as well. And we said, this is what we do. It’s not who we are.
So even though I loved it and I was passionate about it, I never saw myself as
just that I saw myself in many other ways.
I saw myself as a philanthropist. Now, one of my biggest duties is, the
competitive edge that you talk about. I turn it on being a dad that’s really
important. because I think if we look at some of our issues today, what are the
things that are happening in society?
Those are all symptoms too. I think one problem, I think there’s almost 20 million
households that have, single parent homes, So to me, that’s very important. I
have a wonderful, he’s been a tremendous example and I know the importance
of having a cheerleader at home as opposed to somebody even booed you at
home.
So you never really, turn it off at the same time. It’s if you approach your careers,
that. That’s what I do. And it’s not who I am. I think it’s easier to transition
because I saw myself as so much more, even though I was passionate about it. I
wanted to be the very best at that.
I never saw myself fully as just a football player.
Dr. Salvatore Pacella: [00:30:11] That’s great. That’s great advice for any
professional. I can see that translate into our lives here. We know many
surgeons who, died with a scalpel in their hand and never really got to know their
kids or the family or any sort of outside interests.
So that’s great advice, Marcus.
Shari Brasher: [00:30:30] He’s a hall of fame. Dad, let me tell ya.
HOFer Marcus Allen: [00:30:32] Oh, I love my little boy. The one that was crying
in here.
Dr. Sam Rhee: [00:30:35] when you look back and you compare your, time as a
pro football player to now, what are your thoughts about injuries? Now,
compared to the past. And what do you see as trends in athletes then and
athletes now?
HOFer Marcus Allen: [00:30:53] I went out as I looked at the game today,
obviously modern medicine is so much better today in what used to have guys
out an entire year or maybe a year and a half, all the stuff surgery.
They’re back in a matter of a couple of weeks. the fact that guys are walking out
10
of the house, rather the hospital, as opposed to, being put in a cast and
immobilized for like almost, over a year with the leg atrophy to a point that you
could barely recognize it. It has changed a lot. As far as myself was concerned, I
was always a little different than, yeah. I always looked at it. I understood my
body and I understood that football is very emotional, very physical game. and it
could be, so I always thought it was very important to get away and really do,
after the season was over, I really didn’t do much physically. I allowed myself at
least three months to do nothing. I just didn’t gain any weight.
Okay, because I felt that was, that is a lot more strenuous, a lot more difficult to
do to get back into shape when you put pounds on. And so I relaxed, as
opposed to today, after the super bowl, it’s almost like a week later they’re back
working out. So there’s a body ever arrests. they have OTA days and they’re
constantly working out year round. Again, I think it’s too strenuous, a sport too
physically demanding, emotionally demanding too, to be almost a year around
sports. So I think it’s important for that to know their own bodies, because what
happens is you get, some of these, Trainers that, put everybody in a one size fits
all program and everybody’s different and stuff for me, I wasn’t a big weightlifter.
I did martial arts and I did a lot of stretching, a lot of running. I did a lot of things
regarding functional strength, and there’s some guys that may work for me, but it
may not work for them. So it’s important really identifying the individual and what
works for that person.
And for me, I understood my body more much better than the trainer did, And I
think he, again, playing 16 years, it’s almost that’s an aberration. I think Frank
Gore. Is the, I guess it’s playing currently. And he may surpass me, but 15 years
I think was the most finding, running back, in the history of the game. but, and
that hasn’t happened very often. it’s certainly a lot of luck that I was blessed
because I had three, three knee injuries, but none that required surgery. and
then I was back at it and stuff. but, and then the other thing was, I always felt
like. One thing you have to do is understand the mental aspect of the game you
never, ever think about injury ever.
You have to say to yourself, you’re impervious to all that. And because I think
those who think about it, usually it happens to them.
Dr. Sam Jejurikar: [00:33:48] I love that mindset.
Dr. Salvatore Pacella: [00:33:52] That’s great.
Dr. Sam Jejurikar: [00:33:53] Yeah.
Dr. Salvatore Pacella: [00:33:56] we’re, we’re about running out of time here,
HOFer Marcus Allen: [00:33:58] but let’s just get started.
Dr. Salvatore Pacella: [00:34:01] I’ll tell you what we’ll promise you. We’ll have
you back on that’s for sure.
HOFer Marcus Allen: [00:34:04] I’m feeling a little. patriotic right now.
Want to take this? We gotta take this group on tour so we can raise some
money, guys. Thanks you guys very much. Thank you so much.
Dr. Salvatore Pacella: [00:34:22] Thank you so much for taking your time on a
Sunday and Sherry. Always a pleasure. We’ll see you soon.
Shari Brasher: [00:34:27] Okay.
11
Bye.

COSMETIC PLASTIC SURGERY OF THE FACE

Doctor's Advice, Gallery, Plastic Surgery - eyelid surgery, wrinkles - November 1, 2020

WATCH THIS EPISODE LIVE:

BEAUTIFYING YOUR FACE

S01E07 - 3 Plastic Surgeons & a Microphone - Beautifying Your Face
[00:00:00] Dr. Sam Rhee: All right. Welcome to Three Plastic Surgeons and a Microphone. This is episode number seven. Good morning, gentlemen. This is Dr. Salvatore Pacella out of LaJolla, California. His Instagram handle is sandiegoplasticsurgeon and Dr. Sam Jejurikar, Dr. J out of Dallas, Texas. His ig handle is samjejurikar.
And I am Dr. Sam Rhee out of Paramus, New Jersey, and my Instagram handle is bergencosmetic. So welcome today, gentlemen, how are you? 
Dr. Sam Jejurikar: Great. How are you doing? 
Dr. Sam Rhee: Great. All right. So as always our intro. This show is not a substitute for professional medical advice, diagnosis or treatment. This show is for informational purposes, only treatment and results may vary based on circumstances, situation, and medical judgment.
After appropriate discussion, always seek the advice of your surgeon or other qualified health provider. With any questions you may have regarding medical care and [00:01:00] never disregard professional medical Viceroy delay seeking advice because of something in this show. And with that, we're going to get right into it.
I know we're going to be talking today about cosmetic surgery of the face. And, Dr. Pacella has, a lot in it store for us in that regard. We're also going to take a look at a couple, well known, photographs of some of, celebrities who, have had some, aesthetic work done for their face.
But the first topic today, which I'm going to bring up here is something that. I think we should talk about, as well. And I know Sal feels very strongly about it too. And this was an article that was originally published a couple of days ago, and then withdrawn, it's called a prevalence of unprofessional social media content among young vascular surgeons.
And it's spawned a large hashtag let's go ahead and read down and then we can describe it a little bit. So basically. It examined publicly, socially available media content. And they felt that such media [00:02:00] content could affect patient choice of physician hospital or medical facility. And they thought that their and their goal was to evaluate the extent of unprofessional social media content among recent vascular surgery fellows and residents.
And this was out of Boston University in Massachusetts. they basically found. They looked at 480 vascular surgeons, 61 or 26% of the accounts that they found had cleared the, what they labeled clearly unprofessional or potentially potentially unprofessional content. Eight accounts had a clearly unprofessional, such as obvious and alcohol intoxication, uncensored, profanity, offensive comments about work.
Patients or colleagues put potentially unprofessional content included, consuming alcohol, controversial, political comments, inappropriate or offensive attire, sensor, profanity, and controversial social topics. And I think one of the things that was mentioned [00:03:00] was, unprofessional content included bikini wearing or swimwear by some of the women. vascular surgeons that they identified. Thoughts, Sal and Sam. 
Dr. Salvatore Pacella: Yeah. So, so first off, let me say, you know, I understand what the authors were trying to do here. The whole idea is to preserve the patient. Dr relationship as being professional, but it, it sort of, it completely backfired. And there's one specific issue that came out here and which is the, the wearing of unprofessional attire.
And unfortunately what they did was they focused on female surgeons wearing bikinis or wearing provocative outfits, et cetera. And you know, this, this is, this just comes off as a completely misogynistic article. condemning women and it's, I certainly don't agree with it. I think it's terrible. and I don't really understand how the journal of vascular surgery was able to publish this.
[00:04:00] People really need to understand that this isn't just something that was posted willy nilly. when, when you apply for an acceptance of an article of academic quality to a major journal and undergoes a significant peer review process. So several other authors had to look at this article and go through it.
And so the fact not only did these authors, write this article, but the article was approved by at least three separate authors. So it just goes to show you the blinders on here. And you know, this article would have had much more validity if they just pulled it out the, the images of bikinis and not use that as a criteria.
So two other things to say here. you know, I, I think this is, well, let me, let me, let me reach out to, Texas Sam and see his thoughts here. 
Dr. Sam Jejurikar: Well, you know, I, I think, I pretty much agree with all that you've said, and I think there's some broader issues. I didn't really hear about this article until I saw all the social media postings over the last couple of days from very intelligent [00:05:00] surgeons and anesthesia anesthesia providers with whom I work, where they sort of talk about the body shaming that's been happening with us. And this hashtag medbikini, that Dr. Rhee talked about, and I think it, this, this I'm I'm, I'm encouraged by the outrage at this article has spawned by the quick decision to withdraw it.
I think it is demonstrative of the bias that we've had in surgery for decades, you know, centuries where there's been an element of misogyny, you know, for years, surgery was a male dominated, profession, regardless of what specialty you're looking at. And with it, there has been some inherent gender bias and massage.
That's gone along with it. And as the world is changing and as surgery is changing, that mentality needs to change, you know, particularly given our field, which is one geared towards aesthetics. There should be no, there should be no room whatsoever for body shaming, people for being attractive, you can be an attractive human being and you can be an incredibly intelligent person.
The world is changing surgery, changing. This is ridiculous context [00:06:00] for an article. it sort of shows that in academic medicine, sometimes you just need a print articles and the things that they think about sometimes, really bear no resemblance whatsoever to moving the specialty forward. So I would agree with everything Dr. Pacella said.
Dr. Sam Rhee: I think one of the things that was especially outrageous is that they considered bikini and provocative Halloween costumes to be unprofessional when they were basically targeting young women surgeons on how they dress during non-work time, that's sort of ridiculous to make those judgments about how we as surgeons dress outside of work, is, as Texas Sam said, profoundly misogynistic. And I think basically reflects an older, outdated, you know, prejudicial culture that, that we've seen in, in surgery and, is no longer accepted, has never been acceptable, but it's certainly not acceptable in 2020. 
Dr. Salvatore Pacella: Right. You know, it's interesting like you, what what's, what's completely, jaw-dropping to me is how they [00:07:00] went about this study.
So these authors actually ghosted several social media accounts to be accepted by other social media accounts in order to do the research. And it's, it's just overall very creepy. You know, how they went about it was a study, you know what I mean? Just, just absolutely crazy. you know, on the same token, it, I think as physicians, we do have to present an aura of professionalism. Okay. And certainly I agree with making, you know, with limiting your political comments, you know, or, Or coming down on people who make racist or, or, or offensive comments, you know, I think that certainly has criteria for a study like this, but the, the pictures and the, the bikini shots.
I mean, it's just, it's just so ridiculous. I mean, why you know, what, how does that affect your ability to care for patients? It does not. 
Dr. Sam Jejurikar: So are you saying [00:08:00] unprofessional for surgeons to talk about their political views? 
Dr. Salvatore Pacella: I think when it becomes offensive to other people, I think we have to have a, a common ground of, of, others' opinions.
So when you, when you do so when you do this in such a way that you, you sound misogynistic racist, bigoted, you know, that that has no place in medicine and in professionalism, just like in any field, you know, So, 
Dr. Sam Rhee: I know 
Dr. Salvatore Pacella: You don't want to be a Doctor Kevin or a Doctor Karen, if you know what I mean, I, 
Dr. Sam Jejurikar: I'm on that bandwagon. My wife, whose name is Karen, but she had literally been living a miserable life for three months. So I'm going to leave that one alone. 
Dr. Sam Rhee: I know that a lot of surgeons are now posting themselve in pictures with bikinis on. So I fully expect both you Sal and you Sam being in hot states to go ahead and join the trend [00:09:00] and post selfies with bikinis on. 
Dr. Sam Jejurikar: Well, I don't believe in body shaming others, or even body shaming myself so that's probably not going to show up. So I think, yeah, but I think it, you know, just to sort of close this topic off, it's been incredibly encouraging to see so many surgeons and anesthesia providers and physicians of all specialties sort of rising up against this. I think the world really is changing for the better. 
Dr. Salvatore Pacella: Yeah, there's, there is a, as you said earlier, there's a tremendous gender bias and surgery. It's a, it's a male dominated field and, you know, we, there are amazing and talented professional female surgeons and you know, it, we need to, we need to be inclusive. You know, this is just a terrible article, terrible article. 
Dr. Sam Rhee: I will say for the record, the, lead author did, Issue a public apology and the editors of the journal retracted the, the [00:10:00] article and they  acknowledged all the errors that were pointed out that you pointed out including the, review process issues, the creepiness in terms of, obtaining these, this data. And, hopefully this will be a teachable moment for, as they used to say in our, for all of us, in medicine. Right.
Okay. Sal, do you want to start us off talking about cosmetic surgery of the face and what your plan is to talk about it today? And then we can maybe sort of for contrast show some celebrities and discuss their plastic surgery as well. 
Dr. Salvatore Pacella: Sure, sure. Sure. Sure. Well, why don't I do this? Let's just go straight to our case here. I'm going to share my screen. Alright. Are you guys able to see this? 
Dr. Sam Jejurikar: Yep. Yep. Okay, great. 
[00:11:00] Dr. Salvatore Pacella: Okay. So, here we have a wonderful older lady she's in her late seventies and came to see me. she just did not like the appearance of her face and, you know, stated that she felt that her face was very deflated. There was excess skin. And overall people always asked her why she looks so tired and uncomfortable and you know, let's, let's just kind of talk about what you guys see here. 
Dr. Sam Jejurikar: Do you want to go first Jersey Sam? Or should I start 
Dr. Sam Rhee: Please, Texas. 
Dr. Sam Jejurikar: So, you know, I think, you know, I think as Dr Pacella mentioned, this is, just sort of chose the effects of gravity over time and the loss of facial volume.
And so. When you look at this at this woman, she still looks wonderful for her age, but she shows the general signs of gravity. So what I'll generally point out to people is if we start with the lower portion of the face, you can see that the jawline has largely been obscured because [00:12:00] the mid facial fat has dropped and as, and has created as fullness of in jowling. She's got prominent called nasal labial folds, or marionette lines around, around the nose. She's got, no, no worries. she, she's got generalized to send to the mid face away from the lower eyelids. You can see that the prominent dark line, which sort of demarcates, the middle portion of the face from the lower eyelids. When you look at the lateral portion of the eyelids, there's this heavy hooding that goes around with it, which shows that the brow has dropped as well. And so, you know, the, the big things to sort of tell patients about when you first see them is One. There's no nonsurgical intervention. That's going to really give them the full appearance they would like this requires what we sort of call pan facial rejuvenation, where we need to think about treating the brows and the eyes and the face and the neck and the chin and this patient, because she's got an under projected chin, potentially adding volume to [00:13:00] the form of a fact round. So a broad sort of expansive approach is needed to this case.
Dr. Sam Rhee: Yes. I second, everything that Texas Sam said, I would, And some of what you also discussed is not only facial aging changes, but just aesthetic facial proportion. So I know when we were residents, we had to do aesthetic analyses of patients and, split the face into thirds and look at proportions.
And you can certainly see, as Sam pointed out that the chin is significantly under projected compared to the rest of her face. And so it's not just aging changes, it's, actual, underlying aesthetic proportions that this patient, disproportion that this patient has. The other thing is, is in addition to the, the gravity changes she's also lost a significant amount of volume. So my guess is just like all of us, if you look at any of her pictures from 20 or 30 years ago, she had way more soft tissue volume, which was elevated and significant, you know, that's [00:14:00] what makes us look useful youthful. So yeah, that involution or loss of volume is also something that you could pretty much tell in this patient as well. 
Dr. Salvatore Pacella: Yeah, those are all very astute comments here, gents. So, you know, in, in San Diego and LA Jolla, there's a huge retirement population. And I, I see a lot of patients who have, have not had any work done throughout their lifetime.
And then, you know, they're still very healthy and still, very vibrant. And, you know, at age 70 80, sometimes they're coming in for facial rejuvenation and it, this makes the, the. It makes it a bit more challenging than somebody who's in their sixties or fifties. So, and, and just to reiterate what you guys were saying here, I think, you know, the pan facial approach is very, very important.
And many times patients just focus on one specific attribute of their face. So for example, their eyes. You know, this, this woman, her, her major complaint was these lower eyelids. Obviously we have a big, lower eyelid [00:15:00] bag here, but we also have this thing right below the eyelid bag called a malar festoon and that's, that's an anatomic issue right here.
There are some ligaments that go directly from the skin all the way to this, to the base of the skull base here. And it, it it's a challenge. If you don't know what you're looking for here to release these ligaments. And so just simply rejuvenating the eyes is not is, is to help with the central face, but it doesn't help this lateral face.
The other issue is that we, we sort of get into this scenario. The older you are that if you start tightening up one aspect of the face, it makes the other aspect of the face look very redundant and unnatural. For example, here, if we were to suspend her lower face only I would make an incision along the, the front of the ear here.
I would tighten this area up, but then all of a sudden that creates this redundancy in the brow area. The analogy I like to use is you know, imagine, imagine yourself, going to [00:16:00] Nordstrom rack and getting a dress or a suit, and you try the suit on it's a size too big. You can't just simply take it to the tailor and tighten up the waistline right. Because if you do that, it's just going to make the the top and the bottom look bunched. Do you have to really recontour the bust the line, the entire, the entire construct of that, of that fabric. And that's really the philosophy of facial rejuvenation. If we want things to look natural, if you want things to look unnatural, you could just certainly tighten things up willy nilly or tighten a little bit of skin, but patients will be sorely unhappy.
Dr. Sam Rhee: No, Sal I would like to add, I think that, yeah. Issue or issue also can be communication with the patient. So if this patient came in and said, okay, I don't feel like I am myself anymore. I just need some lip filler. And I think that's what will feel, you know, fixing my aging issues then, and you have to talk a lot with that patient.
So [00:17:00] sometimes it's like you said, it's about, not only understanding what the patient needs, but communicating with the patient about what they perceive their issues to be. 
Dr. Sam Jejurikar: Yeah. And along and along those lines, you know, as you said, sort of alluded, this is a woman in her seventies who clearly hasn't been doing fillers or Botox, I'm going to make the assumption that whatever you do to her has to result in a natural aesthetic.
There are patient differences, regional differences, sort of based off of the amount of work people have had up to a given point that influence with their expectations for a final result. So to me, a good result in a patient like this would be something that made her look the way she did 10 or 15 years ago, as opposed to something that would make her look different than she ever has before.
And, and I know that sounds silly, but there are people who want to look dramatically different or have had a lifetime of fillers who already look somewhat unnatural when you're starting with a, and they'll get a very different sort of result, 
Dr. Salvatore Pacella: Right. So, so let's go over, our plan here. So, so obviously, [00:18:00] you know, I did, I did, discuss what they're doing, a pan facial rejuvenation, and let's start from the top here.
So really, you know, looking at the eyebrows, we want to suspend the eyebrows up a bit higher. So I, I described something called a direct brow lift, which is done in the right underneath the skin, as opposed to the, fascia of the face. And that achieves a nice brow lift. We talked about doing an upper blepharoplasty, which is involves removing the skin and adding a little bit of volume with some fat to the upper lid.
The, her lower eyelids, obviously a tremendous amount of deformity here. So I talked about doing an extended, lower lid blepharoplasty or lower lid lift with adding some facial fat in this region. So going back to the facial fat concept, she's really very deflated. So. One of my strategies is not only pulling things up to a higher position, but adding some natural restorative facial volume.
If you look at her face here, it's very elongated, very thin in this area here, very [00:19:00] under deflated right here. And we want to create more of an oval aspect to her face something a little bit more balanced, and that's what we can easily achieve with fat transfer. And then finally doing a, a, a deep smas or high smas facelift.
The smas face lift not only takes the skin and suspends it up, but the deeper, muscle component of the face gets suspended upwards, and that'll really help with this jowling effect. And then finally, we talked about her chin, her chin, anatomically, if you looked at her, her photos, when she was 20, we didn't have any photos, but clearly this chin has been this way her entire life, her chin is very under projected, and it gives us appearance of having a pointed looking face all the way down here. there's virtually minimal balance to her lower face here, and we want to restore some of that balance with that with perhaps a chin implant. One thing I want to point out out here is this distance from her nose to her upper lip compared to the distance from her lower lip to her chin. This is obviously a very long [00:20:00] distance here. We talked at one point about doing something called the lip lift to shorten this distance. So she has a little bit more perky or pouty looking lip. so that is certainly an option. It's somebody with an elongated lip.
This is a very common thing we see in older patients. but she opted against that. So, but everything else, she she's good to go. any comments or how you would address any of these differently? Gents? 
Dr. Sam Jejurikar: No, I was just curious to see your final results and then ask you questions on that. 
Dr. Sam Rhee: Sam and I have not seen or discussed this case with Sal before he presents.
Dr. Salvatore Pacella: All right. So, so here we are, we did a brow lift, upper and lower blepharoplasty, extended lower blepharoplasty, fat transfer to the cheeks and full face and neck lift with a chin implant. Let me show you the side view here. And, you know, just looking at the side view here, you can see the distance that this chin adds to her lower lip. And I used it implant that was about, 1.8 millimeter projection that really helped to balance this position right here. We [00:21:00] want to bring this chin forward up that way. 
Dr. Sam Jejurikar: A few interesting observations, first of all, obviously a great result, obviously dramatic change she looks 20 years younger than she did before. a few tactical questions. Once you said you did a high smas facelift, but you also added some fat as well. Did you say that sort of how much, how much, how much fat in general, do you add to a patient like this? Cause she has so much more youthful volume than she did preoperatively.
Dr. Salvatore Pacella: Yeah. So, in this particular patient I added, about 25 CCS in the cheek and zygomatic area directly. And then into the nasal labial folds a bit. And then usually just a CC or two in the lower lids. 
Dr. Sam Jejurikar: 25 per side or 25 ...
Dr. Salvatore Pacella: Per side, per side. Yes. Okay. Yes. So a substantial, you know, volume, I would say. 
That looks amazing. And then, what kind of incision did you do for your subcutaneous browlift? Did you go on the hairline? Cause we noticed her hair is different. Now that was she hiding or that, 
Yeah. So, I, I actually make two [00:22:00] separate incisions here. So if you see here, you can see a little bit of the cut right here into the central area of the face, but then the subcutaneous brow lift in order to get up here, I, I made a, a hairline incision right here.
So this was not all one particular incision. 
Dr. Sam Jejurikar: And I think what's really awesome about her results was you talked about how you discussed with her potentially doing an upper lid, an upper lip lift. You didn't do it, but yeah. So it looks like you did, which is, which is fantastic. And that just shows how big of a difference adding volume and re suspending things to where they should be, can really make a youthful appearance. I mean, it looks like you shorten that distance without actually doing it. 
Dr. Salvatore Pacella: And I think a lot of this is really the chin implant. Just, just look at the side view here. You know, you can see how that chin implant just really extended to the chin length nicely, and just really magically helps this position of the nose to the upper lip.
By elongating this area here, it makes her face look long, a little bit longer, but more oval shaped. 
Dr. Sam Jejurikar: So for [00:23:00] people listening, a high smas facelift is definitely sort of a more invasive tightening of the smas, really powerful results that come along with it, but sometimes more postoperative swelling.
How long did she feel like she looks socially unacceptable after surgery? 
Dr. Salvatore Pacella: Yeah. So that, that's a great question. So, you know, I tell patients for, if you're just simply talking about a face. And not the eyes, socially acceptable for close to about three to four weeks afterwards. You can still get some swelling in and around the chin and facial area when we're adding the lower eyelids, the lower eyelids without question are, are singularly the, the most swelling that one can have in facial rejuvenation, without question. So I routinely tell patients your lower eyelids may bit be a bit swollen for at least three months after surgery. That may include some swelling of the white of the eyes. Looking like your eyes are tearing some redness associated with the lower eyelids.
So they, they really have to go, to buy into the fact that the lower eyelids are going to be swollen for [00:24:00] several months. 
Dr. Sam Rhee: What I really like about this result? I mean, it is absolutely fantastic is, You know the fact that, I mean, a lot of times when we do rejuvenation, we are restoring, but we're not actually altering facial proportions or at least skeletally. But in this case, by actually doing the chin implant, you have reduced that mentalis strain, the, her upper lip has changed in a very positive way because she had to basically pull her upper lip way down in order to achieve repose with her lips closed. And then adding that support with that chin implant, like you said, basically what allowed her to keep that upper lip length shorter and basically affected those proportions without doing a lip lift for her.
She looks natural without being overdone. And I think a lot of times when you start changing skeletal proportions, you have to watch out for that. And, and this was. a great [00:25:00] example of making someone look youthful within, without changing them, dramatically in that regard.
Dr. Salvatore Pacella: You know, one other, one other issue, that, that I find to be a bit of a challenge has many patients say, you know, Dr. Pacella it's. We, you know, I just don't like the consistency of my skin, you know, this leathery looking appearance to my skin and, and, you know, sitting here in Southern California, San Diego, LA Jolla, there's a tremendous amount of sun damage that most people have, even in their forties or fifties compared to their eighties.
And so, you know, one of. I don't necessarily want to do facial resurfacing, meaning changing the consistency of the skin time of the face with, but that is certainly an option. I work with a cosmetic dermatologist, right that can add a significant amount of laser resurfacing here. But the key here is it's you got to start with the lower foundation of the face.
You got to tighten things up before you start adding laser here. So for example, in this gal, You know, this, [00:26:00] this is without any laser resurfacing or any other, any other modality. And, you know, she still has these pigmentation changes. She's it still has some fine wrinkling here, but overall, if you just see how much smoother her face and neck is, you know, that that just is a bigger bang for your buck when it comes to laser resurfacing after the fact. 
Dr. Sam Jejurikar: Yeah, they go hand in hand, but you're completely right. The foundation has to be addressed first and on the surface stuff is an ongoing and lifetime thing that you, you need to do. around the time of surgery and throughout your life. Otherwise, sun damage will always come back 
Dr. Sam Rhee: On a personal note I just sometimes will throw a chemical peel in at the same time I'm doing either lower lids or mid face. They have to recover anyway. They have to be fairly fair complected. Or have some resurfacing experience. So I know I'm not going to cause hyperpigmentation, but that's, that's a freebie that I'll throw in sometimes.
Dr. Sam Jejurikar: Yeah. I'll, I'll commonly do a resurfacing laser at the same time as well for areas that I haven't undermined or lifted the skin up for our viewers. I'll I'll, I'll do that commonly [00:27:00] too.  
Dr. Sam Rhee: Very nice. 
Dr. Sam Jejurikar: Great. 
Dr. Salvatore Pacella: Alright. Gents.
Dr. Sam Jejurikar: Well, we are, do we have time for one more thing? Or do you think we should wrap it up? Gentlemen? What do you guys think? 
Dr. Salvatore Pacella: Well, we're at about a half hour. I think we can always 
Dr. Sam Rhee: Hit the celebs later. 
Dr. Salvatore Pacella: Yeah. Yeah. That's true. 
Dr. Sam Rhee: I mean, I don't think it's going to top what we just saw anyway. And so why shame some celebrity plastic surgeon out there. 
Dr. Sam Jejurikar: Before already shamed a vascular surgeon we don't know, there's been enough shaming for the day. Great. 
Dr. Sam Rhee: That was amazing. Do you routinely do pan facial rejuvenations like that because that's, that's a pretty dramatic, but also extensive. 
Dr. Salvatore Pacella: Yeah, it is a pretty extensive procedure. something like that would take me probably a good six and a half to seven hours to do, you know, the, the lower eyelids, particularly when she has [00:28:00] so much, deformity there, you know, that, that takes a bit of time to get right.
And, you know, it's a symmetry of both sides that's the issue and, you know, you, you both trained at at great institutions in addition to Michigan, but your fellowship programs. So, you know, the, the, we, I think three of us understand just how intricate the faces and going into the sub smas position is, is a little nerve wracking sometimes and take some talent. So it, you've got to take your time doing a case like this, you know, this is an all day event. So,
Dr. Sam Jejurikar: No one, no one ever said Dr. Pacella is the greatest surgeon. He did my case in three hours. They say he's the greatest surgeon because he took his time. Right? And that's an amazing result. If she's not ecstatic, then there's no point to be in plastic surgery.  Cause that's as good as the result as you can get. 
Dr. Sam Rhee: I like the fact that you took the time to really go through this with her. You can tell, cause you said, listen, we talked about all these different things. And when you make that kind of dramatic change, you know, finding a surgeon who will communicate well and you know, make that patient feel comfortable going into something like this that's important. 
[00:29:00] Dr. Sam Jejurikar: Yeah. And one thing I have definitely learned from Pacella, because you know, we all have our areas of specialty, but Pacella really is considered nationally to be an eyelid specialist. I mean, he is well known for doing that and, It's really true, patients sometimes don't respect the lower eyelids as much as we, as plastic surgeons do.
They think, Oh, it's just this little thing. It's this little structure on the face. I should recover really quickly from it. But it is a tough thing in, in our, in our practices that if you haven't adequately warned people about the swelling they can get after lower eyelid surgery  they can be pretty unhappy.
So I've, I like hearing you emphasize that aspect over and over again, about how much you need to respect a lower eyelids, because that's something that viewers should listen and other plastic surgeons watching, they should also really stress to their patients. 
Dr. Salvatore Pacella: And this is, this is a gal who's never had any facial or lower eyelid surgery before. And I tell patients like this three months of recovery, I also see a fair amount of a revision patients on the lower eyelid, people who have substantial deformities of [00:30:00] their eyelid ectropion or other shortening deformities of the eye and, you know, recovery, those cases, gosh, can take upwards of a year.
It's a real challenge, you know, so, but yeah, but rewarding, nonetheless, I mean, this is, to me, this is some of the most rewarding and fun surgery that we do in plastic surgery. Yeah. 
Dr. Sam Jejurikar: Well, thanks for another illuminating session, gentlemen. Alright. Learned just as I always have. 
Dr. Sam Rhee: Always. 
Dr. Sam Jejurikar: Have a great Sunday everyone.
Dr. Salvatore Pacella: Signing off. 
Dr. Sam Rhee: Take care guys.
Dr. Sam Jejurikar: Take care.