Dr. Pacella & colleagues discuss the Top Ten Myths of Facial Aging

 

 

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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.