One in eight Americans is now on a GLP-1 medication like Ozempic, Wegovy, or Zepbound. The weight loss can be life-changing, but there is a side of this story that rarely gets talked about openly: what these medications are doing to your face, your skin, your muscle mass, your bone density, and your body contour.

In this episode, board-certified plastic surgeons Dr. Sam Jejurikar (Dallas, TX) and Dr. Sal Pacella (San Diego, CA) bring a combined four decades of surgical experience to one of the most pressing topics reshaping their practices today.

They break down the predictable patterns of facial volume loss they are seeing, including hollowing of the cheeks, temporal wasting, dark circles from mid-face descent, and loss of skin elasticity that goes beyond what you would expect from weight loss alone. They discuss why fat grafting results in GLP-1 patients may not be as durable as expected, and why GLP-1 receptors expressed on fat cells themselves may be to blame.

The episode features a lively disagreement on Sculptra: Dr. Pacella is firmly in the skeptic camp, calling it a reverse ATM machine, while Dr. Jejurikar makes the case that conservative, layered treatments delivered every six to eight weeks can serve as an effective volumizing foundation for the right patient. They also explore the promise and limitations of AlloClae cadaveric fat grafting, currently FDA approved for the breast and body but generating serious interest for facial applications.

The conversation then shifts to the body, covering the underappreciated impact of GLP-1s on muscle mass and bone density, why resistance training is now a clinical conversation happening in plastic surgery offices, and why brachioplasty and thigh lift volumes have increased fivefold in recent years. They also tackle Ozempic butt directly, explaining the combined role of fat loss, muscle atrophy, and pelvic structural changes, and why excisional lifting procedures are increasingly replacing the Brazilian Butt Lift for this growing patient population.

GLP-1 medications are not going anywhere. Newer agents, oral formulations, and triple-mechanism drugs like Retatrutide are already in the pipeline. For patients and surgeons alike, understanding the downstream effects is no longer optional.

Dr. Sam Jejurikar is a board-certified plastic surgeon and President of Dallas Plastic Surgery Institute. Dr. Sal Pacella is a board-certified plastic surgeon in private practice in San Diego, California. Together they host Beauty and the Beasts, a podcast dedicated to honest, unfiltered conversations about plastic surgery, aesthetics, and the science behind looking and feeling your best.

Follow Dr. Jejurikar on Instagram: @samjejurikar Follow Dr. Pacella on Instagram: @sandiegoplasticsurgeon

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

The Plastic Surgery Consultation What Patients Should Expect

In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella focus on one of the most important parts of plastic surgery that often gets overlooked: the consultation.

For many patients, the first visit with a plastic surgeon can feel intimidating. Most people arrive having done extensive online research and often come in asking for a specific procedure. Dr. Jejurikar and Dr. Pacella explain why the best consultations are not about requesting an operation, but about clearly explaining concerns, goals, and what truly bothers the patient.

The conversation explores how experienced surgeons structure a consultation, beginning with open ended questions and careful listening. The hosts emphasize the importance of rapport and trust, noting that plastic surgery is often a concierge style relationship that requires strong communication before, during, and after surgery.

A major focus of the episode is the physical examination and why it remains essential in plastic surgery. Dr. Pacella discusses the value of face to face interaction, hands on examination, and tissue evaluation, and why these elements cannot be replaced by electronic medical records or imaging alone.

The episode also covers the questions patients should expect to have answered during a consultation, including safety, recovery, and implant related concerns. The surgeons discuss how they address breast implant associated conditions, including lymphoma and breast implant associated illness, and why transparency about what is known and unknown is critical.

Financial considerations are addressed as well, including third party financing and how patients can prepare in advance to understand costs and options. The role of three dimensional imaging is discussed, with insight into how modern tools are best used for communication and assessment rather than exact prediction of results.

The episode concludes with a discussion on board certification and recovery planning, explaining why training, qualifications, and a clear understanding of postoperative recovery are essential before moving forward with surgery.

This episode is ideal for anyone considering plastic surgery, preparing for a first consultation, or wanting a clearer understanding of how to choose a surgeon and get the most out of the consultation process.