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

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

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

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

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

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

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

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

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

The Plastic Surgery Consultation What Patients Should Expect

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

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

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

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

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

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

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

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

Revision Breast Surgery Why Secondary Breast Operations Are So Common

In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella discuss secondary and revision breast surgery and explain why it is one of the most common procedures in modern breast surgery.

Many patients are surprised to learn that breast implants are not lifetime devices. Over time, changes in breast tissue, aging, pregnancy, weight fluctuation, implant wear, and personal preferences often lead patients to require revision surgery. In many practices, secondary breast operations are performed as frequently as primary breast augmentation.

The conversation covers the most common reasons patients seek breast revision, including capsular contracture, implant rupture, malposition, bottoming out, asymmetry, and changes in desired implant size. Dr. Jejurikar and Dr. Pacella explain what capsular contracture is, why it occurs, and how it can affect both comfort and appearance.

The episode highlights why revision breast surgery is significantly more complex than primary breast augmentation. Unlike first time surgery, revision cases often require pocket reconstruction, correction of the breast fold, reinforcement of tissue support, and frequently a breast lift to restore proper shape and nipple position.

Dr. Pacella explains the role of internal support systems, often referred to as internal bras, and why tissue that has supported implants for many years is often unreliable on its own. The surgeons clarify that internal support does not replace the need for a breast lift and discuss how physical exam findings determine the surgical plan.

Implant technology and capsular contracture prevention are discussed, including Motiva implants, acellular dermal matrices, and bioresorbable meshes. The surgeons explain what the current medical literature supports and where data is still lacking.

The episode also addresses ruptured breast implants, how they are diagnosed using ultrasound or MRI, whether ruptures pose health risks, and why addressing them sooner rather than later can simplify revision surgery.

This episode is ideal for patients with breast implants, those considering revision breast surgery, and anyone who wants a realistic understanding of why secondary breast operations are common and how they are approached safely and effectively.

Rhinoplasty - Form, Function, and Natural Results

In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella explore rhinoplasty, one of the most technically demanding and misunderstood procedures in plastic surgery.

Rhinoplasty is often thought of as cosmetic nose reshaping, but the surgeons explain why it is just as much about structure and breathing as it is about appearance. The discussion highlights why rhinoplasty requires a unique skill set, why experience matters, and how small changes can have a major impact on both aesthetics and airflow.

Dr. Jejurikar and Dr. Pacella compare open and closed rhinoplasty techniques and explain why the choice depends on surgical goals rather than patient requests. They discuss cartilage support, tip shaping, and why the small scar associated with open rhinoplasty is usually insignificant.

The episode addresses common patient misconceptions, including the desire to copy celebrity noses. The surgeons explain why nasal skin quality, facial proportions, and individual anatomy make this unrealistic and why the goal should always be for the nose to fit the face while preserving identity and character.

Male and female rhinoplasty differences are discussed, with a focus on subtlety in male patients and the risks of over reduction. The surgeons explain how masculine nasal features differ from feminine ones and why preserving these differences is critical.

A significant portion of the conversation focuses on functional rhinoplasty and breathing. Dr. Pacella explains how airway evaluation, septal alignment, and internal nasal valve support are essential parts of planning surgery. Dr. Jejurikar discusses how cosmetic maneuvers can unintentionally affect breathing if not carefully managed.

Recovery is covered in detail, including what patients can expect in the first few weeks, why swelling resolves gradually, and why final results continue to refine over a full year. Dr. Pacella also shares his personal experience undergoing rhinoplasty for breathing issues and how it shaped his approach to patient care.

This episode is ideal for patients considering rhinoplasty, those researching cosmetic or functional nose surgery, and clinicians interested in the intersection of aesthetics and airway preservation.

Eyelid Surgery - Why Small Does Not Mean Simple

In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella take a deep dive into eyelid surgery and explain why one of the smallest operations in plastic surgery can also be one of the most complex.

Many patients think of eyelid surgery as a quick or minor procedure. In reality, successful eyelid rejuvenation requires precise judgment, careful technique, and a thorough understanding of how the brow, upper eyelids, lower eyelids, and surrounding structures age together. Dr. Pacella explains why lower eyelid surgery is often the most technically demanding area in facial plastic surgery and why prevention of complications is far more important than aggressive correction.

The conversation covers upper eyelid surgery and the importance of conservative skin and fat removal to avoid hollowing, dry eyes, and difficulty closing the eyelids. Dr. Jejurikar discusses how preserving volume and respecting brow position leads to more natural and youthful results.

The episode then shifts to lower eyelid surgery, where the surgeons explain why eyelid laxity is frequently underestimated and how improper technique can lead to ectropion, malposition, and shape changes that are difficult to fix. Different surgical approaches are discussed, including transconjunctival fat removal, conservative skin excision, laser resurfacing, and various methods of canthal support.

Dr. Pacella also shares insight into complex lower eyelid reconstructions, including rare cases where the eyelid support system must be rebuilt. Common postoperative issues such as chemosis are explained along with strategies for prevention and treatment.

Recovery expectations are addressed in detail, highlighting why upper eyelid surgery often has a short recovery while lower eyelid surgery can involve weeks of swelling and temporary vision changes. The surgeons also discuss ice, supplements, and other strategies that may help with healing.

This episode is ideal for patients considering blepharoplasty, anyone researching upper or lower eyelid surgery, and clinicians interested in nuanced eyelid decision making and complication management.

Episode 8: The Importance of Fat in Plastic Surgery

In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella discuss how fat has become one of the most valuable tools in modern plastic surgery.

Once considered something to remove and discard, fat is now recognized for its regenerative properties, growth factors, and ability to restore youthful volume in both the face and body. Advances in fat harvesting, processing, and injection techniques over the past decade have significantly improved outcomes and consistency, making fat transfer a core component of aesthetic and reconstructive surgery.

The conversation explores how fat loss contributes to facial aging and why fat transfer plays a key role in natural facial rejuvenation. The surgeons discuss patient selection, skin quality, and why careful handling of fat is essential for long term success. They explain what patients should realistically expect after fat transfer, including typical retention rates and how fat behaves over time.

Dr. Jejurikar and Dr. Pacella also address potential complications such as asymmetry, cyst formation, and fat necrosis, along with strategies used to minimize risk. The episode expands into fat transfer for the breast and body, including historical concerns about breast safety and current evidence that has shaped modern practice.

The discussion concludes with a candid look at Brazilian Butt Lifts, including how cultural trends influenced demand, why safety concerns emerged, and how ultrasound guidance and strict technique standards have improved outcomes.

This episode is ideal for patients researching fat transfer, facial fat grafting, natural facial rejuvenation, and BBL safety, as well as clinicians interested in the science and evolution of fat grafting in plastic surgery.

Male Plastic Surgery What Works, What Fails, and Why Subtlety Matters

In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella tackle the growing and often misunderstood topic of male plastic surgery.

Cosmetic surgery for men has become increasingly common, yet many male patients still worry about stigma, visibility, and looking unnatural. In this conversation, the hosts explain why male aesthetic surgery requires a different mindset, different techniques, and a strong emphasis on preserving masculine features.

They discuss the most common procedures men seek today, including liposuction for the abdomen, flanks, and chest, treatment of gynecomastia, upper eyelid blepharoplasty, neck lifts, facial surgery, and hair restoration. The episode highlights why procedures that work beautifully in women can look feminizing or overdone in men if not carefully adapted.

The discussion also explores scar placement challenges in male patients, how surgeons approach jawline definition and neck contouring, and why volume must be used sparingly in the male face. Real world examples are used to illustrate how subtle changes can dramatically affect how natural or noticeable a result appears.

The episode concludes with a deep dive into hair restoration, including modern follicular unit extraction techniques, candidacy, limitations, and why hair transplantation has become one of the most sought after procedures among men.

This episode is ideal for men considering cosmetic surgery, patients researching male specific procedures, and clinicians interested in sex specific aesthetic planning and outcomes.