S04E68 Mastering the Art of Mini-Lifts: Revolutionizing Facelifts with a Minimalistic Approach

Ever dreamed of achieving facial rejuvenation with a more natural, surgery-free look? Dr. Salvatore Pacella @sandiegoplasticsurgeon takes co-hosts Dr. Sam Jejurikar @samjejurikar and Dr. Sam Rhee @bergencosmetic through an exquisite masterclass on the art of mini-lifts, a revolutionary approach to facelifting that minimizes scarring and impact on the patient, with actual before and after cases of patients.

This episode brims with professional insights about identifying ideal candidates for mini-lifts and crafting a tailored approach for each patient. Our conversation dives deep into the techniques used, the anesthetics involved, and the expected recovery period. We make sense of the swelling and bruising that might occur, and discuss why vertical pulls help create natural-looking results. We also tackle the use of absorbable sutures in mini-lifts, the safety of local anesthesia, and the benefits of different operating settings. 

Join us in this exciting exploration of mini-lifts and gain a fresh perspective on this game-changing surgical technique.

@3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery  

S04E68 Mastering the Art of Mini-Lifts: Revolutionizing Facelifts with a Minimalistic Approach

[00:00:00] 

Dr. Sam Jejurikar: well, welcome everyone to yet another edition of Three Plastic Surgeons in a Microphone. It has been a while since we've been recorded and we're so glad to be back after a little summer break. As always, I am joined by Dr. Salvato Patella from La Jolla, California and Dr. Sam Re from Bergen County, New Jersey or Paramus, New Jersey.

Still, still getting that down.

Dr. Salvatore Pacella: It's only been, it's only been a few years.

Dr. Sam Jejurikar: I know, I don't know why I stumbled with that, but, uh, you know, we all have our things that we struggle with. That's apparently one of mine. Um, today we're talking about a really exciting topic that, uh, Dr. Pacella is going to lead the conversation. We're going to talk about, um, what, uh, what are called mini lifts or, uh, sort of lesser invasive facelifts and what's entailed with that.

So before we get going with that, Dr. Uh, Rhee is just going to read the normal disclaimer of our usual business.

Dr. Sam Rhee: This show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for [00:01:00] informational purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment after appropriate discussion. Always seek the advice of your surgeon or any qualified or other qualified health provider with any questions you may have regarding medical care.

And never disregard professional medical advice or delay seeking advice because of, because of something in this show.

Dr. Sam Jejurikar: Wonderful. So, um, you know, Dr. Pacella, I'm, I'm. Excited to pick your brain on this because, you know, we'll get calls in the office and you have some patients that are trying to avoid surgery, um, to look rejuvenated, other patients that are ready for a full fledged, you know, facelift, neck lift, brow lift, bleph, all that sort of thing.

But you're talking about someone that kind of falls, I imagine, between those two categories. Just tell me what is a mini lift.

Dr. Salvatore Pacella: Well, so a midi lift is a procedure that is designed, um, to minimize the total amount of scarring and minimize the impact on the patient. But, but before we get into that, I, I just want to maybe chat a [00:02:00] little bit about the, um, the philosophy of facelift, facelifting and sort of what that means to a plastic surgeon.

Um, and I can tell you that. Um, throughout my career, I've trained with some incredible surgeons, and each time I've scrubbed with, uh, some of these giants like Dr. Hester, Dr. Nahai, Dr. Codner, um, they had been in practice for many, many years. And I asked them, when did you feel completely 100 percent comfortable with facelifts?

And you know what their answer was? I still don't.

Dr. Sam Jejurikar: Okay.

Dr. Salvatore Pacella: So, um, and, and I, and I took that to, to it, uh, I took that to believe not necessarily that, that the operation is technically challenging. Um, it does take a tremendous amount of knowledge to understand where these nerves and blood vessels are going and what plane you're supposed to be in.

But the finesse associated with, um, creating. An appearance that looks like it hasn't been lifted or it hasn't had surgery. Okay. [00:03:00] Um, and, and to me, that is, that is the Holy Grail of plastic surgery to look like you haven't had surgery. Right. Um, you know, I'm from New York, uh, New York state, originally upstate.

I trained in the Midwest like you guys trained in the South, you know, my, not to, not to rag on our guys in Beverly Hills, but you know, there's a certain look of, of, of facelifting out on the West coast. That's a little odd, right? I mean, Patients look like they've been over pulled, overdone, windblown, et cetera.

And, and, you know, the, the, the tailoring or the bespoke nature of facelifting that I feel like I've picked up over the years, I think really gels to this, you know, it's, it's not a, it's not a procedure where you're going to come out looking like, man, you had just this, this complete wind tunnel look, um, you know, I approach this in a way that makes it look natural, makes it look, uh, feminine for the most part, um, and, um.

And less, less traumatic on the, on the patient's skin,

Dr. Sam Jejurikar: Yeah, and I love, I love that you use the [00:04:00] term bespoke. I mean, I think that really illustrates that, um, in this era right now where it seems as though people are calling and everybody wants to get a deep plane facelift, which means they get the deep soft tissue repositioned somehow. Um, not all facelifts fit all people.

So tell us a little bit about how many lifts fall into that bespoke approach that you take.

Dr. Salvatore Pacella: right? So, um, so to me, uh, a mini lift or what we call a short scar facelift is a procedure that really is designed for the central area of the face. This area, the central triangle of the face, and it's really ideal for middle aged women or middle aged men that really see this folding near what we call the marionette lines or the nasolabial folds.

Unfortunately, it is not a procedure necessarily that is designed to really get the central neck here. So if you have a patient coming in, I'm sure you all agree that when patients come in and they have these thick, long platysma bands underneath their chin and a massive amount of excess skin, [00:05:00] a mini lift or short scar lift is really not going to do that.

To some extent, it will do it a little bit because the vertical component of the pulling will get a little bit of this, but somebody who's got a tremendous amount of sun damage. Um, it's just, it's just not going to do much for that. And I think patients understand that once you sit down and you explain it to them.

Um. The other difference, I would say, in a mini lift compared to a full deep plane facelift that I may perform is the angle of pull. So, for example, when you have a pull on the neck, you're pulling a little bit more posteriorly and you're pulling a little bit more obliquely. With a short scar lift, The key is pulling this in a vertical way without creating bunching in and around the temple.

And so to me, that's the key. Um, you know, I try to use this analogy for patients, um, getting back to the whole bespoke thing, right? Um, you know, many times patients come in, they don't know a ton about facelifts and they say, well, I, you know, I just, I just want my neck done. I just want this. I [00:06:00] just want to pull this right.

I don't want to go into the face or I want to just concentrate on it here. I don't want to go into the neck. And I, and I use this analogy. I say, well, let's imagine you're shopping for a dress for an event. Okay. And you don't want to spend 2, 000 on a designer dress. So you go to Nordstrom Rack and you see this beautiful dress and it's discounted 90%, you know, you pay a couple hundred dollars for it, you try it on.

It's a little bit too loose, right? So, you take it to this tailor next door, to Nordstrom Rack, and you say, I just, I just want the waist taken in a little bit. And they say, no problem. So then you try the dress on, and the waist is tight, but everything else looks odd. The bust is bunched up. The A line is all sort of, um, Mangled, right?

And that's a lesson for patients, right? Because in order to make these things look natural, you can't just address one area, this is a continuum of skin throughout the middle face and the neck. You have to sort of taper this into these anatomic plates. And I think patients get that sometimes, or many times [00:07:00] when we explain it.

Dr. Sam Jejurikar: Yeah, I think that's awesome. I think, um, you know, one of the things that I know you talk to your patients about too is, um, we sometimes patients will, will get the skin components of their facial aging and the deeper soft tissue component a little bit confused. And where I think the mini lift that you're going to tell us about comes into play is when people.

Particularly where their neck is concerned, don't have a lot of skin access for their neck. Um, you know, you can do, um, you can do a wonderful job sometimes actually taking care of those, you know, there's issues with their neck and still keeping a relatively short scar. I think a mini lift is a really, really nice option too in women that have short hair.

Women, uh, men in particular, like when you want to hide that scar, so. I know you have some cases that I think you're going to show us, uh, but I'll help illustrate that. That would be awesome if we could see

Dr. Sam Rhee: yeah. When you, as you bring those up, I do want to just concur that when you say bespoke, I think what some patients do, and we, we just talked about this a second ago before we got on is people get caught up on [00:08:00] terminology. Like, is this full, is this mini, is this, this, and a lot of, you know, is this deep plane and a lot of it is really.

Trusting the surgeon that you go with to know and recommend and talk about these different, uh, things because honestly we've all seen people who've gotten certain procedures that by definition are one procedure but it's something else and I think that really what you need to do is say okay forget about all these terms because it's just better.

You know, they can be misleading. What is it that you want to do for me? What do you think is going to make me do the best? I. e., a bespoke procedure. Something that you said, uh, in your words. Like, let, let the dress fit me. Let me figure out... Tell me what that is and forget about like all these terms. That being said, I think the great thing about mini lifts or the term mini lift is that you're trying to emphasize the least invasive type of procedure that will [00:09:00] achieve the result that you want to get.

And I think that that's really what patients want. What is the least invasive procedure that will still help me achieve the results that we're looking for here? And, and if you're going to use that term mini lift to. To embody that, then you and your surgeon are on the right track with it.

Dr. Salvatore Pacella: You know, I would say the beauty of the mini facelift too, is it, um, I try to combine a little bit of fat transfer, not a ton, um, as well as the skin and deep plane lifting. Um, and this can be done in the office in a short period of time, two to three hours. Uh, You know, not, not so much the lifetime or the lifestyle or lunchtime lift that, uh, were very popular years ago, but this can be done under just oral sedation with, uh, uh, injection and local anesthesia.

So that's, that's the real beauty of the procedure. Um,

Dr. Sam Jejurikar: As you're talking, question for you, when you're describing a mini lift, is there ever a submental incision as part of it or is it all,

Dr. Salvatore Pacella: usually not just a lateral facelift. I think, you know, in my [00:10:00] practice, uh, when I make a submental incision, I'm, I'm going pretty deep into the neck and, uh, To me, you know, operating on the, the deeper plane of the neck through the center portion in an office setting. That's asking for trouble, you

Dr. Sam Jejurikar: yeah, no, no, well, no, I, I totally get that. I just didn't know if you were defining that as a mini lift as well. So is a mini lift in your practice then just done under local in the office? Are these Okay, okay.

Dr. Salvatore Pacella: But, but to be honest with you, sometimes patients just, you know, they want to be put to sleep for it. They want to be comfortable. And I'll do a mini lift under general anesthesia too, particularly if we're doing, doing it in the, uh, setting up. Look, look at this guy right here, this guy right there. Particularly if we're doing it in the setting of a brow lift or blepharoplasty or something like that, you know, so it's really, really, uh, related to the technique, not necessarily the anesthetic component. so that being said, let's kind of dive into a few cases here. So, um. Okay. So here's a [00:11:00] older lady.

She's in her late seventies and really concerned about the marionette lines of her face. And when I refer to that as this area right here, and this is where, if you see this sort of rectangular appearance that she has to her face, this is what, this is what drives people nuts when they, when they want facelifts, both, both young and older women.

And so with her, this was done, uh, in the office setting, um, under local anesthesia. With really the intent of concentrating on just this area here, this central triangle to the face. So the incision was made, um, just in front of the ear, and we added a little bit of fat to the cheek line. So if you see the difference here, I think this says a lot between, um, taking a rectangular face and making it look more oval or triangular.

Dr. Sam Jejurikar: So you just did a short scar facelift on her without any, because her platysmal bands are gone.

Dr. Salvatore Pacella: yes, so we did [00:12:00] we did a little bit of Botox underneath there and pulled a little bit laterally So with this particular patient, I pulled a little bit behind the ear not all the way extended to where To where I'm gonna go behind the ear along the hairline But sent but a little bit more towards the the posterior aspect of the ear So again, this is this is exactly what I was talking about bespoke.

You gotta tailor your technique to every single patient. Not every single patient looks exactly the same or has the exact same anatomy.

Dr. Sam Jejurikar: And how far post op is she in this? Like, how long did

Dr. Salvatore Pacella: these are a year, a year. My policy is to never show pictures that are beyond or that are earlier than a

Dr. Sam Jejurikar: Well, let me ask you a different question because patients obviously are concerned about their amount of downtime. Do you tell them when they're getting, because a traditional facelift where you're, where you're doing a lot of deep, um, soft tissue manipulation. You know, their, their swelling is, is substantial for, for six weeks and they may look, and they may look like they're, you know, a little strange for three or four months.

What do you tell these patients? [00:13:00] How, how long they're going to look socially unacceptable?

Dr. Salvatore Pacella: Well, you know, I, I, it's funny you use that word socially unacceptable because that's exactly the word I use, Hack Newman, right?

Dr. Sam Jejurikar: came from Hack Newman, exactly.

Dr. Salvatore Pacella: And so, um, um, so, you know, I, I tell patients not to discount how much recovery is involved with this. I mean, a facelift. Or mini lift is not a, it's not a skin procedure. You know, it's not just on the out surface of the skin.

We are deep down inside there. We're just doing it in such a way that it's going to minimize the scar. So there is a lot of swelling. I, I, I try to cut that time in half, but sometimes it's longer. Sometimes it's less, it depends on the patient, you know, but I do try to. to tell them you have to be prepared for a bit of swelling.

Dr. Sam Rhee: Now...

Dr. Sam Jejurikar: And I think that's, that's, I'm sorry, Sam, go

Dr. Sam Rhee: Oh, I was just gonna say, so that jowling correction is strictly with a SMAS plication.

Dr. Salvatore Pacella: Uh, no, this is a, this is a SMAS elevation. So what I did in this particular case was I did a high SMAS [00:14:00] technique, so not a plication. So going underneath the SMAS, um, down to release the deeper facial ligaments. And then re suspending this above the zygomatic arch at the temporal fascia. And that's what gets that, the neck, right?

When you're, when you're pulling in a vertical component, even though you may not be going into the neck and tightening up the platysma bands, you are, you are suspending them just by, just by

Dr. Sam Rhee: How much of a SMASH

Dr. Sam Jejurikar: And you're doing this,

Dr. Sam Rhee: sorry, how much of a SMAS,

Dr. Sam Jejurikar: this in the office?

Dr. Salvatore Pacella: Do this in the

Dr. Sam Rhee: I was about to say, cause how far down the SMAS are you dissecting? Cause you can get into tiger country there with the, with the nerve branches, right?

Dr. Salvatore Pacella: Um, yeah, as far as I could see, as far as I could go, um, and I'll usually use a blunt dissection, um, spreading scissors, uh, to avoid any major cutting. I mean, I, I have, I have essentially the same setup in the office as I do in the operating room, right? So I have, uh, loop dissection, I wear loops, I wear headlights, um, I have the same types of retractors, you know, and you'd be surprised at [00:15:00] how, how, how well you can go.

The other key component to this. Um, which is discounted, I think, is the, the anesthesia component. Okay. So several years ago, I switched my practice for anesthesia from simply just using off the shelf lidocaine with epinephrine to fresh mixture of lidocaine, marcaine. Epinephrine, fresh epinephrine, and transexemic acid.

We had a discussion quite a while back about TXA as a, as an adjunct to local anesthesia, and I think that's a total game changer. Um, that really minimizes the blood loss, particularly when you're injecting it deep into the face, which makes the operation so much more smooth.

Dr. Sam Rhee: TX and A.

Dr. Salvatore Pacella: TXN day.

Dr. Sam Jejurikar: I, um, a couple of things I want to point out to the listeners of this, one is Dr. Pacella had mentioned the lifestyle lift. Lifestyle lift for listeners who haven't heard of it was something, it was a company that I think they went [00:16:00] bankrupt after multiple lawsuits where they would basically do a very small skin elevation in the office.

If they had a decent, there was a national company, so they had, you know, tons of ENT and plastic surgeons working with them. If there was any work done on the deeper soft tissue. Um, it was minimal at best, and the results didn't last very long. Dr. Pacella is doing an in office facelift with relatively small scars, but he is doing a very real facelift on these patients.

This is a substantial manipulation of the deep soft tissue through minimal scars, and so it's important that listeners sort of understand that. Even though we're describing a mini incision, this is not mini results. This is not mini recovery. Um, this is a real substantial facelift. And honestly, I think I would not feel comfortable doing this in the office.

I don't have the same setup that, that you have in the office, and my OR lighting is just substantially better. I'm [00:17:00] blown away by how good and even in office. Facelift. This is, but again, I don't know anybody else that does. This could have been in office facelifts. Like most people, most people in office facelifts are a few stitches in this mass or the deeper soft tissue and they call it a day.

So this is awesome.

Dr. Sam Rhee: Well, I, I agree. I think you did some real foundational work here, which is why I was asking about the extent of your SMAS dissection, because you can only get this if you're really. Moving that SMAS in a significant manner, which, as Sam says, most of the time, a lot of these in office procedures are sort of faux SMAS, you know,

Dr. Sam Jejurikar: yeah, cause you have to do considerable dissection. I mean, um, I mean in order to, to get that degree of

Dr. Salvatore Pacella: Well, so, so I think, you know, to me that the key is really where you enter into the SMAS. Um, so for example, um, you know, you guys may feel the same way when we did [00:18:00] facelifts at Michigan, but you know, we, we would always start the facelift, the sub SMAS component of the facelift or the deep plane component of the facelift kind of right around here at the zygomatic arch.

And, and, you know, I, I gotta tell you, years of frustration of doing that. It's like. You know, you start pulling the SMAS. You don't know how thick it is. You don't know how thin it is in certain patients. You start pulling through, you get into the parotid fascia, you get holes in it. It's just a, it's a real pain.

So years ago, I started entering down here below the ear. Okay. So right as the platysma starts, the muscle is thicker and you can use that to, to sort of create the plane that you go superiorly. So, and, and that means. And you could still view this by just going a little bit behind the ear. You don't, again, you don't have to make this big sort of extended neckline lift.

Um, but just right here, you can really get into this platism very nicely. And that can just creates the plane for you going immediately.

Dr. Sam Rhee: do you use to suture your SMAS placation [00:19:00] up to the zygomatic?

Dr. Salvatore Pacella: I usually. I usually use 2 0 PDS. Um, so I think, um, you know, I'm a firm believer in using absorbable sutures, but sort of semi permanent absorbable sutures. Um, I don't see a real need to have ethabond or thicker sutures in the middle of the face. Those oftentimes not, and they don't go away. Uh, for all practical purposes, PDS is a...

is a permanent suture. By the time tissue planes are attached, you don't need the PDS anymore, in my opinion.

Dr. Sam Rhee: And where do you get the fat to, uh, graft to the, uh...

Dr. Salvatore Pacella: Oh, just, just from the abdomen, just from the abdomen. Yeah. And I would say.

Dr. Sam Jejurikar: So that's, again, a substantial, how much fat did you put in her?

Dr. Salvatore Pacella: About 10 cc's on either side. So not a ton.

Dr. Sam Jejurikar: So how much local are these patients getting with this degree of fat grafting? Like, I mean, and this degree of dissection in the face, I mean, do you worry that sometimes that you're sort of exceeding the concentration that we would want to give?

Dr. Salvatore Pacella: so, so, so great question. I, I [00:20:00] went over this with my pharmacy, uh, uh, the pharmacy manager at, at my hospital at Scripps Green Hospital. And the way the aliquot is performed or mixed in by pharmacy. So let me back up a bit. So when I do these kinds of cases at the hospital, when I, I desire this, local anesthesia that is pre mixed. They do it in such a way in the pharmacy to make it sterile in the operating room, etc. And so there is a 50 cc bag of saline that all of this goes into. And so by the end of it, it turns out to be about 70 cc's. You can use up to two bags of that, safely, because the concentration of Marcane and Lidocaine, which are the rate limiting steps, is so diluted, okay, um, that it's safe.

So, routinely, if I do a full facelift in the operating room, I may use 70 to 80 cc's of this, of this mixture. And these patients are being watched under general [00:21:00] anesthesia, uh, they're getting an EKG constantly, they're getting their, their O2 sat monitored, et cetera. So I need dramatically less for an in office mini lift.

Okay. Maybe half. So I think you, so I usually do about 20 cc's on either side in the middle of the face here. So that's about 40 total. And then I'll inject Tumescent into the abdomen in a small area, maybe 20, 30 cc's at most to get the amount of fat I need. So it's. It's not dramatic, the amount of local anesthesia they need.

I think it just potentiates so much better with the epinephrine. Fresh.

Dr. Sam Jejurikar: What? Yeah. And we, and we, um, I think, so do you have like an outpatient surgery center option for you to do your facelifts in? Cause it's, it's interesting where you're talking about the hospital versus doing it in your office,

Dr. Salvatore Pacella: Yeah, so, so I, so I operate in three places. Okay. So I operate in the [00:22:00] hospital ASC. Okay. I operate at a dedicated outpatient ASC and then I operate, I have a office procedure room that I do most of my skin cancer repairs on. Okay, so that office procedure room has surgical lighting, it has a bovie, it has everything you need except for an anesthesiologist.

Okay, so that's why I have the benefit of doing that. Now, interesting you say that because now my philosophy is as a surgeon, um, when I do a neck procedure, so a full deal deep plane facelift, I'm never doing that in the in the office operating room, and I actually am never doing it in the Outpatient ASC.

I'm always doing it at the hospital ASC because, you know, deep inside the neck, I don't care how good of a surgeon you are. There can potentially be problems. There can be problems with airway. There could be problems with swelling. There can be problems [00:23:00] with hematoma. Okay. A lot of these patients are older, 70, 80.

They all have medical, a lot of them have medical problems, diabetes, high blood pressure, et cetera. I am doing that case in the hospital with the intention of sending them home. If there's any blinking, anything that goes afoul, they can be omitted immediately. And to me, that is a tremendous amount of comfort when I'm doing this.

And I think it's a comfort to patients too, you know.

Dr. Sam Jejurikar: I just, yeah. And that makes a ton of sense. I've, I've got a slightly different setup just because we've got an overnight facility as part of

Dr. Salvatore Pacella: hmm. Mm hmm.

Dr. Sam Jejurikar: Surgery Center. And I feel like our surgery center, which is a dedicated plastic surgery ambulatory surgery center, just runs more efficiently than the hospital.

So it's just personal preference. I can, but I get it. That makes a ton of sense. Um, well show us the next case. I know you've got more than one.

Dr. Salvatore Pacella: okay. So, um, so here's a lady, uh, in her mid fifties, okay, and if you can see here, she's got, um, deep jowling in and around the face, okay, right here, [00:24:00] and so I did a combination of fat transfer. Okay. Um, and this was a mini lift also done, um, under sedation, but in the operating room. Okay. Now the difference is with her, this was done under in, in the hospital operating room, in the operating room.

Meaning we can have comfort, we can put her to sleep if needed. This was done under deep sedation, even with just a little vertical pull here. You see this, this connection to the neck here, this, this, uh, uh, the skin underneath the neck. We've got a little bit of pull here. We didn't get really. The bottom portion of things and that's, that's okay.

That's exactly what we're talking about. So the mini lift can get a bit of the neckline as well.

Dr. Sam Jejurikar: It's great. Yeah. I mean, she looks 15 years younger. What a great result. And the shape of her mid face?

Dr. Salvatore Pacella: Uh, about 12 cc's on either

Dr. Sam Rhee: You know what's great about this is that the mini lift adds a lot to it, but then the fat [00:25:00] grafting adds a lot to it. And either alone would not help you

Dr. Salvatore Pacella: Another one here too.

Dr. Sam Rhee: such a great result, but they're almost synergistic in the way they sort of reshape the face and the facial dimensions, which is awesome.

Dr. Salvatore Pacella: Um, you know, a lady is a little bit older. She had, um, Multiple facelifts in the past. I think mine would have been her third facelift. Um, and you could see she's got this marbling of her skin in and around the perioral area, you know, some deep pinning acne scars. Uh, this was her after a simple in office procedure.

Uh, in her, I believe I did a SMAS placation, not, uh, not necessarily a deep plane all the way in. And, you know, with this kind of marbling you see in and around the perioral area and around the nasolabial fold, you know, the. Depending on how deep you go... And how, how medial you go with the facelift. You can really, um, you can really get at that very nicely.

Um, unfortunately she has a turtleneck on here. I [00:26:00] can't really see your neck, so.

Dr. Sam Jejurikar: That's the bet. That's the way to make your neck look awesome. And your post op pictures, long hair and a turtleneck. I love it. Like.

Dr. Salvatore Pacella: Another one here. So, um, so you can see here, she's, uh, you know, very, very attractive lady here, but really unhappy with this, uh, central jowling she has around the marionette line. Simple office procedure, um, mini lift. And, you know, we've gotten a really good line. You can see this kind of central wrinkle right here at the jowl.

That's pretty much ablated afterwards. If you look at this corner of the mouth right here, much tighter, and a little bit, quite a bit more

Dr. Sam Rhee: I'm just impressed how much improvement you can get so far, medial, peri aurally, like that's, that's impressive.

Dr. Salvatore Pacella: Thank you.

Dr. Sam Jejurikar: Nice results. Well, good. I think that's been an awesome conversation on, um, I still think I love, I love that Dr. Pacella is calling these mini lifts because these [00:27:00] are all, these are full fledged mid face lifts through a short scar. Not a lot of people can do these operations, Dr. Pacella.

Dr. Sam Rhee: Who might?

Dr. Sam Jejurikar: trying to think

Dr. Salvatore Pacella: get, I get to, there's a few, there's a few. Maybe you guys,

Dr. Sam Jejurikar: maybe Steve. Yeah. Yeah. But, uh, great results. Um, really elegant operation that you're doing for patients. And again, it just shows how you can offer the full, you know, the full armamentarium of facelift procedures in a variety of clinical settings, um, to tailor to the specific needs of a patient. So very nice.

Dr. Sam Rhee: again, the term is misleading, because as Sam said, if someone else says Minilift, we're talking about a completely different animal than what This mini lift is and so it really behooves someone when they talk about these terms Asking the surgeon what exactly are we doing here? And what is going to be achieved because like Sam said what you're achieving with a [00:28:00] mini facelift is nine million times more Structurally intensive and better than what most people out there would think or would do in terms of what a quote mini lift in office would be.

So, um,

Dr. Salvatore Pacella: This is,

Dr. Sam Jejurikar: Yeah, and then,

Dr. Salvatore Pacella: like a, this is almost like a CrossFit mini lift, right? like on steroids.

Dr. Sam Jejurikar: but it, but it's, but, but you know, it's, it's interesting to come back to the

Dr. Salvatore Pacella: talk about CrossFit.

Dr. Sam Jejurikar: you know, to come back to the whole deep plane conversation, right? There are so many patients that, um, we're calling and wanting a deep plane lift, which this is not technically a deep plane lift because you are creating a different elevation of the, the skin from the deeper soft tissue, but there's extensive repositioning and manipulation and augmentation of the deep plane.

And so this is a. Mini lift, but it is a very extensive deep plane lift all at the same time. So it's, um, it's a great operation, beautiful results.

Dr. Salvatore Pacella: Thank you.

Dr. Sam Jejurikar: Well, anything else [00:29:00] to add gentlemen? I think, feel like we've done a really nice, uh, kind of summary of a, of a short scar facelift and the potential that it can have any, anything, any last thoughts,

Dr. Sam Rhee: very impressive.

Dr. Salvatore Pacella: Thank you. I would say the first rule about mini lifts, always talk about mini lifts.

Dr. Sam Rhee: Your dog is so cute. Do you see your dog in your background cell? Like

Dr. Salvatore Pacella: Yeah. Where is

Dr. Sam Rhee: right by the window.

Dr. Salvatore Pacella: Oh, come here. Come here, buddy. Come here, Hockey.

Dr. Sam Jejurikar: Uh,

Dr. Salvatore Pacella: Yeah. He's a, he's a, he's a Velcro dog. He just doesn't leave your side. He's

Dr. Sam Rhee: Love that. Love it.

Dr. Sam Jejurikar: Nice. Alright y'all, well let's call it a day. Good catching

Dr. Sam Rhee: All right. Thank you.

Dr. Salvatore Pacella: signing off.