Dr. Sam Jejurikar and Dr. Sal Pacella cut through a two hundred billion dollar industry to answer a simple question: what actually works?

In this episode of Beauty and the Beasts, Dr. Sam Jejurikar explains why "medical grade" skincare is not a category the FDA recognizes, why a fifteen dollar sunscreen applied every day beats a two hundred dollar one applied occasionally, and how a genuinely effective regimen can be built for around a hundred dollars a month.

The two surgeons walk through the four pillars they recommend to patients: daily broad spectrum sunscreen at SPF 30 or higher, retinoids stepped down to retinols for maintenance, an antioxidant such as vitamin C, vitamin E, or niacinamide, and a moisturizer. Dr. Pacella makes the case for physical blockers containing zinc oxide and titanium dioxide, and argues that what you put in your body matters as much as what you put on it.

They also cover why the peeling and redness from tretinoin is a sign the product is working rather than an allergic reaction, why exosomes are heavily marketed and thinly supported by evidence, and how to think about laser resurfacing for sun damaged skin. Ablative versus non-ablative. Fractionated versus full field. CO2 versus erbium. Plus a blunt rule of thumb: the effectiveness of a laser treatment tends to track with its downtime.

The episode closes on the sun protection blind spots almost everyone misses. The eyelid margins. The light reflecting off pavement, right under the brim of that hat. The sunglasses that focus ambient sun back onto the skin. The ears. As Dr. Pacella puts it, it is the only skin you have.

Dr. Sam Jejurikar is a board certified plastic surgeon in Dallas, Texas. Dr. Sal Pacella is a board certified plastic surgeon in San Diego, California.

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Lip filler has been responsible for some of the biggest aesthetic failures in cosmetic medicine. That is the bold claim that kicks off this episode, and both hosts agree it is true.

Board-certified plastic surgeons Dr. Sam Jejurikar (Dallas) and Dr. Sal Pacella (San Diego) dive into the most visible topic in plastic surgery: the lips. They trace the evolution of lip aesthetics from the thin lips of old Hollywood through the J.Lo gloss era to the overfilled Kylie Jenner years, and explain why the pendulum has finally swung back toward natural results.

Along the way they cover the permanent scarring that years of filler can leave behind, the silicone lip implant disaster that should have never happened, who is (and is not) a good candidate for a lip lift or corner lift, why fat grafting to the lips so often disappoints, and Dr. Pacella's preferred technique of using the patient's own SMAS tissue during a deep plane facelift for longer-lasting augmentation.

For anyone considering their first syringe of filler, the advice is simple: less is more. And for patients with years of built-up, scarred filler, the hosts walk through the "lip rehab" approach of dissolving old product over multiple sessions before starting fresh.

Plus, a cautionary tale about Botox around the mouth that involves one of the hosts, a missing front tooth, and nine months of talking funny.

New episodes every other Tuesday.

Dr. Sam Jejurikar and Dr. Sal Pacella dig into Preservé, the new breast augmentation technique built around the Motiva ergonomic implant, and ask the question dividing plastic surgery right now: is it a real breakthrough or just great marketing?

Dr. Jejurikar makes the case for why Preservé may be changing breast augmentation in a way the field has not seen before. Rather than cutting the tissue behind the breast, the technique uses fluid infiltration and a balloon dissector to gently separate the natural plane between the breast gland and the muscle, preserving the circumareolar ligament that locks the implant in place. The payoff is a smaller incision, no tissue cutting, and an implant that sits remarkably stable. He shares what he is seeing across more than 100 Motiva cases and why he has become a believer, while staying candid about what the data does and does not yet prove.

Dr. Pacella brings the skeptic's eye, drawing on the technique he has watched performed in Costa Rica and pressing on pocket tightness, capsular contracture, and whether the balloon dissector is truly necessary or whether this is simply a small implant through a small incision. Together they land on the points patients need to hear, including the local anesthesia marketing, the micro-texturing and capsular contracture debate, and the key caveat that Preservé is a retroglandular procedure without the long term track record we have for subfascial and subpectoral placement.

In this episode:
The embryology behind breast preservation surgery
How the Preservé balloon dissection actually works
Local versus general anesthesia for augmentation
Micro-texturing and the capsular contracture data
Why the implant may matter as much as the technique
Does Preservé just mean using a smaller implant?

Whether you are researching your own options or you work in the field, this is the honest, two sided breakdown the Beauty and the Beasts audience comes for.