Cosmetic Procedures: Your Options to Look Good, Feel Better (podcast)

Board-certified plastic surgeons can deliver safe, satisfying results

Scripps Clinic Plastic Surgeon Salvatore Pacella, MD.

Dr. Salvatore Pacella, Plastic Surgery, Scripps Clinic

Board-certified plastic surgeons can deliver safe, satisfying results

As we age, our skin tends to lose its elasticity, evident as droopy eyelids, stretch marks, and a belly bulge that sticks around long after childbearing. Aging is inevitable, but plastic and reconstructive surgeries can counteract some of its cosmetic effects.

In this episode of San Diego Health, host Susan Taylor and guest Salvatore Pacella, MD, head of Plastic and Reconstructive Surgery at Scripps Clinic Del Mar, discuss why our skin tends to sag as we age, common cosmetic procedures for the face and body, including the popular plastic surgery package known as the Mommy Makeover — a tummy tuck and breast augmentation performed at the same time. They also touch on cosmetic procedures trending with men.

The majority of cosmetic procedures are far less invasive than they were in the past and many can be done on an outpatient basis. There are risks associated with cosmetic plastic surgery, as with all surgeries, but choosing Scripps comes with the peace of mind that all surgeries are performed by board-certified surgeons and anesthesiologists are on hand at all times.

Listen to the episode on the most common cosmetic procedures

Listen to the episode on the most common cosmetic procedures

Podcast highlights

Why does the skin sag as we age? (1:01)

As we age, the natural glue that keeps our skin attached to the under surface of the body tends to loosen up, and that causes pretty tremendous sagging of skin over time.

What causes droopy eyelids? (1:16)

You have to think about this as the complete continuity of the brow with the upper eyelids. When your brow gets saggy, what happens is you tend to see that quite a bit in the upper eyelids as well. So, it’s really one complete unit that we’re talking about.

Can droopy eyelids affect your vision? (1:41)

Absolutely. Usually your peripheral vision. It tends to obstruct things while we’re driving, I tend to have patients that come in that say, “You know I don’t notice a car coming up on the side of me.” And that can be quite dangerous sometimes. But cosmetically, it’s also very important to rejuvenate around the eyes.

What is an eye-lift? Are there side effects? (2:06)

The eye lift is a relatively simple procedure. It takes about 30 to 45 minutes. It involves removing a bit of skin from the upper eyelid. In addition, many times as we age, we tend to lose fat in the upper eyelid. Sometimes we can take a little strategic fat from the abdomen, put it in the eyelid and rejuvenate the upper eyelid.

The side effects are fairly minimal. A little bit of bruising afterward. Recovery is relatively quick. Sometimes patients can get some dry eyes for a short period of time. But recovery is actually quite quick, probably about one to two weeks. Most patients can go back to work after that time, or resume their lifestyle, working out, etc.

What is a brow lift? What is a forehead lift? (2:56)

The brow lift is a little bit more extensive. We’re talking about two weeks of recovery. It involves a small incision that is hidden right within the hairline. It’s designed to raise the brows to a much more natural position. A brow and forehead lift are really referring to the same concept. [You’re moving things up and getting rid of wrinkles in the process.]

Outpatient surgery is preferred for these procedures. We want you to recover comfortably at home. We want you to be around your family. We want you to eat your own food, sleep in your own bed.

What can you do for sagging neck? (3:41)

Let me first say that as we get into the age of technology, we’re always looking at our phones. We’re always looking downward. Once we used to stand up and have good posture. Now we’re all sort of hungover and crooked down. That tends to exacerbate the neck quite a bit. There is a fairly good procedure for that. It’s called a lower-face and neck lift. It’s a little bit longer of a procedure, three to four hours to perform. It is also done as an outpatient procedure. But it can really do an extensive job of tightening up the neck.

What can you do for sagging breasts after breastfeeding? (4:23)

We have some great procedures for that, depending on what a patient would like. For example, after pregnancy many women notice that their breasts have dropped down a bit. They’ve lost a lot of volume. Many women that come into my office say that during pregnancy they actually like the size and shape of their breasts. Many times we have a few arrows in our quiver. We can utilize breast implant to restore some fullness to the breast. If the breasts are hanging down lower, we can do a breast lift or a combination of the two.

What can you do about pregnancy-related weight gain? (5:01)

Plastic surgery is not really a substitute for weight loss. Prior to going into plastic surgery, we really want you to be at your stable weight. Where we think we can really help patients after pregnancy is if you’ve gone back to working out and you just can’t get that pooch of the belly gone. Plastic surgery can help with that. An abdominoplasty or tummy tuck, is a common procedure. It’s a little bit more extensive procedure. It takes about four weeks to recover from that. It is also an outpatient procedure, but it can make your tummy really snug and really tight.

What can you do about stretch marks? (5:43)

Stretchmarks are caused by a loss of the collagen underneath the skin. Often times it’s caused by rapid weight loss or weight gain. We also see it in pregnancy. There is a stretching of the abdomen and stretching of the skin. Sometimes laser treatment can help with stretchmarks. But unfortunately, many times the best method to treat stretchmarks is to simply do surgery and remove those stretchmarks. When we see those in the lower abdomen, a tummy tuck is a great operation for that.

What is body contouring, or body sculpting? (6:45)

This is a common procedure we perform in patients who have lost a substantial amount of weight, say 50 to 100 pounds. Often times that weight loss can be coupled with some sagging skin of the arms, the chest, the thighs. We also see it in the abdomen and breasts. Body contouring refers to a combination of both surgery and non-surgical treatments, such as liposuction, which can remove fat from different areas.

How does liposuction work? (7:19)

Liposuction is a really minimally invasive technique. We make a small cut in the skin and utilize a cannula, or a device, to manually remove the fat. It can do a great job of contouring the skin. If your skin is stretched out however, liposuction doesn’t work that well. If we have a good amount of elasticity in the skin, that tends to be the best for patients who require liposuction.

How does a tummy tuck work? (7:47)

A tummy tuck is a open surgical procedure. You’re asleep for this procedure. What that involves is making an incision that goes from hip to hip. We make it right within the underwear line or bikini line, so to speak. The incision is hidden. We lift up all that skin from underneath the surface of the abdomen. Often times, this can be coupled with tightening up the muscles on the inside of the abdomen. Your belly button stays in exactly the same place, and then we sculpt and re-stretch the skin around it so that the skin can be nice and flat and nice and tight.

How long do cosmetic procedures take? What’s the recovery time? (8:27)

It all depends on the type of procedure. Some of the facial procedures are an hour or two. Some of the body contouring procedures may be several hours. In general, for most procedures, we don’t want to go over four or five hours in the operating room.

Recovery varies. Recovery for something like a tummy tuck is rather extensive. You probably need to be off of work for about two weeks. We don’t want you really working out or lifting weights for about four weeks after surgery. But for some facial procedures, it could be one week recovery. We can go back to work with a little bit of makeup. We can hide some of that bruising.

What are “Mommy Makeover" cosmetic procedures? (9:30)

The Mommy Makeover is a great procedure, very popular in our communities. A Mommy Makeover commonly refers to the combination of a tummy procedure with a breast procedure. Very commonly, we see a tummy tuck done at the same time as a breast implant or a breast lift. They can be done safely. You get a little bit of synergy with recovery. You get the benefit of recovering from both procedures at the same time.

What are “Daddy Do-Over ” cosmetic procedures? (10:20)

We commonly see men in their late 30s, early 40s for these procedures. After their wives have children, they tend to gain just as much weight or lose the ability to fit into their pants. That’s commonly something we see, myself included.


Common procedures in men include body contouring procedures, such as liposuction. Men tend to wear their fat a little bit more around the abdomen and lower back area. So, that’s a very common procedure. Many men can develop a symptom called gynecomastia, where they get some tissue around the chest area. Liposuction can be a very powerful and very common procedure for men in that regard.

What are the risks in plastic surgery? (11:12)

Any surgery has risk associated with it. We don’t want to approach plastic surgery as if you were going to the hair dresser. That’s one of the beauties of being at Scripps. We’re a large health system. We do all of our surgeries within a certified operating room. We have board-certified anesthesiologists with us at all times.

Surgery is serious. We want make sure you’re very healthy going into surgery. We often recruit our medicine colleagues, or your primary care doctor, to make sure that you’re healthy enough to go for surgery.


With any procedure there can be side effects. There can be side effects with anesthesia. That can include some nausea, potentially some vomiting after surgery. And then there are specific, potential consequences after the surgery related to the surgery that we’ve done. For example, patients may have some extended pain after surgery but it goes away. Swelling can occur. Sometimes strategically we want to place the scars in a specific area. Sometimes the scars can be rather red or visible for a couple months after surgery. That often fades over time. But in general, plastic surgery is very safe. These are very reliable procedures.

Who is not a candidate for plastic surgery? (12:36)

Usually everyone is a candidate for plastic surgery if you’re healthy enough. What I mean by that is if you have a bad heart or bad lungs, that’s something we want to evaluate ahead of time with your cardiologist or your primary care physician. With patients who are on blood thinners, often times we approach plastic surgery very cautiously. We want to work with your medicine doctors to determine a safe interval or a safe window to perform surgery.

What are some major changes in plastic surgery? (13:09)

One of the biggest changes in plastic surgery has been the use of fat transfer. We’ve really understood a lot about aging, particularly in the face, over the last several years. What we’ve seen is that, if we follow patients’ photographs for many years, not only does the skin become saggy, but we tend to lose a lot of fat in the cheeks, or upper eyelids or in the temple area. We’ve had a lot of technology and a lot of science behind removing fat from different areas of the body, packaging it up, purifying it, and re-injecting it into different areas of the face. That can really make a huge difference and make surgery look very, very natural.

What should you ask yourself before deciding on plastic surgery? (14:03)

Number one is: What are we trying to get out of this? Are we trying to change our appearance, or are we trying to fix areas that are relatively stubborn? Really understanding what each patient wants out of surgery is very important.

Second thing I think is exceptionally important. If you seek plastic surgery, you want to do so from a board-certified plastic surgeon. Board-certified plastic surgeons have gone through all of the education, all of the training, and will be operating in accredited facilities that will be affiliated with a hospital. Patient safety is key.

Watch the San Diego Health video on common cosmetic procedures.

Watch the San Diego Health video with host Susan Taylor and Scripps Clinic Plastic Surgeon Salvatore Pacella, MD, discussing common cosmetic procedures and your options to look better and feel better.

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