Celebrity Facelifts, GLP-1s, and the Kris Jenner vs Denise Richards Debate

Celebrity plastic surgery is everywhere right now, and the Kris Jenner and Denise Richards facelift stories have quietly touched off a real debate inside the plastic surgery world. In this episode of Beauty and the Beasts, Dr. Sam Jejurikar of Dallas and Dr. Salvatore Pacella of San Diego go past the headlines and talk through what is actually going on.

Two board-certified plastic surgeons explain why a third facelift at 70 is a completely different operation than a first facelift in your 50s, why the safest technique is often the smartest choice on a revision, and why almost everyone looks phenomenal at three months postop, a phenomenon one surgeon calls the siren of swelling. They get candid about how GLP-1 weight loss medications can quietly undo facelift and fat transfer results, the realistic healing timeline every patient should expect, how age and skin elasticity change the outcome, those six-figure price tags, and the uncomfortable trend of surgeons piling on one another online.

If you have ever wondered what a facelift really looks like as it ages, or how much of what you see on social media is filtered, swollen, or simply too good to be true, this is the honest conversation you have been looking for.

In this episode:
 The two very different stories behind Kris Jenner and Denise Richards. Why filtered photos and early swelling make results look better than they will hold. The real timeline of recovery from three weeks to six months. First facelift versus third facelift and the risk to the facial nerve. Why GLP-1 medications matter more than most patients realize. What you are actually paying for when a facelift costs more than a car.

Beauty and the Beasts is hosted by Dr. Sam Jejurikar and Dr. Salvatore Pacella, two board-certified plastic surgeons sharing honest, behind-the-scenes conversations about aesthetic surgery, the industry, and the stories making headlines.

This episode is for educational and informational purposes only and is not medical advice. It does not create a doctor-patient relationship. Always consult a qualified, board-certified physician about your individual situation.

Transcript

SPEAKER_01 0:00

Can it be said that Chris Jenner's surgeon did a did an inadequate facelift? No, I think he did a very safe facelift. He did a uh a smas ectomy or a smas placation, whatever the procedure is he does that does not dive deep into the deep plane. And quite honestly, I think I would do exactly the same thing in a revisional three-time facelift.

SPEAKER_00 0:26

Well, welcome everyone to the latest episode of the Beauty and the Beast podcast. I'm Sam DeJuricar from Dallas, Texas. And as always, I'm joined by Salvatore Pachella, plastic surgeon and good friend from San Diego. Welcome, Sal. How are you doing today? Fantastic, my friend. Well, today we're going to talk about a topic that we have to talk about because it's all over the news and social media, and that's celebrity plastic surgery. It's something that I've resisted wanting to talk about in these sorts of forums for a while, just because it always has seemed kind of salacious to be talking about other people's specific work. But there's been a lot of attention in the last year or so on a few specific uh celebrities. Uh and the two that kind of stick out the most to me are Chris Jenner and Denise Richards. What's your impression of what we're sort of seeing from these stories and where your head's at with all of this right now?

SPEAKER_01 1:19

Sure, sure. So um, so two different um, two different problems, I would say, you know, Denise Richards and Chris Jenner. So Chris Jenner is a pay is obviously someone who's a lot older than Denise Richards, who has arguably much more facial cosmetic surgery than Denise Richards probably had throughout her lifetime. Um, and then you have Denise Richards who, you know, may or may not had a bunch of plastic surgery in the past. Okay. And so the controversy is very interesting because you have um Chris Jenner had a paid uh extensive amount for a facelift out of a surgeon in New York. And um, looking back at this, um, she showed her pictures visibly to the world um a few weeks afterwards, and she looked phenomenal. Okay. And now there is some controversy out there. There's a news media story that came out that said that Chris Jenner is very unhappy with her facelift. She's fuming that Denise Richards had one and it looks so good compared to what she looks like now. And so it's created this sort of controversy in the plastic surgery community as to what is the best type of facelift to perform? And, you know, are we giving the right facelift for each of these patients?

SPEAKER_00 2:40

Yeah, exactly. And I think um there are two different stories out of this one big story. A, is Chris Jenner truly unhappy? And B, you know, is this really a story about a rivalry amongst different schools of thought in plastic surgery? Because, you know, um, Chris Jenner's plastic surgeon is well known for performing an operation that is thought to be a little bit more limited in terms of there is work being done on the deeper layer or the deep plane. Um, Denise Richards went to a surgeon who is well known for doing deep plane and more extensive um soft tissue work. And and, you know, is there is this a rivalry being driven by plastic surgeons? Is the story even real? But I think there's a few things to unpack. So let's let's start with Chris Jenner first. Um, and and I'm being open about this because she actually sort of told the media that she had this done. But um, by all accounts, this was her third facelift. Um, she's 70 years old. Um, she showed results that look phenomenal three or four months out from surgery. The images look like they were heavily filtered. So I think that almost all of my facelift patients look amazing at three or four months post-operatively. I think all of your patients look amazing at three or four months post-operatively. I think everyone's patients look amazing at three or four months post-operatively because there is a degree of swelling and there hasn't been any relaxation in the soft tissue. Um, what's the normal thing that you tell your patients? Look, this is what you can expect in terms of how your facelift is going to age over the first few months, year, two years, five years, et cetera.

SPEAKER_01 4:18

So it's an interesting, interesting concept you're talking about here. So there's a it's a very insightful surgeon, a very good thinker out of Kentucky, Jerry O'Daniel, and he he refers to this as the siren of swelling, the beauty of swelling, if you will. And so that's exactly what I think we saw with the Chris Jenner phenomenon. And I do see that in my patients too. They're, you know, where there's once there's sort of still swelling available in the face, um, particularly if I've used fat transfer, you know, that leads to a high cheek. It you leads to, you know, a more refined look. A lot of the sort of fine wrinkles are ablated by that swelling. But but it takes, it's gonna take some time for that to go away. And I think, you know, in my patients, I I really try to discuss with them this timeline of swelling. And I break this up a bit. So I I usually say to them, you're gonna look terrible for three weeks. Okay. Um, after about three weeks, you can go to your third favorite restaurant. Okay. I know you like that line. I love it. And so so then the next milestone of swelling is at about six weeks. Okay. And so that six-week time, you're feeling a bit better, but that's when you're starting to say, wow, my face looks really good. And that's at a and that extends to about three months, I would say. Okay. So at three months, you still have quite a bit of swelling, but the scars are starting to fade a bit. It's kind of starting to look a little bit more like you. At six months is when all of that swelling, in my opinion, a lot of it goes away. 95% of it may go away. And that's the time where I start having patients come back and saying, Well, you know, Doc, I wish I was just a little tighter. I've got a little bit of stuff right here going on, you know, and and that's something I counsel patients about ahead of time, but they seem to forget that that discussion. Yeah. And so, you know, it's that six-month turnaround time, and that I think is really important to be prepared for.

SPEAKER_00 6:11

Yeah. And uh, and there's even beyond the resolution of swelling. I mean, I can't tell you how many of my patients will tell me in the first few weeks, man, I have a hard time opening my mouth. Everything is so tight. Well, it turns out as things happen, as you open your mouth and you close your mouth and you swallow and you turn your head from side to side, there is some mild stretching that occurs. And as that relaxes, things aren't just quite as tight.

SPEAKER_01 6:34

Right. Or this, you know, we spend a tremendous amount of time tightening up the mid-neck area, right? Doing platisma plication or platisma repairing and tightening this up. And oh my God, I can't breathe after this facelift. It's super hard. But then that goes away.

SPEAKER_00 6:50

Yeah. The the other, you know, issue is as a surgeon, what is your level of concern and what are the challenges posed to you by someone who's having their third facelift versus someone having their first facelift? Right.

SPEAKER_01 7:04

So huge, huge issue, I would say. So uh arguably, I would say, as a plastic surgeon, no, I I consider the facelift the holy grail of plastic surgery. Okay. It is to me the most complex operation we do in aesthetic surgery, period. Okay. And part of it is the anatomy, part of it is the variance of it. Okay. You may see patients that when you open up their face, they have a big parotid gland and those the fatty tissue, the SMAS layer is exceptionally thick, and it's really easy to tighten them up. You have other thinner patients that the SMAS layer is essentially non-existent. Okay. And you can just imagine that if you've had a facelift previously, how much harder that tissue is to dissect and how much harder it is to determine the actual plane that you need to be in. And you can't get that information from reading the pre patient's previous op note. There's just no way it's going to say this was released at five centimeters from this angle, et cetera. So the more times you go back into a facelift, certainly the more danger it becomes dangerous it becomes for damaging nerves. Yeah.

SPEAKER_00 8:16

And specifically, yeah, the facial nerve, which is the nerve that is responsible for moving your face. Right.

SPEAKER_01 8:22

So can it be said that um Chris Jenner's surgeon did a did an uh inadequate facelift? No, I think he did a very safe facelift. He did a uh a smasctomy or a SMAS placation, whatever the procedure is he does that does not dive deep into the deep plane. And quite honestly, I think I would do exactly the same thing in a revisional three-time facelift. So imagine the consequence if he did a deep plane facelift on her and she had a devastating nerve injury. Yeah, her, she would, her career is over, her, you know, it would be tough.

SPEAKER_00 8:57

100% agree. It is definitely the operation that I would do on a third-time facelift as well. But the thing that's really interesting is um, you know, she is a 70 years old, comparing herself allegedly, this may not even be a true story, and we'll get into that. Allegedly comparing herself to someone who's 15 years younger getting their first facelift. But one of the things that I think is really alarming, interesting, is on social media now the number of surgeons who are going online and commenting about this in a manner that is negative. You know, there's there's two kinds of dialogues that I'm seeing. One, I'm seeing surgeons who are who are going online and kind of doing what we're doing, talking about what we're seeing, what's normal, what's realistic. And then I see a group of surgeons that are going online just piling on, talking about why their technique is better and why they wouldn't have this happen. And I think that's really sort of the the the worst part of this whole thing, where it's it's uh surgeons trying to pile on and use this to promote themselves when ultimately, you know, human soft tissue is gonna relax to variable degrees in all patients. And some every surgeon has amazing results, and every surgeon has has good results. And and they're not all gonna, they're not all gonna be, they're not all gonna be a home run.

SPEAKER_01 10:16

Right. And, you know, getting back to what you said about the the surgeons kind of you know dissing on other surgeons, um plastic surgeons are a unique personality. I think you have to be a unique personality to be successful in this field. But let me ask you a question. You are as a plastic surgeon, how many of your best friends are plastic surgeons? How many of my breast friends?

SPEAKER_00 10:38

Best friends, excuse me. It's a trick question. I mean, you. But um, no, it's true. I have many more friends that are orthopedic surgeons. Orthopedic surgeons stereotypically are sports-loving, fun-loving guys who like to work out a lot. Orthopros. Ortho bros. Yeah. Uh, and then you're basically an orthopro who happens to be a good plastic surgeon. So, yeah.

SPEAKER_01 11:04

Exactly my point. So I think, you know, trying for, you know, you see this not infrequently at national meetings when people stand up and they give talks. You know, there's there's open ridicule, like in a non-professional manner, right? And I think, you know, if there's one thing when I retire that I will not miss about the specialty, and that's few and far between things, is just how we as plastic surgeons treat each other, particularly without me knowing anything about the doctor-patient relationship between her New York surgeon and Chris Jenner or Denise Richards and her LA plastic surgeon. You know.

SPEAKER_00 11:42

Yeah. And in fact, most of the speculation that we're hearing is that this may not even be a real story, that it's strictly planted by another plastic surgeon, which is really a sad commentary on the profession. You know, though I think another thing that's worthwhile talking about when we're talking about why a facelift might relapse, though, are just some other factors that potentially cause that. Because I think it's very linear the way people think, well, I had a facelift, it should last X amount of time. But we're seeing that there are certain things that happen postoperatively that can actually affect the results. Um GLP1s being um kind of top on the list. Um I think celebrities may have jumped on the GLP one bandwagon before it was common terminology for the general public. But how do GLP ones, how do you counsel your patients who are who are on these medications and are getting a facelift? Like how it could affect the results.

SPEAKER_01 12:35

Absolutely. So we know, you know, from the science that GLP ones affect skin, they affect soft tissue, they affect fat, they affect muscle, and they can affect bone, right? And so, you know, the facelift only supports a few of those structures, skin and soft tissue, muscle, et cetera. So let's imagine, you know, the whole lower part of the face is one muscular band. It's the smest, the platisma, okay? And that's a that's a muscle that goes from ear to ear and then along the neckline. If you're having atrophy of that muscle and you tighten it up, what do you think is going to happen as time goes on? It's gonna loosen up, right? It's not like a like a platisma in an 18-year-old. And so there's there's that component of things. The other component is, you know, I have no way of knowing if or if these patients, if uh Chris Jenner or Denise Richards had any fat transfer placed at the time of their facelift. It's something I routinely do in 95% of my facelift patients. And so GLP ones getting back on those will absolutely affect the results of your fat transfer. So if I'm injecting fat into the upper face area here, the zygoma, where I want to hold projection and prevent a facelift flattening deformity on the side, you know, I'm absolutely going to caution patients to not get back on the GLP one immediately.

unknown 13:57

Yeah.

SPEAKER_00 13:58

And in addition to the two things that you said, it also causes loss of skin elasticity as well. And so if you start to see a little bit of early jowling or that nex laxity that you were talking about before, that can be exacerbated by a GLP one. Another thing that I think can also affect it is age. You know, I think my patients that are in their 70s versus patients that are in their 50s are not gonna stay as tight. Um, what's the oldest patient you've ever done a facelift on? And you don't even have to answer this, but if you think about that patient and you looked at that patient, you know, one year post-op and you compared it to a patient in their 40s, I think that you're gonna notice that the rate of relaxation, am I right, was was was much more.

SPEAKER_01 14:40

Yeah, I mean, so you know, I would say the oldest is probably in the 80s, the early 80s. Um, and you know, taking, I would say in general, facelifts maybe turn back the clock 15, 20, 25 years, perhaps. Okay. So when you take an 80-year-old and your your strategy is to make them look like a 60-year-old, how successful is that compared to a 50-year-old trying to make them look like they're 30? So, and it's all related to what you just mentioned is that skin elasticity. Um, you know, you and I come from an old school of training where, you know, at back in our residency, we would never think about doing a facelift on a 45-year-old, right? And it's like, oh, you just gotta wait, you know, at 45, maybe you want to do your upper eyelids only, right? And so now I think we're seeing the benefits of time with patients that do facelifts in mid-age. And it looks a hell of a lot more natural. Uh, this the scars are better, the healing's better, there's less tightness, uh, there's less retractability of where that smash is going to go if they're just starting at a little bit of laxity compared to a dramatic amount of laxity. So I think, you know, that's that's something I think patients really have to understand as they go through the process of facial aging.

SPEAKER_00 15:53

Yeah. I think there's been one other thing in sort of the rash of news stories about celebrity plastic surgery that's been interesting. And that is the price tag that celebrities are apparently paying for this. Um, you know, again, this is all hearsay, but uh Chris Jenner apparently paid $300,000 for her facelift. Denise Richards apparently paid $200,000 for her facelift. Um patients sort of mentioned that outlandish price tag to you. Have you found that that sort of influenced how they react in your office? Like what's your reaction to that?

SPEAKER_01 16:25

Yeah, I mean, I I guess I, you know, I think about uh, you know, $300,000 facelift, is that worth the price of a Lamborghini? You know? Maybe, maybe not. Um, but I think in general, you know, I operate on very few, if any, celebrity patients or uber-rich billionaires that can afford $300,000. I operate on, you know, patients that are modestly successful. They have the resources to maybe pay for a facelift. I can tell you, I certainly don't charge $200,000. Uh, I don't think that's worth it for really anybody. But I think the thing we do have to understand is a facelift is not inexpensive by any means. Um, it is not like a breast augmentation that takes maybe an hour, hour and 15 minutes to do. You throw some implants in, everybody's happy. Um, patients are very price sensitive when they're in their 20s. Okay. Um my patients that are in their 50s, 60s, 70s, they're less price sensitive because you know they live in a fluent community, they can potentially afford a little bit more. Um and I think, you know, a facelift, as I said, is the holy grail of plastic surgery. There are a tremendous amount of blood vessels, there's a tremendous amount of nerves. There are so many ways to screw up a facelift. And that comes with a level of expertise, a level of practice, and a level of efficiency that surgeons have. So are you paying for my time for to do that facelift for five hours? Yes, but you're also paying for my expertise of trying to do the right thing.

SPEAKER_00 18:02

Yeah. And the other thing with a facelift is a facelift may be an all-day affair for you. You know, some facelifts take you five hours to do, some take you seven or eight hours to do.

SPEAKER_01 18:12

And the eyes, add the brow, add lips, you know?

SPEAKER_00 18:14

Yeah, and it's and it is, nobody ever said, man, I had the best facelift surgeon. It only took them four hours to do my case. No, if they're critiquing you on the quality of your scars, how tight their jawline looks, how their cheekbones look, make sure making sure their facial nerve works. There's a lot of finesse involved with the operation. I do think that these high price tags help illustrate to the general public that this is a finesse operation that requires a lot of skill and a lot of expertise. Ultimately, you you shouldn't pay for surgery that you can't afford, but you should expect to pay a lot to have a face left.

SPEAKER_01 18:50

Yeah, the other level of expertise that I think we have to, you know, talk about is the symmetry involved with it, right? Um, we've all seen that um that strategy of you know, you divide a line down the face and you you look at the mirror image of opposite sides. And so you look at the right, right side, transposed on the right side, left side transposed on the left. And it looks like two different people. So pay people's faces are inherently asymmetric. So part of what we're trying to do in facial rejuvenation surgery or facelifts is to make them more symmetric. So there's a tremendous amount of going back and forth, making sure that stitches are placed in exactly the same area. Um, do you remember what our good friend Dr. Steve Buckman used to say about facelifts?

SPEAKER_00 19:31

You know, not a lot of people can do this operation. Maybe Henry.

SPEAKER_01 19:37

Maybe maybe it was something else he said, if you recall. He said a facelift would be great if it was just one side.

SPEAKER_00 19:43

Oh sorry, I'm quoting the wrong Steve Buckman quote.

SPEAKER_01 19:47

Okay. And so, and and there's some truth to be said to that. I mean, it's it's a synergistic operation on both sides, but it's not like the second side becomes less than less important, right?

SPEAKER_00 19:59

So, I think that's all I have on this topic. Anything else you want to throw in before we end it up?

SPEAKER_01 20:05

I don't think so. I think uh, you know, we talked a bit about I think the expectations, the price tag, and you know, it's not it's not an operation for the faint of heart from the surgeon's standpoint or from the patient's standpoint, but it is a time tested operation, regardless of the technique that your that your surgeon uses. Thanks for watching. We'll see you in the next one.