Picture an early morning in Beverly Hills, California. It’s 2009, and Hollywood’s favorite neighborhood is waking up. The gyms are experiencing their first round of celebrity sweat, and local stores sell fresh juices and overpriced lattes.
Nearby, in a small office tucked away on North Bedford Drive, two men have been awake for hours, trying to perfect an invention that would eventually change the face of cosmetic surgery.
The two form an unlikely duo. Side hustles are usually reserved for those of us still striving to make our mark on the world. But Dr. Gregory Mueller and Ted Gagliano had already made it.
In Mueller’s first year in practice, he went from renting a room to buying a house in Beverly Hills. Gagliano’s Hollywood resume as a supervisor of post-production includes “Titanic” and “Star Wars.” (His living room has a framed picture of him with Steven Spielberg.)
But Gagliano and Mueller had a surprising obsession: the neck.
Over the next decade-plus, they would spend millions dealing with the FDA, pioneer the use of virtual reality in healthcare, and bring a surgery traditionally reserved for Hollywood to the masses.
Then, they almost shut it all down — until the thing they thought would kill their business made it more popular than ever.
Meet your protagonist: the neck
Kris Jenner. Courtney Love. Sharon Osbourne. These are just some of Hollywood’s finest who have reportedly received neck lifts, which experts say can trim fat in an area of the body that tends to stay the same even after exercise.
Courtney Love. (Mick Hutson/Redferns via Getty Images)
Mueller performed plenty of neck lifts as a Los Angeles surgeon. But he’d heard complaints from his patients about the invasiveness of the procedure — it required the neck to be cut open, general anesthesia, and significant downtime post-surgery. Even worse, touch-up was sometimes required ten years down the line.
It was a major surgery with a major price tag. And unless you were an actress or a model, most people didn’t want the hassle of getting a traditional neck lift.
One day, while driving to San Diego for a conference, a thought wouldn’t leave Mueller alone: What if there was a way to perform a neck lift without cutting open the neck?
It was an unusual thought. The economics of being a plastic surgeon are simple: the more time you spend in the operating room, the more money you make. Even his own brother warned him about the opportunity cost of pursuing a venture on the side.
But Mueller was different. When he was 11 years old, he hacked his parents’ washing machine to signal when a load was complete. He would’ve patented the idea if his father hadn’t vetoed the $1k investment.
During medical school, Mueller had his own wood-working shop — his mother, terrified that he’d cut a finger off, pushed him towards plastic surgery where he could continue working with his hands without the risk of a saw interfering.
After tinkering with ideas for an improved neck procedure, he landed on a prototype. By attaching a light to the end of a threading rod with a suture, Mueller could track its brightness under the skin to gauge depth. A fading light signaled he was too deep, near the arteries, while an amber glow meant he could safely sew the neck muscles without opening it.
He was onto something. The problem? He had no idea what to do next.
A series of fortunate occurrences
The odds of your next door neighbor being a patent lawyer are low, but then again you probably don’t live in Beverly Hills.
One day while taking out the trash, Mueller casually mentioned his side project. When his neighbor, a patent lawyer, asked him if he had filed a patent yet, Mueller said no. His neighbor freaked out.
When Mueller then told him that he was also working with a biomedical engineer who hadn’t signed any sort of NDA, the neighbor booked him an appointment with his firm the very next day.
And so on December 4th 2006, Mueller filed the patent titled NECKLIFT PROCEDURE AND INSTRUMENTS FOR PERFORMING SAME:
Mueller’s patent. (US Patent and Trademark Office)
Mueller’s patent, twenty pages long, explained how he had devised a way to lift and tighten the neck with minimal invasiveness. It was the first of twelve utility and method patents that allowed him to develop a kit that made neck lifts easier and less expensive.
His first ever patient was his office manager. But soon word got out that a young plastic surgeon had found a way to drastically reduce the recovery time needed to get work done on your neck. Hollywood clientele and other Angelenos began lining up.
They could now get a neck lift in under an hour and return to work the same week. No PTO needed.
If Mueller wanted to be able to commercialize his invention, though, he would need clearance from the FDA. And for that to happen, he needed to raise money. About eight figures, actually.
Fortunately, the seventh person he operated on was Gagliano, a Hollywood producer and former Stormtrooper in Return of the Jedi whom Mueller had first met on a rafting trip.
Gagliano was raised in a family of doctors. And plastic surgeons were regarded as the “very top” by his father, who was impressed by their ability to work long hours on their feet. Despite being an accomplished post-production executive at 20th Century Fox, Gagliano was still considered the black sheep of the family.
“And so when I could say to my family at Thanksgiving that I’m hanging out with a plastic surgeon and he’s an inventor, it was super cool,” he says. “I could join the family Thanksgiving talk.”
Gagliano’s role in the partnership slowly started to grow, and he would soon realize that making a movie wasn’t too different to bringing a medical procedure to market.
Just as in the movie business, they had to lean into technology.
Lights, camera, action
Despite taking care of regulation, financing, and proving a market existed for the innovation, Mueller had never thought about how hard it would be for other surgeons to pick up. And when he launched the procedure officially, the surgeons struggled. They couldn’t learn it.
He needed a new way to teach them. And the answer would come through Gagliano’s Hollywood pedigree: They turned an operating room into a movie set.
Gagliano, working with an early user of virtual reality cameras named Tonaci Tran, set up two pairs of RED digital cameras together to capture footage of Mueller performing the neck lift in action. Then they uploaded that footage to VR headsets, which were cutting edge in this pre-Oculus area. They found the headsets in an area on the 20th Century Fox production lot known as The Bunker.
Ted Gagliano surveys an operating room full of Tran’s cameras. (Courtesy of Ted Gagliano)
Luis Flores holds a pair of two Red cameras glued together with a modem in between. (Courtesy of Ted Gagliano)
The edited footage was used to create a first-person stereoscopic VR experience that made it easier to learn Mueller’s neck lift technique. These were distributed to surgeons, allowing them to step in the operating room virtually.
It marked one of the first ever usages of virtual reality in the healthcare space — an intersection that has exploded exponentially over the last twenty years.
Olivia Heller/The Hustle
The VR training led to many surgeons buying Mueller’s and Gagliano’s kit, which was called the MyEllevate kit and cost $1k. It contained all the tools needed to perform the procedure.
By saving time and being less invasive, the surgeons would typically charge patients $7k-$10k for a surgery with the MyEllevate kit, far less than previous neck lift prices of $25k-$45k.
Soon, people outside of Hollywood would even want the procedure.
The world shuts down
When the pandemic erupted, Mueller wanted to shut down production. But Gagliano had a different idea. He wanted to get a few thousand kits on the shelf.
They had two distinct advantages:
Their VR video was available to surgeons who now had more spare time as patients stayed at home.
Millions of people were about to see themselves on Zoom, usually from the neck up, and be unsatisfied with how they looked.
In 2020, MyEllevate kit sales grew 30% quarter over quarter. And in 2021, MyEllevate was acquired by medical device company Cynosure, after which the number of U.S. surgeons performing the procedure quadrupled—from 60 to over 250 in 2024. Cynosure also expanded the procedure to Europe and Australia.
Riding the momentum of MyEllevate kits, neck lifts became the fastest-growing cosmetic surgery, nearly doubling from around 21k procedures in 2019 to over 42k in 2023.
Olivia Heller/The Hustle
Worldwide, the number of cosmetic procedures has surged from 25m in 2019 to 35m in 2023, according to the International Society of Aesthetic Plastic Surgery (ISAPS). The neck lifts popularized by Gagliano and Mueller may be a fraction of that total, but the numbers are enough for them.
As much as Mueller enjoys coming across a patient’s MyEllevate story in the wild, aka his Instagram feed, he emphasizes that the procedure is not for everyone.
“If somebody is looking for a procedure to help them find the perfect mate, or help them make more money at their job, those are the wrong motivations,” he says. “We really dig deep psychologically with our patients and we tell them: you’re picking me as a surgeon, but guess what — we’re also choosing you.”
Mueller and Gagliano, meanwhile, are glad they chose to become business partners many years ago. When I asked them about what they learned from their entrepreneurial journey, they gave similar answers: expect it to be twice as long and twice as costly as you think.
In any case, it wasn’t the only lengthy, expensive, and fruitful project of their careers. Gagliano worked post-production on “Avatar.”
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