Originally from Ogallala, Nebraska, Gregory Mueller, M.D., FACS, knew from the get-go that he wanted to be a doctor. While most children look for any excuse to avoid going to the doctor, Dr. Mueller jumped at the chance to watch physicians at work, even tagging along on his siblings’ appointments. Fascinated by their ability to assess a patient's symptoms, find the problem and heal a myriad of ailments, Dr. Mueller fell in love with medicine at a young age. After his mother began working as a scrub tech for the local surgeon when he was in 7th grade, Dr. Mueller began stopping by to watch the intricate operation process. For him, there was never any question as to what he wanted to do with his life, his entire focus locked on becoming a doctor.
While attending medical school at the University of Nebraska, he did an experimental externship in surgery, which revealed his skill in performing detailed surgical maneuvers with expert precision. It was clear his artist’s hands were made for surgery, so he left Nebraska for California after finishing medical school and spent the next seven years training in general and trauma surgery at the University of California, Irvine.
It was there that Dr. Mueller became fascinated with plastic surgery, amazed by the breadth of the field and, in the end, hooked by the creativity involved. He recalls, “Every patient was unique and the surgeons would sort of be designing when they performed a procedure, the way they would make an incision or if we were doing scar revisions. It was different every time, so I was very attracted to that.” After finishing his training in general and trauma surgery at USC, Dr. Mueller spent another two years there training in plastic surgery. After he completed training, he opened up his practice in Beverly Hills, California, in 1998.
The First Jolt of Inspiration
It was after he went into practice in Beverly Hills that Dr. Mueller's passion for improving and innovating new techniques for neck rejuvenation procedures developed.
“I felt like the neck was an area where what I was trained to do was very elegant, and it required a lot of technical skills to open someone’s neck, move the muscles around and sew them together to shape and rejuvenate the neck, making the jawline look more youthful and attractive. However, I felt like in a lot of patients' cases, the procedure was too much and too invasive. When they came in, they wanted a little improvement or were just slightly aging. I felt like there was no middle of the road option for those patients,” explains Dr. Mueller.
The more invasive procedure for neck rejuvenation available at the time also came with the problem of scar tissue and results that could appear less than natural. “I also felt like opening the neck oftentimes created scar tissue or healing problems, so when someone would heal, it might look a little irregular or overdone and so sharp that the results didn’t look very natural,” he says.
Dr. Mueller knew his answer to this problem lay in finding a less invasive way to rejuvenate the neck. He states, “I thought if there was a way I could make a small incision that allowed me to go under the skin and sew the muscles without having to surgically open the whole front of the neck, that could be the key because I could still sew the muscles, lift and shape them, but not lift the skin away, causing all this destabilization.”
Having mulled over how to achieve this, a lightning bolt of inspiration struck one day in 2005 while Dr. Mueller was using his endoscope during another procedure. He realized that while an instrument like an endoscope was too large to fit under the taught skin of the neck, the effect of the light shining through the skin could be the key to developing a tool that would allow for a less invasive procedure for neck rejuvenation.
“I realized when I saw the light shining through the skin that if I had a sewing needle that was illuminated, then I could pass it under the skin and see the light shining through. This would let me know exactly where I was and how deep I was, and that’s when I came up with the whole idea,” recalls Dr. Mueller.
Engineering the ICLED
While Dr. Mueller had found the answer to his dilemma, he still needed a way to implement it. This was going to require the help of an experienced engineer. “I’m not an engineer, so I hired a biomedical engineer and I came up with the sequence of tools that we would need to pass the suture and make little punctures in the skin. During our first meeting I just had these drawings on note paper. I drew this whole sequence of how we had to have something to mark the skin and something to puncture the skin. In the early version, I had little skin ports you would screw in because it’s very key that when you’re putting in permanent suture, which is what MyEllevate is, the suture material goes down in the muscle and doesn’t get stuck in the skin. I went through all these things with him and then he would make prototypes, we would meet back up in two weeks, he would show me what he’d made and then we’d test it out.”
Since Dr. Mueller couldn’t test out these prototypes on an actual person, they had to get creative to simulate the skin and muscle of the neck area. Dr. Mueller explains, “I would use the prototypes on leather chamis placed on top of a sponge to simulate skin and muscle, pretending the leather was the skin as I made little punctures and looked at the light shining through underneath it. We did that for a long time until we really narrowed it down to the five tools that we have currently, which are barking tape, a little puncture device, a dermal clearing device, the light source and the nine-inch fiber optic rod, as well as the suture attached to it.”
After financing the entire project from 2005 to 2008, Dr. Mueller received FDA approval for his device, which he originally called the iGuide, in 2009 and was able to get funding to continue his work.
Take One: The Trampoline Technique
The original procedure Dr. Mueller developed using the ICLED light guided suture system was called “the trampoline,” a technique involving weaving the suture underneath the skin in a crisscross pattern to create a kind of netting under the surface of the chin. While Dr. Mueller had mastered this intricate technique for rejuvenating the neck, it was not so easy to teach it to other surgeons well enough for them to successfully replicate the process and produce the same results.
Dr. Mueller explains, “The trampoline procedure was this: if you look at the under surface of your chin, think if you had a shoelace and you just went from side to side and tied it in front. It was this crisscross formation, like a netting, that we would create with suture material. It worked very well for me, but we couldn’t teach it to other surgeons and get them to reproduce the results reliably. So, the doctors were like, ‘You know what? I’m going to just keep doing it the way I’ve done it.’”
Convincing the naysayers to give his new device a chance was Dr. Mueller’s biggest challenge along the way, and one that he spent the next decade working tirelessly to achieve as he developed what became the MyEllevate technique. He remembers people commenting that he would probably have continued using the device and his original trampoline technique even without the light-guidance, which Dr. Mueller answers firmly in the negative.
“The light guidance is really important,” he states, “When we published the first paper on MyEllevate, which back then was called 'The Trampoline,' in the Aesthetic Surgery Journal in 2012, we had about a 15% revision rate and that’s just not good. You don’t want to tell patients that 15 out of every hundred patients have to come back for a revision. In that paper, we demonstrated that you need the light on the needle to reliably travel underneath the skin and know where you are. We did not have the FDA clearance yet, so we just used a rod with a suture attached to it and the revision rates were 15%. With the lighted rod, the revision rates are less than 5%.”
Dr. Mueller explains that the intensity of the light shining through from underneath the skin is what helps him ascertain how deep the suture is and if he needs to adjust his placement. “The light gives me feedback. If it’s nice and yellow, I know I’m right in the right place, in the fatty layer. If it’s kind of red, that means I could have gone underneath the muscles, so I need to back up and go closer to the surface of the skin. If the light is really bright, that means I’m too close to the skin and I know to back up and go a little bit deeper. So, it’s extremely helpful and essential,” explains Dr. Mueller.
That paper also demonstrated that the muscles and ligaments that hold the skin to the muscle of the neck are strong enough to “withstand 10 pounds of force before they break,” says Dr. Mueller, making his invention and technique not only possible but an innovative way to take advantage of our incredible anatomy to create a less invasive option for neck rejuvenation. The key to getting other surgeons to adopt it would all come down to refining the technique and its teachability to go along with his device.
Take Two: The MyEllevate Technique
Dr. Mueller spent the next decade after getting FDA approval creating the MyEllevate technique to use with the ICLED. It just so happens that another invention of his, the oVio360 imaging system, was vital to this process. Dr. Mueller originally built it in 2011 to help him study and understand the detailed nuances of how the neck works and moves, with the goal of improving the MyEllevate procedure.
“If it weren’t for the imaging system, I don’t think I could have ever invented MyEllevate. It helped me see how the neck looks and all the different positions of the neck, so that I could engineer the procedure to have the sutures placed exactly where we wanted them to give the best results. So, the two go hand in hand. I think the oVio360 is such a big part of the story because if I didn’t have the imaging system, I would have never seen things like I’m able to with the additional help of the images in order to evolve the procedure. There’s no way that the human mind could remember exactly how you looked before I operated on you and translate that to exactly how you look after,” says Dr. Mueller.
The journey to creating and perfecting MyEllevate was a long and arduous one, with many roadblocks and setbacks along the way. His perseverance alone is a testament to how dedicated and passionate Dr. Mueller is to providing the best possible care and aesthetic treatment results for his patients and aesthetics patients in general.
He speaks to this passion and overcoming the challenges he faced, saying, “You have to feel passionate about it and be realistic. There were so many disappointments. You don’t know until you’re standing there in that moment and you realize ‘Oh gosh, this was not a good move. We need take a step back, rethink everything and move in a different direction.’ It was a lot of that. When you’re doing something for the first time, and you’ve never done it before, you just don’t know 'till you know. We had so many years, so many times where we would think everything was going to go well, and then boom, we’d hit an obstruction that we didn’t even know was there. But, you just can’t give up.”
Adding the Finishing Touches
Finally, in 2018, after spending years studying the detailed images of every angle and movement of the neck, painstakingly mapping out the changes in the skin and muscles depending on whether the neck is relaxed, looking up, flexed, etc., using the oVio360 and gradually perfecting the MyEllevate technique, Dr. Mueller was finally ready to test out how well he could teach it to other surgeons. It was time to beta test the finalized treatment and training program, so any last tweaks could be made.
Dr. Mueller relates, “We didn’t realize the importance of beta testing prior to this. We had surgeons come and watch the procedure and got feedback from them. It was really all about seeing how they reacted and then reviewing their answers to the questionnaire we had them fill out afterwards, which asked them certain questions that we knew were key points of understanding how to replicate the procedure. We literally stepped into the other surgeon shoes, which helped us realize what specific points of the procedure seemed obvious to us but not so to surgeons seeing it for the first time. We were then able to really customize the treatment or the training program. That was the key part of it, the beta testing and the whole process of perfecting it so everything was exactly the way it needed to be for other surgeons to successfully learn it.”
Once everything was finalized and perfected, it was time to launch, and despite launching MyEllevate during the pandemic, this major advancement in neck rejuvenation has taken the industry by storm.
From Humble Beginnings to Industry Gamechanger
Coming to the end of his incredible story, Dr. Mueller comments on his own amazement at the success of what began as an idea for how to improve the level of care and aesthetic results he could provide his patients.
“When I created MyEllevate, I never imagined that I would be inventing an FDA device that I would be traveling the world introducing. I thought it was just for me. I was doing it just to improve my own patient care. it’s been a fun journey. It continues to be fun going forward, and other doctors using MyEllevate and the ICLED are coming up with other ways to use the technology. So, although I think the best use for MyEllevate is sculpting the jawline, there’s going to be other areas that will come into play in the future that other doctors will innovate. I love hearing that other doctors are coming up with new ways to use it because that was always my dream, that someone would find different ways to use the technology.”
Dr. Mueller leaves us with this final piece of advice for other innovators in the medical aesthetics industry, “If you’re improving your patient care and improving the way we treat patients, I think it’s good to stick with it. That’s what I did. I knew it was a better way and offered a new way of thinking and rejuvenating the neck that would help patients achieve what they wanted less invasively and with less risks. And, you know, I think that it was something that had to be proven, so I had to do it myself. It wasn’t something that I could just invent and sell or license to someone because no one else saw the value except me. I was the end user of the device, and that made me determined and gave me the tenacity to stick with it. It doesn’t happen overnight. It is expensive and takes a lot of time, but it’s so worth it. If someone has an innovation, if you believe it will help your patients and patient care, and be a safer and effective way to do things, then don’t give up.” 
