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The Manhattan Mouth Maven

Heather Rypien, Certified Nurse Injector

Contributed by
Heather Rypien

Luscious lips are popping up everywhere. Or, perhaps you may not have noticed; and this I promise, is a good thing! The best “work” is work you cannot detect. As a nurse injector living in the south, I had experience with lip plumping but never did I think I would become what I have secretly dubbed myself….The Manhattan Mouth Maven. For real….it has become my reality. On an average day I may have the privilege of plumping 6-10 pouty puckers.

So how did this madness come about? Well…… it all started a few months ago with a beautiful young patient with naturally beautiful lips that just was looking for a little perk. I remember how sweet and how excited she was. I had a great canvas to work with and this was a fairly easy task. We laughed, I injected, she was thrilled, and before I knew it……YELP. NO, I did not “Yelp” I was Yelped….. You know that crazy social media tool that will make you or break you? Yes… that’s the one. Well, let’s just say it was the beginning of a game changer for me and my career, here in NYC and at Pearlman Aesthetic Surgery.

That social media post with her Before-and-After pictures generated such a buzz, lip seekers started to fill her private message option on her yelp page, true story. Before I knew it, the face of our Park Avenue office lobby began to change as well. Our once primarily “upper crust” more mature clientele, evolved into younger, colorful (in every sense of the word) patients seeking not only luscious lips, but the secret to the fountain of youth.

Lips

I have had many patients comment that, until meeting me, were inclined to believe that the reviews had to be made up or solicited. My response is the secret to my success–

  1. Less is more. ALWAYS. Period. Drop the mic.
  2. We can add product if necessary or desired, but let’s not have to take out.
  3. Good work should go unnoticed ALWAYS- just because you think it looks great doesn’t mean the vast majority will….just sayin’
  4. Kylie Jenner’s lips work for her but it’s important to remember that for every girl that aspires to achieve this look, there are probably 5 that are trying to avoid it.
  5. I welcome a picture of “dream lips,” it gives me a good idea on the look we are going for and which product to use but remember…….we are looking to enhance, not rebuild.
  6. Listen to your gut!!! The procedure-room chair is not the place to make a decision. If you are not fully committed when you sit in that chair, sit at the bench and play later. It’s your face, the only one you have- be smart and be excited.
  7. We are a team, but I’m not afraid to say no; it’s my reputation and people trust me. It is my job to be a provider not a salesperson.
  8. Just because you can does not mean you should……
  9. I’m from the south no matter what, you will get a hug and your ”heart blessed” by me.
  10. At the end of all this…….IF and ONLY IF you are completely happy- the best compliment you can give is a good review. After all, this is how my new friends find me.

My Facelift Journey

Contributed by Heather Rypien.

The decision to undergo a surgical procedure, let alone a facelift was one I did not take lightly. My entire life I have struggled with a double chin which consistently was up and down with fluctuating weight loss, genetically, the cards were stacked against me as a saggy lower face is a family trait.

Little bit of background? I am a 45-year-old woman who has worked in the field of aesthetics for over 10 years. I am a Certified Aesthetic Nurse Specialist, basically, a master injector who has not only had the pleasure of injecting many hundreds of patients, but have had the opportunity to inject every FDA approved dermal filler on the market. I have actively pursued every educational opportunity to remain on the cutting edge of advanced injection techniques. I guess where I’m going with this…. I’ve tried it all! So I knew that to achieve my desired result, a surgical intervention was my only option.

Discussing cosmetic surgical procedures is not always an easy conversation. First off, wonky “botched outcomes” sit at the forefront of the minds of many: despite the fact that they are exceptions to the rule. It’s rare that the mags feature “a good facelift” because the reality is, no one can detect a good facelift! Secondly, some just do not ethically or morally believe in altering the face! Despite what others may think, what matter is what YOU think, so, please let me impress upon you this: the absolute most important thing you can do is research and educate yourself to ensure you choose an expert provider.

Although North Carolina is my home and I have established a successful practice there, I decided a year ago to Join Dr. Steven Pearlman and The Pearlman Aesthetic surgery team.It was important to me to work with the best and I found it at my new work home in NYC. Dr Pearlman sets the bar for every one on his team to the highest standard. He is a phenomenal surgeon and a kind, compassionate, honest, and ethical man. Always the patient advocate, Dr. P will never make a decision based on anything other than what is best for the patient. He is quick to give you everything he has while being the first to say no if an expectation is unrealistic or has potential to yield an unnatural result.

Obviously Dr Pearlman was the only choice for me moving forward with the procedure. At first, Dr. P was not on board, he patiently sat with me and explained that I could wait a few years, not that I remotely thought I had a chance at changing his mind IF he felt I would not benefit. I expressed what was bothering me. I had recently lost over 30 pounds; I was not a candidate for Kylbella because my problem was skin laxity. I had been successful in the past with dermal fillers and Sculptra but the loose skin sag could only be ameliorated with surgery. After a thorough consult and discussion, which covered all my questions, concerns and what I expressed was my desired outcome, Dr. P agreed and we booked the surgery.Before and after weight loss

My Facelift experience was phenomenal! I remember looking in the mirror for the first time shocked I did not have a single bruise! I was in my NYC apartment the second day virtually pain free. I had my stitches taken out 6 days later and still think this minimal pain was the worst of the whole procedure! Even though it’s not recommended, I felt comfortable going back to work after just one week! Seven small days of downtime for a huge, beautiful, confidence-boosting life change!  A small amount of time, to be sure! My patients at P.A.S. were amazed–everyone thought I had a new haircut and got some sleep. The remainder of the stiches came out on day 8. I was able to fly home the following weekend and even attend a conference in Chicago that same weekend. My friends who work for some of the top facial surgeons in the country were in awe over my result and sang praises of Dr. Pearlman’s work.beforeafter-facelift

Today is day 16 post surgery. I am still a bit swollen but feel amazing. My face looks better each day and I am excited to see the subtle changes over the next few weeks. Hands down, best decision I have ever made.

beforeafter-facelift-day16

What life is like after a facelift – A Surgical Journal- Week 1

Dr. Steven J. Pearlman Wins RealSelf 500 Award

 RealSelf 500

New York Facial Plastic and Reconstructive Surgeon Recognized as Top Social Influencer in Cosmetic Medicine 

 

New York, NY – March 7, 2016 – Local physician Dr. Steven J. Pearlman is one of 500 doctors in the nation to receive the prestigious RealSelf 500 Award, out of nearly 13,000 board certified specialists with a presence on RealSelf—the leading online community helping people make confident choices in elective cosmetic procedures.

In a time when 1 in 4 U.S. adults share their health experiences on social media channels, the medical professionals that made the 2015 RealSelf 500 are recognized both for having an outstanding record of consumer feedback and for providing credible, valuable insights in response to consumer questions about elective cosmetic treatments, plastic surgery, dentistry and more.

Dr. Steven J. Pearlman is a distinguished Facial Plastic and Reconstructive surgeon, educator, and humanitarian with a wide range of professional credentials. He is uniquely dual board certified in both Facial Plastic and Reconstructive Surgery and in Head and Neck Surgery.

With extensive clinical and academic backgrounds in both fields, Dr. Pearlman provides his patients with a unique expertise and understanding in the cosmetic and reconstructive surgery of the nose, face, and eyes. He has authored over 30 medical-journal articles and book chapters, and also serves on the editorial board of a number of prestigious medical periodicals. Dr. Pearlman served as President of the American Academy of Facial Plastic and Reconstructive Surgery, 2004-2005.

“In 2015, these 500 doctors collectively impacted tens of millions of consumers, with nearly 30% of our total doctor content posted by this relatively small group,” said Tom Seery, RealSelf founder and CEO. “When I started RealSelf, many doctors questioned why they should ‘give away’ their expertise ‘for free’ on the web. Now, eight years later — and with over one million doctor answers on our platform — we are proud of the standard this select group has set. They’re leading the way by empowering millions of consumers to gain access to the information they need to make smart and confident health and beauty decisions.”

Dr. Pearlman is an expert contributor to RealSelf, and to date has posted over one thousand answers to questions on RealSelf. Each month people from all over world ask important aesthetic-related questions, for surgical procedures such as primary and revision rhinoplasties, facelifts and lip implants as well as non-surgical procedures like Botox and facial fillers. Dr. Pearlman also maintains a patient star rating of five out of five stars in RealSelf reviews. For more information on Dr. Pearlman and Pearlman Aesthetic Surgery, please visit mdface.com, and for the full list of RealSelf 500 Award winners, visit http://www.realself.com/RS500.

 

About RealSelf

Since its founding in 2006, RealSelf has created the world’s largest community for learning and sharing information about cosmetic surgery, dermatology, dentistry, and other elective treatments. Our extensive collections of reviews, photos, videos and doctor Q&A make RealSelf the most trusted resource for those who are looking for help beyond the beauty counter. www.realself.com

 

2016-RealSelf500-2015

Bangs or Botox, You Decide…

Beauty Expert

Contributed by Audrey Matney

New York City women are no stranger to the wonderful world of aesthetic medicine. Being a wise observer, I will venture to guess that you too have encountered women with that undeniable “Botox look.” This bizarre looking phenomenon is of epic proportions and has become so mainstream that even children can recognize this overly done, frozen facial appearance.

An inherent fear of an unnatural appearance has led many woman to opt of trying the most popular aesthetic procedure elective aesthetic procedure in the country, if not the world according to world renowned facial plastic surgeon Dr. Steven J. Pearlman. Dr. Pearlman has received countless confessions from patients whose fear of looking frozen sent them running to their hairdressers for help. What could a hairdresser do, you ask? Cut bangs to hide forehead lines, as if the sweep them under the rug, or in this case, under the bangs.

Although a clever route to staving off the needle, what if one doesn’t have the face for bangs? What if you don’t want to spend additional time maintaining (smoothing, blow-drying, trimming) them? Not yet ready to commit to chopping off all that hair? What you really need is Botox education to quell your fears.

Before you dismiss Botox all together and go running to the nearest hairdresser, consider this: In 2014 over 6.5 million patients received Botox injections in the U.S. alone, so you have to say to yourself, it can’t all be bad, can it? First, you should understand how wrinkles are formed, and how Botox works so diligently to eliminate and even prevent them. You might not remember your high school biology lessons, but to fully understand Botox, you must first comprehend the relationship between opposing facial muscles. Facial muscles fall into 3 categories, elevators,  depressors and corrugators, which work synergistically to enable facial movements and create expression, i.e.: laughing, pouting, scowling, and smiling. Botox works by eliminating the depressor muscles that pull down. It does not eliminate expression (if your injector is a pro). Depressor muscles include the corners of the eyes, in between the brows, jaw, and neck…and then you have the elevator muscles that lift the brow and chin. Corrugators, do just that: they create vertical lines that are perpendicular to the muscle action, or the “11s” between your eyebrows. While finding an excellent injector who knows musculature is key to natural looking results, you also need to ensure that your provider understands your aesthetic goals, and that their visual aesthetic is in line with yours.  If your injector does not know the anatomy of all these muscles, please run away.

Now back to your Biology lesson, the muscles that can be treated with Botox for anti-aging are: the Frontalis Muscle which controls brow elevation (elevator), Corrugators which enable you to scowl (corrugator and depressor), the Orbicularis Oculi which controls eye and lateral brow movement enabling you to wink and squint (depressor), the Depressor Anguli Oris which controls the ability to frown (depressor), levator anguli oris which assists in pursing and pouting, the Mentalis which when overactive causes a cobblestone appearance of the chin, the Platysma aids in swallowing and causes vertical neck bands to form (depressor), and the Maseter Muscle which helps you chew. No injector expects you to know medical terminology, but it’s terrific if you can enter your appointment with a basic understanding so you feel like a player on your own team.

With age, as the skin begins to lose its natural suppleness and elasticity, the depressor muscles under the lip tend to pull down the corners of the mouth resulting in marionette lines. Relaxing this muscle can eliminate such lines, as well as turn up the corners of the mouth in an aesthetically pleasing manner. Since depressor muscles under the lip have been hard at work your entire life, you may also lose the superficial fat that covers the muscle; an issue that would need to be addressed with a dermal filler.

Depressor muscles under the jaw pull down the cheeks leading to loss of jawline definition and flattened cheeks. By utilizing Botox, a neuro-toxin that temporarily inhibits the use of these muscles, the large depressor muscles of the lower jaw and neck are treated, reversing the balance of power, allowing the cheek elevators to act unopposed. The result is a more defined jawline, and a non-surgical neck lift. Another name for this is the Nefertiti lift, names after the famous bust of the ancient Egyptian Queen Nefertiti. Her famous bust statue from the 13th century demonstrates a long elegant neck.

When trying to eliminate horizontal forehead lines, Botox is injected into the frontalis muscle–the muscle that elevates the brows. By gently relaxing this muscle, you can reduce horizontal lines and still be able to move the brows. But children, beware (!): knocking out this muscle completely will result in a frozen forehead.

As with all Botox treatments, it can take up to a week to take full effect, 2 weeks to notice a reduction in fine lines, and the results typically last 3-4 months.

Still not convinced that Botox can produce natural looking results? Enter Micro Botox, or as we call it: HD Botox, our newest weapon in the war on aging. HD Botox is a new procedure that has been developed for use in conjunction with standard injections. It is a treatment for patients who opt for more natural-looking rejuvenation, as opposed to that “frozen” look that traditionally prepared botulinum toxin can give. Traditional Botox treatments aim to disrupt the communication between your muscle and nerve, which in turn minimizes the dynamic lines that have formed with facial expressions over time. Micro-Botox however, targets only the most superficial muscle fibers with a series of small, highly diluted micro-droplet injections. This innovative treatment not only minimizes the finest of fine lines that traditional Botox cannot treat, but acts like shrink wrap for enlarged pores, which makes crepe-paper like skin look much smoother. Dr. Pearlman is an expert at Micro Botox.

The most essential areas for HD Botox are the forehead, under-eye region, and the neck. After HD Botox, the forehead lines are wonderfully smoothed, yet retain the ability to move and elevate eyebrows, making this perfect go-to-treatment for on-air personalities, models and celebrities, or anyone under the relentless scrutiny of HD Cameras.

With the use of HD Botox, you can also target under-eye wrinkles without affecting eye function (pretty important). The same is true in the neck,  treating platysma bands does not result in smooth skin, after HD Botox, however, the skin appears to be shrink-wrapped eliminating the crepe paper-like appearance of the skin.

The take-home message, now that you have the tools to make informed decisions about your aesthetic goals is that there is no need to fear Botox any longer. Simply seek out a master injector like Dr. Pearlman, national trainer and educator for Allergan, the makers of Botox, who has the credentials and training to deliver natural-looking results. Our patients leave looking rested and refreshed, not surprised and Stepford wife frozen. And for this, their kids love them all the more.

Boutique Botox

Contributed by Heather Rypien

Heather Rypien administering Botox on a patient

OK! Let’s face it. Most of us shudder at the thought of “getting old” – whether it’s facing the fact that our energy level is not what it used to be, or the fact that those dreaded wrinkles are constantly a literal walking advertisement of our age. Most of us are on a mission to preserve the youth we once took for granted. I mean really, who ever thought we would become “that old person”? With advancements in research and technology, we now have available to us many tools to fight Father Time, that dastardly Muther! From hormone replacement therapy, to using plasma rich protein to rejuvenate the skin, it seems the growing possibilities are endless.

That being said….let’s talk some BOTOX…the (safe) gateway drug to youthfulness.

I hope that got your attention.

Seriously, who likes wrinkles? I realize that wrinkles are actually our character lines and tell a story – but why not use them to be a mystery novel? When people hear the word Botox, reactions vary. Many will say they can’t live without it, others…not so much, I mean who wants to look like Keith Richards, then again, who wants to look stone-faced? What’s the happy medium? One of the toughest parts of my job as a nurse injector is properly educating our patients and instilling the confidence to try something new, especially if a consult happens to occur around the same time as the Grammy or Academy awards! To have the confidence to try something new that will still look like YOU…a refreshed, smoother version and natural-looking is key.

I started this little blog with Botox, as it has been the gold standard in wrinkle releasers (ok neuromodulators but who uses that word) since 2002 when it first became FDA approved for the use on those Angry 11 lines between the eyes. Since then, we have come a long way, baby. Not only have we expanded the areas practitioners are able to treat but, there has been some new competition on the market – same game, different name! Although newer products such as Dysport and Xeomin vary in their chemical properties, the mechanism of action is the basically the same. So we know we have options with product, but how many of you really knew that we now have multiple options on what these “refreshers” can do for us?

I decided to incorporate a new approach to non-surgical cosmetic procedures in our practice. I guess if I had to come up with a name for it I could call it Boutique Botox. The experience I give our patients is unique and exciting. We only have one face. I like to think that, similar to purchasing a big ticket item from Best Buy, people do their homework and educate themselves and research all of the options available. It all begins with the consultation process. So many times my patients have told me that they have never had someone explain to them in depth the “why behind the how” when it comes to any cosmetic injection. I have to say this amazes me. Seriously, if you do not know HOW the product works and WHY it is being injected where it is…how could you possibly understand what the outcome will be- Seriously folks there is more out there than just getting rid of a line! I often wonder, did you really just go in somewhere allow them to stick needles in your face and just go home hoping you would wake up with no wrinkles! If this is the case, please do not do it again.

You are in the driver’s seat of you anti-aging process–Let me be your trusted co-pilot!

Wrinkle reducers should come with a menu. It’s all about the muscles. To make it short and sweet, we have two basic muscle functions in the face, depressors (help make the tired mean face, and elevators (our happy approachable face). It is the happy yin/yang balance of manipulating these muscles that helps us achieve our aesthetic goals. Naturally.

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