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Category: Facial Plastic Surgery

Lifting Your Appearance With The PearLift

During this past month we held a media event announcing the release of a brand new non-surgical procedure that starts with Ultherapy  which tightening the underlying facial structures including the SMAS and Platysma. After that we continue with the Dot™ fractionated CO2 laser. That way the skin is rejuvenated inside and out. 

We were fortunate enough to have Carol Ruth Weber attend our event this past month and go through the motions of the Pearl Lift. Like any patient she had concerns, which we were able to address. 

You can read her account of our event by clicking here

Are You Aging Too Quickly?

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Are You Aging Too Quickly? The beauty experts help you decide at Pearlman Aesthetics , a highly regarded Plastic surgeon in New York, is known as a go-to resource for professional, experienced assistance regarding anti-aging and other cosmetic concerns. From facial rejuvenation to non-surgical and surgical lifts, the professionals at this facility offer a wide range of services to individuals who are looking for a way to fight the signs of aging—and with today’s high-speed lifestyle, these signs appear faster than some may realize.

A recent article published by the Huffington Post shares five different signs that an individual is aging prematurely. Premature aging occurs when the signs of aging, such as wrinkles, fine lines, loose skin, uneven skin tone, and more, start to appear earlier than normal. The article explains: “Aging is inevitable but looking old before your time is not. Many factors can accelerate aging, everything from smoking to a lack of exercise. But, fortunately, many of these factors are under our control.”

The Beauty Experts at Pearlman Aesthetics agree, as they work daily with individuals who are looking to turn back the hands of the clock and reinvigorate their appearance. While aging is not something that people can avoid forever, it is a process that can be slowed with today’s medical breakthroughs and an understanding of a healthy, well-rounded lifestyle.

The first sign that the article provides is that an individual has a larger number of wrinkles than they should for their age. Additionally, the development of jowls shows that the skin is loose. Ultimately, yo-yo dieting can cause this issue, as the skin is continually stretching and retracting when individuals fluctuate greatly in their weight. Furthermore, eating a diet that does not support skin health can result in skin that is unable to bounce back from weight fluctuations, regardless if individuals yo-yo diet or lose weight and keep it off. As such, it is important for individuals to improve their diet with foods focused on boosting skin health.

The next sign that the article highlights is droopy eyelids. This is natural, as the skin around the eyes stretches as it ages and the muscles beneath it tend to weaken. For many individuals, cosmetic surgery is the way to go when addressing significant droopiness; however, there are non-surgical ways in which individuals can improve this aspect of their appearance, including staying hydrated, cutting down on sodium intake, and getting more sleep each night.

The third sign is also related to the eyes: premature aging can lead to red eyes. Basically, the article states, “Swollen or dilated blood vessels can make your eyes look red or bloodshot—as well as old. Sitting in front of a computer all day, and not getting enough sleep, can cause redness in eyes. Putting a cold compress on your eyes for 10-minute stretches should help. But you should seek help from a doctor if you have persistently red eyes.”

The fourth sign that the article offers is impaired hearing. In many cases, wax blockage may cause this issue and the removal of the problem can greatly improve hearing capabilities. In other cases, though, hearing aids may be necessary.It is important for individuals who are experiencing hearing loss to talk to their doctors and keep an eye on their health, as this condition has been linked to others, including Alzheimer’s disease.

Finally, the last sign that the article provides is that individuals wake up with dry mouths. Also called cotton mouth, this is an extremely uncomfortable situation that can be sparked by a number of things, ranging from smoking to certain pharmaceuticals to the aging process. Sprays may help the mouth to avoid getting dry by sparking the production of additional saliva. Additionally, drinking water, reducing caffeine consumption, and chewing gum can help, too.

The Beauty experts encourages Dot therapy for Anti-Aging. The Beauty experts understand that slowing the aging process is an important priority for many people. With so many different treatment options on today’s market, there is certainly a procedure out there for everyone. One of the most exciting is Dot therapy, which is a new approach to anti-aging that uses fractional resurfacing of the skin. The goal of the Dot therapy system is to minimize the appearance of wrinkles and fine lines while improving skin tone and texture, tightening loose skin, and diminishing scarring.

Ultherapy works by emitting ultrasound energy. This energy heats the skin and creates an environment in which molecular vibration takes place. This vibration leads to collisions of the molecules and, ultimately, the resurfacing of the skin. Because of the nature of this treatment option, the Beauty Experts explain that Dot Therapy can be used on many parts of the body, including the neck, face, chest, hands, extremities, and back. Furthermore, the professionals at Dr Pearlmans assert, this treatment is well suited to a wider range of skin types than others.

The beauty experts at Pearlman Aesthtics are known as a wonderful resource for individuals in NYC and surrounding areas who are looking to slow down the aging process and mature in a graceful manner. As such, the Beauty Experts working at Dr Perlmans encourage anyone who is interested in learning more about the signs of premature aging or the Ulthera and Dot therapy procedure to call the facility today.

Adventures in Amsterdam Part 3.

Friday was the final day of the course, a day devoted to revision rhinoplasty. I gave the featured lecture, titled: “Lessons learned in revision rhinoplasty, how to avoid it in the first place.” This lecture evolved from a study I performed and published reviewing the reasons patients seek revision rhinoplasty. Since over almost half of my rhinoplasty practice is fixing problems, I presented the most common reasons patients seek revision rhinoplasty, what likely went wrong, how I fixed it, and most importantly, how to avoid it in the first place. As in all of medicine, the best treatment for a problem is prevention. 

 

That night we had an elegant dinner with our hosts Drs. Gilbert Nolste-Trenite and Dirk Jan Menger and their wives. Not only was the dinner wonderful, but Gilbert is a wine aficionado, so the wines were spectacular. Friday afternoon, Saturday and Saturday night, Ali and I were on our own to further explore Amsterdam. Included was the newly renovated Riiksmuseum, just recently re-opened after 10 years of renovation. 

 

My wife and friends sometimes ask me why I travel so far and often to lecture. My travel and hotel were covered by the meeting but I’m taking days off from my practice without pay. Academic medicine is about teaching others, giving back and the opportunity to share ideas with other experts from around the world. It’s an immeasurable experience to lecture around the world, an excuse to travel and an unmatched opportunity to share ideas with others. 

Adventures in Amsterdam Part 2

The second of the course included a live televised rhinoplasty that I performed. This was a stressful, yet exhilarating experience. The patient was recruited by one of the faculty members. She had a deviated septum and was given the option for a cosmetic rhinoplasty by a visiting Professor from the U.S., namely me. I treated her just like one of my own patients. I received the photos by email a few weeks prior. I uploaded the photos into my computer and performed computer imaging on the photos. I then saw the patient the afternoon before for a personal examination and to discuss our plan. Most importantly, to make sure that the patient was comfortable with me and the surgical plan. When the consultation was complete, she was quite excited at the prospect of a new nose. She had a crooked nose and a very wide twisted nasal tip that was over-projected (stuck out too far from her face).

I maintained my routine of doing what Dr. Robert Simons and my mentors always taught: a rhinoplasty is performed 5 times. The first time is when you meet the patient, discuss their desires and perform a thorough nasal examination. The surgery is already being planned in the surgeon’s mind. The second time is reviewing the photos and imaging, often with the patient at a second consult. The third time is the morning of surgery. I review the photos, the written surgical plan and the imaging. The fourth time is actually performing the surgery. For a primary rhinoplasty, surgery rarely deviates from the plan given a careful evaluation and intimate knowledge of nasal anatomy. The fifth time is a year later, comparing the before and after photos to see how the nose actually came out. We critique our own results to help affirm or look to further refine our personal technique. For this young lady, the first two steps were reversed, but the rest adhered to. I had gone over this plan many times in my head before her surgery.

 Back to the surgery, I went to the operating room on Thursday morning, a beautiful newly renovated facility. I was even given bright yellow surgical O.R. clogs to wear. They have them in every size, and are cleaned after every surgery just like the surgical scrubs. I was then wired for sound and off to the surgery. There were three video cameras, one above the patient, a second from the side and a third with a close up view from below the nose. I was quite comfortable narrating my rhinoplasty since I am usually accompanied in surgery by ether a fellow in Facial Plastic Surgery or a resident from the New York Presbyterian, Columbia, Cornell program.  The moderator back in the lecture hall was Prof. Gilbert Nolst-Trenite, a recognized international leader in rhinoplasty education and author of numerous textbooks and hundreds of articles on rhinoplasty.  He asked questions throughout the surgery and related questions from the audience. By the time I started surgery, my butterflies were gone. With a scalpel in my hand, I felt quite at home. Surgery went very well. The feedback during surgery from the other faculty in the lecture hall and attendees was quite positive. 

Thursday afternoon was a relief. Despite having performed thousands of rhinoplasies, this was an exception; the pressure of a live rhinoplasty in front of the symposium as well as a dozen faculty of established rhinoplasty surgeons was now over. I had one more lecture that afternoon.  But first there was a cadaver dissection lab. This is quite routine for me since I have participated in and taught in many of these lab sessions. There is a room with fresh frozen cadaver heads on trays. These are from people who have donated their bodies for medical study. The cadaver heads are always treated with respect and will be used by a number of specialties in pursuit of medical educations. The faculty members helped the attendees perform dissections and surgical techniques on these specimens according to a planned lab manual.

My afternoon lecture was,  “Intra-nasal Rhinoplasty, a dying art?” Another name for intra-nasal rhinoplasty is closed rhinoplasty. This is a topic for another series of blogs. In a nutshell, most young surgeons only taught the open rhinoplasty approach. There are a number of contributing factors for this. However, for most patients, I feel that a skilled, experienced surgeon can get equal results with closed intra-nasal rhinoplasty without an external incision across the bottom of the nose. A better view of the tip cartilages doesn’t automatically make for a better surgeon or better results. It’s as stated prior: precise analysis, understanding nasal anatomy and an armamentarium of sufficient rhinoplasty techniques is what it takes to obtain quality results. This is with or without an incision across the bottom of the nose. 

That night was a banquet dinner for the entire meeting, including faculty and attendees. There were a few speeches and I was honored and surprised with a crystal cut glass wine decanter. At dinner, another faculty member had just arrived for his talks the next day, Prof. Tony Bull from Great Britain. Dr. Bull is recognized as one of the most well respected rhinoplasty surgeons in the world. He also has a tremendous sense of humor that comes out in conversation at dinner plus throughout his lectures.

 

Adventures in Amsterdam

A photo of my wife Ali taken while we were out exploring the city.

I was invited to be the featured guest speaker at the Amsterdam Rhinoplasty course about a year ago. Officially entitled “20th International Course in Modern Rhinoplasty Techniques”, the course was run for most of the past two decades by Prof. Gilbert Nolst-Trenite. It has recently been taken over by one of his very accomplished students, a well-established rhinoplasty surgeon and teacher in his own right, Dr. Dirk Jan Menger. I brought my wife, Ali, with me on this trip. I submitted a number of topics to lecture on. Among the five talks I was to give, they chose one of my favorite subjects, Revision Rhinoplasty, to be the “Lecture of Honor” for the final day of the symposium. That would become the subject for all lectures that day.

We arrived on Tuesday and had the entire day off to tour and catch up on our jet lag. Right after checking in at our hotel we immediately proceeded to the Van Gogh Museum. This is a spectacular museum, with four floors of Van Gogh masterpieces arranged to mirror his life and the evolution of his work.  I heeded the advice I received from my Uncle from when I was backpacking in Europe as a student: that the one thing not to skimp on fees is the audio program. These programs offer insights on the art that only a student of the subject can appreciate. After a nice stroll around Amsterdam we went back to our hotel for a power nap. Dinner was with our host Dr. Menger and his lovely wife at a beautiful brick-walled restaurant.

On Wednesday I was picked up at 7:45 a.m. by Dr. Menger to go to the meeting at the University Hospital of Amsterdam. This is a huge, modern hospital with a soaring roof that housed not only the hospital, but stores, restaurants, and kiosks for the benefit of hospital staff, patients, and their families. Most attendees at this course were practicing surgeons looking to hone their techniques and learn about new innovations in rhinoplasty. There were surgeons from Europe, Asia, and the Middle East. I had two lectures to give later that day. These were preceded in the morning by a live televised surgery by Dr. Menger. I got a preview of what was expected of me for the following day, my own live surgery. Dr. Menger did a beautiful job.

My first lecture was on “Graduated Tip-plasty.” Surgery for the nasal tip is the most challenging part of rhinoplasty. Each patient needs to be assessed and treated as an individual. Volume, length, strength, and the shape of the nasal tip cartilages are all evaluated, as well as the relationship of the nasal tip to the rest of the nose and the patient’s face. Treatments range from simple to complex and may involve trimming some cartilage and/or rearranging parts of the tip cartilage. Sutures and grafts of the patient’s own cartilage are also often used to obtain the desired result.

I gave my second lecture that afternoon, “3-D Imaging, a New Dimension in Consultations, Evaluation and Planning.” I have been using computer imaging for rhinoplasty since the beginning of my practice 25 years ago. Like surgical techniques, this technology has evolved from black and white video capture, to color cameras, to digital photography, and now to 3-Dimensional imaging. Computer imaging is not just for showing potential results, it helps stimulate a dialogue with patients about potential changes, mutual goals, and what can and can’t be achieved in rhinoplasty. Vectra 3-D imaging takes this to the next level. It is also excellent for an academic rhinoplasty practice such as mine, since precise measurements can be made of each nose and compared to both projected as well as actual outcome. These can be recorded and used for medical studies on rhinoplasty.

My last presentation for that day consisted of a few case presentations. I projected the “before” photos of a patient and a panel of experts from the faculty discussed how they would treat these patients. This was followed by a discussion of my results. It’s quite interesting to see how other experts on rhinoplasty think and plan for surgery, sometimes quite differently. This underscores the fact that there is rarely one solution to rhinoplasty. It’s not a cookbook approach of learning, a series of techniques, but more the art of evaluation and planning.

Dinner that night was with the course faculty. This was a chance to get to know my European colleagues in a more cordial atmosphere. Two of the distinguished faculty included Dr. Miriam Bonish from Austria and Dr. Peter Hellings from Belgium.

A Rhinoplasty Story Three Years in the Making.

rhinoplasty surgeryA week ago  I did a rhinoplasty on a very lovely and determined young lady. I first met her in 2010 at the age of 22, when she was a student and waitress. She came to see me from New England because I did a rhinoplasty on a relative of hers and “loved” the result. She was very eager and determined to have a rhinoplasty, but couldn’t afford the surgery and was going to do this on her own.  Over the past 3 years she sent us checks starting at $200 every month.

More recently she graduated and is working in her chosen profession. Since then the checks were more in the $400 range. Finally she called 2 months ago and booked her actual surgery. The balance was paid and she came down with her mother for surgery, who also remembers me from the previous rhinoplasty.

Even though I have done thousands of rhinoplasties, I felt more pressure than usual for this young lady since her surgery was three years in the making. The rhinoplasty went very well and her nose looked great on the table. We can usually tell how a nose will turn out when the surgery goes exactly according to the pre-op surgical plan and how it looks right before we put the cast on and swelling begins. She is also getting married late next spring, so she should look great by her wedding pictures.
 

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