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Steven J. Pearlman, MD, FACS Dual Board Certified in Facial Plastic Surgery

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Teaching Facial Plastic Surgery

Teaching Facial Plastic Surgery in Las Vegas

I just returned from Las Vegas where I was lecturing at the 7th annual Multispeciality Foundation course on Facial Plastic Surgery. The first reaction from friends is, “oh, Vegas must have been a lot of partying and fun.” This course is so comprehensive that I didn’t want to miss anything, so I was inside the lecture halls from 7 AM until after 6 PM every day for 4 days straight. At night were dinner demonstrations and meetings with the various laser, filler (Juvederm, Restylane, Radiesse, Sculptra, Belotero) and neurotoxin (Botox, Dysport) vendors to see what’s the latest and greatest.

I gave four talks at this meeting. Three were on rhinoplasty:

  1. spreader grafts for primary and revision rhinoplasty
  2. What causes nasal obstruction other than a deviated septum
  3. Treatment of the complications of rhinoplasty
  4. Wow cheeksTM How to make nasolabial folds look better than just treating the lines. 

I also moderated a half day session on eyelid rejuvenation, including lectures on blepharoplasty, browlifts, Botox and fillers for the eye area.

This meeting has an amazing cadre of lecturers, equal numbers from each of the “core” disciplines of cosmetic surgery: Plastic Surgery, Facial Plastic Surgery, Oculoplastic Surgery and Dermatologic Surgery. Attendees can really see how different specialists approach facial aging and the varying ways that internationally recognized experts from each discipline treat facial aging.

This meeting was a true testament to the organizing committee and founder Dr. Randy Waldman; a long time friend and facial plastic surgeon (in that order of importance) from Lexington, KY. He ran a similar but smaller meeting in Newport Beach, CA for 17 years before this and is a true meeting genius.

Steven J. Pearlman, MD, FACS

Rhinoplasty, Botox, Fillers Pre-wedding

It’s wedding season, why not get freshened up.

New York, NY: 

The goal of pre-wedding aesthetic enhancement is to achieve the ultimate “look” on the day of the wedding. There are a number of treatments we can offer ranging from minimally invasive to aesthetic surgery. This applies to the bride as well as the mother of the bride and the mother of the groom. As I say to all “mothers” the most important individual at the wedding is the bride. Next is the mother of the bride. Third is the mother of the groom and 4th but not least, is the groom.

 For surgical enhancement, I often see brides-to-be right after they get engaged for rhinoplasty consultation. Wedding photos will be a keepsake for the rest of their lives and if they haven’t been happy with the way their noses photograph this is a great time. I typically have half a dozen weddings that I am helping to “prepare” brides’ noses for each summer season. Since the bride is the center of attention. I like to have at least 4 months or more between surgery and the wedding for adequate swelling to go down. It really takes a year to see close to the final “nose” but by 4 months the nose should already look better than pre-op.

 The same guideline applies to mothers of the bride (or groom) seeking a facelift for the upcoming wedding. I think we can shorten this to 3 months, minimum. Most patients will look better at a month, but just in case healing is a little slower, I don’t want to take any chances. Other than the “mothers” we can go down to a little over a month healing. For example, recently I had the mother of the bride and her sister, the aunt, come in for facelift consultations 2 months before the wedding. With creative scheduling I could get 1 ½ months of healing before the wedding but no way would I operate on the mother of the bride with this short period. The aunt had her facelift and looked great by the wedding.

 For blepharoplasty and browlift, the healing is faster. 1 ½ to 2 months is adequate healing time before a wedding, although healing still improves the result for 6 months.

 Many brides are no longer in their 20’s and want the makeup to glide on for their wedding. When it comes to minimally invasive “tune-up,” we have a number of treatments to erase wrinkles and get a stress free appearing bride. Botox smoothes frown lines, crows’ feet and forehead lines. For Botox regulars, I suggest the last treatment 3 to 4 weeks prior to the wedding, just in case they get a rare black-and-blue mark. The same holds for facial fillers to enhance nasolabial folds and cheek enhancement.  Expertly performed Botox can smooth wrinkles yet maintain some facial expression, brides do not want to look flat (or like too many Hollywood actresses) for their photos either.

 For Botox and filler rookies, I don’t like treating brides less than 4 months before the wedding. This way there is a trial period to make sure they like the results. If so, a booster 2 to 3 weeks before will restore their look. For the rare few who are not happy with the results, Botox will have worn off and a reasonable amount of filler will have dissipated.

 The last category is skin care. Everyone should be on a good skin care regimen, with properly selected skin products by a skin care expert, and I don’t mean the counter girl who at a department store who has limited training. For older brides, a series of light office peels can smooth out wrinkles. For any bride, an exfoliating facial with light peel using an alpha hydroxy acid or similar product two weeks before the wedding will leave the best palate for the makeup artist of choice.

Browlift and Botox in New York

The perfect eyebrows

New York, NY:

The perfect brow is club-shaped centrally then tapers along the tail with the center portion beginning at a vertical line drawn upward from the edge of the nostril. The tail extends to a line that runs  from the corner of the nose through the corner of the eye. The height of the brow should be equal at both ends; typically at or just above the rim of the eye socket. Generally, in women, the brow should arc delicately with the highest peak between the corner of the iris and the corner of the eye. The male brow should rest on or at the rim of the eye socket and is more horizontal in shape. Aestheticians commonly use the “pencil trick”* to guide them in eye shaping. The skin portion between the brow and the eye should be smooth and have a youthful fullness, with little excess skin and no over-hang of the skin. This leaves a nice platform to apply eye shadow without flaking or cracking.



Peak of brow
Peak of brow
Tail of brow

Tail of brow



All the above is well and good for teens and models, but as we age, the brow may flatten and droop as well as deflate. There are a number of non-surgical as well as surgical techniques to rejuvenate an aging eyebrow. Eyebrows can be elevated non-surgically by the use of expertly placed Botox. Not only can brows be lifted, but shaped as well. Crow’s feet can also be smoothed. Sometimes it’s more a deflation of the eyebrow instead of drooping. In that case, fillers such as Restylane or Juvederm can be used to restore youthful fullness that mimics a browlift but actually doesn’t lift the brow.

When is surgery necessary? When there is significant wrinkling and redundancy of the eyelid skin, which may be due to excess skin or drooping of the eyebrows. If the brows are in good position and the overhanging skin doesn’t extend far beyond the corner of the eye, a blepharoplasty is the best solution. When the excess skin goes well past the eye, that means that the brow has dropped; a browlift is more helpful. Another way to tell if it is the brows or eyelids that are the problem: if you look worried, sad or angry it’s more likely due to a brow problem. If you look tired it’s usually more from the eyelids. Another way is to pull out photos of yourself from your mid 20’s, and check where your eyebrows once were.

New York Times: To discount or not to discount, that is the question

Many of us, consumers and businesses alike, have been riding high on the last two decades of rapid growth in income and therefore consumer spending. And now the bottom is dropping out. This affects us all: clothing stores, car sales, home sales, restaurants, education, and yes, even cosmetic surgery. Cosmetic surgery is unlike surgery for medical conditions. If you have a hernia, for example, surgery can be put off for only so long. However, surgery is still surgery and therefore should not be taken lightly. Some patients who may have been thinking about a facelift or blepharoplasty (eyelid lift) know that putting that off is not going to affect their overall health, but it certainly is going to affect their sense of well-being, self confidence and outlook on life .  So where is the balance between personal desires and personal finance?

I have found for my own practice and that of a number of my colleagues that all surgeries are down. However, this has affected the number of rhinoplasties a little less than other procedures, especially revision surgery. I feel that this is because when people are unhappy with the appearance of their noses, especially if they can’t breathe well, it is more than just a cosmetic issue. An unsightly nose is a feature that has been with them for life and can affect personal growth as well as acceptance by their peers. For these people, rhinoplasty is more than a cosmetic procedure. A nose that doesn’t fit one’s face may supersede what might be considered more frivolous aesthetic procedures designed to combat facial aging.

In The New York Times last thursday, there was an article by the renowned medical reporter, Natasha Singer, discussing which physicians discount surgery and other treatments such as Botox and facial fillers. This is a very personal issue. Personally, I had discount courtesy cards made up as gifts for my patients that we never got around to mailing. Well, we mailed them today. I think these are great pick-me-ups for looking better fast and I want to share that with my patients. According to a recent survey of patients by the American Academy of Facial Plastic and Reconstructive Surgery [AAFPRS], when it comes to surgery feeling secure with their choice of surgeon is more important than price.

To quote Dr. John Conely, one of the greatest teachers of both cosmetic and reconstructive surgery of the face, head and neck of the past 50 years: “I have never seen anyone die from a wrinkle, but some thought that they might.” 

In closing I would like to reassure you that my practice is still thriving and that, as always, I am plugged into the zeitgeist. To show my sensitivity to these more austere times in which we presently live, I am offering you a 20%-off Botox, Juvederm and Restylane through the end of 2008. 


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