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

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Emerging Trends

Woman Applying MakeupEveryone wants to look their best, and while some wish to do so through various topical treatments, others wish to augment their looks with surgical or non-invasive procedures.

As the years keep flying by, new trends in staying youthful are always taking hold, and the “old favorites” stay popular.


• Platelet Rich Plasma (PRP) — PRP has been used for years in other specialties to assist with wound healing because it is rich in growth factors and is emerging in the non-surgical aesthetic industry. By applying PRP either in a minimally invasive fashion, or by injecting it into specific areas of the face, you can induce new collagen formation and create a beautiful more youthful appearance.

• Ultherapy — Ulthera offers a fast treatment for skin contouring and wrinkles. With very little recovery time, Ulthera allows patients to have firm and more radiant skin without surgery.

• Injections of dermal fillers — Dermal fillers such as Juvederm, Voluma, Restylane, or Sculptra have been used to fill in lines and wrinkles are now being used to add volume to the face. Restoring facial volume can give the face a more youthful appearance. Also, injections of purified proteins such as Botox is used to weaken facial muscles that cause wrinkles.

Cosmetic Treatments and Surgery Increasing in Men and the Alternative to Facelifts.

 Cosmetic facial treatments and surgery increasing in men according to the official AAFPRS stats. I have found the same in my practice. More men are looking to look refreshed.

The face ages in five ways, there are skin changes, dynamic lines,loss of facial volume, loss of elasticity, and the effects of gravity. So when treating these signs you needed to address the specific issue. Improving dynamic lines by using Botox. We treat the skin with lasers and skincare products. We restore facial volume with a procedure we call “Wow cheeks”. However the procedure isn’t fully effective because the real issue is loss of facial volume as well as cheek volume. So fillers will help with cheek volume but it’s not going to lift the tissue. What you really need to do is restore and re-suspend the tissue.

So what do we have that can do this? A Facelift, which re-suspends the tissue by tightening the muscle and lay the skin down gently. Until recently we’ve had no other alternative for this procedure. That is until Ultherapy, the first FDA approved non-surgical face and neck tightening procedure that uses high frequency ultrasonic technology that penetrates all 4 1/2 MM of facial tissue. This restores the jaw lines, the neck, the jowls, and even the brow line.

These are the exact layers I would treat while doing a facelift, without having to preform surgery. Patients will get anywhere from 30% to 50% of the effect you would when getting a facelift. But there are no incisions  it’s a quater of the cost, minimal bruising if any, little down time, and patients can return to work the next day.

Ultherapy is an amazing alternative for either men or women who are considering plastic surgery but either cannot afford the full price or cannot afford being away from work for more than a day.

I talk more about Ultherapy in this Youtube video which you can watch by clicking here or the image above.

Do I need fillers, facelift or facial implants?

04Have you ever wished you could enhance certain parts of your face without surgery?

The good news is that you have multiple options.  If you are not quite ready for a facelift or facial implants; a less invasive procedure might be a good start.

Facial Fillers
Fullness in the cheeks is a highly desired feature for women of all ages.  Through our body’s natural aging process, we lose volume from our upper cheeks. Injectable fillers such as Juvederm, Restylane, Perlane, Belotero, Radiesse, and Sculptra are effective in immediately restoring that volume, and are becoming increasingly popular due to their minimal downtime, and immediate results.  These procedures are performed as outpatient procedures, right here in our office, to fill out any area of the face that needs a little lift, or plumping up.

Not to be confused with facial fillers; Botox,  Dysport, and Xeomin are different types of FDA-approved botulinum toxins which are used to relax the muscles responsible for ‘active’ wrinkles.  An example of a common ‘active’ wrinkle is what is known as the ’11’ between your eyebrows.  We call this an ‘active’ line because it is caused by over-activity of the underlying muscles that you use to frown.  In contrast, facial fillers are effective in treating ‘static’ lines which are not due to activity of underlying musculature.  An example of ‘static’ lines are the naso-labial folds, which run from the outsides of your nostrils, to the corners of your mouth.

When you visit our office we can show you examples of amazing results of restoring youthfulness without the need for a facelift or implants.  The combination of toxins and fillers can shave years off of your appearance both quickly, and inexpensively.

The effects of facial fillers varies by the type of filler used.  Some have a duration of just a few months, while other ‘long lasting’ fillers may last up to two years.  Some of these fillers have even been reported to stimulate new collagen growth; such as Radiesse and Sculptra.  This stimulation of collagen rebuilds the face’s natural support structure, and creates longer lasting effects. The wonderful thing about these products that carry what we call a ‘bio-stimulatory effect’ is that they recruit the help of your body’s own natural materials to rejuvenate your face.

Facial fillers are not meant to correct sagging skin along the neck, brow or jaw line. These cosmetic issues may require surgical procedures (although only a visit to see us can help you be sure).

Facial Implants
If you are seeking a more long lasting solution to your facial features, facial implants are a popular option.  In contrast to the injectables that we discussed earlier, which plump up the soft tissues of the face; facial implants go right to the source and give support to what you already have. Facial Plastic Surgeons insert these facial implants at the bone level to enhance your natural bone tissue, supporting the soft tissue above. Because of this, the results of facial implants are much more predictable.

One common method for inserting these implants used by Facial Plastic Surgeons is to make small incisions in discreet areas of the mouth, so the implants can slide into place. Although the procedure is long lasting, it is reversible if results are not optimal for you.

When you make the decision between injectable facial fillers and facial implants, it is important to consider the long-term effects of your choice. If you want a long lasting change, facial implants are probably your best choice. However, you may just want a temporary, or more subtle fix.  In this case, the use of facial fillers; with or without botilunum toxins, can produce amazing results.

If you’re considering a cheek or other facial enhancement, please take a look at our WOW Cheeks procedure in this video and call us for a consultation: (212) 380-1541

Asymmetry in Rhinoplasty, Facial implants and Facial fillers

Facial asymmetry, it’s more common than you think

As a facial plastic surgeon, people are coming in for facial analysis for treatment of their noses, faces, chins etc. Most people have at least minor facial asymmetry. One eye and/or corner of the mouth is higher. Very often someone comments that their faces look more crooked in photos than in real life. Therefore the “outside world” must see them as being much more crooked than they really are. Some people actually avoid having photos taken or insist on a photo from their “good side.”  Why is that?

We are much more used to the way we look in the mirror. You look in the mirror many times a day; brushing your teeth, coming your hair, putting on makeup or aftershave. We rarely look at our faces up close in photos, except when confronted with a picture.

So for patients with asymmetric faces or noses, the first thing I do is use the reverse mirror image tool my computer to show what they normally see. Toggling back and forth helps to demonstrate that they might not be as asymmetric as they think. I can also compare ¾ views since we rarely see a true profile or ourselves in mirrors or photos. If a spouse or parent is present for the consultation, they are surprised at the mirror image and comment that what the patient sees in the mirror appears more crooked than in real life’, since they are more used to the photographic image. 

As for treatment, they range from simple to complex. For minor facial asymmetries, facial fillers are great. I just use more on one side of the face. Facial implants can be also used, either by carving stock implants to fit the asymmetry or computer generated custom facial implants. Custom implants are created from a model constructed using a 3-D CT scan. Implantech has this amazing technology and is very helpful when it comes to custom facial implants.

As for noses, the tip of the nose, even if crooked, often points down the center of the upper lip. Whatever trauma caused their nose to become that way created an impact in the center of the nose creating a “C” or “S” shape but the tip ends up down the center.

For crooked noses, that is one of the reasons why I might choose to use an open approach for rhinoplasty instead of an intra-nasal, or closed, rhinoplasty. My preferences and indications for closed vs. open rhinoplasty was discussed in an earlier blog.

Facial asymmetry is more common than you think. Facial analysis and treatment with the advent of computer and 3-D imaging is a great tool to both point this out and plan treatment. Steven J. Pearlman, MD, FACS

Skin care, Botox, Facial Plastic Surgery in New York

Whats your New Years’ Resolution? Love Your Face

It’s the New Year and we are all filled with resolutions about how we will eat better, drink more fluids, exercise and take better care of our bodies. Unfortunately, even if that takes place, nothing will firm up your face or prevent the effects of gravity. Of course using sunblock daily, eating well and avoiding smoking will help but nothing can reverse facial aging. As I tell my patients, gravity sucks.

The face ages in 5 ways, we each go through it. Treatment choices depend on your priorities, tolerance and financial means.                           

Facial Aging Treatment
  • Skin changes: red and brown spots, wrinkles
  • Lasers, peels, skin care
  • Loss of volume
  • Fillers
  • Dynamic lines
  • Relax muscles: Botox, Dysport
  • Loss of Elasticity
  • Surgery
  • Gravity
  • Surgery

You can start small with good home skin care and light office peels. My patients love the myBody myPROBIOTIC PEELTM peel that our office nurse Christine Ross does.

If you “Like” my page on Facebook you may qualify to win a complementary peel.

Other minimally invasive treatments that can be done right in the office chair are fillers and Botox or Dysport. In 20 minutes you can knock off three of the 5 causes of aging. There is really no such thing as a “non-surgical” facelift but many patients can look great with peels Botox and fillers.

Surgery is the next step and can be read about on my website. 

Tip of the week: Exercise, hydration and good nutrition can make your body look younger but doesn’t help your face.

Facial Plastic Surgery and Fillers in New York

Celebrities and Photoshop, is this the norm for magazines?

I am often asked by patients about celebrities and two extremes of results. First, why do they look so good? The second question is why do they look so bad? Don’t they have good plastic surgeons in Hollywood? These questions and comments are a result of the many celebrity focused magazines and TV shows.

From NY Times article

Last week I was sent supposed “before and after” photos of a third-tier celebrity to comment on what she had done; facial plastic surgery or other minimally invasive procedure such as Botox and/or Fillers. The problem was that the “after” photo was so photoshopped that it was a joke. I declined to comment replying to the inquiry, that with the amount of “work” that was done to the photo it could easily be Zsa Zsa Gabor at her current age instead of the forty-something reality TV star.

 The N Y Times had an article on that very same topic this week. One former talent agent along with a Dartmouth University computer science forensics expert discussed Photoshop changes on celebrity magazine photos. In a scholarly paper for the prestigious Proceedings of the National Academy of Science, Prof. Farid suggested a software tool for measuring how much a beauty photo has been altered. With this new tool and more “truth in advertising” the consumer would better be able to see what models and celebrities really look like. This could also reduce the often extremely high expectations of individuals seeking cosmetic surgery.

 The AMA actually has a policy on truth in advertising. Cosmetic surgeons are supposed to identify when a website or an advertisement has a model and not a real patient of theirs. Of course, before and after photos should always be un-retouched. Lastly, plastic surgeons should identify if the photos on their websites are actually theirs or generic. All before and after photos on my website are actual patients that have given us written consent for use of their photos.

 As for the “bad” side of celebrity cosmetic surgery; this is a topic for another blog. I have addressed fillers in past blogs. For some reason, if 1 cc of filler is good for a lay person’s lips or cheeks, for some reason in Hollywood they think 3+ syringes is better.

Celebrities often look better in magazines as a result of Photoshop. Plastic Surgeons cannot do this, so why can the media? Steven J. Pearlman, MD, FACS

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