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

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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.

Conclusion
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

Facelift or Facial Fillers in NYC

To lift or fill the face?

I recently saw a patient who came in because I did a facelift on one of her childhood friends and she liked what she saw: a more youthful look without looking “pulled.” She had a facelift about 7 years ago and feels that it helped a little but the skin of her lower face is “wrinkley” with some excess skin under the neck and cheek folds. She sought out a few opinions of other doctors and the suggestions ranged from fillers to implants to a revision facelift. My first inclination was to suggest another facelift. This would help the jowls and extra skin under her neck. What concerned me is that when listening to this lady, she was more distressed about the way the skin hung around her mouth and narrowing of her cheeks. As a surgeon, facelifts are more interesting and fun for me to perform, plus this patient was basically asking if a revision facelift would be the best solution without specifically stating it. However, I felt that a facelift wouldn’t be the best initial solution for her concerns. I suggested that we first try Sculptra to restore volume to her face and fill out the deflated cheeks and areas around her mouth. A facelift can be performed later to lift the drooping facial skin and muscles.

This is really about deciding priorities. I categorize facial aging into 5 categories: skin changes, dynamic muscle action, loss of volume, gravity and loss of elasticity. Everyone experiences all 5 as they age. It’s more a matter of what should be addressed and in what order. For this patient, I feel it is volume first (high volume fillers with longevity – Sculptra) then combat gravity and loss of elasticity next (facelift). 

 The face ages in 5 ways: skin, muscle action, volume loss, gravity and loss of elasticity. When the question is to fill or lift the face, both the doctor and patient need to determine the best treatment plan per the patients priorities. Steven J. Pearlman, MD, FACS

Botox, Facial Fillers, Juvederm New York

Role reversal or just an early Mother’s Day?

New York, NY: A few weeks ago, I treated three Baby-boomer moms. What made that day unique was that each was brought in by their daughter for facial rejuvenation. One was the mother of a beautiful teen on whom I did a rhinoplasty and had a fabulous result. The second daughter had prior Botox and the third just found me through “sources” and dragged her mother in for a fix-me-up. Each of these mothers are vibrant ladies in their 50’s and were there for their daughters, now it was the daughters who were telling the moms what they needed.

Each mom had office facial rejuvenation with Botox, fillers and skin care. Botox was used to soften their frown lines, reduce crow’s feet, reduce downturned corners of the mouth; and in one mother smooth the forehead. By individualizing treatment and using only the necessary amount of Botox, each looked smoother yet retained facial expression.

Next, they had Juvederm to restore youthful cheeks. As we age, one of the first things to go is mid-face fat. Nasolabial folds aren’t so obvious in a young adult, but become much more visible when the mid-face gets hollow. When I used to just fill nasolabial folds, patients were happy but not ecstatic. Restoring youthful “apple” cheeks give what I call the “wow factor,” each looked in the mirror after only one cc per side (cheek, nasolabial fold and marionette line) and said exactly that: “wow, this is how I used to look” and could now compare themselves to their daughters. One of the mothers also had Restylane to her tear troughs to camouflage the appearance of lower eyelid bags.

Lastly, each was put on a skin care regimen designed for their face. The core for each of their product selections was TNS, a great skin rejuvenation product that I even use myself on a daily basis. So, mother’s watch out, your daughters are watching out for you too! Steven J. Pearlman, MD, FACS

Facelift vs Fillers New York

Non-surgical facelift, can you get away with it or do you need the real thing?

New York, N.Y.

There is much buzz in the media and on the internet about non-surgical or alternative less invasive procedures instead of facelifts. These treatments include fillers, neurotoxins (Botox and Dysport), and devices such as lasers and radiofrequency machines. Many of these procedures can help restore a more youthful look, but none really lifts the face. You can follow this link to my website for a more comprehensive discussion of the 5 ways the face ages: 

  1. Skin changes
  2. Dynamic lines from muscles underneath
  3. Loss of volume
  4. Effects of gravity
  5. Loss of tissue elasticity

To treat these aging causes, treatment needs to be targeted to the cause. Of course, most patients experience all 5 in some capacity. I then break down their priorities by need, time frame, importance to them, time off to heal and cost.

Targeted treatment for each or some combination is really what is best: 

  1. Skin changes             Lasers and peels for the skin
  2. Dynamic lines            Botox or Dysport to relax muscles
  3. Loss of volume          Facial Fillers (Juvederm, Restylane, Radiesse, Sculptra, Fat)
  4. Effects of gravity       Surgery
  5. Loss of elasticity        Surgery

Fillers, Botox and Lasers can go far to make someone look younger, but to lift a drooping jowl, treat a “turkey neck” or low brow, nothing works like a surgical facelift or browlift.

Don’t get me wrong, my new techniques in facial fillers are really getting beautiful results. Now that I target cheeks and the mid-face with fillers, entire faces light up. But this is not a lift. There is a doctor in New York advertising a “insert letter here” lift (I am leaving out the letter as not to offend); but all he is doing is placing many syringes of facial filler deep in the face and under the skin. It’s not a lift but volumizing the face.  Fillers are a good thing, but more is not better. Plump is good but so is lifting.

Lasers and RF machines don’t really lift the face either. Most reports have been disappointing and based more on subjective findings instead of objective long term results.

So, for comprehensive facial rejuvenation, all 5 areas of the face need to be examined and treated.

Steven Pearlman, MD, FACS

Treating Crows Feet NYC

Treating Crows feet and more with Botox

Treating crows feet comes with relative ease since the arrival of Botox

New York City, NY – One of the first areas to show the signs of aging is the crows feet area. These are the lines that are adjacent to one’s eyes. We all have some lines when we smile but and the lines remain when the smile is long gone, it may be time to do something about them. Maybe this is why oversized sunglasses are so popular; for the younger set sunglasses can help prevent lines and cover them in the older set.

Thank goodness we have Botox. Years ago, we used to inject collagen filler into these lines. Unfortunately, this skin is so thin and delicate, that no fillers are really useful and can leave behind both lumps and serious bruising. While many very popular creams and lasers are touted to remedy crow’s feet, if the cause isn’t addressed (overactive underlying muscle) all these treatments will be ineffective. Botox relaxes the thin circular muscle around the eye called the orbicularis oculi muscle. The skin is less compressed with smiling and squinting so most of the lines go away. However some lines will always remain. If you push your cheek up to simulate a smile, a few lines still form from the skin being bunched.

As an experienced Botox physician, we can extend treatment to adjacent areas. The tail of the brow can be raised in many patients creating a “Botox browlift.”

Browlift with Botox only

Browlift with Botox only

Deep lines under the eyes can also be treated… however they should be treated with caution. If a patient has a weak eyelid, the eyelids can become droopy. Also, the orbicularis muscle may be the only layer left holding back lower eyelid fat from pouching out. If you have early “eye-bags” then you might not be a candidate for treatment within this area of the eyelid. I caution all patients who are treated in this area of the eyelids and find that about 1 out of three do not repeat treatment under the eyes.

Some patients even have lines extending down their faces from and below the crow’s feet. Now that we are getting into the mid-face area, Micro-Botox is a better solution. Very tiny amounts are used to help the superficial lines but not change the smile.

Lastly, relaxing the muscle needs help with the overlying skin. Quality skin products such as TNS and rejuvenating eye creams work very well with Botox beneath. Many of the popular over the counter creams make amazing claims but produce little results.

Steven J. Pearlman, M.D., F.A.C.S.

Facial Fillers New York City

Facial Fillers – Juvederm, Perlane, Radiesse, Restylance and Sculptra

New and better ways to use facial fillers for facial folds and anti-aging

New York City, NY – As I perform more and more facial filler treatments, I am using less and less in the nasolabial folds and more in the mid-cheeks for a more youthful appearance.

Most patients seen in consultation for treatment with fillers point to their nasolabial lines and folds. The nasolabial folds are the lines and folds that go from next to the nostrils to the corners of the mouth. They are caused by the facial muscles inserting into the skin at that fold. Smiling, laughing, living creates the folds and etched lines in the overlying skin. Add this to sagging of the cheeks over this fixed line of attachment. The cheeks drape over the fold creating a mound that exaggerates the fold.

When patients with nasolabial folds are examined, most have both the fold and the mound. As explained above, the mound is partially draping of the skin and underlying fat/muscle over the fold. A third contribution is age related loss of volume in the mid-cheek.  If we just fill the nasolabial fold below, patients might appear almost like a rhesus monkey. What most patients really need is refilling of the mid-cheek area, and then only a little filler is necessary for the nasolabial fold. By re-inflating the cheeks, the nasolabial mound and fold are lifted up and out creating a natural, more youthful facial appearance.

If you want to simulate what this looks like, just smile. Mid-face fullness might be one of the reasons why people look better when they smile.

Which fillers do I use? For first timers and those who need a little filler, I prefer 1 to 2 cc of Juvederm Ultra Plus. A little more, Radiesse and for the most volume and longest lasting result, Sculptra.

Steven J. Pearlman, M.D., F.A.C.S; Facial Plastic Surgeon

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