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Considering a Nose Job? Ask yourself these 5 key questions

Rhinoplasty, better known as a “nose job”, is performed to alter the size and/or shape of the nose and is one of the most commonly performed types of plastic surgery. An estimated 77,000 people got rhinoplasty in 2010; while some simply didn’t like the noses they were born with, others needed corrections to previous surgeries or accidents that damaged their noses.

Before opting for any kind of cosmetic surgery, there are some key questions you should ask yourself before going under the knife.

Am I healthy enough to get plastic surgery?

Cosmetic surgery has its risks just like any other type of surgical procedure. The risks are even greater in people who have preexisting health conditions. That is why it is wise to take your health into consideration before getting any type of cosmetic procedure. Your plastic surgeon may require that you receive clearance from your physician.

Have I considered the alternatives?

There are a number of ways you can improve their appearance without getting rhinoplasty. Trying a new hairstyle or wearing makeup are two of the many ways to improve your looks without going under the knife. Makeup tricks can also change how your nose appears, and some cosmetic injectable fillers can alter the appearance of your nose temporarily without invasive surgery.

Am I doing this for myself or to please others?

Far too many women get cosmetic surgery to conform to society’s standard of beauty or to impress someone else. While a nose job, or any cosmetic surgery, can improve your appearance and life, it’s important to do it for the right reasons. Do it for yourself, not someone else.

Can I afford this procedure?

Nose jobs can cost thousands of dollars, depending on the surgeon and the complexity of the procedure. Because most nose jobs are elective, they aren’t covered by insurance. While you may be able to setup a payment plan with your surgeon’s office, you may be expected to pay a significant amount up front. Note that many med spas and clinics accept credit cards, so that’s always an option as well.

Can I afford to take time out of work and school?

In the end, it’s worth it, but in the meantime, you will be sore after your nose job. Patients are expected to stay home for at least a week after surgery and are advised to avoid strenuous activity. Make sure you can afford to miss work or school during this time period and that you have help with daily tasks, such as child care and household chores.

Once all the above answers are “yes” make sure you choose a doctor who specializes in rhinoplasty. Ask your doctor of choice, how many they perform per year, look at their before and after photos and consider computer imaging to make sure you are both on the same page.


Copyright 2012. As licensed to Pearlman Aesthetic Surgery. All rights reserved

Teaching Facial Plastic Surgery

Dr. Pearlman, course director for the AAFPRS

Two weeks ago was the 46th Annual Fall Meeting of the American Academy of Facial Plastic and Reconstructive Surgery. As co-director with Dr. Rick Davis from Miami, Florida, we spent countless hours over the past year working hard to make this meeting a success. From the feedback we received, it certainly was. There were approximately 85 hour-long courses, 9 invited lectures, 10 panels, 7 half day workshops, over 100 vendors, plus a number of special luncheon sessions. By meeting time, all of the hard work was done. We spent most of the meeting just making sure things ran smoothly and that all speakers and panels stayed on time and on topic. 

The most outstanding part was the speakers that we invited. We kicked off with Dr. Timothy Marten from San Francisco, an excellent lecturer on facelift surgery. Dr. Val Lambros presented his unique ideas on facial aging, based on years of studying individuals and how they age and comparing generations within the same family. Prof. Wolfgang Gubish from Stuttgart, Germany, a prolific rhinoplasty surgeon, gave a few outstanding lectures on treating very crooked and devastated noses; a topic on which he is world renown. Dr. Raj Kanodia lectured on his personal technique of subtle rhinoplasty and minimally invasive facial rejuvenation. Dr. Fred Menick demonstrated why he is one of the recognized experts in nasal reconstruction following cancer removal. Dr. Jeffrey Spiegel gave us new insights into beauty with a lecture on facial gender transformation surgery. Three endowed lectures were also given. Dr. Fred Stucker spoke on over four decades of performing rhinoplasty. Dr. Mohit Bhandari discussed the ever growing field of Evidence-Based Medicine. Dr. Richard Linnehan gave an inspiring presentation having flown four Space Shuttle missions. 

Overall, running this meeting was a busy but very rewarding experience. Having been involved in academic medicine for 24 years, I am able to fulfill one of the original definitions of doctor: to teach others.

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

Revision Rhinoplasty and Septoplasty in New York

The new Flexible PDS Plate is a great tool for difficult revision rhinoplasty, septoplasty and even for children with smashed noses

In November, I blogged about my initial experience with the newly approved flexible PDS plate for a difficult revision nasal septoplasty. That patient is now three months post op and doing very well. He is breathing much better after I performed his third (my first for him) septoplasty.

Last month I operated on the 6 year old I talked about in that blog; I will call him “N.” N is a cute, energetic little boy who just can’t stop smiling. He smashed his nose at Yankee stadium last summer. He had severe swelling inside his nose that looked like a hematoma. Nasal septal hematoma is one of the very few emergencies you can have that accompanies a broken nose. Blood collects and swells the inside of the nose. If the blood is not removed quickly, the nose can collapse. So, a colleague brought N to the operating room under the assumption N had a hematoma. What the surgeon found was that the cartilage was so damaged that it was zigzag with portions lying horizontally instead of vertically, mimicking a hematoma. However, due to severe alteration of his nasal septum his nose collapsed anyway, despite the rapid care he received. This doctor subsequently referred N to me for revision surgery.

After allowing the nasal cartilage to heal, I operated on N in early December. Externally his nose had collapsed and what we call a “saddle” nose. This may be subtle I the photos but would get exaggerated as he grows. When I opened up his nose, I found pieces of septal cartilage pointing in every direction and parts overlapping. I used the flexible PDS plate to rebuild his nasal septum and restore a natural nasal profile. That was accomplished by actually removing the entire nasal septum and rebuilding it on a back table using the flexible PDS plate as a template hold the fragments straight. Because the cartilage was partially destroyed, I also used some cartilage from the flat part of his ear (so it would not show any deformity whatsoever after healing) to fill in missing pieces.

The new septum was stitched back into place and the remaining middle third cartilage (called the upper laterals) and the tip cartilages were elevated and sewn to the newly repaired septum at the restored height. This has been commonly used by rhinoplasty specialists in Europe for many years but is still very new in the U.S. since flexible PDS plate use was only FDA approved in September 2010.

N is doing extremely well. He and his parents report much better breathing and he is no longer snoring at night. N also says that he can smell everything better.

I feel strongly that the new Flexible PDS Plate is an excellent tool that will improve results in difficult revision rhinoplasty and septoplasty and for correcting very crooked noses, even for pediatric cases.

Revision rhinoplasty and Revision septoplasty innovations with a PDS Plate

PDS Plates, the latest and greatest in revision rhinoplasty and septoplasty.

Two weeks ago I was lucky to get a sample of the new PDS plate to use in a tertiary revision septoplasty case. The PDS plate is made of the same material that is used in my favorite suture material for sewing cartilage in rhinoplasty. PDS suture material lasts around three months, long enough for healing and long lasting cartilage bonding to take place but not so long that the body rejects it and tries to “spit” it out. The PDS plate has been around in Europe for a number of years. European colleagues have talked about it in their lectures and published on it in 2005: Dr. Wolfgang Gubisch, Archives of Facial Plastic Surgery vol 7, July/Aug 2005 and Boenisch and Trenite also in Archives of Facial Plastic Surgery vol 13 Jan/Feb 2010.

Finally us of the PDS plate for nasal surgery was FDA approved for use in US early this fall. The parent company, Mentor, was well represented at the AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) meeting in Boston with very informed vendors and an armful of papers documenting the advantages of using PDS plates.

After all that fanfare, I had the ideal case 2 weeks following the meeting (2 weeks ago); a gentleman who had two prior deviated septum operations with persistent nasal septal deviation and nasal obstruction. What he needed was to have the septum taken completely apart and have something like this plate to hold the healing cartilages pieces in place as the septum heals straight. After all this buildup, I was told that they were back ordered and the product wouldn’t be available for many weeks. Well, it pays to have a good relationship with a superb rep. She was able to procure a plate for me in time to use for the surgery and I really think it will help get a superior result.

This weekend, I am an invited guest to go to St. Louis to hear lectures by the doctors who invented and perfected the use of the PDS plate as well as a lab demonstrating the many ways they suggest it can be used. Fortunately for me and my patient, I had a jump start on the process.

By the way, I already have my next case in mind. This is a 6 year old boy who smashed his nose last summer and had a failed attempt at fixing his destroyed septum. His nose is also collapsed. I believe the PDS plate will help restore a straighter septum nasal height with less surgery than he would otherwise require without it.

I really feel that the new PDS plate is an excellent new product that will help enhance the results in revision rhinoplasty and revision septoplasty.

Rhinoplasty, Revision Rhinoplasty and teaching Facial Plastic Surgery

It’s been a few weeks since my last post. I have been quite busy, academically. I was lecturing in a course on Rhinoplasty in mid-September in St. Louis. The following week was the AAFPRS annual meeting followed by lecturing last week at the ENT (Ear Nose and Throat) annual meeting.

The week before last was the annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Over 800 facial plastic surgeons from around the world were in attendance. I really enjoy going to this meeting for three reasons:

  1. From attending and lecturing at 4 to 6 meetings and courses per year, I have made some great friends given our mutual interests and backgrounds.
  1. I get to lecture to peers and young physicians on surgical techniques that I have mastered such as rhinoplasty and revision rhinoplasty.
  2. I learn from my peers. If I pick up at least two pointers at a meeting, I deem it a success. The most learning is done in the hallways between lectures, when I can get the real scoop on the latest techniques and lasers right from the innovators.


As for social events, the past president’s dinner is always at a top restaurant. This is one group that no one can join, buy in or donate to attend. As a past president of the AAFPRS we are invited to a black tie dinner where we socialize and really discuss very little medicine. The next night was another black tie function, the founders club. This is always held at an unusual venue. This year it was in Fenway Park, a fun place to visit as a long time Yankee fan.

I gave three lectures and seminars. I taught a course in revision rhinoplasty. I pointed out the most common things I see that brings patients in to see me for revision surgery and discussed what likely went wrong. The best treatment is doing things right in the first place and avoiding the need for revision surgery. I also included a description of how I restored these noses to a normal appearance and function.

My second lecture was given with Wendy Lewis, who is a world authority on plastic surgery. She lectures to physicians around the world, advises potential patients about what and who is best for them to see. Wendy has written 11 books on cosmetic surgery. This seminar was on how to talk to patients and media in “non-medical” speak. Too many doctors address patients and writers/reporters in technical terms that leave heads spinning.

My third lecture was at the ENT (otolaryngology) meeting the following week. I went back to Boston for the day to teach a course on the nasal valve with Dr. Maurice Khosh. We discussed this important area of nasal anatomy and physiology, and how it is important to respect as well as sometimes strengthen the nasal valves in rhinoplasty.

Next week I will review what new educational pearls I picked up that I am going to use to improve my surgical techniques.

Rhinoplasty and revision rhinoplasty lectures at the Multispeciality Foundation

Multispeciality Foundation for Facial Plastic Surgery 6th annual Updates Meeting July 2010

New York, NY. I had the privilege of attending, lecturing at and moderating the afternoon session on Rhinoplasty at the 6th annual meeting of the Multi-Specialty Foundation on Facial Rejuvenation in Las Vegas last month. This meeting was organized by Drs. Randy Waldman and Eddie Cortez with over 800 cosmetic surgeons in attendance. The first day was devoted to advanced techniques in rhinoplasty. Many of the most well respected teachers of rhinoplasty were on the program from around the country as well as Europe and Asia. It is humbling to see these experts demonstrate nuances they have picked up and wish to share with colleagues. Given the opportunity to sit on a panel with these surgeons as well as discuss techniques off the podium, in the halls, at dinner and on the run is always enlightening.

I presented two lectures. The first was entitled, “What Makes a Nose Look Fixed,” where I explored the main reasons patients come in for a consultation feeling that their noses appear “done” or look as if they had a nose job. In this lecture I explained how and why this happens, tips on how to avoid it in the first place and how I fix these specific issues.

My second lecture was a summary of a study I conducted last year and soon to publish in the Archives of Facial Plastic Surgery. I surveyed 100 consecutive patients seen in consultation for revision rhinoplasty and reported the top concerns they had and the reasons they sought revision surgery. This was a unique study since it was looking at revision rhinoplasty from a fresh perspective: the patient’s point of view.

Some new principles that I picked up at this meeting are, first, that I am doing things right. I acquired a few tips on the best way to use sutures to either curve or straighten cartilage. Also, that the European surgeons tend to like larger noses than their American counterparts.

Among the seasoned experts were Drs. William Silver, Ronald Gruber, Robert Simons, Russell Kridel, Shan Baker and Gaylon McCollough. My peers and colleagues included Drs. Jonathan Sykes, Steven Dayan, Paul Nassif, Rick Davis, Phil Miller, Fred Fedok, Minas Constantinides and Jay Calvert. From Europe and Asia, there were the following leading authorities: Drs. Wolfgang Gubish, Patrick Tonnard, Pietro Palma and Woffles Wu.

In summary, rhinoplasty is a complex procedure. Even the most accomplished nose surgeons still exchange ideas and learn new techniques from their colleagues. Steven J. Pearlman, M.D., F.A.C.S.

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