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

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Plastic surgery – reconstructs your self-esteem, too.

ultherapy1A rhinoplasty can do more than rebuild your nose – it can build confidence, too.

Looking good is something that everyone wants and there is nothing wrong with that. If a little bit of plastic surgery is going to give you the confidence that you need to take that extra leap, either professionally or socially, then cosmetic plastic surgery is something you shouldn’t feel ashamed to consider.

This is especially true if there is something about your appearance that makes you want to hide or keeps you from exploring new opportunities due to fear and anxiety.

This isn’t only for cosmetic procedures like nosejobs, accident victims also fall into this category and tend to be great candidates for reconstructive  facial plastic surgery.  This may affect your social life, love life, or even your willingness to take professional risks like public speaking or leadership positions.  While your surgeon will recommend that you receive mental health care to deal with any emotional or psychological trauma you suffered during your accident, he will be able to assist you with the physical trauma and scars to help you along as well.

It’s important to note that facial plastic surgery is a major operation, so choose your surgeon wisely.   An unskilled doctor could, instead of raising your self esteem, botch a procedure and leave you worse off than when you started. In fact, many skilled plastic surgeons who are very talented in body plastic surgery procedures do not achieve the same results a facial plastic surgeon can for facial cosmetic surgery procedures as they do not specialize. Also, make sure you ask you friends and family for references and then do a check with the national medical association on your doctor. Ask your doctor to see before and after pictures of other patients they have worked on. This will give you the courage to go ahead with your plastic surgery.

Plastic surgery can take years off of your face & neck. Live like a celebrity, and treat yourself to a more attractive you.

Call for a consultation today: (212) 380-1541

Rhinoplasty Teacher from New York

Lecturing at an International Rhinoplasty course in Milan, Italy. Spring 2011

I had the privilege to be invited to speak at the 6th Biennial Milan Masterclass in Rhinoplasty. This was a course directed by my friend and master Rhinoplasty teacher Prof. Pietro Palma from Milan. There were over 700 attendees from 58 countries in attendance. Faculty was from around the world as well. My biggest criticism of the course was that the content was so good that I found it difficult to skip out to see Milan. Fortunately we arrived a few days early and left 2 days after the completion of the meeting so we had a chance to see Milan. Pictured is a home my wife and I encountered when walking around Milan. These beautiful statues represent exactly what I believe is the foundation of rhinoplasty: pursuit of beauty and preservation of architecture. I gave lectures on revision rhinoplasty, brand identity and presented a video on the use of spreader grafts in rhinoplasty.

 When giving my first lecture, I was excited to look down and see Prof. Rudolph Meyer. He is a master rhinoplasty surgeon and teacher, who had written a number of texts on rhinoplasty and countless articles. Prof. Meyer is close to 90 years old and was still the most attentive individual in the room. In the photo below, he is giving a speech at the reception dinner and is surrounded by course directors Professors Castelnuovo and Palma from Italy and visiting Prof. Gilbert Nolste-Trenite from Holland.

We rounded out our trip with a one day visit to Venice. I truly enjoy speaking around the world; it always gives me a new perspective from international faculty and the chance to both share and learn from them, plus a great excuse to travel.

International travel to medical meetings not only is a chance to visit new places but exchange knowledge with experts from around the world.

Rhinoplasty and Facial Fillers in New York

What I learned at the Annual AAFPRS (American Academy of Facial Plastic and Reconstrutive Surgery) meeting last month

First and foremost, it’s nice to see that most of what the “experts” are teaching isn’t much different than what I am already doing in my practice. There were two rhinoplasty seminars with excellent talks by Drs. Bahman Guyron, Dean Toriumi, Ira Papel, Pietro Palma, Jack Gunter, Norman Pastorek and Peter Adamson to name a few. A few of the take-home messages that I got were tips on reducing pain for the patient in rib cartilage harvesting and techniques for straightening out a crooked nose, which is the most difficult skill for perfecting a rhinoplasty.

Facial fillers have always been a hot topic at recent meetings and still were in Boston. Of course, everyone has their favorite fillers. The fillers change with the volume and applications. For smaller volumes, hyaluronic acid fillers such as Juvederm and Restylane still rule. For fine lines, Prevelle Silk. As we get to larger volumes, Radisse takes over and for the most volume and longest lasting results, Sculptra is likely best. Dr. Rebecca Fitzgerald gave a 1 hour breakfast seminar on Sculptra that actually lasted for two hours. Sculptra is now injected deeper under the facial tissues, just on top of the bones in most areas of the face.

What new products did I discover? Finally PDS foil is FDA approved for use. This has been used very successfully for years in Europe for nasal support in very crooked deviated septum repairs, revision rhinoplasty and other areas of the nose as well. I was invited to attend a special meeting in St. Louis in early November to learn the nuances of this new product. I was fortunate to have received a sample, which I used to help repair a much deviated septum. This particular patient had two prior attempts at correction, but the nose was still very crooked. I will discuss this procedure next week.

As much as I have learned in my past 22 years of medical practice and teaching Facial Plastic Surgery, it’s still important to keep on learning and modifying my patient care techniques.

Rhinoplasty FAQ’s in New York

There are a lot of misconceptions about rhinoplasty that I will soon be addressing in a section in my website under FAQ’s. Below are two of the more common question asked during a rhinoplasty consultation.

New York, N. Y.

1. Doctor, do you have to “break” my nose? The technical term for this is osteotomy.

In most cases, yes. Osteotomies are necessary in the majority of rhinoplasties. They do not make the nose less stable nor do they make the results less predictable, they actually improve the results in rhinoplasty. This takes about 2 minutes in a two hour operation.

The reasons why I perform osteotomies are two-fold. First, when a hump is removed from the nose it’s like slicing off the top of a pyramid. That leaves a gap called an open roof. If the side walls aren’t closed down then the upper part of the nose has a flat-top and may even look like railroad tracks. I sometimes see this in patients seeking revision rhinoplasty. Secondly, osteotomies are performed to narrow a wide nasal bridge.

The only difference is that the black and blue around the eyes may last a few days longer to get a better looking nose for the rest of your life. Sometimes patients have seen other surgeons who promise that they don’t “need” to break the nose. Maybe they use a euphemism such as “micro-osteotomies” which is really the same thing. What you see on TV is usually dramatized and not as violent as it really is. Using very sharp osteotomies makes a clean cut with little trauma, just like having quality carving knives in the kitchen; there is less tearing and damage to the surrounding tissue.

2. Doctor, can you just remove the “bump?”

Sometimes just the bump can be removed without touching the rest of the nose. However, most of the time even large noses are in balance. That means the nasal tip is usually a little large as well. Removing a hump without narrowing the nasal tip will make the nose look out of balance and un-natural, exaggerating the size of the tip. Another scenario is when there is a mildly drooping tip as well; again, a larger but balanced nose. Removing a bump alone will make the nose appear longer. The bump breaks up the profile. Raising the tip will restore a normal appearing nose.

This is one of the best reasons for using computer imaging for rhinoplasty. I can demonstrate to patients the potential changes from just removing a bump vs. minor reduction of the entire nose to maintain, even improve balance. Most of the time, more natural results can be achieved when the entire nose is addressed. Even if it means a millimeter off here and two millimeters off there, such small changes in multiple areas will yield more beautiful noses.

In summary,  “breaking” the nose in rhinoplasty yields superior results in most cases. Bumps alone can be removed, but more beautiful noses are created when the entire nose is addressed.  Steven J. Pearlman, M.D., F.A.C.S.

Teaching Facial Plastic Surgery in New York

New York, NY

I got a taste for teaching facial plastic surgery going back to my residency where I presented at a national meeting in front of hundreds of practicing physicians. One year and two other journal publications later, I was asked by my facial plastic surgery fellowship preceptor and mentor Dr. William Friedman to co-author two chapters for an upcoming textbook in facial plastic surgery.

  1. Friedman W.H. and Pearlman S.J., Preoperative Evaluation and Patient Selection for Blepharoplasty. Aesthetic Facial Surgery, Krause, C.J. ed. J.B. Lippincott Company. Philadelphia 1991.
  2. Preoperative Evaluation and Patient Selection for Rhinoplasty. Aesthetic Facial Surgery, Krause, C.J. ed. J.B. Lippincott Company. Philadelphia 1991.

I recall a lot of pressure to write something that was befitting sharing authorship with such a respected physician plus the knowledge that it will likely be read by thousands of peers. As a fellow, I rounded daily in the hospital with residents from Columbia Presbyterian Hospital. Thus began my academic career. Teaching is a big responsibility. It requires me to be on top of my game at all times. At rounds, answers to residents’ questions need to be precise and accurate. Teaching in the operating room requires comprehensive understanding of the procedure, background, reasons for all maneuvers and discussion of potential complications (and how to avoid them, of course).

Over the past 22 years in practice, I have authored over two dozen articles in peer reviewed journals (the most recent on revision rhinoplasty) and textbook chapters (the most recent on Endoscopic Browlift) and have given hundreds of lectures on various topics in facial plastic surgery. I now teach my own fellows as well as residents. Currently I have a fellow, Dr. Jason Moche, who is about to graduate. We are working on a combined project looking at revision rhinoplasty. I also have two ongoing research projects with residents on rhinoplasty techniques. So, if you want to find a surgeon who is on their toes and knows the latest about their specialty, look for those who teach.

Septoplasty New York

Septoplasty – Deviated Septum Part I

New York, NY

What exactly is a deviated septum? How do I know if I have one? How did it happen? Will it change the way my nose looks if I have my deviated septum fixed, even if I don’t want to? Maybe I have one and no one knows? Will it get me a “free” or discounted nosejob?

These are just a few of the many questions patients and non-patients alike have when it comes to the elusive deviated septum. I will attempt to answer the above questions and more. My answers just kept on going and going so I am going to divide this into two parts.

The definition of a septum is a dividing wall. The nasal septum divides the two sides of the nose. The front 2/3 is made of cartilage and the back portion derived from two different thin bones. The septum sits in a groove of the bone that is above the palate of the mouth. When any or all portions of this structure are crooked, it is a deviated septum. We usually don’t even know when it became crooked. Maybe from falling on your face as a child, during sports or maybe even while you were being born; unless you can pinpoint a specific episode when you got hit in the nose followed by bleeding and a subsequently reduced airway.

Many people have crooked nasal septums and don’t know it. If there is no blockage of breathing or exacerbation of sinus and allergies then there is no need to worry or ever treat it. Many people have asymptomatic mildly deviated septums. The most common problem a deviated septum can cause is nasal blockage. If one side of your nose tends to be more blocked than the other, it is a high probability that you have a deviated septum. Other structures in the nose that can also contribute to blockage are called turbinates. These are curly bones that are covered with skin (mucosa) and tissue that swell with blood to warm and humidify the air we breathe. By the time air gets to your lungs it is 98% humidity and body temperature; most of this occurs in the nose. The turbinates work by swelling alternately, one side than the other. So, if one side is blocked then it alternates but you get good air through both together there really is no problem, just a normal nasal cycle. This cycle is even more evident at night, the “downhill” nostril swells. This is obvious when you turn over and the open nostril switches sides. If one side is almost always blocked, that means there is a fixed obstruction; a deviated septum or other abnormal structure such as a nasal polyp. Allergies, colds and other conditions that cause the inside of the nose to swell will also cause obstruction. This obstruction can be worse if there is also a deviated septum.  A deviated septum is diagnosed by a careful examination of the inside of the nose. Sometimes a CT scan helps delineate the back of the septum and can demonstrate possible associated sinusitis. Deviated septums can even be a cause of chronic headaches.

Sometimes a deviated septum may be asymptomatic. However a mild deviation can become a problem if the nose is made narrower in cosmetic rhinoplasty. This is why every rhinoplasty candidate should have the inside of their nose examined. If you see a doctor for a rhinoplasty and they don’t look inside your nose, it can lead to breathing difficulties after. Cosmetic rhinoplasty should go hand in hand with functional nasal surgery. It might not be necessary to address the septum, but it is important to make sure that it is not crooked; otherwise rhinoplasty may cause breathing difficulties. It amazes me that when I see patients for revision rhinoplasty with breathing issues how often they report that their prior surgeon never even looked inside their nose!

Steven J. Pearlman, MD, FACS

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