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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.

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, 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.

Facelifts in NYC

Facelifts, what works best: more highlights from the Multi-Speciality Foundation for Facial Plastic Surgery 6th Annual Meeting

New York, NY, There were so many world authorities at this meeting that my head was spinning. One of the more interesting panels and set of presentations was on facelift surgery. Just when you think that most people agree on something there is a panel of recognized experts with a vast array of differing opinions on facelifts. The most senior was Dr. Bruce Connell, who taught or at least influenced many of the most accomplished facelift surgeons and teachers with his bi-plane, bi-directional  extended SMAS facelift. He was supported by one of his former students and now a superior teacher in his own right, Dr. Timothy Marten. Other facelift ideas were presented by the inventor of the MACS facelift, Dr. Patrick Tonnard from Belgium, Dr. William Little with totally new ideas on vertical SMAS lifting and Dr. Gaylon McCullough with an excellent perspective from his many years performing and teaching facial plastic surgery.  The outstanding statement of the meeting came from Dr. Little; when asked about his SMAS technique as a departure from the rest, he prefaced his answer by stating that he needed to watch what he said since he shared the podium with the “SMAS mafia.”

What did I take from this panel? There are many ways to perform a facelift. Most agreed that the SMAS needs to be addressed in all patients. For most, the more aggressive surgeons get with the SMAS, such as deeper plane facelifts may last longer but are technically more difficult to perform. Facelifts also need to be individualized.

As with noses, there isn’t one facelift operation that fits all. A simple short scar facelift with a few sutures in the SMAS may be easy, fast and can be done under local anesthesia and even mass marketed by national companies under catchy names, but doesn’t last for patients with more advanced facial sagging. I find myself in discussions with other plastic and facial plastic surgeons, who state, “Wow, you really do a deep plane facelift?” It takes longer and patient recovery is longer but the results are superior and the results last longer

In summary: there are a number of ways to perform a facelift. A more comprehensive the procedure such as the deep plane facelift may take longer to perform and take longer to heal from, but the results last longer. Steven J. Pearlman, M.D.,F.A.C.S.

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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