September 29th, 2009
Some of the simplest things that we surgeons take for granted can be of utmost importance to patents. Just this week I saw a model/actress in follow-up. She cut her lips last year in Paris in a motorbike accident, and had her lip stitched up in an emergency room. Unfortunately, a thick scar formed and she had been unable to work since. Six weeks ago, I performed upper and lower lip scar revision. She is back to work and just booked a national TV commercial for the upcoming holiday season (HIPPA privacy prevents me from revealing more details).
The principles of scar revision have to do with what makes a scar visible and how to better hide the mark. The least visible are usually the ones that come from our own planned incisions for facial surgery, either cosmetic, for facial reconstruction or to fix facial fractures. Many of these approaches were pioneered by Dr. Tessier in his quest for the least visible scars when reconstructing children with inborn facial defects.
In order of preference:
- The best place to make an incision is inside an orifice such as the mouth, nose, etc.
- Next is at the junction of two structures such as the hairline or ear and cheek
- Third is to use what are called minimal skin tension lines, MSTL, where I have patients smile and grimace. The lines that form in the skin are perpendicular to the underlying muscles, and future scars will have the least amount of tension on them. As we get older these lines are visible at rest and called resting skin tension lines, RSTL.
- Undermine (lift up under the skin) to eliminate tension on closures.
As for traumatic scars, what makes them visible? Scars contract and may widen as they heal. Also long scars that “go against the grain” or RSTL of the face are more visible. Thirdly are pigment changes (red and and brown).
Facial lacerations should be sutured by a facial plastic surgeon or plastic surgeon since our training focuses strongly on skin healing and cosmesis. When an incision or scar is closed, the skin should be undermined to reduce tension. Tension pulls on scars as we move around. This is why scars on the body, arms and legs tend to widen. On the face they should be tension free. The skin is then closed in layers with the edges slightly everted (turned out) so as it heals the scar flattens, since scars contract. Color differences can also be reduced with lasers.
Posted in Home, scar revision | No Comments »
September 21st, 2009
I trained as a surgeon with the top experts in the field during my residency and fellowship and even today to enhance my practice offerings. Yet, I find myself writing more and more these days. I just completed updating the content on my website at http://www.mdface.com/ and am in the process of creating a new website that will be devoted entirely to the topic of revision rhinoplasty. I have vowed to update my blogs regularly to provide helpful and interesting information to my patients, and have become an active medical expert on http://www.realself.com/ to answer consumers’ questions about facial plastic surgery procedures. These answers are also posted to my Twitter account, which you are invited to follow @DrPearlman. As for my offline activities, I teach facial plastic surgery to residents from Columbia University and have a post residency fellow currently in my practice. I also present regularly on facial plastic surgery, including primary and revision rhinoplasty at meetings held by the American Academy of Facial Plastic and Reconstructive Surgery.
I am a firm believer that teaching helps me reach more patients than I can actually touch. In fact, one of the oldest definitions of physician is teacher. Residents and fellows seek out information from many sources. In order to be a useful resource for residents and fellows, it is important that I stay ahead of the game in terms of patient education and advances in the field. Last, but certainly not least, I firmly believe it is my responsibility to educate consumers. We are in an era of information, sometimes more information that we know what to do with. Patients should be educated about treatment options available to them as well as detailed information about the procedure(s) they are interested in, including the expected results and recovery time, whether the procedure is surgical or applied. An informed patient is the best kind of patient. If you have any questions related to this blog or would like to make a comment, I welcome you to do so.
Posted in Facial Plastic Surgery, Home | No Comments »
September 14th, 2009
We are preparing for office re-accreditation. One of the most important things we do to earn your trust is to participate in the quality assessment program of the Accreditation Association for Ambulatory Health Care (AAAHC). This is to assure you that our surgical suite complies with all national and regional regulations regarding patient safety. Accreditation means that surgery in our office is as safe and sterile as if it is to be performed in a hospital. An added twist this year is that as of July 2009, New York State requires accreditation for any facility where surgery is performed under sedation to be accredited. We have been far ahead of that trend and long ago recognized the importance of this milestone on behalf of our patients. Our office and operating room is being inspected next week for our third consecutive three-year accreditation. Assuming we pass, of which there is little doubt, it officially recognizes us for delivering excellent health care services to our patients. AAAHC is one of three national organizations recognized to provide certification. The AAAHC only accredits facilities that are committed to providing high-quality medical care and services. It is our way of demonstrating our commitment to providing the best care possible.
I would like to publically thank my staff in advance, especially Christina McRoberts, R.N., for all their hard work in making this happen. You can’t imagine the stacks of papers and requirements necessary for our upcoming review. However, when it comes to our patients, assuring the utmost for their safety is most important.
Posted in Home | 1 Comment »
September 9th, 2009
Our new website has been upgraded to not only look more attractive and inviting, but the navigation has been improved per your requests. We’ve added more actual patient before and after photos. More importantly, the design highlights what we do best: We empower beautyTM. To make it easier for our patients, we now have a concierge section to ease travel for our out-of-town patients. You can even download patient registration forms to make your initial visit an even more relaxed, organized and smooth experience.
Posted in Home | 1 Comment »
