November 30th, 2009 Dr. Pearlman
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
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.
November 18th, 2009 Dr. Pearlman
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
November 3rd, 2009 Dr. Pearlman
NEW YORK, NY - There is a steady stream of patients seeking revision rhinoplasty to fix a bad nose job, which is all too common. Primary rhinoplasty is often considered the most difficult procedure in cosmetic surgery. It seems simple, right? Just shave off a bump and reduce the tip a little. Not so fast. That is when an uninformed surgeon finds himself in trouble, as each and every nose is a little different. The nose has paired nasal bones, which make up only the upper third part. The middle portion has two cartilages called upper lateral cartilages that insert, not into, but beneath the nasal bones, plus the nasal septum in the middle dividing the two sides. Below that is the nasal tip. These paired horseshoe shaped cartilages may sit in a variety of positions and have different shapes as well as strength. The nose is a multi-faceted three dimensional structure that has many fixed parts as mentioned above, plus varying ligaments and muscles holding these parts together.
To make it even more confusing, modifying any individual part of the nose affects the nose in many ways. Reducing a hump not only accomplishes that, but the gap needs to be closed for an aesthetic result, so we do “osteotomies,” which means closing the open roof to pull in the upper lateral cartilages, which in turn narrows the middle vault as well. This may be a desirable additional change or may require something such as spreader grafts to prevent over-narrowing and an “inverted-V deformity.”
When I review the operative reports from prior surgeons, I often see techniques that a true rhinoplasty expert abandoned years ago. Surgeons need to keep abreast of the latest techniques. Unfortunately, some surgeons take that too seriously as well, and leave too much behind to avoid creating a “pinched” nose. Or, perhaps they learned at a meeting that you should put certain grafts into a nose so they put them in without forethought of what they are really trying to accomplish. If it sounds like I am confounding this issue, I am. The real students of rhinoplasty are the experts, who after 20 or more years in practice are still sitting in the front row of a meeting trying to learn even more from their peers. See some actual before and afters