February 24th, 2010 Dr. Pearlman
Septoplasty Part II
Fixing a Deviated Septum
New York, NY - Fixing a deviated septum is usually performed from inside the nose by a closed or endonasal approach. Crooked bone and cartilage is moved, removed and/or straightened. There should NOT be any changes to the way the nose looks or any “black and blue” whatsoever. As I tell my septoplasty patients, your mother couldn’t tell that you had surgery 3 days later. On the other hand, if you have a deviated septum it might be the ideal time to have a rhinoplasty if you have been thinking about it. Your surgeon will be operating in the neighborhood. Also, with modern rhinoplasty, often cartilage from the septum is used to strengthen the nose as we re-model it. Because of this, I suggest that if you are considering rhinoplasty and have a deviated septum, they should be performed at the same time. Other than the convenience of going through only one operation and one recover period, the fact that I often use cartilage from your septum to strengthen the nose during rhinoplasty is reason to do them together.
Please make sure that your surgeon looks inside your nose and checks for any causes of nasal obstruction; those that exist and those that may inadvertently occur during rhinoplasty. Based on Bernoulli’s Law of air flowing through a column, a minor asymptomatic deviation or other cause for obstruction can become more significant if the nose is narrowed. A rhinoplasty surgeon should be well versed in sinus surgery and all the associated consequences of functional nasal surgery.
A common misconception is that if you have or your doctor finds a deviated septum then you get a free or discounted nosejob. This might have been the case years ago. Insurance companies paid well and freely for nasal surgery. Doctors would call it a deviated septum and old nasal fracture or other creative names. Insurance companies got wise to this. Rhinoplasty is a cosmetic procedure and really isn’t the responsibility of your medical insurance company. Unless you broke your nose within the past year or so and have good documentation of a significant new deformity, don’t even think about it. There are some doctors who still add inappropriate codes to get higher reimbursement and others who will “throw in” a rhinoplasty if you have a deviated septum, but they aren’t necessarily the best surgeons. Be careful, you may get what you paid for: discount surgery.
There usually is some cost savings from doing a Septorhinoplasty together. Part of the operating room and anesthesia fees may be covered for the functional aspects of surgery. The functional portion of the Septorhinoplasty may also be covered by your medical insurance and may mean no or little additional cost beyond a cosmetic rhinoplasty for the functional (septoplasty) procedure. This depends on your insurance coverage.
This is the nose that you will have for the rest of your life. You want it done once and done right. You should find the best surgeon you can, one who specializes in noses and does what is necessary to get a great nose. Steven J. Pearlman, MD, FACS
February 16th, 2010 Dr. Pearlman
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
February 11th, 2010 Dr. Pearlman
Topical vitamins, health and anti-aging for skin care and facial aging
New York, NY - If you told me as recently as 2 months ago that I would be blogging based on a question from my Facebook Fan page, I would have thought both you and I were crazy. Well, here it is; I had an inquiry from Pauline, a lovely lady from Charlottesville, VA about vitamins and skin tightening. This came as a response to an article in Natural Health Magazine February 2010, where I was quoted on the benefits of topical vitamins for skin rejuvenation.
We have long known about the beneficial effects of various vitamins on anti-aging. The most well documented is Retin-A, a vitamin A derivative. Technically, Retin-A is only FDA approved for the treatment for acne. However, people have been using this for decades for more youthful appearing skin and it is probably the single best anti-aging topical treatment you can use at home for facial aging. Retin-A has been demonstrated to reverse the signs of aging right down to the cellular level. There are potential side effects though; dryness, redness and sun sensitivity. So, use it at night and use daily sunscreen (as everyone should do so already). Other Vitamin A preparations are also available that have moisturizers or modified retinoids that may be less irritating and better tolerated by your skin.
Vitamin C is an antioxidant that is effective in fighting aging skin. Anti-oxidants combat the formation of free radicals. What does all that mean? Ultraviolet (UV) radiation from the sun penetrates the skin and causes the formation of free radicals. Free radicals damage the skin cell membranes, enzymes, surrounding fluid and proteins making the skin age prematurely. Vitamin C neutralizes some of this damage. It is also a necessary building block for a number of the enzymes that make collagen for our skin. UV exposure also depletes the skin of Vitamin C making it less available for the skin cells. Oral vitamin C is good for overall health, but little gets to the skin so topical is helpful as well. Unfortunately, you can’t chop up vitamins and smear them on your skin. The vitamin C molecules need to be of a specific size and associated with certain carriers that enhance skin penetration and absorption. This varies from product to product.
Pauline also asked about Vitamin D. Vitamin D has been a hot topic lately, as it was even featured in the New York Times Science Section last week. Vitamin D is made in the body from sunlight and also found in fish and fortified milk. There are well documented health advantages from Vitamin D for many disease processes as well as overall health. What is not known is if we really need to take supplements other than what we get naturally from food and sunlight. Active healthy patients have higher Vitamin D levels. But is this from outside sources or do healthier people produce more Vitamin D themselves?
When it comes to vitamins taken orally, nothing beats a balanced diet and good hydration for healthy skin. The #1 thing I recommend for overall health is adding Omega 3 fatty acids. These are the highest in fish but can be obtained from a number of other sources such as flaxseed oil or even oral supplements.
Here’s to a healthier you. Steven J. Pearlman, MD, FACS
February 3rd, 2010 Dr. Pearlman
The Little Baby Face Foundation
Pro-bono reconstructive surgery for children around the world born with facial defects
New York, NY. I am thrilled and honored to have been added to the medical advisory board for the Little Baby Face Foundation. The Little Baby Face Foundation provides pro-bono reconstructive surgery for children from around the world with facial deformities. Over 100 children have been treated since its inception. All surgical, medical and dental care is donated without fees by the medical advisory board members. Each child also undergoes a full medical evaluation including exams, scans, X-Rays and other diagnostic tests. All non-participant physician costs – such as diagnostic tests, hospitalization, travel to and from New York, including hotel costs for the family – are covered by the foundation.
This foundation was founded in 2002 by Dr. Thomas Romo. Tom is a gregarious giant of a man when it comes to measuring heart. Having participated in Face to Face, a pro-bono program from the American Academy of Facial Plastic and Reconstructive Surgery, I, like Dr. Romo, have travelled around the world offering pro-bono reconstructive surgery for needy children. With familial and personal responsibilities back home, it is difficult to do this very often. Through this foundation, we bring the patients to us so we can treat them year-round.
A short list of some of the procedures that are offered are: Atresia (malformed ear canals), Bite, Jaw and Dental Abnormalities, Cleft Lip and Palate, Microtia (malformed ears), Eyelid Deformities, Malformed Faces, Nasal Deformities, Vascular Lesions, Bone Anchored Hearing Aids, Dental Implant Surgery, Distraction Osteogenesis, Orthognathic Surgery and Temporal Mandibular Joint Surgery.
To quote Winston Churchill, “We make a living by what we get, but make a life by what we give.”
If you are more interested in this foundation and want to know more about us or how to help, please visit the website http://littlebabyface.org/.