March 22nd, 2010
Non-surgical facelift, can you get away with it or do you need the real thing?
New York, N.Y.
There is much buzz in the media and on the internet about non-surgical or alternative less invasive procedures instead of facelifts. These treatments include fillers, neurotoxins (Botox and Dysport), and devices such as lasers and radiofrequency machines. Many of these procedures can help restore a more youthful look, but none really lifts the face. You can follow this link to my website for a more comprehensive discussion of the 5 ways the face ages:
- Skin changes
- Dynamic lines from muscles underneath
- Loss of volume
- Effects of gravity
- Loss of tissue elasticity
To treat these aging causes, treatment needs to be targeted to the cause. Of course, most patients experience all 5 in some capacity. I then break down their priorities by need, time frame, importance to them, time off to heal and cost.
Targeted treatment for each or some combination is really what is best:
- Skin changes Lasers and peels for the skin
- Dynamic lines Botox or Dysport to relax muscles
- Loss of volume Facial Fillers (Juvederm, Restylane, Radiesse, Sculptra, Fat)
- Effects of gravity Surgery
- Loss of elasticity Surgery
Fillers, Botox and Lasers can go far to make someone look younger, but to lift a drooping jowl, treat a “turkey neck” or low brow, nothing works like a surgical facelift or browlift.
Don’t get me wrong, my new techniques in facial fillers are really getting beautiful results. Now that I target cheeks and the mid-face with fillers, entire faces light up. But this is not a lift. There is a doctor in New York advertising a “insert letter here” lift (I am leaving out the letter as not to offend); but all he is doing is placing many syringes of facial filler deep in the face and under the skin. It’s not a lift but volumizing the face. Fillers are a good thing, but more is not better. Plump is good but so is lifting.
Lasers and RF machines don’t really lift the face either. Most reports have been disappointing and based more on subjective findings instead of objective long term results.
So, for comprehensive facial rejuvenation, all 5 areas of the face need to be examined and treated.
Steven Pearlman, MD, FACS
Posted in Facelift, Home, facial fillers | No Comments »
March 16th, 2010
Who is a good candidate for facial plastic surgery?
New York, NY
The best candidates for facial plastic surgery are motivated individuals who are healthy, inherently happy and looking to enhance their appearance. Of course, health comes first. Cosmetic surgery is still surgery. It inevitably involves anesthesia of some sort, be it local, twilight or general. That means patients need to have normal healing, clotting and must be medically able to tolerate surgery and anesthesia. There are well established pre-surgical testing requirements that have been set forth by the national Anesthesia society. For a young healthy person, it has been shown through studies that doing a stack of tests are not necessary. Age, sex and medical status standards determine what each potential patient needs to deem them safe for surgery and anesthesia.
I have turned away a number of patients seeking facelifts who are on medications for heart conditions and/or have heart stents. This is because they cannot safely be off blood thinners for the necessary amount of time to heal normally from surgery. Some have begged me, or their primary care doctors, to take them off the blood thinners or operate on them anyway. Of course, I said no. This decision is really up to your primary care doctor. It is not worth looking good if there is a chance that you may have a heart attack, or worse.
Cosmetic surgery is to make patients look better and to improve self image and self confidence. However, no matter how good you look after, if you have a poor sense of self image, surgery may not help. The best patients are those who are happy yet look to improve features that may detract, such as a big nose or jowls. Fixing this aesthetic flaw then restores or enhances self esteem. I often see personality changes that far outstrip the cosmetic changes, but this is as a result of, not a reason for cosmetic surgery.
Over 15 years ago, I performed a rhinoplasty on a friend (at his insistence). He was extremely affable and a great person, plus the #1 salesman in the country for a large international corporation. So, he certainly didn’t lack self confidence. After surgery, his professional confidence spilled over to his social being. He finally asked out the girl he admired from afar for years. They are now married with two children. I didn’t make that much of a physical change, but the psychological change far outstripped what we did for his nose. He was able to apply that great personality to his social life.
In reviewing some articles on patient selection for facial plastic surgery, they said that an educated patient is part of the criteria to be considered a good candidate. But given the media attention to cosmetic surgery and enhanced beauty, too much is not good either. Airbrushed celebrities and models don’t help give accurate accounts of what they really look like. Actors can also take off months to hide and heal before appearing back in public (as they don’t have 9 to 5, 52 weeks a year jobs to get back to right away). The internet is full of excellent information, forums and blogs, but not all of these are helpful. Sometimes too much information is not good. Details of a surgical procedure can sometimes be daunting and confusing to patients; especially when highly respected surgeons even differ. How can a non-physician make a choice? Also, unhappy patients tend to be more prolific on the internet than happy patients.
Cosmetic surgery is an amazing way to enhance one’s appearance for healthy well motivated patients. It’s always a good tool to research your options but beware of misleading information from the internet. Steven J. Pearlman, MD, FACS
Posted in Facial Plastic Surgery, Home, Rhinoplasty | No Comments »
March 9th, 2010
Athletic faces: facial fillers, broken noses, septoplasty, rhinoplasty
New York, N. Y. ,
Two weeks ago I saw a lady that I first treated 14 years ago as a promising college varsity soccer player. She was referred to me by the school’s athletic trainer for a broken nose. She was happy with a straighter nose and went back to playing with a face guard for the rest of the season. She came back to see me three weeks ago for a long overdue follow-up. In addition to getting a professional degree, she went on to play for the national team of her ancestral origin and is now slowing down her athletic career. She is looking to fix a deviated septum that often occurs with nasal fractures as well as a few other cosmetic changes for her nose. She also appears prematurely aged due to eyelid changes, small bags under her eyes and narrowing cheeks. I am leaving out specifics to protect her privacy, although she did consent to allowing me to tell her story.
It is very common for the septum and nasal bones to be pushed over when a patient breaks their nose. The nasal bones should be fixed within two weeks, but a septum needs to heal for 6 to 8 weeks before addressing it surgically. A number of other changes can occur in the nose from trauma that isn’t addressed by a “closed reduction” (simple straightening of displaced nasal bones). I will go into broken noses in a future blog.
As a long time athlete, she demonstrated what I see in these individuals of both sexes. Lean bodies are often associates with prematurely hollow cheeks. This was first recognized in devoted marathon runners. I was quoted in New York Magazine on Yoga Masters suffering the same consequences. Having little body fat, they often lose their facial fat even faster than the rest of us do as we age. I have discussed facial fillers to combat facial aging in past blog posts as well as on my website. To treat this lovely patient, I used Restylane under her eye “bags” to camouflage aging changes of her eyelids and Juvederm in her cheeks to restore a more youthful facial appearance. She is extremely happy with these treatments and may consider Septoplasty with Rhinoplasty in the near future.
Steven J. Pearlman, MD, FACS
Posted in Home | No Comments »
