April 23rd, 2010
Heidi Montag: too much, too young
New York, NY, It is probably a little too late to be commenting on Heidi Montag’s multiple plastic surgeries. However it is obviously still in the mind of the media and therefore the public since I was interviewed and quoted in the Daily News on Wednesday April 21. I will try to confine my comments to her face since I specialize in Facial Plastic Surgery and don’t venture south of that professionally.
Going from top to bottom:
- Mini-brow lift: From her pre-op photos, I don’t think she really needed a brow lift. The key to the brow is shape and not height. I discussed the ideal brow shape in an earlier blog. Heidi’s brows were a little low but so are many top models and actresses. She did have the proper arch and now has too much of an arch.
- Botox: in the forehead and frown lines. No matter how much a 23 year old frowns, it won’t leave lines. I am not a fan of using Botox when there are no lines at rest to “prevent them” from eventually appearing. I also think that too many actresses get too much Botox. It is disconcerting when watching a TV show or movie and there is no expression in anyone’s face anymore.
- Nosejob revision: This I agree with, as her previous nose was slightly too wide for her slender (and now even more slender) face.
- Fat injection in cheeks, nasolabial folds and lips. Everyone, even children and teens have nasolabial folds. These are a sign of character and expression. Also, fat is good but doesn’t always last in the nasolabial folds or lips.
- Chin reduction: she did have a large chin, this one is a plus.
- Neck liposuction: there needs to be a little fat between the skin and the muscle of the neck called the Plastysma muscle. This cushions the skin and if too much is removed you will be able to see every fiber of neck muscle as she ages. She is also a little young for facial liposuction. The facial fat changes a lot from the 20’s to the 30’s.
- Ears pinned back (otoplasty): I cannot comment on this since her hair covered her ears in all pre-op photos I found.
As for the body stuff, as I said I can’t comment as a professional. But, as a male, I think her breasts are way too big and were more attractive before surgery.In summary, patients benefit from multiple plastic surgical procedures but there really needs to be a limit. Some people, such as Heidi Montag, went way over the line.
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April 14th, 2010
New York, NY
I got a taste for teaching facial plastic surgery going back to my residency where I presented at a national meeting in front of hundreds of practicing physicians. One year and two other journal publications later, I was asked by my facial plastic surgery fellowship preceptor and mentor Dr. William Friedman to co-author two chapters for an upcoming textbook in facial plastic surgery.
- Friedman W.H. and Pearlman S.J., Preoperative Evaluation and Patient Selection for Blepharoplasty. Aesthetic Facial Surgery, Krause, C.J. ed. J.B. Lippincott Company. Philadelphia 1991.
- Preoperative Evaluation and Patient Selection for Rhinoplasty. Aesthetic Facial Surgery, Krause, C.J. ed. J.B. Lippincott Company. Philadelphia 1991.
I recall a lot of pressure to write something that was befitting sharing authorship with such a respected physician plus the knowledge that it will likely be read by thousands of peers. As a fellow, I rounded daily in the hospital with residents from Columbia Presbyterian Hospital. Thus began my academic career. Teaching is a big responsibility. It requires me to be on top of my game at all times. At rounds, answers to residents’ questions need to be precise and accurate. Teaching in the operating room requires comprehensive understanding of the procedure, background, reasons for all maneuvers and discussion of potential complications (and how to avoid them, of course).
Over the past 22 years in practice, I have authored over two dozen articles in peer reviewed journals (the most recent on revision rhinoplasty) and textbook chapters (the most recent on Endoscopic Browlift) and have given hundreds of lectures on various topics in facial plastic surgery. I now teach my own fellows as well as residents. Currently I have a fellow, Dr. Jason Moche, who is about to graduate. We are working on a combined project looking at revision rhinoplasty. I also have two ongoing research projects with residents on rhinoplasty techniques. So, if you want to find a surgeon who is on their toes and knows the latest about their specialty, look for those who teach.
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April 6th, 2010
Role reversal or just an early Mother’s Day?
New York, NY: A few weeks ago, I treated three Baby-boomer moms. What made that day unique was that each was brought in by their daughter for facial rejuvenation. One was the mother of a beautiful teen on whom I did a rhinoplasty and had a fabulous result. The second daughter had prior Botox and the third just found me through “sources” and dragged her mother in for a fix-me-up. Each of these mothers are vibrant ladies in their 50’s and were there for their daughters, now it was the daughters who were telling the moms what they needed.
Each mom had office facial rejuvenation with Botox, fillers and skin care. Botox was used to soften their frown lines, reduce crow’s feet, reduce downturned corners of the mouth; and in one mother smooth the forehead. By individualizing treatment and using only the necessary amount of Botox, each looked smoother yet retained facial expression.
Next, they had Juvederm to restore youthful cheeks. As we age, one of the first things to go is mid-face fat. Nasolabial folds aren’t so obvious in a young adult, but become much more visible when the mid-face gets hollow. When I used to just fill nasolabial folds, patients were happy but not ecstatic. Restoring youthful “apple” cheeks give what I call the “wow factor,” each looked in the mirror after only one cc per side (cheek, nasolabial fold and marionette line) and said exactly that: “wow, this is how I used to look” and could now compare themselves to their daughters. One of the mothers also had Restylane to her tear troughs to camouflage the appearance of lower eyelid bags.
Lastly, each was put on a skin care regimen designed for their face. The core for each of their product selections was TNS, a great skin rejuvenation product that I even use myself on a daily basis. So, mother’s watch out, your daughters are watching out for you too! Steven J. Pearlman, MD, FACS
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