August 30th, 2010
To lift or fill the face?
I recently saw a patient who came in because I did a facelift on one of her childhood friends and she liked what she saw: a more youthful look without looking “pulled.” She had a facelift about 7 years ago and feels that it helped a little but the skin of her lower face is “wrinkley” with some excess skin under the neck and cheek folds. She sought out a few opinions of other doctors and the suggestions ranged from fillers to implants to a revision facelift. My first inclination was to suggest another facelift. This would help the jowls and extra skin under her neck. What concerned me is that when listening to this lady, she was more distressed about the way the skin hung around her mouth and narrowing of her cheeks. As a surgeon, facelifts are more interesting and fun for me to perform, plus this patient was basically asking if a revision facelift would be the best solution without specifically stating it. However, I felt that a facelift wouldn’t be the best initial solution for her concerns. I suggested that we first try Sculptra to restore volume to her face and fill out the deflated cheeks and areas around her mouth. A facelift can be performed later to lift the drooping facial skin and muscles.
This is really about deciding priorities. I categorize facial aging into 5 categories: skin changes, dynamic muscle action, loss of volume, gravity and loss of elasticity. Everyone experiences all 5 as they age. It’s more a matter of what should be addressed and in what order. For this patient, I feel it is volume first (high volume fillers with longevity – Sculptra) then combat gravity and loss of elasticity next (facelift).
The face ages in 5 ways: skin, muscle action, volume loss, gravity and loss of elasticity. When the question is to fill or lift the face, both the doctor and patient need to determine the best treatment plan per the patients priorities. Steven J. Pearlman, MD, FACS
Posted in Facelift, facial fillers, Facial Plastic Surgery, Home | No Comments »
August 11th, 2010
Facelifts, what works best: more highlights from the Multi-Speciality Foundation for Facial Plastic Surgery 6th Annual Meeting
New York, NY, There were so many world authorities at this meeting that my head was spinning. One of the more interesting panels and set of presentations was on facelift surgery. Just when you think that most people agree on something there is a panel of recognized experts with a vast array of differing opinions on facelifts. The most senior was Dr. Bruce Connell, who taught or at least influenced many of the most accomplished facelift surgeons and teachers with his bi-plane, bi-directional extended SMAS facelift. He was supported by one of his former students and now a superior teacher in his own right, Dr. Timothy Marten. Other facelift ideas were presented by the inventor of the MACS facelift, Dr. Patrick Tonnard from Belgium, Dr. William Little with totally new ideas on vertical SMAS lifting and Dr. Gaylon McCullough with an excellent perspective from his many years performing and teaching facial plastic surgery. The outstanding statement of the meeting came from Dr. Little; when asked about his SMAS technique as a departure from the rest, he prefaced his answer by stating that he needed to watch what he said since he shared the podium with the “SMAS mafia.”
What did I take from this panel? There are many ways to perform a facelift. Most agreed that the SMAS needs to be addressed in all patients. For most, the more aggressive surgeons get with the SMAS, such as deeper plane facelifts may last longer but are technically more difficult to perform. Facelifts also need to be individualized.
As with noses, there isn’t one facelift operation that fits all. A simple short scar facelift with a few sutures in the SMAS may be easy, fast and can be done under local anesthesia and even mass marketed by national companies under catchy names, but doesn’t last for patients with more advanced facial sagging. I find myself in discussions with other plastic and facial plastic surgeons, who state, “Wow, you really do a deep plane facelift?” It takes longer and patient recovery is longer but the results are superior and the results last longer.
In summary: there are a number of ways to perform a facelift. A more comprehensive the procedure such as the deep plane facelift may take longer to perform and take longer to heal from, but the results last longer. Steven J. Pearlman, M.D.,F.A.C.S.
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August 2nd, 2010
Multispeciality Foundation for Facial Plastic Surgery 6th annual Updates Meeting July 2010
New York, NY. I had the privilege of attending, lecturing at and moderating the afternoon session on Rhinoplasty at the 6th annual meeting of the Multi-Specialty Foundation on Facial Rejuvenation in Las Vegas last month. This meeting was organized by Drs. Randy Waldman and Eddie Cortez with over 800 cosmetic surgeons in attendance. The first day was devoted to advanced techniques in rhinoplasty. Many of the most well respected teachers of rhinoplasty were on the program from around the country as well as Europe and Asia. It is humbling to see these experts demonstrate nuances they have picked up and wish to share with colleagues. Given the opportunity to sit on a panel with these surgeons as well as discuss techniques off the podium, in the halls, at dinner and on the run is always enlightening.
I presented two lectures. The first was entitled, “What Makes a Nose Look Fixed,” where I explored the main reasons patients come in for a consultation feeling that their noses appear “done” or look as if they had a nose job. In this lecture I explained how and why this happens, tips on how to avoid it in the first place and how I fix these specific issues.
My second lecture was a summary of a study I conducted last year and soon to publish in the Archives of Facial Plastic Surgery. I surveyed 100 consecutive patients seen in consultation for revision rhinoplasty and reported the top concerns they had and the reasons they sought revision surgery. This was a unique study since it was looking at revision rhinoplasty from a fresh perspective: the patient’s point of view.
Some new principles that I picked up at this meeting are, first, that I am doing things right. I acquired a few tips on the best way to use sutures to either curve or straighten cartilage. Also, that the European surgeons tend to like larger noses than their American counterparts.
Among the seasoned experts were Drs. William Silver, Ronald Gruber, Robert Simons, Russell Kridel, Shan Baker and Gaylon McCollough. My peers and colleagues included Drs. Jonathan Sykes, Steven Dayan, Paul Nassif, Rick Davis, Phil Miller, Fred Fedok, Minas Constantinides and Jay Calvert. From Europe and Asia, there were the following leading authorities: Drs. Wolfgang Gubish, Patrick Tonnard, Pietro Palma and Woffles Wu.
In summary, rhinoplasty is a complex procedure. Even the most accomplished nose surgeons still exchange ideas and learn new techniques from their colleagues. Steven J. Pearlman, M.D., F.A.C.S.
Posted in Revision Rhinoplasty, Rhinoplasty | No Comments »
