June 7th, 2011
Lecturing at an International Rhinoplasty course in Milan, Italy. Spring 2011
I had the privilege to be invited to speak at the 6th Biennial Milan Masterclass in Rhinoplasty. This was a course directed by my friend and master Rhinoplasty teacher Prof. Pietro Palma from Milan. There were over 700 attendees from 58 countries in attendance. Faculty was from around the world as well. My biggest criticism of the course was that the content was so good that I found it difficult to skip out to see Milan. Fortunately we arrived a few days early and left 2 days after the completion of the meeting so we had a chance to see Milan. Pictured is a home my wife and I encountered when walking around Milan. These beautiful statues represent exactly what I believe is the foundation of rhinoplasty: pursuit of beauty and preservation of architecture. I gave lectures on revision rhinoplasty, brand identity and presented a video on the use of spreader grafts in rhinoplasty.
When giving my first lecture, I was excited to look down and see Prof. Rudolph Meyer. He is a master rhinoplasty surgeon and teacher, who had written a number of texts on rhinoplasty and countless articles. Prof. Meyer is close to 90 years old and was still the most attentive individual in the room. In the photo below, he is giving a speech at the reception dinner and is surrounded by course directors Professors Castelnuovo and Palma from Italy and visiting Prof. Gilbert Nolste-Trenite from Holland.
We rounded out our trip with a one day visit to Venice. I truly enjoy speaking around the world; it always gives me a new perspective from international faculty and the chance to both share and learn from them, plus a great excuse to travel.
International travel to medical meetings not only is a chance to visit new places but exchange knowledge with experts from around the world.
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March 15th, 2011
What should you do when you break your nose?
This sounds simple but even some doctors don’t know how a specialist in facial plastic surgery treats broken noses. First, there are only two true emergencies when you break your nose. First and most obvious is a non-stop nosebleed. Obviously, get to the nearest ER or specialist and have them treat your nose, which likely requires topical decongestants and/or nasal packing for a few days.
The other emergency that rarely occurs when you break your nose is called a septal hematoma. The same very delicate blood vessels in the septum that may bleed can also bleed under the “skin” or mucosa of the nasal septum. This causes the septum to blow up like a balloon on both sides of the nose with blood that can’t get out. If this blood isn’t drained (by a specialist), it can cause the septal cartilage to get weak and collapse over a few months time causing a saddle deformity (severely scooped nose). So, if you have trouble breathing after breaking your nose, the inside needs to be checked for a hematoma, preferably within 24 hours.
Now to address the nasal bones: If you do break your nose use ice right away and keep in place, 20 minutes on and 10 minutes off for the first two days. If the only problem is shifting of the nasal bones to the side, they can be repositioned by a minor surgical procedure called a “closed reduction.” Unless you are seen right after trauma, the nose is usually too swollen to do this right away. However, after about two weeks, the bones start to heal so the ideal time is somewhere between three days and two weeks. Beyond two weeks, we may need to wait two months for the bones to fully heal before re-breaking.
If there is a simultaneous deviated septum, cartilage heals differently. I prefer to wait at least six to eight weeks before treating the crooked septum. So, if both a nasal bone fracture and deviated septum are present, I delay fixing the broken nose for the stated minimum of six to eight weeks then re-break it when I fix the septum so the patient only has one operation instead of two (closed reduction then septoplasty).
As for a rhinoplasty after sustaining a broken nose, I prefer waiting at least two to three months to let everything heal and settle if I we are to do more than straighten the nasal bones and a deviated septum.
Treatment for a broken nose can be a simple surgical procedure. But if not treated properly, the consequences can be more severe.
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February 2nd, 2011
Reflections from a facebook post
I recently posted new photos of my office staff to my Facebook Fan page, Dr. Pearlman. Yes, I have a Facebook fan page to update friends and interested parties on the latest and greatest in facial rejuvenation. Back to the photos, one “friend” who happens to live in the building where my office is asked “who is the person in the hat.” He well knows it’s the Doorman, Chester Adamik. Chester is the first and last individual patients see when they come and go from 521 Park Avenue. Doormen in a landmark Park Avenue building need to be diplomats and ambassadors, yet support both the physicians and tenants alike.
I posted the staff photo to demonstrate the extraordinary individuals who go into making the patient experience the most comfortable and pleasant possible. It was at a staff meeting that Chester first came up. We were discussing the process for patient consultations: a patient arrives at the office and is greeted by Salma (Reception manager or as a friend refers to this individual, patient experience coordinator.) Kim is also often at the front desk (patient coordinator.) Forms are then filled out, or turned in since they are now available on our website. They are then escorted to my office to discuss why they are here, with a wait that rarely exceeds 10 minutes.
We discuss patients’ goals and desires as well as reviewing their medical history. We then go to the exam room where I examine each individual and we plan their treatment, surgical and non-surgical. For rhinoplasty and revision rhinoplasty, I really like computer imaging as an excellent discussion tool and establish mutual goals for the surgery. 
Following my examination and any treatments, patients then meet with Kim in the consult room for scheduling and other business matters. To discuss ins and outs of having surgery, Christine (Plastic Surgery RN) is always available. They then finish with Salma. BUT, on the way out, there is always Chester, the last person they see here, who helps them exit with a smile. He is always extra kind, sensitive and helpful with patients who are bandaged from recent surgery.
We do our best to make every patient’s experience the most favorable possible, from the time they enter the building until they exit, refreshed and more beautiful. Steven J. Pearlman, MD, FACS
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January 18th, 2011
The new Flexible PDS Plate is a great tool for difficult revision rhinoplasty, septoplasty and even for children with smashed noses
In November, I blogged about my initial experience with the newly approved flexible PDS plate for a difficult revision nasal septoplasty. That patient is now three months post op and doing very well. He is breathing much better after I performed his third (my first for him) septoplasty.
Last month I operated on the 6 year old I talked about in that blog; I will call him “N.” N is a cute, energetic little boy who just can’t stop smiling. He smashed his nose at Yankee stadium last summer. He had severe swelling inside his nose that looked like a hematoma. Nasal septal hematoma is one of the very few emergencies you can have that accompanies a broken nose. Blood collects and swells the inside of the nose. If the blood is not removed quickly, the nose can collapse. So, a colleague brought N to the operating room under the assumption N had a hematoma. What the surgeon found was that the cartilage was so damaged that it was zigzag with portions lying horizontally instead of vertically, mimicking a hematoma. However, due to severe alteration of his nasal septum his nose collapsed anyway, despite the rapid care he received. This doctor subsequently referred N to me for revision surgery.
After allowing the nasal cartilage to heal, I operated on N in early December. Externally his nose had collapsed and what we call a “saddle” nose. This may be subtle I the photos but would get exaggerated as he grows. When I opened up his nose, I found pieces of septal cartilage pointing in every direction and parts overlapping. I used the flexible PDS plate to rebuild his nasal septum and restore a natural nasal profile. That was accomplished by actually removing the entire nasal septum and rebuilding it on a back table using the flexible PDS plate as a template hold the fragments straight. Because the cartilage was partially destroyed, I also used some cartilage from the flat part of his ear (so it would not show any deformity whatsoever after healing) to fill in missing pieces.
The new septum was stitched back into place and the remaining middle third cartilage (called the upper laterals) and the tip cartilages were elevated and sewn to the newly repaired septum at the restored height. This has been commonly used by rhinoplasty specialists in Europe for many years but is still very new in the U.S. since flexible PDS plate use was only FDA approved in September 2010.
N is doing extremely well. He and his parents report much better breathing and he is no longer snoring at night. N also says that he can smell everything better.
I feel strongly that the new Flexible PDS Plate is an excellent tool that will improve results in difficult revision rhinoplasty and septoplasty and for correcting very crooked noses, even for pediatric cases.
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December 9th, 2010
In the spirit of the holidays, I am promoting some specials through Gilt City.
Botox – 40% off
Restylane or Juvederm – 40% off
Chemical Peels – 50% off
You can find out the rest of the specials on Gilt City.
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November 18th, 2010
First it was frequent flier miles, then hotel chains. We even get to use almost any airline with Amex rewards. I drew the line there. It seems everywhere you turn you can get frequent user points: Starbucks, the local car wash, even nail salons. I choose not to save these cards. But now it’s right here in my office. Brilliant Distinctions is for patients who get repeat treatments with Botox and/or Juvederm. You can accumulate points on their website so that rewards can be accumulated towards money off (from Allergan) on Botox, Juvederm or even donate your points to charity.
To me, this is a no-brainer. As we know, Botox lasts an average of 3 to 4 months and Juvederm from 6 months to a year. To maintain the same level of rejuvenation you then need to return a few times a year to stay looking fresh and young. So, why not sign up?
A few years ago my Botox rep suggested that we have patients come in automatically at around 3 ½ to 4 months as their Botox is wearing off for repeat treatments. At first I thought it was a ploy to sell more Botox. However, by keeping muscles at rest and not allowing them to fully recover they undergo atrophy. That means the facial muscles get thinner from disuse. This will enhance the smoothing action and after a few years may reduce Botox requirement for steady patients. So, when my receptionist offers to schedule your next Botox appointment right after you just had one, it’s to help maintain your wrinkle-less face.
In summary, Botox and fillers help rejuvenate your face. Timely visits will maintain a youthful look and now can even be redeemed for discounts on future treatment.
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November 12th, 2010
Kim Roberts, the cosmetic patient coordinator for Pearlman Aesthetic Surgery just completed advanced training from SkinMedica. Below is a guest blog with her personal skin care tips:
I recently attended the SkinMedica Long Island National Seminar. I love skincare! Having tried many products touted as “anti aging” I was anxious to learn about the products that I have come to rely on and see what new skin care miracles they offer.
Below are the key skin care tips that I learned:
- Don’t skip Toner, it restores the skin’s PH balance also removes dead skin cells
- Use exfoliator that has spherical beads, others will scratch and damage the skin
- TNS (Tissue Nutrient Solution) has the highest concentration of Growth factors available. Growth Factors stimulate cellular growth
- Vitamin C is the best antioxidant. Vitamin C works even better when combined with Vitamin E since Vitamin E traps the vitamin C in the skin
Products I personally can’t live without:
- TNS Essential Serum
- Retinol Complex
- TNS Eye Repair (this has eliminated my need for under eye concealer!)
After years of sun worshiping (something I don’t advocate) TNS Essential Serum is my anti-aging Super Hero! It has improved my skin tone and texture dramatically. I use it AM/PM immediately after cleanser/ toner, followed by moisturizer.
TNS Eye Repair is a must! Used morning and night it has changed my life; virtually eliminating the dark circles and crepey skin around my eyes.
Retinol Complex completes my routine. I use this every night. I have used other brands of Retinol over the years and this one is by far my favorite. The texture of my skin is now smooth and clear.
To summarize, here is my daily routine:
1-Cleanser AM/PM
2-Toner AM/PM
3-TNS Essential Serum AM/PM
4-TNS Eye Repair AM/PM
5-Retinol Complex PM
Here’s to a more beautiful you!
To add a personal note from Dr. Pearlman; I too use the SkinMedica products daily. Why? because they work and my skin looks great.
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November 4th, 2010
PDS Plates, the latest and greatest in revision rhinoplasty and septoplasty.
Two weeks ago I was lucky to get a sample of the new PDS plate to use in a tertiary revision septoplasty case. The PDS plate is made of the same material that is used in my favorite suture material for sewing cartilage in rhinoplasty. PDS suture material lasts around three months, long enough for healing and permanent cartilage bonding to take place but not so long that the body rejects it and tries to “spit” it out. The PDS plate has been around in Europe for a number of years. European colleagues have talked about it in their lectures and published on it in 2005: Dr. Wolfgang Gubisch, Archives of Facial Plastic Surgery vol 7, July/Aug 2005 and Boenisch and Trenite also in Archives of Facial Plastic Surgery vol 13 Jan/Feb 2010.
Finally us of the PDS plate for nasal surgery was FDA approved for use in US early this fall. The parent company, Mentor, was well represented at the AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) meeting in Boston with very informed vendors and an armful of papers documenting the advantages of using PDS plates.
After all that fanfare, I had the ideal case 2 weeks following the meeting (2 weeks ago); a gentleman who had two prior deviated septum operations with persistent nasal septal deviation and nasal obstruction. What he needed was to have the septum taken completely apart and have something like this plate to hold the healing cartilages pieces in place as the septum heals straight. After all this buildup, I was told that they were back ordered and the product wouldn’t be available for many weeks. Well, it pays to have a good relationship with a superb rep. She was able to procure a plate for me in time to use for the surgery and I really think it will help get a superior result.
This weekend, I am an invited guest to go to St. Louis to hear lectures by the doctors who invented and perfected the use of the PDS plate as well as a lab demonstrating the many ways they suggest it can be used. Fortunately for me and my patient, I had a jump start on the process.
By the way, I already have my next case in mind. This is a 6 year old boy who smashed his nose last summer and had a failed attempt at fixing his destroyed septum. His nose is also collapsed. I believe the PDS plate will help restore a straighter septum nasal height with less surgery than he would otherwise require without it.
I really feel that the new PDS plate is an excellent new product that will help enhance the results in revision rhinoplasty and revision septoplasty.
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October 14th, 2010
First and foremost, it’s nice to see that most of what the “experts” are teaching isn’t much different than what I am already doing in my practice. There were two rhinoplasty seminars with excellent talks by Drs. Bahman Guyron, Dean Toriumi, Ira Papel, Pietro Palma, Jack Gunter, Norman Pastorek and Peter Adamson to name a few. A few of the take-home messages that I got were tips on reducing pain for the patient in rib cartilage harvesting and techniques for straightening out a crooked nose, which is the most difficult skill for perfecting a rhinoplasty.
Facial fillers have always been a hot topic at recent meetings and still were in Boston. Of course, everyone has their favorite fillers. The fillers change with the volume and applications. For smaller volumes, hyaluronic acid fillers such as Juvederm and Restylane still rule. For fine lines, Prevelle Silk. As we get to larger volumes, Radisse takes over and for the most volume and longest lasting results, Sculptra is likely best. Dr. Rebecca Fitzgerald gave a 1 hour breakfast seminar on Sculptra that actually lasted for two hours. Sculptra is now injected deeper under the facial tissues, just on top of the bones in most areas of the face.
What new products did I discover? Finally PDS foil is FDA approved for use. This has been used very successfully for years in Europe for nasal support in very crooked deviated septum repairs, revision rhinoplasty and other areas of the nose as well. I was invited to attend a special meeting in St. Louis in early November to learn the nuances of this new product. I was fortunate to have received a sample, which I used to help repair a much deviated septum. This particular patient had two prior attempts at correction, but the nose was still very crooked. I will discuss this procedure next week.
As much as I have learned in my past 22 years of medical practice and teaching Facial Plastic Surgery, it’s still important to keep on learning and modifying my patient care techniques.
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October 4th, 2010
It’s been a few weeks since my last post. I have been quite busy, academically. I was lecturing in a course on Rhinoplasty in mid-September in St. Louis. The following week was the AAFPRS annual meeting followed by lecturing last week at the ENT (Ear Nose and Throat) annual meeting.
The week before last was the annual meeting of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). Over 800 facial plastic surgeons from around the world were in attendance. I really enjoy going to this meeting for three reasons:
- From attending and lecturing at 4 to 6 meetings and courses per year, I have made some great friends given our mutual interests and backgrounds.
- I get to lecture to peers and young physicians on surgical techniques that I have mastered such as rhinoplasty and revision rhinoplasty.
- I learn from my peers. If I pick up at least two pointers at a meeting, I deem it a success. The most learning is done in the hallways between lectures, when I can get the real scoop on the latest techniques and lasers right from the innovators.
As for social events, the past president’s dinner is always at a top restaurant. This is one group that no one can join, buy in or donate to attend. As a past president of the AAFPRS we are invited to a black tie dinner where we socialize and really discuss very little medicine. The next night was another black tie function, the founders club. This is always held at an unusual venue. This year it was in Fenway Park, a fun place to visit as a long time Yankee fan.
I gave three lectures and seminars. I taught a course in revision rhinoplasty. I pointed out the most common things I see that brings patients in to see me for revision surgery and discussed what likely went wrong. The best treatment is doing things right in the first place and avoiding the need for revision surgery. I also included a description of how I restored these noses to a normal appearance and function.
My second lecture was given with Wendy Lewis, who is a world authority on plastic surgery. She lectures to physicians around the world, advises potential patients about what and who is best for them to see. Wendy has written 11 books on cosmetic surgery. This seminar was on how to talk to patients and media in “non-medical” speak. Too many doctors address patients and writers/reporters in technical terms that leave heads spinning.
My third lecture was at the ENT (otolaryngology) meeting the following week. I went back to Boston for the day to teach a course on the nasal valve with Dr. Maurice Khosh. We discussed this important area of nasal anatomy and physiology, and how it is important to respect as well as sometimes strengthen the nasal valves in rhinoplasty.
Next week I will review what new educational pearls I picked up that I am going to use to improve my surgical techniques.
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Lecturing at an International Rhinoplasty course in Milan, Italy. Spring 2011
