This week I had the wonderful experience of speaking to my 4 ½ year old daughter’s pre-school class about surgery. They have been studying the body in class and had a visit by another parent, an internal medicine specialist who demonstrated how she examines people using devices such as stethoscope and blood pressure cuff. My wife and the teacher suggested I come in and talk about surgery. I was incredibly nervous, what can I talk to 16 4-5 year olds about?

I started the morning by wearing surgical scrubs and my cleanest sneakers. I bestowed each child with a medical degree for the day; as they introduced themselves I had them call themselves doctor. Dr. X xxx, Dr. Yyyy, Dr. Zzzz , etc. We discussed that there are a number of different kinds of doctors such as pediatricians, medical doctors, dentists and of course, surgeons. Sometimes surgery is necessary when medicine doesn’t work.

We talked about how clean an operating room is. Each child put on (or was helped), surgical booties, hats and masks. We then discussed special hand washing; 5 times for each side of the hands then arms. This was simulated by each one with a dry scrub brush followed by a surgical towel. Lastly, each put on blue gloves.

My daughter chose a doll as a patient. We discussed how a mask is used by a doctor called an anesthesiologist, whose very important job it is to make sure that the patients are asleep and don’t feel anything. I taped on an IV then used a mask to “put the patient to sleep.”  Following, I demonstrated some surgical instruments and then sew up patients.

We finished with discussing the body. The heart pumps blood to the body. The brain helps us think, talk, see, hear and move. Bones support the body. I brought a gold painted simulated skull. The finale was when I opened the top and it was filled with candy.

Whew! This was more nerve wracking than surgery. It went extremely well and I cannot describe how wonderful I felt after. I made my daughter so proud. I wouldn’t trade the chance to share with my daughters and their friends for anything.

As a facial plastic surgeon, people are coming in for facial analysis for treatment of their noses, faces, chins etc. Most people have at least minor facial asymmetry. One eye and/or corner of the mouth is higher. Very often someone comments that their faces look more crooked in photos than in real life. Therefore the “outside world” must see them as being much more crooked than they really are. Some people actually avoid having photos taken or insist on a photo from their “good side.”  Why is that?

We are much more used to the way we look in the mirror. You look in the mirror many times a day; brushing your teeth, coming your hair, putting on makeup or aftershave. We rarely look at our faces up close in photos, except when confronted with a picture.

So for patients with asymmetric faces or noses, the first thing I do is use the reverse mirror image tool my computer to show what they normally see. Toggling back and forth helps to demonstrate that they might not be as asymmetric as they think. I can also compare ¾ views since we rarely see a true profile or ourselves in mirrors or photos. If a spouse or parent is present for the consultation, they are surprised at the mirror image and comment that what the patient sees in the mirror appears more crooked than in real life’, since they are more used to the photographic image. 

As for treatment, they range from simple to complex. For minor facial asymmetries, facial fillers are great. I just use more on one side of the face. Facial implants can be also used, either by carving stock implants to fit the asymmetry or computer generated custom facial implants. Custom implants are created from a model constructed using a 3-D CT scan. Implantech has this amazing technology and is very helpful when it comes to custom facial implants.

As for noses, the tip of the nose, even if crooked, often points down the center of the upper lip. Whatever trauma caused their nose to become that way created an impact in the center of the nose creating a “C” or “S” shape but the tip ends up down the center.

For crooked noses, that is one of the reasons why I might choose to use an open approach for rhinoplasty instead of an intra-nasal, or closed, rhinoplasty. My preferences and indications for closed vs. open rhinoplasty was discussed in an earlier blog.

Facial asymmetry is more common than you think. Facial analysis and treatment with the advent of computer and 3-D imaging is a great tool to both point this out and plan treatment. Steven J. Pearlman, MD, FACS

I’m thrilled to announce that we now have the latest in imaging: a Vectra-3-D

The difference between men and boys is the price of their toys. I have a fabulous new “toy” for my office. It’s called Vectra 3-D imaging. This system uses 6 cameras that take simultaneous photos of your face to construct a 3-dimensional virtual model. This model then can be morphed, like the now old fashioned computer imaging, but with fewer yet more sophisticated steps. What makes this even cooler are the 3-D glasses that give a stereoscopic 3-D view of these images. Here are the main advantages of 3-D imaging;

• Faces can be rotated and viewed from any angle imaginable
• Morphing is performed on a 3-D image so it doesn’t need to be repeated for each view as is necessary with 2-D imaging
• Actual volume changes, such as how much to remove from a nose or add to a cheek or chin are instantaneously available
• Far superior for facial surgery such as facelifts, facial implants and facial fillers than 2-D imaging, which I felt was great for noses and chins, but not much else

Another advantage of the Vectra 3-D system is the many analysis tools available. Facial contour changes can be evaluated by color changes and actually measured, similar to a geographical contour map. Since I have an academically active practice and like to analyze everything we do to assess improvement and maximize patient results, we can actually measure volume changes following facial fillers. To see a consultation with 3-D imaging please check out this link: http://www.youtube.com/watch?v=MjHOjl5TqGA

 Our Facial Plastic Surgery fellow is currently conducting a study on facial fillers and assessing volumes placed with aesthetic improvement. We want to see how much it takes to get the “Wow” in Wow cheeks^TM.

3-D Facial Imaging adds an exciting new tool to facial assessment and is a wonderful device for evaluating facial changes that may and do result from surgery and facial fillers.

This morning as I was sitting getting a shoeshine I thought about simple things that make us happy. I was introduced to shoeshines by my fellowship mentor, Dr. William Friedman. He taught me more than surgery and how to treat patients, he also taught style. Out of the blue when he wanted to take a short walk and get a quick “boost,” he would say “let’s go get a shine.” This actually works! So I continued the same tradition with my former junior partner (when I was with a big group), Dr. Eric Cohen. He still talks about it. 

Since my move to Park Avenue over 10 years ago, I now go to Jim’s on east 59^th St. They have 6 chairs and yet always manage to have a short line. 

I figure this is akin to my wife going out to get a mani-pedi, a facial or a new outfit. Amazing what a little thing can do for your spirits. I find that my patients feel the same way after getting a refreshing Probiotic Peel, a little Botox or fillers (Juvederm and Restylane). The peel is performed by Christine Ross, our extraordinary cosmetic surgery nurse; a new peel that doesn’t actually peel but leaves your skin glowing.

 A number of patients come in with friends and some mother-daughter teams for quick Botox, maybe some Juvederm or Restylane for the cheeks or lips and then off to lunch in the city. Steven Pearlman, MD, FACS

So, for a quick pick-me-up try a Probiotic facial peel, Botox or even a shoeshine.

70% of physicians who offer Botox in their practices actually get treated with Botox and half have actually injected themselves! I designed and conducted a survey along with my co-authors on physicians in core specialties regarding Botox and Facial Filler treatments. This survey was published last week in the Archives of Facial Plastic Surgery. Over 6500 doctors from the four specialties were polled including: Facial Plastic Surgery, Plastic Surgery, Dermatologic Surgery and Oculoplastic Surgery (these are considered to be the core specialties for facial fillers and neurotoxins by the Physicians Coalition for Injectable Safety, http://www.injectablesafety.org).

These astounding statistics speak for themselves. Doctors trust Botox and fillers so much that not only do a majority who offer them in their practices get them, but half of these physicians actually inject themselves. Nothing speaks louder when it comes to trust than findings like this. I am often asked if I would have such – and –such a treatment done on myself or a family member, well here it is.

The third part of this study looked at who else doctors trust to inject them. Two thirds preferred a physician colleague, 27% a Physician’s Assistant, Registered Nurse or Nurse Practitioner. Additionally, two percent of those surveyed allowed non-medially credentialed individuals to inject them. Why? I have no idea but this is not condoned by any of the above groups. So, if you are wondering about the safety of Botox or Facial Fillers, consider what doctors actually do. Steven J. Pearlman, MD, FACS.

It’s the New Year and we are all filled with resolutions about how we will eat better, drink more fluids, exercise and take better care of our bodies. Unfortunately, even if that takes place, nothing will firm up your face or prevent the effects of gravity. Of course using sunblock daily, eating well and avoiding smoking will help but nothing can reverse facial aging. As I tell my patients, gravity sucks.

The face ages in 5 ways, we each go through it. Treatment choices depend on your priorities, tolerance and financial means.                           

You can start small with good home skin care and light office peels. My patients love the myBody myPROBIOTIC PEEL^TM peel that our office nurse Christine Ross does.

If you “Like” my page on Facebook you may qualify to win a complementary peel. http://www.facebook.com/PearlmanAestheticSurgery

Other minimally invasive treatments that can be done right in the office chair are fillers and Botox or Dysport. In 20 minutes you can knock off three of the 5 causes of aging. There is really no such thing as a “non-surgical” facelift but many patients can look great with peels Botox and fillers.

Surgery is the next step and can be read about on my website. 

Tip of the week: Exercise, hydration and good nutrition can make your body look younger but doesn’t help your face.

I am often asked by patients about celebrities and two extremes of results. First, why do they look so good? The second question is why do they look so bad? Don’t they have good plastic surgeons in Hollywood? These questions and comments are a result of the many celebrity focused magazines and TV shows.

From NY Times article

Last week I was sent supposed “before and after” photos of a third-tier celebrity to comment on what she had done; facial plastic surgery or other minimally invasive procedure such as Botox and/or Fillers. The problem was that the “after” photo was so photoshopped that it was a joke. I declined to comment replying to the inquiry, that with the amount of “work” that was done to the photo it could easily be Zsa Zsa Gabor at her current age instead of the forty-something reality TV star.

 The N Y Times had an article on that very same topic this week. One former talent agent along with a Dartmouth University computer science forensics expert discussed Photoshop changes on celebrity magazine photos. In a scholarly paper for the prestigious Proceedings of the National Academy of Science, Prof. Farid suggested a software tool for measuring how much a beauty photo has been altered. With this new tool and more “truth in advertising” the consumer would better be able to see what models and celebrities really look like. This could also reduce the often extremely high expectations of individuals seeking cosmetic surgery.

 The AMA actually has a policy on truth in advertising. Cosmetic surgeons are supposed to identify when a website or an advertisement has a model and not a real patient of theirs. Of course, before and after photos should always be un-retouched. Lastly, plastic surgeons should identify if the photos on their websites are actually theirs or generic. All before and after photos on my website are actual patients that have given us written consent for use of their photos.

 As for the “bad” side of celebrity cosmetic surgery; this is a topic for another blog. I have addressed fillers in past blogs. For some reason, if 1 cc of filler is good for a lay person’s lips or cheeks, for some reason in Hollywood they think 3+ syringes is better.

Celebrities often look better in magazines as a result of Photoshop. Plastic Surgeons cannot do this, so why can the media? Steven J. Pearlman, MD, FACS

Late last spring I was interviewed by Inside Edition on Bristol Palin’s surgery. To view the video click here:  Inside Edition Palin chin  The producers brought photos for me to comment on her jaw surgery. Ms. Palin reported that she had chin and jaw surgery to correct an abnormal bite; this is called orthognathic surgery. I don’t personally do this type of jaw surgery but sometimes it is necessary to correct an abnormal bite or TMJ (jaw joint) problems that can result from misaligned teeth. As you know, your bite can be very sensitive and even a small change can make a big difference. Even an abnormality the size of a grain of sand can alter awareness of your bite.

Jaw surgery usually has the added benefit of moving the chin forward helping to improve the patient’s profile and align facial features. If Ms. Palin truly had jaw problems, she also aesthetically benefitted from the surgery. Since her surgeon was already there, jaw surgery is sometimes accompanied by a chin implant or sliding the chin bone forward (a sliding genioplasty).  

During the interview I was asked if I thought Ms. Palin’s surgery was cosmetic. I said that I could only go by what was released to the press, that she had jaw surgery. However, the consequence of her surgery was also an aesthetic improvement. After being asked the same question three or four different times, they got a sound bite with me saying that the surgery was cosmetic. Well, yes it might have been, but as a consequence of or in conjunction with functional surgery. No matter what, she looks great. The “after” photo makes her look more like a Kardashian than a Palin.   

Weak chinks can be improved by chin implants, but may also herald jaw problems that may require corrective jaw surgery

Steven J. Pearlman, MD, FACS

National Breast Cancer Awareness Month is celebrating 25 years of awareness, dedication and empowerment. Even many pro football players are wearing pink shoes, socks and towels to heighten awareness for this devastating disease.  Breast cancer affects women young and old. While Breast cancer isn’t something that I come across as a treating physician since I confine my practice to the face and neck, this subject still holds dear to my heart. I know excellent physicians who dedicate their skills to helping victims. 

I dedicate my expertise to another dreadful cause for human suffering that is also being recognized this month – Domestic Violence.  Every 9 seconds a woman is battered in the U.S. by her partner. Over 500,000 cases of domestic violence are reported each year; however experts say that the incidence may be as high as three times that number. This applies to teenage relationships as well.

We are doing our part by participating in the Face to Face program of the American Academy of Facial Plastic and Reconstructive Surgery. The organization offers complimentary consultations, surgery, counseling and support to shattered victims of domestic abuse who otherwise would not be able to afford reconstructive or facial plastic surgery. My office is taking action against domestic violence and offering pro-bono reconstructive surgery through Face to Face. Facial trauma is a visual reminder that can never be hidden. The brave lady below met with me last spring through the Face to Face program. She had reconstructive surgery of her nose and a deviated septum. Her new nose means so much more to her than just ‘a new nose’. She no longer sees her past while glancing into the mirror each morning. She now has a new career, a beautiful family, and a new reflection on life.

If you know someone who is being abused, you must get them help and out of the relationship. It’s been documented that abuse is most likely to escalate. If you know someone who has been or might be subject to domestic violence, have them call the Women in Distress 24 – Hour hot line at 954-761-1122 or visit http://www.womenindistress.org/.

This is the month to protect and empower women who fall victim to two devastating conditions: Breast cancer and domestic violence. There are many ways that you can take a stand and spread awareness on both issues. You can walk a marathon, contribute to charities, or, like many teams on the NFL, show your support by wearing pink! Steven J. Pearlman, MD, FACS

Two weeks ago was the 46^th Annual Fall Meeting of the American Academy of Facial Plastic and Reconstructive Surgery. As co-director with Dr. Rick Davis from Miami, Florida, we spent countless hours over the past year working hard to make this meeting a success. From the feedback we received, it certainly was. There were approximately 85 hour-long courses, 9 invited lectures, 10 panels, 7 half day workshops, over 100 vendors, plus a number of special luncheon sessions. By meeting time, all of the hard work was done. We spent most of the meeting just making sure things ran smoothly and that all speakers and panels stayed on time and on topic. 

The most outstanding part was the speakers that we invited. We kicked off with Dr. Timothy Marten from San Francisco, an excellent lecturer on facelift surgery. Dr. Val Lambros presented his unique ideas on facial aging, based on years of studying individuals and how they age and comparing generations within the same family. Prof. Wolfgang Gubish from Stuttgart, Germany, a prolific rhinoplasty surgeon, gave a few outstanding lectures on treating very crooked and devastated noses; a topic on which he is world renown. Dr. Raj Kanodia lectured on his personal technique of subtle rhinoplasty and minimally invasive facial rejuvenation. Dr. Fred Menick demonstrated why he is one of the recognized experts in nasal reconstruction following cancer removal. Dr. Jeffrey Spiegel gave us new insights into beauty with a lecture on facial gender transformation surgery. Three endowed lectures were also given. Dr. Fred Stucker spoke on over four decades of performing rhinoplasty. Dr. Mohit Bhandari discussed the ever growing field of Evidence-Based Medicine. Dr. Richard Linnehan gave an inspiring presentation having flown four Space Shuttle missions. 

Overall, running this meeting was a busy but very rewarding experience. Having been involved in academic medicine for 24 years, I am able to fulfill one of the original definitions of doctor: to teach others.

Steven J. Pearlman, M.D., F.A.C.S.