I have had a number of patients, friends and family of friends ask me about the Lifestyle lift. This is a company with very enticing advertising and superb before and after photos. I have a few problems with this approach. According to the Hippocratic oath, medicine is supposed to start with a doctor-patient relationship. Before embarking on an invasive surgical procedure it is important to know your doctor and his capabilities; yes this is invasive and major surgery no matter what people tell you. The lifestyle lift is a company based in Detroit that opened centers throughout the country where patients are directed from their advertising. They employ dozens of surgeons of varying skill and experience to perform a basic suture plication facelift.  

Over the past two decades facial rejuvenation has made a large paradigm shift. As facial plastic surgeons, we used to do two things to the face: peels or dermabrasion for skin color and texture, and facelifts to surgically lift sagging faces. Now we do more commonplace things: Fill theFace. Enter Botox^®; Botox^®  has been used for cosmetic purposes since the early 1990’s and was first published in medical literature in 1992. I don’t feel I need to go into much more detail here since Botox^® has been significantly covered by the lay media and in advertising. Check out my site link for more info: http://www.mdface.com/procedures_botox.html. The other area of facial rejuvenation that is rapidly growing, both literally and figuratively, is facial fillers.  Looking back to the early 90’s, we had very few choices for facial fillers. Other than a few fillers that came and went, all we had was Collagen. Collagen was an excellent product to treat facial lines. The addition of Zyplast, a thicker version of the original Zyderm type Collagen, allowed us to go a little deeper and treat some facial folds. Some docs even started injecting Collagen into lips (beautiful lips are another story for another time/blog). The biggest drawback of Collagen treatment was that it didn’t last very long, plus you had to come in for a test one month prior to make sure you weren’t allergic. 

Around the same time that Botox^® was first being used for wrinkles, my friend Dr. Sydney Coleman was modifying the once little-known technique of fat transplantation to create what is considered to be one of the most dynamic contributions to cosmetic surgery for that entire decade. Despite controversy over the longevity of fat transplantation, Dr. Coleman expounded upon the concept of facial deflation with aging. Few surgeons ever considered this third dimension of facial aging: that we lose facial volume as we age. From the first time I saw Dr. Coleman lecture on facial fat transplantation, it became evident that facial volume loss is significant in many of our patients. However, performing fat transplantation correctly to get longevity is akin to a surgical procedure and may be accompanied by significant post-treatment swelling. As I started to perform fat transplantation, I realized that the evaluation of facial volume is necessary in all patients.  With the new Millennium, so came new fillers to the market. With so many available fillers we have long lasting products that can be taken out of a box instead of surgically removed. The process of facial volume restoration is now much simpler. We can treat facial lines, wrinkles, folds and even restore significant volume loss without a surgical procedure.  So, which filler to choose? Firstly, are we treating lines, folds, crevasses or volume? Treatment differs for each. The more superficial the wrinkle, the thinner the filler required. Longer lasting (thicker) fillers often leave lumps. The filler needs to fit the treatment; here are my current choices for facial fillers.  

• Superficial etched or “stiletto” cut lines. These can be along the corners of the mouth, smile lines around the mouth (naso-labial folds) and around the eyes: Cosmoderm, Restylane Fine Lines (not FDA approved so I don’t carry this yet), and Juvederm
• Facial folds, naso-labial folds and marionette lines below the corners of the mouth: Juvederm, Restylane
• Crevasses (deep folds), same as facial folds only deeper: Juvederm Ultra, Perlane (thicker version of Restylane), Radiesse
• Facial Volume Enhancement, cheeks, hollowing below the cheekbones, jawline, temples and under the eyebrows: Juvederm Ultra, Perlane, Radiesse, Sculptra, fat grafting 

When deciding which filler to choose, an easy guide is: the longer a filler lasts, the higher the price, the longer the healing time and potential side effects.  I purposefully left out the latest filler to be approved, Artefill. I choose not to use Artefill at present. Its predecessor, Artecoll was available in Europe and Canada in the past. Some patients developed granulomas (small lumps under the skin) up to three or four years following treatment. The manufacturer claims that the cause has been eliminated. Since there are so many reliable options already available, I prefer to wait a few years to make sure Artefill is completely safe before using on my patients. If you are being offered this by a surgeon I advise you to research further before consenting to Artefill injections. Remember, all aging still cannot be fixed with injections.

We can relax and fill the face but none of these (nor any existing laser) can really re-suspend sagging facial tissue like surgery. Beware when you are told about a “non-surgical” facelift. A true non-surgical facelift does not exist; it is fancy marketing speak for in-office quick fix procedures that are, in essence, nothing like a facelift in technique or result. Needle injections, lasers and peels can make faces look much younger but they will not lift the face. So, which facelift, short flap, deep-plane, SMAS lift or lifestyle lift is right for you? I will address this in a future blog. 

For those of you who had the kindness and interest to read to the bottom, what’s filling up my life are my new twin girls born October 2, 2007. Certainly not a relaxing undertaking to be sure, but the ultimate definition of “true beauty” as far as I can see. 

Remember the “old days” when this was an annual composition that you wrote in school every September? Well, I am going to revive this tradition. 

My summer started off with a few medical seminars. Boring? Not really. I actually enjoy speaking at meetings and teaching. Giving a lecture to doctors in my own specialty keeps me at the top of my game, since I need to give information that they will feel is useful and worth having spent the time and money to come to the meeting. In early June I spoke on Rhinoplasty and facial aging at a seminar in Las Vegas at the Multi-Specialty Foundation for Facial Plastic Surgery. There were over 500 facial plastic surgery specialists at that meeting. Two weeks later, I was on the faculty for the AAFPRS (American Academy of Facial Plastic and Reconstructive Surgery) semi-annual course in rhinoplasty held in Boston. This course is considered by many to be the premiere rhinoplasty course of the year.

Just two weeks later my wife and I traveled to Los Angeles to spend the 4^th of July holiday with my in-laws. L.A. is a great place to visit. I got to combine all my passions: family, friends, golf and facial plastic surgery. The trip started with a mellow 4^th where we got to watch the fireworks from Gladstones; a timeless beachside restaurant. Friday, I spent some time visiting with a friend and fellow facial plastic surgeon, Dr. Raj Kanodia. I had the opportunity to observe him performing surgery and learned why he has become one of the most sought after rhinoplasty surgeons on the west coast.

Later that day, I played a round of golf with a friend of the family, and brilliant physician, Dr. Marty Gordon and a surprise guest, our mutual friend Dr. Bill Binder. By coincidence, Bill is a friend of Marty’s as well as having attended the same residency program that I did. Bill happens to be my personal “guru” when it comes to facial implants.

Saturday, was a little quieter, we spent the afternoon at Dr. Andrew Frankel’s pool with his wife and two fabulous children. Yes, another accomplished facial plastic surgeon, L.A. rising star and good friend. That night was a barbecue at my in-laws with a few of their friends. As always, a few ‘celebs’ dropped by. After living in LA for over 30 years, my in-laws certainly know a lot of people.

Sunday was another round of golf, with yes you guessed it, another friend and skilled facial plastic surgeon, Dr. Paul Nassif. By coincidence, we played at the very same course as I did on Friday, Wilshire Country Club, although this time I scored much better than I did on Friday.

In early August, we spent a week (actually my wife was there for a week, I spent Thursday afternoon through Monday night) in Shelter Island. It was a very relaxing time; sitting at the beach, hanging with my brother, sister in law and good friends, reading and enjoying the beautiful surrounds of Shelter Island. We had the good fortune to spend two more weekends on Shelter Island, one in the early summer and the second in September. The latter was to attend the wedding of my close friend and celebrity cosmetic Dermatologist, Dr. Howard Sobel.

Now that the summer is over, it’s time to spend more time at home. This is perfect timing since my wife and I are expecting twins very soon. Keep posted for updates on the twins. I hope you all have a great fall, I know mine will be!

Revision rhinoplasty is my specialty. I am often called on to reshape noses that are “pinched” or deformed from previous surgery or traumatic injury. Many times I will also revise noses that are too narrow or collapsed from trauma or just plain old do not function well.

My background is in Ear, Nose and Throat surgery, so I feel I am adept in creating a more functional and sculpted nose for my patients. To quote a traditional architectural theme, in terms of the nose, “form follows function.” It is my passion to restore this function.
Most of the functional and breathing problems I encounter deal with blockages of the nose from conditions like a deviated septum and sinusitis. I can address both of these issues at the same time.

I perform a thorough exam of the inside of the nose during your consultation, using a specialized headlight for viewing the nose. Sometimes I may need to use nasal endoscopic equipment to get a better view.

Other nasal procedures that I perform are septoplasty, reconstruction of the skin and structures of the nose after removal of skin cancers and correction of septal perforations.

If you have any questions on Rhinoplasty, please feel free to contact my office for a consultation. For more information on Rhinoplasty or other cosmetic surgery procedures, please visit my web site. Here you will find detailed information and before and after photos.