Hi Doctor Persky, well I want to have rhinoplasty. I'm 20 years old, but there's a problem - my mom is scared that something might go wrong. How can I convince them that I'm not confident with myself and need the procedure?
Thank you Doc.


Hi Kat,

Please email a photo of your face from the front and profile, and from below as well. I will then get back to you. With any surgery there is the possibility of risks and complications, but we must weigh the risks versus the benefits. If the benefits far out weigh the risks, then by choosing the surgeon whom you feel most comfortable with (one with an excellent reputation, with results that appear beautiful to you, who understands what troubles you, and feels confident that your surgery would be successful), you have the best chance of achieving your goals with the lowest chance of something "going wrong."

In the meantime, the best thing that you can do is to let your mother know how you truly feel, what it is that bothers you, what you would be satisfied with, and let her know how it affects your confidence. Let your mom know how long you have felt badly about your nose, if you have been teased about your nose or if there have been incidents where you have been hurt, share these with her.

If you have an ethnic nose, your mother may be concerned about you losing your ethnicity, not "fitting in at family get-togethers". Let her know that it is possible to change your nose without losing your familial appearance. You may also volunteer to help defray the costs of surgery by getting a part time job, etc.

You must know that rhinoplasty is not answer to "changing" one's life. It won't get you "that job","that guy", make you more popular or anything like that.

I hope that everything turns out for the best for you. If it does not work out for you now, know that you will eventually be able to have your surgery later in life.

While you are waiting to have your rhinoplasty, I hope that you can smile when you remember the old saying about noses, “you can pick your friends, and you can pick your nose, but you can't pick your friend's nose."

Good luck and be well.

Football Hall of Fame (to be) quarterback Brett Favre has been in the news with his second "un-retirement" with the Minnesota Vikings. One of the big questions about the 39 year old Favre is whether he is too old (by football standards) to withstand the rigors of the NFL season.

The media footage of Favre with his teammates is striking in how comparitively old Brett looks. Fortunately for Mr. Favre, his employment is not dependent on how he looks. Unfortunately for many men looking for employment in today's competitive business climate, appearance does influence hiring decisions, and studies have shown that even their salaries are affected.

Higher percentages of males are now opting for hyaluronic acid fillers such as Juvederm and Restylane and/or Botox to look younger and rested. The treatments are quick, easy, and should not be "obvious" if performed correctly. As for the prematurely grey Brett Favre, shaving that grey beard stubble off will make him look years younger. Enjoy the 2010 football season! To view a recent Favre photo go to http://media.photobucket.com/image/brett%20favre/Viking_fan1/Favre.jpg?o=14

(Image courtesy: Photobucket)

Recently while cleaning out my desk I came across an article with Audrey Hepburn's list of beauty tips. Ms. Hepburn, an internationally acclaimed beauty, was allegedly a carrier for the Belgian Underground Anti-Nazi Movement in WW II as a teen. She learned the importance of a good heart as well as good character early.

Here is her list:


1. For attractive lips, speak words of kindness.

2 For lovely eyes, seek out the good in people.

3. For a slim figure, share your food with the hungry.

4. For beautiful hair, let a child run his or her fingers through it once a day.

5. For poise, walk with the knowledge you'll never walk alone.

6. People, even more than things, have to be restored, renewed, revived, reclaimed, and redeemed; never throw out anybody. Remember, if you ever need a helping hand, you'll find one at the end of your arm. As you grow older, you will discover that you have two hands--one for helping yourself, the other for helping others (by the way, Kirk Douglas in a recent article said that helping others keeps the elderly from becoming depressed).

7. The beauty of a woman is not in the clothes she wears, the figure that she carries, or the way she combs her hair. The beauty of a woman is seen in her eyes, because that is the doorway to her heart, the place where love resides. True beauty in a woman is reflected in her soul. It is the caring that she lovingly gives, the passion that she shows. And the beauty of a woman only grows with passing years.


Thank you for your wisdom Audrey, you were physically beautiful, but your soul will remain eternally beautiful.
Disclaimer: The image above is intended to serve an aesthetic purpose only and is not meant to reflect the practice of our office in any way

Dr. Persky was interviewed online by The Orange County Register's "In Your Face Chat" today. The complete transcript of the chat, along with interesting before and after rhinoplasty photographs can be found here.

Highlights included discussions about teenage rhinoplasty, Marilyn Monroe, Angelina Jolie, Halle Berry, the Olsen twins, Jennifer Grey, Ashley Tisdale, Sharron Stone, Madonna, Meg Ryan, Barbara Streisand, and Cher. The last segment of the chat included discussion about restoring lost facial volume with fillers, "The Liquid Lift".


(Image courtesy: Photobucket)
Disclaimer: The image above is intended to serve an aesthetic purpose only and is not meant to reflect the practice of our office in any way

Christine Nyholm in Examiner.com writes,
"HBO presents Youth Knows No Pain- exploring America’s obsession with eternal youth in a documentary that debuts on August 31, 2009, exclusively on HBO. Youth Knows No Pain explores the obsession with anti – aging procedures and the pursuit of eternal youth, creating a $60 billion a year enterprise."

"The anti – aging business, which caters to and fuels the fear of growing old, is a $60 billion a year enterprise in America. Mitch McCabe, the daughter of a plastic surgeon, has long been intrigued by the extreme measures that people take to maintain the appearance of youth."

"In an era when plastic surgery and injectable substances have become socially accepted age fighting options, this documentary shows how fear of aging shape a youth-obsessed culture and supports a lucrative market that holds out the promise of miracle cures. Mitch McCabe spent two years traveling the country to visit doctors, experts and anti-aging enthusiasts, interviewing hundreds of men and women ranging in age from 18to 93 for YOUTH KNOWS NO PAIN. In the process, her own opposition to “beating the clock” began to weaken."

Reigning plastic surgery (some good, some not so good) spokesperson Joan Rivers, author of "Men Are Stupid, and They Like Big Boobs" was recently roasted on Comedy Central. Cheers to Joan for having the courage to be roasted with so much on her face to be roasted about.
Here are the top 5, some from Joan herself:

1. "My motto is 'Better a new face coming out of an old car than an old face coming out of a new car.' Spend your money on you."
-- Joan Rivers

2. "You used to look your age. Now you don't even look your species."
-- Greg Giraldo

3. "I know that deep down you have a very, very warm heart, your only original part left."
-- Brad Garrett

4. "You know, my Joanie, Jewish girls are supposed to grow up and marry doctors, not support them."
-- Kathy Griffin

5. "Money can't buy you happiness, but it can pay for the plastic surgery."
-- Joan Rivers

Dr. Persky was interviewed online by The Orange County Register's "In Your Face Chat" today. The complete transcript of the chat, along with interesting before and after rhinoplasty photographs can be found by copying and pasting the following link:

http://www.ocregister.com/articles/chat-face-noon-2532299-questions-href

Highlights included discussions about teenage rhinoplasty, Marilyn Monroe, Angelina Jolie, Halle Berry, the Olsen twins, Jennifer Grey, Ashley Tisdale, Sharron Stone, Madonna, Meg Ryan, Barbara Streisand, and Cher. The last segment of the chat included discussion about restoring lost facial volume with fillers, "The Liquid Lift".

Dr. Persky was interviewed online by The Orange County Register's "In Your Face Chat" today. The complete transcript of the chat, along with interesting before and after rhinoplasty photographs can be found by copying and pasting the following link:

http://www.ocregister.com/articles/chat-face-noon-2532299-questions-href

Highlights included discussions about teenage rhinoplasty, Marilyn Monroe, Angelina Jolie, Halle Berry, the Olsen twins, Jennifer Grey, Ashley Tisdale, Sharron Stone, Madonna, Meg Ryan, Barbara Streisand, and Cher. The last segment of the chat included discussion about restoring lost facial volume with fillers, "The Liquid Lift".

Plastic surgeon Dr. Michael Persky of Encino, a member of the O.C. Register’s panel of cosmetic medicine experts, will discuss celebrity nose jobs and answer readers’ questions about plastic surgery in this week’s online “In Your Face CHAT.”

The event is scheduled for noon to 1 p.m. on Wednesday, Aug. 19.
CLICK AND PASTE HERE
http://inyourface.freedomblogging.com/2009/08/18/chat-coming-stars-nose-jobs-your-questions/9401/
to drop in on the chat during those hours or to arrange for a reminder ahead of time.

The first topic of discussion will be nose jobs, both for celebrities and regular folks. Dr. Persky will also discuss non-surgical face lifts.

Advance questions will be accepted by email and Twitter through mid-morning on Wednesday:

Email cstewart@ocregister.com with “CHAT question” in the subject line; or
Send a Twitter message referencing @InYourFace.
Or simply join us online and ask your questions live, starting at noon Pacific time Wednesday.

Because each “In Your Face CHAT” will be on the Internet, visitors can participate from anywhere - at 3 p.m. Eastern time or 8 p.m. London time, for example.

According to a report appearing in Plastic Surgical Products, there is a new filler in town. "Hydrelle, the first hyaluronic acid-based dermal filler approved by the FDA that contains the anesthestic lidocaine", has been released.

"The drug, manufactured by Anika Therapeutics and distributed in the United States by Coapt Systems Inc, is injected into the mid-to-deep dermis for the correction of moderate to severe facial wrinkles and folds, and is reportedly a cheaper alternative to traditional fillers, such as Allergan’s Juvederm and Medicis Pharmaceutical’s Restylane."

According to the firm, "patients require about 50% of typical injection volumes, meaning that fewer injections are needed to fully correct facial wrinkles. In addition, Hydrelle is marketed to produce results that are longer lasting. Side effects include swelling, redness, bumps, bruising and tenderness which might be experienced by some patients."

Preville Silk is a hyaluronic based dermal filler that was previously released. I look forward to hearing more about Hydrelle and welcome the comments from patients who were a part of the clinical studies to get Hydrelle FDA approved. I will reserve my personal endorsement of the product until I have first hand experience with Hydrelle.

As a facial plastic and reconstructive surgeon, my reputation is most important. I strive to offer my patients the best and most effective treatments available.

In the world of facial cosmetic surgery, new technologies are constantly being offered to consumers, many that have not been proven. The most recent 'It sounds too good to be true' technology is called Zerona, a passive laser treatment that claims to remove inches of fat within two weeks. I am currently following the results of early using physicians, as well as patient reports on the internet.

Another technology that I have been following now for about 10 years is Thermage, which has had inconsistent patient results. As techniques and protocols improve, perhaps I will incorporate these treatments into my practice, but until then, I will offer only tried and tested consistently effective treatments.

Here is a patient testimonial that I received today:
"3 years ago, I had a thermage treatment, I didn’t see any difference in anything. I will have a 2nd fraxel repair and even a third fraxel repair with Dr Persky, because, the one fraxel repair I had with Dr Persky did more for my skin then any other treatment I have had to date. Go Fraxel repair!!!!"

Be well. Dr. P

The film "The Picture of Dorian Gray", based on the 1890 novel by Oscar Wilde opens next week. It is the dreamlike story of a young man who sells his soul for eternal youth and beauty.

The ads for the movie cry out "FOREVER YOUNG" and "ETERNALLY PERFECT".

The parallels between Wilde's 1890's and today's facial cosmetic surgery are striking. Our desire for beauty and looking our best pre-dated even Wilde's era by thousands of years. The African beauty Queen Nefertiti and Egypt’s Queen Cleopatra stand out among others in "the quest for beauty’s" long history.

Preceding the cosmetic use of Botox by 100 years, one of Wilde's characters, Lord Henry tells Dorian, "Good heavens, my dear boy, don't look so tragic! The secret of remaining young is never to have an emotion that is unbecoming." Sound familiar? Looks familiar looking at the Botoxed faces of "Desperate Housewifes". Most of us wish to look our best, or at least "as young as we feel". Lord Henry seems to agree when he tells Dorian, "The tragedy of old age is not that one is old, but that one is young." Well, enough of this gibberish, enjoy the movie, even better read the book, and as Rod Stewart says, "May you stay forever young." Be well.
Dr. P

Disclaimer: The image above is intended to serve an aesthetic purpose only and is not meant to reflect the practice of our office in any way

I was recently asked on RealSelf.com a question about the injection of Radiesse filler for "marionette lines". The patient had received filler in the past that made her jaw and chin look masculine. She wanted to avoid this look when injected with the longer lasting Radiesse product.
Here is my answer.........

"Your question emphasizes the importance of choosing an injector physician who has the proper eye for facial proportions and beauty.

Injecting the marionette lines is not a commodity that you arrive at the physician's office (or as seems to be the trend nowadays the spa, nurse's house, or podiatrist's office) and order up like a Strawberry and Cream Latte with White Chocolate powder at Coffee Bean.

There is an art and science to injecting, and every patient is a little different.

The judgment and experience of the injector is important. As the saying goes, 'Good judgment is based upon bad experiences; good experience is based upon bad judgments'.

Sounds like you have already had a bad experience in the past; hopefully it has helped your injector's judgment."

Good luck and is well......

One of the nicest compliments that can be given or received is "What a kind face you have."

What makes a kind face? Start with the best form of plastic surgery.....smiling. Add a little sparkle of soul to the eyes. Care about others and help others. Get fresh air, exercise, and don't spend much time texting or hooked to electronic communications. Stay hydrated and wear sun block. Be grateful. Breathe deeply and often.

Once all non-cosmetic remedies have been exhausted, eliminating or softening the angry look of furrowed eye brows with a little Botox, and turning up the drooping corners of the mouth with a touch of hyaluronic acid filler (Juvederm or Restylane) will change a sad, or angry appearance to a happier, friendly, kinder look.

Or you can follow the lead of an Old English Sheep Dog, probably the friendliest dog known to mankind with the kindest face. Woof, woof!


The image above is intended to serve an aesthetic purpose only and is not meant to reflect the practice of our office in any way.

You do not necessarily have to look like you lost an Ultimate Fighting Championship fight after having rhinoplasty. Every surgeon is different, and as you can tell from the variety of answers to this question on www.RealSelf.com, some create more bruising and swelling than others.

I have found that when the proper techniques are used, my patients have a small amount of bruising around their eyes that looks like a bit of bluish-purple eye shadow for two to four days. Most of their swelling (80%) has gone down by the fifth day after surgery when the cast or splint is removed. Swelling continues to dissipate over the next few weeks; the final nasal result evolves over months to years.

I have found that injecting local anesthesia with epinephrine (adrenaline) in key locations, performing the surgery meticulously in the proper plane of dissection, and NOT using intra-nasal packing for days following the surgery are the most important points to minimize bruising and swelling.

Not using nasal packing allows for the nose to drain onto the moustache bandage and not accumulate in the soft tissues of the nose, eyes, and cheeks. Not to mention the fact that if polled, rhinoplasty patients consistently will tell you that “the worst part of having a rhinoplasty was having the packing in the nose, and having it removed days later”.

Ask to see some of your prospective surgeons post operative patients to get an idea of what you can expect from her or him. If they look like they lost that bar room fight, visit another surgeon who may pack less of a punch.

Do choose your rhinoplasty surgeon most carefully.

Good luck and be well.