Somnoplasty of the inferior nasal turbinates is a non-surgical treatment for the improvement of air flow and breathing through the nose. Prior to Somnoplasty availability, patients with nasal breathing obstruction had only one choice, surgical correction. Deviated nasal septum’s and enlarged nasal turbinates cause nasal obstruction, recurrent sinusitis, and snoring. Patients with nasal obstruction had to have surgery under anesthesia, many times with uncomfortable nasal packing left in their nasal cavities for days after the surgery, hemorrhage, and other complications.

Fortunately today, in the vast majority of nasal obstruction cases due to a deviated nasal septum or enlarged turbinates, Dr. Persky is able to treat the problem without surgery. Since using Somnoplasty of the turbinates in 1998, Dr. Persky has been able to avoid surgery in about 75% of his patients presenting with septal deviation and/or turbinate hypertrophy.

Using precise radio-frequency energy, Somnoplasty shrinks the volume of turbinate tissue, improves nasal breathing, and helps with snoring. It is a 30 minute treatment in the office with topical anesthesia inside of the nose. Once the nasal mucosa is numb from the topical anesthesia, lidocaine is painlessly injected into the turbinates for further local anesthesia. 2 to 4 areas in each nostril are then treated with the radiofrequency for about 1 to 2 minutes each. There may be a mild sensation of heat or transient dull achy feeling during the application of the radiofrequency energy. There may be a few drops of blood after the procedure from the needles, but uncomfortable packing has never been necessary in the hundreds of patients treated by Dr. Persky, as the bleeding is minimal.

Patients are able to leave the office by themselves and return to work the next day. It feels like a stuffy nose without being sick. The stuffy nose lasts for 3 to 7 days, at which time nasal breathing returns to the pre-treatment state. Breathing and air flow through the nose continue to improve over the following months. 95% of patients require only one treatment, 5% a second treatment.

If nasal obstruction was the cause of the patient's snoring, then a side benefit of the treatment is a very happy spouse or bed partner. As they say, "When you laugh, the world laughs with you; when you snore, you sleep alone."

The Fraxel Dual Laser is the latest and most effective improvement in laser therapy for the treatment of bothersome brown spots. Certainly, Fraxel Dual is not as exciting, romantic, or dangerous as the "duals" created by Alexandre Dumas in his classics, "The Three Musketeers" and "The Count of Monte Cristo", but when treating brown spots on the skin, worthy of Athos, Porthos, and Aramis' motto, "One for all, and all for one!"

Fraxel Dual is a quick, easy, and painless laser skin rejuvenation safely performed in the office. Downtime is minimal involving 2 to 3 days of redness and swelling followed by another 4 to 7 days of peeling (like after one of those early summer sun burns when we were sun worshipping teens). The face, neck, chest, hands, and any other area of the body can be treated. The laser is 25% faster than previous technologies.

Patients comment that their skin looks and feels rosy and fresh, and that even fine wrinkles are improved. One of our most recent patients who had previous experience with multiple series of IPL (Intense Pulsed Light) laser treatments remarked, "The Dual is great, it is like IPL on Steroids!"

I am sure that you will be seeing and hearing a great deal of positive press in the near future regarding Fraxel Dual skin rejuvenation. In the meantime, if you have not yet read "The Count of Monte Cristo" I recommend it highly. Enjoy!

Be well.

Fraxel restore is the original Fraxel laser product, a fractionated Erbium laser that works at 1550 nanometer wavelength. It is non-ablative, heats the skin in pixilated columns that results in collagen stimulation over time, resulting in improvement of fine to moderate lines and wrinkles, and improvement in skin pigmentation (as well as tone and texture). The older Fraxel restore required a series of treatments (4-6) separated by about 2 to 3 weeks. The Dual's 1550 has been modified to be faster, more effective, and more comfortable than the prior Fraxel re:store laser. Usually patients will require 3 instead of 4 treatments with this laser as compared to the previous version. It is also effective for the treatment of acne, traumatic, and surgical scars.

Fraxel Dual laser adds another laser to the restore laser. The new wavelength is 1927 nanometers; it is a Thulium laser (say that a few times in a row). 1927nm is very specific and effective at treating brown pigment including sun damage lentigines (sun spots), aging spots, and studies are being conducted for the treatment of melasma. In a single treatment, remarkable clearance of pigment occurs within 7 to 10 days. The treatment is very tolerable, either with or without numbing cream. The face as well as the entire body can be treated. Unlike IPL treatments, usually 1 to 2 treatments are all that are necessary for fresh rosy skin.

Patients also like the comfort, quickness, and uniform application of the laser. Solta, the company that makes Fraxel, will not be offering stand alone Fraxel restore units. They will only be selling the "Fraxel restore Dual". Another advantage of the Dual is that the two laser treatments can be combined at the same treatment session for those patients who desire a deeper treatment for collagen stimulation along with eradication of brown spots.

We believe that Fraxel restore Dual will be a very popular treatment, especially here in California. Many of the first patients treated have been actresses, treating their face, chest, and hands. Patients are extremely happy and excited with their fresh new skin. The big question is how long will the results last? That will depend on the individual patient, their sun protection habits (including clothing, hats, physical sun block, etc.), and in melasma patients their hormone levels (which should be normal at the time of treatment).

Dr. Persky is proud to be the first facial plastic surgeon in Southern California to offer his patients all of the available Fraxel laser platforms including Fraxel restore Dual and Fraxel repair.

Good luck, be well, and wear your sun screen.

Dr. P

British comedian and 2010 Golden Globes host Ricky Gervais was entertaining and funny at the awards show last night. He even commented on plastic surgery in his opening monolog: "Seriously folks, as I look at all of the faces and stars in the room tonight I am reminded of the great body of work that has been produced this year by.......plastic surgeons."

It is surprising that there aren't more fractured noses given the number of times our noses are traumatized, especially our active children. The most common question and cause for concern after nasal trauma is, "Doc, is the nose broken?" Here are 10 tips on broken or fractured noses :

1. Don't panic. All bleeding eventually stops. Apply pressure with your fingers to the upper 1/3 of the nose, and hold a little pressure on the nostrils while squeezing them, holding a few Kleenex under the nostrils.

2. Put some ice on the bridge of the nose, and avoid blowing the nose.

3. It is seldom necessary to rush into surgery to correct the nasal fracture, as it is best to wait at least 5 days for the swelling to resolve, especially in children. Unfortunately, unsuspecting parents may be exposed to an unethical surgeon who will immediately operate on the child's nose even before the swelling has resolved. Many of these children do not need surgery, and are exposed to the unnecessary risks of anesthesia and surgical complications such as severe hemorrhage.

4. The nose should be checked by a facial plastic or ENT (ear, nose, throat) surgeon within 12 to 24 hours of the injury to make sure that there is not internal nasal septal bleeding (a septal hematoma, a very rare condition that is the only reason for immediate surgery). The child should then return for re-examination 5 days later.

5. Apply "baggies" of frozen peas to the bridge of the nose during the first 48 hours after the trauma. The cold packs can be kept on for 10 to 15 minutes and then off for 10 to 15 minutes.

6. Have your child keep his/her nose above the level of their heart when lying down, and when sleeping (sleep up on 2-3 pillows). This will help keep the swelling down, as well as help with breathing.

7. X-rays of the nose usually don't mean a thing other than for insurance companies and medical-legal reasons. Once the swelling has resolved, the nose will either be visibly crooked or not. The decision to treat the nose is made by clinical examination. If the bones feel and look straight, surgery is not necessary. I have seen fractures where the X-ray showed broken bones, but the nose was straight. These noses heal well by themselves. On the other hand, there have been noses where the X-ray appeared normal, but the nose was quite crooked.

8. The only surgery that should be performed on a child's crooked, recently fractured nose is a "closed" nasal reduction which involves manipulating the nose with an instrument inside the nostril. No incisions need to be made. The closed reduction should be performed between 5 to 14 days after the injury. By 18 days, the nasal bones may have healed and are difficult to shift back.

9. If "open" surgical correction is necessary, it should be delayed at least 6 months to allow for full healing from the trauma. It should also be delayed until your child is past puberty, and their growth has slowed down. If they have a deviated septum with difficulty breathing, sometimes the surgery can be performed earlier.

10. When in doubt, always get a second opinion, and choose your physician carefully. Be well!

Dr. Persky was honored this month to be included in the January 2010 issue of Los Angeles Magazine as one of the Southern California "Super Doctors" in Cosmetic and Reconstructive Surgery. Key Professional Media asked 31,000 medical professional to nominate one or more doctors, other than themselves, from specified medical specialties based on the one question: "If you needed medical care, which doctor would you choose?"
Happy and healthy 2010 to all. Be well.

Here is a list of frequently asked questions about the new Fraxel Dual Laser by Solta:

What is different between the new Fraxel re:store Dual and the older Fraxel re:store?

The Fraxel re:store Dual is a combination of the 1550nm laser which the older re:store had, and the 1927nm laser, which is the only laser with this wavelegth. With the older Fraxel re:store, 4 treatments were recommended, now the same correction with the Dual can usually be done in only 3 treatments. The improvements in the 1550nm are:

Faster Treatment Times - With upgrades in the software, you can cut treatment times by about 25% and have no degredation in effectiveness More Comfort - The new handpiece has an integrated Zimmer Cooling Device (cold air) which allows for the skin to be chilled directly where the treatment is occuring.

The 1927nm wavelength allows for:

Groundbreaking pigment eradication - The 1927 allows for a very superficial resurfacing which can eliminate pigmentation from melasma, hyperpigmentation, sun damage, actinic keratosis safely in all skin types, on all parts of the body. It is thought that it will be more effective in treating melasma as it produces minimal heat compared to other laser systems.

Extremely comfortable - very little, if any topical anesthesia is needed for using just the 1927nm laser. This allows for large surface areas to be treated in a single session.

Superfical resufacing similar to a superficial CO2 laser resurfacing - without the downtime or wound care. It is partially ablative, partial nonablative.
When used simultaneously with the 1550nm laser, you get more effective resurfacing - a superficial and deep resurfacing - leading to less treatments for the same results.

Safe for all skin types and all body surfaces.

Please explain further the Fraxel Dual 1550nm nonablative fractional resurfacing?
Fractional laser resurfacing is treating a fraction of the skin with the laser and leaving the majority of the skin uneffected. Typically about 20-35% of the skin is treated with microthermal zones (MTZ's). These MTZ's are columns of tissue heated by the laser that are about 1/10'th the diameter of a hair. By only treating a portion of the skin, the downtime and risks are minimized but the treatment depths can actually be higher - leading to more effective treatments. The 1550nm laser is an Erbium laser which is a rather "cold" laser. It causes very little "peripheral" damage when creating MTZ's, and just heats the tissue. This is nonablative resurfacing. In contrast, the CO2 laser vaporizes tissue (removes tissue) which is ablative resurfacing. Typically, nonablative resurfacing will require multiple treatments, and will have minimal or no downtime.

What can this laser do?

FDA indications include treatment of pigmented lesions, acne scars, melasma, mild to moderate periorbital rhytids (wrinkles), surgical scars and actinic keratosis. Physicians have been using the 1550 nm restore for stretch marks, burns, improvement in pore size with great results. The addition of both wavelenths in a single treatment makes the improvements faster and increases its effectiveness.

For pigmentation, should I do IPL or Fraxel Dual?

An IPL is limited by the natural pigmentation in the skin. If there is a large difference between the area of pigmentation which one wants to remove and the natural skin color, IPL is effective. However, if the pigmentation is light, or very close to the skin color, an IPL has trouble safely removing the pigment. The Fraxel Dual does not care what skin color you are or what color the pigment is. It works by going down to the layer of skin where the abnormal pigment is, and renews/resurfaces it. An IPL can take up to 4 treatments to remove pigment and the Dual should take 1 or 2.

What can I expect after the procedure?

You will have pinkness and mild swelling for about 3 days. There is no wound care, and no dressing changes. Your skin will feel dry and we recommend a moisturizer such as SkinCeuticals Hydra-Balm or Epidermal Repair, Cetaphil, or Aquaphor. After a few days your skin will bronze and feel rough. It is about to peel at this time, and the peeling will take about 3 days to complete. Your skin will then look very refreshed and pink and will return to its natural color in about 5-10 days. By 10 days, my patients look like they have make up or powder on because of the uniform color of their skin.

What are other physicians saying about the Dual?

“With the new technology I can offer my patients the safety, comfort and minimal downtime of a non-ablative treatment and achieve results comparable to superficial fractional CO2 treatments. Dr. Vic Narukar, San Francisco, CA

“The expanded versatility of the Fraxel re:store Dual System, with the addition of the new 1927 nm wavelength, increases the number of patients I can treat by providing a safe and very effective treatment for the pigmentation and actinic keratoses associated with photodamage.” Dr. Roy Geroneumus, New York, NY

"I think that Solta Medical (Fraxel) is underestimating the potential for the 1927 laser. I have seen tremendous improvements in my patients in areas other than pigmentation. The beauty of the minimal downtime and minimal discomfort makes this laser very well received with clients, particularly with its effectiveness. This might be the most effective laser vs downtime on the market. I’m very excited about its possibilities." Steve Weiner, MD Santa Rosa Beach, FL

"It is the best Dual since at least Hamilton-Burr" Michael A. Persky, MD Encino, CA
If you should have any further questions or concerns regarding this incredible new technology, please contact me. Be well and wear you sun protection. Dr. P

Seeing is believing. After treating his own patients and closely following the remarkable results of their treatments, Dr. Persky has added the Dual Fraxel Laser System to his Encino practice where many of Beverly Hills and Hollywood's "faces" are treated. Dr. Persky is the first facial plastic surgeon in Southern California to offer his patients all of the available Fraxel platform laser treatments including Fraxel restore, Fraxel repair, and now Fraxel Dual (renew). Dual is the premiere laser treatment for the removal of brown spots, aging spots, and melasma. Dr. Persky has treated patients worldwide with Fraxel lasers, and is very excited about this groundbreaking technology.

The advantages of Dual Fraxel treatment are that up to 50% of the face, and 40% of body surface areas may be treated at one time. In the past, only 20 to 30% of facial and body skin could be treated requiring 3 to 5 treatment sessions. With Dual, most patients require 1 to 2 treatments.

Dual treatments are not only very safe (only the upper 0.2 millimeters of the skin is treated) and effective, but are also quick and relatively painless when compared to the other laser treatments currently available. It can be adjusted to treat all skin types and skin colors.

Fraxel Dual is 2 lasers in one, an improved Fraxel restore for wrinkles, scars, strechmarks, pigment which is faster, involves less treatments, and less discomfort. The second laser system is a unique, new wavelength added - 1927 nm - for rapid resolution of pigment on any skin type, any part of the body with one or two treatments. Superficial resurfacing similar to superficial CO2 without the downtime.

We are most excited about helping our patients get rid of those bothersome age related brown spots on their face and body. So whether it's on the "Red Carpet", or in the grocery store check-out line, we are pleased to have added more one tool to help you achieve your cosmtic goals. Be well and wear your sunblock.

Botox and fillers will become more popular and the cost of cosmetic surgery will continue to rise, according to a group of industry experts, who recently released their forecast for the top ten plastic surgery trends of 2010 according to the editors of Consumers Guide to Plastic Surgery.

Here are the top ten trends in Plastic Surgery for 2010 (sorry not as exciting or funny as David Letterman's Top 10 List):

1. There will be a 5% tax on elective cosmetic procedures (recently voted down by the Senate in the Health Bill, thankfully).

2. A larger variety of fillers to go with Juvederm, Restylane, and Radiesse. Novabel and other new fillers will hit the market.

3. A continuing rise in non-invasive, non-surgical procedures. (Dr. Persky agrees. Procedures such as Sculptra, Fraxel repair, and Fraxel's newest laser, Dual, as well as in office blepharoplasty under local anesthesia have become very popular)

4. An increase in fat grafting for breast augmentation.

5. FDA approval of cohesive gel "gummy bear" breast implants.

6. Fat freezing liposuction, the recently FDA approved Zeltiq is the first to hit the market.

7. An increase in non-surgical fat injection liposuction "mesotherapy", which melts fat with injected chemicals (Dr. Persky does not agree with this unless there are major respected scientific studies that show that it is safe and effective. The past 5 years have seen many mesotherapy "spas' closed down and out of business).

8. Improved body contouring for bariatric (obesity surgery) patients.

9. Non-invasive tummy tucks.

10. An increase in face implants (again Dr. Persky disagrees as face implants not only look unnatural, they require a surgical procedure. Sculptra will be the preferred biologic facial volume filler of the immediate future).

I believe that we will continue to see more non-invasive facial procedures, as well as the non-surgical management of fat and cellulite.

Happy, healthy, and prosperous 2010!

Old man time, he’s so mean Meanest man you’ve ever seen

He gives you youth; then he steals it away He takes your nice pretty hair; turns it gray.....

He gives you beauty charm and grace Then puts wrinkles on your face.

Those are a few of the lyrics of Jimmie Durante's old song "Old Man Time". I was approached by a young, 49 year old woman, at the gym a few weeks ago. We had spoken about my practice as a facial plastic surgeon many years before. She told me that she was "turning 50" and wanted to come in for a little rejuvenation of her face, and asked what I would do. She said that her husband is not a big fan of plastic anything, but that he would be willing to give her a 50'th birthday present at my office if that is what she wanted.

She asked the common question that makes those in my profession cringe. We are too often asked, usually in front of too many others, "What would you do to improve my face?" Having grown up in a household with two sisters, no brothers, now living with two daughters and no sons, and working with seven women, no men, I know how to answer the question....with calm silence followed by, "What bothers you?"

She is the perfect example of an athletic, fit, good looking woman who has never "had anything done". Loss of volume in the face particularly in the temple area, the cheeks, and jaw line result in nasolabial folds and early jowls, and a overall tired look. Sculptra is an excellent choice to use to return her face to a more youthful oval, fuller, rested state.

By 50, most upper eyelids have a bit of excess lax skin that can be easily remedied with an upper eye lid skin only blepharoplasty performed under local anesthesia in the office. Four days of stitches, five to seven days of minimal bruising, and wah-la, a much younger appearance. Her lower eyelid hollows could be corrected with a small amount of Restylane.

Lastly, the sun damage from those days at the beach. Fraxel Dual is a revolutionary new wavelength (Thulium 1927) that enables better treatment of pigmentation and other dyschromia on the entire body with minimal discomfort.

So with a little hair coloring, diet, exercise, and a short trip to Dr. Persky's office, Old Man Time doesn't have to be as "mean" as he was when Jimmie Durante sang his song.

....So you don't ever have to fret Fall in love and you‘ll forget

That’s old man, old man time… Yes old man, old man time.

Happy Birthday!

Dr. Persky is the only facial plastic surgeon in Southern California with all of the Fraxel platforms available to his patients.

American Health and Beauty, a cosmetic surgery patient information website has named Fraxel as the top fractional laser treatment in going into 2010.

Fractional resurfacing is the next level of skin treatment. With little downtime and no surgery involved, it is a popular choice for those desiring better skin.

Unlike traditional laser devices, fractional laser systems treat only a fraction of skin at a time, leaving the surrounding area intact for fast healing. Rather than a large beam of energy, there are several smaller energy columns that leave undamaged spaces of skin in between - resulting in greater patient comfort and quicker healing.

1 Fraxel
Fraxel from Solta Medical is one of the most well known of all fractional resurfacing procedures. Fraxel refers to not just one machine but a family of lasers which include the Fraxel re:pair, re:store, and re:fine. This year, they released their latest laser - the Fraxel re:pair Dual that is the first to use the 1927nm Thalium laser, allowing treatment of areas other than the face.

2 ActiveFX
ActiveFX from Lumenis is a fractional CO2 laser procedure performed in a single treatment with minimal patient downtime. During the procedure, a high-energy beam of laser light is used to smooth out lines, wrinkles and scars, remove brown spots and other irregularities. ActiveFX is the most common of a group of procedures performed by the UltraPulse Encore CO2 laser.

3 Pearl Laser
The Pearl procedure combines the impact of resurfacing lasers with the gentleness and safety of non-invasive procedures to treat aging and sun-damaged skin. Pearl, developed by Cutera, reduces wrinkles, uneven texture and solar damage with fewer treatments and less overall recovery than other technologies to provide a healthy, pearl-like glow.

4 Affirm
Affirm Laser treatments are taken to the next level with the Combined Apex Pulse (CAP) technology in the Affirm system, from Cynosure. The Affirm is a fractional light energy device that allows for a more relaxed and effective treatment with lasting results for patients.

5 eMatrix
eMatrix from Syneron became very popular in September when Sublative Rejuvenation was added to the device. Sublative Rejuvenation using eMatrix provides a safer alternative to traditional facial rejuvenation procedures. eMatrix RF with Sublative Rejuvenation is even available for many people whose skin type or skin color makes traditional ablation techniques impossible. Yes, Sublative Rejuvenation is safe for ALL skin types.

American Health & Beauty www.americanhealthandbeauty.com Source: AHB