Take time to enjoy the beauty of life, a wise philosophy.

Over the next two weeks we have the privilege of observing the world's greatest athlete’s compete in the 2010 Vancouver Winter Olympic Games. The beauty of the Olympians, their specialized trained bodies, instantaneous split second reactions, their focus on task all are worthy of artful inspiration. Enjoy the beauty of the 2010 Olympic Games.

Our deepest prayers of sympathy and support go out to the family, teammates, and friends of Georgian luger Nodar Kumaritashvili. We pray that his soul is bound to eternal life.

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!

Facial plastic surgery is in the midst of a revolution. It is now well accepted that the aging face results from loss of volume. There is loss and remodeling of bone and fat as we age. Thanks to the dedicated research and clinical studies by Val Lambros MD, Sidney Coleman MD, Danny Vllegar MD, Rebecca Fitzgerald MD, Joel Pessa MD, Rod Rohrich MD, and Sam Lamm MD to name just a few, plastic surgeons, facial plastic surgeons, and cosmetic dermatologists are in the midst of changing how we have addressed the aging face for the past 50 years.

Today, a large percentage of patients are able to be rejuvenated without surgery. Instead of cutting and pulling, we are filling and buffing. By replacing lost volume, natural youthful facial contours are restored. The choice of material to replace volume varies and includes Juvederm, Restylane, and Radiesse; newly FDA approved "for cosmetic use" Sculptra, or a patient's own fat. The tone, texture, color, and additional tightening of facial and neck skin can be further enhanced with fractionated CO2 laser treatments such as Fraxel repair.

By combining volume replacement with fractionated CO2 laser skin resurfacing, patients achieve their goal of looking healthy, youthful, and natural without the need for general anesthesia, operating rooms, or scalpels. As evidenced by the emphasis of volume replacement and fractionated CO2 laser skin rejuvenation lectures and instruction courses at our national and international dermatology, facial plastic, and plastic surgery meetings, there is truly an unprecedented revolution occurring in the treatment of the aging face. In patients with excessive skin redundancy, there will still be the need for surgery. For the most part though, the future facial cosmetic surgeon will likely be asking, "Syringe please" instead of "Scalpel".

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.

Seth Godin, author of "The Dip", many other books and daily blog has discussed "Beauty" in his blog today. His article is true not only for facial cosmetic surgery, but to all facets of our lifes that we add value to. His article begins, "What's beauty? You know it when you see it, sure, but what is it? It turns out that beauty is an important evolutionary byproduct. An organism needs to invest energy in being beautiful. You won't see healthy skin on a sick animal, because maintaining a healthy coat is too 'expensive'. A sick peacock isn't as spectacular as a healthy one. Or a genetically damaged chimp isn't going to have as symmetrical a face. As a result, most creatures evolved their definitions of beauty in a mate to match the displays of healthy creatures. Human beings have adopted this signaling strategy with a vengeance. I know a woman who is going to spend more than $9,000 having her hair styled in 2009 (hey, that's less than $200 a week). Entire industries are based on human beings spending time and money in order to manufacture temporary physical beauty. Businesses build lobbies that they rarely use, giant atriums with big windows and lots of empty space. It's a waste, it's expensive and it's beautiful. It's beautiful because it's expensive. Stop for a minute and think about the relationship between expense and beauty. Do you make something beautiful? It could be the way you write hand written letters or leave a little extra on the product, even if maybe it's not so efficient. Sometimes efficiency is beautiful, but only when it took a lot of extra effort to get there. Ordinary products are almost never beautiful. Austere products might be, but only when real effort is expended to make them that way." To read the entire article go to http://sethgodin.typepad.com/seths_blog/2009/01/beauty-as-a-sig.html. You can subscribe to Seth Godin's daily blog.

Facial beauty is all about symmetry, volume, tone, texture, and color. As we age, we lose volume from our faces, especially in the midface area, under the lower eye lids, and in the "marionette" area below the corners of the mouth. Additionally, sun damage causes dyschromia (brown and red spots), and causes changes in tone and texture. As grim as this may sound to those who wish to look (as in the words of Rod Stewart) forever young, there are non-surgical methods of recreating and maintaining volume, tone, texture, and color. These non-surgical techniques include fractional CO2 lasers, fillers, and neuromuscular modulators. A single Fraxel re:pair treatment will improve tone, texture, and color of the skin, as well as restoring some volume to the midface. Fillers such as Juviderm, Restylane, Radiesse, and patients own fat will restore volume. Neuromodulators such as Botox will help eliminate wrinkles caused by excessive muscle movement in the upper third of the face. By using these modalities, facial plastic surgeons now have safe, dependable, and effective non-surgical techniques to restore and maintain youthful faces. These techniques involve the artistic skills of a sculptor combined with the knowledge, discipline, and scientific skills of a cosmetically trained surgeon. Choose your cosmetic physician carefully. Trust your face to a Facial Plastic Surgeon.

There are three characteristics that are common to beautiful faces. They are in no particular order: 1. The Nose. The nose should get out of the way of the other facial features. A natural nose that does not attract attention; and allows attention to be focused elsewhere on the face (the eyes and mouth). 2. Volume. A beautiful face maintains its volume, especially in the midface (cheek) area. As aging progresses, the volume of the face decreases, giving a deflated appearance. 3. Jaw line. The jaw line should be relatively straight without one of the earliest signs of aging, the dreaded jowl. By filling the pre-jowl sulcus with volume, beauty is restored to the jaw line. 4. Skin. Healthy, vibrant skin without the signs of sun damage (brown spots, wrinkles). Use of sun blocks, and when indicated Fraxel repair laser will restore youth to the skin. These four secrets" of beauty are a simple guide to restoring youth and beauty to an aging face.

Patients in their thirties and early forties begin to show signs of aging because of loss of volume. Early signs of jowl formation and loosening of the skin of the neck and face are common complaints in my practice. It is surprising to hear how many of these patients have spoken to surgeons who have recommended major facelift surgery. I find that by using a combination of non-invasive treatments, patients can maintain a natural improved appearance without the risks and downtime of major surgery. Accent XL radio-frequency treatment can tighten the loose skin around the jowls and neck. Radiesse injected from inside the mouth to the cheeks restore lost volume of the face without bruising or lumps. Fraxel laser can improve the color and texture of the skin, as well as improving fine to moderate wrinkles. The benefits of Properly placed Botox are well known. As aging continues, then fat transfer can be used to more dramatically restore facial volume and contours. As a photographer of "the stars" shared with me today, "There are some celebrities that look as if they want everyone to know that they have had work done, but they don't look good. Then there are those who look fabulous, whom you know have had work done, but can't tell what it was that they did to look so good". Save surgery as a last resort, when it comes to facial rejuvenation often times "less is more".