Los Angeles dermatologist, Dr. Jessica Wu reports that there is a hot new reason for aging of the skin, heat. Here is her report:

"Beware of your heater and fireplace!

We’ve all heard that the sun’s UV rays can damage the skin, leading to wrinkles, sun spots, and premature aging. But recent research shows that heat can also damage your skin in much the same way. Chronic heat exposure (like from sitting too close to a fireplace, or using a hot water bottle continually) can cause a condition called “erythema ab igne,” which produces mottled, red-brown patches on the exposed skin. At first, the blotchy discoloration can fade when the skin is protected from the heat; however, it can eventually become permanent if the skin is repeatedly exposed to high temperatures.

New studies show that heat can damage your skin even before you see this type of discoloration. Exposure to heat has been shown to destroy collagen and elastic fibers in the skin, so over time, high temperatures can lead to thinning of the skin and eventually premature wrinkling. Heat, just like UV rays, has also been shown to stimulate angiogenesis (new blood vessel growth), which can lead to “broken” capillary veins, red blotches, and uneven pigmentation. Lastly, heat has been shown to generate “free radicals,” which are particles that damage collagen and DNA in your skin.

Based on this new information, scientists are now suggesting that heat may cause aging in human skin. Therefore, in addition to sunscreen to block the effects of UV rays, it may also be important to protect your skin from heat. So what should you do?
Avoid sitting directly in front of the heater or fireplace for prolonged periods of time. If you notice your skin becoming red, turn down the heat or walk away to cool down. If you use a small space heater near your desk or chair, change its position so it doesn’t continually hit the same part of your skin."

Or if you are like me, enjoy the fireplace with a little hot chocholate, just don't sit too close. Be well. Dr. P

I recently ran across this article published a few years ago in the Long Beach Hillel.

"A 24-year-old woman today was saved from death by a rocket in the most peculiar fashion. No, not by a handsome Israeli soldier-man sweeping her off her feet (although I’m sure that she, along with many other women, wouldn’t mind), but another matter of the heart.

According to a hospital in Netanya, this woman had rocket shrapnel in her chest, which was inches from her heart. However, they were caught… in her breast implants.

Yes, breast implants.

I don’t know if this goes into support of the plastic surgery that tends to run rampant in the Jewish community. But who would have thought breast implants could produce miracles? According to the doctors at the hospital, if she didn’t have them, she would have never survived.

Well, um… ookay. All right, carry on!"
Say what you will about breast implants, but they were a life saver for this woman. Be well.

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.

Rhinoplasty is a permanent surgical procedure, so the results should last your lifetime. The most important aspect of your rhinoplasty is choosing an experienced and skilled rhinoplasty specialist whom you can trust with your nose. Rhinoplasty is considered the most difficult of all facial plastic surgical procedures.

Everything about your proposed surgery should be explained to you by your surgeon at your consultation and again at your pre-operative appointment. You should have pre-operative lab work and surgical clearance from an internist if indicated.
On the day of surgery at our office, your anesthesiologist and nurse will ask you a few questions before taking you into the operating room suite. Once you lay down on the bed, you are made comfortable by the nursing staff with pillows and warm blankets. Once the monitors for your heart, blood pressure, and oxygen level are in place, the only uncomfortable thing that you feel is the small amount of numbing medicine that the anesthesiologist injects next to a vein in you hand. The I.V. is then placed painlessly. At this point the anesthesiologist gives a little medicine in the IV that makes you feel very good ("Just Say NO to Drugs, except in the operating room), then we ask that you think of your favorite place with your favorite person, and you are off to pleasant dreams and a restful sleep. Our anesthetists usually use a medication called Diprovin (made famous by Michael Jackson, but in our center only board certified anesthesiologists administer the medication with proper monitoring) and once you are asleep they then place a laryngeal mask (LMA) to facilitate administraton of oxygen. The LMA also protects the airway and stomach from any fluid. Depending on what needed to be done to your nose, your operation may last anywhere from 1 to 3 1/2 hours. I prefer to not use post-operative "packing" into the nose. If you ask patients who have had rhinoplasty,"What was the worst thing about your rhinoplasty?", if they had packing in their nose for a few days, they will say, "The packing!"

Next thing you know, you are waking up in the recovery room with tape and splint on your nose. After about one hour, once you are fully awake, you are allowed to go home. Once you are home, we recommend that patients get into bed with there head elevated up on 3 to 4 pillows so that their nose is elevated well above their heart. Baggies of frozen peas are kept on the bridge of the nose as tolerated. Surprisingly, our patients seldom complain of pain, but rather a stuffy nose or sinus headache type of pressure that is usually relieved with Tylenol.

Patients return to the office two days after surgery to have their nose cleaned of any mucus or dried blood, the nasal passages are suctioned so that breathing is a little better. The nose will become congested again for a few days. On the fifth day, my favorite, the tape and splint are removed and the new nose is unveiled. Swelling and bruising continue to resolve over the next few days so that patients are quite presentable between 7 to 14 days after surgery. Physical activity is limited for the first two to three weeks after surgery. The appearance of the nose should continue to improve over the next 6 to 12 months. We then see our patients at one week, one month, three months, six months, one year, and then once a year as needed.

All patients should be aware that there is usually between a 3% to 10% chance of revision surgery after initial rhinoplasty.

Good luck and be well.

Dr. P

The best compliment that a facial plastic surgeon can receive is the following :

Bumping into a patient whom he had not seen or treated for many months, the facial plastic surgeon who had treated the patient with fillers and Botox many months before was very impressed with how naturally beautiful and flawlessly youthful the patient still looked after all of that time.

She looked so good in fact that the facial plastic surgeon suspected that she had gone to another cosmetic physician for treatment. It got the best of the facial plastic surgeon and he could not resist asking, "You look so good, have you been seeing another cosmetic doctor?"

To which his patient replied, "No doc, only you! Thanks."

That my friends is the best compliment that you can receive as a patient from your physician, and the best compliment that a facial plastic surgeon can receive as well.

Be well.

Sculptra Aesthetic (Dermik Lab., Sanofi-Aventis) is an exciting, new facial injectable treatment. Sculptra is injectable Poly-L-lactic acid (PLLA). PLLA is what absorbable suture material is made of. Sculptra has been used cosmetically outside the U.S. since 1999 and is a very popular procedure in Europe and Canada.

Dr. Persky has been following the use and development of Sculptra since its introduction to Europe in 1999. As with all new products and treatments related to facial plastic and reconstructive surgery, Dr. Persky is extremely conservative and believes that it is important that the treatment be proven not only effective, but more importantly safe. The Hippocratic Oath admonishes, "Physician, first do no harm!"

Early Sculptra treatments were very effective at replacing lost facial volume, so much so that in 2004 Sculptra was FDA approved for use in volume restoration from fat loss (facial lipoatrophy) for HIV patients. Some plastic surgeons and dermatologists began using Sculptra off-label to treat non-HIV lipoatrophy patients for cosmetic volume replacement. There were troublesome nodules and granulomas (lumps and bumps) during the early years of treatment with the product before techniques were improved.

In the past few years, physicians have learned how to minimize the occurrence of nodules with Sculptra. It is now injected in a much more dilute fashion. Patients massage the injected areas for 5 minutes, 5 times a day for 5 days. Injection techniques now avoid injecting through muscles that previously caused nodules. Superficial injections are now avoided. With a much greater safety profile, Dr. Persky now feels very comfortable treating his patients with Sculptra.

At The South Beach Symposium in February 2009, Dr. Persky met with the world leaders in Sculptra use, including Danny Vlleggar, MD. Impressive and natural before and after photos of patients treated with Sculptra, along with the much improved safety profile piqued Dr. Persky's interest in the product. What ultimately convinced Dr. Persky that Sculptra was going to be the filler of the future was seeing and speaking with 3 relatively young, beautiful, intelligent, well known female U.S. dermatologists who have had Sculptra injected into themselves as their facial volume filler of choice. If it is good enough for those experts to use on their world famous faces, then that was good enough for Dr. Persky to begin using Sculptra.

In July of 2009, the FDA approved Sculptra for the cosmetic indications of volume deficiency and facial wrinkles. Once it was FDA approved, Dr. Persky began using Sculptra to contour and sculpt faces.

The beauty of Sculptra is that is works by stimulating natural collagen production. John Joseph, MD of Beverly Hills says, "It is like putting a grain of sand into an oyster to form a pearl". I like to think of Sculptra as wonderful "seeds" that are spread where facial structure needs volume to restore youth.

Sculptra Aesthetic is different from all other filler products. Sculptra is injected as a very dilute cloudy solution that is mostly water and local anesthetic. Once injected, the patient can see a "preview" of what they will ultimately look like after their complete correction. Within hours to days, the fluid is reabsorbed by the body, and the treated patient’s appearance returns what it looked like before the injections, with possibly a new bruise or two. Over the next 6 to 8 weeks as collagen production occurs, the patient's face subtly and gradually establishes a foundation for the correction. Re-evaluation and a second injection session are then carried out. Most patients are treated over 3 sessions with varying amounts of Sculptra depending on their individual need and individual response. At full correction, the result is natural and has been shown to last 25 months and longer. As aging continues, touch-up treatments restore lost volume.

Sculptra gives physicians the ability to treat faces after analyzing the skin, muscle, fat, and bone; determining what needs to be replaced, and then using asthetic injection skills to achieve facial rejuvenation. Patients with early signs of aging from volume loss in their 30's and 40's are great candidates for Sculptra to correct early "jowling" and loss of volume in the cheeks. In older patients, Sculptra can be used beautifully to restore volume in hollow temples, jaw lines, chins, and to shorten elongated upper lips, restoring the proportions of youth to the face. Other than in the nasolabial folds, all of these cosmetic uses are "off-label."

Patient satisfaction studies have shown 84.9% satisfaction at 13 months and 80.0% satisfaction at 2 years. Sculptra should not be used in patients with a history of keloid formation or hypertrophic scarring, or in those patients allergic to absorbable stitches.

Dr. Persky is very excited about having Sculptra as a new powerful facial filling and contouring agent to go along with traditional fillers and fat. As with any treatment or product, it behooves the patient to do their homework and choose their injecting physician most carefully. It takes a combination of proper Sculptra technique with an aesthetic sense of beauty and proportion to help patients gradually look natural without feeling different or like someone else.

To view before and after patients who have been treated with Sculptra go to http://www.sculptra.co.uk/content.asp?section=3&subsection=3&picID=44.

Be well.

Fraxel laser has become the leader in fractionated non-invasive skin rejuvenation laser technologies. As predicted, "Fraxel" as become a verb in the English language as in, "I am Fraxeling my face". What began in early 2001 as a challenge from the brilliant and forward thinking Rox Anderson, MD (Boston, MA) to Reliant Inc. has evolved into 4 distinct Fraxel laser treatment platforms; restore, refine, repair, repair Lite, and Dual. Solta Inc. now manufactures Fraxel.

Michael A. Persky, MD has embraced Fraxel technology from its original Fraxel restore release in early 2004 to the current recent release (1/10) of Fraxel Dual. Dr. Persky would like to share his thoughts about Fraxel.

Fraxel Dual combines two lasers in one system, the restore and the Thulium 1927. The restore is an amped up version of the originally released Fraxel restore (SR750, now 1550) that works by heating the skin with an Erbium laser that stimulates collagen production without damage to the superficial skin, thus with very little downtime. Patients are red and slightly swollen for about 2 days followed by 3 to 4 days of "bronzing", and then return to their normal state with a few less fine to moderate wrinkles and brown spots. This newer version of restore is 25% faster, and more effective, requiring on average 25% fewer treatments.

The latest addition to the Fraxel menu is theThulium 1927 portion of Fraxel Dual which addresses brown spots and melasma on the face and body. It is very effective at treating age spots, freckles, and other brown pigment skin problems, in many cases with a single quick, painless treatment. It has been referred to by one of Dr. Persky's patients as "IPL on steroids!" With Thulium 1927 downtime is related to superficial skin peeling which takes from 5 to 10 days depending on the individual.

With Fraxel Dual, the restore and Thulium lasers may be combined for both superficial and deep non-ablative skin resurfacing with minimal downtime.

The most dramatically rejuvenating of the Fraxel lasers is Fraxel repair. Fraxel repair is an ablative fractionated carbon dioxide (CO2) laser that is capable of helping patients look years younger, retaining their natural appearance with a non-surgical treatment. Our experience with treating patients with Fraxel repair over the past two years has been excellent. The laser actually removes a volume of skin causing tightening immediately followed by 4 to 6 months of collagen production. It is particularly effective around the eye lids, cheeks, and neck. Skin tone, texture, and color improve. Some patients have opted for second treatments with repair, and benefit from results that are greater than single treatments added together. Surgical and acne scars respond dramatically to the treatment, but for scars usually 2 to 3 treatments are required for optimal results. The downtime for repair is 7 to 10 days for return to work, but it may take 4 to 8 weeks for skin color to return to normal. Most patients enjoy the " sun-vacation color" from about the second week on.

Fraxel repair Lite is a popular treatment among patients who want to keep a fresh rosy glow to their face. It involves using Fraxel repair at very low settings; therefore there is minimal downtime, maybe two days of moderate swelling and redness. Patients love the way their skin looks and feels after Lite treatments, but a recent repeat Lite patient commented, "Dr. Persky, you need to warn your patients that this Lite is addictive because my skin looks so good." Lite is also effective at boosting the effects of full Fraxel repair treatments in patients who desire a little more kick to their skin rejuvenation.

Fraxel refine is a controlled version of Fraxel restore, with limited power and treatment settings to allow the placement of the laser into medispas and cosmetology salons.

As with all facial cosmetic procedures, patient expectations are paramount. Dr. Persky's vast experience with Fraxel since 2004, particularly with Fraxel repair has resulted in an emphasis on patient expectations at the original consultation. The vast majority of patients respond extremely well to the treatment, looking years younger. There have been a handful of patients who have not responded to the treatment as well as others. Many of these patients respond well to a second repair treatment or Lite treatment. These secondary treatments are provided at reduced charge, the cost of operating the disposable components of the laser.

Lastly, we recommend that our patients protect their investment in their skin rejuvenation by using excellent skin care products following Fraxel treatments. A commitment to using sun protection and avoiding excessive sun exposure is most helpful.

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.