Q. I had Ulthera on my neck November 2016…

RealSelf actual patient comment:

“5 months later I look just awful, what should I do to fix it?”

A. The excess skin on you neck can be reduced by either surgery or minimally invasive non-surgical procedure called Profound. Profound uses radio frequency energy emitted through micro-needles below the skin to tighten lax skin of the neck, jowls, cheeks and forehead. As always, be sure to choose your treating physician most carefully.

Q. Bulbous nose reshaping – can it be done without redoing whole nose?

RealSelf actual patient comment:

“Can it be done without redoing whole nose? Not looking to have full reshape, but just the tip.”

A. Your question is a common one and is best answered in person after examination and evaluation by an expert rhinoplasty surgeon.  ​Shaping a nose is like sculpting, once one part is changed it is essential to be sure that the rest of the nose is in harmony.  Rhinoplasty has evolved over the years to where the surgery is more conservative, we consciously attempt to preserve more of your underlying bone, cartilage, and soft tissue.  When I consult with a patient with your goals, we share a computer image of before and after, and then decide on the plan.  Sometimes thinning and refining the tip is all that is needed, in other cases, small refinements of the rest of the nose is required for the best aesthetic outcome.  The most important aspect of your rhinoplasty is making sure that you choose your rhinoplasty surgeon very carefully based on their experience, skill, knowledge, and natural artistic vision.

Q. If I decide on a tip rhinoplasty and then want a full rhinoplasty, is that bad?

RealSelf actual patient comment:

“What is your advice? I’m just a little too worried about actually having them hammer and break the nasal bone. I’m also terrified about anesthesia going wrong and being awake during.”

A. Rhinoplasty is an artistic procedure.  Everyone’s nose is different.  Some noses may lend themselves to just having the tip refined, and the majority of noses benefit from having the entire nose shaped to create nice harmony that does not attract attention to aspects that may be out of proportion.  Fortunately, anesthesia today is much improved over years past. When my patient is undergoing anesthesia prior to rhinoplasty, I tell them just before the IV medication that lets them “go to sleep” to think of their favorite people, places, things to do (i.e. paddle boarding in Hawaii, etc.).  Our patients experience what seems like a one minute dream and the next thing that they know is they are in the recovery room comfortably awake from the 2 to 3 hour rhinoplasty. There is no need to worry about “waking up” during the rhinoplasty surgery.  You should not be aware that the nasal bones are being cut (“hammer and breaking”).  I would not limit your rhinoplasty because of this fear, whether to address your nasal bones or not should be based on the goals of the surgery, your anatomy, and your shared artistic vision with your rhinoplasty surgeon. Choose your rhinoplasty surgeon based on their experience, skill, knowledge, and most importantly, their natural artistic vision.

Q. Skin Tightening? Any doctors have experience with “Profound RF” treatment?

RealSelf actual patient comment:

“The Profound procedure looks very promising. Is any doctor doing it? What can one expect as far as down time? What is the typical pricing?”

A. Profound uses paired micro-needles that emit radio frequency energy in a precise temperature controlled manner that  maximizes the production of new elastin, collagen, and hyaluronic acid in the treated skin.  I have used Profound on the face and neck (including the forehead to lift tired brows) resulting in impressive lifting, tightening, and natural rejuvenation.  We have also treated cellulite of the thighs with Profound.  Patients are quite swollen after the treatment, usually lasting 5 to 7 days.  Bruising varies and also resolves within 5 to 7 days.  Our pricing varies depending on the areas treated, anywhere from $4,500 to $8,000.  I personally perform all Profound treatments on my patients.  Make sure to choose your treating aesthetic physician most carefully based on their experience, skill, knowledge, and natural artistic vision.

Q. “Injectable laser” for tightening? Profound? Has anyone used it on legs yet?

RealSelf actual patient comment:

“I recently read about a new laser that is supposed to be “injectable” for tightening?? I think that it is called Profound? I think they have been using it on the face but going to be getting a new way to use it on the legs for loose skin? Has anyone heard of this and what kind of results it is having? I’m curious about it. I would love to have tighter skin on my legs.”

A. Yes, we have used Profound on the thighs to treat cellulite with nice results and no downtime.  There are certain areas on the legs where if the skin is thick enough Profound can tighten loose skin.  It does work very well on the face and neck to tighten and lift, rejuvenating the face in a natural rested fashion.

Q. Can you suddenly develop an allergy to Juvederm? What are the chances that the same thing will happen again?

RealSelf actual patient comment:

“I had a horrific and traumatizing experience with Juvederm Summer 2015, which has lead me to fear any type of lip fillers or fillers in general. I got a hematoma, which lead to an infection, which lead to a huge bump on my lip, which had to be drained at the ER. Before this happened, I had no problems with Juvederm, and had it done regularly over the Aquamid which I’ve had in my lips for over 8 years. I want to do Juvederm again, but I’m so afraid that the same thing will happen again!?”

A. Sorry to hear about your bad experience with lip filler injection.  What you experienced was not an allergy to the Juvederm injected into your lips, rather you had a vascular (blood vessel) event, either there was too much bleeding from a deep needle puncture, or you may even have had filler injected into a blood vessel which can cause overlying skin to break down.  Aquamid has been known to have severe delayed response infections and that may have played a role in your complication.  It is most important for you to consult with and be treated by only an experienced, skilled, and knowledgeable physician injector in the future.  I believe that you may be able to have lip injections again, but only with precautions taken.

Q. How do I choose my rhinoplasty surgeon?

A. The absolute most important aspect of your rhinoplasty is your choice of rhinoplasty surgeon. Rhinoplasty is considered the most difficult of all facial plastic surgeries combining art and science. You should consult with at least 3 or more rhinoplasty surgeons prior to making your decision. Your decision should be based on the surgeon’s experience, skill, knowledge, and most importantly their natural artistic vision. Make sure that your rhinoplasty surgeon listens to your concerns about what bothers you about your nose as well as appreciating your aesthetic rhinoplasty goals. It is important to be on the same wavelength prior to surgery so that you are not left to be surprised by unwanted results. Look at before and after photos, ask to meet or speak with the surgeons rhinoplasty patients, ask if anyone in the office has been operated on by the surgeon. Computer imaging is helpful to communicate your goals for rhinoplasty, make sure that the imaging is realistic and not just a nice photo-shopping job. Should you have any further questions about selecting your rhinoplasty surgeon, feel free to contact me. Good luck and be well.  ~Dr. P

Q. Can Sculptra Be Injected Into the Lips?

A. Sculptra is an excellent facial volumizer. It works by stimulating your body to make new natural collagen where it has been injected. There are areas where Sculptra should never be injected and the lips are one of those areas. Sculptra is injected deep to muscle and over bone in most facial areas. When injected in areas without underlying bone, Sculptra is injected beneath the skin. Sculptra is not injected in the lips or superficially around the eyes because unwanted lumps and bumps can form. We prefer to inject lips with Juvederm, Restylane, and Restylane Silk, all of which in our hands results in natural beautiful lips. Always make sure to choose your injecting physician most carefully to ensure safe, effective, and long lasting results.  Good luck and be well. ~Dr. P

Q. Is Ultherapy permanent?

A. Ultherapy costs vary depending on the area(s) treated as well as on who is performing the treatment. In my practice, I perform all Ultherapy treatments because as a facial plastic surgeon I believe that my knowledge of anatomy and my ability to keep my patients as comfortable as possible leads to the best possible results safely while minimizing any adverse reactions or complications. My charges are slightly higher than the charges in a practice where the treatment is delegated to an assistant with little or no knowledge of vital facial structures and anatomy, and minimal experience in the treatment. The three main areas of Ultherapy treatment are the face, neck, and brows. The cost of the treatment varies depending on whether all three areas, or one or two areas are treated. Good luck and be well. ~Dr. P

Q. Why does Ultherapy cost vary so much?

A. Ultherapy costs vary depending on the area(s) treated as well as on who is performing the treatment.  In my practice, I perform all Ultherapy treatments because as a facial plastic surgeon I believe that my knowledge of anatomy and my ability to keep my patients as comfortable as possible leads to the best possible results safely while minimizing any adverse reactions or complications.  My charges are slightly higher than the charges in a practice where the treatment is delegated to an assistant with little or no knowledge of vital facial structures and anatomy, and minimal experience in the treatment.  The three main areas of Ultherapy treatment are the face, neck, and brows.  The cost of the treatment varies depending on whether all three areas, or one or two areas are treated.   Good luck and be well. ~Dr. P

Q. What constitutes of a thorough facial analysis?

A. Patients come to my practice not for a syringe of filler or a certain number of units of Botox. My patients benefit from my technique of full facial analysis using natural artistic vision to create the best naturally beautiful version of themselves. Over years of experience as a facial plastic surgeon treating thousands of patients, teaching others how to perform treatments, and staying up to date on the latest safe and effective facial rejuvenation treatments, I have developed the ability to thoroughly analysis your face and recommend the best individual plan to keep you looking your best. Leonardo da Vinci, hundreds of years ago described the “devine” or golden ratio that is found in nature as well as in beautiful faces. I use those natural ratios to create beauty on your face after careful analysis. At your consult, we will discuss the analysis of your face and give you a beauty plan for years to come. Good luck and be well. ~Dr. P

Q. When can a patient shoot a gun after otoplasty and rhinoplasty?

A. It is always best to consult with your surgeon when you have questions after surgery. We ask our patients to avoid strenuous activities for about 3 weeks after rhinoplasty at which time they may resume all physical activity other than boxing and diving head first into swimming pools, lakes, or the ocean. After otoplasty it is important to not traumatize the ears again for about 3 weeks. Good luck and be well. ~Dr. P

Q. Can all dermal fillers be dissolved?

A. Not all facial fillers can be dissolved. We prefer to use fillers in the face that can be dissolved, especially in areas of the face where there are significant blood vessels. Permanent fillers such as Bellafil and Silicone cannot be dissolved at all.  Radiesse, though not a permanent filler, cannot be dissolved. The fillers that are made up of hyaluronic acid (Restylane, Juvederm, Voluma, Belotero) can be dissolved with an injection of hyaluronidase, an enzyme that rapidly breaks down the filler. The advantages of fillers that can be dissolved are that any lumps, bumps, or filling that is not good can be quickly corrected, and in the rare case of filler being injected into a blood vessel with vascular compromise, impending vascular necrosis can be avoided. Sculptra is a biological collagen stimulating filler that cannot be dissolved, yet is very safe as the fine Sculptra particles are dissolved in water and local anesthetic solution. My philosophy is to avoid the use of permanent fillers in the face because if there is a problem it can be very difficult to take care of….”Permanent filler, permanent problems.” Good luck and be well. ~Dr. P

Q. How long do dermal fillers last?

A. There are long lasting dermal fillers, short lasting dermal fillers, and those in between. The longest lasting dermal fillers are permanent fillers that include Bellafill, Silicone, and the patient’s own fat. The advantage of these fillers is that they last forever, the disadvantage is that they last forever and are very difficult to remove. The next longest lasting dermal filler is Voluma which is said to last up to 2 years. Sculptra is a bio-stimulating product that stimulates natural collagen production. Once patients have reached their “full correction” point with Sculptra, the results last for 2 to 4 years before additional treatment. Radiesse, Juvederm, Restylane may last from 9 to 12 months. Belotero is the shortest lasting dermal filler, lasting about 3 to 4 months. Make sure to choose your injecting physician most carefully to ensure that your treatment is safe and effective. Good luck and be well. ~Dr. P

Q. What is the difference between Fraxel restore and dual?

A. Fraxel restore laser was the first laser to use “fractionated” technology.  Fractionated lasers treat a percentage or fraction of the skin surface area which is different from how older lasers treated the entire skin surface.  The advantage of fractionated lasers is that normal skin aids in a more rapid and natural healing without the lines of treatment demarcation between treated and untreated areas.  Fraxel restore laser is considered a non-ablative laser which means that it leaves the surface of the skin intact without removing any skin.  Restore sends columns of heat through the skin which stimulates new collagen production and improves brown spot pigmentation.  Restore treatment involves a 20 minute treatment, usually repeated 2 to 4 times every two to three weeks.  Restore results in improvement of fine lines and wrinkles, better skin tone, texture, and color.  The treated area is red and slightly swollen for 1-2 days, followed by a bronzing appearance that leads to a powdery flaking on days 3-5.  By one week the skin looks beautiful.

A second type of laser was added to the Fraxel restore platform, this second laser is Thulium laser which specifically targets brown spots.  The combination of the two laser systems is called Fraxel Dual.  The Thulium laser is the best treatment for brown spots.  The two lasers may be combined at the same treatment session to give patients a true “dual” treatment that results in beautiful skin.  Good luck and be well. ~Dr. P

Q. What is the typical recovery after fillers?

A. Fortunately most of my patients are able to return to their normal activities immediately after their injectable filler treatment. In rare cases, there can be a small bruise which I minimize by using special advanced injection techniques. In the event of a small bruise, our patients are given arnica gel skin patches which have been proven to minimize bruises within 24 hours. We ask our patients to discontinue any medications that thin their blood for one week prior to treatment, and they can be resumed the day after treatment. We have found that not working out strenuously for one day after injections helps to decrease any late bruising or swelling. We like to see our patients back for follow up examination 10-14 days after their initial treatment to make sure that they have an excellent naturally beautiful result. As with any aesthetic procedure, be sure to choose your injecting physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. What is the best way to get rid of this “tired, saggy” look on my face?

A. Many of our 35 to 50 year old patients complain of looking tired and noticing that their face is sagging for the first time in their life. Fortunately there are some great choices of treatments that address the problem quickly, safely, and effectively. I particularly love to immediately correct “tiredness” with strategically placed injection of Voluma using The Master Injector Technique. With a 10 minute comfortable treatment, properly placed Voluma helps to rejuvenate the under eye area, the cheeks, the nasolabial folds, the corners of the mouth, and even the jawline. Ultherapy is the best lifting, tightening non-surgical treatment for the face, neck, and brows. Depending on the patient, Botox and/or Sculptra are used to complete their natural beauty rejuvenation. As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. What makes Voluma different from other facial volume fillers?

A. Voluma has been a God send in my ability to rejuvenate patient’s face within 10 to 20 minutes. A small amount of Voluma is able to lift the face unlike any other facial filler. It is also the longest lasting non-permanent facial filler, lasting for up to two years. Voluma injection experts such as Dr. Persky are able to inject the product strategically to maximize the lifting effect while using the minimum amount of product to give you your best naturally beautiful results at the most economical cost…the biggest bang for your buck! More than any other aesthetic treatment that we perform, when patients are handed a mirror after their Voluma treatment, they respond with a spontaneous, “Wow!” As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. How Often Do I Need to Repeat My Voluma Treatment?

A. The nice thing about Voluma treatment is that the effects are additive and cumulative. The first time that I treat a patient I like to remain conservative, usually using only 1 or 2 cc syringe(s) for a naturally beautiful result. I re-evaluate our  Voluma patients about 10 to 14 days after their treatment to make sure that their results are maximized. Though Voluma lasts for a long time (when Voluma is injected properly, the results are very natural and long lasting, up to 2 years), I can usually find somewhere to place another little bit of Voluma to make you look even better. I recommend that patients consider a little more Voluma whenever they wish to look better, refreshed, rested, and beautiful. That can coincide with holidays, special occaisions, birthdays, etc. It is best to have your treatment 10 to 14 days before your special occasion. As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. Why Do Many Voluma Patients Say That It Helps Them to “Go From Hottie to Oh My Goddie!”?

A. Recently while speaking to a new patient I asked whether she had ever had Voluma injected. She responded that she loves Voluma more than any of the other facial fillers that she has experienced and added, “In 5 minutes Voluma made me go from Hottie to Oh My Goddie!” Voluma results are immediate and long lasting. The injections are less uncomfortable than Botox injections according to our patients experience. As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P

Q. What is The Dr. Persky Facial Beauty Plan?

A. Dr. Persky believes that each of his patients deserve an individualized beauty plan, not just for their immediate treatment but for the long term over many years. At your initial consultation with Dr. Persky, he will discuss what your goals and motivations are for your aesthetic needs. Next, Dr. Persky will perform a complete facial analysis discussing your unique rejuvenation. There will be recommendations made for immediate treatment, treatments for maintenance, and then long term treatment plans. Dr. Persky is conservative and usually proceeds with moderate improvement at a time. Included will be a discussion and recommendation of the best skin care products that will compliment and maximize your rejuvenation. As with any aesthetic procedure, be sure to choose your treating board certified cosmetic physician very carefully based on their experience, care, knowledge, skill, and most importantly their natural artistic vision. Good luck and be well. ~Dr. P