Keeping Houston Beautiful
An interview with Joseph M. Perlman, M.D., F.A.C.S .
article courtesy Joseph M. Perlman M.D., F.A.C.S.
CLICK HERE to visit the website of Joseph M. Perlman M.D., F.A.C.S.
Everyone wants to live longer and look better, and there are an increasing number of options to help us do just that. Each year more and more people are taking control of their lives by using surgical and non-surgical cosmetic procedures to reverse the visible signs of aging and achieve a confident, more youthful appearance. This proactive approach stems from an evergrowing number of safer, more effective and longer-lasting procedures, many of which are minimally invasive and offer greatly reduced recovery time and expense. As a result, younger people - those in their thirties and forties - are increasingly drawn to these cosmetic treatments as a way of maintaining their appearance without undergoing more extensive procedures.
"A lot of patients, especially younger patients, are looking for less invasive procedures with little or no downtime," says Dr. Joseph M. Perlman, Medical Director at the Advanced Plastic Surgery Centre. With more than 20 years of experience in the field of aesthetic plastic surgery, Dr. Perlman has seen the industry change dramatically in both types of treatment available to patients, and in the age of demographics of those seeking cosmetic procedures to reduce or eliminate facial and bodily signs of aging.
"Twenty years ago, a person seeking cosmetic facial surgery either came in for a full facelift or they didn't," Dr. Perlman continues. "Now there are so many options we can offer people, including stopgap measures to turn back the clock. Today's younger patients don't want to miss too much work or social time, and they want a natural, healthy, refreshed look."
Patients looking to correct bothersome aspects of their appearance can now focus exclusively on the area needing treatment.
"For example, we're doing a lot of endoscopic brow lifts," Dr. Perlman tells us. "The lowering or drooping of the eyebrows is one of the earliest signs of aging, and a browlift can correct this problem without a person having to undergo a traditional, more extensive facelift. The endoscopic technique hides the incisions behind the hairline, so no one can tell you've undergone a cosmetic procedure. It's a subtle change that nevertheless produces a dramatic improvement in your appearance."
Patients' desires for more flexible treatment have spurred the advance of new and improved techniques that translate into superior results with an emphasis on safety and patient recover. "One procedure that I've developed recently and had great success with is a cheek lift which uses permanent sutures placed through incisions in the mouth and hairline to lift the cheeks. It's far better than the so-called "feathertouchÓ or "easy liftÓ facial procedures, which typically do not last long," Dr. Perlman explains.
"This procedure lifts the fat pad up to where it ideally should be, rejuvenating the appearance of the middle portion of your face, which is an area often not improved by a conventional facelift. This type of cheek lift can of course be done in combination with a facelift or other procedures, but it gives great results as a stand-alone procedure as well. Younger people in their late thirties or forties who don't have a lot of loose skin, but who feel their cheeks have dropped down or that they have an older look, can benefit tremendously from this minimally invasive technique. It's an in-office procedure that only takes an hour."
New facial fillers offer even more options for rolling back the signs of aging. Long-lasting products such as Restylane and Radiesse have largely replaced the use of collagen and fat. "In my experience," says Dr. Perlman, "collagen and fat transfer typically only last two to three months before they are absorbed by the body. Restylane lasts around eight months and is giving our patients amazing results by filling in deep facial lines and areas around the nasolabial fold, or giving them the fuller, more sensual lips they desire. It's hyaluronic acid-based, which is a normal building block in the skin, like collagen. Radiesse is a calcium-based filler that lasts for approximately 12 months and is also an excellent product for filling in deeper facial lines. Since they are natural, these fillers are completely safe for the body to absorb. There have been no known incidences of rejection. Our patients have been extremely pleased with both of these products."
And then, of course, there's Botox. This widely accepted - and wildly popular - treatment dramatically reduces facial lines, wrinkles and crow's-feet, usually within two weeks after it has been injected into the skin. Dr. Perlman, who has one of the largest Botox practices in the Houston area, says, "It's incredible how many people are wanting Botox these days. We've performed more than 3,500 treatments in the past five years."
"We treat 16 to 20 patients every week and with good reason. Botox treatments are easy, and they work. In fact, Botox works particularly well in combination with soft tissue fillers to markedly improve areas of the face that show signs of aging."
Dr. Perlman and his staff believe that good skin care is the crowning touch to any cosmetic makeover - and an equally important choice for anyone who hasn't had a cosmetic procedure but who wishes to slow down the aging process. The Bellezza Skin Care Clinic at the Advanced Plastic Surgery Centre offers a complete line of doctor-approved beauty products and services for a healthy, radiant complexion. Treatments include chemical skin peels, European oxygen facials, microdermabrasion, FotoFacial skin resurfacing, spider vein therapy and more. "My aesthetician, Lisa Filer, sees a lot of patients in concert with me," Dr. Perlman says. "She has more than 10 years of experience in the field and has a genuine gift for knowing which products work best for which skin types. She can teach you the secrets of good skin care that will help maintain your cosmetic results for as long as possible, or help you to improve your natural appearance.
We believe so strongly in the importance of skin care that we recently, working with a chemist in California, developed a line of fine skin care products, SkinDeep, to help our clients achieve the most beautiful skin possible. This line is comparable to the best skin care products available anywhere, but is very affordable. We've had such great results using it that we can't keep it on the shelves. We're probably going to expand to direct selling on the Internet."
But it's not all about the face and skin. Treatments for improving the body's shape have evolved as well. Liposuction, which formerly required hospitalization and general anesthesia, can now be performed on an outpatient basis using only local anesthesia with vastly superior results than were previously possible. As a result, it's become the most popular and effective treatment for reducing the volume of fat in the neck, waist, hips, thighs and posterior, significantly improving the contour of the body.
"Our practice uses the VASER," says Dr. Perlman, "the most advanced method available. This is an ultrasonic liposuction technique, which offers better results wth less bruising and swelling, less pain and a faster recovery than the conventional, wet suction technique. The addition of ultrasonic waves, once the tumescent fluid has been injected, breaks the fat up and emulsifies it, making it easier to remove. Liposuction gives best results to those who are close to their ideal body weight and are seeking treatments of local areas of fat. However, I have found that overweight patients who are unable to stick to diet and exercise programs often become highly motivated to maintain their weight once they have improved their appearance with more extensive liposuction."
Dr. Perlman elaborates on other procedures which give the body a healthier, more youthful shape. "A high lateral tension abdominoplasty, or tummy tuck, is a particularly good procedure to address a sagging abdominal area by removing access skin and fat and tightening the abdominal wall muscle. This is ideal for women who want to restore body shape and skin tone lost due to pregnancy or significant weight loss.
"Breast augmentation through implants and/or a breast lift is also very popular among women seeking re-proportion or balance their figures. Proper selection of the size, shape and placement of the implant produces the most natural result, which looks the best in my opinion. About 25 percent of our breast augmentation patients also undergo a mastopexy, or breast lift, if there is significant sagging of the tissue. A breast lift can also be used to raise the breast without implants.
"Lower body lifts have been growing in popularity since the 1990's and address sagging or drooping skin left behind as a result of heavy weight loss of 50 or more pounds, such as obesity surgery or large weight gain from pregnancy.
"If there are significant fat deposits to address, we will perform liposuction first and then wait three to six months before performing the lower body lift and/or abdominoplasty. These are extensive procedures, requiring between six to eight hours to perform, depending on if liposuction and/or abdominoplasty procedures are combined. But a lower lift will dramatically firm and tighten the buttock and thigh area. In the preoperative area, when marking the incision sites, we have the patient wear her underwear or bikini bottom she wants to get into, and this determines where our final scar is going to be, hidden beneath that line. My patients are absolutely astounded at how much better they look once they see their results."
People who have lost a tremendous amount of weight - 100 pounds or more - through obesity-related surgeries, such as gastric bypass and stomach-banding procedures, can especially benefit from upper or lower body lifts. "These patients will often find," Dr. Perlman confides, "that once their weight has been stabilized after their obesity surgery, they have an excessive amount of loose, sagging skin in areas such as the abdomen, thighs, buttocks, arms or neck. This can cause a great deal of embarrassment and psychological distress. An upper and lower body lift can restore the skin to its proper position and relieve this discomfort.
"These patients typically come to see me a year or two after their surgery - although some consult with me beforehand to plan their treatment ahead of time - and we work closely with their medical doctor to map out a course of events and to deal with any remaining medical problems such as high blood pressure, diabetes, poor wound healing or metabolic complications from their bypass procedures. I don't like to put patients through more than eight hours of surgery, so for these patients, treatment is best done in stages, waiting three months between surgeries. If an extensive amount of liposuction is necessary, we do that first and then wait three to six months to allow the skin to settle, giving us a better idea of how much skin needs to be removed. Staged procedures give the best results and provide the most safety for the patient.
"There really are so many options to correct problem areas of the body. Anyone interested in exploring these should visit my website, www.advplasticsurgery.com, and e-mail me with any questions, or call my office to schedule a complimentary consultation." Whatever cosmetic procedure you may be interested in, it's essential to choose the right professional to gain the best result possible without compromising safety. Dr. Perlman believes that there are three important elements to consider. "The first is a surgeon's credentials," he says. "As a surgeon who is certified by the American Board of Plastic Surgery (ABPS), I believe very strongly that anyone considering cosmetic surgery should seek doctors who have this certification and are in good standing with the American Society for Aesthetic Plastic Surgery (ASAPS). The ABPS is the only board in plastic surgery and its related fields that is recognized by the American Board of Medical Specialties, and only those surgeons who have completed the most stringent surgical training and exams are certified by the ABPS.
"The second element to consider is the surgeon's results. You need to view before-and-after photos of previous patients, and speak with some of those patients if possible, to see if the surgeon can deliver the outcome you desire. I feel gratified that many of our former patients are happy to share their experiences with individuals who are considering our practice. In fact, probably 50 percent of our new patients come from personal referrals from former patients."
"The third element to consider is trust. You should be genuinely comfortable and confident with the doctor and his staff. Cosmetic surgery can be a very personal and emotional decision, and you should feel that the practice you choose is compassionate, attentive and respectful to your needs from the moment you call for a consultation throughout the entire process, including the recovery stage. All of your concerns should be addressed and the procedure explained in as much detail as possible.
"It's important to me personally to communicate honestly with each patient, and to match their needs with the services we offer. I don't believe in trying to pressure people into having procedures that they don't need or want. My entire staff shares this philosophy. We don't want patients to feel as if they've been run through the mill. We want them to feel like they can confide in us and that they are receiving the care they deserve. My nurse, Debbie Madigan, works one-on-one with each patient to ensure this. We receive many compliments regarding her sincerity and compassionate approach. Nancy Johnston our patient coordinator, Shannon Garcia, our office manager, Lisa Filer, our aesthetician - all of us strive to make each patient's experience as comfortable, stress-free and enjoyable as possible.
"The patient's goal is our only goal. Our greatest satisfaction is in being able to use all of our knowledge, experience and skill to help each person we care for achieve the goals that are right for them. Our mission is to bring out the best in our patients. When we impact a person's life in a truly positive way - helping them realize a better self-image, have more self-confidence, a more outgoing personality - then we feel that the best has been brought out in us as well."