Facial Plastic Surgery Secrets

Video Highlights 0:06 Intro 0:17 The holy grail of plastic surgery 0:44 Non surgical tightening 0:50 What is Thermage? 0:59 High patient dissatisfaction 1:13 The case with Thermage 1:24 Other alternatives for non surgical tightening 1:55 The use of radio frequency 2:27 Benefits of radio frequency procedure 2:53 The risks involved 3:11 Ultrasound devise – Ulthera 3:45 Is radio frequency tightening painful? 4:12 Is there scarring? 4:19 Short term side effects 4:57 Why Venus Freeze 5:09 The importance of realistic expectations 5:57 Why not all get the same results? Hi, this is Dr Michael Persky from Encino California or as we like to call it, the Beverly Hills of the San Fernando Valley. I’m a facial plastic surgeon at the Persky Sunder Facial Plastic Surgery. Tonight I’d like to speak to you for a few minutes about one of the holy grail of plastic surgery which is non invasive body tightening of lose skin. In our practice we see patients who are often complaining of loose skin on various parts of their body including the abdomen, the arms, the legs, the thighs, the butt, pretty much wherever we have skin there are some patients who wanted to be tightened and they wanted to be tightened without surgery, non-invasively. The original skin tightening, non-invasive devise was Thermage, came about 15-20 years ago. The problem being, that there was a high patient dissatisfaction with the procedure. Reports of 30-40% patient satisfaction currently on www.realself.com you can look up whether the procedure [1:16:19] or not. Thermage has a 38% patient satisfaction rate. Other radio frequency devises such as Tighten at 53%, Accent Excel at 56%, Exilis at 70%. We also have not great patient satisfaction rates. The current leader of patient satisfaction with non-invasive skin tightening devises that use radio frequency is the Venus Freeze which has an 87% patient satisfaction rate. Patients want to know how radio frequency works. It works by heating the skin, similar to the way a microwave heats material. The waves are carried through the skin down to the tissue creating just enough heat to cause some damage. The bodies healing response forms collagen which results in tightening of the skin. It usually requires multiple treatments. Usually a treatment once a week for 4-6 weeks, followed by maintenance therapy which can be once every 1-3 months. The benefits are that it’s a non invasive modality of tightening the skin. No surgeries required. There’s minimal discomfort. It feels like a warm massage. There’s no more risk of skin changes. All skin types could be treated. And there’s no downtime with the procedure.  The risks are some of these devices have reported rare burns. The skin could be red for a few hours after the treatment and rarely there can be lost of volume. Which is why in our practice we don’t really radio frequency devices on the face. We’re quite happy with using ultrasound devises. Naturally ultrasound devise, Ulthera, to lift and tighten the face, neck and browse. Radio frequency devises such as Venus Freeze, Exilis are good for non invasively lifting or tightening the neck and jawline for patients who aren’t quite ready for the more intensive, effective ulthera treatment. The frequently asked questions about radio frequency skin tightening – Is it painful? It should feel like a warm massage. There are some devises that are quite painful. Fortunately, the Venus Freeze that we’ve been trialing in our office currently just feels like a warm massage and most of our patients, all of our patients who have tried it so far are quite pleased with their results. Is there scarring? Very very rarely and it hasn’t been reported with the Venus Freeze devise. One of the short term side effects, there can be temporary swelling, redness and temporary numbness. All these things go away within hours. Do patients need anesthesia for the treatment? The answer to that is no, not with the Venus Freeze. So, I hope that answers most of your questions about what the current best non invasive radio frequency skin tightening modality is. Currently I believe it’s Venus free. We’ll see. It’s certainly been the holy grail of plastic surgery. To wrap this up, as with all of our treatments, I think it’s very important that patients have realistic expectations and it’s our job as physicians to convey those to the patient. As you heard from the patient satisfaction rate, even with the best of these technologies there’s a 15-20% patient dissatisfaction rate or patients are not seeing much results or they don’t think it’s worth their money. The last thing I ‘d want on our practice is to have unhappy patients. Again, it’s important that our patients have realistic expectations. This is currently the best technology that’s non invasive to tighten the skin but doesn’t work for everybody. We’re not smart enough to know why that is, who it’s going to work on, and who it’s not. But there will be patients that will see great results and there will be unfortunately a small percentage of patients who don’t see the results they want. So that’s to be taken into consideration prior to undergoing a cost of both money and time and pursuing these radio frequency technologies. If you have any questions about any non invasive skin technology, please feel free to call me. Be well. Take care of yourself. Bye Bye. Dr. Michael Persky and Dr. Sarmela Sunder are located in Encino, California and Beverly Hills, California but service all of Los Angeles and the San Fernando Valley. Including, Beverly Hills, Hollywood, Hancock Park, Brentwood, Santa Monica, Pacific Palisades, Malibu, Sherman Oaks, Studio City, Calabasas, Woodland Hills, Tarzana, Westlake, Thousand Oaks, Agoura Hills, La Canada, Pasadena, and more. Please subscribe to our blog by clicking the link above, right, and “Like” us on Facebook. Thank you! + Michael Persky

  Video Highlights 0:06 Can ulthera pain be reduced? 0:15 What is ulthera? 0:31 Common patient concern about ulthera treatment 0:38 Managing ulthera pain 0:48 Persky-Sunder ulthera technique 1:07 Strategic use of anesthesia 1:21 Feedback from clients 1:56 Ulthera pain is manageable 2:16 Call us for consultation Hi, this is Dr Michael Persky from Encino California or as we like to call it here, the Beverly Hills of the San Fernando Valley. Today I’d like to talk to you about easing the pain during your Ulthera treatment. Ulthera is the only FDA Approved non-invasive device that’s been approved for lifting, and tightening of the neck, face, and eyebrows. It’s a very effective treatment but the big thing that we hear from patients is they’re worried about the pain of the treatment. Certainly other practitioners who call us about Ulthera are also concerned about managing the pain of the treatment. Over the past 3 years, we as facial plastic surgeons at Persky-Sunder Facial Plastic Surgery have developed techniques that make the ulthera treatment quite comfortable for our patients. As facial plastic surgeons, we know the nerve distribution of the face and neck and are able to use small amount of strategically placed local anesthetic to make it a very comfortable procedure for patients. In fact just yesterday, I received a very nice email which you can see on my blog at drpersky.com The patient had her Ulthera treatment, extended neck treatment from the corner angle of her jaw to her clavicles to lift and tighten the neck and clean up the jaw line. She had it two days ago and wrote saying she couldn’t believe how relatively painless the procedure was. Even the injections she said she felt that we were injecting her in areas that are already numb. So, Ulthera doesn’t necessarily have to be a painful procedure to get very very good results. We do perform all of our own anesthetic and treatments here. If you have any concerns about Ulthera, any questions about it or the comfort levels during the treatment, feel free to call us and we’ll be happy to get back to you. Be well, Bye bye. Dr. Michael Persky and Dr. Sarmela Sunder are located in Encino, California and Beverly Hills, California but service all of Los Angeles and the San Fernando Valley. Including, Beverly Hills, Hollywood, Hancock Park, Brentwood, Santa Monica, Pacific Palisades, Malibu, Sherman Oaks, Studio City, Calabasas, Woodland Hills, Tarzana, Westlake, Thousand Oaks, Agoura Hills, La Canada, Pasadena, and more. Please subscribe to our blog by clicking the link above, right, and “Like” us on Facebook. Thank you! + Michael Persky  

Video Highlights 0:07 What is Ulthera? 0:16 What areas can Ulthera be used? 0:38 Does it hurt to undergo Ulthera? 0:43 Dr Persky’s Ulthera technique 0:56 The secret to minimizing patient discomfort 1:04 Should you administer a local anesthetic? 1:36 Can Ulthera be done even without anesthesia? 2:02 Why choose our Ulthera service Hi, this is Dr Michael Persky from Encino, California, suburb of Los Angeles. We like to call it the Beverly Hills of the San Fernando Valley. Today I would like to talk to you a little bit about Ulthera, the only FDA approved technology that is approved for lifting and tightening the skin of the face, the neck and the forehead and the eyebrows. One of the things about Ulthera that we hear about often, particularly when I lecture about it or teach other physicians and talk to patients is that Ulthera, what we hear about it is it hurts so much. It’s not necessary to have a great deal of pain with Ulthera. Here at our office, I take care of all the patients that we see and treat with Ulthera. I perform the procedure myself and I make sure that my patients are as comfortable as possible and minimized any discomfort with a number of methods that I’m often asked about by other physicians and clinics. I find that using just a little bit of local anesthetic goes miles in terms of making people very comfortable with the Ulthera. I’ve just done with a procedure that’s why I’m talking about it right now and trying to educate people. This patient came in. We took five minutes to anesthetize her neck completely and she didn’t feel anything during the treatment. This was a second treatment that she had. The previous one she decided to do without any anesthesia and she said it was night and day it was unbelievable how pain free she was with this treatment. So I do perform all the treatments myself and I do make sure that my patients are as comfortable as possible, before the treatment, during the treatment and after the treatment. Ulthera is great treatment and who says that Ulthera hurts doesn’t necessarily have to be true if you choose the right practice to have it done in. If you have any questions about Ulthera, feel free to call me. I’ll be happy to answer them for you. Be well, take good care of yourself. Bye Bye. Dr. Michael Persky and Dr. Sarmela Sunder are located in Encino, California and Beverly Hills, California but service all of Los Angeles and the San Fernando Valley. Including, Beverly Hills, Hollywood, Hancock Park, Brentwood, Santa Monica, Pacific Palisades, Malibu, Sherman Oaks, Studio City, Calabasas, Woodland Hills, Tarzana, Westlake, Thousand Oaks, Agoura Hills, La Canada, Pasadena, and more. Please subscribe to our blog by clicking the link above, right, and “Like” us on Facebook. Thank you! + Michael Persky

Video Highlights 0:13 Freezing the fat ads 0:29 CoolSculpting by Zeltiq 0:32 Non-invasive fat treatment 0:50 Fat reduction through freezing 0:56 Decrease rate of 20-25% 1:04 Choosing the right areas to target 1:09 Three common areas where you can use CoolSculpting 1:58 Want this service? Call 808-501-3223 Hi, this is Dr Michael Persky from Encino California or as we like to call it here, the Beverly Hills of the San Fernando Valley. In Los Angeles there are billboards and radio advertisements on ESPN about freezing the fat and what is freezing the fat patients often say to us. Actually we have the freeze the fat machine in our office. That machine is something called CoolSculpting by Zeltiq. What it does in a non-invasive manner while a patient sits in a comfortable position and reads or works on their computer, it grabs the fat bulge with a suction apparatus and it freezes it for one hour. Over a period of about 2 months, those fat cells break down and the fat layers decrease approximately 20-25% per treatment. Most patients require one or two treatments some go for a third treatment. It’s most effective on fat bulges that are resistant to diet and exercise such as the abdomen, the love handles and bra back. We offer here at our office in Encino, again, there are major billboard campaigns, ESPN commercials, you’ll hear on the radio. I wouldn’t be surprised if we start seeing advertisements on television for freeze the fat or freeze your fat or let’s make that fat cool. But whatever the advertisements are, we do have the technology right here at our Encino office and I personally supervise the placement of the hand piece and evaluate and treat all of our patients. If you have any questions about that bulge that’s just bothering you, please give us call. Be well and eat well and diet. Bye Bye. Dr. Michael Persky and Dr.  Sarmela Sunder are located in Encino, California and Beverly Hills, California but service all of Los Angeles and the San Fernando Valley. Including, Beverly Hills, Hollywood, Hancock Park, Brentwood, Santa Monica, Pacific Palisades, Malibu, Sherman Oaks, Studio City, Calabasas, Woodland Hills, Tarzana, Westlake, Thousand Oaks, Agoura Hills, La Canada, Pasadena, and more. Please subscribe to our blog by clicking the link above, right, and “Like” us on Facebook. Thank you! + Michael Persky

Video Highlights 0:07 Methods of rejuvenation of the face 0:20 Simple male secret to looking younger 0:25 That’s shaving! 0:30 Why do men grow their beard? 1:00 Get rid of greyish or whitish beard 1:42 For other ways to look younger, call us. Hi, this is Dr Michael Perksy. I’m a facial plastic surgeon in Encino California. In facial plastic surgery we have a wide variety of methods and procedures to rejuvenate the face. All the way from the most extensive facelifts to the smallest little things. And today I would like to talk about just a little thing that men can do to make themselves look much younger and that little thing is called “shaving”. As you’ve noticed, I have grown a little beard over the last week. Beards are great. Men love them. Many women love them. Man who has not worn a beard, grows a beard and he’ll start to get compliments from people that he wouldn’t think normally would notice. Beards are a nice addition to a man’s appearance. But if a man wants to appear younger, particularly if his beard is getting lighter, greyish, whitish, a quick 5 minute shave can take 5-10 years off. As you will see when I return. Hold on a second. So we a re back. Cleanly shaven and hopefully I look a little bit youngerthan I did when I had that white beard. So for men it is probably the easiest way to take a few years off our appearance just by taking a razor, put it to our face and shaven off that beard. If you have any other questions about how Men can look rejuventaed, please feel free to call us. Be Well, Good bye Dr. Michael Persky and Dr. Sarmela Sunder are located in Encino, California and Beverly Hills, California but service all of Los Angeles and the San Fernando Valley. Including, Beverly Hills, Hollywood, Hancock Park, Brentwood, Santa Monica, Pacific Palisades, Malibu, Sherman Oaks, Studio City, Calabasas, Woodland Hills, Tarzana, Westlake, Thousand Oaks, Agoura Hills, La Canada, Pasadena, and more. Please subscribe to our blog by clicking the link above, right, and “Like” us on Facebook. Thank you! + Michael Persky

Video Highlights: Sculptra Los Angeles 0:23 Who makes Sculptra? 0:34 The characteristics of Sculptra 0:40 What is Sculptra and does it do? 1:10 The dread of aging and the role of fillers 1:57 Combining Sculptra with other fillers 2:13 The cost of Sculptra 2:15 Why is Sculptra more economical than other fillers? 2:28 Sculptra versus fat transfers 3:26 Session requirements 3:55 Collagen growth 4:45 How long will Sculptra last? 5:09 The benefit of building a personal base of collagen Hi this is Dr Michael Persky. I’m a facial plastic surgeon here in Encino California. We’d like think of Encino as the Beverly Hills of the San Fernando Valley. I am a consultant and lecturer as well as an instructor for Valiant which is the company that makes Sculptra. And today I’d like to talk to you about one of the questions a patient asked me about today during consultation which is, what makes Sculptra different from other fillers. Sculptra Los Angeles. Sculptra is a biostimulatory filler which means that when we inject it stimulates the immune system to make volume and increase the volume of the face. All other fillers fill the hollows of the face, fill the lines of the face. A few years back, thanks to the work of Bryan Ambro, Rod Rohrich, Joe Pesa, Rebecca Fitzgerald, Amy Lager a consensus about facial aging was come to and that is rather than filling the lines of the face when they occur, those lines are occurring because of the lost of volume in the face from the lost of fat and the preauricular area, over the brows, the cheek, the chin and that’s what’s causing the lines. Rather than just filling lines, what we are now doing, again our philosophy has changed, we are now filling the areas up where we’ve lost the volume and by reinflating the face it actually takes care of those lines without having to fill them. Of course, even with Sculptra, there may be a few superficial lines that will be filled with other fillers. So it’s nice to combine other fillers with Sculptra. it’s not all of one or all of the other. But what’s nice with Sculptra is it globally fill the face in a way that’s not really possible with other fillers. Younger patients may need one or two. Older patients may need three to four sessions. Much older patients who have a lot of volume loss would probably be better served by having a facelift and maybe fat injected at the same time. Economically, Sculptra makes sense over other fillers. And that once the patient reaches full correction and the face is rejuvenated, we don’t have to treat patients again for 2-4 years. So when you amortized the cost of Sculptra over time, it’s a lot less expensive than the other fillers that you need to start over again every time they run out.Even with fat when we take patients to the operating room and do fat transfers we are able to again, fill the place but Sculptra is a lot more predictable and reliable than fat when we put fat transfers in. Approximately 40 to 60 percent of the fat survives. We don’t know how much of it will survive and where it will survive so as Dr Ambro says the most common procedure to fat surgeons do is fat transfer and the second most common is a second fat transfer and then the third one is because the fat that stays is permanent is removing the fat. So with Sculptra, we are able to predictably rejuvenate the face by replacing lost volume. That’s really the main difference between Sculptra and other fillers. The other difference is with other fillers the injection process is done. Face is filled and the patient walks out and there’s a finite amount of time, six to twelve months before the patient needs to come back to have more filler put in. With Sculptra, the amount of volume changed is directly related to how many sessions the patient has so in other words, the first time a patient has Sculptra inject them, we don’t inject them to fill all the hollows. You have to think of that more in terms of spreading seeds out to grow new collagen in the places where we want to grow it. And we can’t and we don’t fill those areas up to max so it would be like putting a fertilizer on a lawn up to here and expect it to grow more grass. There’s only so much collagen that will grow at one time with a treatment session of Sculptra so, after this session, the patient will wait a good six to eight weeks, come back and then we can treat again in the areas where more volume is needed. The amount of volume replacement with Sculptra is directly related to how many injection session the patient has or needs.Sculptra Los Angeles. And again, the nice thing about Sculptra at that 2-4 year point where you put a little bit more in, you don’t have to start all over by building things up because the patient has a nice based of their own collagen. So, I hope that answers most of your questions about Sculptra. Certainly if you have any more, please feel free to contact me either my website, you can call my office, or email me, i’ll be happy to get back with you. Be well. Bye Bye.

Video Highlights 0:05 Chin implantation demand growth 0:20 Has social influenced this trend? 0:42 The procedure 1:27 Healing period 1:44 Chin implant assessment 2:30 The caution 2:57 Ideal chin 3:12 Pre Jaw implants 3:59 Chin implant inquiries 4:06 Why consider a chin implant? Hi, this is Dr Michael Persky. I’d like to talk to you about chin augmentation using chin implants. Both for men and women, chin implantation is one of the fastest growing facial plastic surgical treatments. We’ve seen an increased in demand for this procedure. And many people think it may be because of social media and the preponderance of the digital age seen ourselves on video cams, computer, Face Time, Instagram, etc. It’s a relatively simple procedure to have done. It’s done through a small incision under the chin and a crease where most of us have little traumas in the past. The scar when it heals is almost undetectable and the procedure is done through that incision. The section is carried down to the actual mandible bone. A small pocket is made in the tight lining of the bone on either side and the chin implant is then tucked in to that pocket. The muscles then closed, the soft tissues closed, and the skin is closed.  The stitches stay in place for 4-5 days. Once it heals it’s very difficult to even tell that there’s anything in there both from the patient’s perspective as well as from other people’s perspective. When patients come in for chin implant consultation, we assess their anatomy. We have different sizes of chin implant sizers that are then placed over the area. The implant fits somewhat like this (demonstrates) Depending on how much projection the patient needs, the correct implant is selected. During surgery the implant is placed along the inferior border of the mandible and it sits kind of like this (demonstrates). The most important thing when performing the surgery is to make sure that your surgeon dissects low on the mandible to avoid these little holes called, where the mental nerve comes out and if this is damaged you can end up with some numbness. So it’s very important for the surgeon to know their anatomy obviously as with any surgery and to avoid that. Ideally you want your chin to hit your lower lip if a line was dropped straight from your lower lip to your chin tangentially. That’s about the projection that you want. Another interesting aspect of augmentation implants in that area is a pre- implant which doesn’t really have the projection for the chin but it has projection out here for the jaw and these and the pre jaw. So what it does is it blends the jaw area with the chin and gives the patient a stronger chin line. So it sits there like this (demonstrates). It doesn’t really give you projection but it fills in the jaw area permanently. The chin implant and pre jaw implant are available. It’s a relatively simple procedure it takes probably about 30 minutes to do. It’s usually done in the operating room. If you have many more questions about your chin or chin implants, please feel free to contact us. One of the really nice things about chin implant is the bigger the chin is the smaller the nose looks. Be well, bye.

Video Highlights 0:05 Rejuvenation of the hands 0:19 Why you should have a rejuvenated of hands after face rejuvenation 0:39 Hide veins and tendons in the hands 1:00 Fraxel Dual Laser 1:14 Cost of the procedure 1:20 What is Radiesse? 1:38 Why repeated Laser is needed? 2:08 A brand set of hands for $2000! Hi this is Dr. Michael Persky. I’d like to talk to you a little bit about rejuvenation of the hands. Why would a facial plastic surgeon be talking about rejuvenation of the hands? Well, after we take care of the face and get the face looking good. The last thing that a patient wants to do is put their hands up to their face, not that my face and hands are looking that great. But the last thing that a rejuvenated patient wants is to put their hands up to their face and have the rejuvenated face be given away by aging hands. So there’s a couple of things about the hands that are pretty exciting that we are doing right now, including filling hands to hide veins and to hide tendons and make the hands look more youthful as well as resurfacing the hands and getting rid of sun damaged brown spots and also some wrinkles in the hands. The Fraxel Dual Laser does a wonderful job of resurfacing the skin. It’s a minimal downtime procedure. The two most common questions that patients asks us about any procedure is how long will it last and how much will it cost? In terms of the filler using a RADIESSE® in the hands, RADIESSE® usually last anywhere from 1 year to 2 years in the hands. RADIESSE® is a biological stimulatory filler which means it stimulates your own collagen when it’s in place. So even after it wears off, your hands are still gonna be better off than before you had it place. As far as the laser goes, it may need to be repeated for stubborn brown spots but it can last for years. The costs of these things are very dependent on how much RADIESSE® we use. But in general a syringe of 1.5cc of RADIESSE® is used in each hand, that’s usually around $600 to $700 per syringe and the laser runs about $600. So for brand new hands, you get in and out of the office usually for about $2000.

Video Highlights 00:14 – Beauty Secret 00:35 – Botox + what? 01:01 – What fillers to use 01:10 – Picasso’s proportions 01:20 – Da Vinci’s facial harmony 01:40 – Areas to work on 02:00 – Don’t go by what others look like Hi this is Dr. Michael Persky, I’m a facial plastic surgeon in Encino California, suburb of Los Angeles, it’s approximately 20-25 minutes from both Beverly Hills and Hollywood, California. Today I’d like to share with you a little beauty secret that came up during the day in the office. While consulting with a 50 year old very beautiful woman who wanted to look a little bit better for her upcoming birthday party. She was receiving her Botox injections and asked me what she could have done that would make her look better. What would I do. And I told her that it looked like her face need a little volume in both the mid cheek area and jaw area.  Oh No no no! I was working out in the gym today next to a 30 year old woman who was just puffed up. I will never do fillers on my face. She looked ridiculous. And what I told her was, it’s not really what fillers you used or how it’s done but it’s rather the artistic vision of the person who’s putting it in. If the doctor or nurse studied under Picasso’s proportions, they’re gonna look funny. They’re gonna look like a genetic mutant. If that doctor studied rather under Da Vinci’s proportions of facial harmony, then no matter what fillers you use they’ll end up looking good. If somebody looks obviously done, then we’ve failed them as facial plastic surgeons. So in her case, she again could have used volume in her mid cheek area, in her marionette area and as well as anterior to her jaw area. So she’s gonna consider that, but seriously, when you are considering whether you should have a treatment done, don’t go by what other people looked like. If the person who put the material into the face studied out Picasso’s school of cosmetic surgery they’ll look funny but if they’ve done their work and know about facial beauty and harmony and the shape that a face should have then they’re in good hands. That’s our beauty secret of the day. Be well and we’ll see you soon.

Video Highlights 0:21 Earlobe repair and rejuvenation 0:42 When ear piercings go bad 1:08 Normalizing the earlobe to restore it’s beauty 1:28 Nearly painless procedure 1:36 Excision of the hole 1:56 Recovery period 2:30 Ready for a new earring! 2:43 Repair of an earlobe that’s been purposely made larger 3:52 Rejuvenation of the large ear 4:40 Rejuvenation of the aging ear 5:02 Solution to volume loss   Hi this is Dr. Michael Persky, I’m a facial plastic surgeon from Encino California. For those of you who don’t know where Encino is, it’s a small suburb of Los Angeles, approximately 20-25 minutes Northwest of Beverly Hills, California and pretty non-traffic. Today I’d like to talk to you about earlobe repair as well as rejuvenation of the aging earlobe. Earlobes are an often overlooked aspect of facial rejuvenation. And as a facial plastic surgeon we try to not to get caught up just with one aspect of the entire face in keeping it in harmony. First thing i’d like to talk to you about is when ear piercings go bad. Ear piercings can stretch out making it difficult to wear beautiful earrings the way you would like to. They become hang down and can even fall out when the earlobe becomes too large. When patients present with that problem it’s relatively simple to repair although it needs to be done properly so that the earlobe looks normal once it’s repaired. What we do is, we do this under local anaesthetic, and it’s quite, nearly painless. If you pinch your earlobe, you’ll find,  as hard as you pinch it, there’s very few nerve endings in that area so even the local anaesthetic injection is relatively painless. Once it’s anaesthetize, the hole around the opening has to be excised to freshen up the skin so that we can sew the hole back together. If you are to sew skin to skin it wouldn’t stick when the stitches came out. So by freshening up the inner part of the opening we are able to sew both the front and back together. The stitches remain in place anywhere from 5-7 days. And then removed after about 6 weeks of healing the patient returns to our office for re-piercing of the ear usually with a gold or stainless steel stud. This stays in place for approximately 6 weeks. During that time once a day, the patient twist the earring and cleans it with alcohol. After the six week period, the re-pierced ear is ready for any beautiful earrings. Usually a spouse, boyfriend, or significant other will purchased a new present if they are informed why the ears have been repaired. Second thing that I’d like to talk about is repair of an ear that’s been purposely made larger.  If you think of the African tribes with their large ears and large lips, many patients here find the process of “gaging” an ear were that’s pierced and gages were actually put in their like buttons that increase the size of the ear hole over time. Many patients after years of having that, or are looking for a new job or they just want to have their old ear back, present to our office for that repair. And that involves a more artistic vision and planning to get the ear to close properly. Sometimes it involves a little flap. It usually takes us about 15 minutes longer than the usual 15 minute earlobe repair. The third thing I’d like to talk to you about is rejuvenation of the large ear. We have patients with large earlobes. We have patients who show up and just say, woman will show up with a large ear and say this is my dad’s earlobe. I love the way the rest of my face looks but make this smaller. And that can be done again under local anaesthetic here in the office. Again it takes a little bit more artistic vision and planning. Usually a pie shaped wedge of that earlobe is excised and then meticulously closed. And again the same process for repair of the stretched earlobe is undergone in terms of letting it stay close for approximately six weeks, repiercing after six weeks and the stud stays in place for another six week. Lastly, I’d like to talk to you about rejuvenation of the aging ear. Two things happen to the aging ear, one it loses volume, some of the fat in the ear goes away like the rest of our face. And again, similar to the rest of our face, the ear can look wrinkled. So for those two things, for the volume loss, we can add fillers such as Sculptra, Restelin, Radius, actually not Radius, but Restelin, and Sculptra work particularly well. And then for the wrinkles on the ear, some of the oblative and non oblative lasers work very well at rejuvenating the aging ear. So that covers earlobe repair and treatment of the aging ear. If you have any questions about that, feel free to contact me at drpersky@drpersky.com