Eyelid Surgery (Blepharoplasty)

This week I spent 3 days at the Multidisciplinary Facial Cosmetic Surgery meeting in Las Vegas. This is my third year as an invited faculty member at this impressive meeting. The first day of the meeting is a scheduled “Rhinoplasty day”, where I gave three talks on rhinoplasty: 1. Functional Rhinoplasty; 2. The Thick-Skinned Tip; and 3. Running, Micro-Perforating and Cross-Root Osteotomies. The Bellagio Hotel is a great venue for the meeting and it was great seeing colleagues from around the country and from around the world. My next meeting will be the American Academy of Facial Plastic and Reconstructive Surgery’s (AAFPRS’) Annual Fall Meeting in Boston, where I will present talks and run a panel on nasal cosmetic and functional surgery. This will also be my second year as an elected member on the Board of Directors of both the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) and the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS).

My local and national speaking opportunities continue to increase. Last weekend I again participated in the NYU Rhinology Update, where I have been speaking for some years now. I spoke on the importance of preserving function in rhinoplasty and discussed my own innovations in functional rhinoplasty. I shared the podium with Dean Toriumi, who is still acknowledged by most as the foremost and most innovative rhinoplasty surgeon practicing today.

Today I arrived in Bodrum, Turkey. Here I am attending RhinoCamp, a 3 day nasal extravaganza with many international attendees and instructors. As the honored visiting professor from the U.S. in Rhinoplasty, I am speaking tomorrow on “The Fundamentals of Rhinoplasty”, “The Crooked Nose”, “Functional Rhinoplasty”, “Cartilage Grafts in Rhinoplasty”, and “Alloplasts and the Saddle Nose”.

Bodrum is on the Aegean Sea, with the Greek Islands of Rhodes and Cos just off its coast. Today I swam in a 72 degree Aegean which was sparkling and crystal clear. I plan on exploring the corner of Turkey before I leave on Saturday.

This past weekend, I was in Chicago administering the American Board of Otolaryngology’s (ABOto) oral board examinations in the Facial Plastic Surgery Section. During the weekend about 100 experts administer one-on-one exams in four subsections to surgeons who want to become board-certified in Otolaryngology-Head & Neck Surgeons. In addition to Facial Plastic Surgery, the other sections include Head and Neck Surgery, Otology/Neurotology, and General Otolaryngology (includes Rhinology and Laryngology). It is an honor to be selected as a board examiner; this is the third year that I have been selected. The candidates have to solve four protocols in each subsection in 50 minutes. This rigorous oral exam is preceded by a day long written exam. Surgeons must qualify for the exams by completing a 5-year surgical training program in Otolaryngology. Often candidates study 6 to 12 months for the exam.

To be an examiner one must have demonstrated leadership in one’s subspecialty nationally. The experience is enriching. The examiners must try to insure that board certificatoin means that the highest standards of the field are maintained.

In June I will again be an examiner for the American Board of Facial Plastic & Reconstructive Surgery. This more specialized board insures a high standard within Facial Plastic Surgery for those who wish to focus their practices in this subspecialty of Otolaryngology.

Last Saturday, April 10, I had the honor of being invited to participate in a Rhinoplasty Panel at the Spring Meeting of the NY Regional Society of Plastic Surgery. This is a particular honor for an Otolaryngology-trained Facial Plastic Surgeon. To the credit of Dr. Alan Matarasso, the scientific program chair of the meeting, he invited a balanced panel of 2 ENT Facial Plastic Surgeons and 2 Plastic Surgeons. The participating panelists were: Me; Dr. Rollin Daniel of Newport Beach, CA; Dr. Russel Kridel of Houston, TX; and Dr. Mark Constantian of Nashua, NH. All are top minds in rhinoplasty. I was indeed honored to be a part of it.
I spoke about Combining Functional and Cosmetic Rhinoplasty. My talk centered on how the application of structural support for nasal obstruction must complement the aesthetic goals of the patient. A enthusiastic discussion about the role of spreader grafts in rhinoplasty occurred during the Q&A session after the talks, originating with my observation that spreader grafts are not always as effective as we expect them to be in the severely obstructed patient.
Later that day my wife Melissa and I hosted Dr. Daniel at a wonderful dinner at Oceana Restaurant. The owner, an old friend, happened to be there, making the dinner all the more memorable. My next talks on Functional and Cosmetic Rhinoplasty will be during our upcoming 10th International Facial Plastic Surgery Symposium in Hollywood, FL at the end of April. Stay tuned!
Minas Constantinides, M.D.

Successful rhinoplasty surgeons. Here are my thoughts:
1.The best surgeons do not compete, but rather do the best they can for their patients. Given our competitive society, you would think that in order to become a busy and famous rhinoplasty and facial plastic surgeon you have to compete with your neighboring surgeons. Having met dozens of top surgeons personally and having shared many a podium, drinks and dinner with them, I have found that the opposite is actually true. They all share one striking quality when you meet them: they are remarkably selfless. Indeed, when asked to what they attribute their great success, they all reply with some variation of, “Well, I’m just very fortunate and lucky.” Anyone who does complex primary rhinoplasty and revision rhinoplasty knows that this is actually very far from the truth. Rhinoplasty surgery is so difficult and predictable results so hard to master, that no one can consider himself a master without having done at least 1000 of rhinoplasties and revision rhinoplasties, learning from their mistakes along the way. This pain-staking process of learning through long-term follow-up requires a dedication to self-discovery and self-criticism for which there is no parallel in any other field that I can think of.
2.The best rhinoplasty surgeons have their own style; they are not all things to all people. I know that the selection of rhinoplasty patients on my website reflects a certain style. I prefer noses that look natural. What this means to me is that I would rather leave a high, straight bridge and a less-pointy tip in my rhinoplasty patients. Of course there are rhinoplasty patients on my website that look more “done”, but usually it is because that is what my patient had wanted based on a one-hour discussion and after photo-imaging. However, if a patient pushes the envelope of “doneness” too far, I try to persuade him/her to back off that outcome. If he/she is insistent, I don’t accept him/her as my patient. Fortunately, most New York patients don’t want that overdone look.
3.The best rhinoplasty surgeons care about each individual patient. The best rhinoplasty surgeons spend more, not less, time with any patient that is having difficulty with their recovery. This difference came into sharp focus for me during my recent trip to Ecuador (See: http://www.newyorkfacialplastics.com/blog/?p=1941 ). I had the pleasure of spending one hour of uninterrupted, up-close and personal time with Dr. Fernando Pedroza of Bogota, Columbia. Dr. Pedroza has single-handedly put Facial Plastic Surgery on the map in South America. Imagine the most famous plastic surgeon of the U.S., double his reputation and surgical volume, and you will come close to getting a picture of Dr. Pedroza’s practice. Dr. Pedroza and I spoke about our rhinoplasty patient consultations and it was startling how similar our methods are in speaking to our rhinoplasty patients for the first time. We both spend an inordinate amount of personal time with our rhinoplasty patients (45 min to one hour), and the rhinoplasty patient spends another 1-2 hours with our staff being further educated before they are asked to schedule surgery. The amount of personal effort that each of us invests is huge, so that our rhinoplasty patients know that we are committed to providing them with as much information as they need to make an educated decision. Dr. Pedroza commands the highest prices in South America and could easily spend less time with his rhinoplasty patients and not have his surgical volume suffer. That he does not is a testament to his commitment to insuring the deepest satisfaction in his rhinoplasty patients.
4.The best rhinoplasty surgeons educate others to their philosophies, approaches and techniques. One of the things that distinguishes surgical education from other forms of intellectual capital is that we surgeons give away our intellectual capital for nothing. The more famous the rhinoplasty surgeon, the more he teaches others his rhinoplasty techniques and publishes them in books and professional journals, expanding the knowledge base for everyone to share in. It astounds me how much this point is overlooked by the general public. There are numerous rhinoplasty surgeons in most communities who have terrific websites and are good salesmen, but who simply do not participate in the educational process. Most of us who teach, write, and perform research do so to further the knowledge base of rhinoplasty. The best rhinoplasty surgeons even travel around the world to try to further rhinoplasty in other countries. I personally have traveled to Vietnam, Columbia, Turkey, Portugal, Germany, Peru, and Ecuador to educate the local surgical communities in rhinoplasty, all in the last two years.
Knowledge of rhinoplasty alone does not make a top rhinoplasty surgeon. A top rhinoplasty surgeon is someone who derives extraordinary positive energy and focus from caring for his rhinoplasty patients as individuals, and caring for his surgical community without guarantee of fame or personal gain. The core values of the best rhinoplasty surgeon makes him someone that you would want to trust with your face and nose. The best rhinoplasty surgeon never promises perfection, but does promise to do his best using all of his abilities to give you as good a result as you can possibly have. The best rhinoplasty surgeon promises to take care of you in times of fear and uncertainty, getting you through difficult healing periods or unexpected revisions. The best rhinoplasty surgeon understands the leap of faith it takes to choose him as your surgeon, and values his responsibility to you, his patient, above all else.

Last week in South Beach, I attended the American Academy of Facial Plastic & Reconstructive Surgery’s (AAFPRS) winter Board of Directors meeting. As Group VP of Research, Awards and Development, elected last year by the facial plastic surgery national membership, I represent the committees whose job it is to build research efforts by the AAFPRS, to distribute research awards, and to help in developmental activities, including pro bono national and international activities. Here is a recap of the activities we discussed, with a bias to those I am working on:
1. Research: On Friday we met with senior leaders of 3companies to help pave closer affilitation that can benefit the AAFPRS membership. Each year we meet with several such companies, and this year we made an effort not to invite competitors. As a result, the companies that attended (LifeCell (makers of Alloderm), Sanofi (makers of Sculptra), PNC Skin (makers of skin care lines and peels) all spoke openly of what direction they were going in and how they wanted our Academy to participate with their growth. From our part, we discussed the possible formation of an LLC that could help to organize outcomes research at arm’s length from company oversight. This is important because most companies now fund their own outcomes research, but such research can be potentially tainted by bias from the funding company. Our company would be able to commission research that would be funded by industry, but not directed by industry. This will create tremendous value for industry, the AAFPRS, and for science at large.
2. Awards: The AAFPRS continues to participate with the CORE grant process administered by Otolaryngology. Last year due to the poor economy there were insufficient funds to pay for the CORE grant recipients. Otolaryngology stepped up and funded the awards, allowing worthy recipients to fund their winning research projects. This year we hope that the improved economy will allow us to continue to fund the awards, endowed by the generosity of Dr. Leslie Bernstein.
3. Development: Face To Face, the domestic and international pro bono arm of the AAFPRS, continues to find success. The Domestic Violence Project, that helps victims of domestic violence find volunteer surgeons to care for them for free, continues to help over 100 women per year across the country. The international program continues running successful trips to Vietnam, China, Russia, and Africa. With the launching of Faces of Honor, the AAFPRS has once again founded a worthy program where injured veterans of Iraq and Afghanistan can be paired with volunteer surgeons who are willing to help them. For more information see FacesOfHonor.org. We also discussed sending AAFPRS members information about how to volunteer in Haiti. The AAFPRS will soon compile a database of surgeons willing to deploy on short notice to areas of natural disaster world-wide.

Education: Although the VP of Education oversees these programs, I have been intimately involved in developing a new educational opportunity for our members. The Domestic Observership program was approved by the Board of Directors to pair mentors with mentees for 1 to 3 month observerships. This program will launch soon, allowing any member who wishes to spend time with a senior Fellow and mentor in the AAFPRS in a post-graduate learning experience. Although completely observational, so quite unlike our hands-on Fellowships, this program will allow members an additional learning a venue. The program will be overseen by the Fellowship Committee of the AAFPRS (of which I am immediate past-chairman).
Overall, the effort that our Board displays in working for more member benefits and opportunities continues to impress me. I look forward to continuing to serve our members in the years to come.

My wife Melissa and I just returned from a week-long trip to Peru. The trip began in Cuzco, which was the capital of the Inca Empire when the Spanish colonized the area. Cuzco is at 12,000 feet and travelers are often affected by altitude sickness. Fortunately the hotel we stayed in, the Monasterio, had supplemental oxygen available in the guest rooms. The next day we took the Hiram Bingham train to Macchu Picchu. This was an enchanting area, deeply spiritual in its feeling in the heart of the Peruvian Andes. The area left us with a profound feeling of peace and wonder, so much so that a return trip to spend several days in the area is part of our future plans.

Upon returning to Lima, I taught a 3-day course on Rhinoplasty, joined by Dr. Ted Cook from Portland and Dr. Roxana Cobo from Columbia. The course was jointly administered by the Peruvian Society of Otorhinolaryngology and Facial Surgery and the Latin American Society of Rhinology and Facial Plastic Surgery. It drew 180 surgeons interested in expanding their rhinoplasty techniques. The lectures I gave were on Fundamental Concepts in Rhinoplasty, Functional Rhinoplasty, Advanced Nasal Tip Techniques, Revision Rhinoplasty, Internet Marketing and Rhinoplasty, The Crooked Nose, and Complications of Rhinoplasty, totaling 6 hours of lectures. Our hosts, Dr. Francisco Saliverry (President of the Latin American Society of Rhinology and Facial Plastic Surgery) and Dr. Miguel Garcia-Calderon (President of the Peruvian Society of Otorhinolaryngology and Facial Surgery) made the time in Lima memorable and filled with wonderful food and social events. The educational enthusiasm of the Peruvian surgeons was so impressive that I have promised to return next year for another course, this time including live surgery.

Today I flew to San Diego for a 5-day stay. The Annual Meeting of the American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS) begins on Thursday, but tomorrow is a full day of committee meetings and board meetings. Last year I was elected to the Board of Directors of the AAFPRS as Group Vice-President-elect of Awards, Research and Development by a national vote of the membership. I have been participating with Board activities in the “elect” capacity over the last year, and my official 3-year term begins at this meeting. This is a personal milestone for me, something that I had dreamed of since beginning my practice 15 years ago at NYU, but not really believing I could achieve at the relatively young age of 48. I consider a great honor to serve on the Board and representing our members, especially in this time of tremendous impending change in our health care system.

This meeting also marks my nomination to be on the Board of Directors of the American Board of Facial Plastic & Reconstructive Surgery (ABFPRS; www.abfprs.org ). This is the organization that administers the annual written and oral board examination in Facial Plastic & Reconstructive Surgery. The examination is another worthy endeavor that helps patients understand the competency of their doctors.

I will be again chairing the Fellowship Committee of the AAFPRS, where we help to improve the quality of the fellowship program administered by AAFPRS. I have been a Fellowship Director for 8 years, elevating facial plastic surgery to the next level at NYU Langone Medical Center. This year I hired my graduating fellow, Dr. Matt White, into my Division of Facial Plastic & Reconstructive Surgery, further expanding the services we provide.

I will also be attending numerous other committee meetings, among my favorite the Face To Face Committee, where I am senior advisor. We will be launching a new program: Face To Face Veterans Initiative. This program will couple volunteer surgeons with injured veterans from Iraq and Afghanistan. When armed forces healthcare and the VA system can no longer help these Vets, the AAFPRS program may, by making advanced expertise available at no cost to the Veteran.

Finally, I will be joining forces with Dr. Dean Toriumi of Chicago and Dr. Russel Kridel of Houston to teach a one-hour course on Open Rhinoplasty Finesse. To be able to share the podium with these two Past Presidents of the AAFPRS leaves me feeling giddy. It should be a lot of fun for all of us and for the course attendees.

Stay tuned for updates on the meeting, on this blog and on twitter.com @drconstantinide.

Its been too long, but my absence from the blog scene was for good reason. I’ve been busy traveling around Europe speaking about Functional Rhinoplasty, Cosmetic Rhinoplasty, and the Patient-Physician Relationship. Our trip spanned the two weeks between the last week of August and the first few weeks of September, with the Labor Day weekend as the middle weekend of the trip. Accompanying me were my wife Melissa and our son Dimitri. Our trip started in Paris, the only stop that had nothing to do with Facial Plastic Surgery. Dimitri loved the Louvre, where he was able to visit the Mona Lisa, who he had studied in school. I recently saw a History Channel segment hypothesizing the Mona Lisa was a self-portrait of Leonardo DaVinci. Kind of takes the wind out of one’s sail thinking about that. Whoever she was, she certainly captured a mysterious beauty that is more androgynous than feminine, but certainly not masculine.

After Paris, we flew to Porto, Portugal for the European Academy of Facial Plastic Surgery’s Annual Meeting. I gave lectures about Cartilage Grafting in Rhinoplasty and the Patient-Physician Relationship, and a one-hour course on Rhinoplasty: From Planning through Recovery. Porto is a beautiful city perched on a hill overlooking the Douro River and resting beside the Atlantic Ocean. Famous for the center of port wine production, it is an old, beautiful city with winding streets. It is also the musical and cultural center of Portugal. The closing dinner was a highlight of the trip, held in Taylor Wine Cellars where great food and wine was accompanied by a cabaret of Broadway show numbers. Portuguese wine is an amazing value for its price, with rich reds that stand up to the biggest meats. Fortunately they are becoming easier to find in New York.

Munich, Germany was our last stop. This was my first visit to Germany, and I was surprised that Munich, the capital of Bavaria, was a beautiful old city with numerous outstanding restaurants and the ever-present Bavarian beer. Our hotel, Tobrau House, was in the center of the old city having been built in 1490. Many of the buildings withstood the heavy Allied bombings that leveled most of the outer city during WWII, so Munich retains much of its old-world charm. It is an easy city to negotiate, and the locals are friendly and very proud of their heritage.

In Munich, I spoke at the largest Head & Neck training program in Germany at their annual Rhinoplasty Course. Day 1 included lectures by me on Functional Rhinoplasty, Cartilage Grafting in Rhinoplasty, Advanced Tip Techniques in Rhinoplasty, and the Patient-Physician Relationship. Day 2 was Live Surgery, where I performed a Functional Rhinoplasty on one of the most crooked noses and septums that I have seen in my career.

My patient was an Iranian immigrant who spoke only Arabic. He had a friend who spoke Arabic, German and Greek, so we were all able to communicate with only one level of translation. He had been a boxer and was known for his immense nose. I could imagine the young attending in the clinic seeing him and thinking, “Have I got a case for the famous visiting professor (ME!).” Surgery, piped in live to an auditorium of 50 course participants, was difficult and tedious and took 4 hours to complete. In the end, after extensive reductions of tissue volume while adding strengthening structural grafts, I left him with a nose that would work a lot better and look much straighter and smaller, though still masculine. The audience was impressed and I was confident that I had taught them something beneficial, thanks to this courageous Iranian.

Sometimes I am fortunate enough to have observers from other countries watch me perform rhinoplasty surgery in New York City. This is a photo of Dr. Wen, a visiting surgeon from China that spent some time in my operating room. He was extremely pleasant and inquisitive, and I know he learned a great deal. Some day perhaps I will be able to visit him in China. Minas Constantinides, MD.