Eyelid Surgery (Blepharoplasty)

Monet, Picasso, Degas, and Dr. C? What do those artists have in common with Dr. C you ask. They can all be found on Fifth Avenue. We now have a second location right across from the Metropolitan Museum of Art at 990 Fifth Avenue between 80th and 81st Streets.
Our new office is found in a landmark building designed in the Italian Renaissance “palazzo-style” by Rosario Candela and the firm Warren & Wetmore. It was built in 1927 and is right in the middle of Fifth Avenue’s “Museum Mile” and directly opposite the sound end of the Met. We will be seeing patients there on Fridays from 9:00-5:00 and look forward to seeing and hearing from you.

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.

After many months of planning, Dr. Mark Delacure and I, working with a team of plastic and reconstructive surgeons, rebuilt Brandy’s nose today. I began the surgery by opening her nasal airways and preparing the nose and midface for Dr. Delacure’s free flap. He harvested the free flap that had already been constructed into a nasal shape on her forearm, then transfered it up to her face. This major nasal reconstruction was a novel application of a well-known technique of using forearm skin and bone to rebuild the nose. However, most often this is used as the lining of the nose, with the cover coming from a forehead skin flap. In this case, the flap was used partly for cover and partly for lining. Brandy will need another surgery in a few months to finish the reconstruction of her nostrils. But after this surgery, she will be able to breathe and smell for the first time in 5 years.

For press coverage of this story, see the Daily News article: NYU Medical Center to give shooting victim brand new nose Tuesday http://www.nydailynews.com/news/2009/07/28/2009-07-28_miracle_surgery_new_nose_for_crime_victim.html

Monday this week was a perfect facial plastic surgery day. It began with my doing a deep plane face and neck lift in my accredited office based surgery center. The patient was a beautiful fair skinned woman with early jowls, submental excess, and midface ptosis. This was a patient that many of my plastic surgery colleagues might have done a limited surgery. However, I strongly feel that that might look good for a year, but then the face would start to look funny. The deep plane lift is such a great and versatile procedure. Because it raises the whole face back to where it belongs, it works well in mild aging problems and in severe ones. She will look 10 years better, never overdone, just like herself.

After that 4 hours of surgery, I hustled up to Day Surgery at NYU Langone Medical Center. There, I performed a revision rhinoplasty for a wonderful woman who just did not get the result she wanted one year ago from another surgeon. Not only did she not like how her nose looked, but she could not breathe from either side of her nose. I managed to get through all her scar and effectively improve her nasal appearance. For her breathing, she needed internal nasal valve improvement, so I used a combination of spreader grafts and upper lateral cartilage splay sutures. Her tip volume was reduced, but because of her scarred skin I was worried that her skin would not be able to contract down to the new framework that I built. So, I removed some of her skin to pull it down tighter over the framework. All the reconstruction was done using septal cartilage grafts, with no need for ear or rib. It was a fantastic 4 hour effort.

I ended the day by repairing a fractured zygomatic arch in a young man who was mugged last week outside a club in Manhattan. In addition to the depressed cheek bone, he couldn’t easily open his mouth or move his jaw to the affected side. Fortunately, a relatively easy reduction could be accomplished by simply making an incision in the temporal hair, following the temporalis muscle under the arch, and popping the arch up. The bone fragments locked up beautifully, avoiding a larger and more complicated operation. This approach, called a Gilles repair, doesn’t always work perfectly, but his fracture was the perfect type for this.

This was a day that allowed me to apply all my skills in facial plastic surgery: Cosmetic, functional airway, and reconstructive. After 9 hours of actual surgery, I felt invigorated and happy I could do such great work that would help my patients with their concerns, giving them increased self-confidence and better function.

Last week I again was an invited speaker at the Facial Plastic Surgery Meeting in Las Vegas with Melissa. I spoke about new techniques in Rhinoplasty and the Physician-Patient Consultation. The meeting also included fantastic talks on every aspect of facial plastic surgery including Dysport, the new botulinum type A toxin. Face lift, eyelid lifts, and the latest laser techniques were discussed. The Bellagio was again a fantastic venue, with the most beautiful pools in Las Vegas. Nights were spent dancing, eating, and enjoying new friends from all over the world. This meeting has become a tradition for Melissa and me, a time to be away from New York, meet new people in Facial Plastic Surgery, and re-connect. Both of us can’t wait until next year!

Dr. Constantinides recently attended an International meeting in Philadelphia composed of Rhinology societies worldwide. He saw friends and colleagues from Turkey and Columbia as well as the U.S. while making new acquaintances from here and abroad.
Although Rhinology World is an international meeting with a large presence of sinus surgeons from all over the globe, Dr. Constantinides was among a select few from the Facial Plastic Surgery specialty to be asked to speak. It was an honor to be chosen to share his knowledge of Rhinoplasty, how he practices the art of Rhinoplasty in New York City.
Below is a list of courses Dr. Constantinides gave while he was there. They were well attended and received by his peers.
1. “Confusion, the Clarity, at the Internal Nasal Valve”, Mini-seminar Lecturer: Experience is the Best Teacher.
2. “Alar Strut Graft Applications”, Mini-seminar Lecturer: Marriage of Function & Aesthetics in Rhinoplasty
3. “Alar Base in Ethnic Rhinoplasty”, Instruction Course Lecturer: Ethnic Rhinoplasty
4. Chair of Mini-seminar: Nasal Valve/Functional Rhinoplasty

This month starts something new on the blog. We will be following the cosmetic reconstruction case of an amazing girl named Brandy Elias. Over two years ago Dr. Constantinides was asked to consult on a case involving a young girl from Guyana named Brandy Elias. She was the victim of a drive-by shooting in 2004. This was a completely random act of violence and in no way was Brandy targeted. She was shot six times with two of the bullets hitting her in the face. The multiple gunshots removed most of her nose and damaged her sinuses so that her eyes continuously tear. Brandy is a remarkable young woman who was introduced to Dr. Constantinides by Mr. Jeremiah Drake, an artist and instructor at the Riverside Church in New York City.

Mr. Drake and Dr. Constantinides had met several years ago in 2006 when he was in search of a facial plastic surgeon to speak with regarding women in his community that had been victims of domestic violence. Jeremiah is known for his art project called Restoring the Icon and visual arts series called The Slashing of the Icon. These are his artistic statements on domestic and social violence which causes facial and bodily disfigurement. He had contacted the main offices of Face to Face and was directed to the Domestic Program. Face to Face is the pro bono arm of the American Academy of Facial Plastic and Reconstructive Surgery which is dedicated to treating women with domestic violence injuries, traveling to countries such as Vietnam, China, and Russia to name a few where surgery is performed by members of the AAFPRS on local people who would be unable to afford or have reconstructive or cosmetic surgery to correct facial defects. The director of the Domestic Program referred Jeremiah to Dr. Constantinides. They spent some time talking on the phone about ways in which Dr. C. could be of help to his community. Several days after their discussion Jeremiah saw an article in the Daily News about a young woman named Roshauna Tate. Roshauna was slashed in the face by her boyfriend during a murder/suicide attempt. After slashing Roshauna’s face he dove into New York Harbor with their 9 month old son Nacir in an attempt to drown them both. A NYPD officer jumped in after them and was able to save Nacir but unable to save the boyfriend. He had two thoughts at the time. The first was to contact Roshauna and the second was to have her consult with Dr. Constantinides.

During one of Roshauna’s follow-up visits with Dr. Constantinides, Jeremiah showed him pictures of Brandy. Immediately he knew that she was someone he could be help if she was able to come to New York. Two years have now passed and Roshauna’s facial scars have been repaired along with two large keloidal masses that have been removed from her ears. She is engaged, attends cosmetology school, and has recently celebrated Nacir’s 2nd birthday.

Jeremiah was interviewed by the Daily News after Roshauna’s surgery. In the article he mentioned Dr. Constantinides and the success of Roshauana’s surgical outcome. The story came out on November 22, 2006. Soon after it was printed Mr. Drake met with Brandy’s godfather, Mr. Bobby Bowden. He had heard about Dr. Constantinides’ successful work with Roshauna and his collaboration with Jeremiah. The story gave him hope that he had found two people who would bring Brandy some closure and more importantly help her to heal inside and out.

After agreeing to take on Brandy’s case Dr. Constantinides entered her into the Langone NYU Medical Center’s International Services Program. Through the incredible and exhaustive efforts of Mr. Drake, Maria Corbo who is the Director of the International Services Program, The Office of Congresswoman Yvette Clark, Dr. Constantinides, and our amazing office, the arduous process of petitioning the State Department and the U.S. Embassy in Guyana began. They had to secure and help put in place the immigration visa for Brandy so that she could travel to the states for her reconstructive surgery with Dr. C.

Brandy arrived at JFK International Airport on Friday November 14, 2008 and is now here on a permanent visa.

Over the next few months Dr. Constantinides and his colleague Dr. Mark Delacure will perform surgeries on Brandy culminating in one final surgery to attach a nose to replace the bandage that she is using to cover the scars of her ordeal. There will be 3 surgical stages.

The first stage, which involved designing a skin flap on her left arm took place on Monday February 2, 2009 and was performed by Dr Mark Delacure.

The 2nd stage will take place about one month after this first surgery. The 3rd and final stage which is the major surgery will take place about one month after her second procedure. This final stage is where the free flap from the arm will be transferred to the face, the airway will be opened, and her left eye repaired, will be about one month after that. The dates of her next two surgeries are yet to be determined.

We will keep you all informed about Brandy’s progress as it becomes available to us. Along with that information we will post photos of the step by step evaluation and progress from beginning to end of this remarkable reconstructive process.

We look forward to any comments you may have and words of support for Brandy as well.

We wanted to start off this month’s blog by wishing Dr. Constantinides a HAPPY BIRTHDAY!!! Our office celebrated by ordering from one of his favorite takeout restaurants for lunch and then we surprised him with a handmade cake with his office logo on it designed by Cupcake Café here in New York City, also another of his favorites. I have attached some pictures of the festivities.

This celebration started me thinking of how age is really just a number. These days we have all begun taking exceptionally good care of not only our bodies but our skin, all in the quest of a more youthful and healthy appearance. Many products on the market are targeted to consumers with the promise of giving your skin a “healthy glow” or reducing the appearance of fine lines and wrinkles. These products are not necessarily for everyone and the results vary, but there remains one product we all need that helps us to not just keep our skin looking younger but our bodies too. Sunblock. Although you would not associate sunblock with cold weather and snow, sunscreen is essential in the wintertime. You can find SPF in make-up, lotions, and creams to name a few but this is not enough protection. You need to make a point of applying sunscreen with an SPF 35 to ensure you experience minimal sun damage. You can feel your age but that does not mean you have to look it.

As this year winds down and a new one fast approaches we wanted to recap a few truly memorable moments here in Dr. C’s office. We’d also like to give thanks to our patients, family, friends, colleagues, and staff for their endless support throughout the past year.
Over the past year we have held a few of our famous “Nights of Beauty”. They were not only well-attended but the feedback that patients have given us has been so positive, we are planning another one in the spring of 2009. The date will be Thursday May 14th from 6-9pm. We look forward to seeing you all then.
In July we welcomed Lindsey to the office. She is a welcome addition to our already amazing group of women.

As you know Dr. C travels quite a bit to lecture both abroad and here at home. Here are a list of a few places he visited this year:
-In January, Dr C weathered the slopes of Vail, CO at the Mid-Winter Ski Meeting for the AAFPRS. This multidisciplinary meeting included facial plastic surgeons, oculoplastic surgeons and dermatologic surgeons, providing great camaraderie amongst cosmetic specialists.
-April was a big month as he held his first course here at The Langone New York University Medical Center. It was called “Rhinoplasty and the Central Face”. The course was well attended and the response from faculty and attendees was very positive. It looks like there will be a second one in the near future.
-Dr. C also took his first trip to Cartagena, Columbia in April to speak at the International Federation of Facial Plastic Surgical Societies’ meeting. His talks were so well received that he was invited back again and instantly agreed to do so in the fall.
-In May he was a guest speaker at a conference in Long Island on rhinoplasty.
-June was a fun month. We went to Las Vegas and really embraced the town. The talks were successful and the best part was the relationships formed between the plastic surgeons and the facial plastics surgeons in attendance.
-In September Dr. C was elected to the Board of Directors of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) as Group Vice President of Awards, Research and Development. This was not only an enormous honor but one of his lifelong dreams. His love and dedication to the AAFPRS, rhinoplasty and facial plastic surgery, and most importantly to his patients, make him the perfect board member.
-In November he went to Manizales, Columbia and enjoyed the many meetings, dinners with colleagues, historic sites, and coffee buzz that only Manizales could provide. He had promised to return to Columbia and he did. He was also inducted into the Columbian Society of Facial Plastic Surgery as an honorary member.
-This brings us to December. We are happy to let you know that our Facial Rejuvenation Spa has been updated and more services have been added, including Laser Hair Removal. Check the Spa Page of the website for specials and services.

This year has been a busy one for Dr. C as you can tell and his many successes are shared by not only us but with you as well. Our patients and those of you who check in to see “what’s new” help to make our practice a better one.
We wish you a very happy holiday season and we look forward to seeing you in the New Year.

Welcome back from summer! Here’s what’s been happening in the office.

This summer was very active for us here at Dr. C’s. Alison our office manager was the most active. She went to Maine and besides eating lobster for breakfast, lunch, and dinner, much to many people’s surprise, hiked and camped for a week. Our daredevil Lindsey went sky diving in Virginia. She’s still in one piece. Lyuda our nurse took a romantic trip with her husband to Paris. She ate plenty of cheese and chocolates. Of course she had some fabulous wine as well.

As for Dr. Constantinides and me, our family went to Greece at the end of August for two weeks. We visited family in Khalkidhiki and then introduced our three boys to the islands of Santorini and Skiathos. Our days were spent at the beach snorkeling, swimming, and relaxing while our nights were spent enjoying the local foods and customs of my husbands heritage. To end our trip we went to Athens for a few days and visited the Acropolis, the National Gardens, and Monastiraki, famous for its gyro restaurants. As you can tell by the many wonderful and amazing things our office staff did this summer we are ready to jump back into work and continue to provide you with the care and service you have come to expect from us.

We are already well into September and yet it’s hard to let go of summer. As our tans start to fade (What tans? You wore sunscreen, right?), it’s time to fall into A Night of Beauty. Join us Thursday, October 2nd from 6-8 pm for drinks, hors d’oeuvres, and a preview of the latest in cosmetic procedures. More details to follow soon, or give us a call to find out and register!

Melissa Constantinides