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Fernando Burstein MD, Facial Plastic Surgeon
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Fernando Burstein MD, Facial Plastic Surgeon
Just another WordPress site
Fernando Burstein MD, Facial Plastic Surgeon
Just another WordPress site
Fernando Burstein MD, Facial Plastic Surgeon
Just another WordPress site
Fernando Burstein MD, Facial Plastic Surgeon

In the more than twenty-five years that I have been a board certified plastic surgeon and otolaryngologist I have had many patients come to me with questions about nasal surgery, or rhinoplasty.  Whether to improve facial symmetry and appearance or correct functional issues caused by accidental trauma or defect, surgical procedures to modify the size and shape of the nose are among the most popular cosmetic plastic surgery procedures performed in the United States today.  Still many men and women have questions about what exactly these procedures entail.  Here are answers to a few of the questions I am most commonly asked about nasal surgery.

Am I a good candidate for rhinoplasty?

reconstructive-rhinoplasty-atlanta-gaIdeal candidates for nasal surgery are men and women who are in good physical health, do not smoke, and who have realistic goals in mind for the improvement of their appearance or nasal function.  While nasal surgery is ideally performed on patients whose facial features are fully grown and developed, there is not a specific age at which I will begin performing facial plastic surgery on a patient for cosmetic purposes and adolescent rhinoplasty performed by a skilled and experienced surgeon has been proven to be both safe and effective.  I believe that multiple factors, including a patient’s expectations and their physical and emotional maturity, need to be carefully taken into consideration in order to maximize each patient’s satisfaction while minimizing the need for revisionary rhinoplasty.

What is the recovery time following rhinoplasty surgery?

Nasal surgery is most frequently performed on an outpatient basis under general anesthesia, and takes between one and two hours, depending on the amount of internal nasal surgery that is combined with the aesthetic procedure.  Patients generally do not require an extended hospital stay, and can return home on the day of the surgery.  However, I strongly advise rest and relaxation, including head elevation for five days and cold packs for the first 24 hours, in order to hasten recovery and minimize bruising and swelling.  Showering can resume the next day and all nonresorbable sutures will be removed, along with the nasal splint (if one is used), at a follow up visit five to seven days after the surgery.  Patients can usually resume light exercise after the splint is off but should refrain from heavy contact for at least six weeks.  Nasal congestion may persist for up to six weeks, and nasal edema may take up to a year to completely resolve, although approximately 75% will be gone by the time the splint is removed.

What do I need to do in order to help make sure that I get the best possible results?

As with any cosmetic plastic surgery procedure, the best outcomes require clear communication between the surgeon and patient both before and after the surgery.  This process begins with a thorough and honest discussion of realistic expectations and potential pitfalls that may occur.  Only when the doctor fully understands exactly what a patient wants, and the patient completely understands exactly what is reasonably attainable, can they both work together towards the same goal.  I recommend that my patients who want external nasal changes undergo computerized facial imaging prior to surgery.  This allows the patient and surgeon to view the potential surgical results and these computerized images provide a guide or a template which I refer to during surgery.  After surgery, it is absolutely imperative that you scrupulously adhere to all post-op instructions and attend all of your follow-up appointments.  When patients fail to follow after-care instructions, complications may spoil an otherwise excellent result.  These concerns are much easier to correct when discovered during early follow up visits and addressed immediately after the procedure.

Since every patient is unique and requires individualized assessment, I would advise that you contact my office in order to schedule a consultation so that we can determine if rhinoplasty is right for you.  Don’t forget to connect with me, Dr. Fernando Burstein, on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.

I have mentioned on many different occasions that I believe the best way to address the various signs of facial aging is with a graduated approach, using subtle, minimally invasive treatments early and only moving on to more comprehensive plastic surgery procedures when they become necessary.  While it is true that all faces age differently, and there is no single course of treatment that is universally best for all patients, I have found that the first steps towards combatting facial aging can often be taken when a patient is in their late twenties or early thirties with various non-surgical facial rejuvenation treatments.

atlanta facial plastics surgeryMany of the earliest signs of facial aging come in the form of tiny expression lines and wrinkles that start to form in the forehead and around the eyes.  The constant movements of the facial muscles, whether they come from laughing or frowning, effectively fold the skin over and over again.  While the skin is young and well hydrated, these folds don’t leave any lasting marks, but as the skin ages these facial movements come to leave permanent creases in the form of laugh lines, frown lines, and crow’s feet.  Botox® cosmetic injections effectively relax the muscles that form these fine lines and wrinkles, causing them to fade away for four to six months with a single fifteen minute treatment.  Moreover, relaxing these muscles not only alleviates existing lines, but also helps prevent new lines from forming.  Many have found that long term use of Botox® treatments keeps the skin looking younger, longer, and delays the point at which more significant facial plastic surgery, like a brow lift, may become necessary.

Over time, the skin can also lose volume and fullness as it comes to produce less hyaluronic acid, a substance that occurs naturally in youthful skin.  Hyaluronic acid attracts and binds to water, “plumping up” the skin while filling and smoothing out any surface wrinkles.  Non-animal collagen based dermal fillers, like Juvéderm®, can instantly add volume to the facial tissues by restoring hyaluronic acid, but also appear to stimulate the production of collagen and elastin, two proteins that help contribute to the skin’s fullness and elasticity.  By replacing these vital skin components, Juvéderm® and other facial fillers help temporarily counteract the effects of time and sun damage and maintain the skin’s healthy and youthful appearance.

Eventually, however, injectable cosmetics and facial fillers are no longer sufficient to hold back the effects of facial aging.  While these products can do a great deal to turn back the clock, they cannot stop it entirely.  Still, the use of these gradual maintenance treatments allows me to precisely address individual areas of concern as they arise.  By using facial plastic surgery procedures like mini-facelifts, which can specifically target regions of the upper, middle, or lower face as needed, I can more easily achieve subtle and natural looking results that require minimal surgical downtime.  Ultimately a graduated approach allows you to maintain a youthful look without any obvious or drastic changes in your appearance.

If you are interested in any of the plastic surgery procedures that I perform, please contact me, Dr. Fernando Burstein, to schedule a consultation.  Don’t forget to connect with me on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.

One of the most fascinating things about medicine is that even the tiniest changes can make a tremendous difference.  Nowhere is this more evident than in craniofacial plastic surgery, where, for example, removing tiny fat deposits from the eyelids during a blepharoplasty or subtracting a few millimeters from the nose during nasal reconstruction has the potential to change the entire look of the face.  During my time as director of the Center for Craniofacial Disorders at Children’s Healthcare of Atlanta, I have had the opportunity to develop a minimally-invasive treatment for a relatively common birth defect known as congenital muscular torticollis, which can achieve dramatic, life-long results with only the tiniest surgical incisions.

Affecting about one in every 9,000 infants, muscular torticollis is a congenital disorder in which the child’s head is noticeably tilted to one side.  It most commonly results when the sternocleidomastoid muscle suffers damage, either in the womb or during birth.  As the muscle heals, scar tissue forms, but this scar tissue does not grow in the same way that healthy muscle does.  Instead, this scarring causes the muscle to tighten and shorten, which in turn pulls one side of the head down towards the shoulder as the chin tilts to the opposite side.  Left untreated, the condition can cause severe limitation of neck position and the effects of gravity can lead to significant facial asymmetry.  As growth progresses, the jaw and bite may be affected, requiring complex orthodontic work or even surgical jaw realignment.  Cases that are left untreated may eventually require combined craniofacial and neurosurgical intervention to correct the head and orbital deformities that may result.

In some cases, these problems may not be immediately evident, as the trauma to the neck muscle may not affect the way the neck moves until the child is a few months old.  But regardless of when the symptoms are first observed, it is best to treat cases of muscular torticollis as early as possible, preferably starting when the infant is between nine and twelve months of age.  I recommend early treatment with vigorous physical therapy, where a physical therapist works closely with the parents to formulate a daily routine of safe stretching exercises that will gradually restore the muscle length.  A corrective collar or orthotic cranial helmet may also be necessary, depending on the specific needs of the individual patient.  However, if patients fail to respond to these measures, or if there is a worsening of the patient’s facial deformities or severe neck angulation, surgical intervention may be necessary to fully alleviate the symptoms.

My unique endoscopic approach uses instruments similar to those used in arthroscopic knee surgery to carefully remove the scar tissue, release the muscle, and allow the regular course of natural development to occur.  The tiny endoscopic camera enters through a small incision high on the scalp behind the ear and is carefully threaded down the neck until it reaches the treatment area.  There the magnified, high-definition image allows me to observe the muscle, scar, and nerves in full detail, so that the incisions can be made in precisely the right place to avoid damaging the delicate nerves.  Since the nerves remain intact, there is a significantly lower chance of muscle atrophy, and the entire procedure leaves only a single tiny scar that is easily hidden behind the ear.  Once the scar tissue has been removed, the head returns to a natural, balanced position and the muscle is able to resume growing correctly.

I have personally performed this surgical correction on more than 300 patients, and each has shown marked improvement with no infections, no blood clots, and no nerve injuries.  This endoscopic approach has proven itself to be a safe and effective alternative to traditional surgery and has achieved consistently exceptional cosmetic and functional results.  If you would like to schedule a personalized appointment where we can evaluate your child’s specific needs, please contact me, Dr. Fernando Burstein, today.  Be sure to connect with me on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.


 

  1. Burstein, FD., Cohen, S.: Endoscopic Surgical Treatment for Congenital Muscular Torticollis. Plastic & Reconstructive Surgery. 101:1:20-4, 1998.
  2. Burstein, FD., Cohen, S., Huang, M., Simms, CA.: Applications of Endoscopic Surgery in Pediatric Patients. Plastic & Reconstructive Surgery. 102:5:1446-51, 1998.
  3. Burstein, FD.: Long Term Experience with Endoscopic Surgical Treatment for Congenital Muscular Torticollis in Infants and Children: A Review of 85 Cases. Plastic & Reconstructive Surgery., 2004 Aug; Vol. 114, No. 2, 491-493.

Since facial plastic surgery can be so effective in treating the signs of facial aging and effectively turning back the clock to make a person appear younger, many believe that the various plastic surgery procedures are only useful to older patients.  This could not be further from the truth.  In fact, it has long been my philosophy that the treatment of facial aging is best accomplished with a graduated process that starts with subtle, minimally invasive procedures to maintain the look of the younger face and only moving to more comprehensive facial plastic surgery when necessary.  Moreover, some cosmetic and reconstructive procedures can address issues that can affect patients of all ages.  For example, otoplasty, or ear surgery, can help improve the shape, position or proportion of the ear by correcting a defect in the ear structure that was present at birth, treating alteration in the shape of the ears caused by injury, or even reducing the size of ears that have grown larger due to the effects of time and gravity.

atlanta ear surgeryBetween the third and sixth months of fetal development, the cartilage forming the outer ears begins to undergo a series of folds which give the ear its characteristic appearance.  However, in some cases, the developmental process can be interrupted, resulting in prominent ears where a missing fold causes the ears to stick out from the head unnaturally far.  Cosmetic otoplasty techniques can often decrease the prominent ear by recreating the missing cartilage folds, bringing the ear closer to the head, and reducing the size of the earlobes in order to give the ear a more normal anatomical appearance1.  These procedures are generally carried out on children between the ages of five and seven years, when the ear is nearly of adult size and the cartilage is of adequate thickness to tolerate scoring or hold sutures2.

In adult patients, external factors can also lead to changes in the appearance of the outer ears that may make cosmetic or reconstructive ear surgery necessary.  Specifically, blunt trauma to the ear resulting from accident or violence may cause blood clots to interrupt the usual blood supply to the cartilage.  Over time, this may result in cauliflower ear, an acquired deformity of the outer ear that gives it a lumpy and shriveled appearance.  In this case, reconstructive ear surgery, using either cartilage taken from other areas of the patient’s body or artificial grafts, can reshape the ear and create a more balanced, aesthetically pleasing appearance.

Finally, sagging, drooping ear lobes can sometimes be a source of concern with older patients.  Studies have determined that all ears naturally elongate by 0.22 millimeters per year, a fact that can even be used by forensic scientists to determine the approximate age of a person.  While this may seem like a small amount, it can be enough to subtly shift the proportions of the facial features and unbalance the appearance.  Ears, like any other facial feature, also tend to sag with age, due to the gradual loss of elasticity in the skin and soft tissues combined with the effects of gravity.  This phenomenon can even be accentuated by a lifetime of wearing heavy earrings.  Cosmetic otoplasty can often be used to treat the problem and give the ears a more natural and youthful appearance.

Many other plastic surgery techniques can be used for both cosmetic and reconstructive purposes.  If you are interested in learning more about any of the plastic surgery procedures that I perform, please contact me, Dr. Fernando Burstein, today.  Atlanta Plastic Surgery, P.C. also can provide a variety of options for financing, including CareCreditSM, in order to assist you.  Be sure to connect with me on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.


  1. Burstein, FD.: Cartilage-Sparing Complete Otoplasty Technique: A Ten Year Experience with 100 Patients. Journal of Craniofacial Surgery. 2003 Jul;14(4):521-5.
  2. Cohen, SR., Burstein, FD.: “Protruding Ears.” In: Spitz, L., Coran, A.G. (ed.), Rob & Smiths’ Operative Surgery. Chapman & Hall Medical, London, 1995.

Giving Your Brows a Lift

April 29th, 2015 | Posted by drburstein_marketing in Blog | Educational - (Comments Off)

There are a total of forty-two individual facial muscles in the human face, all working together to move and shift the features and create the myriad expressions we make every day.  Unfortunately, the constant movement of these various facial muscles causes the skin to stretch and fold.  As the skin gets older, it slowly loses much of its elasticity and so these folds and wrinkles eventually become permanent marks on the skin’s surface.  This process can be particularly evident in the upper third of the face, between the eyebrows and the hairline, where deep furrows and frown lines are some of the most common signs of facial aging.  However many patients have found that this area can be smoothed and revitalized with forehead surgery, or a brow lift.

Dr. Fernando Burstein Eye RejuvenationMany facial expressions involve movement of the eyebrows, so it is little wonder that the skin of the forehead is constantly stretching and contracting.  However, just like an elastic band, the skin can be stretched to the point where it no longer is capable of rebounding to its original shape.  At this point it becomes slack, and gravity causes the skin to slide lower, creating deep furrows in the forehead and giving the brows a heavy, hooded appearance.  A brow lift, or forehead lift, works to reshape and smooth the forehead and tighten the underlying muscles in order to lift the brows to a more youthful position.

One of the benefits of a brow lift is that it can achieve results visually similar to those of a facelift with a far less invasive surgical procedure.  Every patient is different, and not all facial features age at the same rate.  In many cases patients may seek to alleviate specific signs of aging that have developed in key areas, but do not require a full facelift as other areas of the face still look youthful.  A brow lift can help minimize deep forehead wrinkles, frown lines, brow furrows, and sagging eyebrows by tightening the skin and muscles of the upper third of the face through the use of short incisions hidden within the hairline or by using an endoscope in what is known as the “key-hole” technique.  Use of these advanced endoscopic brow lift techniques can often allow patients to recover and return to their normal routines in less time and with less discomfort.

In my experience, I have found that the results of a brow lift surgery can often be made even more impressive when the procedure is combined with eyelid surgery, or blepharoplasty.  By removing excess skin and accumulated fat deposits from the upper and lower eyelids, a blepharoplasty can make the eyes appear wider and more refreshed, further complementing the effects achieved by a brow lift procedure.

If you are interested in learning more about a plastic surgery procedure I perform, please contact me, Dr. Fernando Burstein, today.  Atlanta Plastic Surgery, P.C. also can provide a variety of options for financing, including CareCreditSM, in order to assist you.  Be sure to connect with me on Facebook, Twitter, and Google+ for the latest facial plastic surgery news.