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07-02-17 | Posted by

What’s most important to Dr. Berkowitz is the patient-doctor relationship, he is genuinely caring about what his patients have to say. His goal is to alleviate any concerns they may have and to make them feel as comfortable as possible from the beginning to create a positive experience and relationship.

Dr. Berkowitz focuses on creating a refreshed “relaxing vacation” look instead of looking like you just had surgery; he believes in less is more. He usually discourages radical or extensive procedures, as he believes impressive results can be achieved through less work, minimal scarring, and without creating drastic changes in appearance.

BITB chatted with Dr. Berkowitz about the latest plastic surgery trends and treatments for maintenance and anti-aging.


1. How has rhinoplasty changes over the past decade? Is there anything new?
Since rhinoplasty for aesthetic purposes first became a reality in Berlin after World War I by an orthopedist/trauma surgeon Dr. Jacques Joseph – his basic technique has barely evolved, and in the past century – the instruments used have also barely evolved. For years, it was almost a stone age procedure with uncontrolled bone removal with rasps and chisels, and the narrowing of wide nasal bones with a hammer and a curved chisel. Needless to say, this brutal technique led to quite varying and uncontrolled outcomes.  Some surgeons here and abroad became very adept at this operation but the outcomes were still somewhat unpredictable, and then there was the recovery! Recovery is hampered by swelling and bruising.

Then there was the popularity of “open rhinoplasty” (not done through tunnels but by connecting incisions inside the nose) introduced in 1978 by Goodman and Charbonneau in Montreal and slowly gained traction in the US and abroad over the ensuing decades. This open technique promised greater visibility and exposure to permit better control of bleeding and produced more consistent results. But the instruments didn’t change and the bruising was still a problem – not to mention asymmetry and inability to refine to a more polished infrastructure.

Open rhinoplasty was the biggest change we had seen over the last century – until now. There is a new technique which I refer to as “power assisted rhinoplasty.” I introduced the concept of using power tools to the Rhinoplasty Society in 2005 and have since generated new interest from surgeons across the U.S. since the development of even smaller, higher speed power tools adapted for our specialty. [We refer to them as Piezo electric tools.]  I have been leading the charge in the U.S. – educating surgeons on this quickly adaptable modality and the patient results are astonishing.

This new technique gives the surgeon more control over the bone cuts.  Unlike traditional rhinoplasty, results are consistent. Bones are shaped, cut and moved – as opposed to previously rasped or chiseled and fractured.  It could take a lifetime and many unhappy results for a surgeon to be able to master that technique.  With power tools, the learning curve is much shorter.  To the patient – the benefits are more predictable results, dramatically decreased bruising and pain since this technique doesn’t cause blood in tissue planes which can be extremely painful and inflammatory.  The reason for this is because by not manually breaking the bones, there is less extension of fracture lines that can extend up towards the eyes and cause bleeding. This new technique also results in less internal scarring and quicker overall recovery.  We can routinely return our patients to work or school within one week.

2. As a plastic surgeon, what are the biggest trends you are seeing among your patients? (what are they asking for, don’t want, most concerned about. etc)
Emerging trends, of course, is patients who want less invasive and more rapid recovery with their chosen procedures.  Patients still want the more definitive changes that only surgery can deliver, but they shy away due to the perceived downtime and financial impact they may experience from time taken off work.

New techniques, however, such as the Piezo electric tools for rhinoplasty diminish downtime and bruising, often eliminating bruising entirely. Newer, intravenous anesthetic techniques provide a far more comfortable recovery and no “hangover” effect. In addition, the use of certain medications such as Desmopressin improves clotting ability to again reduce bruising and the swelling that accompanies it.

Besides quicker recovery, patients are looking for a decidedly more natural, believable appearance. In facial surgery, that includes the minimal access cranial suspension [MACS] lift which is where we reduce wrinkles and lift sagging facial tissue. I have refined this procedure over the past decade so that there is less incision and less tissue disruption which leads to a less altered appearance.

Fat grafting is also in high demand because of the more natural three-dimensional improvement to the face compared to static fillers that never truly incorporate into the body the way living fat does.

As far as body surgery, we are seeing an increased demand for more plausible breasts—sizes based on the patients’ dimensions – not imagination. Shaped implants also are becoming increasingly popular.

3. For someone who isn’t ready or doesn’t want surgery yet, what are your most recommended “go to” treatments for maintenance and anti-aging? (you can use brand names here)
Facial rejuvenation is definitely something that can be enhanced in most patients without surgery through treatments such as Botox and Dysport which serve to selectively disable the muscles that contribute to aging and an unhappy countenance. There are also procedures, such as Sculptra, that act as a facial filler in lieu of fat to fill empty facial compartments.  Enhancement of prominences with Voluma or Lyft has given sinking cheeks a lift.

Then there are patients who do not want fillers but want fat removed – yet do not want to undergo liposuction surgery.  Coolsculpt can satisfy many patients in this regard. Cryolipolysis freezes unwanted fat and just after a few sessions patients will begin to see a reduction in areas where they felt were “bulging.” With this procedure, there is no anesthesia and no downtime.

Lastly, to improve skin quality we offer Sciton’s BBL – or broadband light treatments –  that diminish discoloration and improve skin quality without the downtime or swelling associated with lasers.  Microneedling has also been extremely popular to diminish fine lines without the heat imparted by lasers.

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