Admitting or Not Admitting to Plastic Surgery
By admin | March 4, 2010
Admitting or Not Admitting to Plastic Surgery
Recently, Allure magazine, ran an excellent story concerning how and why some people “fess up” to having cosmetic surgery and others don’t.
Coincidentally, a recent consumer survey conducted by the American Academy of Cosmetic Surgery reported that “71% of respondents believe society is less judgmental about cosmetic surgery compared with five years ago.”
I suspect that may have something to do with the cosmetic surgery TV reality programs such as DR 90210 and Extreme Makeover. I was pleased to be one of the original DR 90210 doctors and felt that the program did help open the eyes of the viewing public to the very positive nature of cosmetic surgery. Likewise, Extreme Makeover really “wowed” the viewers by showing them the potential for rather impressive changes in entire body appearance. Of course, on Extreme Makeover, any and all forces were brought to bear: both facial and body cosmetic surgery, injections such as Restylane, Juvederm, Botox, plus topping off with hair styling and makeup artistry. But the bottom line was that the public could see some pretty impressive results. From the privacy of their home, they could learn about cosmetic procedures.
Interestingly, the same American Academy of Cosmetic Surgery survey showed that “62% of respondents said society’s attitude towards cosmetic surgery made them feel more comfortable about undergoing a cosmetic procedure.” This is a reflection of increased openness in our society. Again, I credit the television programs with helping people understand that there is no shame, nor is it a badge of narcissism, that one has cosmetic procedures. In my 33 years of private practice experience, most patients have sound, logical and proper reasons for having cosmetic enhancement. And, when they do not, we suggest they reconsider their desires.
Let us not forget that for thousands of years, men and women have yearned to improve their appearance. Even Cleopatra was into it. She wrote the first book about improving one’s appearance. The difference between then and now is we have plenty of techniques, products and supplies to do the job. In her day, they had alabaster stones to smooth the skin (primitive dermabrasion), sour milk bathes (they understood that lactic acid, the chemical produced by spoiled milk was a mild skin peeling agent) and various oils, e.g olive oil, for moisturizing the skin.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery | No Comments »
Dr. Kotler Featured in American Way
By admin | March 4, 2010
The American Airlines Magazine, American Way, Features Dr. Robert Kotler and Dr. Stuart Linder
We all read the in-flight airline magazines while traveling. Personally, I find them always interesting and I particularly enjoy American Airlines’ American Way mainly because of the Mensa quiz. Those are real brain-teasing questions and I always try to pit myself against the smartest people in the world.
I also enjoy the feature articles. In the February 15 issue, for an article entitled Vacationing for a New You, Dr. Stuart Linder and I were honored to be resources. The well-written piece describes the influx of patients, from throughout the world, to Beverly Hills for their cosmetic surgery. I won’t steal the thunder of the article’s content but rather suggest that you follow the link to it. I think you will find it interesting and enlightening.
Incidentally, Dr. Linder and I represent somewhat of a new wave or new trend in cosmetic surgery. I see it as a very positive trend for the specialty. Each of us is a superspecialist. I operate only on the face and neck; Dr. Linder only operates on the body. While I perform facelifts, eyelid surgery, nose surgery — both for appearance and function — and procedures chin augmentation, neck sculpting and ear pinning, that’s the limit of my procedures. No reconstructive surgery. No cancer surgery, no accident surgery, no major reconstruction.
Likewise, Dr. Linder performs only breast augmentation and reduction, breast lifting, tummy tucks and body liposuction.
None of us can be experts in everything and typically the best results always come from those specialists who further refine their practice within a given specialty. Only via such narrowing of practice scope can they become what we in the medical profession refer to as master surgeons. That should be the goal of every surgeon in practice.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Neck Sculpting, Nose Surgery, Rhinoplasty, Rhinoplasty Specialist | No Comments »
Beverly Hills Cosmetic Surgery Fees
By admin | February 24, 2010
Three Wise and Practical Reasons For Cosmetic Surgeons
To Reduce Fees in a Tough Economy
A very savvy business friend of mine said to me several months ago: “I don’t know of anybody who has not been adversely affected by the very difficult economic times now facing the United States.”
Certainly, when the economy is tight, people have less money available for nonessential services such as cosmetic surgery. Therefore, plastic surgery practices will see decreasing patronage. For that reason, practices have to be realistic and ask themselves if there is not a way that they can contribute to helping ease the discomfort of a slow economy and at the same time benefit their practice.
I hereby submit that there are three good reasons why a cosmetic plastic surgery practice is wise to lower its fees:
1. Physicians have a responsibility to help patients. If economic difficulties present themselves, there is no reason why we cannot soften the blow by reducing our fees. After all, physicians who treat illness such as internists, pediatricians, surgeons have treated the needy in exchange for diminished fees. It is a tradition in medical practice that all be served. Even though our work is not medically necessary, it is still a valuable and important service to patients. Therefore, it is perfectly consistent with medical ethics that we lower the economic barrier for the sake of our patients.
2. To be most proficient, surgeons need to be busy. “Beware of the surgeon who operates infrequently” is an ancient and well-respected axiom in the world of surgery. My experience and that of other superspecialist surgeons is that in fact, the most gifted and proficient surgeons are busy. They are busy because they attract patients through their talents. They are also busy because they will accommodate themselves to the needs of the patients including the economic realities.
3. From a purely business standpoint, it is still better for the practice to do a case at a significant courtesy discount than not to do the case at all. Medical practices have large fixed expenses including rent and staff salaries. Accountants have long held that for elective surgery, a practice would be foolish not to discount its fees and continue to keep the operating schedule busy rather than take an aloof and distant stance and pass on surgical cases that would otherwise help the practice and the business’s bottom line.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Home, Nose Surgery, Revision Rhinoplasty, Rhinoplasty, Rhinoplasty Specialist | No Comments »
Making Revision Rhinoplasty Too Complicated
By admin | February 19, 2010
Are We Making Revision Rhinoplasty Too Complicated?
Today a patient came to see me in consultation. He was a young adult who had a history of sustaining a broken nose and having delayed in having it repaired. Finally, unhappy with the appearance and the breathing, he had reconstructive surgery done by a plastic surgeon who was not specialized enough to render the result that might have been achieved. He waited for one year and then had a second surgery by a more specialized surgeon. This “first revision rhinoplasty” according to the operative report was quite complex and intricate. It involved transplanting tissue from the scalp and cartilage from the ear into the nose. Apparently the surgery took five hours. The patient said that it took nearly “two years” for all the swelling to go away. I was somewhat astonished by that initially, but then after reviewing the operative report, and seeing all the maneuvers, techniques and manipulations that were performed, it made sense the operation would take that long.
Before and after photo of another patient of Dr. Kotler who in another state, sustained two prior, yet unsuccessful operations to improve appearance and breathing. Dr. Kotler was able to create a natural nose that worked normally and relieved the patient of her blocked nose and sinus headaches.
Unfortunately for this patient, it did not render satisfaction and thus we are going to have to perform another operation on him. If it were not reasonably predictable that the outcome will be better, I would not consent to perform the surgery. I think it is very important that the “odds” of success be taken into account when performing yet another revisional rhinoplasty surgery.
My assessment is that the operation can be done more simply, efficiently and that this in itself will allow faster healing.
The issue of healing is of major concern for the patient. Because he works with the public he cannot afford to be away from work for weeks and months because the nose and face are so swollen.
Interestingly, and coincidentally, his experience is not unique. Later in the day as I was reviewing a medical magazine, I noticed an article on a young woman who required two revision rhinoplasty operations. Her surgeon noted that “one year post procedure she will be about 30% healed, and only 40% healed after two years.” That is a long time line. Most patients are not happy with the prospect of healing that takes so long.
My point is that it may be that when the operations are done, the techniques involved are just too complicated, too complex and too prone to take so much time to heal that the patient sits in a state of suspended animation for a period far longer than they would like.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Revision Rhinoplasty | No Comments »
Beverly Hills Cosmetic Surgery Consultation
By admin | February 11, 2010
Why I Like an Interactive Consultation
I enjoy a consultation where there is a lot of give and take between myself and the patient. I like the patient to have prepared for the consultation, ideally by having visited our website and other high-quality, educational websites. If the patient has really done their homework well, they will have read or at least perused several of the excellent books that are available such as our Secrets of A Beverly Hills Cosmetic Surgeon, the Expert’s Guide to Safe Successful Surgery, or The Essential Cosmetic Surgery Companion, Don’t Consult A Cosmetic Surgeon Without This Book!
Like everything in life, preparation is essential to achieve the best results. When patients have viewed websites, including looking at the before and after photos, which is very important, and they have had a chance to read and study, they are more apt to ask some questions. I like questions.
The reason why I like questions is that patients should not have anxieties and fears based on lack of information. If I am able to answer questions either through the technology of our website or the pages that fill my books or the one-on-one with the patient, then the patient is going to have a smooth sailing through the cosmetic facial surgery process. It is when patients don’t know enough that they are anxious, uncertain, and often this leads to really not doing as well as others might.
We always tell our patients, “If you have any questions, please ask them.” And, you can ask them right up to the evening before surgery because I give my patients my home phone and cell phone numbers. Our anesthesiologist calls the patient the night before surgery so that if there are any issues concerning anesthetic, they are put on the table.
My colleagues are often amazed that I give patients my home phone and cell phone numbers. They get it when I say to them: “You know, I get very few calls at home after surgery.” Here’s why: the patients are prepared, they know what to expect, and any questions that they may have had were answered before surgery. I’m not worried about getting a deluge of calls—before or after surgery.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, My Books, Secrets of a Beverly Hills Cosmetic Surgeon | No Comments »
Beverly Hills Cosmetic Surgery Follow-Up
By admin | February 10, 2010
The Pleasures of Follow Up With a Happy Patient!
I refer you to page 108 in my book, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON, The Expert’s Guide to Safe, Successful Surgery. On that page in the section on correction of protruding ears, known medically as Otoplasty, is a photo Matthew Crosby before surgery and then after surgery in the office with yours truly. The book reproduced a nice handwritten note from Matt saying, “Thank you for making me look better. You did a great job. From Matt.” Plus a smiley face.
Dr. Kotler's Otoplasty Patient
So we received a Christmas card in December from Matt and his mom, Debbie Crosby. The Crosbys live in the northwest but Matt has been going to school out east. This tripych (collection of three photos) shows Debbie with school kids in India where she did some good missionary work. Matt and Debbie are in the middle photo and on the right is Matt doing some photography. Obviously Matt is a bit more mature than what is portrayed in the book because the current photos are about ten years after his surgery. From the photos, his ears look good and natural and we are very gratified. But most importantly, the Crosbys report that it was such a very positive experience for Matt to have his otoplasty procedure because he just felt a bit self-conscious as they stood out more than that of other young people.
One of the great joys of being a physician and particularly a cosmetic plastic surgeon are the inner rewards that come from having done good work for a young person that will last all that person’s life.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, My Books, Secrets of a Beverly Hills Cosmetic Surgeon | No Comments »
Demystifying Cosmetic Surgery
By admin | February 5, 2010
Demystifying Cosmetic Surgery
I am glad that the internet has become such an important educational tool for all of us. In the world of cosmetic plastic surgery, it has allowed prospective patients to do a “quick study” of the subject. Today, patients come to the office with much more knowledge than they did previously, and I see that as very healthy.
It is also important to demystify what we do. There is no magic or hocus pocus in cosmetic facial surgery. We operate and we use chemical skin peeling or lasers to erase wrinkles and age spots. We inject paralyzants such as Botox and Dysport for forehead and brow wrinkles and deep smile lines. We treat with fillers such as Sculptra, Restylane, Perlane, Juvederm. Each of our processes, procedures and techniques have value.
Patients come in understanding what some of these procedures do.
There are other ways that we help educate and demystify. The most important is computer imaging. Computer imaging allows us to morph your digital photo head shot and show you he predicted result of any and all of the cosmetic enhancements that are available. Then, the patient has a very clear image of the result. You can see for yourself whether or not the improvement demonstrated would be reasonable and satisfactory to you. They can also decide if it is worth the outlay of dollars and time. There is nothing like a graphic, a photo, an image, when you are talking about cosmetic surgery, a visual subject.
I have been a devotee of computer imaging since 1989. The technology at that time was rudimentary compared to today, but we still had very satisfactory ability to communicate with the patient. That’s what computer imaging is; a communication tool so that the patient no longer has to read the mind of the surgeon with respect to envisioning the “after”.
Besides viewing the computer imaging at the office, we send the patient a hard copy in the mail so they can keep it at home, share with their family, and receive some input.
As far as I am concerned, a consultation with a cosmetic plastic surgeon is not worth very much if it doesn’t include computer imaging. After all, why guess what you will look like after cosmetic plastic surgery?
Topics: Chemical Peel, Cosmetic Plastic Surgery, Cosmetic Surgery | No Comments »
Heidi Montag’s Cosmetic Surgery
By admin | January 29, 2010
The Heidi Chronicles. Heidi Montag’s Cosmetic Surgery Still Getting Press. It Has Legs. And Breasts. And Thighs. And Necks. And Noses.
I thought it would be over by now. A quick blast – like the Los Angeles rainstorms – and then gone. Heidi Montag’s cosmetic surgery marathon and PR juggernaut is still rolling.
I was wrong. Heidi was on ABC Television’s Nightline Friday night, January 22. The interview was rather insipid. The interviewer kept pounding away at Heidi, hoping to get her to say her chosen cosmetic procedures, all ten of them, were not appropriate, not wise or whatever would make all the viewers feel better.
Heidi held her ground. And, told us something that further explains the rash of PR she is getting. Just so happens, she has a new record album coming out. Amazing coincidence.
I won’t say anything else. I thought I said it all on my WebMD blog which is currently posted. What I did not know at the time I wrote the blog was that the great album since Thriller was about to hit the stores.
My original contention that this was a deftly-executed publicity stunt has been confirmed. Heidi became January’s “Balloon Boy”. Anything for press, including a trip to the operating room.
Incidentally, Heidi treated a post-op near miss it as a minor sideshow. She reported that she was found to have had too much Demerol (a narcotic pain-killer) on board while at a recovery retreat, that she “was taking only five breathes per minute (normal is 12-16). If such is true, that was not good. Luckily for Heidi and the PR campaign, one of her security detail, moonlights as an Emergency Medical Technician. He recognized the problem, took action and the campaign then continued to roll on.
Finally, don’t anyone try to deny the power of good public relations. A top publicist is a magician. Getting a wannabe anything on national TV and in the national magazine with a two million circulation, PEOPLE, is not easy. Now, it seems everyone knows Heidi. Of course, then the question: What will Heidi do now?
Be sure to link to my WebMD blog; it’s had more comments from readers than any other blog I have written in nearly two years. So, I guesss that says it all.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery | No Comments »
Los Angeles Rhinoplasty
By admin | January 27, 2010
What’s With the Five Hour Rhinoplasty?
I am hearing some amazing stories from patients. While we always learn from listening to our patients, I am not only learning but becoming a bit dismayed with respect to what I am hearing about nasal cosmetic plastic surgery. Patients report operations taking three, four and even five hours that ultimately were unsatisfactory for the patient. It seems the operations become longer as more grafting and transplantation of tissue takes place. Now certainly there are indications for adding on tissue into the nose, particularly if there has been previous surgery or if there has been an accident that has destroyed some of the tissue. But, even if that is the case, why are these operations taking so long? I am not sure of the answer, except, my sense is that some surgeons are making the operation much more complicated and complex than need be. For many of the grafting or transplanting needs, there is adequate tissue inside the nose itself. This of course makes it very economical and efficient to be able to harvest the tissue since it is coming right from the area that we are working on. Often, we use cartilage and bone from the nasal septum because we are taking it out anyway to correct the deviated nasal septum and improve the airway, and correct problems that might lead to sinusitis and other serious complications. While only very rarely is it necessary to take cartilage from the ear, I am now hearing stories of almost routine harvesting of rib cartilage and even rib bone to be place inside the nose, and of course, that makes for a very involved, complicated and long duration operation since other surgical sites besides the nose must be operated upon. I guess I am just from the old school. We do nearly all our surgeries from inside the nose using completely hidden incisions, closed with absorbable stitches. That is called a “closed rhinoplasty“. The “open rhinoplasty” requires an external incision, and I just don’t see the need for that very often. And I have done over 4,000 cases in my career which now spans nearly forty years. The other issue is that some surgeons are not efficient. It just takes them too long to get the job done. I would attribute that to less-than-optimal training in the residency programs as well as inexperience. Generally, inexperienced surgeons are slower than veteran surgeons. The “occasional nasal surgeon”, the doctor who spends more time doing other cosmetic plastic surgeries such as breast augmentation, tummy tuck, breast reduction and liposuction just doesn’t develop the facility for rhinoplasty because he doesn’t operate on the nose often enough. He cannot become a master nasal surgeon. In my experience, most cosmetic nasal surgery or rhinoplasty procedures could be done within an hour. If you need to add on the functional or breathing operation, that adds another 20-30 minutes. The total time in the operating room, including going to sleep and waking up from the anesthetic, should rarely be more than two hours.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Revision Rhinoplasty, Rhinoplasty, Septoplasty | No Comments »
Recovery From Beverly Hills Cosmetic Surgery
By admin | January 21, 2010
Some Surgeons Make Recovery From Cosmetic Surgery Much Easier Than Others. How is That Possible?
Patients come in a consultation and ask “Is there going to be a lot of swelling and bruising?” This always weighs heavily on their minds. Often, they related friends and family histories of having massive bruising, swelling and even facial distortion.
Frankly, that should be rare in today’s high-tech, modern cosmetic nasal surgery environment. Typically, the most experienced and narrow-focused surgeons, the cosmetic nasal surgery superspecialists have techniques and the talent in performing the surgery such that it will take less time on the operating table. That translates directly into less trauma to the tissues and, therefore, less swelling and bruising.
In addition, we now have at our disposal a large range of medications to help reduce swelling and bruising. There are prescription medications to reduce swelling and non-prescription, homeopathic medicines that are thought to reduce bruising. Even what you eat can have a benefit as foods such as fresh pineapple and fresh papaya can be helpful in reducing swelling and bruising. And, of course, ice packs immediately after surgery are a long-standing aid in preventing or reducing the swelling and bruising.
It is very important that blood pressure be controlled after surgery and typically blood pressure rises because of pain. So every surgeon who is a master of cosmetic nasal surgery has long recognized that it is very important to provide adequate pain medication. You see, if pain is present, blood pressure goes up, and if blood pressure goes up, there is more leakage of blood from the tiny blood vessels that were inadvertently severed during the operation. All bruising is the result of leakage of blood from open blood vessels.
Don’t forget that too much activity immediately after surgery may well cause additional swelling and bruising. That is why we recommend, for the first 24 hours, that patients pretty much relax and not do very much in the way of activity.
By the second post-operative day, the rules change. By then, it is generally wise to start walking and thereby increase the circulation. People feel better if they do not stay in bed where they tend to start feeling more tired and a sense of lassitude envelops them.
Sleeping is important. If pain is not controlled, it is hard to sleep. Therefore, we pay close attention to pain control which could interfere with sleep. No reason to spare the paid meds. However, some pain medicines may cause stimulation and, therefore, they have trouble sleeping. In that case, we change the pain medication. However, if despite pain control, the patient reports that sleep is poor, we prescribe a sleeping medication. The world looks a lot better and happier after a good night’s sleep!
I have always felt that the care of the patient after surgery is just as important as the operation itself. It must be conducted with the same attentiveness and focus. In cosmetic plastic nasal surgery, the results, and the patient experience are all about detail, detail, detail.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Nose Surgery, Rhinoplasty | No Comments »
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