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 »
Rhinoplasty Prices in Beverly Hills
By admin | January 14, 2010
Has the Recession Affected Rhinoplasty Prices in Beverly Hills?
The recession has affected nearly every business, industry and profession in the United States – including Beverly Hills. While Beverly Hills remains a cosmetic plastic surgery destination for many people from the United States and throughout the world, the reality is that in a recessionary environment, fees are reduced.
However, it is important to understand that a low fee by itself should not be the decision-making factor when considering having cosmetic plastic nasal surgery. The price range of rhinoplasty encompasses both the less experienced, younger practitioners and the veteran superstars and super specialists of the cosmetic surgery world.
It is accepted that young doctors, eager to build their practices will charge less for their services and hope to attract patients in that manner. For patients, there sit risks. Because, often, the younger surgeons do not have the talent and long line of experience to handle anything but the most simple case.
But, few nasal plastic surgery cases are simple. Often, there are breathing or sinus problems that should be corrected. Nasal septoplasty and turbinate resection to improve the airway should be considered in such cases. Does the young surgeon have the training, talent and experience to handle all those issues?
The reality is that rhinoplasty fees in Beverly Hills may be higher than they are in Omaha, Nebraska or Oshkosh, Wisconsin, but of course, that reflects the cost of doing business including rent, salaries, etc.
One should always inquire from the office as to what the cost of the rhinoplasty is and to ask if, in fact, there are some ways to be granted a courtesy. Don’t expect to get a courtesy reduction in the fee just for asking, however, because that is not likely. What will help you get a reduction in the fee is being able to schedule your case at the time that is convenient for the outpatient surgery center and the surgeon’s office. That is the most common and proper reason for fees to be reduced.
Remember that rhinoplasty prices also reflect the complexity of the case and the time involved in performing the surgery. Particularly, if you need revision rhinoplasty in addition to that septoplasty and turbinate resection to help you breather, the fee will be higher than that for just shaving a bulbous tip.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Rhinoplasty, Rhinoplasty Specialist, Septoplasty | No Comments »
Beverly Hills Nose Job Problems
By admin | December 31, 2009
“My Friends All Have Trouble Breathing After Their Nose Jobs”
– patient consulting for nasal cosmetic plastic surgery
This is a very important statement. If a prospective patient believes that the majority of patients who have cosmetic nasal surgery are likely to wind up with breathing problems, then our specialty has a problem.
Difficulty breathing after rhinoplasty should not necessarily occur. The competent cosmetic plastic nasal surgeons are trained in the evaluation of the internal nasal structure and the correction thereof. They need to know if there is a breathing problem before any surgery. Often, patients are not even aware they have a breathing problem. It is very easy to check because you ask the patient to close one nostril and with lips closed breathe through their right nostril and then shift the focus to the left nostril as the right nostril is closed. Very quickly, one gets the airflow picture.
Once the diagnosis of airway obstruction is established, it is incumbent upon the operating surgeon to figure out why. The most common reasons are that there is a deviated septum which is a crookedness of the internal vertical partition that separates the two nasal passages. For many patients, particularly those with allergies, there is also the issue of enlarged turbinates, particularly the inferior turbinate. Turbinates are the three shelf-like extensions that fill a portion of the nasal passages, on each side, to increase the surface area so there is further warmth, humidification and filtering of the incoming air in preparation for inhalation into the lungs.
If the surgeon diagnoses a breathing problem or such borderline breathing that it is possible that narrowing of the nose as a result of the cosmetic nasal plastic surgery, or rhinoplasty, might throw the patient’s breathing over the edge, it is incumbent upon that surgeon to plan to deal with the blockage and correct it.
My sense is that perhaps a fair number of surgeons who are willing to take on rhinoplasty cases may not be trained in the functional and reconstructive surgery.
If the doctor’s ego will allow it, when facing an airway problem that he feels he cannot address, the doctor can always call in a consulting surgeon with the “inside” skills to perform that portion of the operation. After all, it is not unique to cosmetic and reconstructive nasal plastic surgery to have a team instead of a solo surgeon. It certainly occurs in heart surgery and liver and kidney transplants, etc. It is all for the patient’s benefit.
The recent edition of The New York Times happened to address that very issue whereby some surgeons conceded that it is “normal” to have a breathing problem after some cosmetic nasal surgeries. I think that is a very damning comment and represents a lack of concern for the patient’s interest. Steps must be taken to correct the breathing problem at the same time as the cosmetic plastic nasal surgery.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Home, Nose Surgery, Rhinoplasty, Rhinoplasty Specialist, Septoplasty | No Comments »
Beverly Hills Cosmetic Surgery, Not Like Dropping-In For a Haircut
By admin | December 23, 2009
Having Cosmetic Surgery is Not Like Dropping-In For a Haircut
Today our patient correspondent and consultant, mentioned a conversation with a patient from Europe. The patient was coming to us to have nose surgery done and seemed a bit put off when told that it was necessary to make all the arrangements ahead of time. Ideally, the arrangements would include having a Skype consultation with Dr. Kotler so any questions or issues that the patient wanted to present to him could be done before the patient gets on an airplane and travels thousands of miles to come here. Secondly, after the Skype session, if the decision has been made to have the surgery, it is very important that the patient have a physical exam and the appropriate laboratory and x-ray work done well before surgery. After all, if there is a medical problem, surgery cannot be performed. Cosmetic plastic surgery is only done when the patient’s general health condition is excellent. There can be no compromises. So if there is a problem, you surely want to know well ahead of time so that schedules can be amended and most importantly the medical problem could be attended to before flying across the pond.
It seemed that the patient thought he could come in on a Monday, have a consultation and go to the operating room on Tuesday. And maybe that is because he, as others, tend to minimize the importance of a proper pre-operative evaluation and workup and that everything be put in proper order.
There are logistical issues that have to be considered. We have to reserve the operating room. We also have to reserve the doctor-anesthesiologist so that everything is properly anticipated and done properly. Depending on the procedure, necessary supplies and equipment have to be available and that cannot always be done on a one-day’s notice.
Most importantly, Dr. Kotler and the patient must have time together to discuss the patient’s desires either via Skype or, of course, person-to-person when the patient is here. Our preference, for patient safety and comfort, is that all possible communications and arrangements be made well ahead of time. And the patient just doesn’t get off the plane and go to the operating room. There is always a visit with me in the office one or two days before the procedure. It is important for me to do a complete examination and determine those things that are not possible to determine via Skype and computer imaging, of course. I want to explain in detail, face to face, how the procedure will be conducted. I explain to the patient that the anesthesiologist will call the night before, that the patient will see me in the morning, that the patient will have my home phone and cell phone number so that he knows we are ready and prepared to give the patient the care that he or she deserves.
It may be a tribute to cosmetic surgery that people feel that it is a “minor undertaking.” If it is a tribute, it is because we have been able to handle all the issues such as discomfort and provide for rapid recovery. But the truth is, we do not treat it with any less importance than a neurosurgeon treats a patient upon whom he will be doing brain surgery. After all, we trained as long to do our work as the neurosurgeon trained to do his.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Home, Nose Surgery, Revision Rhinoplasty, Rhinoplasty, Rhinoplasty Specialist | No Comments »
Hazards of Over-the-Counter Medications
By admin | December 21, 2009
Alexa Joel, Daughter of Billy Joel, And the Hazards of Over-the-Counter Medications
We are pleased to hear that Alexa Joel recovered from the overdose of over-the-counter mediations that she took. These episodes should act as a wakeup call to patients who are considering cosmetic surgery. The point is that one must understand that even over-the-counter medications have the potential to cause major problems. That is why, before having any cosmetic procedure or any other surgical procedure, it is very important that the surgeon and the anesthesiologist both know all the medications one is taking. That includes homeopathic and non-prescription medications, as well as prescription medicines, of course. We even need to know about vitamins and supplements because, believe it or not, all these things can have an effect on the safety of anesthesia and even on blood clotting. I discuss all of this in great detail in my book, Secrets of a Beverly Hills Cosmetic Surgeon.
We always ask about “the 5Gs.” The 5Gs are medications that can possibly interfere with normal blood clotting: Ginkgo (biloba) , garlic, ginseng, ginger and goldenseal. Remember, we’re on your side. We want you to have a safe, successful operation. We’ll do everything on our end to have a successful outcome for you. We only ask that you give us all the medical information that we ask for so that nothing is overlooked. So that going into the operation, all the “ducks” are lined up for a satisfactory and safe operation with a great outcome.
Topics: Cosmetic Surgery, My Books, Nose Surgery, Rhinoplasty, Secrets of a Beverly Hills Cosmetic Surgeon | No Comments »
Cocaine and Rhinoplasty in Beverly Hills
By admin | December 15, 2009
Cocaine and Rhinoplasty in Beverly Hills
Unfortunately, cocaine use is still with us. There are significant consequences to cocaine abuse. The worst complication is its effect on the heart and blood vessels which causes high blood pressure that can possibly lead to a stroke – or even death.
Cocaine and Rhinoplasty Surgery Do Not Mix!
There are problems that come with septal perforations: crusting, whistling and bleeding. It is a real hassle. And once that hole is created, it is very difficult to surgically close it. While there are some appliances that can be inserted to act as a “stopper,” just be aware that one is asking for considerable problems with long-term cocaine abuse.
The other issue is that one should never consider having any cocaine in their body at the time of surgery. This sets the stage for a possible anesthetic catastrophe! There can be an unfavorable interaction with the anesthetic drugs as well as the local anesthetics that must be injected.
Remember, doctors are not judges. We are not an arm of the legal system. Our conversations and records are private and cannot be shared with anyone without your permission. We don’t have an editorial position on personal choice issues. Our only job is to serve you. However, you need to be frank and honest with your doctor whose only aim is to have a safe surgery and a satisfactory outcome for his patient.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Nose Surgery, Revision Rhinoplasty, Rhinoplasty, Rhinoplasty Specialist, Septoplasty | No Comments »
Taxing Plastic Surgery In Beverly Hills
By admin | December 10, 2009
Taxing American-Based Cosmetic Surgery
Here’s why the proposed 5% surtax on cosmetic plastic surgery is an insult to any thinking American.
Consider a cosmetic plastic surgery practice a business – which it is.
Each doctor’s practice/business starts from zero. To build a practice, we doctors first invest in ourselves by pursuing long and arduous training and education. Up to 15 years after high school! And for some of us, we added on a couple more years serving our country in the military. But in order for the public to benefit from our skills, we need to have a place to work; we then invest further in the “bricks and mortar”. We build an office, to deliver our services – right here in America.
We borrow from American banks; construction and equipment loans. We buy equipment and supplies from American distributors. We create jobs for Americans – administrators, nurses, medical assistants. We utilize the services of American attorneys, accountants and practice management consultants. We don’t set up dummy headquarters in the Cayman Islands to evade taxes. We don’t communicate with our customer-patients from inexpensive secret call centers in Mumbai. We don’t earn our dollars by operating Ponzi schemes out of Wall Street boiler-rooms.
We grow our practices by providing quality service and good value. We seek to be honest craftsmen. And, many of us give back to the community by teaching – without pay – at the local medical schools or Veterans Hospitals.
That’s why it seems ironic that Congress has singled out a small but productive home-grown 100%-American industry –cosmetic plastic surgery — to levy an additional tax. Have we done something wrong besides being successful and making Americans’ lives better?
I wonder why these Washington economic heavyweights didn’t think about taxing multinational corporations that have huge incomes, much of which is garnered from operations outside the United States. General Motors sells a lot of Buicks in China. They are making a lot of money there. All their sobbing about losing money in America was inconsequential to the bottom line of their financial statements. Maybe they don’t make a profit here; it’s just being done with non-American labor far across the sea. How about a tax on foreign manufacturing by American-based companies? Wouldn’t that be fair?
There’s always hot air and hypocrisy from Washington, of course. I guess the problem is that we cosmetic plastic surgeons and our patients don’t have the army-like lobbying force that GM and the other multinationals hurl into Washington. Seems Congress thinks it’s O.K. for them to siphon off jobs and money from the United States – and not pay any price. Multinationals have more friends than we do. Even Nancy Pelosi, obviously a devotee of cosmetic plastic surgery, won’t speak up for us. Maybe her lips are paralyzed from too much Botox or Dysport.
Somehow, we cosmetic plastic surgeons will soldier on and somehow we shall still continue to serve Americans who want our services. Our practice, and I suspect others, has decided to absorb the tax ourselves and not further burden the patients. We shall “eat the tax”; just like our favorite camera store does to help keep traffic flowing and contribute to the fight against the recession.
Finally, unlike, GM we won’t ask for a government bail-out. Maybe we’re too proud to ask for handouts. We’re old-fashioned. We ask nothing from Washington, other than to be left alone and to use the talents we spent half a life perfecting. However, our doors are not necessarily open to everyone. We still have the right to decide whom to accept as patients. So, Senator Harry Reid, who concocted this legislative abomination, listen up: When you are bruised and battered by the health care reform debate, you will be shown the door and given a map to the Mexican border. There are plenty of medical clinics there. They will be glad to see you and there’s no 5% tax.
Topics: Cosmetic Plastic Surgery, Cosmetic Surgery, Home, Rhinoplasty Specialist, Taxing Cosmetic Surgery | No Comments »
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