As I write this, I am in the Upper Midwest.  While I spent some of my time in a small town, Green Lake, WI, population 1,100, I didn’t have too many discussions with people about rhinoplasty or cosmetic nasal surgery.  In that part of the woods, nose jobs are not very commonly done because the sub-culture of a rural area in South Central Wisconsin doesn’t emphasize cosmetic surgery. 

However, what is fascinating is that the young people recognize Dr. 90210. Ah, the power of television!

We had a fun encounter on the golf course at Lawsonia, on the shore of Green Lake. On the course, high school and college students drive the refreshment carts.  Refreshments include snacks, soft drinks, ice-cold water, and they are much appreciated on these hot and humid Upper Midwest summer days. 

One of my golfing buddies, chatting with one of the young lady golf cart drivers, pointed to me and apparently said something to the effect of, “See that guy, he is one of the doctors on Dr. 90210.”  He reported that her eyes opened widely and her jaw dropped. The thought of a “Hollywood Celebrity” being in Green Lake, WI, population 1100, may have been just too much for her.  Luckily, she didn’t pass out.  He said to her “Would you like Dr. Kotler’s autograph?”  Apparently she did and met us at the next hole with all due speed. I was pleased to give her a copy of my Secrets of a Beverly Hills Cosmetic Surgery book card with my signature. 

As I walked away to tee off, one of the guys in my group reported that she immediately got on her cell phone to call one of the other young people who work on the course to report that she “just met Dr. 90210” and that she has his autograph!

So, the Dr. 90210 fame continues and deservedly so, in my opinion.  The program was educational as well as entertaining and demystified the subject of cosmetic surgery and simplified patient understanding of the course of the cosmetic surgery patient.

Rhinoplasty, which is cosmetic plastic surgery of the nose, has long been staple in Hollywood.
The reason is that Hollywood thrives on showing the world beautiful faces and it is impossible to have a truly beautiful face without a satisfactorily-shaped nose.

Some people are lucky and are born with a nose that is proportional and is pleasing to the eye.  Elizabeth Taylor comes to mind.  Likewise Grace Kelly and Catherine Deneuve. 

Those who have not had luck on their side with respect to receiving a “good nose”, have always had the option of having the rhinoplasty surgery. Of all the procedures that a younger person can do to improve their appearance, rhinoplasty ranks number one.  It is more important and more commonly requested than chin augmentation or blepharoplasty.

Remember, also, that many people have the rhinoplasty surgery at the same time as they have nasal septoplasty and turbinate resection to improve the airway or correct a sinus problem. This “double need” is more common in men than women, of course.

Marilyn Monroe had rhinoplasty.  Comedian Milton Berle and actor Dean Martin also had rhinoplasty.  

Years ago when I was researching for my book, Secrets of a Beverly Hills Cosmetic Surgeon, I visisted a photo archives facility in Venice, California.  It was fascinating to leaf through the drawers and recognize that many familiar faces had indeed had rhinoplasty surgery at some point in their life. 

Incidentally, some people go to great lengths to conceal the fact that they are having such surgery.  If you ever saw Barbara Streisand in the movie Funny Girl, you would know that it was the story of comedienne Fanny Brice.   In the 1930s, Fanny had a rhinoplasty performed in a hotel suite.  She felt that was the best way of keeping it a secret.

Today, rhinoplasties are not performed in hotel suites and, frankly, they are rarely performed in hospitals.  It is appropriate to perform such a procedure in a credentialed outpatient surgery center or a duly qualified physician’s office surgical suite. 

Sometimes it is difficult for patients to envision or visualize the results of Restylane, Perlane, Juvederm, Sculptra or Radiesse fillers about the face.  Other patients may also not appreciate how a poorly performed rhinoplasty or “nose job” can be improved by filling injections.  Even those with a receding chin have trouble visualizing what the result might be. 

One way to “try before you buy” is to have a “demo” test.  This “no-risk” demonstration is achieved by injecting sterile saline (salt water, the same liquid that is used as intravenous fluid) to display the results of the proposed long-lasting filling injection or even some surgeries.

The sterile saline can be injected into the fold of the deep nasolabial creases around the mouth to show the effect of the common fillers.  It can be injected into the tissues of the chin to show how the profile would look if the chin were augmented, the so-called “chin augmentation.”  It can be injected into the nose to show how one who has a very low, scooped out or over-pinched result from cosmetic nasal surgery would look.

The sterile saline “test drive,” if you will, can be rendered almost painless by the application of a topical anesthetic about one half hour prior.  The results will last for one to two hours.  Photographs can be taken before and after for documentation so that the patient can study the improvement before making a commitment to having natural fillers. 

It makes sense doesn’t it?

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.

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.

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.