2009 June | Rhinoplasty Surgeon Beverly Hills Blog

Dysport is Botox’s Only Competitor

Posted on June 29, 2009 by admin

Recently, the FDA approved for cosmetic use the only a rival for Allergan Corporation’s Botox Cosmetic. The new product, Dysport™ functions similarly with respect to temporarily paralyzing the muscles which cause the frown lines between the eyebrows and crow’s feet around the eyes. This new medication has proven itself in testing and long use overseas.

The claim that is being made for Dysport™ is that it takes effect sooner. According to the trade journal, Plastic Surgery Practice, a professor of dermatology at the University of Miami said that in tests done in Brazil, “. . . physicians noted a maximum response in 2 days for Dysport™ versus 5 to 7 days for Botox”. The Miami dermatologist also noted that “. . . physicians who have used Dysport™ indicate that the drug may last longer than Botox, 5 to 6 months, versus 3 to 4 months.”

It may well be that the newer product has some advantage in terms of speed of onset and longevity, but until there is a large pool of specialists who use it and report on the results, it will be impossible to make a direct comparison nor recommendation.

Beverly Hills Revision Rhinoplasty

Posted on June 26, 2009 by admin

Dr. Kolter's patient had a series of permanent filler injections - no surgery was done.

Dr. Kotler's patient had a series of permanent filler injections - no surgery was done.

If you are not happy with your rhinoplasty, what should you do?

First, understand that an imperfect outcome doesn’t necessarily mean that the doctor did not give it his best effort or that the doctor is not adequately skilled. Sometimes things just don’t go well even in the most talented, experienced and superspecialist‘s hands. Sometimes complications can occur such as infections which are certainly beyond the control of the surgeon.

Remember, however, that an imperfect result or the results of a complication can generally be improved. Sometimes improvements can take place through a series of office treatments. Certain injections such as cortisone can reduce some areas of scarring and swelling. Other injections, such as liquid silicone, Juvéderm, Restylane and collagen are used to fill depressions, divots and dips in the architecture.

Regardless of what needs to be done, be sure to spend time speaking with your surgeon as to what he believes led to the imperfect result and what he feels can be done to improve the appearance. Often the doctor may suggest a consultation or second opinion with another doctor who has similar skill and experience. This is important. There is no shame in asking for help and advice, and it is for your benefit.

Consultations are always helpful because when you go to another surgeon he has a chance to think objectively and carries no predisposition. But, remember when you do go for that consultation or second opinion, be sure to bring copies of all your records, including copies of your before and after photographs, the operative report, any CT scan or x-ray reports that were done for the sinuses, particularly if you had a blockage of your nose due to a deviated septum or enlarged turbinates.

Insurance and Cosmetic Nasal Surgery in Beverly Hills

Posted on June 24, 2009 by admin

By definition, a cosmetic procedure is one that is unrelated to bodily function. It is just a matter of improving your appearance. Health insurance policies cover illness and are not written to underwrite vanity surgery.

However, some patients need to combine functional surgery with cosmetic surgery and that makes sense. It certainly is logical to have one operation with one anesthesia and one recovery period that accomplishes two goals. So, if you can’t breathe, be sure to call that to the attention of your surgeon before the day of the surgery. The cosmetic surgeon will want to evaluate your nasal passages and see if there is a deviated septum, allergies or enlarged turbinates. If so, those can be corrected such that you will breathe better and those components of the operation may be eligible for insurance coverage.

It is always wise to ask the doctor to give you the computer code numbers for these functional procedures so that you can check it out with your insurance company and confirm that they will pay.

Remember, the insurance company is also obligated to pay the surgical facility, whether it be a hospital or outpatient surgery center and the anesthesia specialist also.

Beverly Hills Chemical Peel

Posted on June 15, 2009 by admin

Chemical peels whether in Beverly Hills or other cities, remain when done using aggressive techniques, the most successful of all processes to remove wrinkles, fine lines and age spots. The deep chemical skin peel using phenol has been a particular favorite of mine for nearly 40 years. I had the opportunity to study with the great masters of the technique both in Chicago where I trained in my residency at the University of Illinois and here in Los Angeles as a student and protégé of Jack P. Startz, MD. Dr. Startz was one of the world’s great skin peelers and I was very fortunate to have studied at his side.

Before/After of Dr. Kotler's chemical peel patient.

Chemical skin peel which is also known as a chemical facelift, is in fact the chemical wrinkle line removal process. The acid-like prescription which is prepared individually for each patient is painted onto the skin and over a period of five days, the outer layers of skin literally sloughs off revealing fresh new pink skin underneath.

The procedure is done under an anesthetic in a licensed outpatient surgery center. I always have a doctor anesthesiologist administer the anesthetic. The postoperative recovery period is also very important. All our patients stay in a professional post cosmetic surgery recovery facility for two nights. Following that period, dressings are removed and the remainder of the skin care is done at home for the next three days.

One week after the procedure, the fresh new pink, wrinkle-free, smooth and youthful skin is present. Now it is appropriate to use camouflage and cosmetics such that one can return to normal work and activities typically at two weeks after the procedure has been performed.

Dr. Kotler's patient who had a chemical peel (phenol) in 1986 and still looks amazing!

Beverly Hills Cosmetic Surgeon, Dr. Robert Kotler, Recently Awarded by UCLA

Posted on June 12, 2009 by admin

In addition to my cosmetic surgery practice, I also teach and participate in many charities, which I enjoy immensely. I would like to share a few awards I recently received.

At the invitation of the Presidential Inaugural Committee, Dr. and Mrs. Kotler were invited to Washington to participate in the inauguration of President Obama and Vice President Biden.

Dr. Kotler honored by UCLA for his 30 years of voluntary teaching. At the annual Resident Graduation Ceremony, Dr. Kotler was awarded a certificate “In recognition of outstanding contributions in the capacity of a clinical faculty member” by the Division of Head and Neck Surgery at UCLA Medical Center.

Dr. Kotler named to University of Illinois President’s Council. Dr. Kotler received the honor of being elected to this major support group for the University of Illinois, his residency alma mater. Dr. Kotler served his residency at the University of Illinois Hospitals at the West Side Medical Center in Chicago, at that time the world’s largest medical center.

Rhinoplasty in France

Posted on June 8, 2009 by admin

There were both professional and personal reasons for my recent visit to France. The latter was to learn more about the Roman Empire and its excursion into what is now France. In Provence, the southern region, there were relics of the Roman presence 2000 years ago.

Dr. Kotler and Family in France

Professionally, I wanted to evaluate trends in skin care and what has been happening with respect to rhinoplasty in France. My impression, confirmed by conversations there, is that rhinoplasty is not sought out as commonly in France as in the USA. One reason is that most French, whose ancestors trace long roots, have quite fine facial features. The exceptions are those with the classical Gallic nose; a very large and prominent nose, e.g. General Charles De Gaulle, hero of World War II. Such disproportionately large noses, projecting or protruding also have a bulbous tip.

The more common facial structure demonstrates a nose well proportioned to the face. There is an obtuse angle between the nose and the lip, a straight profile (no hump or bump) and satisfactory space between the nose and the lip. Further, the tip is often very refined, thus the need for rhinoplasty is less common.

Dr. Kotler and Family in France

Dr. 90210 Touches Worldwide

Posted on June 5, 2009 by admin

Greetings from France! I am here to see patients from France and England, meet with American friends living here, and of course, see the sites. I am also interested in learning about rhinoplasty and revision rhinoplasty in a sophisticated foreign country.

I have traveled to France as an Army Medical Officer, but I am visiting areas not previously toured, Burgundy, the great wine producing area – and Provence with lots of ancient history, which I enjoy learning about.

En route to France, I stopped in the Bahamas for a close friend’s daughter’s wedding. The bride, a patient of ours, was beautiful. One day at the hotel desk, the clerk asked me if I was “The Dr. Kotler from Dr. 90210?” She said she enjoyed the program, particularly the nose cases I have done. My friend who was with me said to her, “you know, Dr. Kotler is the top rhinoplasty specialist in the world!”

A sense of humility doesn’t allow me to say that myself, but I am nonetheless pleased to carry that title.

I guess the world gets smaller and smaller as communication gets smarter and smarter.

HOW MODERN BIOTECHNOLOGY REDUCES BRUISING, SWELLING AND SPEEDS HEALING AFTER A FACE AND NECK LIFT

Posted on June 2, 2009 by admin

The aim of every cosmetic surgeon is to deliver a surgical result that is not only satisfactory to the patient, but is not a burden in terms of prolonged healing. It is important for people to be able to return to work and normal duties as quickly as possible. Towards that aim, we have used a modern biotechnology advance that aids in healing below the surface. Since it is very important for the skin to reattach to the underlying tissues following a face and neck lift, with minimal swelling and bruising, any help that we can get from the research labs is appreciated. Platelet-rich plasma is an example of modern biotechnology aiding healing.

While the patient is asleep, blood is withdrawn and processed such that prior to the conclusion of the operation, just before the final stitches are placed, the undersurface of the skin and deeper tissues are sprayed with an extract from the blood. This extract is rich in certain biological factors, which reduces bruising, minimizes swelling and most importantly speeds the “welding” of the tissue together which translates to faster healing.