Comparing Surgical Fees From Two Cosmetic Surgeons’ Offices in Beverly Hills

Posted on October 30, 2009 by admin

Comparing Surgical Fees From Two Cosmetic Surgeons’ Offices in Beverly Hills

It is very important to understand the financial commitment that you must make when having cosmetic surgery. After all, it is elective and not an emergency. You have time to do your homework, to research and to decide whether or not the services you want – by the doctor you want – are within your budget. The best way, of course, is to have a consultation with several doctors so that you learn as much as you can and contrast the doctors and their offices so that you can make the best possible decision.

Remember that it is usually a mistake to make the doctor selection just based upon the fee – high or low. Ultimately, you could be disappointed with that choice because there are many variables that determine what the doctor charges for a service. There are issues of location, the number and quality of the staff and, of course, the doctor’s expertise and degree of specialization.

Superspecialists, the most highly-trained, narrow-focused and most skilled surgeons, tend to be very efficient in their work. Often, their fees are not higher than the “I-do-it-all” cosmetic plastic surgeons. That’s because the superspecialist’s efficiency translates into shorter operating room times which mean you save money. Because operating room costs are based on hourly use.

Remember that it’s very important to compare “apples to apples and oranges to oranges.” You need to clearly understand the components of the costs being quoted. Does the fee include the outpatient surgery center charges? Does it include the services of a certified registered nurse anesthetist or a doctor-anesthesiologist? Does it include all the medications and supplies? If you are going to a postoperative recovery facility, are those charges included in the “global fee?”

It’s impossible to ask too many good questions at consultations but certainly don’t miss the opportunity to spend time with the office manager and be comfortable that you have received all the cost information. And finally, when you leave, make sure that quotation is in writing!

You've Had Fillers In Your Nose. Can You Have a Beverly Hills Rhinoplasty?

Posted on October 23, 2009 by admin

You’ve Had Fillers In Your Nose. Can You Have a Beverly Hills Rhinoplasty?

The first question is, “Which fillers?” If you’ve had temporary fillers such as collagen, Restylane, Juvederm or Sculptra, you might wait for these to dissipate before a final decision is made with respect to rhinoplasty or cosmetic plastic nasal surgery. As a matter of fact, it is advisable because a surgeon should not base his decision on the temporary appearance of the nasal structure.

Dr. Kotler's Non-Surgical Rhinoplasty Patient

If you’ve had a permanent filler such as medical grade liquid silicone or even ArteFill or Radiesse, this can present a technical challenge for the surgeon. He is going to have to “plow through” tissue that has had a filler injected into it and has developed a fibrous or scar tissue reaction to the filler which is responsible for the filler’s maintaining its position and appearance.

It is very important that the surgeon knows what material was used. If necessary, the medical records should be retrieved.

I would advise patients considering using fillers to first ask themselves if they have not given any consideration to the rhinoplasty. It is always wise to do the rhinoplasty procedure – with or without nasal septoplasty and turbinate resection for breathing – prior to any placement of filling material. I like to think of the fillers as the dessert or “topping off”: they can be used to correct any minor imperfections so that in the end, the patient gets the result closest to their wishes.

Disposable Stitches For Beverly Hills Nasal Surgery

Posted on October 15, 2009 by admin

Disposable Stitches For Beverly Hills Nasal Surgery

Nasal surgery can be performed either as an open rhinoplasty or closed rhinoplasty. Open rhinoplasty implies that there is an incision made on the nasal exterior between the nostrils and sometimes at the junction of the walls of the nostrils and the cheek in addition to internal hidden incisions. Closed rhinoplasty is the title for a cosmetic nasal plastic surgery that is done entirely through hidden incisions within the nose. The choice of surgical incision approach depends on the experience and training of the surgeon. Excellent results can be obtained by either procedure in the hands of the skilled, experienced surgeon. My observation is that those surgeons who have been in practice longest, who have the largest case volume, the greatest experience and highest degree of specialization – the superspecialists – favor the closed rhinoplasty.

Closed Rhinoplasty Performed by Dr. Kotler

In open rhinoplasty, the incision may be closed with what are known as “permanent” sutures (stitches). Permanent is a misnomer; these sutures unless those placed internally into a body cavity such as the abdomen, are not permanent; they have to be removed. But in closed rhinoplasty, since all the incisions are placed on the interior and would be more difficult to remove because of their hidden location, absorbable or “disposable” sutures are placed.

There are a variety of sutures which may be used, everything from synthetic, man-made sutures, to sutures known as “catgut” or “gut”. Such sutures are processed from lamb intestine. Catgut sutures treated with chromium are known in the surgical world as “chromic sutures”. Such immersion in chromium allows the sutures to resist digestion longer and thus remain longer to encourage healing.

Suture selection is made depending on the desired duration of the stitches holding the tissue together or closing incisions. For some particular cases, say tummy tuck, it is important to have the stitch stay in place for several months until strong internal repair tissue is formed. Typically for closed rhinoplasty incision closure, five to ten days of presence is adequate. The process of dissolution of the sutures is automatically performed by the body. It silently attacks and digests them since they represent a foreign material. The process is hastened in a moist atmosphere, hence the reason to use the saline or salt water nasal spray after cosmetic nasal surgery or reconstructive surgery such as nasal septoplasty and turbinate resection to correct nasal obstruction. Likewise, the A&D ointment when placed inside the nostrils will keep the stitches remaining soft and less brittle-like and, therefore, better tolerated by the patient.

Care Package After Cosmetic Surgery in Beverly Hills

Posted on October 13, 2009 by admin

Care Package After Cosmetic Surgery in Beverly Hills

“Care Package” is a term very familiar to many Americans regardless of interest in cosmetic surgery. The original Care Packages were donations of food and supplies to the poor of war-ravaged Europe, beginning in 1945. Americans, the most generous people in the world, not only helped prop up devastated Europe through the economy-boosting Marshall Plan, but individual Americans sent care packages to share with the less fortunate in England, France, and even to our former enemies, Germany and Italy.

Today, 60 years later, in the world of cosmetic surgery, the term Care Package has now become common parlance for a kit that contains all the supplies and medications necessary for home care after cosmetic plastic surgery. Since cosmetic facial surgery including rhinoplasty, with or without septoplasty and turbinate resection to improve nasal obstruction, face and neck lifting, eyelid surgery, chin augmentation, neck sculpting, liposuction and chemical skin peel, are outpatient procedures – not hospital procedures. It is important that patients have all the needed supplies and medications, at hand, at home.

I have always felt that it is incumbent upon the cosmetic plastic surgeon’s office to provide as much guidance and support for the post-operative care as possible, regardless of where the surgery took place: hospital, outpatient surgery center or office operating facility. I stressed that in both my books, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON and THE ESSENTIAL COSMETIC SURGERY COMPANION. For that reason, our home care package includes pain medication, antibiotics as appropriate, and all routine wound care supplies. Such home care supplies would consist of nose sprays, both decongestant and refreshing saline or salt water. These are important after cosmetic plastic nasal surgery or functional nasal surgery including septoplasty and turbinate resection. The kit has vitamin A&D ointment to be placed inside the nose to prevent crusting as well as small dressing pads placed under the nostrils to collect any drainage from the nose.

Dr. Kotler's post-op care kit given to his patients to take home after surgery

The Care Package for facelifting, eyelid surgery, chin augmentation and neck sculpture would include Q-Tips and ointment for application of the ointment to the incisions. For chemical skin peel patients, there are additional supplies including special eye drops and large amounts of antibiotic ointment to be placed on the healing facial skin.

Procedure-specific written instructions are provided for each operation performed and are also placed in the bag. Further, the patient has a listing of my home telephone and cell phone numbers so they can reach me immediately.

As I have always stressed to the young doctors I teach at UCLA and USC, the care of a surgical patient does not end with placement of the last stitch.

Beverly Hills Rhinoplasty Surgeon's Correction of the Pinched Nose Deformity

Posted on October 2, 2009 by admin

Beverly Hills Rhinoplasty Surgeon’s Correction of the Pinched Nose Deformity

There are two means of correcting the pinched nose deformity. Noses looked pinched or overdone because two much cartilage was taken out of the tip at the original surgery. And, there are a few people who are born with this deformity. In the case of the latter, the cartilages at the tip of the nose instead of being convex are concave.

The solution is identical. Either cartilage is grafted or transplanted from either inside the nose or from the ear and placed underneath the skin over the existing cartilage or the pinch is corrected by incremental filling injections.

The decision whether or not to have surgery performed or use filling injections, which is an office procedure, must be made after a thorough analysis. If breathing is an issue and there are other deformities of the nose which cannot be corrected by filling injections, then surgery is indicated although often even after surgery, the filling injections are helpful to achieve an optimal result.

I am very pleased with liquid silicone which is the permanent filling injection material. On the cover of my book, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON, you will see a young man who had very severe pinching on the left side of the nose. While part of this overall unsatisfactory look was a deviated septum and poorly performed rhinoplasty previously, it was necessary to use filling injections on the left side. The result speaks for itself. Liquid silicone is permanent but must be injected gradually over a period of several months because it cannot be easily removed.

How This Beverly Hills Rhinoplasty Surgeon Corrects Asymmetric Nostrils

Posted on October 1, 2009 by admin

How This Beverly Hills Rhinoplasty Surgeon Corrects Asymmetric Nostrils

Asymmetrical nostrils may present themselves before surgery. That is why it is very important for the surgeon to conduct a very thorough evaluation and examine for asymmetries. More often than not, nostril assymetry is caused by a deviated nasal septum. The septum, which attaches between the two nostrils, may be off-center and, therefore, influencing the size and shape of the nostrils.

If the nostril asymmetry is caused by the deviated septum, then at surgery, correction of the deviated septum should correct the problem. However, some people may have been born with asymmetrical nostrils. Also, some people as a result of unpredictable healing after rhinoplasty, will have a difference in the nostril shape and size.

I believe the most practical, economical, expeditious and reliable technique to correct asymmetrical nostrils is to use a filling injection. The filling injection can be temporary such as Juvederm or Restylane or permanent such as medical grade liquid silicone. The nostril that has the highest peak and largest size is filled to match the other side.

Interestingly, the eye recognizes asymmetries more than gross dimensions. Therefore, it is very important that even though the nostrils may not be the perfect configuration then at least they can be made symmetrical to avoid detection.