Beverly Hills Nose Job Problems

Posted on December 31, 2009 by admin

“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.

Beverly Hills Cosmetic Surgery, Not Like Dropping-In For a Haircut

Posted on December 23, 2009 by admin

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.

Hazards of Over-the-Counter Medications

Posted on December 21, 2009 by admin

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.

Cocaine and Rhinoplasty in Beverly Hills

Posted on December 15, 2009 by admin

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!

With respect to nose surgery in Beverly Hills, patients who have been abusing cocaine present significant surgical problems. First, the lining of the nose is terribly inflamed and irritated and it is impossible to conduct a proper operation under those circumstances. Secondly, the abuse of cocaine can lead to creation of a hole within the internal partition of the nose. This is known as a nasal septal perforation. The hole can be anywhere from the size of the tip of a fountain pen to the size of a nickel.

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.

Taxing Plastic Surgery In Beverly Hills

Posted on December 10, 2009 by admin

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.

Beverly Hills Rhinoplasty Surgeon

Posted on December 4, 2009 by admin

The Right Beverly Hills Nose for the Right Face

Recently I read of a research study that evaluated prospective patient satisfaction with a variety of computer imaged noses that were presented to them.

Various positions of the bridge, among other things, were presented, and the conclusion was that there are certain ethnic and nationality predications for certain nasal shapes and sizes which must be considered.

Beverly Hills and the greater Los Angeles area has become anrienormous melting pot of multiple cultures from around the world. We are now considered one of the most cosmopolitan regions of the world, so we see patients from many countries and continents.

One of the most unsettling observations that I make as a superspecialist in nasal cosmetic plastic surgery is that, often, surgeons who are obviously inexperienced and perhaps not highly specialized, consistently deliver the same “cookie cutter” nose to patients from a variety of cultures and nationalities. It just doesn’t look right. It does not work.

The most experienced, talented superspecialist surgeons always determine the patient’s taste, desires and delivers the nose that is in conformity with the other facial features and appears “natural.” A well-done rhinoplasty carries no sign.

Dr. Kotler's Rhinoplasty Patient

Ask ten prospective nasal cosmetic surgery patients what one word would describe the outcome that they desire. The answer, always, is “natural.”