Monthly Archives: February 2010

Beverly Hills Cosmetic Surgery Fees

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Three Wise and Practical Reasons For Cosmetic Surgeons
To Reduce Fees in a Tough Economy

A very savvy business friend of mine said to me several months ago: “I don’t know of anybody who has not been adversely affected by the very difficult economic times now facing the United States.”

Certainly, when the economy is tight, people have less money available for nonessential services such as cosmetic surgery.  Therefore, plastic surgery practices will see decreasing patronage.  For that reason, practices have to be realistic and ask themselves if there is not a way that they can contribute to helping ease the discomfort of a slow economy and at the same time benefit their practice.

I hereby submit that there are three good reasons why a cosmetic plastic surgery practice is wise to lower its fees: 

1. Physicians have a responsibility to help patients.  If economic difficulties present themselves, there is no reason why we cannot soften the blow by reducing our fees.   After all, physicians who treat illness such as internists, pediatricians, surgeons have treated the needy in exchange for diminished fees.  It is a tradition in medical practice that all be served.  Even though our work is not medically necessary, it is still a valuable and important service to patients.  Therefore, it is perfectly consistent with medical ethics that we lower the economic barrier for the sake of our patients.

2. To be most proficient, surgeons need to be busy.  “Beware of the surgeon who operates infrequently” is an ancient and well-respected axiom in the world of surgery.   My experience and that of other superspecialist surgeons is that in fact, the most gifted and proficient surgeons are busy.  They are busy because they attract patients through their talents.  They are also busy because they will accommodate themselves to the needs of the patients including the economic realities.

3. From a purely business standpoint, it is still better for the practice to do a case at a significant courtesy discount than not to do the case at all.  Medical practices have large fixed expenses including rent and staff salaries.  Accountants have long held that for elective surgery, a practice would be foolish not to discount its fees and continue to keep the operating schedule busy rather than take an aloof and distant stance and pass on surgical cases that would otherwise help the practice and the business’s bottom line.

Making Revision Rhinoplasty Too Complicated

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Are We Making Revision Rhinoplasty Too Complicated?

Today a patient came to see me in consultation. He was a young adult who had a history of sustaining a broken nose and having delayed in having it repaired. Finally, unhappy with the appearance and the breathing, he had reconstructive surgery done by a plastic surgeon who was not specialized enough to render the result that might have been achieved. He waited for one year and then had a second surgery by a more specialized surgeon. This “first revision rhinoplasty” according to the operative report was quite complex and intricate. It involved transplanting tissue from the scalp and cartilage from the ear into the nose. Apparently the surgery took five hours. The patient said that it took nearly “two years” for all the swelling to go away. I was somewhat astonished by that initially, but then after reviewing the operative report, and seeing all the maneuvers, techniques and manipulations that were performed, it made sense the operation would take that long.

Before and after photo of another patient of Dr. Kotler who in another state, sustained two prior, yet unsuccessful operations to improve appearance and breathing. Dr. Kotler was able to create a natural nose that worked normally and relieved the patient of her blocked nose and sinus headaches.

Unfortunately for this patient, it did not render satisfaction and thus we are going to have to perform another operation on him. If it were not reasonably predictable that the outcome will be better, I would not consent to perform the surgery. I think it is very important that the “odds” of success be taken into account when performing yet another revisional rhinoplasty surgery.

My assessment is that the operation can be done more simply, efficiently and that this in itself will allow faster healing.

The issue of healing is of major concern for the patient. Because he works with the public he cannot afford to be away from work for weeks and months because the nose and face are so swollen.

Interestingly, and coincidentally, his experience is not unique. Later in the day as I was reviewing a medical magazine, I noticed an article on a young woman who required two revision rhinoplasty operations. Her surgeon noted that “one year post procedure she will be about 30% healed, and only 40% healed after two years.” That is a long time line. Most patients are not happy with the prospect of healing that takes so long.

My point is that it may be that when the operations are done, the techniques involved are just too complicated, too complex and too prone to take so much time to heal that the patient sits in a state of suspended animation for a period far longer than they would like.

Beverly Hills Cosmetic Surgery Consultation

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Why I Like an Interactive Consultation

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.

Beverly Hills Cosmetic Surgery Follow-Up

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The Pleasures of Follow Up With a Happy Patient!

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.

Demystifying Cosmetic Surgery

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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?