Non Surgical Neck and Jowl Lift

Posted on September 17, 2010 by admin

“Neck and Jowl Lift (non-surgical) $2,900”

This was part of an ad that appeared in a local newspaper here in Los Angeles. There was an asterisk referencing a caveat at the bottom of the page, but the problem was the typeface of the caveat/disclaimer was so tiny that I, even with strong magnifiers, could not read it.

I am not sure what a neck and jowl lift that is non-surgical is. Nor, why it costs $2,900. The reality of lifting tissue is that the only lift that works is a surgical lift. How does one fight gravity with anything other than that? While some of the high-tech laser-like machinery promotes them as providing a “lift”, the reality is, after a period of time, the skin which is the only organ that could be affected by this superficial treatment, stretches back and no longer provides support to tissues which then re-sag.

Everyone would like to believe there is some product or service or technology that will somehow make surgery obsolete. Well, the reality is there isn’t, and there probably never will be. Yes, it is attractive to offer things that are non-surgical because people have, understandably, an aversion to surgery. Yes, surgery takes some time, yes it costs some money, and yes there is a tiny risk of problems and complications. However, surgical procedures such as well-performed face and neck lifts, neck sculpture and in some cases, focal liposuction have proven themselves for decades. They work and they have good longevity.

Advertising is great when it is informative and educational. But not when it preys on people’s fears and anxieties.

Researching Cosmetic Surgery Online

Posted on September 10, 2010 by admin

Doing Research on the Internet. Better Distinguish the Cosmetic Surgery Pros from the Amateurs!

The Internet is a wonderful educational innovation. All of us use it every day to learn more. However, there are negatives. First, there is no scrutiny of many of the postings. Some of the websites are either accidentally or deliberately misleading, often for commercial purposes. Some websites have no filter or review that would prevent misinformation from being made public.

The second negative, for those researching cosmetic surgery, it is possible for a particularly cosmetic plastic surgery site to gain some attention during Internet searches, strictly by virtue of having invested large amounts of money in a website. Loading it with lots of bells and whistles, but less substance. Some websites are built to be attractive, enticing and yet the content is poor. Worse, sometimes misleading.

Site visitors may loose focus and may not understand that the most important value of a particular site is the quality and volume of the content. Plus, the history of the doctor. The training, experience, degree of specialization, continuing education and prominence in the community of like specialists. Those are the sites of the real pros.

I like to visit sites of the pros. The heavyweights of the specialty of cosmetic plastic surgery who are its superspecialists. These are doctors who have “earned their spurs” through long and intensive training including residency and fellowship. They have served their time, and therefore, have the wisdom that is delivered by that long run in the operating room and in caring for patients before and after surgery. There is no substitute for experience!

To help you understand how you get the most out of visiting websites for cosmetic surgeons, heed the following advice: First, look at the professional bio. How long the doctor has been in practice. Has he written research papers on the operations you are considering? Does he teach in a medical school? Has he served in the military – a huge advantage? Does the doctor focus his practice on a limited number of procedures or is the doctor a “Jack of All Trades”, content to perform a large breadth of procedures. Remember, in the world today, the trophies go to the superspecialists and not the generalists.

For you prospective patients, the most important part of a cosmetic surgeon’s website is the gallery of before and after photos. If you only see six or eight patient case histories, that tells you the doctor doesn’t have the long experience and a large volume of patients from which he can cull typical examples to share with you. You should be seeing hundreds of before and after photos on the doctor’s website. The top educational photos galleries show technically clear and consistent befores and afters – beware differences in lighting, make-up! Each photos case history should have a caption describing what was done. Look for solid consumer-oriented information including commentaries from patients as to what their experience has been with the practice.

Today, most sophisticated, most specialized and advanced practices offer prospective patients telephone consultation, doctor-patient conversation via Skype and computer imaging where an interested patient, anywhere in the world, from the privacy of home, can see the predicted result of their cosmetic procedure(s).

Pardon me for being a bit proud, but frankly, having authored two books for the public, my very capable and veteran staff have delivered loads of information that would otherwise not be available in a single source! Books are still great learning tools. I am proud to be among that small group of doctors who have taken the time and energy to also be writers. To help educate. After all, the root word for “doctor” is the Latin, docere, “to teach”.

Remember, websites should not about sales and marketing, hype and fluff. The best websites are about education.

Non-Cosmetic Surgeons Doing Cosmetic Surgery?

Posted on August 27, 2010 by admin

Non-Cosmetic Doctors Profiting by Doing Cosmetic Procedures?

A recent article in USA Today described a situation not unknown to those of us who are long-time cosmetic surgery-only practitioners.

Writers Jayne O’Donnell and Jillian Berman did a nice job of pointing out what many people in the public don’t quite know or understand: there is a migration across specialty lines by some practitioners anxious to augment their income by performing elective cosmetic plastic surgery procedures that are beyond the usual boundaries of their specialty.

Writers O’Donnell and Berman reported the history of a patient who stated that “…her OB/GYN offered to do a tummy tuck after she delivered the lady’s third child.”

Next, the same patient reported that her eye doctor suggested injectables to the wrinkles between her brows when she went in for an eye exam.

The patient couldn’t quite figure out what was going on.

Traditionally cosmetic plastic surgery procedures on the body have only been performed by plastic surgeons. Surgeons who pass the test of the American Board of Plastic Surgery are expected to be the only specialists who are duly qualified to perform tummy tucks. While OB/GYN specialists have knowledge of the anatomy of the lower abdomen, tummy tucks and liposuction are not taught in obstetrics and gynecology residencies. They are not considered part of the specialty.

What about an eye doctor suggesting injectables for the wrinkles between her brows, such as Botox or Dysport? If the doctor is a subspecialist in ophthalmic plastic and reconstructive surgery, those injections are properly part of his toolbox. But, the average ophthalmologist may not have the training and experience to be a superstar at it. Patients need to know that.

In my book, Secrets of a Beverly Hills Cosmetic Surgeon, I discuss this migration across specialty lines and why prospective patients must be on the ball when evaluating an offer from their doctor that seems unusual and at odds with respect to the typical scope of that specialty. Understand that because of the inequities and burdens of dealing with health insurance companies, many doctors are so frustrated and fed up that they look for an alternative form of practice. It is not always practical or possible to go back and take a full six or seven year residency, so many of them decide to try to master some of the techniques that have been perfected by other specialities.

This is not to say that an ophthalmologist would necessarily be incompetent at doing Botox or Dysport. Know that there is not much downside to these procedures; difficult to get into major trouble.

However, an obstetrician/gynecologist doing a tummy tuck enters a whole different realm and I would be very skeptical, as a patient, before signing up to have the procedure done by that doctor. The more appropriate doctor is one who is board certified by the American Board of Plastic Surgery and has long-time experience performing a procedure after the prescribed period of education and training.

Today, unfortunately, it is a matter of Caveat Emptor. Buyer beware.

Cosmetic Plastic Surgery Questions

Posted on August 27, 2010 by admin

Got a Question? Ask it! Why Worry?

I like for patients to have every question answered. Before surgery, it is very appropriate to have questions about anesthesia, recovery, pain. Even worries of nausea and vomiting, which are now rare, should be addressed.

After surgery there are questions such as “When can I resume my exercise?”, “When can I start nursing my baby?”, “When will the bruising and swelling be gone so I can return to work?” “When can I start to have sex again?”

These are important questions and deserve answers. Sometimes patients are reluctant to ask these questions because they “don’t want to bother the doctor”, or they are a little shy about asking questions, particularly the “sex question.”

I encourage patients to ask questions at any time during their care with us; before surgery, after surgery, day time and evening time. There is no reason to worry. There is no reason to fret. Often concerns and worries are exaggerated and may even keep people from sleeping.

This post was inspired by a conversation I had this morning with one of our patients who lives in another city. She came to us to have upper and lower eyelid cosmetic surgery or blepharoplasty plus brow lift and had cosmetic nasal plastic surgery or rhinoplasty. And, incidentally, at the same sitting, with a plastic surgery colleague who is a superspecialist in body procedures, she had tummy tuck and breast reduction.

She was concerned that her smile had not returned in full force. Her fear was that somehow this would be permanent. I quickly reassured her that after her particular type of rhinoplasty, or cosmetic nasal surgery, it wasn’t unusual that the smile would be limited because of some temporary swelling and malfunction of the upper lip muscles. That function always returns. I reminded her that I witnessed it in my own daughter whose rhinoplasty I did when she was 16 years old.

Being a doctor is a 24/7 job. Your doctor should be available. If you have a question make the phone call, get the answer and sleep tight.

Why Breast Implants are Big

Posted on August 20, 2010 by admin

Why Breast Implants are Big

Figuratively, not necessarily literally.

My point is that breast augmentation surgery is popular because women desire to have as fine a figure as possible. I think it is a great idea. Some women are born with breasts that are too small. Others have breast asymmetry. Some have problems with nipple inversion. Some people need to have breast surgery to reduce over large, pendulous, supersized and therefore not particularly pretty breasts.

The most common operation is the breast augmentation. It is a good operation because it is successful and has a low complication rate.

Women like to look good, that’s why clothing styles and hair and makeup are important. For those who are self-conscious, or carry a lack of self confidence because of small breasts, this one- hour operation can literally change their life. In that regard, I liken it to rhinoplasty, one of my specialty procedures, for teenagers. Both of these operations give lifelong satisfaction and an increase in self-satifaction and self-confidence. I have witnessed it for my entire career.

If breast augmentation sometimes gets a bad name it is only because of bad judgement on the part of either the patient and/or the doctor. The classic example is Heidi Montag, the aspiring actress-personality. Common sense was thrown out the window when her reasonable looking breasts were replaced by gigantic and unnatural breast implants. She became a poster girl for bad cosmetic surgery. Frankly, I blame the patient for that unrealistic desire which, by the way, in Heidi’s case was followed by some period of pain and unhappiness as reported in the media.

Cosmetic plastic surgeons have a responsibility too. They need to do the right thing and to be proud of their work. When such oversized implants are stuffed into the chest, there is a greater chance of problems and complications. Problems that discredit the specialty and the medical profession. There is nothing wrong with breast augmentation that delivers natural-looking, properly sized and proportioned breasts. With today’s terrific implants that come in various sizes and shapes, there is ample opportunity for body cosmetic plastic surgeons to do great work. And, by and large, they are doing great work. That is why the operation is so popular.

As I said, breast implants are big. I didn’t mean to imply they were oversized. What I am really saying is that the subspecialty of breast implant augmentation is popular and well accepted and that is what young people call “big.”

Unhappy with Your Cosmetic Surgery?

Posted on August 13, 2010 by admin

What Do You Do If you Are Unhappy with Your Cosmetic Surgery?

Some patients will not be satisfied with their cosmetic surgery. In many cases, their dissatisfaction is warranted; in other cases it is not – the patient may not have been realistic about what results could be achieved.

In any event, the dissatisfied patient has the right to have a detailed conversation with her or her surgeon and ask why things did not go well and what can be done to improve the situation. I also believe a second opinion, from an objective outside source – ideally a superspecialist in the procedure – is extremely valuable. I always make this recommendation: “When in doubt, seek a second opinion.”

I have had occasion in my practice where neither the patient nor I were completely satisfied with the result. He is what I say to the patient, “Frankly, I’d like to have some input from a colleague and get an opinion as to what the best step would be going forward.” Patients very much appreciate the offer. I see to it that there is no charge made to the patient for that. And often the patient and I both learn something. All this is done in the spirit of preserving a good, solid professional relationship, with the object being to have a satisfied patient and a gratified surgeon.

One thing that is very important is that the consulting doctor have access to all the medical records including pre-and post-operative photos. Remember, regardless of the state of friendliness between the patient and the original surgeon, the surgeon is obliged to provide these records to the patient. Medical ethics, and state laws governing medical practice, demand that all must be done in the interest of the patient and, therefore, any and all medical records including the photographs, x-rays or whatever, must be available to ether the patient or to a physician of his/her choosing.

The reason to have the medical records at hand during the second opinion consultation is to understand the history and to see what the pre-operative state was and make a realistic judgment as to what could be reasonably achieved and what could not be achieved. It is also important to read the operative report to see if there are extending circumstances to compromise the result. Were there complications after surgery that had a bearing on the outcome? All these things are best understood by a thorough review of complete records.

You are entitled to have the best service possible. Don’t be shy. You are entitled to the records and you are entitled to the input from another doctor who may well say that the best was done that could be done. But in any event, you will feel better about hearing it from a second source.

The Best Ethnic Rhinoplasty Surgeon

Posted on August 6, 2010 by admin

The best ethnic rhinoplasty surgeon is the surgeon that can operate on an ethnic patient and yet deliver a nose that looks as though that patient were born with it. Natural. Fitting the facial features and not resembling other noses, as if it were picked from a catalog.

Patients are very concerned about maintaining their ethnicity, as they should be. They are proud of it. They feel that it is very important, while improving their nose, to not have a nose that looks operated and obviously done.

There is a big difference between nationalities, and therefore a difference in what a typical nose should be on the face of a patient of a particular nationality. We see patients of Asian ancestry, including Vietnamese, Chinese, Japanese, Cambodian and Thai. We see many people from the Middle East; people from Syria, Lebanon, Iran, Saudi Arabia, Kuwait, Israel and Turkey.

My aim is to study the face and deliver a nose that is an improvement and yet carries no sign of cosmetic plastic surgery. Remember, if the nose is unnatural it becomes a neon sign.

If the nose is well done, and looks natural and un-operated, it speaks for beauty, but without a voice.

Dr. 90210 Nose Job

Posted on July 23, 2010 by admin

Dr. 90210 Nose Job

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.

Computer Imaging and Hollywood

Posted on July 15, 2010 by admin

Computer Imaging and Hollywood

There is something magical about computer imaging. The uniqueness is that the prospective patient can see their predicted result on a computer screen and immediately understand “what it is all about.”

The discussion of cosmetic procedures is often very abstract without some visuals. The most powerful graphic they can have would be a computerized prediction of the outcome of whatever procedure they are considering, whether it is rhinoplasty, blepharoplasty, face and neck lift, chemical skin peel or neck sculpturing with or without chin augmentation.

Previously all we had available to demonstrate to patients would be a magic marker to “erase” the bump on the nose. We have used computer imaging in our practice since 1989. Today’s technology, of course, is far advanced over those rudimentary computer systems we had and patients very much appreciate the chance to have that as an important part of their consultation.

In Hollywood, the home of the stars, we sometimes kid our patients who come from out of state to see us that “Welcome to Hollywood, now we will show your transformation to a Hollywood star!”

Rhinoplasty Costs in Hollywood

Posted on July 12, 2010 by admin

Rhinoplasty Costs in Hollywood

Do rhinoplasties cost more in Hollywood than in other parts of the country? I suspect they do. There are several reasons for this. One is that we do have more superspecialists here performing cosmetic procedures, including rhinoplasty. Superspecialists tend to command slightly greater fees because of their prominence, their excellence lower rate of re-do or revision surgery.

The cost of doing business is higher in Hollywood than it is in Lincoln, Nebraska or Appleton, Wisconsin. The labor costs are higher; nurses and surgical assistants command higher wages, all of which are a factor of the higher cost of living in California. Ditto for New York and other centers of excellence.

If one had blepharoplasty and chin augmentation he or she would expect to pay a bit more than you would elsewhere, although not greatly more than in other large cities that have very sophisticated practitioners of cosmetic plastic surgery including New York City, Miami and Houston.

When looking at costs in Hollywood or anywhere else, always be mindful to ask about “the entire cost.” You need to know what additional costs there would be for the outpatient surgery center, and anesthesia specialists, medications and perhaps even a postoperative recovery facility in which to stay for one or two nights.