Category Archives: Cosmetic Surgery

Non-Surgical Wrinkle Relief:Top 5

Posted on by
2
"A lovely woman searches a mirror for wrinkles"

No Wrinkles!

Concerned about wrinkles?  There are always the tried and true surgical methods, chemical peels, dermabrasion and lasers. Or the king of the minimally invasive, Botox. And now Dysport.

But there some wrinkle prevention you can do on your own. No cosmetic surgeon needed! Here are the top 5:

  1. Sleep on Your Back

No kidding! One place you don’t want to make a great impression is on your pillow. Because your pillow bites back….into your skin, according to the American Academy of Dermatology. Catching Z’s on your side increases chin and cheek wrinkles while snoozing on your stomach puts more lines into a furrowed brow.

2.     Food

Studies have shown that eating more fish – with Salmon leading the list—is good because a fish oil known as omega-3 is good for your hide. Also, add more soy to your diet — it protecst against sun damage. Don’t like the taste? Try soy supplements. Also, ditch the morning Joe for Cocoa; a 2006 study in the Journal of Nutrition revealed that Cocoa has great ingredients for skin while protecting your complexion from Ol’ Man Sol.

3.      Reading Glasses

Spectacles for skin care? Come on! Actually, it’s true; wrinkle development on the fairest visage known will happen if many repetitive movements are made in the face. Why?Those  contractions, done over and over for years, put grooves in muscles below the skin and leads to…..well, you’ve got the picture by now. Squinting while you read creates bunches of deep groves.  While we’re talking glasses, add in some sunglasses for outside wear to protect your facial bark against sunshine and you’re way ahead. Besides, don’t shades look cool?

4.  Get into The Right Stuff — and we’re not talking pilots!

Try reducing facial fine lines and wrinkles, especially around the eyes, with some natural fruit acids, technically known as Alopha-hydroxy Acids, or just AHAs. Recent studies show that AHAs promote collagen – a natural tissue that plumps out your skin. Another good move is slapping on some topical vitamin C to protect your face from sunlight and pigmentation woes. Don’t forget the prescription-required Retin-A. Think of it as a vitamin cream for the skin that erases superficial discolorations. With consistent use over the long haul,  it helps thicken the outer layer of skin. Thicker skin is more resistant to wrinkling.

5.   Don’t Scrub Your Face Too Much

University studies reveal that tap water is not good for the face. Seems it removes too many essential oils. So look for soaps that include moisturizers or use a facial cleanser and skip the soap.

Look at some before and after chemical wrinkle removal  pictures.

Sleep Apnea on the Rise

Posted on by
1

Recently, the Health & Wellness section of the Los Angeles Times had two excellent articles that dealt with the problem of sleep apnea and snoring

According to the Los Angeles Times, “2% of women, or at least 4% of men, suffer from obstructive sleep apnea.”  If you are not familiar with sleep apnea, it is a condition “in which the airway collapses and blocks breathing for 30 seconds, or even up to a minute or two.  The brain senses that it isn’t receiving enough oxygen and sends a signal to the patient to wake.”

People with sleep apnea (apnea is translated as “without breath”), find themselves in an unsatisfactory and untenable situation because their sleep quality is poor.  Poor sleep quality can generate  a myriad of problems including sleepiness at work and leisure, and even possible elevations of blood pressure, and other imperfections in your normal bodily function.

Maybe there is a connection between the rise in obesity in the United States and sleep apnea.  The paper says, “the incident rises with age: experts estimate that it affects about 40% of people age 65 and older.”  What we are seeing in the United States is that older people tend to be heavier.  That is not good news on many fronts. 

The articles also points out that it’s not just about age.  The overweight issue is very significant.  Overweight patients have double the risk of sleep apnea according to Dr. Lawrence Epstein, of a sleep center chain in Massachusetts.  Incidentally, if you have ever seen kids with large tonsils and adenoids struggling to get breath when they are sleeping at night, which is not that uncommon, you have a clue as to what sleep apnea is like. 

The article pointed out that there are mechanical remedies available including the infamous CPAP (“Continuous Positive Airway Pressure”) device, which is a spaceman-like mask which affixes tightly and to the face, akin to a scuba mask.  An external electrical power source drives the air into the lungs under pressure at night.  It is not too pretty; but, it does provide relief for people. 

Other technical aids are dental mouth pieces, and even some of these external nasal breathing strips. 

I was a bit disappointed that the article did not discuss management of one of the key causes of sleep apnea – that is a blocked nose. Nasal obstruction.

More on that to follow because there is a huge pool of patients in the United States, and worldwide, whose problems can be helped with a veteran, venerable, and reliable one-hour surgical procedure – nasal septoplasty and turbinate resection, with or without rhinoplasty. 

~Robert Kotler, MD, FACS

 

 

THE LAST THING TO BARGAIN ABOUT SHOULD BE THE SERVICES OF A DOCTOR ANESTHESIOLOGIST

Posted on by
Reply

Today, anesthesia is safer than ever.  The reason is giant strides towards patient safety and comfort achieved by the specialty of anesthesiology. 

Several patients have asked me whether it is necessary to have an anesthesia specialist.  They ask, “Is it not possible to do the procedure under local anesthesia, without an anesthesiologist?”  I think this question is being posed because there are some marketing companies that promote “lunchtime” or “one-hour” or “quick” facelifts, whose patients do not have the benefit of an anesthesiologist. 

Not having that “second doctor” in the operating room is one of the most foolish decisions a patient can  make. For cosmetic surgery–or any surgery.  Why wouldn’t you have a specialist whose entire work is devoted to patient comfort and safety?  Is anything more important than either for you?  Today’s anesthesia is so safe that, in fact, you’re safer in a certified outpatient surgery center or hospital, with a doctor anesthesiologist at your side, than you are on the freeway or road you took to get to the surgery center! 

Finally, if people are attracted to a program that does not include an anesthesiologist within the package of services, consider that the anesthesiologist’s fee typically is no more than 10% of the total outlay for all services, including the surgeon’s fee, outpatient surgery center or hospital, postoperative medications, and postoperative recovery facility. 

It’s a false bargain to try to save money when your very life is on the line. 

Considering Rhinoplasty?

Posted on by
Reply

CONSIDERING RHINOPLASTY?  BE SURE TO CHECK OUT YOUR CHIN ALSO.

Many people have rhinoplasty because they are not satisfied with their profile.  There might be a hump or the nose may project too far from the face.  The nose may be too long ; even  “so long” that it nearly touches your lip when you smile.  Most people do not see their profile and, rarely, can make the same objective judgment about their nose that they can about the width, which is visible from the front.  Often, photographs are what drive people to see us for consultation concerning their nose because, “Whoa, I saw what I look like from a side view, and I sure don’t like what I see.”

A complete consultation will include evaluation of the appearance of your nose in all views.  The wise cosmetic surgeon, or plastic surgeon, or facial plastic surgeon will also take into account the dimensions and position of the chin.  It is very important because often the nose appears unduly large because the rest of the face is not large enough.  In other words, there is a disproportion between the nose and the face based on how the other facial structures are formed and what their dimensions are.

The chin often needs to be augmented.  In other words, the profile is improved if the nose is made smaller, and the chin is made larger on the profile.  I am not talking about looking like Jay Leno.   But, I am suggesting, and in some people, just a very small increase in the forward projection of their chin will compliment the improvement in the nose and make the profile as good as possible.  At consultation, it is very important that all aspects of your appearance be considered.  Do not go in with a narrow-minded view of “I need a rhinoplasty.”  The point of consultation is for you to learn and understand what the anatomic issues are.  If the surgeon suggests that you consider a chin implant, do not take it as an insult, but, rather, that the surgeon is thinking about your entire face, and that is exactly what his mission should be.

 

Rhinoplasty Packing Anxiety

Posted on by
Reply

After nasal surgery, cosmetic or reconstructive to improve nasal breathing, there is generally some sort of “packing” placed inside the nose.  The same process for people having a nasal and sinus surgery.  Whether it be a cotton pad or Telfa, or cloth-like material, the purpose is to maintain the reconstructed parts in the proper anatomic position, reduce the chance of bleeding, and to deliver important medications into the tissues, such as antibiotics and even medications to speed healing.  So, packing has always been a traditional part of rhinoplasty, nasal septoplasty, and turbinate resection, but not necessarily welcomed by patients. 

Patients, understandably, dislike the complete blockage, the feeling as though “there is a clothes pin put on my nose.”  They do not like it because it produces a dry mouth and, worse, a sense of anxiety that they cannot catch their breath.  One patient likened his experience to being “waterboarded.”  Another said it was one of the worst experiences of his life because he was very anxious, he could not sleep, and was “generally miserable.”

Interestingly, the specialties of facial plastic surgery, head and neck surgery, ear, nose and throat and general plastic surgery have not paid enough attention to  patient satisfaction with the post-operative experience. While the results of the rhinoplasty and other procedures generally been good, patients rarely give high grades to the experience.

With that in mind, recently, I have developed a new medical device that allows patients to breathe completely freely and normally during the entire postoperative period, including right after surgery.  This Kotler Nasal Airway is placed by the surgeon at the operation, and then the packing is placed.  So, the airway is guaranteed, and the comfort and security of being able to breathe is assured. 

More to follow on this later.

Rhinoplasty Cost

Posted on by
1

Beverly Hills Rhinoplasty Cost

Patients always wonder whether or not there is a “excise tax” placed upon surgical fees in Beverly Hills.  In other words, are people paying for the location, perhaps, without any correlation with quality.

The hard economic reality is that the costs of doing business are higher in Beverly Hills.  Particularly, the so-called “Golden Triangle,” where there is an extremely high concentration of some of the most sophisticated specialists – in all areas of Medicine – residing.  It is a medical campus without a hospital.  But, there are many outpatient surgery centers for the types of elective surgery that we perform, for example.  So, yes, the cost of doing business is higher in Beverly Hills, and, therefore, the surgeon’s fees may be a bit higher.  But, they are not double or triple what they are elsewhere. 

There are advantages to seeing doctors who are at the top of the list of super specialists because they tend to be the most proficient in the procedures they perform, and they tend to congregate together.  The reasons why the highest quality physicians and cosmetic plastic surgeons tend to congregate is that there is ease of consultation and referral.  These translate into significant benefits for patients.  Some of our patients come from out of town and appreciate the fact that we can make arrangements with the other specialists whom they may want to see for other services.  For example, patients often come to see us to have rhinoplasty, cosmetic nasal surgery, and also septoplasty and turbinate resection for breathing.  They may also want to have breast augmentation.  We have a very close working relationship with some of our plastic surgery colleagues who specialize in body plastic surgery, and; therefore, are super specialists “below the neck,” as we are super specialists “above the neck.” 

Typically, fees for cosmetic procedures do not have that wide a variation.  Therefore, while it may cost perhaps 10% or 20% more to have the procedure done in Beverly Hills, most patients feel that, indeed, “you get what you pay for,” and if the most highly skilled, most super specialized doctors are in Beverly Hills, because they are there in a central location surrounded by other top specialists then, it is not unreasonable to pay a bit more. 

 

Heidi Montag is Back in the News

Posted on by
Reply

Now, Heidi Montag is complaining that she had too much cosmetic surgery.  This lady really knows how to work the media and get some press. 

Apparently, Heidi made the comment that of all the ten procedures she had on that one marathon day, the ear surgery, known as otoplasty, was the most painful.  I guess she has to say something to fill the pages of the newspapers.

I don’t know why she found the ear surgery so uncomfortable.  Our experience has been that it is not painful unless there is a complication whereby blood leaks under the skin, is trapped, the skin expands and causes pain.

We take every precaution to prevent that, of course, with very meticulous sealing of blood vessels and placing what is known as a “drain” which is a rubber band-like strip of fabric or rubber to encourage migration from inside to outside of any fluid that accumulates underneath the skin.

Know that the incisions are hidden behind the ear and are typically closed with absorbable stitches. 

No patient should ever suffer from pain.    With the large variety of pain medicines, why should anybody be plagued with pain?  If one does not work, we merely prescribed another.  We go up the line until pain relief is achieved.  Sometimes we have to use very strong pain medications like Percocet or morphine or Demerol but that is rare.  Most patients having routine cosmetic facial and body surgery get along very well with mid-strength Tylenol with codeine or Vicodin. 

As a matter of fact, excess pain is a warning sign, as I mentioned above, possibly heralding bleeding or fluid collection underneath the skin.   So when we hear that the patient is having pain, particularly if their pain medication requirement is going up, we need to see them and make sure that nothing bad is happening.

As in all areas of surgery and medical practice, early recognition of complications and problems is essential.

 

Cosmetic Surgery, Why Wait?

Posted on by
Reply

 “Why Did I Wait So Long?”

We always hear that from patients who delayed having surgery to improve their breathing.

Those patients with blocked noses or a nose that is not attractive typically started out early in life with that problem.  It is not a matter of aging.

Patients with deviated septums, uncorrected nasal fractures and enlarged turbinates due to allergies, typically are plagued with these conditions for many, many years before they start to do something. For some, the nasal blockage pre-disposes them to sinus infections.

Frankly, some of our brethren in other medical specialties do not recognize the architectural problem soon enough.  A good family practitioner or internist should be able to evaluate the inside of the nose to see if, in fact, there is a deviated septum and/or enlarged turbinates or crookedness of the entire nose which could be contributing to the blockage causing the misery that follows a cold or allergy attack.

It is not normal to not be able to breathe. Period.

Our happiest patients are patients where we correct the deviated septum, trim the turbinates and also do rhinoplasty to improve their appearance because in one two-hour session, they have not bettered their quality of life for the rest of their life.  It is so great to do teenagers with these problems because they will not be plagued being self-conscious about their appearance or suffer from blocked noses for another 60, 70 or 80 years. 

Recently one of our patients came and uttered that often-heard remark, “Why did I wait so long?”   Well one reason was he really was afraid to have it done because he was concerned about what he heard from other people who have had the operation.  There is a little bit of “bad press” going on out there, not because of the operation itself nor the results.  It is because the pos-toperative period has been uniformly unpopular since the surgeons have had to put packing of some form inside the nose.  Unless some provision is made for providing an airway through the nose, packing equals total nasal blockage. Not fun for the patient.

Packing is placed by surgeons performing rhinoplasty, correction of deviated septum, turbinate surgery and sinus surgery because it is important to help control bleeding following the operation.  Also, today’s packings which may be cotton-like, gauze-like or even a thick liquid gel, have antibiotics and even other ingredients such as bioengineered healing factors which hasten the healing and reduce the chance of infection.

So the packing, of whatever substance or material, is important.  But the patient’s misery of having a blocked nose for up to five days has long been underestimated by head and neck surgeons, ear, nose and throat surgeons, facial plastic surgeons and plastic surgeons.

One patient likened it to having “to walk around with a clothespin on my nose for five days.”  Another claimed, “I felt I was drowning.”  Patients get anxious, somewhat depressed and complain about the dry mouth and soreness of the throat. 

I have been involved personally in trying to better that situation for over three years.  Working at my “work bench,” I developed a soft plastic airway tube that the surgeon seats onto the floor of the nose and allows the patient to breathe very well after surgery despite the remaining nasal cavity being packed with the usual packing devices or materials.

We have had over 93 patients in our clinical research study undergo the routine surgeries and yet have the benefit of the nasal airway in place.  It wins high grades with 95% of the patients endorsing it.

We always try to do better.  Science never sleeps.  Progress goes on and our aim is to have patients more satisfied, more comfortable under the safest of surgical circumstances.

Revision Nasal Surgery

Posted on by
Reply

Discussion of Revision Nasal Surgery

Nasal surgery is an art based on a science, but it is not magic.  As a surgeon, I can only work with what I have been given with respect to tissue characteristics following previous surgery.  The aim is often to improve both appearance and function, and; therefore, there is a challenge introduced when the operation is not the first visit to the tissue.

I want to urge a sense of realism on the part of what the expectations could be.  We always attempt to yield the very best result possible with respect to both breathing and appearance.  So, while maximum improvement is always the surgical goal, and is, indeed, very often attainable, improvement is not the same as perfection.  The reasonable aim is to deliver a nose that is natural in appearance and functions well.

Please understand that in contrast with both primary nasal surgery, or original nasal surgery, the final result takes a bit longer to present itself.  Not that you will look terrible.  It is just that the swelling, although not necessarily highly visible to anyone, just takes a bit longer to subside.  Some noses look very good in 3-4 weeks, and others need more time for maturation.  As one patient said, “I guess it’s sort of like fine wine.  It takes a little time to get to its best.” That is true. 

After Surgery

After the surgical session, it may be important to undergo minor improvements at the postoperative office visits.  We have long experience in the use of medications that can be used to “smooth out” any irregularities or imperfections.  Another class of medication is used to help reduce internal scar tissue and unwelcomed thickening of the skin.  These are the medications that are called “shrinkers.” 

You and I make the decisions, jointly, before committing to any of these treatments.

For more information, please consult our website dedicated to revision nasal surgery at http://www.revisionrhinoplastydoctor.com/.

Middle Eastern Rhinoplasty

Posted on by
Reply

Noses are different within the varied ethnic groups that populate the planet.   An Asian nose has certain features which distinguishes it from the Northern or Central European nose which is different than the Middle Eastern nose which is different than the Central American nose.  One’s color which is a reflection of racial ancestry has an influence also irrespective of the geographic location.  For example, Asian patients regardless of where they dwell in the world, typically have a broad nose with a low bridge and wide nostrils with thick nostril walls.  These are racial characteristics.  Due to intermarriage, often certain features are improved or worsened depending on the genetic match.

Rhinoplasty or cosmetic nasal surgery for Middle Eastern patients must take into account the following typical features of the nose:  There is usually a bump or hump.  The nose tends to be long and somewhat curled down.  When smiling, the tip of the nose drops down even further.  The nose may be wide with very broad lower cartilages causing large nostrils.

The management of such noses has to be very judicious.  It is important to remove the bump without causing a scooped-out appearance.  The nose should be narrowed but never pinched.  The tip needs to be raised up such that the nose no longer seems like it is going to touch the lip when smiling.  And, speaking of smiling, the little muscle that causes the tip to depress with smile generally has to be severed.

The ideal result would be a nose that has not been made too small, is not turned up too much and, as noted earlier, does not have a scooped bridge or a pinched tip. Improvement with preservation of ethnic identity is the key to success.