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What is the “Kotler Rhinoplasty” in Beverly Hills?

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What is the “Kotler Rhinoplasty” in Beverly Hills?

Interestingly, I never created the term “Kotler Rhinoplasty”. A patient did.
But, I like it.

The young woman, who did quite a bit of on-line research regarding the procedure and choice of surgeon, shared some thoughts with us:

“When I looked at your dozens of website photos of rhinoplasty patients, I came to the realization that there was a consistency. The consistency – a good one – was that there was NO CONSISTENCY of appearance. Each patient had very much a customized result. No cookie-cutter nose jobs there”, she wrote.

“When I visited other sites, I felt embarrassed for some of these doctors whose results were not very good and yet here they were being shown to prospective patients. For the most part, they looked
“done”, artificial and unnatural.
  
What I decided to term the ‘Kotler Rhinoplasty’ was a nose that looked as though the patient could have been born with it. That, to me, is what great rhinoplasty surgery is all about. The patients’ noses wore no sign or placard announcing a nose job.”

I appreciated reading this young lady’s comments. It does embody our approach to cosmetic nasal surgery that has been in effect for the 38 years I have been performing nasal surgery; over 4000 cases.

For the understanding of what patients want and for the education and training by which natural and satisfactory results can be delivered to happy patients, I thank my teachers.

Searching For Rhinoplasty Information in Beverly Hills?

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Searching For Rhinoplasty Information in Beverly Hills?

There are several ways that one can get up to speed about rhinoplasty or cosmetic plastic nasal surgery. One source, of course, is to read books on the subject. I am partial to SECRETS OF A BEVERLY HILLS COSMETIC SURGEON because I wrote it. I also like its sequel, THE ESSENTIAL COSMETIC SURGERY COMPANION, but there are other good books.

Among the best of the cosmetic surgery books are The Bevelry Hills Shape by another and mighty superspecialist, Stuart Linder, MD. The Smart Woman’s Guide to Plastic Surgery is quite good. Cosmetic Surgery Without Fear by Patricia Burgess and What Your Doctor Can’t Tell You About Cosmetic Surgery by Joyce Nash are both very consumer oriented and very “ matter of fact”.

The internet, of course, remains a very rich source of education. However, it takes quite a bit of time and effort to weed through much of the information since the sources of the information being posted vary in knowledge, experience and particularly degree of specialization. I always favor articles or blogs written by superspecialist cosmetic surgeons since these are the people at the top of the totem pole in terms of their education, training, experience and practice focus.

Now, I will share some advice with respect to how to get the most information from the internet. I would suggest that you use the following core search terms: rhinoplasty, septoplasty, secondary rhinoplasty, nonsurgical nose job.

If you have need for consultation regarding improving upon a previously performed rhinoplasty, use the following search terms: revision rhinoplasty specialist, secondary rhinoplasty, revision rhinoplasty doctor. Incidentally, I mentioned nasal septoplasty. A septoplasty is an internal nasal procedure which often but not necessarily accompanies cosmetic nasal surgery. The reason why it is important to understand the role of a septoplasty is that if one has a breathing problem, then undoubtedly, the examining doctor must look to determine if there is a deviated nasal septum. That may come from an accident or one may be born with it. The nasal septum is that vertical partition that separates the two nasal passages. If it is crooked or injured, it often assumes an S-shaped curvature and impedes the airflow.

Also study turbinates. Turbinates are normal structures within the nose that help to humidify, moisturize and filter the incoming air. Particularly in allergic patients they become large and contribute to a blocked nose.

The reason why I mention these terms is that often it is wise to have improvement in breathing done at the same time as a rhinoplasty. Therefore, having a nasal septoplasty and turbinate reduction in addition to the rhinoplasty makes sense in terms of economy of time and even dollars.

Addressing A Twisted Nose Is A Common Occurrence

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Addressing a Twisted Nose is a Common Occurrence
for this Beverly Hills Rhinoplasty Specialist

Addressing a twisted nose is a daily event for this Beverly Hills rhinoplasty specialist. Twisted noses are very common, particularly in men as a result of athletic injuries. A twisted nose is generally due to a deviation of the nasal septum. A deviated nasal septum is a consequence of an injury which has detached the septum from its normal internal attachments and made it bowed or crooked. Sometimes it is even S-shaped. This twisted look can exist whether or not the nasal bones have been broken. If they have, the twist will be even worse and that requires surgery on the nasal bones.

The major culprit in the twisted nose, including the tip leaning to one side or the nostrils appearing asymmetrical, is that deviated septum. The crookedness corrected by a strictly internal procedure that seeks to reattach the septum to its proper attachments or even remove a bent portion which is causing the crookedness. Sometimes it is difficult to make the nose perfectly straight because the cartilage has a “memory,” but in almost all cases, there is significant improvement in breathing. Typically at the same time, enlarged turbinates are also reduced further improving the airway.

If one wishes to have a cosmetic plastic surgery or rhinoplasty performed, that can be done also. Often, the best strategy is to have all the issues corrected at the same time rather than submit to two separate surgeries.

Collapsed Rhinoplasty Nose Is Avoidable, Also Fixable in Beverly Hills

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Collapsed Rhinoplasty Nose Is Avoidable,

Also Fixable in Beverly Hills 

Collapsed rhinoplasty is where the bridge has been lowered so much either by radical take-down. Or the internal support, the septum which was crooked, has been weakened so much that the buttress supporting the bridge has been inadequate and there is a large dip or “saddle” deformity.  It is avoidable if the surgeon does the operation carefully and incrementally.   Shaving down the bridge, a sliver at a time, helps prevent that problem.  Likewise, when performing correction of the deviated nasal septum, one needs to constantly assess how strong the upper margin of the septum is and be wary not to remove too much of the higher septum that supports the bridge of the nose.

If the patient has a result which demonstrates a collapsed nose, it can be fixed.  There are three techniques.  One is to place a preformed plastic part or prosthesis under the skin to fill the “dip.”  The second is using the patient’s own cartilage from the internal nose and external ear.   And third, to use filling injections to raise the bridge to the point that it is satisfactory for the patient.

I recommend the patient consult very carefully before making a final decision about the preferred technique.

Every Rhinoplasty In Beverly Hills Or Anywhere, Is An Ethnic Rhinoplasty

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Every Rhinoplasty In Beverly Hills Or Anywhere,

Is An Ethnic Rhinoplasty

The United States has a different ethnic makeup than it did even 25 years ago.   And while the great wave of immigration to the United States occurred between 1880 and 1920, there has been a second wave of immigration primarily in the last 25 years.   While the great wave of 19th and 20th century immigrants came from Eastern and Central Europe, this wave of immigrants comes from a wider swath of territory including the Middle East, Central and South America and Asia.   That means that in a sophisticated, superspecialist rhinoplasty practices such as many of us have in Beverly Hills, we are going to see patients whose ancestors came from all over the world.  In a sense there is such a large mix of patients that every patient is ethnic. The classic northern or central European American who is fair skinned, blonde and blue-eyed is now in the minority.   Patients with black, brown or yellow skin and different noses are the norm.   The nose is different in terms of lower bridges such as we see in Asian patients, wider nostrils in Asian and Hispanic patients, bulbous tips in all ethnic groups and even in select areas of the world like the Middle East offer different challenges.  Patients from Iran, Iraq, Syria and Egypt, often have a bump on their nose as well as a flat, plunging tip. 

Beverly Hills rhinoplasty superspecialist surgeons have experience dealing with all these patients because Los Angeles has become America’s most internationally-flavored city.

Five Good Reasons Why Patients Come To Beverly Hills For Second Rhinoplasty Surgery

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Five Good Reasons Why Patients Come To Beverly Hills For Second Rhinoplasty Surgery

Beverly Hills indeed is a Mecca for people seeking improvement in their appearance.  This applies for all the procedures done including facelifts, eyelid surgery, chin augmentation, chemical skin peels, breast augmentation and reduction, tummy tuck and liposuction.  There is a skill level in Beverly Hills that is not found in most American cities.  With the high concentration of cosmetic surgery superspecialists, there are at least five reasons that patients come to Beverly Hills for a second rhinoplasty surgery:
1. The patient had an unsatisfactory experience with a less specialized and less-experienced surgeon elsewhere.

2. Patients recognize that a revision rhinoplasty is a more difficult case and this calls for
 the talents of those who make rhinoplasty the featured procedure in their practice.

3. Patients know that Beverly Hills is well equipped to handle the out-of-town visitor and
 patient.   Nearby hotels cater to patients.  There is a professional recovery
 hideaway where one may have round-the-clock nursing services, within a hotel, which
provides 24-hour room service.  This “recovery hideaway” provides transportation to and from the office. 

4. Beverly Hills is only 20 minutes from Los Angeles International Airport.  Patients often are accompanied by friends or family. Some families with children take the opportunity to make it a mini vacation.   After revision rhinoplasty, patients are not prisoners in their hotel room.  After one or two days, it is possible to be outdoors and out and about and participate in some tourist activities.

5. There are some surgeons in Beverly Hills who do specialize in non-surgical rhinoplasty revision surgery.  Using temporary or permanent injections, often a revision rhinoplasty surgery can be avoided.  The service is generally not available in most other American cities.

Beverly Hills Crooked Nose Can Happen After Rhinoplasty Too

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A Crooked Nose Can Happen After

Rhinoplasty Too

There is an old adage among surgeons that “The only surgeon who has no complications is the surgeon who does not operate.”

Sometimes after a well-intended rhinoplasty surgery, the nose may have a bit of crookedness where there was no apparent crookedness before.  The answer to that surprising fact is that typically when one has a rhinoplasty, the bridge is lowered as the hump or bump is removed.  When one lowers the bridge of the nose, it may be discovered that the internal support of the septum is crooked.  If the surgeon did not either recognize this crookedness or did not deal with it adequately, the end result may be that the nose is crooked.  Now there is a remedy for that.  If it is minor, it can be improved by injecting the concave part of the crookedness with a filling injection.   But that is limited to those cases where the nose is not already wide.  More commonly, it would require a 20-minute touchup whereby entirely through internal incisions, the crooked septum which is now playing a part in the appearance of the nose is straightened.

Pain Management After Plastic Surgery in Beverly Hills

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Pain Management After Cosmetic Surgery in Los Angeles

Postoperative pain varies from patient to patient.  It depends on the procedure.   Operations that are performed on tissues or areas that are in motion tend to be a little more sensitive.  Therefore, tummy tucks can be a bit more uncomfortable because every time one sits up or changes position, there is the requisite tightening of the abdominal muscles and some discomfort.  Breast augmentation and breast reduction tend to be less uncomfortable. Likewise, nasal cosmetic surgery and nearly all the facial procedures carry little postoperative pain burden because there is less movement.

However, the pain threshold is different from patient to patient.  The discomfort can also be a function of swelling and bruising.  For that reason, cosmetic surgeons will typically provide for the patient anti-swelling and anti-bruising medication and, of course, pain medication.  The best indication for what the ideal pain medication is for a given patient is their past experience. 

The surgeon should ask:  “Have you ever had previous surgery, and if so, what pain medications did you take that were effective?”  This will be a guide.  Our experience has been that for most patients, mid-level pain medication such as Tylenol with codeine or Vicodin suffice.

For those patients in whom Vicodin or Tylenol with codeine are not satisfactory, the practice can provide stronger pain medication.  Typically, this is only necessary for a day or two.  Please remember that in the postoperative period, when one is taking narcotic pain medications and less active than usual, there is a greater chance of developing constipation and so that should be foreseen and properly addressed.

Beverly Hills Nostril Narrowing

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Some patients presenting for cosmetic surgery need to have a change in nostril size and shape. 

The most common reason for narrowing the nostrils is that the width of the floor of the nostrils is too great, in proportion, to the remainder of the nose. 

It is often a feature of certain ethnic noses that the nostrils require attention.  Typically, wide nostril floors are common in Asian people.  Combined with that are rather thick walls of the ala or wings which are the outer portion of the nostril.  If the walls are very thick and the width of the floor of the nostril is wide, then there is a strong reason to narrow the nostril.  Note that it is not possible to reduce the thickness of the nostril wall, however, effectively, the nostril wall “moves in” as the nostril floor’s width is diminished.

The procedure is usually done at the time of the other cosmetic nasal surgery procedures.  In order to hide the incision it is placed in the crease between the nostril and the upper lip.  The incision is carried into the floor of the nose.  The external portion is closed with several layers of stitches.  The outer layer of which is typically removed in 5-7 days.  Deeper hidden incisions ultimately dissolve, but remain in place for up to 90 days to reduce the chance of any separation of the incision, therefore maximizing the cosmetic appearance.

Dr. Kotler After Photo

Dr. Kotler's Patient After Nostril Narrowing

It is important that symmetry and a natural look be achieved.  Further, over-narrowing of the nostrils, in addition to producing unsatisfactory appearance, might have an influence on breathing.

Beverly Hills Cosmetic Plastic Surgery Aftercare

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It’s important to recognize that there is the possibility of complications that occur after “the last stitch” is placed by the surgeon.  To reduce that chance, it’s important to know your doctor’s philosophy on aftercare. 

Since cosmetic surgery does not involve a major body cavity such as the chest cavity or abdomen and involves itself only with the skin and tissues directly underneath, routine post-operative hospitalization is rare.   But you do need to ask yourself the following questions:  Where will I recover?  Who will be with me during my recovery period? And how often will the doctor need to see me after surgery and how will I get to his office for those visits?

Some patients will be most comfortable convalescing at home.  This can be appropriate after nearly all cosmetic procedures if there is either a responsible adult available and willing or, better yet, a trained medical professional present.   There are professionals who do home care.  They may be registered nurses, practical or vocational nurses or medical assistants. Since there is no major nursing duty involved in routine cosmetic plastic surgery post-operative care, their title and credentials are less important than their experience.  I would be reluctant to have an attendant who has not cared for cosmetic surgery patients.  So be sure to ask about the nurse’s experience with your procedure.

For those patient’s desirous of complete care outside the home, there is the “recovery hideaway” alternative. Cosmetic surgery in Beverly Hills is fortunate to have several facilities who have long been on the scene to care for our patients.   Shanteque, nearby in Century City, and Serenity, in adjacent Santa Monica, are very well established and very sophisticated facilities that provide for all needs for the after-cosmetic surgery patient, including transportation to and from the office.

Such hideaways are professionally-staffed, hotel-like facilities offering appropriate meals, around-the-clock nursing attention and, of course, act as the eyes and ears of your doctor. 

Typically patients from out of town will find it convenient to stay in such a facility since without family or friends to provide a locale, this is their best option.