Category Archives: Revision Rhinoplasty

Deviated Septum in Beverly Hills

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Deviated Septum in Beverly Hills

We see many patients who come to us who are unhappy with their breathing.  Now, ours is not a typical “plastic surgery” practice.  First, of course, we only operate on the face and neck.  Secondly, 70% of the practice is devoted to nose surgery.  My background is a head and neck (ear, nose and throat) specialist and my additional formal training in cosmetic, plastic and reconstructive surgery of the nose plus my military experience gives me comfort in limiting my practice so narrowly and majoring in nasal surgery, including rhinoplasty, revision rhinoplasty, correction broken nose, nasal septoplasty and turbinate resection.

Patients do come to Beverly Hills because their sense, and it is usually correct, is that the most sophisticated superspecialists practice here.   We see patients with problems of a deviated septum because they have either had previously unsuccessful surgery or, in fact, had a rhinoplasty surgery and never had the problem of the crooked nose or the breathing addressed.  Typically when there is a deviated nasal septum, there will be in addition to a breathing difficulty, a high percentage of patients who also have crookedness to the nose.

The significance to the patient is that if you have trouble breathing and your nose is crooked, you will have to have surgery on that deviated nasal septum to achieve an optimal result.

Beverly Hills Before and After Photos Will Help You Decide On Rhinoplasty Surgery?

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Will Viewing Before and After Photos Help You Decide Whether Or Not You Should Have Your Revision Rhinoplasty in Beverly Hills?

The purpose of the consultation with the cosmetic surgeon is to learn more.  One of the most valuable components of that visit is the chance to view a large number of typical “before and after” examples.  The primary reason for some people’s post-surgical remorse and the need to come to Beverly Hills for revisional surgery is the original failure to study the first doctor’s work.   You need to get a sense of his art form, his style and his results.  Photographs offer an impression of that particular surgeon’s idea of reasonable improvement.   They also help give you, the patient, a grasp of the realistic results of your rhinoplasty.

I am often amazed when I learn of people who have been disappointed with their cosmetic surgery and when asked:  “Did you see the doctor’s work before?  Did you see a lot of before and after photographic examples of his work?”  They answer:  “No, I didn’t.  I asked the doctor for before and after pictures but the doctor said he didn’t have any for me to look at,” or the reply is:   “Well, he only had a couple to show me.”

That was a tip-off that they were not dealing with a rhinoplasty superspecialist.  A surgeon whose practice is focused on rhinoplasty will have dozens of examples to show you and you should be able to see within those examples a case study similar to yours.

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.

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.

Beverly Hills Sinus Problems

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The sinuses are the most maligned of all body parts.  Radio and television ads, newspaper and magazines constantly remind patients that various nose drops, nose sprays, pills and decongestants will all help their “sinus problems.” 

In fact, true sinusitis or infection of the sinuses is rare.  More commonly, the patients suffer from blocked nasal passages, but the patient can’t distinguish between an infection of the sinuses and just a blocked nasal passage, which can be due to deviated septum and/or enlarged turbinates.

The sinuses, which are air-filled chambers numbering 7, all rely on an open nasal passage to pass air into their openings.  There are sinuses within both cheek bones, on either side of the eye, just above the nose on the forehead, and one far back in the skull underneath the brain and above the highest part of the throat.

True sinusitis is a diagnosis that will always come to the attention of a physician because the symptoms are so profound.  The patient will be acutely ill with high fever, weakness and lethargy.  Green, yellow or brown pus will come out of the nose.  There will be a severe headache or, if the sinuses involved are those within the cheek bones,  the sensation of an upper toothache.  There may be swelling and redness on the face.  In extreme cases, one may even have the eyeball pushed forward.

Typically the patients who are most susceptible to attacks of sinus infections are those who have nasal obstruction due to a broken nose, deviated septum, enlarged turbinates and nasal allergy.  Also a contributor is cigarette smoking.

Typically patients that have sinus problems will be those who live in a cold weather climate in the winter where indoor heating to compensate for the outdoor cold carries with it dryness.  Dryness is the enemy of normal nasal and sinus function.

It is very important that before patients have rhinoplasty, a purely cosmetic surgery, that there is a determination as to whether or not they have harbored sinus infections in the past.  The reason is that if there is still an ongoing indolent sinus infection then there is a chance that the nose is seeded with bacteria which is not a good idea if one is contemplating an elective procedure.

There are x-rays and CT scans available to either establish or eliminate the diagnosis of sinusitis, and these should be performed prior to surgery if there is any question about the patient’s history of sinus infections.

Beverly Hills Revision Rhinoplasty

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Dr. Kolter's patient had a series of permanent filler injections - no surgery was done.

Dr. Kotler's patient had a series of permanent filler injections - no surgery was done.

If you are not happy with your rhinoplasty, what should you do?

 

 

 

First, understand that an imperfect outcome doesn’t necessarily mean that the doctor did not give it his best effort or that the doctor is not adequately skilled.  Sometimes things just don’t go well even in the most talented, experienced and superspecialist‘s hands.  Sometimes complications can occur such as infections which are certainly beyond the control of the surgeon.

 

Remember, however, that an imperfect result or the results of a complication can generally be improved.  Sometimes improvements can take place through a series of office treatments.  Certain injections such as cortisone can reduce some areas of scarring and swelling.  Other injections, such as liquid silicone, Juvéderm, Restylane and collagen are used to fill depressions, divots and dips in the architecture.

 

 

Regardless of what needs to be done, be sure to spend time speaking with your surgeon as to what he believes led to the imperfect result and what he feels can be done to improve the appearance.  Often the doctor may suggest a consultation or second opinion with another doctor who has similar skill and experience.  This is important.  There is no shame in asking for help and advice, and it is for your benefit.

 

Consultations are always helpful because when you go to another surgeon he has a chance to think objectively and carries no predisposition.  But, remember when you do go for that consultation or second opinion, be sure to bring copies of all your records, including copies of your before and after photographs, the operative report, any CT scan or x-ray reports that were done for the sinuses, particularly if you had a blockage of your nose due to a deviated septum or enlarged turbinates.

Dr. 90210 Touches Worldwide

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Greetings from France!  I am here to see patients from France and England, meet with American friends living here, and of course, see the sites.  I am also interested in learning about rhinoplasty and revision rhinoplasty in a sophisticated foreign country.

I have traveled to France as an Army Medical Officer, but I am visiting areas not previously toured, Burgundy, the great wine producing area – and Provence with lots of ancient history, which I enjoy learning about.

En route to France, I stopped in the Bahamas for a close friend’s daughter’s wedding. The bride, a patient of ours, was beautiful.  One day at the hotel desk, the clerk asked me if I was “The Dr. Kotler from Dr. 90210?”  She said she enjoyed the program, particularly the nose cases I have done.  My friend who was with me said to her, “you know, Dr. Kotler is the top rhinoplasty specialist in the world!”

A sense of humility doesn’t allow me to say that myself, but I am nonetheless pleased to carry that title.

I guess the world gets smaller and smaller as communication gets smarter and smarter.