Category Archives: Rhinoplasty Specialist

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.

Rhinoplasty Prices in Beverly Hills

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Has the Recession Affected Rhinoplasty Prices in Beverly Hills?

The recession has affected nearly every business, industry and profession in the United States – including Beverly Hills.  While Beverly Hills remains a cosmetic plastic surgery destination for many people from the United States and throughout the world, the reality is that in a recessionary environment, fees are reduced.

However, it is important to understand that a low fee by itself should not be the decision-making factor when considering having cosmetic plastic nasal surgery.  The price range of rhinoplasty encompasses both the less experienced, younger practitioners and the veteran superstars and super specialists of the cosmetic surgery world.

 It is accepted that young doctors, eager to build their practices will charge less for their services and hope to attract patients in that manner.  For patients, there sit risks.  Because, often, the younger surgeons do not have the talent and long line of experience to handle anything but the most simple case.
But, few nasal plastic surgery cases are simple. Often, there are breathing or sinus problems that should be corrected. Nasal septoplasty and turbinate resection to improve the airway should be considered in such cases. Does the young surgeon have the training, talent and experience to handle all those issues?

 The reality is that rhinoplasty fees in Beverly Hills may be higher than they are in Omaha, Nebraska or Oshkosh, Wisconsin, but of course, that reflects the cost of doing business including rent, salaries, etc.

One should always inquire from the office as to what the cost of the rhinoplasty is and to ask if, in fact, there are some ways to be granted a courtesy.  Don’t expect to get a courtesy reduction in the fee just for asking, however, because that is not likely.  What will help you get a reduction in the fee is being able to schedule your case at the time that is convenient for the outpatient surgery center and the surgeon’s office.  That is the most common and proper reason for fees to be reduced.

Remember that rhinoplasty prices also reflect the complexity of the case and the time involved in performing the surgery. Particularly, if you need revision rhinoplasty in addition to that septoplasty and turbinate resection to help you breather, the fee will be higher than that for just shaving a bulbous tip.

 

 

Beverly Hills Nose Job Problems

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 “My Friends All Have Trouble Breathing After Their Nose Jobs”

                     – patient consulting for nasal cosmetic plastic surgery

This is a very important statement. If a prospective patient believes that the majority of patients who have cosmetic nasal surgery are likely to wind up with breathing problems, then our specialty has a problem.

 

 

 

 

 

 

 

 

 

 

Difficulty breathing after rhinoplasty should not necessarily occur. The competent cosmetic plastic nasal surgeons are trained in the evaluation of the internal nasal structure and the correction thereof.  They need to know if there is a breathing problem before any surgery.  Often, patients are not even aware they have a breathing problem.  It is very easy to check because you ask the patient to close one nostril and with lips closed breathe through their right nostril and then shift the focus to the left nostril as the right nostril is closed.  Very quickly, one gets the airflow picture.

Once the diagnosis of airway obstruction is established, it is incumbent upon the operating surgeon to figure out why.   The most common reasons are that there is a deviated septum which is a crookedness of the internal vertical partition that separates the two nasal passages.  For many patients, particularly those with allergies, there is also the issue of enlarged turbinates, particularly the inferior turbinate.  Turbinates are the three shelf-like extensions that fill a portion of the nasal passages, on each side, to increase the surface area so there is further warmth, humidification and filtering of the incoming air in preparation for inhalation into the lungs. 

If the surgeon diagnoses a breathing problem or such borderline breathing that it is possible that narrowing of the nose as a result of the cosmetic nasal plastic surgery, or rhinoplasty, might throw the patient’s breathing over the edge, it is incumbent upon that surgeon to plan to deal with the blockage and correct it.

My sense is that perhaps a fair number of surgeons who are willing to take on rhinoplasty cases may not be trained in the functional and reconstructive surgery. 

If the doctor’s ego will allow it, when facing an airway problem that he feels he cannot address, the doctor can always call in a consulting surgeon with the “inside” skills to perform that portion of the operation.  After all, it is not unique to cosmetic and reconstructive nasal plastic surgery to have a team instead of a solo surgeon.  It certainly occurs in heart surgery and liver and kidney transplants, etc. It is all for the patient’s benefit.

The recent edition of The New York Times happened to address that very issue whereby some surgeons conceded that it is “normal” to have a breathing problem after some cosmetic nasal surgeries.  I think that is a very damning comment and represents a lack of concern for the patient’s interest.  Steps must be taken to correct the breathing problem at the same time as the cosmetic plastic nasal surgery.

Beverly Hills Cosmetic Surgery, Not Like Dropping-In For a Haircut

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Having Cosmetic Surgery is Not Like Dropping-In For a Haircut

Today our patient correspondent and consultant, mentioned a conversation with a patient from Europe. The patient was coming to us to have nose surgery done and seemed a bit put off when told that it was necessary to make all the arrangements ahead of time.  Ideally, the arrangements would include having a Skype consultation with Dr. Kotler so any questions or issues that the patient wanted to present to him could be done before the patient gets on an airplane and travels thousands of miles to come here.  Secondly, after the Skype session, if the decision has been made to have the surgery, it is very important that the patient have a physical exam and the appropriate laboratory and x-ray work done well before surgery.  After all, if there is a medical problem, surgery cannot be performed.  Cosmetic plastic surgery is only done when the patient’s general health condition is excellent.  There can be no compromises.  So if there is a problem, you surely want to know well ahead of time so that schedules can be amended and most importantly the medical problem could be attended to before flying across the pond.

It seemed that the patient thought he could come in on a Monday, have a consultation and go to the operating room on Tuesday.  And maybe that is because he, as others, tend to minimize the importance of a proper pre-operative evaluation and workup and that everything be put in proper order.

There are logistical issues that have to be considered.  We have to reserve the operating room.  We also have to reserve the doctor-anesthesiologist so that everything is properly anticipated and done properly.  Depending on the procedure, necessary supplies and equipment have to be available and that cannot always be done on a one-day’s notice.

Most importantly, Dr. Kotler and the patient must have time together to discuss the patient’s desires either via Skype or, of course, person-to-person when the patient is here.  Our preference, for patient safety and comfort, is that all possible communications and arrangements be made well ahead of time.   And the patient just doesn’t get off the plane and go to the operating room.  There is always a visit with me in the office one or two days before the procedure.  It is important for me to do a complete examination and determine those things that are not possible to determine via Skype and computer imaging, of course.  I want to explain in detail, face to face, how the procedure will be conducted.  I explain to the patient that the anesthesiologist will call the night before, that the patient will see me in the morning, that the patient will have my home phone and cell phone number so that he knows we are ready and prepared to give the patient the care that he or she deserves.

It may be a tribute to cosmetic surgery that people feel that it is a “minor undertaking.”  If it is a tribute, it is because we have been able to handle all the issues such as discomfort and provide for rapid recovery.  But the truth is, we do not treat it with any less importance than a neurosurgeon treats a patient upon whom he will be doing brain surgery.  After all, we trained as long to do our work as the neurosurgeon trained to do his.

Cocaine and Rhinoplasty in Beverly Hills

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Cocaine and Rhinoplasty in Beverly Hills

Unfortunately, cocaine use is still with us.  There are significant consequences to cocaine abuse.  The worst complication is its effect on the heart and blood vessels which causes high blood pressure that can possibly lead to a stroke – or even death.

Cocaine and Rhinoplasty Surgery Do Not Mix!

Cocaine and Rhinoplasty Surgery Do Not Mix!

With respect to nose surgery in Beverly Hills, patients who have been abusing cocaine present significant surgical problems.  First, the lining of the nose is terribly inflamed and irritated and it is impossible to conduct a proper operation under those circumstances.  Secondly, the abuse of cocaine can lead to creation of a hole within the internal partition of the nose.  This is known as a nasal septal perforation.  The hole can be anywhere from the size of the tip of a fountain pen to the size of a nickel. 

There are problems that come with septal perforations:  crusting, whistling and bleeding.  It is a real hassle.  And once that hole is created, it is very difficult to surgically close it.  While there are some appliances that can be inserted to act as a “stopper,” just be aware that one is asking for considerable problems with long-term cocaine abuse.

The other issue is that one should never consider having any cocaine in their body at the time of surgery.  This sets the stage for a possible anesthetic catastrophe!  There can be an unfavorable interaction with the anesthetic drugs as well as the local anesthetics that must be injected. 

Remember, doctors are not judges. We are not an arm of the legal system. Our conversations and records are private and cannot be shared with anyone without your permission.  We don’t have an editorial position on personal choice issues. Our only job is to serve you. However, you need to be frank and honest with your doctor whose only aim is to have a safe surgery and a satisfactory outcome for his patient.

Taxing Plastic Surgery In Beverly Hills

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Taxing American-Based Cosmetic Surgery

Here’s why the proposed 5% surtax on cosmetic plastic surgery is an insult to any thinking American.

Consider a cosmetic plastic surgery practice a business – which it is. 

Each doctor’s practice/business starts from zero.  To build a practice, we doctors first invest in ourselves by pursuing long and arduous training and education. Up to 15 years after high school! And for some of us, we added on a couple more years serving our country in the military.  But in order for the public to benefit from our skills, we need to have a place to work; we then invest further in the “bricks and mortar”. We build an office, to deliver our services – right here in America.

We borrow from American banks; construction and equipment loans. We buy equipment and supplies from American distributors.  We create jobs for Americans – administrators, nurses, medical assistants.  We utilize the services of American attorneys, accountants and practice management consultants. We don’t set up dummy headquarters in the Cayman Islands to evade taxes. We don’t communicate with our customer-patients from inexpensive secret call centers in Mumbai. We don’t earn our dollars by operating  Ponzi schemes out of Wall Street boiler-rooms.  

We grow our practices by providing quality service and good value.  We seek to be honest craftsmen. And, many of us give back to the community by teaching – without pay – at the local medical schools or Veterans Hospitals. 

That’s why it seems ironic that Congress has singled out a small but productive home-grown 100%-American industry –cosmetic plastic surgery — to levy an additional tax. Have we done something wrong besides being successful and making Americans’ lives better?

I wonder why these Washington economic heavyweights didn’t think about taxing multinational corporations that have huge incomes, much of which is garnered from operations outside the United States.  General Motors sells a lot of Buicks in China.  They are making a lot of money there.  All their sobbing about losing money in America was inconsequential to the bottom line of their financial statements.  Maybe they don’t make a profit here; it’s just being done with non-American labor far across the sea. How about a tax on foreign manufacturing by American-based companies? Wouldn’t that be fair?

There’s always hot air and hypocrisy from Washington, of course.  I guess the problem is that we cosmetic plastic surgeons and our patients don’t have the army-like lobbying force that GM and the other multinationals hurl into Washington. Seems Congress thinks it’s O.K. for them to siphon off jobs and money from the United States – and not pay any price.  Multinationals have more friends than we do. Even Nancy Pelosi, obviously a devotee of cosmetic plastic surgery, won’t speak up for us. Maybe her lips are paralyzed from too much Botox or Dysport.

Somehow, we cosmetic plastic surgeons will soldier on and somehow we shall still continue to serve Americans who want our services. Our practice, and I suspect others, has decided to absorb the tax ourselves and not further burden the patients. We shall “eat the tax”; just like our favorite camera store does to help keep traffic flowing and contribute to the fight against the recession.

Finally, unlike, GM we won’t ask for a government bail-out. Maybe we’re too proud to ask for handouts. We’re old-fashioned. We ask nothing from Washington, other than to be left alone and to use the talents we spent half a life perfecting. However, our doors are not necessarily open to everyone. We still have the right to decide whom to accept as patients. So, Senator Harry Reid, who concocted this legislative abomination, listen up: When you are bruised and battered by the health care reform debate, you will be shown the door and given a map to the Mexican border. There are plenty of medical clinics there. They will be glad to see you and there’s no 5% tax.