Category Archives: Rhinoplasty

Why Breast Implants are Big

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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.”

 

The Best Ethnic Rhinoplasty Surgeon

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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

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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.

Dr. 90210 Rhinoplasty Specialist

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Dr. 90210 Rhinoplasty Specialist

Here, in Zip code 90210, there are some of the world’s most sophisticated cosmetic surgeons. “ The Golden Triangle of Beverly Hills, Zip 90210” has eye doctors who specialize in cosmetic surgery of the eyelids and brow and dermatologists who specialize in chemical skin peels and filler injections such as Juvéderm, Restylane, Perlane and of course, Botox  and Dysport.  We have other cosmetic plastic surgery specialists that have particular expertise in cosmetic breast surgery, both primary and revision breast augmentation.  There is one surgeon whose practice is nearly only breast surgery and he does revision breast augmentation for patients who have had work done elsewhere and are dissatisfied.

Other cosmetic plastic surgeons specialize in tummy tuck and liposuction.

I have always felt that the most specialized and highly focused talents should be the choices for patients.  Patients often don’t recognize or are unaware of the degree to which all medicine has become specialized, sub-specialized and superspecialized.  A superspecialist is a doctor who practices a very boutique practice, focusing on six or fewer procedures. Typically, he has taken additional training beyond a long residency and even after passing the rigorous board exam to become “board certified”.

As one of the doctors who appeared on Dr. 90210 and as a rhinoplasty superspecialist, I can attest to the fact that, unfortunately, there are patients who come to see us who have had substandard work done by surgeons who have had very little training in cosmetic and functional nasal surgery, and who have no focus in that area.  These surgeons may do everything from hair transplants to thigh implants and everything in between.  Rarely will they be the most experienced and proficient practitioners.

What prospective patients need to know is that if they put themselves in the hands of those surgeons who have long experience and a fine degree of specialization, they are more likely to have a satisfactory outcome.

Computer Imaging and Hollywood

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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

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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.

Best Rhinoplasty Surgeon in Hollywood

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Best Rhinoplasty Surgeon in Hollywood

Hollywood has always been synonymous with stardom, with glamour, with beauty.

Not every Hollywood star arrived to make their career in the same state that they were delivered on earth.  What I am suggesting is that many people in Hollywood  have undergone cosmetic plastic surgery to improve their appearance because much of their success is tied to what their face and neck look like on the screen.

For some of the greats like Marilyn Monroe and Dean Martin it was a nose job or rhinoplasty.  For others it was upper eyelid surgery to reduce the sleepy look.  For those with bags under the eyes, the appropriate procedure would be lower lid blepharoplasty.  There have been chin augmentations and neck sculptures and even pinning back of ears.  Some stars should have had their ears pinned back, e.g. Clark Gable.

But the best rhinoplasty surgeon in Hollywood would be the surgeon who delivers natural looking results so that you would not know that the patient had ever had a rhinoplasty.  I have visited photo archives and I have seen many of the before and after photos and I could tell you that Dean Martin had an excellently performed cosmetic nasal surgery and you would be hard pressed to know that he was born with any other nose – but he was.

Rhinoplasty Surgery in Hollywood

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Rhinoplasty Surgery in Hollywood

Rhinoplasty, which is cosmetic plastic surgery of the nose, has long been staple in Hollywood.
The reason is that Hollywood thrives on showing the world beautiful faces and it is impossible to have a truly beautiful face without a satisfactorily-shaped nose.

Some people are lucky and are born with a nose that is proportional and is pleasing to the eye.  Elizabeth Taylor comes to mind.  Likewise Grace Kelly and Catherine Deneuve. 

Those who have not had luck on their side with respect to receiving a “good nose”, have always had the option of having the rhinoplasty surgery. Of all the procedures that a younger person can do to improve their appearance, rhinoplasty ranks number one.  It is more important and more commonly requested than chin augmentation or blepharoplasty.

Remember, also, that many people have the rhinoplasty surgery at the same time as they have nasal septoplasty and turbinate resection to improve the airway or correct a sinus problem. This “double need” is more common in men than women, of course.

Marilyn Monroe had rhinoplasty.  Comedian Milton Berle and actor Dean Martin also had rhinoplasty.  

Years ago when I was researching for my book, Secrets of a Beverly Hills Cosmetic Surgeon, I visisted a photo archives facility in Venice, California.  It was fascinating to leaf through the drawers and recognize that many familiar faces had indeed had rhinoplasty surgery at some point in their life. 

Incidentally, some people go to great lengths to conceal the fact that they are having such surgery.  If you ever saw Barbara Streisand in the movie Funny Girl, you would know that it was the story of comedienne Fanny Brice.   In the 1930s, Fanny had a rhinoplasty performed in a hotel suite.  She felt that was the best way of keeping it a secret.

Today, rhinoplasties are not performed in hotel suites and, frankly, they are rarely performed in hospitals.  It is appropriate to perform such a procedure in a credentialed outpatient surgery center or a duly qualified physician’s office surgical suite. 

Rhinoplasty Training and Specialization

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 “Dr. Kotler, You Really Are Old School!”

That is what a patient said to me after we performed rhinoplasty, or cosmetic nasal plastic surgery, upon her teenage daughter.

Perhaps what she saw as setting us apart was that in our practice, it is 24/7 coverage for the patient.  Our patients receive my home phone and my cell phone numbers.  They are free to call me at any time.  If I am not out of town, I am on call 24/7 every day.  Of course, when I am out of town I have coverage from not only our office staff but two doctors as backup.

Yes, we do practice the old fashioned way.  We stay in close touch with our patients.  We see them often after surgery to check and make sure all is going well; we don’t like surprises.  And, Saturdays and Sundays are just another work day for us when patients need to be seen for either routine or special post-operative care.

The mother appreciated that we brought to the table many years of experience and a high degree of specialization in cosmetic facial surgery of the face and neck. Particularly in rhinoplasty, with over 4,000 nasal procedures having been performed. Such a track record comes with having been in the trenches of practice for many years and becoming a master surgeon, the highest accolade the world of surgeons can bestow.

Since I trained in the golden era of medical education, the 1960’s and 70’s, that should help one understand the value old school holds. In those grand days before teaching hospitals became weakened by all the changes in medical care delivery, we had terrific training and experience. The hours were long –but fascinating. We had demanding and strict teachers. That explains why it was expected of us to conduct ourselves in a manner that today is known as old school.

I am not sure what the new school is like, but I do know one thing, that the old school was the right school to attend. And, that, friends, is always appreciated by patients and their families.

Rhinoplasty For Men

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Men’s Nose Jobs

I have been thinking a lot about men’s rhinoplasty or cosmetic plastic surgery of the nose, the last several days.  In the last two days we performed nasal cosmetic and reconstructive surgery on two gentlemen.

The first was a middle-aged businessman who had difficulty breathing, but who also was motivated by the fact that he felt his “nose was growing”.   The nose, in fact, doesn’t grow, but the tissues within the nose, the loosen, the tip drops and the nose appears more bulbous and longer.  The gentleman’s motivation for that cosmetic enhancement was proper.  Likewise, the desire to breathe was very reasonable and the patient’s deviated septum and enlarged turbinates were causing blockage such that snoring and poor sleep quality was the result.  So it all made sense. 

In the case of that middle-aged gentleman it was very important to fully understand the man’s wishes.  He expressed on several consultation visits the need to have a natural looking nose that would not look artificial, “done” or drastically different from that which his face had carried for many years.  A surgeon needs to listen carefully to these words and understand the mission.  Any miscommunication could result in an unsatisfactory result and an unhappy patient.  That is not what a conscientious and competent cosmetic facial surgeon wants.

The second nasal case involved a young man who had had two prior nasal surgeries, one for breathing and one for appearance.  The former, the nasal septoplasty, was accompanied by reduction of the turbinates.  The turbinate reduction was quite satisfactory but the septum was still deviated to one side, meaning he had internal nasal blockage because of the shift of the septum which is the vertical partition that separates the two nasal passages.  Those “ revision septoplasty operations are not easy because typically some of the cartilage has been taken out of the septum and there is quite a bit of scar tissue underneath the internal lining of the nose.  It does call for considerable experience, expertise and judgment.

The young man’s other wish was to have his nose appear less long.  Indeed the nose was too long for his face and, as he ages, the length would have only increased.  Apparently the original operating surgeon did not heed the patient’s advice and the result did not match the patient’s wishes.

At this young man’s surgery, very conservative elevation of the nose was done such that it no longer looked too long as if it would touch his lip when he smiled.  And indeed, regarding smile, part of the problem was that he had a very strong muscle which, upon smiling, would depress the tip of the nose further.  The breathing problem was corrected by straightening the septum and some other relatively routine internal procedures, and we were able to lift the nose off the lip, release the muscle which had been exerting its downward force on the lip and give him a natural looking nose which was not radically different from what he had before. But certainly better and in keeping with his desires.

It is very important for surgeons to listen to patients, to get a good sense of what they want.  Also, in my opinion, it’s important have computer imaging available so that the perspective patients can see the predicted results of the procedure that the surgeon deems achievable and reasonable.  A meeting of the minds should take place at the computer imaging session such that the patient and the doctor are on the same page based on that computer visualization of the end result of the cosmetic rhinoplasty.

We have used computer imaging in our practice since 1989. It is helpful and important to patients who need the comfort of seeing the projected outcome.