Left, A.H. before rhinoplasty

Many patients pen thank you notes, but one in particular stands out.

When A.D. (privacy laws prevent us from revealing her name) now 29, came to see us, she said she could not recall a time when she liked her nose or willingly posed for pictures.

Her displeasure with her nose was constantly on her mind when dating or attending social functions.

She wrote: “I always wondered if people noticed how big my nose was, the size of the bump on the top or the way it comes down too far, covering my upper lip.”

If you read much about plastic surgery, you’ll find there are many who feel that we should accept ourselves as Nature made us, forgetting “vanity” and nose jobs.

But all that depends on whose shoes you are walking in.

A.H. was in the accept-yourself-as-you-are camp for a while, writing, “I thought I needed to simply accept my nose and finally learn to love it.”

Nonetheless, A.D.s nose had a clear impact on her self-esteem and confidence. Three years ago, she made an appointment with a plastic surgeon but cancelled. And then never rescheduled.

More recently, she realized the hours she fretted about her nose was a waste of time and energy. Like many who have an intensely disliked body feature, she wanted confidence when meeting new people and appearing in pictures.

A.D. then came to us after combing the Internet and doing other research with her mother, an R.N. The duo asked all the right questions and, when satisfied, booked cosmetic surgery. She wrote: “Dr. Kotler’s academic credentials and quality of work were obvious …as was his empathy and compassion.”

She also liked our computer-enhanced “after” image prediction. (Read more about cosmetic surgery “after” imaging.)

Her procedure: Classic rhinoplasty with hump removal, narrowing of the entire nose and raising the nasal tip.

One-month after surgery, A.H. reported that her nose was tender, but she did not require medication. She was delighted no marks were seen on her face while friends said the rejuvenated nose matches her face and is so natural-looking, it makes her face look smaller and her profile softer.

She writes: “I can’t adequately describe how much better I feel knowing my nose no longer haunts me….it’s such a relief to look in the mirror and be happy.”

Regrets? Yes, one.

Yellow pages: Not the best plastic surgeon selection method

The American Bar Association (ABA) Journal recently weighed in on the high cost of medical care. One correspondent noted that (and we quote:) “It’s now common to find gynecologists offering breast augmentation, ophthalmologists doing liposuction, even family practice physicians giving Botox injections.”

Not so fast!

While Southern California has many aggressive doctors – many of whom are not trained in rejuvenation surgery – it is certainly not “common” for untrained physicians to perform cosmetic plastic surgery. Yet there are a few fringe practitioners who move from their core competency like radiology or emergency medicine into cosmetic surgery.

Many have learned how to do a cosmetic surgery procedure  – like liposuction — in a weekend or week-long course.

It may seem contrary to common sense, but any physician who has an M.D. and a medical license can hang out a shingle offering cosmetic surgery. And, yes, some surgeons like that do exist in Southern California.

But the practice is not “common.” (Article continues, below)

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The patient below shows on the left the results of a surgery done elsewhere by an inexperienced surgery which almost completely blocked her right nostril. The corrected nose, on the right, allowed the patient to breathe normally, cured her headaches and stopped sinus woe.

Nonetheless,  what is the defense against wandering into the office of a doctor without many years of plastic surgery training? Or one who does not have board-certification in plastic surgery or head and neck surgery, (a field dubbed by the tongue-twisting name, “otolaryngology”?)

Answer? The patient’s due diligence!

You can check any surgeon’s website for his or her board-certification at www.abms.org. If you don’t see the training or board listed, call the doctor’s office and ask.

Also, inquire what specialty the certification is in. Some fringe doctors advertise “board certification” but their certification is in, say, gynecology or emergency medicine.

The only two specialties that certify surgeons to perform cosmetic plastic surgery: The American Board of Plastic Surgery and The American Board of Otolargyngology.

Once you establish that, you are halfway home.

Next, you want learn if a board-certified cosmetic plastic surgeon does the procedure you want weekly, if not daily. And for at least 10 years.

There are well over 100 plastic surgery procedures so no single surgeon is going to be a total master of them all.

Say, you want a nose job or a face lift. Call the surgeon’s office and ask how many times weekly that surgeon performs the procedure you want.

If he or she specializes in only four to seven procedures, you’re on the right track.

(Read the top 10 questions you can ask on the phone to find a qualified, experienced cosmetic surgeon.)

If ever there was any question, medical science has pretty well nailed down that vexing question about a rhinoplasty making you look younger.

The official answer: you can probably knock about one and one-half years off your true age. It’s not huge, but, hey, every little bit counts, huh?

Actually, the benefit of a nose job is not a reduction in perceived age, but a smoothing and balancing of the features you already have.  If a person has a nose that is:

• Too large
• Misshapen
• Has a hump or hook
• Bent or twisted due to a broken nose

the eyes of another person will largely fixate on the nose.

After rhinoplasty, (and chin implant, if needed) the healed nose then fits and flatters the face and profile while creating a more pleasant facial balance.

After a nose job, the eyes of the person beholding the patient will largely pass over the nose and mostly fixate on the eyes, the next largest facial feature. On the before and after rhinoplasty pictures below, notice how just a nasal change  affects for the better how the whole face is perceived.

We know about the year and one-half of reduced age because University of California researchers asked 50 people to look at before and after nose job pictures of 53 people, 15 to 61 years old. Comparing the two sets of pictures and estimating ages, the study subjects reckoned the after rhinoplasty pictures were an average 1.5 years younger than the patients’ true ages.

One researcher thought the change was due to patients’ new-found self-image.(Check out some video testimonials from plastic surgery patients to see the same joy.)

(Read more about the rhinoplasty study.)

But what about the face? After all, isn’t the whole point of cosmetic plastic surgery to look younger, more rested, refreshed and rejuvenated?

A similar study of before and after face lift pictures was done at the University of Toronto when 60 sets of pictures — showing people close to age 60 – were shown to 40 first-year medical students. The students were asked to guess the ages in the before and in the after pictures.

Results?

Patients who had:

• Face lift
• Neck lift
• Eyelid lift

looked an average of 8.4 years younger.

(Read more about facial cosmetic surgery and perceived ages.)

Beforer and After Rhinoplasty

Kenneth Viste, Jr. M.D.

This post is an exception to our usual blog posts.  The usual aim of this blog is to share my experience and knowledge so that you may have as much information as possible to help in case you have:

• Nasal obstruction
• Deviated septum
• Enlarged turbinates
• Unhappiness  about the appearance of your nose

Rather than devote this blog to that education, we wanted to share the recent passing of a friend. Below you will see the connection between my choice of medical specialty and him.

In medical school, in the class ahead of us, was an extraordinary man:  Ken Viste, Jr. He was one of the last of our generation (slightly pre-“Baby Boomer”) to have contracted polio at age 13 in 1955.  It left him a paraplegic confined to a wheelchair.  But none of that kept Ken from finishing college and then medical school.

Ken was an extraordinary person in terms of his achievements in the medical world.  It is not easy to go through medical school in a wheelchair.  All of us take for granted all our faculties.  To participate in surgery, physical examinations, and the conduct of anesthesia are a lot tougher when you cannot stand up.

We became close with Ken when we worked together on the same “service” at one of our medical school’s teaching hospitals.  On the service were one resident, two interns, and two senior students, known as “sub-interns.” Your truly was one of the two sub-interns.  All five of us worked very closely.  It was a great team we had assembled.  We learned a lot, enjoyed the experience, and particularly enjoyed each other’s company.

Despite the rigors of being an intern, Ken never complained.  He always had a good sense of humor and, of course, engendered tremendous respect and appreciation from our patients.

While a sub-intern, Ken used to razz me about my interest in matters cosmetic.  He often said, “Hey, you’re gonna go and do rhinoplasties, facelifts, blepharoplasties and correct deviated septums?  Hey, that’s not real medicine.  You’re too smart to do that stuff.”

We appreciated the compliment, but I never felt that engaging in cosmetic plastic surgery procedures required any less study and diligence.

We kept up with Ken, and even saw him at one of the medical school reunions about four years ago.  Recently, I read of his passing in the university’s alumni magazine.  I sent a note to his widow along with a charitable contribution in his memory.

We quote from her response:

Dear Robert,

 I am sorry to be so late with this heartfelt thank you for your lovely letter and the gift you made to the Leukemia Research Foundation in Ken’s memory.  Our entire family thanks you for your very kind and personal expression of sympathy.  Over 1,200 cards, calls, and visits containing words of comfort and memory of Ken have helped us through this most difficult time. 

We have found great solace in knowing that Ken will continue to live in so many hearts in addition to our own. 

Warmest Regards,

Jan

Can you imagine 1,200 expressions of sympathy! The man touched many, many hearts in his too-short life.

Finally, we should note that Ken, besides being an exemplary physician, became very active in medical organizations.  He became:

• The President of the Wisconsin State Medical Society
• Served on the alumni board of the medical school
• Innumerable other professional organizations

A difficult life, yet one well-lived.

Ken was, and will always be, one of my personal heroes.

(Read “Three Miles by Wheelchair” on Dr. Viste’s  memorial website.)

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.

On Thursday, April 23rd, Dr. Stuart Linder and I hosted the Beverly Hills Latisse Launch Party. 

Dr. Linder and Dr. Kotler

Dr. Linder is a board-certified plastic surgeon who limits his practice to body sculpting procedures and is the author of The Beverly Hills Shape. I, Dr. Kotler, am a board-certified otolaryngologist.  I limit my practice to procedures of the face and neck.  I am the author of Secrets of a Beverly Hills Cosmetic Surgeon.

Peter Houtz, Crystal Linder, Dr. Hoffman and Dr. Linder

Many of our past patients attended the event and were happy to learn more about Latisse, the new, by- prescription eyelash enhancer that makes your lashes longer, thicker and darker.

Our attendees were thrilled to participate in our raffle.  The prizes given out were a box of Latisse, one syringe of Juvederm, a custom Airbrush Tanning Session with Sunset Tan and a full set of products from Revale Skincare.

Everyone is attendance had a great evening. We have already received calls from people asking “When is the next party?”

Dr. Kotler, Helaine Kotler, Suzanne Sena and Michael Levine