Rhinoplasty Specialist Blog

Rhinoplasty specialist Dr. Kotler has performed over 4,000 nasal surgeries

Plastic Surgery Favorites Change with the Times

Posted on April 25, 2012 by admin

"Nip-Tuck Coach Michelle Farber shows her website picture"

Michele Garber

Hello, Dr. Kotler patients and fans. Did you know that cosmetic plastic surgery favorites change with the times? I’m Michele Garber, a Nip-Tuck Coach, editor of Beauty News Talk and today’s guest blogger.

Cosmetic surgery is no longer for the rich and famous. Today, Plastic Surgery transcends age, gender and income barriers. According The American Society of Plastic Surgeons (ASPS), there were nearly 1.6 million plastic surgery procedures performed in 2011, along with 12.2 million minimally invasive procedures. So, is that to say we as a society are obsessed with beauty, perfection and the “fountain of youth”?

Actually, it’s a personal choice. Almost everyone I know has had some type of cosmetic enhancements like tummy tucks, breast implants and others including:

Face lifts
Rhinoplasty
Dermal fillers
Botox

It’s far more acceptable today to go under the knife than it was even 10 years ago, although many of my friends still prefer to deny the truth behind their “refreshed” looks.

Just like fashion changes in cycles, so does cosmetic surgery. The trend 10-12 years ago in breast augmentation was the bigger the breast implant, the better. As a beauty publicist, I worked with many East Coast plastic surgeons. Most often, the women who worked in these offices were walking advertisements for the practices. A good percentage of them had breast implants that were so big, they often looked cartoonish, unnatural and disproportionate to their physical statue.

The trend today is smaller, more natural-looking breasts. Many women are opting to have smaller implants and those with large implants are switching them out for smaller sizes. I suspect that — just like the length of dresses going up and down — so will breast sizes.

Face lift trends have also shifted from the overly pulled, tight look of the 70’s and 80’s to a more natural appearance. Today’s face lift techniques combine fillers or fat transfers to achieve a more realistic look. Some face lifts seem so natural that only “your hair stylist” knows for sure.

Rhinoplasty is another cosmetic procedure, commonly known as a “nose job”, which has evolved over the years. Growing up on the East Coast of Jewish heritage, a nose job was the rite of passage for most 13-year-old girls in the 70’s. You had a Bat Mitzvah and rhinoplasty. It was the top fashion trend. But certain surgeons were known for their signature cute “couture” noses. You knew the surgeon’s name by the shape of the nose.

In those days, insurance companies often paid for rhinoplasty, because it usually involved correcting a deviated septum. Once you received the diagnosis from two ENT specialists, your rhinoplasty was medically covered.

As other cosmetic surgery trends have shifted, so has the nose job. Noses today are more natural, enhancing a person’s face and profile. Many patients prefer their ethnic noses and only want a slight change. There is no longer one type of nose to fit one type of look.

Rhinoplasty also seems to be one of the more traditionally acceptable cosmetic surgery procedures today, many of my sources and clients say.

Wondering what the next trends in cosmetic surgery will be? While the current trend is toward non-surgical procedures, I guess we’ll just have to wait and see about the rest!

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About Michele GarberMichele Farber: she’s been in the medical aesthetics industry since 1997 and was the founder of dMK Communications, a Lifestyle Communications firm. Michele has worked behind the scenes with both skincare manufacturers and with surgeons. Currently, she is the founder of The NipTuck Coach, an independent cosmetic procedure consultancy and, editor-in-chief of Beauty News Talk, a beauty blog. Coming soon is a new cosmetic surgery blog called Talk Plastic Surgery. Michele is already a frequent guest blogger and speaker on blog talk radio.

She can be reached at www.niptuckcoach.com

Rhinoplasty Surgeon or X-ray Trained Doctor?

Posted on April 24, 2012 by admin

"A young couple search the Yellow pages"

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.

: Deviated Septum Repair;Left, bent septum and resulting repair. (Robert Kotler, M.D. photo.); ___________________________________________________________________________

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.)

Dr. Kotler: Ranked by MapQuest as #5 out of 500 medical & health professionals in Beverly Hills’ “Golden Triangle”

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Nose Surgery and Cocaine

Posted on April 19, 2012 by admin

Cocaine: No Entry!

It’s not on the list of nasal surgeries that we perform, but the phrase, “Cocaine Nose Job” now appears on Facebook and is listed in the Urban Dictionary.

The phrase is often bandied about by people who describe themselves as “recreational drug users.”

Unfortunately, it’s sad choice of recreation — the effects of cocaine on the entire body are not good. Worst of all is what coke does to your blood vessels and heart. Cocaine is a stimulant that increases blood pressure to dangerously high levels and can vastly increase the chances of death or stroke.

Just after or before rhinoplasty, using coke is the worst thing you could do; the cocaine reduces blood supply and oxygen to the healing nose, can cause the loss of the nasal lining (the mucosa) and could lead to collapse of the nose.

Problems develop and continue from coke’s first use. Having seen the results of cocaine use, we can tell you the following woes are apparent:

An irritated, inflamed nasal interior which prevents any safe nose procedure like a nose job, revision rhinoplasty or deviated septum surgery

A hole in the septum, the paper-thin wall of cartilage and bone that separates the two nostrils. (Read more about septum surgery.)

That hole results in crusting, bleeding and whistling with each breath. Medically known as a nasal septal perforation, it can range in size from the point of a ballpoint pen to about the diameter of a nickel. (Blog post continues, below.)

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The patient below shows on the left the unsatisfying result of a rhinoplasty done elsewhere. But a procedure to sculpt and refine her nasal tip brings out and complements her other elegant facial features. (The patient was not a cocaine abuser.) Photo: Robert Kotler, M.D.

: Before, left, and after sculpted tip (Robert Kotler, M.D. photo.); ____________________________________________________________________________________

Moreover, it’s difficult for a plastic surgeon to close that hole during surgery. One method: using a medical plastic plug to plug the perforation. But somebody who has abused coke for many years will probably have continuing problems.

Yet another danger rears its ugly head when a patient has cocaine in his or her system during any surgery. Cocaine, anesthetic drugs and a local anesthetic could have the worst possible outcome.

To cope: be completely open with your cosmetic plastic surgeon, set embarrassment aside and reveal all substances you ingest. Your surgeon is not there to judge; his or her purpose is to keep you safe before, during and after surgery.

According to patient confidentiality laws, your doctor cannot reveal anything about your medical history (or condition) without your permission.

Dr. Kotler: Ranked by MapQuest as #5 out of 500 medical & health professionals in Beverly Hills’ “Golden Triangle”

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After Nose Job Surgery: What Then?

Posted on April 16, 2012 by admin

It seems like most press pictures of people leaving a cosmetic surgery procedure show swollen, black and blue faces with few smiles.

So many patients – having seen others with black and blue marks and even facial distortion due to swelling — ask how much bruising and swelling is going to show on their own faces after a cosmetic surgery like rhinoplasty.

The bottom line answer: depends on the surgeon. For a superspecialist surgeon who concentrates on only about a handful of procedures, you’ll have an easier time during recovery.

But why would one patient look like he went 10 rounds with a heavy weight champ while another patient breezes through healing?

The “money” answer: a master facial surgeon who has done the same procedures over and over for decades disturb less tissue, requires less time on the table and causes less trauma to the face. All that equals fewer bruises and puffy faces.

Medically, all bruising is the result of blood leaking from tiny blood vessels that were severed during the procedure. But if the cosmetic surgeon knows exactly where he is going, fewer vessels are cut.

The master surgeon also has another time-honored tool: he or she considers the after surgery period just as important as the surgery itself.

That means that a lot of extra care goes into pain control because pain has medical consequences. For one, pain causes blood pressure to increase. That then causes more leakage from those tiny severed vessels.

Cosmetic plastic surgeons have a huge amount of medications to help reduce bruising and swelling, including:

Prescription and over-the-counter drugs
Homeopathic preparations through to lessen bruising
Foods like fresh pineapple and papaya
Ice packs just after surgery

After surgery, we recommend just relaxing and taking it easy for the first day. Too much activity right after cosmetic plastic surgery can also cause swelling and bruising.

But on the second day, it’s OK to walk a bit and increase your circulation to promote healing. Additionally, those who get out of bed on the second day usually feel better. (Read more about aftercare.)

Sleep is also important and is yet another reason why pain control is so important — if you feel pain, you won’t sleep well. So we make sure the pain medications don’t get in the way of restful Z’s. And there are always prescription sleep medications.

Ranked by MapQuest as #5 out of 500 medical & health professionals in Beverly Hills’ “Golden Triangle”

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Below, the woman’s unsightly nasal bump and poorly defined, drooping tip corrected using tissue from inside her own nose to create a more feminine nasal tip. (Robert Kotler, M.D. Photo.)

Nose Jobs – Done with Other Cosmetic Surgeries

Posted on April 15, 2012 by admin

Interested in a rhinoplasty or other internal nasal surgery to promote healthy breathing? If you get a nose job, it may be worthwhile considering the other surgeries you could get during the same surgical session.

Why? If you want more than one cosmetic plastic surgery, consider the benefits of a single surgical session which include:

One session under anesthesiology
A single anesthesia charge
One recovery and healing period
Missing less time at work

The most obvious procedure that many choose with rhinoplasty is chin augmentation or mentoplasty, for patients with receding chins.

Mentoplasty does wonders for the profile and sharply improves your whole facial appearance. Patients with receding chins who go ahead with only rhinoplasty often regret it, according to Medical News Today.

We know this because two plastic surgeons from the department of Otolargyngology at Charing Cross Hospital in London, England, rounded up other plastic surgeons and lay people to study before and after rhinoplasty pictures of 100 past nose job patients.

Using four different evaluation methods, the doctors and lay people found that between 17 and 62 percent of male nose rejuvenation patients and 39 to 81 percent of women rhinoplasty patients should have also considered chin augmentation.

Concluded the authors: “Every nation values a balanced face so all cosmetic plastic surgeons should inform potential rhinoplasty patients of the impact mentoplasty can have on balancing facial profile profiles.”

(Read more about the rhinoplasty study.)

Chin augmentation, however, is not the only procedure that facial cosmetic surgeons often provide during one surgical session.

While the upper limit for any one surgery is about five hours, the health of the patient decides the actual time.

For instance, some nose job patients opt to also have otoplasty (ear pinning) while under anesthesia. Some choose to have surgeries of the body like breast augmentation or tummy tuck. In the best scenarios, a facial specialist performs the rhinoplasty while another plastic surgeon who does only surgeries of the body steps in.

An expert facial cosmetic surgeon performing nasal surgery could also perform at the same time:

Eyelid lifts
Face lift
Cheek implants

The best part of all? Most plastic surgery offices offer discounts for “add-on” surgeries after you’ve already decided on one!

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Below, rhinoplasty plus chin augmentation equals a perfect profile (Robert Kotler, M.D. photo)

Chin Augmentation, Before (left) and After

Nose Jobs and Your Sense of Smell

Posted on April 11, 2012 by admin

Most plastic surgery articles list the common side effects of a rhinoplasty, including:

Swelling
Bleeding
Bruising
Possible adverse reactions to anesthesia

But some are surprised to find their sense of smell has gone askew.

Writing in an issue of BMC Ear, Nose and Throat Disorders, a professional journal for physicians, Iranian plastic surgeon Hashem Shemshadi, M.D. and three associates rounded up a study group of 40 to 65 male and female patients, all of whom had rhinoplasty via the open method which peels back the nasal skin to show the nasal framework.

(Read more about open and closed rhinoplasty.)

Before surgery, each patient took and passed a smell test which involved sniffing common odors. Then, one week after the rhinoplasty, the surgeons repeated the test with the exact same smells.

Result? 87.5 percent could not identify any odors at all while the remainder reported losing at least a little ability to sniff ordinary things. The good news: the smell loss was not permanent.

About six weeks after surgery, 85 percent of the study group said they were experiencing only a slight to moderate loss in their olfactory abilities.

The third and final test at six months revealed that all the patients’ sniffers were just as sharp as when first tested. (Read more about the rhinoplasty smell study.)

The Iranian cosmetic plastic surgeons noted that while the study group needed half a year to completely regain their smell, other nose job patients said it took a little longer.

But the larger question for any patient is: why would a rhinoplasty cause a loss of smell, if only for a short while?

The very convoluted, complex nose can sense odors because as you breathe, the air rolls around in eddies within the nose as it passes on to your lungs. Contained within the nose are nerve-rich regions that react to the molecules of various odors. Swelling is a reaction to surgery – and perhaps more so with open rhinoplasty – so scent molecules in that air can’t pass over the correct nerves. When the swelling subsides, so does the loss of smell.

The affect is stronger when a septoplasty on a deviated septum is done in the same surgical session.

Worth noting: the most skilled rhinoplasty surgeons use the closed method in which the surgeon works entirely through the nostrils.

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The patient below had rhinoplasty to improve the appearance of his nose plus septoplasty and turbinate reduction to improve breathing. (Robert Kotler M.D. photo)

"A young man with a humped nose shows his new look in an after rhinoplasty picture"

Before and after rhinoplasty

Nose Jobs and Your Skin

Posted on April 10, 2012 by admin

When you see a cosmetic plastic surgeon about a rhinoplasty, one of your most unlikely features – your skin — will be scrutinized. Why? Well, imagine it like this:

Think about building a carefully constructed model ship or airplane. You’ve labored long and hard to see perfection in every detail, right down to:

Spars,
Ailerons,
Rivets and all other features

Then you use, say, a section of thick rug to cover your delicately created model. What do you suppose your handiwork would look like? Wouldn’t be able to see much detail, huh? But what do you suppose would happen if you used shrink wrap instead? Why, you could see everything.

The same concept applies to your skin quality in a rhinoplasty. Very thick skin tends to mask while thin skin reveals much more of the structure of your carefully and artfully rejuvenated nose after bones, cartilage and other framework tissues that have been changed.

During healing – which can require months up to a year after surgery — your skin and the soft tissue overlaying the nasal skeleton contracts inwards and “shrink wraps” onto that carefully altered nasal framework. That’s one reason you don’t see what your actual nose will look like for some time. Also, swelling is present after surgery, masking the true, eventual look of your rhinoplasty.

Thin skin shows the new nose in all its glory but any irregularities also show. Some people have such thin skin that some medical “padding” is added in surgery.

People with thicker skin may even have the fat layer under their nasal skin reduced somewhat by the plastic surgeon.

Thicker skin is especially important in ethnic rhinoplasty. Such noses can be harder to refine at the tip and have a tendency to retain fluid. This complication is especially common in patients of the following backgrounds:

African-American
Hispanic
Middle Eastern
Mediterrian

Another good option if you’re not happy with what shows through your nose skin: non-surgical rhinoplasty. Provided you only require work on the nose’s outside, many excellent facial fillers can be used if want a temporary filler first.

Later, go to permanent filler.

(Read more about permanent, non-surgical rhinoplasty revision, also known as injection rhinoplasty.)

It’s safe, predictable and cost far less than a surgical revision.

(In the photos below, from left: The patient had an unsuccessful rhinoplasty elsewhere. The after picture, right, shows the result of permanent, non-surgical rhinoplasty revision with fillers only, without any invasive surgery.)

"A woman's nose is shown in close-up before and after injection rhinoplasty"

Non-surgical revision rhinoplasty

Nose Jobs: How You Can Save $

Posted on April 5, 2012 by admin

"A handsome, smiling doctor talks on the phone in the hospital

Answering Savvy Consumer Questions

While our economy is getting better, the cost of plastic surgery is still an issue. The search for a master plastic surgeon can be expensive because most cosmetic plastic surgeons charge anywhere from $100 to $250 for a first rhinoplasty or revision rhinoplasty consultation.

But there is a way you can save while narrowing down your list of possible surgeons who can repair the damage from previous surgery done elsewhere, leaving you with an attractive nose.

How? Let your finger do the walking…..and the saving!

Here’s how:

Search the Internet for surgeons in your area, looking for board-certified cosmetic plastic surgeons who have many years of experience performing nose jobs or revision rhinoplasty.

Create a checklist like the following:

Surgeon’s name________________________________

Office address__________________________________

Telephone number_______________________________

Email address____________________________________

Make a list of likely prospects and grab your phone for some quick calls.

Ask the following:

Is the surgeon board-certified? If so, ask which board. Write down the answer. The best surgeons are certified by the American Board of Plastic Surgery or, for surgeons who specialize in procedures of the face, head and neck, The American Board of Otolargyngology.
Did the surgeon have a fellowship in cosmetic surgery?
Does the practice only perform procedures in cosmetic plastic surgery?
Now, look over your answers. When you do not see at least two positive answers, go back to your list and make more calls – those surgeons were not the most qualified.
On the next calls, ask what the five most commonly performed procedures are in the office of that surgeon. If you don’t hear the procedure you want, say thanks again and good-bye.
Once you find a plastic surgeon who fits all of the above criteria, ask an additional question: “Where does the surgeon perform surgeries? Office, an outpatient surgery facility or a hospital?” Circle the answer.
Then ask: “Is that facility licensed by the state, certified by Medicare or accredited by JCAHO, AAAASF or AAHC?“ Once again, circle the answer or answers. (If it’s none of the preceding, you are risking unsafe conditions.)
Make appointments and pay the consultation fee only when you find board-certified surgeons with cosmetic surgery fellowship who perform your desired procedure often (several times weekly) in a certified operating facility.
Try to take any previous surgical records and before and after pictures to revision consultations.
Revisions take longer and my produce more swelling and bruising. Allow a couple of extra days for healing than during your first surgery.
Ask the doctor if a non-surgical revision rhinoplasty is possible and if a permament filler is approprate. Also inquire about “shrinking injections”. (Read more about non-surgical revision rhinoplasty)

The previous rhinoplasty surgeon left the woman’s nose long and droopy. Dr. Kotler’s revision was done entirely by incisions inside her nose.

Non-surgical Nose Jobs: Top Ten Reasons for Proceeding

Posted on March 29, 2012 by admin

"A pretty young woman is examined by two doctors"

A Little More Here, Please

With so many L.A. rhinoplasty surgeons, some wonder why a nose job patient would skip a nose job and get a better looking nose via non-surgical rhinoplasty means.

Cost

Most can quickly relate to purse or wallet contents. A non-surgical rhinoplasty costs a fraction of the surgery.

The surgeon’s office

No surgeon’s assistants, nurses or anesthesiologist are needed — the entire procedure can be done in the office. So you skip charges for the operatory and the anesthesiologist’s fee. Plus, there’s no need to hang around in recovery, waiting to go home. Leave in ten to 15 minutes, just as soon as the injections are done.

WYSIWYG (What you see is what you get.)

You don’t have to rely on before and after rhinoplasty pictures of other patients. Plus, with surgery, there’s no accounting for Mother Nature when cartilage, bone, fat and other tissue is transplanted or surgically grafted onto a nose. In non-surgical rhinoplasty, the doctor can give you a picture what your nose will look like by using sterile salt water to fill in bad spots or hide bumps on the nose. Salt water lasts a minute before dissolving back into the body. But it’s enough time to snap a picture.

Go back to work afterwards

So you can go back to work, home, the gym or wherever you want with no signs of facial swelling, bruising or other tell-tale surgical signs.

Join in!

Take part by watching in a hand mirror. If you want changes, ask the doctor to place more, use less or say whoa, enough!

No painful needle jab

Afraid of needles? Don’t be – an anesthetic cream is spread on your nose first.

Previous nose job? O.K.!

If you have had no previous nose surgery or if you have gone through a repeat “rescue” rhinoplasty to repair a badly done nose, you can still have non-surgical rhinoplasty.

Temp or permanent?

You’ve got choices, too. Want the fillers Juvederm, Restylane, collagen or Sculptra? O.K., but those are absorbed in anywhere from three months to one year. If you’re hankering for permanence, ask for Artefill or Silikon 1000.

Do it after surgery

Say you have surgical rhinoplasty to improve breathing and then find there are still a few nasal marks, hollows or gouges. Forget going under the knife again and use non-surgical rhinoplasty for a cosmetic repair.

Less is more

Doctors like progressing a little at a time. Non-surgical rhinoplasty is completed when the injections are given about 45 days apart. So the surgeon injects a small amount and then waits to see if more is needed.

"A before and after picture shows permanent, non-surgical rhinoplasty on a young man"

Patient had bad surgery elsewhere. After: permanent, non-surgical rhinoplasty

After Nose Jobs: Looking Younger?

Posted on March 7, 2012 by admin

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.)

"An otherwise lovely girl shows the difference a nose job makes"

Beforer and After Rhinoplasty