Rhinoplasty Specialist Blog

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

Nose Job Gets Lawmaker Fired

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"An Egyptian lawmaker is shown with bandages after a nose job"

After Rhinoplasty

If you follow the ponies, you’ve probably heard the expressing, “winning by a nose.”

In Egypt this week, it was losing by a nose when an Egyptian lawmaker had a rhinoplasty in secret, tried to hide the cosmetic surgery by saying the bandage on his face was the result of a beating and robbery attack – but was caught in the fib.

While nose jobs among the famous have led to lots of embarrassing incidents like celebrities who deny something as plain as, well, the nose of their faces, this incident has the singular honor of being the first scandal in Egypt’s fledgling democracy.

Result? Member of Parliament, Anwar el-Balkimy, was forced to give up his seat. Fired, basically. It got to be crushingly embarrassing because the new speaker of the 40-day old Egyptian parliament went to Mr. Balkimy’s hospital room to wish him well after the attack.

But newspaper reporters – also exercising new freedoms – went to the plastic surgery clinic where the procedure was done and asked staffers who then openly spilled the beans about the nose job.

The lie about the rhinoplasty was such a major event because Mr. Balkimy belongs to Al Nour, an extremely conservative faction of Islam.

High on the no-no list for its members are:

  • Music
  • Most forms of entertainment
  • Cosmetic plastic surgery

But don’t get the idea that plastic surgery is scarcely done in that part of the world. It’s just the opposite.

Elsewhere in Egypt and the entire Middle East, cosmetic plastic surgery flourishes with some extremely talented and highly respected, world-class plastic surgeons plying their trade for millions who – like people everywhere – just want to look better and have more self-confidence.

For instance, the American Academy of Cosmetic Surgery built a multi-million dollar hospital dedicated to cosmetic plastic surgery in the Gulf nation of Dubai. Moreover, one of the highest rates of rhinoplasty anywhere in the world takes place in Iran. It’s because many women choose to wear veils, which only show the nose and the eyes. So it’s noses looking better first.

By the way, if you are heading for a cosmetic rhinoplasty or another other nasal surgery, don’t let the extreme bandaging on Mr. el-Balkimy’s face put you off. Unless you suffered head injuries or were in a car wreck just after your plastic surgery, you won’t look anything like that.

Rhinoplasty: Another Ethnic Group Wants Better Noses

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"Blooywood actor and actress heat up the action for the camera"

Bollywood Action

If rhinoplasty weren’t already the most difficult cosmetic plastic surgery, yet another wrinkle has cropped up in the art and science of performing ethnic nose jobs.

Various U.S. ethnicities crave better noses that fit their faces and flatter their profiles. But, at the same time, those patients want to keep their ethnic identities. For instance, African-American patients may want a less wide nose but they do not want the slim nose typically appearing on a Northern European background person. (Read more about ethnic rhinoplasty.)

So good cosmetic plastic surgeons tread carefully and are well studied in what exactly makes an ethnically appropriate nose. In North American, that means knowing the facial characteristics of:

  • Asians
  • Anglo-Saxons
  • African-Americans
  • Hispanics

Now, a new group has been studied. Writing in the current issue of Plastic & Reconstructive Surgery, a medical journal for plastic surgeons, three cosmetic plastic surgeons studied the nose job requests of Americans with roots in India.

The traditional emphasis in India has been on “internal beauty” (READ: never mind what a nose looks like.) And then the influence of “Bollywood”, the center of films in India, started more people thinking about their appearance. According to the article, India-based plastic surgeons counted 60,000 cosmetic rhinoplasties in 2009.

When more people born in India moved to the United States — and came under the influence of Hollywood beauty standards — the trickle of interest in better noses became a tidal wave.

Three plastic surgeons studied 35 Indian-American women who were unhappy with their noses. Results? A large majority wanted nasal humps flattened. They also complained of nasal tips that pointed down, especially when smiling or a nose that was just too large.

These subjects also wanted to preserve their ethnic identities; but fewer requested reduction of wide nostrils; one patient who wanted only slightly more narrow nostrils brought in the before and after rhinoplasty pictures of an African-American woman who also had very slight nostril reduction.

Another subject, 28, asked for a hump reduction. But the cosmetic surgeon, while examining her nose, found a deviated septum which blocked her breathing.

So, like many American nose job patients, she had septoplasty and cosmetic rhinoplasty in one surgical session.

Results? She breathed better and looked better.

(The patient, below, allowed her full beauty to come through by removing the hump on her nose.)

"A lovely woman shows the difference a bump removal from her nose makes"

Hump Removal

Nose Job: How Teens Can Ask Mom & Dad for It

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"A seemingly pretty teen hides her face in shame due to a big nose"

"Don't look at my nose!"

If you’re a teen boy, at least 17, or a 15 or 16-year-old girl, you may be old enough for a cosmetic nose job.  One thing’s for sure, you’ve got lots of company: in 2010, the best year we have for statistics, about 35,000 American teens had rhinoplasty.

But how do you ask mom and dad?

You’ll make a better case for rhinoplasty if you have been teased at school or if you have a cruel nick-name like “Big Nose.” Then, your self-confidence is flattened. So you dread giving that speech in a class. You also probably don’t want to raise your hand – even when you’re the only one who knows the answer—because you don’t want attention. Some teens go to great lengths to hide their noses, letting their hair grow down over the face or pulling down a baseball hat.

So what to say to parents? Try: “I feel singled out because of my nose – it’s actually holding me back. Because my nose is ugly, I feel ugly and I don’t volunteer for things, I don’t join things and I don’t speak out because I don’t want to people to notice me. I have about zero self-esteem.”

Rhinoplasty changes the entire appearance of a face; when looking at a person with a bad nose, the eye stays on the nose. But when a nose fits and flatters a face, the observing eye then takes in the person’s eyes. (Just look at the teen before and after rhinoplasty picture, below.The only change was to her nose.)

Explain that the ear pinning operation – otoplasty – is often given to kids with big, stand-out ears before they start first grade. It’s because the teasing starts immediately and can sour a youngster on education for life.

Then, go on your computer and Google the studies that find attractive people:

  • Do better in school
  • Get more attention from teachers
  • Make more money at work
  • Are treated better by peers
  • Are more likely to have leadership roles

Offer to pay as much as you can now and repay any money mom and dad spend.

When you go see the cosmetic plastic surgeon, he or she wants to see:

  • The teen has initiated the request
  • You have reasonable goals (i.e. don’t ask for Anglie Jolie’s nose!)
  • You are mature enough to deal with nasal plastic surgery, a little post-op discomfort, having black and blue marks on your face for perhaps seven days and can give up sports for three to four weeks.
"A very pretty girls shows in before and after pictures the difference a nose job has made"

Before and After Teen Rhinoplasty

Rhinoplasty & Nasal Surgery for Pitcher – for Free!

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"Mets pitch Jon Niese is shown at bat before his nose job"

Before Rhinoplasty

When two Big League baseball players were chatting in a locker room in the summer of 2011, one heard his pal saying he would like to have a rhinoplasty along with correction of a deviated septum.

A septum is the thin wall of cartilage separating the nostrils. And we’re talking really thin – as in egg shell thin. Sometimes, people are:

  •    Born with a deviated septum
  •    Injured
  • Hit in the face with a baseball
  • Dive nose first into a base

Met pitcher and Lefty Jonathon Niese had his site set on a cosmetic rhinoplasty that included fixing his crooked septum. Trouble is, if the septum is bent out of shape that affects the breathing. And you know how it is with sports stars – they just gotta breath right.

But Niese seemed to be getting along O.K. and said he would get around to the nasal surgery someday. The cost of the rhinoplasty and septum repair would be about 10 grand, according to a New York plastic surgeon.

“Oh yeah” says Carlos Beltran. “What if it was already paid for? Would you do it then?”

“Of course,” says Niese.

So teammate Beltran pipes up right out of the blue and says to Niese: “Well then, go ahead and get the nose job. I’ll spring for it.” Beltran and Niese were with the Mets from 2008 to 2011.

And then a wrinkle crops up. Beltran gets traded to the St. Louis Cardinals.

Meanwhile, the New York papers get involved and report that Beltran recommended the plastic surgery, a supposition Beltran — who doesn’t know beans about cosmetic plastic surgery — denies.

Says Beltran, fully aware his pal is with another team: “I will have a check ready when the teams met.”

Niese had the nasal surgery in October, 2011, now notices a major league improvement in his breathing (as well as the appearance of his new nose, below!) and looks forward to receiving a  $10,000 check from Beltran who has announced his check is as good as his word.

Sometime after the national anthem is played on March 1, the two teams will face off during Spring training in Jupiter, Florida and Beltran will fork over the nose job money in person.

How’s that for a new high sportsmanship?

"Jon Niese is shown after his rhinoplasty"

After Rhinoplasty

 

Plastic Surgeons, Whitney Houston and Prescription Drugs

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"A close up shows a smiling, happy, healthy Whitney Houston"

Whitney Houston, R.I.P.

The uniquely talented and effervescent Whitney Houston unfortunately joins the list of entertainment industry legends whose lives were sadly cut short, due to drug use and abuse.

Generally, over-the-counter medicines generally cannot kill you.  It’s the prescription drugs that do you in.

So, we have to look at members of the medical profession – including some plastic surgeons — who, often for financial gain and prestige, choose to be the “legal pushers” of the medications that destroy these people’s lives.

Remember Elvis Presley? Prescribed by a single doctor, “The King” was taking enormous amounts of prescription meds, including:

  • Uppers
  • Downers
  • Stimulants
  • Depressants

There’s no defense for that.  As far as we are concerned, these doctors are professional garbage and would be doing society a favor by giving up their medical licenses.

Supporting celebrities’ drug habits is not medical practice. It is a form of prostitution.

Michael Jackson died because a physician with many personal and financial problems was lured by a huge-dollar monthly retainer and could not say no. That doctor just did not have the professional wisdom or strength of character to turn down a request for an inappropriate drug for sleep.

Propofol is a popular, safe and effective anesthetic agent often used in cosmetic surgery. It could have been administered — although somewhat unorthodoxly — under safe and properly monitored circumstances.  But, alas, it was not.

The doctor’s judgment was absolutely flawed in believing that he, — although not formally trained in anesthesia — could conduct a safe sleep session by administering a drug whose “warning box” demands that it be used only in a properly outfitted operating room or recovery room by MDs who are trained in its use. Jackson’s doctor was way out of his league.

There was a report that Whitney Houston consulted with a local cosmetic plastic surgeon about having a face lift or some other form of cosmetic surgery.  But she failed, or would have failed, the pre-operative physical examination so the surgeon declined to operate.

That plastic surgeon functioned at a high level of professional competence and is a credit to the profession.

Contrast that with the careless actions shown by the doctors who supported the drug habits of Michael Jackson and Elvis Presley, and other celebrities who took up tranquilizers, sedatives, and narcotics.

A death from drug dependence and overdose, predicated on long-term prescription drug medication, is a form of slow suicide.

It is also assisted suicide, abetted by misdirected members of the medical profession.  The doctors who supported the deadly drug habits of these notables need to be drummed out of the corps of physicians.

After all, the start of the doctor’s oath is “First, do no harm.”

Is My Nose Really Broken?

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"A close of a woman's nose is pictured with traces of blood"

Broken?

From school boys who have been in their first fist fights to middle-aged, weekend jocks playing Rugby, the question is often the same:

“Doctor, is my nose really broken? Will I need a nose job?”

The question about a fractured nose is pretty common because the nose:

  • Protrudes from the face
  • Contains fragile, eggshell thin bones
  • Comprises almost 40 percent of all facial injuries

The basic dead-bang giveaway that a nose is really broken is changed shape. In a true broken nose, you’ll also feel a change in breathing and may see some black and blue marks on your face with some swelling of the nose. You will likely have a nosebleed, too, which comes from the nasal mucosa, a type of moist tissue found inside the nose.

The most common reasons for broken noses, Rugby notwithstanding, include:

  • Other sports injuries like “touch” football
  • Falls
  • Car accidents
  • Fighting, scuffles, assaults, brawling, melees & donnybrooks

The most serious situation is if you can’t breathe. Then, you’ve got real trouble because the nose’s chief function is passing warmed, filtered air to the lungs. Mouth breathing brings its own set of problems, so being unable to breathe through the nose constitutes a situation close to a nose emergency.

It usually takes about a week for swelling to resolve so that a nasal surgeon can tell – through his sense of touch – what has happened to the nose bones.

A good exam would include a serious look up inside the nose, too.

For instance, an injured nose could have a septal hematoma, a bruise or bleeding from the septum, that thin wall of cartilage that separates your two nostrils. An untreated septal hematoma can lead to destruction of the septum and a condition known as saddle nose deformity.

Plus, there are many different parts of the nose that can be fractured. That’s why it’s best to have it examined by an experienced nasal surgeon who really knows the anatomy of the nose.

It’s a very, very complicated part of your body!

(Read more about deviated septums.)

"A before and after is shown of a man with an old sports injury"This gentleman broke his nose in a basketball game and eventually his nose caved in. Rhinoplasty restore the appearance of his nose as well as his healthy breathing.

Nose Job, Chin Implant: Go Together like Love & Marriage

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"a doctor and patient look at computer picturesMany rhinoplasty patients know exactly what it is about their nose they do not like.

But the one thing that prevents a complete mental picture forming in the patient’s mind about what their nose might look like after a  cosmetic rhinoplasty is…….they can’t see inside the surgeon’s mind.

The surgeon can describe the appearance of an improved nose after rhinoplasty for days on end but it’s like trying to describe a painting; words alone fail.

But there is a way around it: computer imaging. It’s an ap that takes the guessing out of plastic surgery but it’s not found on iPhones.

Here’s how it works: a picture of your existing nose is fed into a special computer.

The nasal surgeon then explains to the computer artist what changes the nose will undergo during surgery.

When the likely, expected after rhinoplasty look is generated on the computer screen, it’s as plain as day to anybody with eyes how much better you will look.

Some patients are surprised when the cosmetic plastic surgeon also mentions that the profile is out of balance and suggests adding an implant to make the chin look less receding.

The icing on the cake often happens when the actual after pictures are taken of the newly healed nose – usually three months after surgery – and fed into the imaging computer to be displayed with before and predicted pictures.

In many cases, improvements to the nose are better than what the computer predicted!

People often ask why cosmetic surgery to the nose alone can make a person look so very much better.

When a nose is seen as too big, twisted, humped, hooked, wide, flat or otherwise unattractive, the human eye stops on the nose.

After plastic surgery, when the nose fits the face and also flatters the profile, the eye skips over the nose and moves up to the other major central point of the face, the eyes. You literally “see” that person’s face differently.

So if you visit a cosmetic plastic surgeon to inquire about a nose job, make sure you:

  • Have a concrete idea what your face may look like after surgery
  • Always ask if your profile appears to be in balance
"A young woman shows the difference a chin augmentation has made"

Rhinoplaty + Chin Implant = Perfect Profile

Nasal Surgery Costs over Skype, E-mail

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"A lovely young woman talks on her phone while working on her computer"

Cosmetic Surgery Consultation

Many cosmetic plastic surgeons offer consultations via:

  • Skype
  • Phone
  • The Internet.

In most cases, the patient sends or emails a picture of the bodily part in question and the conversation flows from there.

(Read more about live, remote contact for nasal surgery consultations.)

Obviously, patients also want to know the cost of cosmetic plastic surgery.

For rhinoplasty, a cosmetic plastic surgeon, working remotely, can get a pretty good idea of:

  • What can be done
  • What needs to be done
  • If the patient is making a realistic request

So the surgeon can provide a fairly accurate quote during the remote conference.

But in the case of, say, functional nasal surgery for healthy breathing in a case of deviated septum or turbinate reduction, the nasal surgeon needs to see inside your nose.

Some patients opt to save time, money and inconvenience by having not only a cosmetic rhinoplasty but an additional procedure like septoplasty to repair a deviated septum in one surgical session.

But the fees for internal nasal surgeries are just too hard to pin down without a personal exam.

It’s too difficult for any cosmetic plastic surgeon to give a patient a fee quotation on internal nasal surgery, based on the photos and information gleaned remotely.

Eventually, the patient must see the doctor in a personal consultation before receiving, solid, take-it-to-the-bank advice and, of course, a carved-in-stone fee schedule.

Several factors come into play about the cost of a nose job, like:

  •    How difficult is the rhinoplasty?
  •    Is a  chin augmentation required?

But for functional surgery, the surgeon needs to examine the inside of the nose to determine its structure and airway function.  The doctor also needs to manipulate the nasal cartilage with his fingers to get an idea of the tissue’s strength.  Likewise, the thickness of your skin is a factor.

So, you may be misinformed by receiving quotation about internal nasal surgery like turbinate reduction via long distance without first being seen by the prospective surgeon.

Also keep in mind, the complete costs of plastic surgery involve not only the surgeon’s fee, but:

  • Charges for the surgery center, hospital, or doctor’s office
  • Additional fees for a doctor/anesthesiologist
  • Pre-surgery exams and blood tests

So be sure and ask your surgeon for the total costs of your plastic surgery.

Nose Job Surgeon: Top 10 Questions to Ask

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"A senior woman talks with a doctor while sitting"

Interviewing a Surgeon

Before having rhinoplasty surgery, you’ll have a consultation with your cosmetic plastic surgeon. That is your chance to ask him or her anything, from where the cosmetic surgeon was trained to the last time he or she flubbed a procedure.

The top 10 best questions include:

  • In what board are you certified?

There are many bogus boards but you should listen for the only two that train cosmetic plastic surgeons: American Board of Plastic Surgery or the American Board of Otolargyngology (head and neck surgery.) Extra points: ask where the surgeon’s fellowship was.

  • How many nose jobs do you do in a typical week?

Look for two to three weekly over the last 10 years.

  • What is your policy on revision rhinoplasty?

Even in the best of hands, things can go astray. Ask who covers what expenses and fees in case you need a re-do or more work after surgery.

  • What is your percentage of satisfied patients?

Read patient reviews on the surgeon’s website and the Internet; there should be many.

Look for patients who had changes like what you want. You should see many dozens, if not hundreds.

  • Do you have computer imaging?

Surgeon and patient really get on the same page when computer imaging shows what you will most probably look like after healing.

  • How long does it take to perform a cosmetic rhinoplasty like I want?
  • How did you handle your last infection?

The national average for infections in plastic surgery is one percent. If the surgeon says he never had one, he’s not being straight with you. A board-certified nasal surgeon has seen every possible, off-the-wall wrinkle that can crop up and knows what to do.

  • What kind of anesthesia do you use and how long does it take to recover?
  • Do you think what I’m asking for is realistic?

Some patients like a particular nose, say, Brat Pitt’s, and tell the surgeon that’s what they want. But Brad’s nose on your face may look goofy; part of the art of rhinoplasty is to perform the changes you want while creating a nose that fits your face and flatters your profile.

(Read 15 more basic questions to ask a rhinoplasty surgeon before you go ahead with surgery.)

After Rhinoplasty: What to Do

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"A surgeon operates with his surgical nurse standing beside him"

In Surgery

One of the most common questions asked by nose job patients is: “After rhinoplasty, what should I do, doctor?”

Overall, don’t put any pressure on the newly rejuvenated nose. Some patients have even found that industrial protection type eye glasses are too heavy to sit on the bridge of the nose.

Our patients can wear contacts one to two days after cosmetic surgery; for those who must wear eye glasses, we show them how to suspend their spectacles from the forehead so there is no pressure on the nasal bridge; that continues for five weeks.

Most cosmetic plastic surgeons have lists of recommendations on how to care for one’s self after nasal surgery so be sure and follow those instructions.

It’s obviously also a good idea to stay away from any sport, hobby, pastime or person which could involve a blow to the nose.

Many are curious when they can resume regular workouts and exercise. For the first seven to 10 days after nose job surgery, let your body concentrate on healing and catch up on your reading although slow walking and stretching can start the day after surgery.

But exercise that really gets the blood going is not a good idea because increased blood pressure can lead to a bleeding nose and a possible increase in swelling and bruising. Another caution about nose bleeds: don’t blow your nose for the first 10 days after rhinoplasty surgery.

If you have stopped smoking for some weeks before rhinoplasty surgery, let the smokes lay unlit for a while longer – the nicotine in tobacco injures veins and reduces the blood flow which is needed to promote healing.

If you are fond of herbs, beware the “Four Gs”: garlic, gingko, ginseng and ginger. Those substances can affect blood clotting and a good cosmetic surgery result.

Catch up on your Z’s because adequate sleep ensures quicker recoveries. Also, mild pain medications, if needed, are usually available to help you sleep. Most patients find the nose is dry after surgery. But you can keep it better humidified by using saline nasal sprays.

Following doctors’ instructions usually means you are good to go in seven to 10 days….. although it may require a month for your breathing to reach its optimal level.

 

The rhinoplasty patient below had the bump on her nose removed while the scoop above the tip of the nose was corrected. (Robert Kotler, MD photo)

"A lovely woman shows her nose, before and after rhinoplasty

Before and After Rhinoplasty