ERASING MENTAL BLOCKS

Secret: There is a responsible answer or solution for every

concern, worry and reservation.

PATIENT COMMENTARY

I can now breathe much better through my nose and I’m very

happy with the way it looks. My nose looks so natural that

no one has been able to notice…Friends and family are

amazed at how natural my nose looks. Even my mother has

mentioned how my nose complements the rest of my facial

features.

-Christian, traffic specialist

Florida

PATIENT COMMENTARY

My final decision to have surgery came when I received a

letter from my 81-year-old aunt who just had cataract

surgery. She said, “If there’s anything that you need to

change, don’t wait as long as I did. Do it as soon as

possible.”

-Susan

California

PATIENT COMMENTARY

I had some hesitation myself. But I had one big advantage. I

had listened carefully to our patients relating their

experiences. Over and over, I heard the following phrase:

“You know, this wasn’t such a big deal. I don’t know why I

worried about it. Why did I wait so long?” We all magnify

our worries and concerns out of proportion; most of the

things we worry about in life never happen. Worry is the

misuse of imagination. Still, we all worry about ‘going to

sleep,’ particularly for an elective procedure. But again,

what I knew is that I was safer in a licensed surgery center

with a doctor-anesthesiologist at my side than I am during

my freeway commute. Those statistics are absolute! Further,

Dr. Kotler will not operate unless the patient “passes” the

required pre-operative physical and lab tests. No one should

have elective surgery unless he or she is medically fit. So if

you are healthy for this kind of surgery, your risk is nearly

zero.

-Karel Rall

Patient Counselor

Cosmetic Surgery Specialists

Medical Group of Beverly Hills

If cosmetic surgery is as positive and satisfying as it sounds, why

isn’t everyone having it done?

Some people cannot have the surgery they desire—under any

circumstances—because of a dangerous medical condition. They will

be informed of this during the requisite physical prior to any surgery

being scheduled.

Other people have been blessed with satisfactory “architecture”

and practice a healthy lifestyle: staying trim, avoiding nicotine,

exercising regularly, eating a well balanced diet, drinking

moderately, and protecting their skin from excessive sun. These

people may not need anything done. In either case, the reputable

practitioner tells the patient they are not a good candidate for

cosmetic surgery, and explains why.

216 Secrets of a Beverly Hills Cosmetic Surgeon

There then remains a third group: healthy,

but not happy with their inherited features or

appearing older than they prefer. They long for

a better appearance but are so ambivalent, they

can’t make the commitment. In our practice

survey patients were asked, “How long have

you been considering cosmetic surgery?” The

range of answers was three months to ten years!

The median time period was three years.

Events, functions, vacations, and assorted

obligations come first. Unlike a broken leg or

gallbladder attack, the elective nature of

cosmetic surgery makes it easy to put off. Often,

however, the ambivalence and hesitation stem from mistaken notions

and misformation, about cosmetic surgery.

Interestingly, we find surprising consistency among prospective

patients when asked to identify reasons that kept them from having

surgery. Here are the seven most frequently stated concerns,

hesitations and blocks.

1. “I’m afraid. The idea of having any surgery and anesthesia

scares me.”

2. “What will I look like? Will the results be natural?”

3. “How long before I can return to social activities, work or

exercise?”

4. “Will it be painful?”

5. “What will my family, friends or coworkers think about

this?"

6. “Can I afford what I want?”

7. “Which doctor is best qualified for my particular case?”

All these questions pose legitimate and proper concerns. The

responses may provide you with the information and reassurance

you need to remove your mental blocks:

Erasing Mental Blocks 217

People are taking advantage

of all the advances in cosmetic

plastic surgery to the degree

with which they are

comfortable. Plastic surgery,

as an option, has become part

of the lifestyle choices made by

Americans who want to look

as good as they feel.

- Walter Erhardt, MD

The 2001 Report of the 2000

Procedural Statistics,

American Society of Plastic

Surgeons

1. "I’m afraid. The idea of having any surgery and

anesthesia scares me"

All cosmetic surgery procedures are anatomically superficial.

They involve only the skin and the tissues just below the skin. These

procedures are not comparable in any way to major abdominal

surgery, open-heart surgery, or brain surgery. Regardless of the

procedure, you are an outpatient and will leave the surgery center one

to two hours after the operation. Should you be having nose, chin,

eyelid surgery or breast augmentation early in the morning, you can

expect to be home by lunch!

PATIENT COMMENTARY

The nasal surgery itself was a piece of cake! I didn’t even use

the pain pills you gave me! It was one of the easiest and

greatest decisions I have ever made.

-Karen, beautician

California

2. "What will I look like? Will the results be natural?"

Unnatural, overdone, plastic-looking cosmetic surgery does not

come from “bad luck.” It is the result of poor surgeon selection. Why

would anyone not want to look natural? Everyone recognizes those

celebrities who have been over-tightened, over-pulled and oversculpted.

They simply do not look natural. The best practices assure

the patients that their results will be as natural as those shown in their

“before and after” album. That’s why I’m so keen on your examining

the real-life or photographic evidence of a doctor’s work.

Caveat emptor! Buyer beware!

INSIDER’S INSIGHT

A Tale of a Dissatisfied Patient - How You Can Avoid a

Similar Error of Judgment

Prospective Patient at Consultation:

Several months ago, my friend had a facelift and I must say she does not look

good. I’m shocked. First, it is obvious something’s been done to her face because it

does not look natural. It’s like her face is always smiling. She has a constant grin — like

The Joker in Batman. And when she smiles or speaks, she gets these strange, horizontal

grooves in her face. It looks terrible. If this is what cosmetic surgery does, it’s not for me.

But I need to ask you: What did my friend do wrong? How do I know it won’t happen

to me?

Insider explanation:

218 Secrets of a Beverly Hills Cosmetic Surgeon

INSIDER’S EXPLANATION

I don’t blame you for being concerned. Your friend’s appearance may well be due

to having had a type of face lift that, if overdone, causes permanent distortion of the

facial features because it involves repositioning many of the muscles and their

attachments to the underlying bones. Or, the ‘lifting’ of the skin—involving a backward

pull—may have been overdone, although, typically, if that is the cause, time should

improve the appearance.

Your friend did not cause these deformities—the surgeon did. It seems his

judgment was poor because no one wants an overdrawn, distorted and unnatural

result. An experienced cosmetic surgeon knows this and avoids the problem by not

performing a procedure that can possibly create such an outcome. These poor results

don’t ‘just happen’ with a qualified, experienced cosmetic surgeon.

If your friend is unhappy, she might look to her decision-making process when she

selected the doctor. Did she see other patients whose facelifts were done by the doctor

she chose? Did she see the surgeon’s before-and-after photo collection? Did the doctor

show her—using a computer imaging program—what he intended to accomplish? And

did she see examples of patients’ actual results compared with the computer

predictions?

The doctor should have a standard or routine technique he uses for his facelifts.

Most likely, then, all his patients will look unappealing to a prospective patient. That is

why it is so important to see multiple examples—either ”live,” or in “before and after”

photos—of the doctor’s results. If you don’t like the results you are seeing, go

elsewhere.

-RK

Modern cosmetic surgery is capable of delivering far better than

this lady’s friend received. You should not have to worry about

wearing the equivalent of a neon sign on your face that proclaims:

“Bad Cosmetic Surgery.” If every patient had cosmetic surgery by the

appropriate superspecialist who performs cosmetic surgery only, the

percentage of dissatisfied patients would be very, very low.

3. "How long before I can return to social activities,

work or exercise?"

If you have nose, chin or eyelid surgery, you can be back to work

and/or be “seen in public” within one week. Figure ten days for

facelifts, wrinkle removal or combination procedures. Strenuous

exercise can be done in ten to fourteen days, but walking is

encouraged three to four days after any procedure. Not bad.

Erasing Mental Blocks 219

PATIENT COMMENTARY

Having my nose done is probably one of the best decisions

I’ve ever made. If only I could have done it sooner!! I was

extremely amazed at the short recovery and how much of an

impact this surgery has made on my life.

-Jerre, sports trainer

California

PATIENT COMMENTARY

It is just eight days since my neck surgery and, although

there is a little bruising, it looks superb and I feel great.

Thanks again.

-Bobbie, businesswoman

California

P.S. When do I start to feel pain?

4. "Will it be painful?"

220 Secrets of a Beverly Hills Cosmetic Surgeon

INSIDER’S INSIGHT

“Doctor, one of the worries that has kept me from this consultation for years is

having heard the horror stories about pack removal after nasal surgery.”

The patient is referring to reports of pain when the internal nasal packs — long

gauze strips or finger-like cotton pads—are removed one or several days after surgery.

Likewise, when I suggest to patients with wrinkles, that chemical rejuvenation would

be an appropriate solution, I hear, “Oh, I heard it hurts too much", or, “My friend had

one and did nothing but complain about the pain. I’d rather live with the wrinkles.”

I am irked by the “bad press” our specialty gets because many of us do it right

every day. In the 21st century there is no excuse for patients to suffer in surgery or

during recovery. Prospective patients need to hear how the pros do it. The negative

stories come from amateur — not superspecialist — offices. There is time, and there

are medicines, to do it properly — painlessly.

-RK

PATIENT COMMENTARY

I have no recollection of pain at all; not during the surgery,

not after surgery. I did not take any pain pills. The only thing

that reminded me about the surgery was my swollen nose.

But the swelling went away soon.

-Natalia, artist

California

In this day and age, if a doctor cannot control pain, he should

retire. Safe, effective pain medications are widely available. They

won’t create addiction; they’re only used for a short time. You should

be provided, as part of your service, a medium strength pain medicine

such as Tylenol© with codeine or Vicodin©. The majority of patients

require nothing stronger. If these are not effective or cause side effects,

there are many substitutes. No physician should let you suffer! Keep

your doctor apprised of your status, and if you're experiencing pain,

don’t hesitate to call the office. The best practices are available 24

hours a day to insure your comfort. Prior to surgery, be sure you have

all the phone numbers to reach the surgeon or one of his staff at any

time.

5. "What will my family, friends, or co-workers think

about this?"

Is it really important what others think? It’s your face or body.

What is important is what you think. Don’t put it out for a vote. If you

want it, “just do it!”

PATIENT COMMENTARY

I want to thank you for the new me. I look so much younger,

I just can’t believe it. My skin is new and wrinkle-free! It

feels great to look as young as my daughters again! I know

that coming to you for my chemical peel was one of the best

things I’ve ever done for myself. Sam was skeptical before I

had the peel; now he takes all the credit for it! He says he

might even keep me around a few more years. Thanks again

for the new skin! I love it! Sincerely,

-Glenda, insurance broker

Tennessee

Erasing Mental Blocks 221

6. "Can I afford what I want?"

The popularity of cosmetic surgery is testimony to its value and

affordability. It is no longer an exclusive indulgence of the rich and

famous. Interest in cosmetic surgery spans into most socioeconomic

levels of American society. Don’t let money alone stand between you

and your appearance. Think of it as an investment in your future.

Earlier, I revealed strategies to soften the expense without

compromising quality. Here are more ideas to make surgery available

to you with less financial sacrifice.

“Stand by” fees

For patients who have a flexible work schedule and

can be available with seven to ten days notice, some

practices offer significant cost savings. A surgeon’s

operating schedule is most efficient when all the spaces

are filled. Airlines offer discounted seats—surgeons can

do the same. Be sure to ask about “stand by” rates.

222 Secrets of a Beverly Hills Cosmetic Surgeon

…people have been

haggling for years over

the cost of things

insurance doesn’t

usually pay for, such as

plastic surgery…

Wall Street Journal,

February 8, 2002

INSIDER‘S INSIGHT

The Daily Cost of a Teenager’s Nose Job

When a teen has a nose job at age 17, she can expect to live another 64 years to

age 81. So, let’s do some math and see what it costs, per day—to own a great nose.

Take the total cost of the cosmetic nasal surgery (including surgeon’s fees, outpatient

surgery center charges, anesthesiologist fees), divide it by the remaining life span of

the teen, and divide by 365 days in a year. That gives you the cost per day.

Sample Calculation:

Lindsey, a 17 year-old high school student wants to have her nose done. She

needs to convince her parents to fund it. Finally finding a practical use for math she

makes the following calculation:

• Her predicted life span=81 years.

• Subtract current age of 17 from 81=64. She can expect 64 years to enjoy

her new nose.

• Assume: total cost of the surgery is $6000.

• Divide $6000 by 64 years=$94 per year!

• Divide $94/year by 365 days/year=26 cents per day!

Less than a local telephone call!

-RK

“Friends and family” group discounts

This popular concept is great for groups. When sisters, cousins, or

friends consult together and have their procedures on the same or

successive days, each member of the group saves money. First, it costs

the practice no more to consult with four people than it does with one.

Next, pre- and post-operative care is very efficient and a cost-saver

when several people have the procedures done in tandem. The

practice’s savings are passed along to you.

“Layaway” plans

Layaway plans are a great way to save towards a purchase and

earn a bonus at the same time. Here’s how it works. Each month for

twelve months, you send in a pre-determined payment. When you

have reached the eleventh month, the practice will reward you with a

discount or bonus towards your final payment. You are then paid up

and ready for your cosmetic surgery of choice!

Financing plans

National consumer credit companies offer financing for cosmetic

and dental surgery as well as other elective professional services.

Most practices have a relationship with these companies and can

provide you with application forms either online or by fax. Often, you

can expect an answer within hours.

Credit Cards

Credit cards are perhaps the most practical and common means of

financing purchases. Some practices accept major credit cards. Patients

enjoy getting “free miles” along with their new face and body.

Company Credit Unions

If you work for an employer with a credit union, borrowing there

may be your best deal. Credit union interest rates tend to be lower

than credit cards.

PATIENT COMMENTARY

It’s the first time in my life I purchased something and got

exactly what I wanted and far more than I expected.

-Mishel,* controller, production company

California

Erasing Mental Blocks 223

* See Mishel’s photo on page 109.

7. Which doctor is best qualified for my particular

case?"

You need to be very comfortable with your decision: Follow the

dictates of this book and you will be. There is no more critical factor

than selecting the most experienced and narrowly specialized

surgeon possible. Surgical outcomes are directly related to the

experience, skill and degree of specialization of the practitioner. The

surgeon who does not focus on the particular procedure you are

considering should be excluded from consideration. And, right there,

don’t be reluctant to ask for a referral to a colleague who does

specialize in that procedure. A conscientious and competent practitioner

will admit he is not comfortable with your case. He will then

make a recommendation that you consult with one or more of his

colleagues whose work is familiar to the doctor.

Keep in mind, there is seldom “good luck” or “bad luck” in

cosmetic surgery. You can do your homework, or roll the dice. Your

choice.

224 Secrets of a Beverly Hills Cosmetic Surgeon

The definition of a professional

is one who puts the interest of the

client (patient) ahead of his own.

-Louis Brandeis

U.S. Supreme Court Justice

A woman’s beauty is her most valuable asset. Every woman owes

it to herself to look as good as she can and avail herself of every

possible aid to increase her attractiveness

-The Making of a Beautiful Face,

by J. Howard Crum, MD, published in 1928

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