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Robert Kotler, MD, FACS, is one of the world’s pre-eminent super-specialists in rhinoplasty. The practice is 90% nasal surgery for both appearance and breathing.

With many years of experience and over 4500 nasal procedures performed, patients have the benefit of Dr. Kotler’s skill, experience and judgment.

He is the inventor of the KOTLER NASAL AIRWAY™, used throughout the US and abroad for patient comfort and safety after any nasal surgery.

You may be a candidate for a non surgical approach to correcting your nasal features. Dr. Kotler is internationally known as the most experienced practitioner of performing a non surgical rhinoplasty as an alternative to a primary or revision rhinoplasty using an FDA-approved permanent filler.

The KOTLER SALINE DEMO is another innovation developed by Dr. Kotler to show patients considering the permanent non-surgical rhinoplasty or permanent non-surgical revision rhinoplasty the final result of such a technique. The Kotler Saline Demo is a chance to see what your results will be without actually undergoing the permanent non surgical nose job procedure.

What is rhinoplasty or a “nose job”?

Rhinoplasty means literally, change of the shape of the nose. A standard and veteran operation to improve the appearance of the nose.

What is involved in a “nose job”?

After the anesthesiologist puts you to sleep and a local anesthesia is injected, internal incisions are made and the architecture of the nose, the bone and cartilages are exposed. Through sculpture-like techniques, the framework is changed. At the end of the operation, the skin shrinks down to conform to the newly fashioned anatomy.

What Happens On The Day Of Surgery?

At the surgical facility, the patient is given a small dose of sedative by mouth. The intravenous is started after pulse, blood pressure and all vital signs are checked to be normal. Then the patient is taken to the operating room for the procedure. Afterwards, one hour is spent in the recovery room awakening and checking all details. We make sure that the caregiver is taught all necessary techniques for home care.

Dr. Kotler delivers natural noses, via the closed rhinoplasty approach and does it in less than half the time it takes most other surgeons. Often, that’s why there’s less swelling and bruising, and thus quicker return to school or work.

How Long Does The Surgery Take?

A standard rhinoplasty generally takes 1.5 hours or less in experienced hands. Some surgeons using more complex techniques, including the open rhinoplasty with multiple cartilage grafts from the ribs, ears and nose, may take three to five hours.

How long does rhinoplasty recovery take?

Typically people return to all normal work and social duties within seven to ten days. At ten days, one has freedom to do all normal exercise regardless of how strenuous. One must be aware, however, that five or six weeks must elapse before the nose has healed and the bones are no longer brittle.

What can I expect after rhinoplasty?

After rhinoplasty, there is very little pain. Swelling and some bruising is expected but generally dissipates within seven to ten days. There may be some numbness of the nose. Generally there is much less discomfort due to today’s better techniques and medications.

How much pain will I have after surgery?

Pain is always variable. Some people have a low threshold, some have a high threshold. Certainly, no patient should suffer.  Therefore our practice provides a prescription for pain medication which is filled prior to surgery so the patient has the medication with them at the surgery center and on the way home so pain relief is a gulp of water away. Typically most people will tell you that they endured less pain than they thought. Dr. Kotler’s own personal experience is that he never took a pain pill and found the discomfort very mild. For some people Advil, plain Tylenol or Extra Strength Tylenol will suffice.

What are the alternatives to rhinoplasty?

The only alternative to rhinoplasty is a “non-surgical” or “injection rhinoplasty” by which certain bumps, divots and even mild crookedness may be corrected with temporary permanent fillers. The patient must be very carefully evaluated as to whether this non-surgical alternative is to be preferable to the standard surgical procedure.

Some patients actually believe that a surgical revision rhinoplasty is to be expected, or is the norm. That is incorrect. The rhinoplasty super-specialists generally have a very low rate of revision rhinoplasty.
A. Norman Enright
Medical Writer

What are the risks of rhinoplasty?

Like all operations, there is a risk, albeit very minor, of bleeding. Infection is extremely rare. Other risks are attendant to the anesthesia which today is safer than ever since it is done with a combination of the Propofol (colonoscopy drug) and local anesthesia. The patient feels no pain, is in a light sleep, wakes up quickly and has little nausea and vomiting.

During a rhinoplasty, what are my options concerning anesthesia?

The decision regarding anesthesia generally is made by the surgeon and the anesthesiologist for ideal comfort and safety. Most people do not want to be awake during the procedure, nor aware of the procedure. For that reason, the techniques called “conscious sedation” or “twilight sleep” are appropriate since the patient is in a deep sleep but not as unconscious as if he or she were having open heart surgery, lung surgery or abdominal surgery. The wakeup is quicker and there is no pain upon waking up because during the operation the surgeon injects local anesthesia, as would a dentist, to provide complete relief of pain.

What is the difference between “open” and “closed” rhinoplasty?

Open implies an external and visible incision which is horizontally placed between the two nostrils. Through this incision, the skin of the nose is elevated to gain exposure to visualize and operate on the bone and cartilage. This is akin to opening the hood of a car. The closed rhinoplasty approach is done through an entirely hidden incision which is closed with dissolving stitches. This techniques requires more experience in manual dexterity. There are advantages and disadvantages to each technique, of course. The most important question is whether your surgeon is skilled in one or the other and the results are superior.

May I go home immediately following my surgery?

Most people leave the surgery center one hour after rhinoplasty.

Can my breathing be improved during rhinoplasty?

Rhinoplasty per se is only a cosmetic procedure. However, people with a deviated septum or enlarged turbinates, which are internal structures and which may be causing breathing problems, can elect to have the septum straightened and the turbinates reduced to give a better airway. Often these are also necessary where the nose has been broken, is crooked and breathes poorly.

Is the cost of cosmetic rhinoplasty greatly reduced when done at the same time as septoplasty or other functional surgery procedures?

Yes, when multiple procedures are done, there is always cost reduction in the second and third procedure performed at the same surgical session.

How old must I be to get a nose job?

Typically young ladies are psychologically and physically mature enough to have it done at age 15. Sometimes even 14. Gentleman, 17 to 18 is considered preferable.

How much time off should I take from school/work following rhinoplasty?

Seven to ten days. Some people have returned in five to six days. The swelling and bruising are a function of various factors including complexity of the case, female menstrual cycle and the tendency to swell and bruise. The symptoms of swelling and bruising always go away. There has never been a patient in the world who has had permanent swelling or bruising after any surgery.

What financing options do you offer?

Our practice and most practices accept credit cards as a form of financing. Also, there are financing companies who finance, sometimes with zero interest for the first year. Generally if one has reasonable credit, financing is available. Even those with poor credit may qualify but typically the interest rate is a little higher.

Will I need to have any post-procedure touch-ups?

It is possible. The percent of patients requiring a surgical revision in our practice is fewer than three in one hundred. Often minor imperfections can be corrected with permanent fillers done three to four months after surgery.

When Do I Come Back To See The Surgeon?

Typically the first office visit after surgery depends on what procedures were done. For a rhinoplasty only operation, the patient is seen one to two days after surgery. The Kotler Nasal Airway™, which allows one to breathe clearly and comfortably after surgery, is removed along with a small tampon. This is painless and quick; the nose is anesthetized with a drop of anesthetic. If a breathing operation has been done, expect the packing and airway to stay in four to five days. The external splint always comes off the fourth or fifth day following rhinoplasty.

When Will I See The Final Results?

The final result emerges over several months. The fact is, even at the first visit four to five days after surgery, the nose is a better nose than it was before. Then it continues to “ripen.” Like fine wine, it takes some time. The photos you see on our web site are taken three to four months after surgery. Generally in the world of all operations, whether heart, lung, skin, nose or arms, there is a 100 day recovery, at which time nature has done 90% of its work. Noses will look very good at three to four months and maybe even a tad better at one year.

What is different about the way Dr. Kotler does the surgery?

Dr. Kotler prefers the internal and closed rhinoplasty technique for its efficiency and absence of external scars. For some people, the external incision may be visible and that is a negative.Therefore if the surgeon has the skill to be able to perform the operation entirely through the nostrils, “like operating through a keyhole,” the patient benefits. Typically there is less swelling at the tip and healing is a little faster.

Another advantage that Dr. Kotler’s long experience and high degree of specialization brings is that he is an efficient surgeon. All surgeons recognize that the most accomplished surgeons are always the most efficient; they operate without pause, uncertainty or delay and get the job done quickly. Not speed for speed’s sake, but rather efficiency and wise methodology. Most of the operation takes place in less than one hour in Dr. Kotler’s hands, and that is deemed quite laudable and valuable.

There is that well-known rule life advice: “KISS; Keep It Simple, Stupid”.We all know from daily experience that the more complicated a job or transaction or activity, the more steps along the way, the more people involved, the less likely the outcome will be as desired.

And, so it is with rhinoplasty. The more complex the operation, with cartilage or bone grafting, whether from the interior nose, or the ear or from a chest rib, the more uncertain the result. Factor in a lengthened operation, with more swelling, bruising and tissue distortion.

That’s why, when possible, the simpler, shorter, approach is preferable. An efficiently executed operation is more likely to be successful.

-Keith Wahl, MD
Facial Plastic Surgeon, Retired
UCSD School of Medicine
Clinical Assistant Professor

Where does the surgery take place?

In our practice, the surgery is done in a licensed, fully credentialed outpatient surgery center on our campus here in the “medical row” of Beverly Hills, California.

When will the results of my “nose job” be visible?

You will see improvement when the dressing is removed. From then on, it just gets better, never worse.

Do you use packing following nasal surgery?

We do use packing. There are benefits to packing, such as easier eating, reducing bleeding and avoiding infection. The packing may be in place for one to five days. However, the negative the packing implies, blocked breathing and a claustrophobic sense, are avoided when Dr. Kotler’s invention, the FDA approved and patented Kotler Nasal Airway™ is in place. This has been a major advance in patient comfort and safety and is used by other sophisticated surgeons in the US and abroad.

Will I have trouble breathing after rhinoplasty?

Not if you have the Kotler Nasal Airway™ in place.

What precautions should I take after surgery?

The main precaution is NOT to take aspirin or other medications, prescription or nonprescription, which may interfere with blood clotting and cause bleeding. Avoid any chance of trauma to the nose. Strenuous exercise should be avoided for ten days. Otherwise, life goes on in a normal manner. People are capable of doing work at home and away from the public eye certainly during the first five, seven to ten days.

Rhinoplasty Before & After Photos

Click photo to enlarge and to read Dr. Kotler’s comments for each case