Robert Kotler, MD, FACS, is one of the world’s pre-eminent nose job specialists. 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.
Many people considering cosmetic facial surgery are not certain if their particular situation is appropriate for either the surgical or non-surgical improvement. To help those just beginning the important research and homework, we offer an opportunity for Dr. Kotler to review your photos.
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
“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.”
“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
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.
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..
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.
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.
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.
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.
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..
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.
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.
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.
Most people leave the surgery center one hour after 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.
Yes, when multiple procedures are done, there is always cost reduction in the second and third procedure performed at the same surgical session.
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.
For more information about our practice, or if you have any questions about a particular procedure we offer, we invite you to contact our office using the form below, or call us today at 310-278-8721 to schedule a consultation. We look forward to helping you achieve natural-looking results.