Rhinoplasty and Cosmetic Surgery

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436 North Bedford Drive Suite 201
Beverly Hills, CA 90210

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.

Patient Testimonials

  • 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 Medical Writer

Frequently Asked Questions about Rhinoplasty

What is rhinoplasty or 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.

I want to do the non-surgical rhinoplasty and I want to know can that be permanent?

Yes. Depending on your desires, permanent non-surgical or injection rhinoplasty may be a possibility. The only recognized permanent filler in use for over 50 years in the US is medical grade silicone, used for micro-droplet injection under the skin of the nose. The material marketed by one company under the name Silikon-1000, is FDA-approved for injection inside the eyeball so its safety is quite well accepted. The use under the skin is “off label” but such use, as for other medications and products in Medicine, is accepted as safe and prudent.

I suggest a consultation and particularly “The Kotler Saline Demo” whereby sterile salt water or saline solution is injected to show you what can be accomplished. It disappears within two hours but you see, first-hand, what the result of the permanent filler injections look like. Photos are taken before and after for your study and review at home. Like test driving a car; if you don’t’ like it, no obligation to own it.

Call our office if you have any questions. I have 36 year’s experience with this technique. I doubt any other doctor in the U.S. has such a long run and so much experience with it.

Thanks for inquiring.

– Robert Kotler, MD, FACS

Are all rhinoplasties purely cosmetic?

Rhinoplasty is cosmetic nasal surgery. However, there is an overlap with a functional or medically indicated procedure when the surgery also involves restoring the nose to its normal shape. Athletic injuries are the most frequent cause of such a change, but purely speaking, rhinoplasty or cosmetic nasal surgery is performed to improve upon what nature gave us.

Do insurance companies pay for a rhinoplasty?

No. Insurance policies cover medical problems and not cosmetic surgery. However, one exception is where the operation is being done to restore the nose to its former shape because of an accident. In that case, the doctor’s terminology should be different. It is called a “reduction nasal fracture” or “nasal reconstruction.” The doctor’s office is familiar with insurance billing practices.

Another exception which can be a point of confusion is when having both rhinoplasty and a deviated nasal septum, turbinate resection or sinus surgery to improve breathing. That gets particularly tricky because now your insurance company becomes a participant. One is never quite sure what allowances are going to be made to the doctor, the anesthesiologist and to the surgery center. You should inquire.

The best offices will help answer those questions for you. Often, they can communicate directly with the insurer; although, depending on the policy, that may not be possible. Some insurance companies, particularly if that office does not contract or agree to work for them, do not allow the office to receive the fee information. The patient, or the insured, certainly is entitled to that information. The best offices will help guide you through the maze.

Remember…if you are having functional surgery, do not expect the insurance company to pay for the cosmetic portion. This should be a pro-rated charge. You should also benefit as much as possible from the insurance, such that the rhinoplasty or cosmetic portion becomes a less than full charge “add on.”

How long before one returns to work and normal activities typically?

After a purely cosmetic rhinoplasty, most people will be back to work in seven to ten days. The packing is out and the splint is off by five days and people typically need a couple more days before they go back to work. I returned to practicing full time seven days after my rhinoplasty.

Can a cosmetic rhinoplasty be combined with a functional surgery?

Yes. Whenever possible it is ideal to combine the rhinoplasty with an operation to improve breathing and help prevent sinus problems. The recovery period is approximately the same. It does not take much more operating time. There is even economy of dollars.

If a filler or injection is a reasonable and proper substitute for revision rhinoplasty, when can that be done?

Generally, not sooner than the three to four month mark. Interestingly, nature takes 100 days to heal everywhere in the body. I have had my own experience with other surgeries and it is absolutely fascinating to see that at 100 days external scars are soft and mature and all the areas are free of pain with mobility. It is the magic “100 days,” and it is no different for nose surgery than for surgeries elsewhere on the body.

If I am not happy with my nose at three months and there is an indication for revision surgery, when is it done?

Typically, most surgeons like to wait at least six months before revision surgery is done and sometimes up to nine months. The reason is that there is still a need for the nose to settle down and be free of any thick internal scar tissue. Generally, it is wise to wait six months. It may be that you have a breathing problem that needs to be corrected and that can be done sooner than six months. For the purely cosmetic aspects, if you are comfortable waiting at least six months, that is wise.

If one plays contact sports such as basketball or other sports that might endanger the recently operated nose, how long does one have to wait?

Typically, the nose is as structurally stable and firm as it is going to be within five to six weeks. Remember that if you break your arm, it is eight weeks; about the same for a leg. The nose heals a little quicker because the bones are the thinnest bones in the body. If you have any qualms about returning to contact sports sooner than that, you need to discuss with your doctor about obtaining a face mask as you have seen some athletes wearing.