Beverly Hills revision rhinoplasty superspecialist Dr. Robert Kotler has performed more than 4,500 nasal surgeries in his over 39 years experience. Of the narrow range of facial procedures he performs, this is the one for which he is best recognized.
Because of Dr. Kotler’s core training in the specialty of head and neck surgery, he has unique training in surgery of the nose, both inside and outside.
His military experience further enhances his already considerable skills.
Following his board certification and fellowship training, he studied with some of the worlds’ leading nasal surgeons, including Dr. Howard Diamond of New York City, the most prolific nasal surgeon in the history of the specialty.
For those considering nasal surgery, Dr. Kotler is as specialized and as highly trained a surgeon you can find.
Sometimes Even In The Most Expert Hands Surgery Does Not Go Perfectly
Fortunately most complications, unsatisfactory results and disappointments can be improved upon.
The competent, concerned surgeon knows what to do and will stick with you until the problem is rectified. “With you all the way.” He wants you satisfied. You are his walking advertisement.
Some imperfections or complications improve spontaneously, so the savvy doctor knows to allow nature some time. This is one more way where experience counts. The more specialized, seasoned veterans, having seen it all, have a larger fund of experience to draw from. This helps them better predict the course of events. These pros also tend to be less anxious about the ultimate outcome because they know that either nature, they themselves or a colleague will help correct the situation. The novice, the inexperienced practitioner, often becomes anxious, nervous and uneasy. This visible lack of confidence can spread to you. Your anxiety and worry need not be compounded by your doctor.
Your doctor should explain the problem to you, outline the possible solutions and suggest the best course of action.
Consulting About a Rhinoplasty Redo?
Be careful! A redo or “revision” is more technically challenging for any surgeon, even the most specialized and experienced. A perfect result can never be guaranteed. The decision making is critical. Sometimes, the best decision is to not re-operate. As I advise patients: Better to keep a minor imperfection than to risk a major one.
Be Sure To Ask About Non-Surgical Rhinoplasty Options
For some patients, a satisfactory improvement can be obtained without another trip to the operating room. Some “bumps” or “rises” can be permanently flattened by cortisone injections under the skin. Depressions can be permanently filled with liquid medical grade silicone. An injection of either takes only seconds and can be virtually painless following the application of a topical anesthetic.
There is one nifty and practical way for you to see immediately the obtainable result from a filling injection. The doctor injects sterile saline under the skin to plump up the depressed area. This salt water preparation is a safe, temporary filler that fills within 20 minutes. We call this a demo or a test drive. If you like what you see and feel, you may consider opting for this non-surgical alternative. In addition to avoiding another trip to the OR, there is zero downtime, the cost is far less and since you are awake with mirror in hand you can participate in the “how much will do the job?” decision. Because it is wisest to inject a non-extractable permanent substance “little by little,” several sessions may be required. Most importantly, you decide when the improved appearance satisfies you. You are in charge.
Saline (Saltwater) Demo
To demonstrate the results of permanent silicone injections.
What you can expect after revision nasal surgery, which is very similar to primary nasal surgery.
Additional Revision Rhinoplasty Info
Revision cosmetic and/or functional nasal surgery aims to create a better appearing and better functioning nose. To render your nose more compatible with your other facial features, the changes Dr. Kotler proposes will not make the nose look “unnatural,” or “done.” The goal is to create a natural looking nose that is pleasing and not recognized as having had surgery.
Anesthesia is administered by a physician anesthesiologist specializing in facial procedures. Under anesthesia, there is no pain and no awareness. An intravenous is started and you “drift off” to sleep.
Approximately 1 hour in the operating room.
Usually 1 hour in a fully monitored state of the art recovery room at the surgery center.
Professional care is optional. If you choose to recover at home, someone must be with you the first night. As with all of our procedures, precise instructions, direction sheets and a “care package” of supplies and medications are provided.
Since most nasal procedures are performed entirely internally, dissolving stitches are placed into the nasal interior. These generally need not be removed.
The First Week:
If your surgery has been only cosmetic, you will remove the internal nasal packing at home the day after surgery. Approximately 5 days after surgery, you will return to the office for removal of the protective cast. For patients who have functional surgery, with or without a cosmetic improvement, the packing will be removed in the office 5 days after surgery, at the same time the protective cast is removed. Contact lenses can be worn 2 to 3 days after surgery. At this time, you are free to return to work and usual activities and functions except for strenuous exercise. If there is any bruising at this time, it should disappear within the next 2 to 3 days and can be easily concealed with make-up (we will provide instruction). If you wear eyeglasses, we will teach you to suspend them from the forehead so that the glasses do not rest on the nasal bridge. This precaution must be observed for 5 weeks after surgery.
After That First Week:
Any residual swelling rapidly diminishes. The nasal airway improves daily. Since the nasal interior tends to be somewhat dry after surgery, we provide a soothing saltwater nasal spray to refresh the healing internal tissues. Optimal breathing is generally achieved within 1 month. Generally, you will be seen twice weekly in the first month after surgery to check healing and answer your questions. Thereafter, visits are infrequent. Postoperative photos are taken no sooner than 3 months after surgery. Just in case you long to see what your “old nose” looked like, we provide copies of your preoperative photos to you.