Media Await "The Money Shot."

The eminent Beverly Hills board-certified plastic surgeon Stuart Linder, M.D – our “Dr. Body” blogger—talks about some of the behind-the-scenes stories that happen when Hollywood celebrities try to have plastic surgery in secret. Also commenting is the well known Robert Kotler, M.D., a top Beverly Hills board-certified cosmetic plastic surgeon who has appeared on television’s Dr. 90210 r. Dr. Kotler – a member of the American Medical Writers’ Association – blogs as “Dr. Face”.

The  American Plastic Surgeon bloggers additionally belong to many professional organizations, including:

• · The American Academy of Facial Plastic Surgery and Reconstructive Surgery.
• · American Board of Plastic Surgery
• · The American Medical Association

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Dr. Face (Dr. Kotler): Not too long ago, a leading talk show hostess  with a household name – and face — recognizable to everybody, scheduled some plastic surgery for 4:00 in the morning and drove herself to a nearby parking garage. But she was apparently still sleepy and crashed her car into a support beam inside the garage and attracted all types of attention, including the police, to herself.

Dr. Body (Dr. Linder): And you don’t mention her name because…….

Dr. Face: Medical privacy. There are strict federal laws these days about identifying any patient with a medical procedure. Celebrities have always required anonymity because they want to project and protect an image of natural, untouched good looks and complete natural beauty. Even though,  by the way, we doctors do not require laws to protect patient identities. Patient confidentiality, without exception, is accepted by society. Not even a court of law can require us to testify about any medical issue, including cosmetic plastic surgery, related to any patient. Famous or otherwise.

Dr. Body: I also heard a story from an older plastic surgeon about Fanny Brice, a famous actress of the 1930s and 40s. She insisted on having plastic surgery in a hotel room instead of a hospital just to keep the story out of the papers.

Dr. Body: I heard an anecdote about a celebrity who is no longer with us – Gary Cooper. I heard the story from the surgeon to whom it happened when he was working, back in the 1950s. Anyhow, Cooper thought his looks were fading a bit so he had a face lift here in Beverly Hills and then accepted an offer from the surgeon to stay in his home while recuperating. It was all supposed to be hush-hush, of course, but the surgeon’s eight-year-old son went to school and told everybody he knew. When the surgeon left for work the next morning, he found his front yard full of reporters and photographers.

Dr. Face: That situation no longer exists for celebrities who not only have cosmetic surgery in complete secrecy but have secret hide-a-ways with nursing staff in and near Beverly Hills.

Dr. Body: We also accommodate models, actresses and other celebrities with a back entrance and invented names on paperwork. It’s very important because people’s ability to make a living is at stake. When a patient leaves my office with a breast augmentation and then makes it into a Playboy magazine centerfold, well, I’ve done more than my job.

Dr. Face: Speaking of recovery centers: I can think of one well known establishment that is known in medical circles as the “Face Lift Hotel”. My patients have used it many, many times. In one case, a man who owned an entire island brought his girlfriend to the recovery center with him. Part of my post-op instructions to rhinoplasty or face lift patients are to refrain from intimacy for ten days because sexual activity will raise the blood pressure to dangerous levels.

Dr. Body: I think I see where this is headed….let me guess, he did not follow doctor’s orders, things got steamy with his girlfriend and…

Dr. Face: Yes! He started bleeding from an incision. So I was summoned from my own bed in the middle of the night to do a quick remediation which did the trick. But I do think he followed my instructions for the rest of his stay in Beverly Hills because there were no more bleeding episodes and his surgery healed just fine. I’m familiar with most aftercare facilities because it is often much easier for me to go there for the morning after surgery medical check than to have the person risk another trip to my office through the throngs of photographers.

Dr. Body: Celebrity photo hounds are so driven, they know the car license plate numbers of top actors and actresses. Thus, famous people who are more camera shy and familiar with photo stalkers wily ways just rent a car to go the plastic surgeon’s office.

Dr. Face:  I once had a very famous actress leave my office after a follow-up appointment for a nose job. But before she walked out the door, she put on a pith helmet with shoulder length dark mosquito netting attached the rim. The U.S. President could have been wearing that get-up, but nobody would ever know it!

Dr. Face:  Bottom line: about the most educated guess among Beverly Hills plastic surgeons is that most celebrities over age 40 have had some cosmetic plastic surgery and will be in the market for more, later on. So the chase will not end soon; newshounds find ever more clever ways to find out what star is having what procedure while plastic surgeons and the stars’ continue thinking up ways to avoid them.

Dr. Body: That’s right, doctor; news people pay huge tips and finder’s fees for good information; they have a whole network of eager “spies” including people on the stars’ own payrolls, bus boys, waiters, parking garage attendants, gatemen and guards at the studios and many, many others. Some news organization members have gone through surgery just to check themselves into a recovery center to get to know a star as just another patient while some news outlets have even purchased homes next door to celebrities to get the “untold” story.

Dr. Face: The only practical answer is operating in the middle of the night! The paparazzi don’t figure on us operating while they snooze.

A broken nose? Not so!

The well known Beverly Hills board-certified plastic surgeon Stuart Linder, M.D – who blogs as “Dr. Body”– tells about the most common myths that patients ask about. Also commenting is the equally well known Robert Kotler, M.D., a top Beverly Hills board-certified cosmetic plastic surgeon (and a former Dr. 90210 star) who blogs as Dr. Face; he also tells about the myths and beliefs he hears.

Dr. Face is a member of the American Academy of Facial Plastic Surgery and Reconstructive Surgery. Dr. Body holds a membership  in the American Society of Plastic and Reconstructive Surgeons, among many other medical organizations.

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Dr. Face (Dr. Kotler): I don’t know about you but I’ve found a few myths about facial plastic surgery circulating out there. We hear them at the first patient consultation.

Dr. Body (Dr. Linder): Such as?

Dr. Face:  Take rhinoplasty, for instance. The myth seems to be that the nose will be “broken.” Some prospective patients seem to envision the process of correcting any malpositioned nasal bones as crude and barbaric. In reality, the nasal bones are sometimes re-aligned and must first be parted but it’s not as though you take a sledge hammer to the nose. Actually, that realignment is a carefully and delicately controlled repositioning of the nasal bones. In addition, the patient is asleep and we use drugs to control pain and bleeding, if any.

Dr. Body: The most common question like that I get in body surgery is from breast augmentation patients who want to know if it’s really true that breast implants must be replaced every ten years.

Dr. Face: How do you explain it?

Dr. Body: I tell the patient that that any one breast enhancement procedure will probably result in another such operation sometime during the life of the patient. But it’s nothing predictable like when the oil in a car must be changed. And, yes, implants do fail due to wear and tear but I have no way of knowing when that might happen. It might be in 20 months or 20 years. I’ve seen both extremes.

Dr. Face:  After I explain the broken nose myth, I listen carefully to make sure that nose surgery patients understand they will look quite decent by ten days after the operation and very good indeed by two weeks. Some have the misconception they will appear battered and bruised for months, post-op. Nasal surgery super-specialists typically deliver results that look very good only seven days after the procedure.

Dr. Body: I must tell breast enlargement patients one thing they hate to hear.

Dr. Face: The cost of plastic surgery?

Dr. Body: No, that they can’t take a shower for 14 days after getting breast implants. But there is a method to my seeming madness. Water washing into a fresh wound can cause a staph infection which means the entire procedure has to be redone. But patients who take no showers for two weeks after the procedure have an infection rate of 1/10^th of one percent. The usual, common, accepted benchmark is an infection rate of about one percent of patients.

Dr. Face:  Even though nose surgery patients look good after one to two weeks, I have to remind them the nose will be fragile for at least six weeks.

Dr. Body: I almost always put breast implants under the chest muscle so I receive a lot of questions about why that is necessary. (Read more about breast implants placed under the muscle.) Many want to know when they can again exercise and the answer to that is a minimum of three weeks. For tummy tuck patients, it’s more like six to eight weeks.

Dr. Face: Many patients quiz me about training. They often ask about the difference between a general plastic surgeon and facial plastic surgeon.

Dr. Body: What do you say?

Dr. Face: Easy. While a general plastic surgeon performs cosmetic procedures all over the body, the facial plastic surgeon limits his work to the face and neck. Training for that is two years of post-M.D. training in general surgery followed by at least another four years specializing in head and neck surgery and facial plastic surgery. Surgeons who want to be eligible for certification by the American Board of Plastic Surgery must complete a minimum of three years of general surgery and three years of plastic surgery throughout the body. Fellowships, the finishing school of both specialties, can add another one or two years of training.

Dr. Body: Next time, let’s talk about how the media influences the practice of plastic surgery. I know I’ve got some thoughts on it and I’ll bet you do, too.

Dr. Face:  In spades, doctor! In spades!

A doctor's comforting hand

Both the eminent Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. (Dr. Body) and and the equally eminent Beverly Hills board-certified facial plastic surgeon Robert Kotler, M.D. (who blogs as Dr. Face) rely heavily on the sense of touch to produce rejuvenations that delight patients.

Often mentioned are the many extra years of training – four to seven years after medical school — required to become a board-certified cosmetic plastic surgeon.

Part of that education comes through hands-on experience that teaches a surgeon’s fingers and hands to walk their way around the human body, guided by the sense of touch.

Jointly, Doctors Face and Body belong to the following medical organizations, including:The American Academy of Facial Plastic Surgery and Reconstructive Surgery; the American Board of Plastic Surgery and The American Medical Association.

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Dr. Body (Dr. Linder:) I was thinking about the sense of touch yesterday while doing some liposuction. In liposuction, a plastic surgeon uses a long suction tool, known as a cannula, inserted through a very small incision in fatty areas. And the only way I know exactly how deep I am in the body is by the way the cannula feels in my hand. I can’t actually see inside the body. And there are three levels, or planes, within two inches under the skin where I remove fat.

Dr. Face (Dr. Kotler:) Can you tell if you are no longer thrusting the tool through fat?

Dr. Body:  Absolutely! It’s the sense of touch that lets me know I have left a fatty area and am approaching muscles with the tool. In fact, one of the dangers of liposuction in untrained hands is puncturing an internal organ with that long tool.

Dr. Face: So if you read that a physician trained in, say, radiology, is offering liposuction to the public after learning the technique in a weekend course, how do you react?

Dr. Body: My hair stands on end! The basic thought in my mind is “Yikes!”

Dr. Face:  With expert plastic surgery professors as your guide, how long did it take to learn it and then feel confident offering to your patients?

Dr. Body: A good six months to learn the technique and a couple more years to offer the procedure with confidence – and also to know when NOT to do it.

Dr. Face: In my area of plastic surgery – facial surgery – surgeons must often lift the skin from the underlying facial and neck muscles. That’s done over the cheekbone, jaw and neck regions. It must be done very diligently and carefully because vital nerves and blood vessels are just underneath.

Dr. Body: Is there an instrument that tells you when enough is enough?

Dr. Face:  Not exactly. After years of watching masters and doing basic general surgery, a facial plastic surgeon uses his or her thumb and forefinger to feel the skin’s thickness to gauge the level of dissection.

Dr. Body: What about the nose? You can’t lift all of that skin, can you?

Dr. Face: Again, the sense of touch tells you. The skin must be lifted from bone and cartilage, the skeleton, to modify the basic shape of the nose. In some nasal procedures, the bones of the bridge of the nose must be realigned while cartilage may need to be trimmed.

Dr. Body: Do you mean broken?

Dr. Face: Yes. And that is also done with thumb and forefinger which first feel the precise location. The other critical part is being able to visualize all the tiny and intricate structures of the nose in your mind. Again, that comes after years of training and experience.

Dr. Body: Breast augmentations and breast revisions are somewhat like that, too. No patient wants a large scar on her breast so we make the incision only as long as necessary and then rely on the sense of touch to know how much we can stretch the incision without tearing it. Then, we use our fingers to work the breast implant into the pocket and feel when it is positioned properly.

Of course, that incision must be a little larger for a silicone breast implant. We use a surgical tool to help with that but just the right amount of force must be applied. Just a tad too much and you may have an unhappy patient.

Dr. Face: Right! The last person we want to have a “Yikes!” moment is a patient!

Plastic Surgeon with Knife

The eminent Beverly Hills board-certified plastic surgeon Stuart Linder, M.D – the “Dr. Body” blogger—mentions a few cosmetic plastic surgery procedures worth skipping. Also weighing in with “don’t bother” procedures for face and skin is the equally well known Robert Kotler, M.D., a top Beverly Hills board-certified cosmetic plastic surgeon and former Dr. 90210 star. Dr. Kotler’s  Nome de plume in the blogosphere is “Dr. Face”.

Drs. Face and Body jointly belong to many medical organizations, including:

• · The American Academy of Facial Plastic Surgery and Reconstructive Surgery.
• · American Board of Plastic Surgery
• · The American Medical Association

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Dr. Body: (Dr. Linder): Do patients ever ask for cosmetic plastic surgery procedures that really aren’t in their own best interests?

Dr. Face: (Dr. Kotler) Do they ever! So many new operations and techniques are written up by eager, breathless marketers that some unquestioning patients are excited and willing to have the procedure.

Dr. Body: Such as?

Dr. Face: So-called “facelifts” done by threads or sutures. The threat fad hit the medical marketplace around 2006. The concept was that a barbed thread inserted in facial skin would lift and hold sagging tissues. Purportedly, with tiny incisions, less bruising and a shorter recovery period.

Dr. Body: Were patients happy with it?

Dr. Face: No. Many patients found the threads would not support the weight of the facial tissues. In many other cases, the threads popped through the skin. Other patients noticed waves in their skin. Eventually, one major company took their threads off the market.

Dr. Body: Many of my patients have read about laser liposuction and asked about it – if not for it. I explain that laser liposuction has not been shown to improve results done by tumescent liposuction which the professional plastic surgery associations consider the “golden standard.” Tumescent liposuction has a long track record of safety, produces good results and is easily tolerated by patients.

Dr. Face: I can think of another reason to avoid laser liposuction. The new machines are very expensive, easily running into six figures. That only drives up the cost of plastic surgery, sometimes as much as several thousand dollars.

Dr. Body: What other Johnny-come-latelys have you seen, doctor?

Dr. Face: For a while, there was a huge craze in so-called “lunch time”, “one hour” or “quick” facelifts. But time and experience have shown the benefits minimize after only several months. Plus, the incision marks often show. Basically, like in any human endeavor, minimal efforts will result in minimal results.

Dr. Body: I have another situation something like that in breast surgery. Somehow, the TUBA, or transumbilical breast augmentation became popular. A TUBA inserts saline breast implants into and under the breast via a tiny incision in the belly button. But the surgeon works with such long tools and so far away from the breasts, the implants are often badly placed. That results in a not-so-great appearance for the patient. Not a week goes by without seeing a patient who wants a correction surgery for her TUBA.

Dr. Face: And we work through the naval because…?

Dr. Body: Because the scar is hidden in the creases of the naval. However, working through the areola, the brown area surrounding the nipple, the surgical scar is not that noticeable and does lighten and fade in about  a year. Standing directly over the breasts gives the surgeon precise control over implant placement and controlling the symmetry of the two breasts along with the amount of cleavage, if any.

Dr.  Face: Many patients ask for a neck lift or want only neck liposuction. But that’s a mistake without removing deeper fat and tightening the platysma, the major neck muscle that results in a “turkey gobbler” neck with normal aging. Skip tightening that muscle and the vertical neck bands may look more obvious than before. The skin is not the problem; it’s the underlying excess baggage.

Dr. Body: I can think of another patient request that is not in their best interests. And that’s buttocks augmentation. In my opinion, both methods – a buttocks implant if the patient is thin or a fat transfer to the buttocks – are doomed because people spend so much time sitting. All that puts immense, killing pressure on the new fat cells injected into the patient’s rear or creates other problems for the implant.

Dr. Face: Speaking of skin, I’ve noticed that the non-invasive surface skin treatments, Thermage and Titan, purport to tighten sagging skin usually but usually result in disappointed patients who are also unhappy with the high cost of the procedures. For instance, I notice on realself.com that of 179 reviews of Thermage or Titan neck lifts, only 40 percent of patients said it was worth it.

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Look at Dr. Body’s before and after breast augmentation revision pictures

See Dr. Face’s before and after nose surgery revisions pictures.

Plastic surgeon does a breast augmentation

The well known Beverly Hills board-certified plastic surgeon Stuart Linder, M.D – who blogs as “Dr. Body”– tells about the most common questions body patients ask. Also commenting is the equally well known Robert Kotler, M.D., a top Beverly Hills board-certified cosmetic plastic surgeon (and a former Dr. 90210 star) who blogs as Dr. Face and tells the FAQs (frequently asked questions) that facial plastic surgery patients want to know.

Dr. Face is a member of the American Academy of Facial Plastic Surgery and Reconstructive Surgery. Holding a membership, among many others, in the American Society of Plastic and Reconstructive Surgeons is Dr. Body.

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Dr. Face: I don’t know about you but I’ve found a few myths about facial plastic surgery circulating out there. We hear them in the first patient consultation.

Dr. Body: Such as?

Dr. Face:  Take rhinoplasty, for instance. The myth seems to be that the nose will be broken. Some prospective patients seem to envision the process of correcting the nasal bones as crude and barbaric. In reality, the nasal bones are sometimes re-aligned and must first be parted but it’s not like you take a sledge hammer to the nose. Actually, that realignment is a carefully controlled repositioning of the nasal bones. In addition, the patient is asleep and we use drugs to control pain and bleeding, if any.

Dr. Body: The most common question like that I get in body surgery is from breast augmentation patients who want to know if it’s really true that breast implants must be replaced every ten years.

Dr. Face: How do you explain it?

Dr. Body: I tell the patient that that any one breast enhancement procedure will probably result in another such operation sometime during the life of the patient. But it’s nothing predictable like when the oil in a car must be changed. And, yes, implants do fail due to wear and tear but I have no way of knowing when that might happen. It might be in 20 months or 20 years. I’ve seen both extremes.

Dr. Face:  After I explain the broken nose myth, I listen carefully to make sure that nose surgery patients understand they will look quite decent by ten days after the operation and very good indeed by two weeks. Some have the misconception they will appear battered and bruised for months, post-op. Nasal surgery superspecialists typically deliver results that look very good only seven days after the procedure.

Dr. Body: I must tell breast enlargement patients one thing they hate to hear.

Dr. Face: The cost of plastic surgery?

Dr. Body: No, that they can’t take a shower for 14 days after getting breast implants. But there is a method to my seeming madness. Water washing into a fresh wound can cause a staph infection which means the entire procedure has to be redone. But patients who take no showers for two weeks after the procedure have an infection rate of 1/10^th of one percent. The usual, common, accepted benchmark is an infection rate of about one percent.

Dr. Face:  Even though nose surgery patients look good after one to two weeks, I have to remind them the nose will be fragile for at least six weeks.

Dr. Body: I almost always put breast implants under the chest muscle so I receive a lot of questions about why that is necessary. (Read more about breast implants placed under the muscle.) Many want to know when they can again exercise and the answer to that is a minimum of three weeks. For tummy tuck patients, it’s more like six to eight weeks.

Dr. Face: Many patients quiz me about training. They often ask about the difference between a general plastic surgeon and facial plastic surgeon.

Dr. Body: How do you explain it?

Dr. Face: Easy. While a general plastic surgeon performs cosmetic procedures all over the body, the facial plastic surgeon specializes from the neck up. Training for that is two years of post-M.D. training in general surgery followed by at least another four years specializing in head and neck surgery and facial plastic surgery

Dr. Body: Next time, let’s talk about how the media influences the practice of plastic surgery. I know I’ve got some thoughts on it and I’ll bet you do, too.

Dr. Face:  In spades, doctor! In spades!

Will My Neck Lift Last?

With all the travel, costs of plastic surgery and other arrangements involved, one of the first questions to pop up is: “How long will my new look last?”

The well known Beverly Hills board-certified plastic surgeon Stuart Linder, M.D – who blogs as “Dr. Body” tells how long body procedures usually last. Also commenting is the equally well known Robert Kotler, M.D., a top Beverly Hills board-certified cosmetic plastic surgeon (a former Dr. 90210 star)  who blogs as Dr. Face. The duo tell what you can expect with the longevity of your rejuvenation surgery.

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Dr. Body: (Dr. Linder) For breast enlargement, there are so many various factors at work, it’s very hard to tell exactly how long a breast surgery will look good.

Dr. Face: (Dr. Kotler) When you are asking about procedures of the face and head, anything that involves bone or cartilage is good for life. That includes ear pinning, or, otoplasty and rhinoplasty, although any nose will naturally change over time and with normal aging. Cheek and jaw implants should be good for life, too.

Dr. Body: There’s a popular myth about breast augmentation, that a woman will need a replacement once every ten years.

Dr. Face:  A myth?

Dr. Body:  It’s due to Mother Nature’s healing process. There is just no pinning down the body’s reaction to a breast implant – which your body sees as a foreign invader – so you may need a replacement in two decades, 14 years, tomorrow or never.

I always recommend that breast enlargement patients ask about a warranty for their breast implants. Some companies will even help with the cost of a breast revision surgery if the implant fails.

Dr. Face: So what can you safely forecast for your patients about breast surgery?

Dr. Body: Breast reduction, for instance,  is fairly dependent on the patient, so if she does not gain a lot of weight and wears a bra with a wire bottom, her reduction should last eight to ten years. But even if she gains just a little weight elsewhere on her body, her breasts may grow to be extra large and once more painful.

Dr. Face: Facial skin and its attachments can be something like that, too. A facial plastic surgery patient may see some sagging of the skin after three to five years, but patients who take care of themselves with diet and exercise may enjoy an enhanced appearance for ten years or longer. We have seen patients who still look quite good 20 or more years later.

Dr. Body: More and more, with the Lap Band and other bariatric surgery, some patients are experiencing what we call Massive Weight Loss (MWL). After losing anywhere from 100 to 150 pounds, the  patient is left with hanging sheets of skin which we plastic surgeons trim in  procedures known as body shaping.

Dr. Face: I bet the results depend on keeping the weight off!

Dr. Body: Right. And when the weight stays off, a brachioplasty — the procedure that removes loose flopping skin from the upper arms – will last a lifetime. Same with body shaping on the upper thighs and the abdomen – provided no more weight is lost. But if the patient loses another 50 pounds, she will have yet more loose, hanging skin.

Dr. Face:  Isn’t there a trade-off in body shaping operations?

Dr. Body: Yes, long scars. In brachioplasty, the scar runs from the armpit to the elbow. On a thighplasty, the scar is on the inside of the thigh from the knee to the crotch. And for the stomach, a panniculectomy produces a long scar across the abdomen or even all the way around the body when the belt lipectomy, or lower body lift, is performed. But those scars lighten and fade over time, like all scars.

Dr. Face: Some facial patients ask how long lip augmentation will last. In some patients, a solid or gel filled implant works. Those could last indefinitely but….

Dr. Body: But what?

Dr. Face:  For lips, removal of any implant is very difficult in case anything goes wrong and is very likely to provide uneven results. Because the lips are in the center of the face, even a small uneven result is extremely noticeable and bothersome to patients. I am not in favor of solid implants; I like the absorbable injections.

Dr. Body: So what do you usually recommend?

Dr. Face: The facial fillers Juvederm or Restylane provide excellent results although the procedure has to be repeated every six months or so. Imperfections, if any, will disappear as the material dissolves over several months. With lips, you need to hedge your bets. They must look perfect or they shout out.

Dr. Body: What about the neck lift when a patient shows up with a so-called “turkey gobbler” neck? How long does that surgical repair last?

Dr. Face:  Like many facial procedures, it’s not necessarily the skin, it’s what is under the skin. In this case, some fat pads and a natural, age-related sagging of the platysma, the neck muscle that runs from the collarbone to just under the chin. We shorten that muscle so it does not show through the neck skin and also liposuction some excess fat.

Dr. Body: It all lasts how long?

Dr. Face: Eight to ten years. It may need a follow-up nip or a tuck after that.

Dr. Body: Can you think of other things that last indefinitely?

Dr. Face: Sure! Taxes and political hijinks!

A Good Read, Anybody?

Surgeons AND  authors? That describes the eminent Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. (who blogs as Dr. Body) and Robert Kotler, M.D.

an equally eminent Beverly Hills cosmetic plastic surgeon who blogs as Dr. Face.

Here, Doctors Face and Body tell how and why they wrote books filled with insider tips and information about getting the very best from what American plastic surgery has to offer.

Dr. Face holds a membership in the American Academy of Facial Plastic Surgery and Reconstructive Surgery while Dr. Body is a member of the American Society of Plastic and Reconstructive Surgeons.

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Dr. Body:  (Dr. Linder) What started you as a book author, doctor?

Dr. Face: (Dr. Face) In about 2001, I kept adding information about face lifts, rhinoplasty and other surgeries of the face to a brochure in my waiting room until it ran to about 144 pages.

Dr. Body: That’s a lot of mimeograph ink!

Dr. Face: Sure. So I eventually added a preface, pictures, captions, editing and an index, gave it to a publisher and — Voila! – I’m an author, now three times over. Before writing the educational books for patients, I had written a textbook for doctors entitled “Chemical Rejuvenation of the Face”. I wanted something patients could take home and study. Or, better yet, read before our first appointment.

Dr. Body: I wrote the “Beverly Hills Shape” a book about plastic surgery of the body because I wanted patients to know the consequences and risks of rejuvenation surgery. I think one of the first quotes in the book is a seldom revealed truth that every patient should know going in: “No plastic surgeon can guarantee the final appearance of a scar.” In nature, scarring is unpredictable.

Dr. Face: I wanted to make it easy for patients to not only find but to compare surgeons. So I created a “take-this-book-with-you” workbook: “The Essential Cosmetic Surgery Companion. Don’t Consult A Cosmetic Surgeon Without This Book!” For use during your initial consultation, it provides blank outlines of the body for the surgeon to draw in where scars will be and gives the key questions to ask.

Dr. Body: Good point! Beverly Hills may be the world Mecca of plastic surgery, as many claim, but it is still a case of buyer beware. I think the common thread between our two books is, suggesting  to consumers the questions we ourselves would ask if we were sitting before a surgeon, trying to decide if this was the person who would perform our surgery. With a combined 10,000 surgeries over 60 years, I think we’ve covered the bases!

Dr. Face:  That’s right. I have no way of providing the actual figures but physicians not trained in cosmetic plastic surgery could actually outnumber the surgeons who have an extra four to seven years extra training beyond the M.D. degree.

Dr. Body:. The first, most on-target question to ask a surgeon during your consultation appointment is: Are you board-certified in plastic surgery? Or, in your case, board-certified in head and neck surgery, Otolargyngology?

Dr. Face: Right, those are the only two specialties recognized by the American Board of Medical Specialties (www.abms.org) to perform cosmetic plastic surgery.

Dr. Body: What do readers especially like about your books?

Dr. Face:  My most recent, “Secrets of a Beverly Hills Cosmetic Surgeon” tells when a rejuvenation surgeon will be happy to grant a discount. Also include: the 15 smartest questions to ask during your first visit.

Dr. Body: I think my book reflects my personal style which is frankness, boarding on bluntness. Sometimes, insider information is never mentioned to patients. For instance, many breast augmentation patients are surprised to learn that, given one breast enlargement surgery, it is very likely she will have at least more operation at that location some time during her life.

Dr. Face: I’ve had many patients tell me they really appreciated the section on how you can have two procedures at once – sometimes, by two superspecialist surgeons, and create a savings in operating and anesthesiologist fees as well as time saved by going through one recovery, and not two.

Dr. Body: What about before and after plastic surgery pictures?

Dr. Face:  Good point! Those are a major source of information about a surgeon any patient should use. I think both books offer some major pointers.

Dr. Body: The surgical center in which your operation takes place is just about as important as the selection of the surgeon. Once you know what to look for, it’s easy to rest assured you are in a top quality operating room with the highest safety standards.

Dr. Face: Can you think of any other common threads in the two books, doctor?

Dr. Body: A few. The tomes are not tattle tale, tabloid-style books about famous peoples’ plastic surgery, but how-to manuals for the smart consumer who wants the best possible outcome in safety at the best possible price.

Dr. Face:  I don’t know about you, but I did have some fun at the library while writing mine.

Dr. Body:  How so?

Dr. Face: I heard three separate writers ask the reference librarian if they knew of any other books by Ibid, that they seem to be seeing his name everywhere.

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Read more about Dr. Face’s book on cosmetic plastic surgery, “Secrets of a Beverly Hills Cosmetic Surgeon.”

Here is Dr. Body’s book on plastic surgery of the body, “The Beverly Hills Shape.”

Perhaps you have seen Dr. Kotler on T.V.’s Dr. 90210 or Dr. Linder on The BBC (British Broadcasting Corporation) programs about American plastic surgery.

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Dr. Face (Dr. Kotler): I’ve noticed that some of my face lift and rhinoplasty patients, when returning for their after surgery check-up, mention how cold it was in the operating room.

Dr. Body (Dr. Linder): That’s understandable but there are some things that patients can do.

Dr. Face:  I think I know where you’re going but what do you have in mind exactly?

Dr. Body: Speaking up! If a patient is in any way uncomfortable, he or she should let somebody know. There are some very good medical reasons for a patient not to be chilly but we also want your surgery to be as pleasant as possible. We have blankets available.

Dr. Face: Of course. Remember that all our procedures are done under anesthesia so the patient will be made warm by the sheets and coverings placed over him or her. So recollections of  “the cold operating room” is only for the five short minutes before going to sleep. In the 1960s’, before air conditioning came into wide use in hospitals, the room could become stifling. As you observe, the huge lights produce heat and the surgeon is also encased in his surgical gowns.

Dr. Body: True enough, doctor. I personally like it cool in the operating room because bacteria grow like crazy in heat. Coolness tends to stifle any stray bacteria that have floated into the room.

Dr. Face:  A very warm room can also make the surgeon groggy or work without efficiency. Back in the pre-A.C. days, surgeons have been known to drip sweat onto patients!

Dr. Body: Today, our high-tech monitors measure the patients’ temperatures, blood pressure, carbon dioxide and oxygen saturation. So patients’ body temperature can be kept at the proper level.

Dr. Face: When needed, even in the pre-op and post-op areas, we can always rig up a special warmer, known as a Bair Blanket. It’s like a very light weight sleeping bag that blows warm air down its length and over the slumbering patient. Patients love it more than electric blankets.

Dr. Body: If anesthesia did not paralyze the muscles, we could watch for goose flesh!

Dr. Face:  If you tend to be “cold blooded”, ask your surgeon if it’s possible in his operating room to warm the fluids before they are transfused into you. We have little ovens to warm the intravenous fluids. Sorry, the one thing we can’t offer is a hot cup of coffee.

Dr. Body:  What did we ever do without microwave ovens?

Dr. Face: Large toaster-type warmers. Now, We use them now to warm ordinary blankets.

Dr. Body: Another place that some patient body heat is lost is in body surgery. If incisions are long, as in a tummy tuck or body shaping, some heat escapes through the incisions.

Dr. Face: There are even smaller Bair devices that warm smaller areas like only the legs or only the chest.

Dr. Body: Now, if somebody would just come up with a way for stethoscopes and other instruments to be instantly warm before touching anybody’s bare flesh!

Dr. Face: Actually, I’ve seen instrument warmers for the office; certainly gynecologists use them. Another way to warm a stethoscope is the old-fashioned way: the doctor, hands washed, presses the stethoscope against the palm of his hand. That’s the ultimate low-tech warmer.

NEXT: Both Dr. Face and Dr. Body are book authors. Dr. Face’s most recent book, “Secrets of a Beverly Hills Cosmetic Surgery” about cosmetic plastic surgery can be seen online. You can also find Dr. Body’s book—The “Beverly Hills Shape” is about  plastic surgery of the body and is at online bookstores.

In our next post, we’ll tell how those books came to be and why they are valuable if you are coming to Beverly Hills for rejuvenation surgery.

In America, certain conditions allow cosmetic plastic surgery on people under 18. The eminent

According to the American Association of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) about 203,308 patients 18 and under had some type of cosmetic plastic surgery in America during 2009, ,the most current year for which statistics exist.

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Dr. Face (Dr. Kotler): I frequently see the members of a family from overseas who keep a house in California for business, educational and cultural reasons.  They usually stay four to six months before returning home but it seems like, every year, another member of this household comes in a for a consultation because many of their children go to college here.

Dr. Body (Dr. Linder): For what procedure?

Dr. Face: It was one of their young cousins, actually, for the otoplasty procedure, commonly known as ear pinning. But in their home nation, people under 18 are not allowed to have any plastic surgery for cosmetic reasons.

Dr. Body: There are thousands of cruel jokes about children with big ears; I bet that kid has heard them all – in several languages, no less!

Dr. Face: That’s right. In America, because of the huge amount of teasing and ridiculing a child faces in school, we prefer for otoplasty to take place at five, before the child starts school. Otherwise, the child can feel singled out, rejected and starts to develop all type of complexes that can affect him an entire lifetime. About 9,700 such surgeries were done on the ears of American patients under 18 in 2009. The average cost of the plastic surgery in the U.S. is about $3000 for the surgeon’s fee.

Dr. Body: Same thing exists in procedures of the body. One of the most common is in teen boys who develop large, fleshy breasts during puberty due to a condition known as gynecomastia. Many pediatricians advise against surgery to reduce those breasts because the lad might have a growth spurt in the late teen years and outgrow the condition.

Dr. Face: I see the problem. While a youngster should be learning new ways to cope with girls, school, sports and develop a measure of confidence and self-worth, he is usually humiliated daily. Instead of becoming outgoing and social, he spends much of his precious teen years trying to hide his breasts and withdrawing from social contacts.

Dr. Body: Teen girls experience a similar situation when they have a common developmental condition known as tubular breasts. Normally, it’s a good idea not to perform breast augmentation until the patient is somewhere around 20 because growth spurts are very common.

Dr. Face: And what’s the situation with tubular breast deformity?

Dr. Body: Those breasts are a true deformity, will remain small and unbalanced and usually take on the shape of small sausages. They are often cruelly known as “Snoopy breasts” and are the focus of harsh teasing by other young girls.

Dr. Face: You would also see some breast reductions, too, among teen girls, would you not?

Dr. Body: Yes. Overlarge breasts on a teen girl – medically known as gigantomastia – not only results in negative attention from boys and men but is also painful. In some cases, each breast weighs between 10 and 20 pounds. Having extremely large breasts usually causes back pain. Due to the extra weight of bra straps on the shoulder bones of such patients, grooves in those bones are often created. American health insurance companies tend to allow breast reduction because the surgery prevents further complications and health problems down the road.

Dr. Face:  In procedures of the face, we often do rhinoplasty for a young man at 17 years of age if our consultation turns up anything about breathing problems. Most often, young patients most interested in a nose job are in their final years of high school, headed for college and can use the extra lift of self confidence that goes along with an aesthetic nose.

Dr. Body: Other, common young person requests are to treat acne and scars. Dermabrasion, microdermabrasion or chemical peels are usually just the tickets for that.

Dr. Face: Over the years, I’ve learned to listen very carefully to young patients during pre-surgery consultations. I listen closely to who is not talking, as well. If a mom or dad is going on and on about what junior miss or the young man needs, I’m not so inclined to go ahead with the surgery. Bottom line in plastic surgery is responding to the wishes and desires of the patient, regardless of age. If a hump on junior’s nose bothers mom or dad more than junior himself, it’s usually a no-go.

Dr. Body: I also like to talk to young patients a lot before surgery to see if the young person fully understands the process and what goes on. I need to know he or she understands the surgery, the recovery and healing process and what the patient must do for himself.

Dr. Face: Right!  When a teen says he or she wants to look like a favorite rock or movie star, the Red warning flags go up and I suggest another consultation in a year. Hopefully, another year of development will help them mature and bring their wishes down to earth.

Dr. Body: Teens are truly amazing!

Dr. Face: I will always remember mine as people who could not remember to feed the pets but nonetheless held a hundred cell phone numbers on the tips of their tongues.

Look at some of Dr. Face’s before and after pictures of young Otoplasty (ear surgery) patients.

Here of some Dr. Body’s before and after pictures of tubular breast deformity surgeries.

How Did I Look Before, Doctor?

Before and after pictures are beloved worldwide.

Here, Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. (who blogs as Dr. Body) and colleague Robert Kotler, M.D.  (the “Dr. Face” blogger) – also a Beverly Hills board-certified cosmetic plastic surgeon — provide insider tips on knowing exactly what you are looking at when seeing the before and after pictures of plastic surgery patients.

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Dr. Face (Dr. Kotler): Did you know that one of the most requested search terms by people using Google or other search engines are for plastic surgery’s before and after pictures?

Dr. Body (Dr. Linder): Yes, I also read that people worldwide are crazy for before and after pictures of  not only people, but refurbished homes, cars, motorcycles and even places that have changed over time.

Dr. Face:  Psychologists say it’s because Americans are crazy about reinvention.

Dr. Body: Well, I don’t know if we can reinvent people but we do more than a fair job of improving their appearances!

Dr. Face: So, looking at before and after pictures can be a good way of judging a cosmetic plastic surgeon with superior skills and years of experience doing the procedure you want.

Dr. Body: The first thing I look for on a surgeon’s website is many, many before and after pictures. For instance, I have about 1500 before and after plastic surgeries on my website.

Dr. Face:  While I’ve done a little over 4,000 rhinoplasties, my website has about 300 of the most representative outcomes.

Dr. Body: What do you think if you bring up a plastic surgery website and don’t see any before and after pictures?

Dr. Face: I think what any wise consumer would think – there aren’t any!

Dr. Body: Well, when you do find some before and after plastic surgery pictures, what do you look for?

Dr. Face:  I’ll tell what I don’t want to see: just a collection of random shots. For medical as well as purchasing decisions, you should be able to see pictures in which everything – the light, the distance from the patent to the camera, the various angles – are all standard. The only different thing should be the appearance of the patient’s face or body.

Dr. Body: And of course, it should be real patients – and not models – that are pictured.

Dr. Face: If I were in the market for, say, a face lift or a tummy tuck, I would look for pictures of others who have had that same exact procedure.

Dr. Body: What about the various angles you mentioned?

Dr. Face: There should be a set of befores that show a front view, a profile and one taken from left and right oblique angles. And the afters would be taken from the same angles.

Dr. Body: What about captions and medical privacy?

Dr. Face: People who show their faces give permission, because there are strict laws in America about medical privacy. If they don’t grant permission, the eyes are usually blocked.

Dr. Body: I don’t have that problem because all my surgeries are on the body with no faces shown. But the pictures should list a few things, like the age of the patient, the procedure, what was done and how far out from the operation the “after” was taken.

Dr. Face: Look for a natural appearing result in the afters. Many patients who are interested in Botox always mention that, in the before pictures, the patients are sandbagging because they are grimacing and exaggerating the folds, lines and wrinkles on purpose. Well, the actual purpose of that is so the surgeon can see exactly where the facial muscles are located so the injections will be on target. If you’ll look at the after Botox pictures, you will see the patients can’t make the same faces. Those muscles were deactivated!

Dr. Body: When you are looking at before and after liposuction pictures, patients should not have their arms raised in the air. That can create a misleading impression of the procedure. If you are looking at breast augmentation pictures, patients should also have their arms at their sides.

Dr. Face: Some after pictures of the face may show close-ups to better reveal the changes after, say, chemical peels and laser treatments.

Dr. Body: Good point, doctor! Looking closely at breast augmentation after pictures, you may see a slight scar around the patient’s nipple. That scar can last up to a year so be sure and check to see how long ago her surgery was.

Dr. Face: I’m thinking one more thing about close-ups.

Dr. Body: What’s that?

Dr. Face: Do any of your movie star patients from Hollywood ever announce they are ready for their close-ups?

If you want to know more about before and after plastic surgery pictures, you may want to read a summary about Secrets of a Beverly Hills Cosmetic Surgeon, Dr. Kotler’s book on cosmetic plastic surgery.

Dr. Linder’s book, The Beverly Hills Shape, is also about plastic surgery and contains a wealth of before and after pictures.