After Cosmetic Surgery

Both the eminent Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. (Dr. Body) and the equally eminent Beverly Hills board-certified facial plastic surgeon Robert Kotler, M.D. (who blogs as Dr. Face) tell their patients that some unwanted conditions and complications can crop up after plastic surgery. The average complication for U.S. plastic surgeons is about once in every 100 cases. What to do if one rears its ugly head? The patient should call the surgeon. But when?

Here, Drs. Face and Body tell what signs you will notice in yourself if you should make that call, even if it’s in the middle of the night.

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Dr. Body (Dr. Linder): Some patients have complications after they leave the surgery center. But if you have selected a board-certified plastic surgeon, you always will be in good hands because they have virtually seen and treated any unwanted complication that can crop up.

Dr. Face (Dr. Kotler): Almost all board-certified cosmetic plastic surgeons tell their patients the usual, run-of-the-mill complications after a plastic surgery include:

• Bleeding
• Allergic reactions to anesthesia (very rare)
• Infection
• Hematomas (a collection of clotted blood under the skin)
• Seromas

Dr. Body: Seromas are a mass of watery blood just under the skin and can cause pain and, later, more scar tissue.

Dr. Face: Your surgeon should tell you during the initial consultation and before any surgery what complications are common to your particular rejuvenation procedure and what signs you should watch for.  Most cosmetic plastic surgeons will include that information on pre-surgery hand-outs. It’s a lot of reading but well worth your time.

Dr. Body: Sure, if you know what signs and symptoms to watch for, the decision to call your surgeon will be easier.

Dr. Face: The leading complication nationwide is excess bleeding. It is not a gusher but just a little trickling of some blood under the bandages.

Dr. Body: In breast augmentation surgery, patients want to watch out for one breast being larger than the other. That may indicate bleeding in that breast.

Dr. Face: Another frequent complaint is temporary numbness. A slight loss of feeling is common to many procedures and happens because some nerve endings just under the skin have been severed. However, virtually all grow back and return feeling in two to four months.

Dr. Body: Another frequent complication in breast surgery is capsular contracture which is a type of internal scarring. It can create hardening, pain and distortion of the breast. Board-certified plastic surgeons see it often and know exactly how to treat it.

Dr. Face: Pain or swelling any time after the third day of surgery is a call-your-surgeon-now moment. Pain or swelling after cosmetic facial procedures should fade away in about 48 hours after surgery and then start to disappear completely.

Dr. Body: In tummy tucks, be alert for severe abdominal pain. Abdominoplasty requires a long incision, running hip to hip, unless you’re having a mini-tummy tuck. Pain in the tummy area worse than a stomach ache could mean bleeding.

Dr. Face: If the skin is reddened or sore to the touch near an incision, an infection may be present. Don’t delay on this one because the quicker we can jump on an infection, the quicker the problem comes under control. In fact, checking for signs of infection is the primary reason we see patients first thing in the morning after a cosmetic plastic surgery procedure.

Dr. Body: In surgeries that require long incisions, wound separation — known to doctors as dehiscence – the edges of an incision come apart after the stitches have been taken out. It happens only rarely but a properly trained and qualified plastic surgeon may be able to close the incision again in just a short appointment. The good news:  revision surgeries are rarely needed for most instances of dehiscence.

Dr. Face: One extremely rare – but very serious — complication after liposuction is blood clots in the veins, a condition medically known as deep vein thrombosis. To help prevent it, most surgeons advise liposuction patients to get out of bed and start moving around as soon as possible.

Dr. Body: You are also at risk for deep vein thrombosis on very long airplane trips, where you must sit in a cramped position for many hours. One way to cope with the remote threat of thrombosis in an airplane is just make the same motion with your feet as when you step on the gas pedal in a car. That stretches your leg muscles, squeezes any pooled blood and gets it moving again.

Dr. Face: There are some very, very rare complications of people being allergic to anesthesia. But your best cosmetic plastic surgeons use highly trained anesthesiologists – who are also M.D.s – to watch over the patient while he or she is asleep under a general anesthesia. Anesthesiologists have seen every complication known. For instance, in the rarest of anesthesia complications, the patient does not even know he or she is allergic to anesthesia. But good anesthesiologists keep a very special — and rare – drug on hand to counteract it. That drug is used somewhere by American plastic surgeons perhaps once every two years. Most stocks of that special drug expire without ever being used. But fresh supplies must be kept on hand in the O.R. nonetheless.

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Look at some of Dr. Kotler’s rhinoplasty revision before and after pictures.

A revision is done on a nose job when another surgery somewhere else did not do a good job and left the patient still unhappy with his or her appearance.

Dr. Linder has a practice dedicated to revision breast surgeries. He, likewise, sees many breast augmentations, breast reductions or breast lifts that were botched by another surgeon somewhere else.

Here are some of Dr. Linder’s breast revision before and after pictures.

Beverly Hills plastic surgeon Stuart Linder, M.D. (who blogs as “Dr. Body”) and Robert Kotler, M.D. (“Dr. Face”)also a Beverly Hills cosmetic plastic surgeon, not only read the latest in the professional plastic surgery press, they also keep up with the many presentations that are made at conferences for plastic surgeons.

The annual meeting of The American Society of Plastic Surgeons, (ASPS) held October 1^st though 4^th in Toronto, Canada, presented many new concepts in cosmetic plastic surgery including the use of your own donated  fat as a material to augment facial and body procedures.

Doctors Face and Body jointly belong to the following medical organizations:

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

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Dr. Face: I know you have followed with great interest and attention the continuing work that has been done on breast augmentation, using the patient’s own donated fat.

Dr. Body: I have and, overall, am not in favor of it.

Dr. Face: Why?

Dr. Body: Several reasons; most transferred fat will die. When that happens the fat can calcify and block X-rays and mammograms that would otherwise find early cancer. The fat that does not die is reabsorbed by the body.

Dr. Face: I’ve read that one downside of fat transfer to the breast is that only one cup size at a time can be done .That means the patient may have to pay as much as two to three times the going rate for a breast enhancement which is stretched over a year or two.

Dr. Body: Did you notice any presentations about fat transfer to the face?

Dr. Face: Yes, some surgeons are fond of transferring fat from patients’ donor sites to fill in hollow areas of the face. But the same problems with fat absorption exist.

Dr. Body: Were any studies presented?

Dr. Face: One surgeon presented a study of five patients who had cheek augmentation via fat transferred to hollow under eye areas during face lift procedures. After a year, only one of the five had any of the transferred fat left.

Dr. Body: What did you conclude from the study?

Dr. Face: I was wont to conclude anything, actually. One could assume the procedure had a failure rate of 80 percent but a study with only five subjects is really not sound. To be taken seriously, a medical study should include at least 50 people and then it should be repeated somewhere else on new subjects to see if the results are valid.

Dr. Body: I see another concern patients should think about before having their cheeks augmented with their own donated fat.

Dr. Face: And what would that be?

Dr. Body: It creates another surgical site on the body to take the fat. That creates another chance for infection, which is the number one worry after surgery.

Dr. Face: You’re correct!

Dr. Body: I have seen some fat transfer to the breast work but the methods involves literally hundreds and sometimes, thousands, of injections placing the tiniest drops of fat. The concept is that many, many drops of fat are more likely to find a blood supply and live. But there are not that many surgeons with the time and patience to spend untold hours placing those extremely tiny drops.

Dr. Face:  Overall, interest in plastic surgery and fat transfer  is going to continue but a lot of work needs to be done first. As far as fat being reinjected back into the body, there is always the danger the fat can get into a blood vessel, travel to a distant location and cause an embolism.

The Grand Canyon

Virtually all  plastic surgery patients of Stuart Linder, M.D. (who blogs as “Dr. Body”) and Robert Kotler, M.D. (“Dr. Face”) want to know how long their recuperative times after cosmetic plastic surgery will be.

According to Dr. Linder, (a Beverly Hills board-certified plastic surgeon) and Dr. Kotler (also a Beverly Hills board-certified cosmetic plastic surgeon) knowing recuperative times are important because international patients must have medical clearance before returning home or continuing on their travels in America.

Doctors Face and Body jointly belong to the following medical organizations:      

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

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Dr. Body: I don’t know about your international patients, but most of mine like to combine surgery and recovery with some sort of touring to see American sights like the Grand Canyon, Las Vegas or, in winter, Death Valley. So they like to know how much time is involved with recovery.

Dr. Face:  Same with my patients. Nose surgery patients are usually good to go between the 5^th and 7^th day; I ask most to wear a splint which protects the nose and leaves a nose like the surgeon shaped it.  But, that external splint  comes off on the 5^th day after surgery, along with the nasal packing and the inside-the-nose breathing tube. Most nose job patients look completely presentable in ten days although it can take up to a year for the nose to fully ripen and look even better.

Dr. Body: How about eyelift surgery?

Dr. Face: Our post op instructions for an upper eyelift lift mention that stitches are usually removed between the 4^th and 6^th days. Lower eyelid stitches, hidden behind the lower lid, are self-dissolving so no worries there. Most eyelid surgery patients can be seen in public again somewhere around the fifth to seventh day after surgery. Any leftover bruising or swelling is hidden by makeup or sunglasses. The upper eyelid surgery patients can back to work somewhere around the fifth to seventh day after surgery.Any leftover bruising or swelling is hidden by makeup or sunglasses. The upper eyelids incisions are hidden in existing creases and can hardly be seen in six weeks. We do ask, however, to hold off on strenuous exercise for 10 days.  We are concerned that exercise will jump the blood pressure which can cause more bruising and swelling.

Dr. Body: Having done about 14,000 breast implant operations, I usually know that my patients will be mad at me for one thing – I ask them to keep the breast area dry for at least 14 days — which means no showering.  Any stray bacteria on the skin can wash into the surgical incisions and create an infection. Breast augmentation patients also must not lift anything heavy (nor anything at all above their heads) for two months after surgery. I also recommend a bra with an under wire to support the new augmentation.

Dr. Face: The average infection rate in plastic surgery, year in, year out, is about 1 percent. Do you happen to know your breast surgery patients’ infection rate?

Dr. Body: Yes, 1/10^th of one percent. I credit that low rate to my “no shower” rule!

Dr. Face: How long before breast surgery patients can resume their regular activities?

Dr. Body: About six to eight weeks before exercising again.

Dr. Face: Many of my international face lift patients are also anxious to see the sights and enjoy some American plays and music. But from the get-go, I ask them to set aside seven  days for the surgery  and immediate recovery, before arranging any social or travel activities. A face lift also requires some post-surgery attention from the patient who sees me briefly the day after surgery for a short medical inspection and to change the dressing.  The surgical drains are removed on day three. On day four, the patient can shower after removing the dressings. Stitches come out on about the seventh day after surgery. At that point, swelling and bruising are at a minimum. By day 10, most patients are looking good and virtually all are good to go – including returning to work or traveling — at day 14. For facelifing, we also ask a hold on exercise or strenuous activity for three weeks. However, there is no prohibition on walking, a great exercise.

Dr. Body: A tummy tuck, or, abdominoplasty, is a more major procedure with a long incision across the abdomen. While the drains are removed at about day five, the patient can usually go back to work in about ten days. But the main thing is not lifting anything heavy or doing any abdominal or other vigorous exercises for at least two months. Typically, the scar resulting from a tummy tuck appears at its worse during the first several months post op. But the scar does lighten and become far less noticeable, in about a year. Tummy tuck scars are placed in locations that will later be covered by clothes, swim wear and underwear.

Dr. Face:  The breast reduction procedure also requires some external incisions, no?

Dr. Body: Yes. Within the first week, any drains will be removed. Bandages will also be changed. Within two weeks, mild exercise and non-strenuous work may be resumed, bruising will begin to fade, and swelling will go down. After a few months, the breasts settle into a more natural shape. As with any procedure, the cosmetic effects will take about a year before the final results are realized. Without the excess breast weight,  patients enjoy life much more, have far less pain and can participate in physical activities that were not possible before the procedure.

Dr. Body: The best tip to remember is asking your plastic surgeon not only how long it takes to recover but what should be done by the patient at home to promote healing. Patients can help themselves a lot.

Dr. Face: To facilitate that, most surgeons will print out directions for the patient to follow during the recuperative period.

Body: Do your best to comply; those instructions are for your benefit. After all, such directives are known as “doctor’s orders” and not, “doctor’s suggestions” for a reason!

Dr. Body (

But almost every performer wants to project an image of natural beauty and do not want to admit to cosmetic plastic surgery. So the procedures must be done in secret. While Dr. Face has performed hundreds of celebrity face lifts, Dr. Body has done an equal number of breast augmentations on top models.

Currently, word is out among photographers that Paris Hilton wants to correct a sagging eyelid that supposedly resulted from an eyelid lift some years ago. So the camera-carrying throng is especially active in Beverly Hills.

Both surgeons are book authors and frequently appear on educational television programs like Discovery Channel, Dr. 90210, the British Broadcasting Corporation (BBC) and many others.

Doctors Face and Body are members in good standing with:

• 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: Did you notice the swarms of photographers and paparazzi on the sidewalk outside my office?

Dr. Body: I could not miss them! The tabloid photographers are staking out the offices of the most likely plastic surgeons, hoping to catch a picture of some star going or coming. Now, there is a law in California reining in reckless paparazzi. (Read more about reckless photographers trying to get pictures of stars after plastic surgery and other activities.)

Dr. Face:  Many people don’t know it, but the tabloids have a literal army of tipsters who do well financially just letting the photographers know what celebrity is going to be where and when. That “army” includes waiters, waitresses, parking lot attendants and even clerks who may work next door to us.

Dr. Body: Sure, they all want to make stars’ cosmetic surgery public knowledge but health professionals are required by law, ethics and good business sense to make sure everything is done quietly. So how do you do it?

Dr. Face: I usually use several layers of concealment. Only a few of us in the office will know about an invented name we use for the celebrity’s paperwork. After that, we refer to him or her by that name because anybody may hear a casual mention of the star and then pass it on to the press. And, so far, knock on wood, our back entrance seems to work for celeb patients going home without being seen after surgery. Also, I know of some plastic surgeons who have separate waiting rooms for celebrities.

Dr. Body: I’ve found that weekends are a good time to perform plastic surgery on celebrities. I’ve also frequently arranged surgery at 4 a.m. while it’s still dark outside and before photographers and their many tipsters are awake, searching for the next big picture.

Dr. Face:  It can be kind of crushing at times when you may have struck up a nice relationship with a celebrity but then, when you run into each other away from the office, that person does not speak because his livelihood can depend on not knowing plastic surgeons.

Dr. Body: It was so much simpler back in Hollywood’s golden era; many celebrities before plastic surgery become so common used actual sticky tape to hold back sagging facial tissues for a short while.

Dr. Face: Many stars come in for facial fillers and Botox before special occasions like the Emmy awards or the Oscars. Then, there is only an office visit to worry about and no danger of being seen in public with facial bruising or dressings.

Dr. Body: And it’s not only performers who want cosmetic plastic surgery in secret. We also see producers, directors, TV news anchors and journalists who want a refreshed look – but strictly on the Q.T.

Dr. Face:  After plastic surgery — because of bruising, dressings and the other signs of a recent surgery — we also have special nurses. They escort famous face lift patients to an aftercare facility and stay with them for 24 hours, sometimes for several days.

Dr. Body: For the celebrity,  is there another trip involved back to your office for the morning after surgery check?

Dr. Face: Many times, it is easier for me to go to the aftercare facility to check on the patient rather than sending him or her out in public again.

Dr. Body: Is there anything in particular you tell your celebrity patients about keeping surgery private and quiet?

Dr. Face: I always tell them not to drive their own cars to my office.

Dr. Body: Why is that?

Dr. Face:  Because every paparazzo in Hollywood and Beverly Hills knows the stars’ license plate numbers by heart!

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View some of Dr. Body’s revision breast plastic surgeries.

Look at some of Dr. Face’s rhinoplasty before and after pictures.

A Surgeon E-mailing

Ever think you may like to have cosmetic plastic surgery from the eminent Beverly Hills board-certified  plastic surgeon Stuart Linder, M.D (who blogs as Dr. Body)? Or, with the equally eminent Beverly Hills board certified cosmetic plastic surgeon Robert Kotler, M.D. who blogs as Dr. Face?

But there you are, 10,000 miles away from California in, say, Japan, Germany or maybe even Africa. And, like many others worldwide, you may be interested in having cosmetic plastic surgery in Beverly Hills. But who has the time to maybe go and see?

Thanks to modern technology, you can learn more about the particulars of your case and the cosmetic surgery you may be considering without physically traveling to Beverly Hills. How? Doctors Face and Body both offer “virtual” consultations through email, Skype and on the phone.

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Dr. Body (Dr. Linder): Keeping up with your e-mail, doctor?

Dr. Face: (Dr. Kotler): Yes, indeed. More patients are asking to set up a “virtual” consultation while considering coming here to Beverly Hills for cosmetic plastic surgery.

Dr. Body: I recently had a woman from San Tropez, France, e-mail me and explain that she had breast surgery twice near her home but still had no cleavage!

Dr. Face: Does she want a breast revision?

Dr. Body: She’s already been here and had the revision breast surgery but our relationship started with an e-mail exchange, including photos. Same thing for some breast revision surgery patients from Denmark and from London.

Dr. Face: I suppose you do a virtual consult like my office does? We like to use Skype as much as possible and get a set of photos through e-mail or regular mail showing the area a person wants treated, their medical history and other information. By the time we get together on the phone to discuss the case, I have also sent the person our computer generated “after” plastic surgery pictures. And asked the person to take care of the physical and other pre-surgery chores before leaving home. (Read more about how distant plastic surgery patients have virtual consultations.)

Dr. Body: Yes, it’s basically the same system although we don’t use predictive pictures. The beauty is, my very capable assistant, Adriana, collects all the information. Then, when I talk to the patient on the phone or through Skype, I have a complete file on the patient. It’s a lot like talking to the person, well, in person.

Dr. Face: I know you do the same thing as I: after the international traveler gets here, he or she comes to my office and we go over everything again as if it were the first time we met. All details are covered and we spend as much time as needed.

Dr. Body: Sure, there are some things in plastic surgery that require hands-on touching that can’t be done in a teleconference or a video conference. But the lion’s share can be completed remotely.

Dr. Face:  An English chap e-mailed recently about his large nose and receding chin line. We took care of all the details and I also explained how the rhinoplasty surgery would be done and provided the cost of cosmetic plastic surgery. We also arranged a limousine pickup from the airport to his hotel. After several days to decompress, he came to my office for an in-person exam.

Dr. Body: Did he also make a vacation out of his stay?

Dr. Face: He did; he stayed for two weeks. He had some business matters to take care of but worked in day visits to Santa Barbara and San Diego.

Dr. Body: The English are very fond of visiting Italy due to its much, much better weather; so most English visitors think those two places in California are the most like Italy. That’s good because we want patients to stay here for at least 10 days after surgery.

Dr. Face: I read a recent study in the Journal of Telemedicine and Telecare that compared a group of patients making both virtual and in-person doctor visits.

Dr. Body: What did they find?

Dr. Face: One of the groups graded the satisfaction rate on the in-person visits at 80 percent and the virtual visits at 84 percent.

Dr. Body: Where can you read that?

Dr. Face:  Just go to: Journal of Telemedicine and Telecare.

Dr. Body: I recently completed a surgery on a Vietnamese woman who spent her after surgery time in Beverly Hills meeting with agents and film producers. Our relationship also started with an e-mail request and pictures from her home nation.

Dr. Face: Speaking of pictures, you can also read more about the best way to take before plastic surgery pictures of yourself for a surgeon’s use during a virtual visit.

Take a look at Dr. Body’s before and after plastic surgery pictures

Here are the before and after cosmetic plastic surgery pictures from the office of Dr. Face

Having served the cosmetic surgical needs of many hundreds of  top celebrities – often in total secret – both Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. (who blogs as “Dr. Body”) and  Beverly Hills board-certified cosmetic facial surgeon Robert Kotler, M.D. (“Dr. Face”) tell why so many famous people have gone so terribly wrong with cosmetic plastic surgery when the very best is so close at hand.

Entire websites are devoted to Hollywood celebrities and film stars who come away with less-than-perfect plastic surgery. Yet, Hollywood and Beverly Hills—the world capital for plastic surgery — sit next to each other in Southern California. What’s more,  virtually all celebrities can afford the best of anything, rejuvenation surgery included. So what goes wrong?

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Dr. Face: (Dr. Kotler) The list of film stars and other celebrities with bad plastic surgery seems to grow each year. Recently, we’ve seen Priscilla Presley, Kenny Rogers, Meg Ryan, Bruce Jenner and others sporting features that are unnatural, artificial-looking and not at all complimentary to their cosmetic plastic surgeons.

Dr. Body. (Dr. Linder) Unfortunately, true. I know in plastic surgery of the body, the dead giveaway to either quick or untrained plastic surgery is when a breast augmentation patient turns up with breasts that look like two grape fruit halves or bowls stuck to her chest – along with a wide space between the breasts that in no way can be called “cleavage.”

Dr. Face: Cosmetic plastic surgeons of both the body and the face want a surgical rejuvenation to look natural. After healing, the person should look rested and refreshed – not someone who draws attention to him-or-herself due to huge fattened lips, surprised looking eye lifts, facial skin as tight as an overinflated balloon or the breasts you mention.

Dr. Body: Sure, the key to good cosmetic plastic surgery is that the patient looks very, very good but still, other people can’t quite put their fingers on what the change is. People usually guess at a new workout program, a vacation, losing weight or a new romance.

Dr. Face: Yet when he was alive, Michael Jackson turned up at the offices of many Beverly Hills plastic surgeons asking for yet more rhinoplasty, long after his nose was already overdone. I’ve known of many famous people who turn on all the charm to pressure a younger surgeon into yet another surgery – one which will do the celebrity no good or one the person should not have for reasons of health.

Dr. Body: So there are many times when the dedicated but thoughtful surgeon must say no. In my practice, I routinely say “no” to anybody with diabetes, celebrities included. Most cosmetic plastic surgeries of the body involve long scars which stand a good chance of separating before healing if the person has diabetes.  Or a terrible infection may set in.

Dr. Face: I’ve also noticed that many celebrities are very given to embracing the latest fad procedure or practitioner. Priscilla Presley (the first wife of singer Elvis Presley) was shown on the television program, Dancing With The Stars about a year ago; viewers could easily see her immense, out-of-proportion lip augmentation. A bogus doctor had gained his way into celebrity, A-list circles and was essentially injecting them with low grade industrial silicone – at a premium price. The “physician” in that case turned out not to be a doctor at all, was later convicted on several charges and deported.

The largest red warning flag of all?

The so-called  “doctor” was operating from his home! Legitimate cosmetic plastic surgeons work from well-staffed, well-equipped offices.

Dr. Body: Actually, many, many Hollywood celebrities have plastic surgery and have it in secret. In a later blog post, we’ll tell you how they do it. But, understandably, celebrities appearances often depend on whether they work or not. So they should be the ones to do the most homework and find the most skilled plastic surgeons possible.

We’ll also tell you how to do that in a post later  on!