Cosmetic plastic surgeons see many people every day who are interested in looking better…but may know next to nothing about plastic surgery. So every cosmetic plastic surgeon uses what Latin teachers call the “Socratic Method,” a technique we know today as “Q&A.”

But there are questions, and then there are questions surgeons wish people would ask.

Dr. Body, the eminent Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. tells his choice of best questions while the equally imminent Beverly Hills board-certified facial plastic surgeon Robert Kotler, M.D. joins in.

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Dr. Face:  (Dr. Kotler) What questions do patients most often ask you, doctor?

Dr. Body: (Dr. Linder) Potential patients want to know — in no particular order — if they are a good candidate for, say, breast augmentation or tummy tuck; what the major risks to each procedure are; how long does recovery from each operation take and what they are going to look like after the procedure.

Dr. Face:  O.K., those are all good questions, but is there one question in particular you wish they would ask?

Dr. Body: Yes, I wish more inquiring patients would ask “Do you perform only plastic surgery procedures of the body?” That would tell me they have been doing their homework and know that a  specialist concentrates on just a handful of procedures and performs each exceeding well, thanks to constant repetition.

Dr. Face: I like to hear the same question; but I can think of a few more that would be welcome in my ears.

Dr. Body: Such as?

Dr. Face:  “How long have you been performing this handful of procedures?” That tells me the patient wants to put his or her procedure in the hands of a cosmetic plastic surgeon who has seen every possible wrinkle, complication and outcome and immediately knows what to do in every instance.

Dr. Body: Now that you mention it, I can think of another question I wish more patients would ask during the initial consultation when we first meet.

Dr. Face: Don’t keep me in suspense!

Dr. Body: I would like to hear: “Where are your ‘hospital privileges?’”

Dr. Face:  Good choice. Hospitals are expert in knowing which doctors enhance their reputations and which doctors cause problems. If a particular surgeon falls into the “problem” category, he or she is very likely indeed to have hospital privileges withdrawn.

Dr. Body: We should tell people that  “hospital privileges” means that a surgeon can have a patient admitted with just a phone call. It’s just another level of patient safety in the unlikely event that something goes wrong.

Dr. Face:  I can think of one more question I wish more patients would ask.

Dr. Body: And that would be?

Dr. Face: ‘May I speak to a patient of yours who has had this same procedure?”

Dr. Body: When I hear that, I know I’m going to have a new patient.

Dr. Face:  If the previous patient is in the office, I just introduce the two people, excuse myself and say: “I’ll leave you two to chat over the surgery you’ve had and the surgery you want. Call me when you need me.”

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

Look at some of Dr. Linder’s breast augmentation revision before and after pictures.

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.

Cosmetic Surgery: Thinking it Over

Virtually every plastic surgery procedure starts with a first meeting in the office between a new patient and the plastic surgeon. It’s known as the consultation and is a chance for the surgeon to learn about the changes you want in your appearance.

Here, Dr. Body (Stuart Linder, M.D.) and Dr. Face (Robert Kotler, M.D.) explain what patients can expect in a consultation appointment and what things they should look for as the signs of an excellent plastic surgeon.

Most board-certified Beverly Hills plastic surgeons charge a nominal fee for consultations. Many usually apply the fee to the costs of plastic surgery. But if you’re on your toes, you can have a second consultation for no additional fee. Drs. Body and Face tell how.

(Read more about what to expect in a fitst Los Angeles or Beverly Hills consultation.)

Dr. Linder is an eminent board-certified Beverly Hills plastic surgeon who specializes in breast augmentation, breast revision surgery, and tummy tucks along with male and female breast reductions.

(A revision is when a botched plastic surgery done elsewhere by another surgeon is repaired by a highly skilled cosmetic plastic surgeon.

Dr. Kotler performs surgery of the head and neck exclusively along with many rhinoplasty, revision rhinoplasty, face lifts and ear pinnings, a procedure technically known as Otoplasty.

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Dr. Face (Dr. Kotler): Whew! What a day. I had eight rhinoplasty consults this afternoon. Was it the same for you with a lot of consultations?

Dr. Body: (Dr. Linder): Actually, I had a string of second consultations. Some patients wanting breast augmentation or breast revisions in Beverly Hills had already spent an hour in my office asking about surgery and, before leaving, said they wanted to think more about it and do a little more research.

Dr. Face:  And you said?

Dr. Body: I responded that it was a perfect idea, that the more the patient knows, the better for all and please come back with any additional questions or thoughts. And, there would be no additional fee.

Dr. Face: Good plan! For a plastic surgeon, that is a perfect tack to take. After all, many patients are nervous at first. After they leave, all types of questions pop into their heads.

Dr. Body: Most returning patients say, at the end of the first consultation, say: “Doctor, I would like to mentally digest everything you said and do a little more research before making a decision on the surgery.”

Dr. Face: I often do the same thing and add that no additional charge is involved. If the surgeon does not mention it, it’s perfectly acceptable for the patient to ask before leaving: “Will I have to pay another fee if I come back for a second consultation?”

Dr. Body: Another way patients can get even more information on a first or second consultation is ask, “Doctor are there any patients in your office right now who have had a similar procedure? And if so, may I speak with them?”

Dr. Face: Perfectly acceptable! In fact, I often excuse myself from the room in such meetings, saying: “You two go ahead and chat. Let me know if you need me for anything.”

Dr. Body: I remember one lighting expert who was asked in a consultation how many people were required to change a light bulb.

Dr. Face:  And…?

Dr. Body: The consultant said “Three – one to change the bulb, one to document the process and one to coach him on how to conform to the process.”

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Look at some before and after breast revision photos

View some before and after nose job revision pictures

Cosmetic Plastic Surgeon at Work

With the onset of summer and toasty temperatures – especially on the U.S. Eastern Coast – some patients have found an unexpected blessing while receiving plastic surgery procedures. The operating room can be much cooler than expected. In fact, sometimes, it can be downright cold!

Here, Doctors Face and body (Robert Kotler, M.D. and Stuart Linder, M.D., respectively) tell what patients can expect, how they can cope with the chill and why the operating theater is cold in the first place.

Dr. Linder is an eminent board-certified Beverly Hills plastic surgeon who specializes in breast augmentation, breast revision surgery, and tummy tucks along with male and female breast reductions.

Dr. Kotler is an exclusive head and neck surgeon, performing rhinoplasty, revision rhinoplasty, face lifts and ear pinning, a procedure technically known as Otoplasty.

Dr. Face (Dr. Kotler): Forty years ago it was just the opposite – operating rooms were steamy. Air conditioning was not always installed in hospitals and other medical facilities.

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Dr. Body (Dr. Linder): Sounds like you were sweating it – literally!

Dr. Face: Sometimes, right onto the patient.

Dr. Body: I’m thankful for the A.C. being cranked up during surgery because being wrapped up in several layers of surgical work garb plus, the big, bright surgical lamps makes it hot enough.

Dr. Face: Sure, but the medical benefits are worth it. Fewer infections as the temperature drops, for instance. And I don’t know about you but I tend to get sleepy when it gets too warm. I’ve heard other surgeons say the same thing. They agree we all work better when it’s cool.

Dr. Body: It can be a different experience for patients, though. Almost everybody who has ever been to a doctor is wary of cold instruments being placed on warm bodies. Cold patients in the O.R. or the receiving areas, just after an operation do have some options, though.

Dr. Face: Like the Bair Blanket?

Dr. Body: One of the many things we do for patients after surgery is cover them with a special blanket into which warmer air is blowing. Some other blankets are being held in little warning ovens.

Dr. Face: A seeming lifesaver for cosmetic plastic surgery patients who are quickly chilled. They can also request that any irrigation or intravenous fluids be warmed before being injected into their bodies. So if you’re cold in the O.R., speak up! Cosmetic plastic surgeons and staff understand and are ready to help.

Dr. Body: Talking about heat reminds me of the new basketball team that may make Miami its home base. I understand they are going to call the team “Humidity” so that it will have some real meaning when Miami basketball fans say, “It’s not the Heat that’s so bad, it’s the Humidity.”

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Look at some breast revision before and after pictures.

View some nose job revision before and after pictures

After Plastic Surgery

While cosmetic plastic surgery has swept the entire planet, the eminent Beverly Hills board-certified cosmetic plastic surgeon Robert Kotler, M.D.  (who blogs as “Dr. Face”) and Stuart Linder, M.D. (whose Nome de plume here is “Dr. Body”) follow the plastic surgery news on the world stage.

Here, they choose  a few of the more noteworthy items.

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News Item: Look like Shakespeare? According to the Shanghai Daily, a well-heeled author, Zhang Yiyi, has set aside $153,000 and four years’ time to have ten plastic surgery face lift procedures to make him look like a dead ringer for English playwright William Shakespeare. (Read more about the Zang’s plastic surgery plans.)

Dr. Face: Thumbs down!

Dr. Body: Double thumbs down!

Dr. Face: Plastic surgery can only make you look like the best version of yourself.

Dr. Body: We’ve seen some off-the-wall contests here in America featuring potential patients who want cosmetic surgery to look like Carmen Electra, Brad Pitt or some other favorite celebrity. One contest winner was supposed to have a surgically-supplied version of Arnold Schwarzenegger’s chest. But such surgery does not work for many reasons, primarily because you would need all of the celebrity’s various body characteristics, skin thickness, bone structure and so on.

Dr. Face: Besides, why Shakespeare? Who wants to look 447 years old?

News item: Plastic Surgery is now the 4^th leading expenditure in China. (Read the news about cosmetic surgery in China.)

Dr. Body: As I understand it, people in China spend their money in the following order: housing, cars, vacations and then cosmetic plastic surgery.

Dr. Face: Plastic surgery has simply exploded in popularity in China. The International Society of Aesthetic Plastic Surgery (ISAPS) found in 2009 that China was only behind America in numbers of plastic surgery procedures performed.

Dr. Body: Perhaps they have caught up by now?

Dr. Face: That would also mean such a rapidly growing field needs better regulation. Which apparently does not yet exist. For instance,  one British journalist went to a hair salon and noticed an eye lift operation going on in the chair next to hers. There will be more to come from China about making plastic surgery safer.

News Item: According to The National, an Arabic business and lifestyle publication, ambitious men in the UAE (United Arab Emirates) are actively embracing plastic surgery to advance their careers. (Learn more about Arabian  plastic surgery.)

Dr. Body: Thumbs up!

Dr. Face: Ditto!

Dr. Body: Given the recent economy and the many men and women looking for work, that trend is actually going on in quite a few nations. Women job seekers often inquire about liposuction, breast implants and – after their families are complete – tummy tucks.

Dr. Face:  Our practice sees quite a few job seekers looking for upper and lower eye lifts, nose jobs and face lifts. In virtually all cases, a surgical rejuvenation works because the person looks more refreshed and energetic. Another thing working against older workers: when facial skin starts to sag and develop deep wrinkles, you can appear angry, weary or sad to co-workers when you actually feel no such emotions at all.

Dr. Body: However, looking good alone won’t get anybody a job, the entertainment industry notwithstanding. I heard about one woman who wrote on her job application: “I’m a rabid typist.”

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Known as superspecialists, Drs Body and Face specialize in revision surgery which repairs unsatisfactory results done by other surgeons in other locations.

Read more about Dr. Kotler’s International and revision cosmetic surgery patients.

Learn more about Dr. Linder’s worldwide plastic surgery revision patients.

Doctors Face and Body offer an expense and time-saving service to their many international patients who are in Beverly Hills for a short time only. U.S. patients also take advantage of it.

Because Dr. Face (who in real life is the imminent Robert Kotler, M.D.) only performs procedures of the face while Dr. Body specializes in plastic surgery of the body, the duo have teamed up to do patients’ plastic surgery in one surgical session. (Dr. Body is Stuart Linder, M.D.)

Two surgeons operating on a single patient in one surgical session is a rare service in American plastic surgery. Additionally, both Dr. Face and Body specialize in revision surgeries, demanding procedures that repair previous cosmetic surgery that was not done well elsewhere.

Here, Doctors Face and Body explain how the two surgeons-at-once service works.

(See a Facebook picture of Drs. Face and Body in the plastic surgery operating room.)

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Dr. Face (Dr. Kotler): Our most recent patient, a 40-year-old nurse from Japan, said she appreciated the close scheduling appointments on our two-on-one plastic surgery system.

Dr. Body (Dr. Linder): Well, she certainly knew how to research cosmetic plastic surgery over the Internet. She wanted to have cosmetic and functional nasal surgery and an upper eyelid and brow lift. Plus, she wanted her 20-year-old silicone breast implants replaced.

Dr. Face: Don’t you have a map showing the worldwide locations from which our international patients have traveled?

Dr. Body: I do. Just go to my plastic surgery website to see a dynamic global and U.S. map of the 39 nations from which our patients have traveled.

Dr. Face: Tit for tat, doctor! I think our readers should have a chance to see some of my 4,000 nose jobs, many of which are done on international patients.

Dr. Body: Anyhow, as soon as our most recent patient was finished with your consultation, all she had to do was walk right across the street where my office is located and have the consultation for her breast surgery.

Dr. Face: She came all the way from Japan because she wanted to see superspecialists, cosmetic surgeons who specialize in only a handful of procedures.

Dr. Body: Medicine is so highly specialized these days. There are even some heart surgeons who specialize in operating on just one area, like the valves, of the heart. So it makes sense for a plastic surgeon to specialize in either surgery of the neck and head or surgery of the body.

Dr. Face: When we get into the operating room, you usually do your procedures first, although this time, I did my work first. Our common patient was put under the lightest anesthesia because she had a brow lift and we needed her cooperation to bring her to a sitting position to make sure everything was nicely symmetrical and balanced in her forehead. We also needed to see her open and close her eyes.

Dr. Body: Then she went under a deeper general anesthesia so I could do her breast revision.

Dr. Face: Sum total, two surgeons, two procedures…

Dr. Body: But in one surgical session, with one session of anesthesia, and one recovery period!

Dr. Face: Right you are doctor. Think what the patient would have to do otherwise.

Dr. Body: Sure, go to consolation, pre-surgical and follow-up visits in two separate surgeons’ offices in addition to going to two surgical centers, going under anesthesia twice and going through recovery twice.

Dr. Face:  Patients often ask why I limit my practice to six most common facial procedures and particularly nasal surgery.

Dr. Body: Same for me. I am asked why I do only body and no facial surgery.

Dr. Face:  I usually explain that restricting my practice to facial procedures and performing them over and over, brings better results because repetition breeds excellence. And, developing proficiency gives patients surgery with less time in the operating room. That translated to faster healing with less bruising and bleeding and, often, a quicker return to work or the home nation.

Dr. Body: I usually explain that “revision” means touching up work that is not ideal. For instance, I have one surgery coming up in which a woman had four breast surgeries in three years in her home nation and her breast still do not sit correctly on her body.

Dr. Face: I often explain that super-specialization is a normal thing in our times. Apply it to music, for instance.

Dr. Body: Music? How?

Dr. Face:  Well, a classical violinist specializes in classical music and sometimes just the music of two or three composers only. But I’m willing to bet that violinist does not play a bluegrass fiddle. And, likewise, you won’t see a bluegrass fiddle playing tackling Mozart!

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Read more about Dr. Kotler’s International cosmetic surgery patients.

Learn more about Dr. Linder’s revision breast surgery patients who come from afar for plastic surgery.

Chinese Singer Wang Bei

Stuart Linder, M.D. (“Dr. Body”) and Robert Kotler, M.D. (“Dr. Face”) follow world news from their offices in Beverly Hills and noticed with alarm the death of top Chinese pop singer, Wang Bei who was undergoing a chin reduction procedure.

In the aftermath, many – both in and out of China — are calling for a crack-down on how cosmetic plastic surgery procedures are done.

Drs. Face and Body suggest what Chinese officials could do to make sure cosmetic surgery is performed under the safest conditions known to medical science.

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

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

Take a look at Dr. Body’s breast revision before and after pictures.

View some of Dr. Face’s before and after pictures of nose job revisions

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Dr. Face (Dr. Kotler): The article I read about Wang Bei was by-lined by a British reporter who sat down one day in a beauty salon for a hairdo and noticed an upper eye lift going on in the chair next to her.

Dr. Body (Dr. Linder): That’s right. At the same time, China already has an established plastic surgery industry with top professionals adding thoughtful, insightful articles to the professional journals that are read worldwide. Last year, China saw three million plastic surgery procedures and slightly more breast augmentation cases than the U.S.

Dr. Face: So apparently, the Chinese cosmetic plastic surgery industry needs a few guidelines, rules and regulations.

Dr. Body: I think so, too. News accounts reported Wang Bei was having a chin reduction via a grinding technique and received a nick in a vein that allowed blood to enter her breathing tube. She died after what has been described as an “anesthesia accident” and “complications from anesthesia.”

Dr. Face: That probably means blood and mucous entered her lungs, whereupon she suffocated or possibly suffered a heart attack due to the strain on her lungs.

Dr. Body: That tells me that anesthesia was being delivered by an unqualified or untrained person. Or worse, the plastic surgeon was performing the anesthesia him-or-herself.

Dr. Face: So all of China is now calling for a crack-down on cosmetic plastic surgery. Where should they start?

Dr. Body: First, make sure that all surgeons performing plastic surgery are trained in that type of surgery. To be competent, anywhere from five to eight years of training after the M.D. degree are required, with a lot of surgery done under supervision of older surgeons and professors.

Dr. Face: The next step would be certifying  those surgeons by a board of highly experienced plastic surgery examiners. A candidate surgeon would have to present at least a year’s worth of surgical cases for examination, and then pass a written and oral exam. Re-certification should take place every five or ten years.

Dr. Body: The next step should be passing laws that require every surgery center to be certified by an examining body. I noticed that one of the gold standard organizations of surgery center certifications, JCAHO (Joint Commission on Accredited Health Organizations) now has a very active International arm which is inspecting and certifying many surgical centers in India, Turkey and other developing nations. It would be a very simple step for China to invite the International JCAHO in to perform that task there. (Read more about what constitutes a safer plastic surgery operating room.)

Dr. Face:  To make cosmetic surgery as safe as possible, China would also need laws requiring cosmetic plastic surgery to take place in those certified operating rooms. As the British reporter noticed, a beauty salon is no place for even a minor procedure.  Plastic surgery is still surgery nonetheless with lists of risks that can be greatly lessened in properly certified surgery centers.

Dr. Body: And of course, the crux of the Wang Bei case was the “anesthesia accident.” Yet another rule should be that plastic surgery procedures should have participation by a board-certified anesthesiologist ,who is also an M.D. and highly trained in keeping the patient safe, pain free and constantly breathing. Had a trained, experienced anesthesiologist been in attendance at Wang Bei’s procedure, that doctor would have known exactly what to do to save her life.

Dr. Face: The enforcement for all this would be the surgery center certifying body. If any surgical center failed inspection, it would lose its license and no procedures could be done there.

Dr. Body: I think all plastic surgeons should have hospital privileges, too. In that system, a local hospital, or hospitals,  have investigated the surgeon on its own and grants him or her the privilege of admitting patients with only a moment’s notice, just in case anything does go terribly wrong.

Dr. Face: What else needs to be done?

Dr. Body: People who are interested in having plastic surgery should know about all this. They should especially know how to select a properly trained and experienced plastic surgeon. (Read more about locating a qualified plastic surgeon in any nation.)

Dr. Face: The Chinese Association of Plastics and Aesthetics appears to be the certifying body for surgeons and should also do all they can to inform the public about safe cosmetic surgery practices.

Dr. Body: That’s a tall but necessary order and we wish them the best of luck! If we can do anything to help, just let us know.

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If you liked this blog post, you may also like:

*American Plastic Surgeons: Do-Over Specialists

*Plastic Surgery Websites: How to Read them

*How to do plastic surgery “Virtual” Visits With Surgeons

Stuart Linder, M.D. (who blogs as “Dr. Body”) and Robert Kotler, M.D. (“Dr. Face”) are two board-certified Beverly Hills cosmetic plastic surgeons who recently became inventors too.

Plastic surgeons work with the same tools on the same sections of the human anatomy, day in, day out, year after year.

Is it any wonder those surgeons often tinker and design better mousetraps and ways to do things?

Doctors Face and Body came into the ranks of inventors by coming up with some new garments and devices to make plastic surgery more comfortable on patients.

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

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

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

Here are some before and after pictures of nose job revisions performed by Dr. Face.

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Dr. Face (Dr. Kotler): Congratulations, doctor. I see the Linder bra is now on the market and available for consumers. Just how did you come up with the idea?

Dr. Body (Dr. Linder): After placing somewhere around 10,000 breast implants over the last 13 years and closely listening to those same patients, I saw a need for a new bra, especially one for women who had just undergone breast surgery.

Dr. Face: What makes the Linder Bra different from others?

Dr. Body: Most bras are only concerned with aesthetics, and not comfort. The Linder bra has adjustable panels under the arms and can allow for another two inches around the chest. Plus, it slims down back, or bra, fat that women just hate. It also creates cleavage by naturally lifting the breasts.

Dr. Face: It sounds like it could also serve as a sports bra.

Dr. Body: Correct! All women are different and each actually needs a custom fit – which this bra can be, it is so changeable. The Linder Bra even breathes well and prevents sweat buildup. It’s also convenient—a front panel has a zipper that makes it easy to slip on and off.  (Read more about the breast surgeon’s bra.)

Dr. Face: We’ve also done a little tinkering.

Dr. Body: For facial surgery?

Dr. Face: Yes, for nose surgery to be exact. Nose surgery to improve appearance, help breathing and relieve sinus problems is not particularly painful after surgery.  However, one item that has not won any patients awards is a technique known as nasal packing. The surgeon packs the entire interior of the nose with a variety of cotton-like or gauze material for up to five days after surgery. That also means no breathing through the nose. Results? Dry mouth and even some anxiety and claustrophobia. One patient said it was like drowning for five days; another side it was like having a clothes pin on the nose for days. The packing is medically wise but patient unpopular.

Dr. Body: Sure, it keeps the tissues in place and perhaps deliver a little medication.

Dr. Face:  Correct. But one recent patient left our office during a pre-surgery consultation after he found out the procedure – which he really needed for normal breathing – required nasal packing.

Dr. Body: He was having none of it?

Dr. Face: None! And after that, I got to thinking. There must be a way to do both – pack the nose and also allow for packing.

Dr. Body: So what did you come up with?

Dr. Face: It’s so simple; I’m surprised I didn’t think of it years ago. It’s the same principle as artists use when they make a life mask. They put some hollow tubes in the subject’s nose to allow for breathing before covering the face with plaster.

Dr. Body: Oh, I get it. You lay the tubes down and then insert the packing around the tubes.

Dr. Face: Correct, again! (Read more about the rhinoplasty tubes.)

Dr. Body: Know of any other plastic surgeon inventors?

Dr. Face: Yes, one that comes to mind is plastic surgeon Elliot Jacobs, M.D., one of our Park Avenue colleagues. He invented some very effective liposuction tools for gynecomastia surgery. Gynecomastia is when men have actual, dense breast tissue that usually cannot be liposuctioned. Most of the time, an incision is made to remove the breast tissue.

Dr. Body: How does the tool work?

Dr. Face: It’s a liposuction tool with a sharpen tip. The surgeon pushes the tool through the dense, fibrous breast tissue and then on the backstroke, a sharp aperture shaves off some of the tissue and sucks into the liposuction system. Going back and forth through the breast tissue many times, speeds up the task. The tool actually works like a Danish cheese slicer. (Read more about the liposuction tool.)

Beverly Hills plastic surgeon

Here, Doctors Face and Body run though the check list of items that warrant a call to your surgeon.

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

View some of Dr. Body’s breast revision before and after pictures.

Here are some before and after pictures of nose job revisions done by Dr. Face.

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Dr. Body: What’s the most unusual call you ever received from a patient who just had surgery?

Dr Face: One man brought his girlfriend with him to Beverly Hills so I cautioned him that sexual activity after surgery was verboten. Nonetheless, he called in the middle of the night about excess bleeding and, sure enough, he and his gal pal could not wait a few days so I had to attend to the bleeding the first night after the surgery.

Dr. Body: One of the prime danger signals after breast augmentation is when one breast is bigger than the other, or becomes swollen or sits higher than the other.

Dr. Face: What’s causing the changes?

Dr. Body: Excess bleeding, with the blood pooling at the bottom of the breast, pushing the breast or the breast implant up.

Dr. Face: Any other rare occurrences in breast enhancement that patients should nonetheless watch for?

Dr. Body: One that happens rarely but is very, very important is when numbness is present in the arm. It means a massive amount of blood or fluid or both has pooled at a very critical point and is compressing the nerves that go down your arm.

Dr. Face: In rhinoplasty, I tell patients to watch for pain or swelling that increases after the third day after surgery. Pain, if any, and swelling should be at its maximum 48 hours after the surgery and then start to recede.

Dr. Body: What about the surgeons’ other bugbear, infection in facial procedures?

Dr. Face:  Signs of infection can be hard to see under the dressings but if the cheeks of the nose job patient start to redden, it would warrant a call to the surgeon. Another obvious sign would be pus coming out of the patient’s nose.

Dr. Body: Anything else?

Dr. Face: The patient’s face may be sore to the touch.

Dr. Body: What else about a face or neck lift?

Dr. Face: Usually, we use drains in both face and neck lift so there should be no swelling. And infection always rears its ugly head by turning the area red. Patients really can’t rely on pain sensation because, in many facial procedure, small pain receptors have been cut and the area becomes numb. Of course, those numb areas recover to a normal state, given a little time.

Dr. Body: As you know, the vast majority of tummy tucks require a long incision that can run from hip to hip. So I worry about excess bleeding first and foremost. The most serious sign of trouble with a tummy tuck is severe abdominal pain – pain that is far worse than your basic stomach ache.

Dr. Face: Any other serious signs?

Dr. Body: Again, it happens rarely but if it does happen, your surgeon will want to swing into action right away. And that is severe pain in a calf in your leg. That may indicate danger of something technically known as a deep vein thrombosis, a blood clot that forms in a vein. If left untreated, that clot can travel up the lungs or the heart and cause terrible problems.

Dr. Face: The basic message I like to get out is: it’s far, far, better to contact your surgeon for something that turns out to be nothing rather than think you are bothering the doctor and waste valuable treatment time for a very serious condition.

Dr. Body: Right you are doctor! Because if it is serious, there is no time to lose.

Dr. Face: It can only become a bigger – and more expensive — problem if you wait when you should be calling and asking about it.

After Lip Augmentation

Virtually all  plastic surgery patients of Stuart Linder, M.D. (who blogs as “Dr. Body”) and Robert Kotler, M.D. (“Dr. Face”) read a lot about the many new gizmos, procedures and machines that help plastic surgeons perform plastic surgery.

But, according to the ultimate plastic surgery insiders, Dr. Face, (a Beverly Hills board-certified plastic surgeon) and Dr. Body, (also a Beverly Hills board-certified cosmetic plastic surgeon) it can be hard to separate big company hype and advertising from items that really provide better results at a lower cost. The doctors tell what’s really new.

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

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

Dr. Body: It seems like every week a new fat-removal machine comes onto the market with heavy advertising My patients have read about them and wonder if I can offer them.

(Read the previous post on plastic surgery and marketing hype.)

Dr. Face:  What do you tell them?

Dr. Body: I just state the facts; I already have an excellent machine with a 20-year history that’s easy to use, well tolerated by patients and is also one that provides great results. It’s the tried-and-true, basic tumescent liposuction procedure. Nonetheless, I’m queried weekly about laser, water-based, ultrasound, power-assisted liposuction machines and others that do not break the skin. Now, thanks to heavy advertising, I’m also hearing about cold-based liposuction. My impression is most of those devices have higher risks of hematomas – pools of fluids and blood trapped under the skin. Plus, most require larger entry ports to accommodate larger suction tubes.

Dr. Face: In procedures of the face, somebody, somewhere is always coming up with a “lunch time”, “30-minute”, “speedy” or some other surgery that provides fast, fast results. Unfortunately, when it comes to invasive plastic surgery, less is less and more is more; the more limited the surgical procedure, the more limited the result. So if a surgeon only spends half an hour on your face lift, the results probably won’t last six months.

Dr. Body: Correct; new technology does not always make for a better or quicker cosmetic plastic surgery.

Dr. Face:  But one of the instances where technology has improved things for the better are the new facial injectors that have been developed by biotechnology. Now you’re really talking minimal downtime and faster recoveries!

Dr. Body: Such as?

Dr. Face: Filler products like Juvederm, Restylane, Radiance, Captique and Sculptra. And since there is no surgery than can remove wrinkles around or between the eyes,  or on the forehead,  Botox Cosmetic and Dysport. The effect is temporary, but the patient has the injection and goes back to normal activities with no downtime whatsoever. And results are visible in a couple of days.

Now, the so-called “smoker’s lines” — the vertical lines of aging above the lips of women (and men)  are tough to erase.  Even pulsed light lasers are not as effective in removing wrinkles. Only heavy-duty lasers or deep chemical peels do the job.

Dr. Body: How did all those soft tissue fillers ever become so popular?

Dr. Face:  It started with collagen. But that’s comes from cattle skin so an allergy test was first required. That required a two-week waiting period. So the various fillers were first developed in the lab to speed things up a bit. Thus, we have true “no downtime” products for lip augmentation or reduction of deep lines around the mouth and lips and the so-called “drool lines” or “marionette” lines that run from the corners of the mouth down the chin.

Dr. Body: In cosmetic breast plastic surgery, some technology that looks promising is known as ADM, or allergenic dermal matrix. That’s a type of donor tissue that can be used in breast plastic surgery to support or cover breast implants. ADM has been used for years in lip augmentation so science pretty well knows the body does not recognize it as a foreign material, thereby causing rejection problems. What’s more, the strips of ADM become part of the patient’s body in time.

Dr. Face:  What about new breast implants?

Dr. Body: Breast plastic surgeons are good to go with the ones they have on hand – saline or silicone breast implants. More questionable, however, are the so-called “gummy bear” implants that have been in testing for quite a few years and may remain in testing for many years. It appears there are problems with the shape of the gummy bears.

Dr. Face: Facial implants are great but not totally foolproof. Plastic surgeons must always think in terms of “what if”. One new facial implant, made of coral, is porous. The supposed benefit is the body grows through the porosity, making the implant more stable. But, what if the implant has to be removed? It would be very difficult. I prefer products and techniques that have a long history that we can study and learn from.

Dr. Body: Anything else new in facial surgery?

Dr. Face: Yet another new technology is platelet rich plasma. A small amount of blood is taken from the patient, while asleep, prior to the procedure. The platelet, or sticky-cell portion, is retained and mixed with other complimentary chemicals. Then, during surgery, we spray the platelet rich plasma on the layers of tissue, beneath the surface, as we are closing the incisions during, say, a face lift or neck lift. That results in quicker recovery with far less bruising and swelling because the platelet rich plasma helps shut off tiny blood vessels that might leak and thus aids tremendously in rapid healing. Another substance, fibrin glue, is also made from other patient’s blood and helps tissue layers to adhere and weld together better. That also generates faster healing.

Dr. Body: One thing’s for sure, though.

Dr. Face: What’s that?

Dr. Body: The more breathless the ad, the bolder the promises of “instant” and “effortless”, the higher the hype!

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Look at some of Dr. Body’s breast revision surgery before and after pictures.

See some of Dr. Face’s  before and after pictures of nose revision surgery.