Dr. Body is Stuart Linder, M.D., F.A.C.S., an eminent board-certified Beverly Hills plastic surgeon who specializes in procedures of the body like breast augmentation and tummy tucks.

During tough economic times, consumers everywhere are pinching pennies and looking for price breaks on all types of goods and services. The costs of plastic surgery are no different.

Dr. Face is actually Robert Kotler, M.D., F.A.C.S., an equally eminent board-certified Beverly Hills cosmetic facial surgeon who specializes in rejuvenation procedures of the head and neck. (You may have seen Dr. Kotler on television’s Dr. 90210.)  Dr. Linder has been featured on the Discovery Health Channel, British Broadcasting Corporation, The View and dozens of other educational T.V. programs.

Additionally, both physicians have written books for consumers and penned many articles for professional journals. Doctors Body and Face jointly belong to:

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

Dr. Face (Dr. Kotler):  Doctor, did you hear the results of a survey among American Society of Plastic Surgery (ASPS) members about the impact of today’s economy on plastic surgery?

Dr. Body (Dr. Linder): Did I ever! Turns out 62 percent of surgeons reported a downturn in procedures compared to the previous year. The Northeast and Southeast are the most affected while the Midwest is the least affected, according to the survey.

Dr. Face: I’ve noticed that procedures in the plastic surgery “hot spots” – Beverly Hills, Manhattan and Miami — continue just a little above last year’s volumes.

Dr. Body: But the important thing is, if you know when to ask for a discount on cosmetic plastic surgery, the surgeon’s business manager is more likely to accommodate you.

Dr. Face: One way we keep our operating rooms at full capacity is via patients who are willing to undergo procedures on a space available basis. Usually, we give the patient anywhere from seven to 14 days notice.  Or, they can give us a list of days on which they are available.  That’s worth a serious discount to us because we always have cancellations for any one of dozens of reasons.  But if we can reach out and quickly fill that cancellation, our operating rooms don’t stand idle —which runs up costs for everybody.

Dr. Body: There are also situations in which a patient’s health insurance may cover some of the costs, even if the outcome of the operation provides an improved appearance.  Take breast reduction, for example. Health insurance may kick in on that procedure because overly large breasts frequently cause other health problems, most notably in the back and shoulders.

Dr. Face: Same situation with nasal surgery.  If the patient’s nose is causing breathing problems, the outcome is frequently a nicer looking nose even when the whole point of the procedure is to improve breathing.

Dr. Body: Any other insurance coverage on facial procedures, Doctor?

Dr. Face: Yes, for some patients who have sinus woes. During the final month of the year, we see many more patients for both nasal and sinus surgery because the insurance deductibles for the year have been recorded. So the insurance company, if the request is granted, picks up most of the tab.

Dr. Body: There are also times when you should not ask for a discount. Typically, the most busy times for body procedures are from late November to the new year and again during April –when people want to get in better shape for summer –and on through July, when the kids are out of school. The slow time for body procedures are when school starts once again

Dr. Face: Here’s another tip for patient savings, Doctor. If you want to bring another person interested in plastic surgery with you to the first consultation, the fee is the same as for one. If two people want to undergo surgery at the same time, the fees will be less than if each had surgery separately.  The savings can continue if two post-surgery patients occupy one room in a recovery center.

Dr. Body: What are your slowest periods for facial rejuvenation, Doctor?

Dr. Face: Many of our patients are a bit longer in the tooth and have requested procedures to make the face appear more youthful. That includes eyelid lifts, face lifts and wrinkle removal. So from the last week in November through the first of the New Year, we are usually booked solid. However, the first two months of the year are the least busy. So if you can arrange to have your facial surgery then, we can offer the usual procedures at only 75% of its full price.

Then, during summer, we become busy again, with many high school and college students booking appointments for nose jobs and other facial procedures.

Dr. Body: Many people are intimidated by plastic surgeons and are reluctant to ask about fees, costs and other pricing. What’s the best way for a consumer to get around that?

Dr. Face: Just call and ask! Everybody – plastic and cosmetic surgeons included – understand we all must be careful about spending right now. Just tell the office manager you are interested in such-and-such a procedure and would like to know if it fits into your budget. She can usually give you a range of probable costs, but you should be sure and leave your initial consultation with a firm quote on the total costs of your surgery.

Dr. Body: Be sure and mention credit cards, Doctor!

Dr. Face:  Gladly! If a patient can write a check or pay cash for cosmetic plastic surgery, ask if there is a discount for that. The reason? If you put the procedure on a credit card, the credit card company also charges the doctor’s office as much as three to five percent of the amount loaned!

Besides, doing without credit cards is the current “in “thing to do in this economy!

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!

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!

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.

Here’s their take on plastic surgery and New Rules.

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Dr. Face (Dr. Kotler): By now, everybody knows that California now requires – under the so-called “Donda West law” — a physical exam for every patient going under the knife of a plastic surgeon or a cosmetic surgeon.

Dr. Body (Dr. Linder): That is basically just good medical practice, supported by the American Association of Plastic Surgeons (ASPS), The American Society for Aesthetic Plastic Surgery (ASAPS) and others to make sure that a cosmetic plastic surgery patient is healthy enough for surgery.

Dr. Face: But I noticed a new law in New York State that requires all plastic surgery procedures to take place in a certified facility. (For a quick reminder of the certifications a surgical center can have, take a quick look at our previous blog post about plastic surgery center certifications.)

Dr. Body: Unfortunately, in America, there is no national law requiring surgeries to take place in certified facilities.

Dr. Face: So the consumer has to check it out on his or her own. But it’s an important consideration because many private American doctors have operatories within their office complexes.

Dr. Body: And if you look around at some new rules and laws worldwide, you’ll see a few more things that could make plastic surgery even safer.

Dr. Face: For instance?

Dr. Body: In Canada, a court has upheld the right of the college overseeing doctors to send inspectors into private clinics to examine their practices.

Dr. Face: So the college that oversees my specialty, head and neck surgery, could send a professor to see how I do things?

Dr. Body: Right!

Dr. Face: Not a bad idea. I recently read that the College of Cosmetic Surgery in Australia requires plastic surgeons to fully explain the risks of all procedures and to standardize the way before and after plastic surgery pictures are taken.

Dr. Body: That’s also good idea and something that any American plastic surgeon would be pleased to do.

Dr. Face:  I can think of a few new rules, I would like to add.

Dr. Body:  Such as?

Dr. Face: Any cosmetic surgeon performing surgery should have hospital privileges. That means the physician must have at least one hospital appointment so that, in an emergency, he can immediately get his patient into a full-service environment.

Dr. Body: Yes, and speaking of hospitals, prospective patients need to know that hospitals are expert in credentialing. Choosing a plastic surgeon who has excellent hospital privileges means that doctor has been fully cleared to perform the procedure – the face lift, the breast augmentation or whatever – you are considering.

Dr. Face:  Another new rule I would like to see is one that requires physicians to advertise their specialty only if they have board certification in that specialty.

Dr. Body: I’ve noticed that, too. Some cosmetic plastic surgeons advertise they are “board certified.” But the certification is in gynecology, internal medicine, neurology or some other discipline not related to the cosmetic plastic surgery arts.

Dr. Face: Muddying the waters even more are non-boards like the Board of Laser Surgery. But the American Board of Medical Specialties (ABMS) only recognizes 23 major medical specialties.

Dr. Body: So it’s up to the consumer to check on the board or ask a potential surgeon during the first consultation: “Which board has certified you?”

Dr. Face:  You can also do that on your computer. Just go to the ABMS website, (http://www.abms.org) register and type the first and last name of the plastic surgeon you are considering into the box on the left that reads “Is Your Doctor Certified.”

Dr. Body: Consumers should do all this because, in America, any physician with a proper medical license can offer plastic surgery.

Dr. Face: Maybe we need another new law! Just look at all the extra training required to be certified in head and neck surgery: the physician must have – after getting the M.D. degree — two years of general surgery training and another four in head and neck surgery.

Dr. Body: To be board certified in plastic surgery, the physician needs three years general surgery training after getting the M.D. degree and then three to five years more training in plastic surgery.

Dr. Body: To receive the certification, a three to five person board of professors and other super specialists examine two years of the applicant’s cases, business practices and character.

Dr. Face:  And then it’s written and oral exams every ten years for re-certification.

Dr. Body: Is it any wonder we have gray hair by the time we start our practices?

Dr. Face: If we have any hair at all!

Read more about the cosmetic plastic surgery training of Dr. Face.

Here is the page about Dr. Body’s education and training in plastic surgery.

Worldwide, recipients of plastic surgery procedures have sent their post-surgical reactions (and thanks) to Stuart Linder, M.D. (who blogs as Dr. Body) and to

Jointly, Drs. Face and Body have 60 years of experience performing cosmetic plastic surgery patients on 10,000 patients, many of whom have traveled to Beverly Hills from foreign lands.

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Dr. Face (Dr. Kotler): I received an interesting letter from a potential Italian patient. The man is very good at crunching numbers about the cost of plastic surgery.

Dr. Body (Dr. Linder): What did he have to say?

Dr. Face:  He has in mind coming here for a rhinoplasty and tells me it costs less for him to fly to Beverly Hills, have surgery, recover for ten days and then fly back home rather than have a similar surgery in Switzerland…..which is two hours from his home.

Dr. Body: And so the relatively weak dollar has spoken!

Dr. Face: What has your patient mail revealed lately, doctor?

Dr. Body: Well, I hear from former patients frequently although none are as good with an adding machine as your Italian correspondent.

Dr. Face:  Such as?

Dr. Body: Listen to this one: D.A., a Canadian woman from Alberta, sent a note saying how she was hesitant at first to cross the border after she had a botched breast augmentation near her home. But she came to Beverly Hills for a revision breast enhancement anyhow. After she healed, she wrote, and I quote: “I’m so glad I made the trip! I’ve got the hottest tatas ever!”

Dr. Face: I received a similar letter from a former rhinoplasty patient, Salome S. who flew here from Ethiopia. After going back home, she sent a note saying, “The hands of god must have guided you, as I feel so blessed!” I’m glad she was so pleased with nose surgery but, really, we don’t anoint people, we just do cosmetic plastic surgery!

Dr. Body: A flight from Ethiopia had to involve several stops at least. I received an extremely praiseworthy note from S.N., a woman from Singapore who came for a Beverly Hills breast lift and tummy tuck. She wrote: “I would make the 20-hour flight again to repair what having three children had taken away…”

Dr. Face:  20 hours in a plane! She should be anointed!

Dr. Body: L.K., another breast revision patient had breast enlargement in Hungary, her home country, but she did not like the results because one breast was higher than the other. After revision surgery in Beverly Hills, she sent back a note saying “her girls” are now bigger and they look the same.

Dr. Face: I saw another Italian patient for rhinoplasty who has no gripes at all about airplanes, probably because she is an attendant on international flights.  She writes that she thinks of us every time she looks at her nose in the mirror. Plus, when she tells friends about her nose job, they always tell her how natural her results looks.

Dr. Body: Here’s another good letter: A.M. from Puerto Rico had one of the most unusual complications known in breast surgery. She had three previous breast augmentations in her home country when the implants rolled together to form what is sometimes known as a “uniboob.” Medically, the condition is known as symmastia or a double bubble breast deformity. Look at her before and after breast surgery revision pictures and you can see how rare the condition is. I might also add – with all modesty – it is equally rare to find a breast revision surgeon with symmastia repair experience.

Dr. Face:  We also have some international patients from Indonesia, Kuwait and a few other nations who have second homes in Los Angeles or Beverly Hills. They frequently have cosmetic surgery for themselves, their teens and other family members while visiting. Some live here half of each year.

Dr. Body: What types of services does your office provide for international patients?

Dr. Face: Because California law and good medical ethnics require doing surgery only on healthy patients, we must have a physical exam completed before surgery. But it can be done from the patient’s home nation. International patients always enjoy looking at before and after facial plastic surgery pictures, too.

Dr. Body: Same for us, our patients must have a physical exam, too. Do you also do “virtual exams” so that you give patients a brief look through email, Skype or over the phone?

Dr. Face:  Indeed we do, doctor! And that will be the topic – Virtual Exams – of our next blog post.

Read how cosmetic plastic surgery appointments work for Dr. Kotler’s Out-of-Town Patients.

Learn how international patients can make arrangements for plastic surgery with Dr. Linder.

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Many American plastic surgeons, like

Both are also voracious readers of those publications and do their best to help patients – and even other doctors – understand the importance of new findings.

They often summarize their readings and findings in News & Views, reviews of the latest articles from the professional press.

While many more professional news reviews will follow from time to time, here is just one.

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Dr. Face:  (Dr. Linder)Everybody is interested in identical twins. But did you know that many, many twins have been studied before and after plastic surgery? One famous study compared twins who lived a healthy lifestyle with twins who smoked, drank, spent too much time in the sun and partied unto the wee hours. Guess which twin most needed facial plastic surgery?

Dr. Body: (Dr. Kotler) Probably the “bad” twin. But do I sense something new in the works about twins and plastic surgery?

Dr. Face: Indeed you do, doctor. As you may know, surgeons have always debated which particular surgical procedure yields the best and most long-lasting results. To find out, four plastic surgeons operated on four sets of twins back in 1995. Each surgeon used his own favorite surgical method which included neither unorthodox nor experimental approaches.

Dr. Body: Good idea for a study. What did they find?

Dr. Face: Plastic surgeons followed the twin patients at professional meetings in 1996, 2001 and 2005. At the last comparison, all of the twins looked good although nobody could answer the question, “Was it the surgeon or the technique?” The twins still look like each other, even after plastic surgery.

Dr. Body: What conclusions did you draw?

Dr. Face: That experienced plastic surgeons who perform a lot of procedures, say. at least two times a week of one particular procedure, get great results, even if they are using a different procedure.

Dr. Body: Very interesting! In what publication was the study printed?

Dr. Face: Plastic and Reconstructive Surgery, Volume 123, # 3, March, 2009.

Dr. Body: The article on twins I read was in the same magazine a month later. 186 sets of identical twins filled out a lifestyle questionnaire and provided photos. A panel of experienced cosmetic plastic surgeons then analyzed everything and presented their conclusions.

Dr. Face:  What was found?

Dr. Body: Of the leading most important lifestyle factors – things like marriage, body mass, sun exposure and even hobbies – cigarette smoking was fingered as one of the most significant. Because you could compare a subject to another person who is a genetic match, it was shown that every ten years of smoking equaled a two and one-half year older appearance.

Dr. Face: Another good reason not to smoke! If one twin smoked for, say, 30 years, he or she would look seven and one-half years older than the non-smoking twin. That is significant for somebody in the late 40s or 50s.

Dr. Face: Another important finding was that sunscreen did offer some protection from sun damage. Also, the study showed that women who had hormone replacement therapy after menopause looked younger than twins who skipped that therapy.

Dr. Body: For people who want to look that study up, how can they find it?

Dr. Face:  Just ask the medical librarian for Journal of Plastic and Reconstructive Surgery, volume 123, #4, April, 2009.

Note: Dr. Body is a leading breast surgery revision specialist while Dr. Face specializes in revision rhinoplasty surgery.