Non-Surgical Rhinoplasty Using Injections - Beverly Hills, CA

I had my first consultation with Dr. Kotler...

I had my first consultation with Dr. Kotler yesterday and I am going to document my experience from start to finish. Hopefully someone will benefit from my experience.
I met with Dr. Kotler yesterday for a consultation on a Non-Surgical Rhinoplasty using permanent silicone injections. I have some previous trauma around my nose that has left grooves and bumps. I like my nose or rather what it used to look like so my goal is to see whether injections to create semblance of symmetry would work for me. I have been doing somewhat of a passive research on my options for the past 5-6 years. Passive - because I was not willing to do a full-on rhinoplasty since 1) it's painful 2) you have to take considerable time-off from work and 3) the results are not 100% predictable. The idea of injections appealed to me on many levels - easy, cheaper and most importantly pain-free. 

It's important to note that Dr. Kotler uses permanent injections that do not disappear if you change your mind or are unhappy. He uses Silikon 1000, an FDA cleared and medical-grade liquid silicone. This is an “off-label” use for this silicone but it's deemed very safe because the FDA approval is for use inside the human eye to correct a detached retina. That said, only a handful of professionals are skilled in using this technique and you have to ask your surgeon about their prior experience. I would highly discourage anyone seeking this technique just from any plastic surgeon - it could be a recipe for disaster. I also consulted my ENT doctor, who I trust 100%. He strongly discouraged me from going down this route. His concern was that silicone, once injected, could move around and end up in unplanned places. Per Dr. Kotler, he has never had this happen to any of his patients. He injects micro-droplets of silicone that the body walls off and automatically plumps up the depression (fibroplasia). At the end of the day, this is my decision and I decided to go for it.

I booked my consultation through RealSelf.com due to the 25% off for the first session offer (I will break it down further). Although RealSelf indicated that someone was going to get back to me ASAP, I did not get a call from Dr. Kotler’s office for several days. I ended up calling them myself. Here’s the breakdown of how the process works:
1) First you have a consultation, which costs $200 and goes towards your procedure fee.

2) You can opt to have a saline demo – basically Dr. Kotler doing completely safe saline injections into your nose for you to pre-experience what it will look like. This optional procedure is not part of the $200 consultation. The saline demo costs $500.

3) After the consultation, Dr. Kotler determines how many treatment sessions you will need. In my case, he mentioned about 3. Each treatment session costs $1,000. In my case because I booked through Real Self, the first treatment is $750.

This is how my payment process went down: I paid $500 for my first visit. It included $200 consultation fee that went towards the saline demo (as opposed to your consult fee going towards your first treatment fee – it doesn’t matter what it goes towards, you end up paying the same amount in the end. In my case I just ended up “delaying” $200 into the next session). So, eventually, I will end up paying $500 + $750 (first treatment with 25% off RealSelf discount) + $1,000 (second treatment) + $1,000 (third treatment) = $3,250 total. Now, it is not exactly rock bottom prices but still a third of what rhinoplasty costs. Also, Dr. Kotler is the best out there, so you’re paying a premium for the best possible outcome. 

Now to my experience with Dr. Kotler – he is smart, confident and has great bedside manner. He doesn't rush you in and out of the appointment, he takes his time, listens to your story and makes sure all your questions are answered. I liked that about him very much. In my research, I found that for me it’s extremely important to have a 100% positive gut feeling. I am allergic to surgeons who are salespeople as opposed to devoted craftspeople. (Now his staff can do all the sales they want, I could handle it from them just not from the doc himself.) The saline demo was a very worthy investment. I encourage everyone to try it. When Dr. Kotler and I first discussed the present shape of my nose, he was a bit tentative about what results he could deliver, almost underpromising (which I also appreciate). Once he started plumping up my nose with the saline (which is basically salty water that absorbs back into the body within two hours) I got a feeling he was pleasantly surprised to see how good the results were. I need to mention that my nose is rather small so giving it a bit more volume for the purpose of disguising grooves and bumps actually worked perfectly for me. Imagine how I felt – I was so emotional, I looked in the mirror and felt like someone had just waved a magic wand. My mental picture of what I was hoping for, materialized in front of my eyes. I also want to mention that I have very realistic expectations – I wasn’t going in there to get Natalie Portman’s nose. I was hoping for some corrections while maintaining the general feel of my face’s geometry. I was elated, happy and probably beaming the entire time. I am going to post the pictures of my saline demo once Dr. Kotler’s office sends them to me. I am ready to schedule my first treatment. Each of my potential three treatments using the permanent silicone filler will be spaced out with 6 weeks in between. This is so that the silicone has time to settle in and form that fibroplasia I was talking about earlier. To be continued.

First Injection 5/22/14

Mr first injection appointment went well, as planned. Right after the injection, things look improved but did not produce the same dramatic "perfect" result as the saline demo. This is because Dr. Kotler likes layering the injections. I am waiting about 6 weeks for the injected silicone to settle before I go for my second treatment. That said, there is a visible improvement. My nose was a bit blue from injections for three days and after that went away, the effect dissipated just a tiny bit. I am posting pictures from my saline demo as well as a picture immediately following the first injection.

Second Injection 7/19/13

BTW, I noticed a typo in the previous update - obviously, we're still in 2013, not 2014. My second round of injections went well and I am still very happy. The micro-droplet technique takes time to take full effect so I just try to stay positive and just try to be grateful / happy for the progress I already see with my nose. As usual, I came in early to numb. Although I had to wait a little longer this time (before they never ran late but this day seemed like a busy one in the office, note to self: come in on tuesdays not fridays) it ended up working out even better because 45 minutes of numbing cream is much much better than 30 minutes. If before, I felt something during injections, this time I felt absolutely nothing. In fact, next time I am going to come in 45 minutes early - might as well. BTW, I don't think I have addressed the pain issue - for me, there is nothing painful about this process. If there is pain, it lasts a millisecond. I haven't addressed it because I don't pay attention to it at all but I could see how some people could be extra sensitive. I could only advise those to communicate that fear to the nurse / doctor right away and perhaps numb for longer than 30 minutes.
The injections are going very well - Dr. Kotler is a true artist because the day of the injections, the effect seems bigger but then it carefully settles into your nose. I see the real effect the following week and every day there is a subtle change. So, to be able to predict how everything will settle on day 45 is not easy. I trust Dr. Kotler because so far everything has settled in the right places. We are still in the process of creating symmetry and also disguising a bump. I am also doing my homework and as the injection is settling I am trying to understand - what do I like about this? what should I ask for next time? Since we are nearing the final round, there is some room for personal preference - do I want a slope or do I not? I realize how important it is to control the process - you are a paying customer and it is key to know what you want and to communicate it properly. So, I have made my observations and am looking forward to my final round of injections in 6 weeks. I am very satisfied with this process so far. Fingers crossed, almost there!

Photos Post 2nd Injection

The first photo is the one I took in my car immediate post second round of injections (7.19.13).
The second photo was taken today (8.4.13) - as you can see, as the 6-week period progresses, the appearance changes a bit. The groove on the left side of the photo (right side of my face) is fighting back.
Beverly Hills Facial Plastic Surgeon

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