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Costly Revision Needed 6 Years After Primary Rhinoplasty
I hate to write this review because he's a really nice guy, but the more important thing is that people get the results they want from their surgeon so here goes:
I'm very unhappy with my nose job 12 years out and I've been unhappy for about 6 years. For the first 5 years it looked great - then, for whatever reason, the tip/bottom of the nose drifted to the left and retracted and caused other facial asymmetries. It's by no means awful, but I do angle my face in pictures to strategically hide it.
The movement had the effect of making the nostril on the right too high and retracted, and the upper lip pulled up with it, so I avoid that side view, and the nostril on the left pushes down on the lip, my understanding is that it's because the nasal base is being pushed on that side, so not only is my nose asymmetrical and jutting to the left, but my face is more asymmetrical with the lip, nasolabial fold, and cheek in general sitting differently because the nostril is pushed on the left. The movement also had the effect of separating the foot plate (forgive me if that's not the right terminology) - meaning the cartilage in between the two nostrils looks separated. This started to appear in ~year 8. The tip retraction also contributed to the nostrils showing too much, particularly the nostril on the right.
It's not entirely clear to me what happened, but as I understand that a decent chunk of nose jobs are revised (some 20%), and it's quite common for a nose to look good and do what it's supposed to for 5 years then start to heal in funny ways from there. My best guess is that he shaved a little more off the right than the left, and that he corrected a deviated septum that deviated back to where it wanted to be over time, pulling the nostrils/base of nose more asymmetrical. Before I had the nose job, I had a bump on my nose and a bulbous tip and he narrowed tip and got rid of the bump. It was also slightly deviated and he fixed that. The deviation was imperceptible to me going in and he mentioned he fixed it after (not complaining about this, just a note)
It's still better than pre nose job nose, and I still prefer to have gotten it, but he implied that the nose would be in its final position by year 1 and stay there (barring movement/growth related to aging), and I wasn't properly informed of the risk of revision/that noses don't really settle into a permanent place like he said. I would have asked questions differently and looked for different things had I known how high the chance of a revision would be and that I should expect it to look good for 5 years.
I started looking for revision surgeons 5 or so years ago, and have met with 5 or 6 and it seems the consensus is that the deviated septum needs to be fixed and rib or ear cartilage would need to be taken to improve the alar rim retraction and the tip turning up. Problem is, there don't seem to be a lot of surgeons willing to take on revision rhinoplasties due to complexity, risk, and skill needed, and the quotes I've gotten for it have ranged from $18-27k. I don't have $18-$27k to make this correction so I just have to live with it (I paid $8k in 2007 for the original surgery) and I'm frustrated.
I tried getting the surgery notes from Kotler's office to help inform my consults for revision and his office lost them so that kinda sucks for guiding a new surgeon around the scar tissue. I tried doing a "nonsurgical nose job" - aka fillers in the nose - it cost $1800 and made a maybe 10-20% improvement and lasts 18 months or so - overall not worth it at all. I tried visiting Kotler to see if he would recognize an error and do a revision less expensively - he said he'd offer a "big discount" - which was $1k off of $15k for a septoplasty, and he didn't seem to want to do it at all (Not great when it's your work I'm correcting). I don't think he saw it as a big enough error - which indicates to me that this isn't uncommon - which indicates to me I should have known this at time of original surgery and makes me concerned how common it actually is for a so-called minor revision (aka it's not horrifying; you can live with it) to be needed years later.
Again, he's a nice guy and I'd venture to say a trustworthy human being in general and I hesitated to write him a negative review. In the period before I became unhappy with my nose, I even referred him business. But I think there should have been more responsibility for correcting it and I should have been informed clearly that this was likely to happen before moving forward.
I'm very unhappy with my nose job 12 years out and I've been unhappy for about 6 years. For the first 5 years it looked great - then, for whatever reason, the tip/bottom of the nose drifted to the left and retracted and caused other facial asymmetries. It's by no means awful, but I do angle my face in pictures to strategically hide it.
The movement had the effect of making the nostril on the right too high and retracted, and the upper lip pulled up with it, so I avoid that side view, and the nostril on the left pushes down on the lip, my understanding is that it's because the nasal base is being pushed on that side, so not only is my nose asymmetrical and jutting to the left, but my face is more asymmetrical with the lip, nasolabial fold, and cheek in general sitting differently because the nostril is pushed on the left. The movement also had the effect of separating the foot plate (forgive me if that's not the right terminology) - meaning the cartilage in between the two nostrils looks separated. This started to appear in ~year 8. The tip retraction also contributed to the nostrils showing too much, particularly the nostril on the right.
It's not entirely clear to me what happened, but as I understand that a decent chunk of nose jobs are revised (some 20%), and it's quite common for a nose to look good and do what it's supposed to for 5 years then start to heal in funny ways from there. My best guess is that he shaved a little more off the right than the left, and that he corrected a deviated septum that deviated back to where it wanted to be over time, pulling the nostrils/base of nose more asymmetrical. Before I had the nose job, I had a bump on my nose and a bulbous tip and he narrowed tip and got rid of the bump. It was also slightly deviated and he fixed that. The deviation was imperceptible to me going in and he mentioned he fixed it after (not complaining about this, just a note)
It's still better than pre nose job nose, and I still prefer to have gotten it, but he implied that the nose would be in its final position by year 1 and stay there (barring movement/growth related to aging), and I wasn't properly informed of the risk of revision/that noses don't really settle into a permanent place like he said. I would have asked questions differently and looked for different things had I known how high the chance of a revision would be and that I should expect it to look good for 5 years.
I started looking for revision surgeons 5 or so years ago, and have met with 5 or 6 and it seems the consensus is that the deviated septum needs to be fixed and rib or ear cartilage would need to be taken to improve the alar rim retraction and the tip turning up. Problem is, there don't seem to be a lot of surgeons willing to take on revision rhinoplasties due to complexity, risk, and skill needed, and the quotes I've gotten for it have ranged from $18-27k. I don't have $18-$27k to make this correction so I just have to live with it (I paid $8k in 2007 for the original surgery) and I'm frustrated.
I tried getting the surgery notes from Kotler's office to help inform my consults for revision and his office lost them so that kinda sucks for guiding a new surgeon around the scar tissue. I tried doing a "nonsurgical nose job" - aka fillers in the nose - it cost $1800 and made a maybe 10-20% improvement and lasts 18 months or so - overall not worth it at all. I tried visiting Kotler to see if he would recognize an error and do a revision less expensively - he said he'd offer a "big discount" - which was $1k off of $15k for a septoplasty, and he didn't seem to want to do it at all (Not great when it's your work I'm correcting). I don't think he saw it as a big enough error - which indicates to me that this isn't uncommon - which indicates to me I should have known this at time of original surgery and makes me concerned how common it actually is for a so-called minor revision (aka it's not horrifying; you can live with it) to be needed years later.
Again, he's a nice guy and I'd venture to say a trustworthy human being in general and I hesitated to write him a negative review. In the period before I became unhappy with my nose, I even referred him business. But I think there should have been more responsibility for correcting it and I should have been informed clearly that this was likely to happen before moving forward.
Provider Review
Board Certified Otolaryngologist
9735 Wilshire Blvd., Beverly Hills, California