I Can't Believe I Didn't Know About This Sooner!

A heads up that this review will be pretty long and comprehensive. But I know how helpful these reviews can be when you're deciding if to have plastic surgery and who to have it with, so I want to include as much detail as possible. [Note: The after photos are from 2 weeks after my third round of injections. I may go back for one more touch-up appointment after it’s fully settled, but these will give you a good look at the close-to-final changes that have been made.]  First, a little of my story:  About 13 years ago, I decided to get a rhinoplasty. I live in a mid-sized city in the Midwest and chose a doctor here in town whom I knew through an acquaintance and without any real research (there weren't all the review sites back then as there are now, though I honestly didn’t give the choice of doctor much thought anyway).    My post-surgery nose looked good. I was happy it was done and ready to move on with my life.  But then after several months, I developed a nodule of scar tissue near the tip that looked like a wart or pimple under the skin. I went back to the doctor who did the original rhinoplasty, and under local anesthesia, he went back in through my nostril to try to get the scar tissue out.  At first, it seemed like he got it. Whew, now I was done and ready to move on with my life.  But, the scar tissue seemed to grow back. You could see the nodule again.  So the same doctor decided to put me under general anesthesia this time and open the nose entirely back up to get a good look at the scar tissue. With this surgery, he felt like he had taken care of it.  Whew, now I was done and ready to move on with my life.  But then another bump started sticking out from under my skin.  I went to a different plastic surgeon in town to have him check it out. He said that now a piece of cartilage had buckled up. He put me under for another surgery where my nose got opened back up, and he stitched down the cartilage.  My nose looked good after that. Whew, now I was really done and ready to move on with my life!   My nose stayed fine for maybe a year after that.  But then things started to change as the next couple of years went by. I don't know if it was from those revisions, or just the general tendency the nose's skin has to shrinkwrap down over time after a rhinoplasty (especially after several revisions), but my nose started looking more and more messed up. The profile got some of that "polly beak" effect; a depression developed on one side of the tip, making it very asymmetrical; one of my nostrils retracted up.  It happened slowly, so I kind of got used to looking at it in the mirror. But now and again when I looked at a photo taken of me, I'd catch my breath. "Oh my gosh!" I would think, "My nose looks terrible!" I would cry and feel despondent. My self-esteem took a big hit. I became less apt to look people in the eye when talking to them, and felt less apt to want to go out and meet people in the first place. I became less outgoing. It's hard to underestimate the effect it has on you when you start feeling really self-conscious about this thing that sits in the center of your face and sticks out from it.  I looked into having another revision rhinoplasty. But the potential complication rate of doing another surgery after you've already had multiple surgeries was not at all encouraging. And when I looked at the before and after pictures that doctors advertised — even the best of the best who specialize in revisions — the results were honestly just not that impressive. With a few exceptions, the noses either didn't look significantly different, or actually looked a little weirder/worse (too small for the face; too upturned) — and these were the *best* cases that the doctors had decided to spotlight in their portfolio! And the after shots were taken soon after their revision surgery; how did their noses look two, five, ten years later? So-so results with the risks and substantial downtime attendant to having another surgery? No thanks. I decided I did want to do revision surgery.  Having never heard of non-surgical rhinoplasties, it seemed I was out of options. So that left me in this endless cycle where I would get used to seeing my nose in the mirror and feel like I could make peace with it, see a picture of myself and realize how terrible it actually looked, cry and feel despondent, accept that I had no options, and try to make peace with it again. I was filled with regret for having my original rhinoplasty, and all along the way I kept feeling pretty terrible about how I looked.  Then several years ago, I came across the idea of non-surgical rhinoplasty using temporary filler. I was filled with hope! Maybe this would be the solution I was looking for. Only one doctor did filler in my home state, so I drove to see him. He was young and not particularly impressive. He told me that he *could* try doing filler with me, but it really wouldn't fix my nose to an acceptable level, that it carried significant risks, and that he didn't recommend it. He instead recommended that he do a revision surgery on me. I was crestfallen and left his office in tears (literally, I have tears in my eyes in the “before” photos he took of me in case I wanted to move forward with the surgery).   So I was back to being out of options. And back to feeling hopeless.  Two years went by. On one of those occasions when I saw an unflattering photo of myself and fell into my cycle of despair, I decided to look into the filler idea again. I decided I would consult with another doctor out of state to get a second opinion on its viability.  I researched different doctors in the country who did temporary filler. I started to feel hopeful that maybe filler could help in the hands of the right doctor. I was concerned, though, about the risks of temporary filler — like blindness and tissue death — even though they're vanishingly rare. And even if I did like the results, did I really want to sign myself up for yearly refills…for the rest of my life? Was I going to have to keep getting my nose topped off when I was 80 years old?  While I was researching, I came across Dr. Kotler. His before and after pictures were so impressive — and to think those people had achieved their results without surgery!  Initially, though, the idea of *permanent* filler seemed a little scary/sketchy. Putting silicone in your nose? Was that actually legit? If so, why are there only two doctors in the country who do it?  But I was so intrigued by the idea that I decided to schedule a virtual consultation with Dr. Kotler. His office set up a time for me to talk to him right away, even though the appointment was after office hours, which impressed me. Dr. Kotler was very kind and helpful in explaining the nature of silicone injections and how the procedure is almost risk-free.  The biggest things that allayed my concerns and may allay yours as well are these:  Dr. Kotler has been doing this for 40 years. 40 years! He's done it on tons of people and on his own family members too. This isn't some new, experimental procedure where no one knows the complication rate and the long-term effects. Dr. Kotler has the track record to be able to declare this procedure very safe and effective.  If this procedure did result in bad results, the world would know it! Again, Dr. Kotler has done this for decades. If it was a sketchy treatment, then the internet would be filled with negative reviews for him. But instead, his reviews are glowing. Glowing! And I'm here to add my own review to that glow.  As to why more doctors don't do it…one can only speculate. It may be because silicone doesn't have the big drug/cosmetic companies behind it the way the name-brand temporary fillers do. It may be because doctors stand to profit a lot more in doing temporary rather than permanent fillers. Doctors will often tout temporary fillers as a more economical alternative to surgical rhinoplasty because they're only ~$1k a pop. But given that they're temporary, you're looking at paying $1k every year for what…30, 40 years?! That's $40k+ over your lifetime! So much for being economical.   I was feeling really good and hopeful after my consultation with Dr. Kotler. A half hour after we spoke, he followed up with an email saying he was looking more at my pictures and felt even more confident he could help me. I was impressed he was still working on my case after hours and took the time to follow up with that email.  I was still nervous about the idea of permanent filler — because it's, you know, permanent! — but I was feeling reassured and excited about the idea and scheduled my first treatment for the following month.  I had to fly halfway across the country and decided to fly in and out the same day, taking an uber from the airport to Dr. Kotler's office, having the injections, and then ubering back to the airport to get right back on a plane. This was obviously tiring and a hassle, and the flights added almost another $1k to the cost of each treatment, but let me tell you, it was entirely worth it!  I did the standard three treatments that are recommended for most patients. It only takes about a half hour for each treatment, and because they put numbing cream on your nose beforehand, it really doesn't hurt bad at all. Very tolerable.   I was amazed at how much better my nose looked even after the first treatment. A 20-minute, in-office, no-downtime procedure can significantly change the way my nose looks? I couldn't believe it. It's the kind of thing that doesn't seem possible and seems too good to be true. But it is true! I can't believe I didn't know this option existed earlier. I can't believe more people don't know about it!  If you're considering a rhinoplasty, here are the things I would recommend thinking through:  Consider whether you *really* want a nose job. Nose jobs are so common that they just seem like a walk in the park, like visiting the dentist. No big deal. But while the majority of rhinoplasties turn out fine, a significant number do have complications. Think about the fact that most plastic surgeons who do noses do both primary rhinoplasties AND revision rhinoplasties. It would be like if auto mechanics specialized in fixing your engine and fixing the fixes they made to your engine. It's not necessarily the doctors' fault (although there are some bad ones out there who make revision-requiring complications more likely); even the best doctors will sometimes run into complications because the nose is simply a difficult thing to work on. So, if your nose doesn't *really* bother you, consider just living with it and leaving good enough alone; trying to fix it may potentially turn into this epic, despair-inducing, time-sucking, money-draining saga for you. Especially if you don't pick the right doctor, which brings me to my next point:   Let's say you do have a significant issue with your nose, and you want to have a rhinoplasty. That's ok! A good rhinoplasty *can* make a huge difference in your life. I once heard another plastic surgeon say that he's like a psychiatrist who does therapy with a knife, and that's actually very accurate. Obviously, there are psychological/self-esteem issues that require actual therapy to fix. But if you feel bad about yourself because of your nose, a rhinoplasty can fix that. I cannot tell you how much better I now feel about myself than I did before the Kotler treatments. I am so much happier. I can look people in the eye. I like to meet people. I am back to being outgoing. It's made a huge, huge difference in how I feel about myself.   So, if this is something you need, go for it. However, if you are going to go for it, then seriously invest in the right, best doctor to do it. This is NOT something where you should prioritize convenience and price. Do not just settle for the doctor in your hometown because he's close by. The doctors in plastic surgery mega centers like LA, NYC, and Dallas are going to be way better than the doctors in some mid-sized city in the middle of the country. Be willing to travel to the best doctor. Yes, it's a hassle. Yes, it will be worth it. Again, your nose sticks out of your face, and it's going to be part of every interaction you have with people for the.rest.of.your.life. It's going to affect everything about the rest of your life. Treat this as the huge investment that it is. Pick the best doctor.  If your nose doesn't have a significant issue, choose a non-surgical rhinoplasty with Dr. Kotler. It can make your nose look significantly better, without the downtime and the risks of complications that come with surgical rhinoplasties. Again, it's just amazing. I wish I would have known it was an option from the start.   If your nose does have a significant issue, e.g., it's too big (injections can't make your nose smaller), then go ahead with surgical rhinoplasty . . . and also choose Dr. Kotler! If your nose does have some post-surgical issue or doesn't turn out exactly as you wanted it (again, even the best doctors cannot achieve 100% perfect results with rhinoplasties), then he may be able to fix the issue with injections instead of your having to undergo a revision surgery.  To sum up this very long review, if you need a rhinoplasty, you can trust yourself in Dr. Kotler's hands, and I cannot recommend his permanent non-surgical rhinoplasty enough, especially for those who are in need of a revision rhinoplasty. Really, I still can't believe this treatment exists and is as good as it is. In the follow-up email Dr. Kotler wrote me after my initial consultation, he said, "I believe the filler will be your nose's salvation, finally.” And that couldn’t have turned out to be more apropos because it honestly feels like a modern-day miracle.