Ask The Doctor

ask dr kotler

This week’s answers:

Q: When I lie down, one side of my nose stuffs up. If I roll over, the other side stuffs up. A pal told me to get my turbinates checked out. What are those? - O.E.

A: Your pal is wise. What you describe is typical of “ turbinate instability”. The turbinates are shelves of bone, three within each nasal passage, which aid in warming, humidifying and filtering incoming air on the way to your lungs. They are important. However, some people’s inferior (lowest and largest of the three) turbinates may swell and shrink with position. It is not the bone that varies in thickness, it is the skin-like covering.

When you get a cold or bad allergy attack, that same skin-like covering which lines the rest of the nose, swells from the cold virus or the allergen to which you are sensitive.

Here is the good news: those two inferior turbinates can be reduced in size making them less obstructive. There are many ways to do it; some more invasive than others. For nearly 40 years I have reduced the size of those turbinates and rendered better breathing for hundreds of patients. It works.

Q: I had a nose lift and my doctor used silicone to augment my bridge.. Is it safe for me to have ematrix performed on my face?My fear is that the silicone will get deformed and then melt.. Thanks a lot…I’m looking forward to your response. - R.V.

A: Don’t worry. E-matrix is directed only at the surface of the skin. Most likely your silicone was deposited UNDER the skin, just superficial to the bone and /or cartilage and so should not be affected by what happens to the skin.

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Missed the latest answers? Here’s what Dr. Kotler has to say about previous questions from our visitors.

Q: How does a nose job work if it is non-surgical? – J. F.

A: Nonsurgical nose jobs are only for the outside of the nose and can’t help if structures inside the nose – like the septum or turbinates — need surgery.

First, a numbing cream is applied to the skin of the nose to make the procedure painless. Then, using very fine needle, facial filler is injected just under the skin where a depression, divot, mogul or groove exists, again, on the outside of the nose. Even humps on the bridge of the nose can be disguised and made to appear straight by filling in the area above and below the hump.

While some surgeons use popular fillers like Restylane or Juvederm, we prefer to make the changes permanent by using Silikon 1000. As you may know, Juvederm and Restylane dissolve back into the body within six to 12 months. However, tiny drops of Silikon 1000, injected just under the skin are permanent. Moreover, the savings are very substantial over surgical repair.

There’s another plus to non-surgical rhinoplasty: we can take the improvements for a “test drive” by injecting saline (a medical grade salt water) into the nose first. Then, you would have about an hour to see and photograph what the changes look like before the saline dissolves harmlessly back into the body.

non Surgical Rhinoplasty

Q: How many types of cosmetic neck surgery are there? – C.D.

A: There is neck sculpture to remove the double chin; an extended neck lift that goes wider beyond the double chin to reshape the neck. Both procedures involve removal of fat and loose, excess muscle, and not skin. But if you have lots of wrinkled, thin skin on the neck, you will need a face and neck lift to tighten the lower portion of the face and the neck.

Q: This may sound stupid but I hear people say all the time they will give you some of their stomach for your breast or butt; can you really do that? – K.C.

A: Only if the donor is a twin. You can’t receive transplanted tissues from anyone but an identical twin because your body will see the donated tissues as foreign and reject them.

Q: In addition to reviewing a doctor’s before/after photos – and particularly seeing how the result compared with the computer-predicted image — is there anything else I can do to be more comfortable with that doctor and come to a comfortable decision?

A: Yes. The next step is to meet with one of the doctor’s patients who has had the procedure or procedures you are considering. Nothing better than seeing the result “in the flesh” to look at the quality of the incisions or to see how smooth and wrinkle-free the skin is. This will also afford an opportunity to hear from the patient how she or he was cared for.

For example, were the doctor and staff helpful and available to you? Did they provide all the services that were promised? How was the surgery center and anesthesia experience? After all, if you see a natural-looking, substantially-approved appearance and the patient felt that she or he was well- cared for and felt safe in that office, most likely you can feel confident that you, too, will have an excellent experience. And, what if the practice does not make available to you such an experience? A good reason to continue interviewing other doctors.

Q: After two kids and emotional eating, with much exercise and dieting, I managed to go from 210 pounds to 170. I feel healthier but wish I had a body I could be proud of. I am 5’6″ with thick arms and waist, loose skin, stretch marks, but no butt or hips whatsoever.I’m not sure I have enough to achieve the butt or hips I want. I’m wondering if body contouring is what I need to be saving up for. Or is it the buttocks augmentation procedure, best for me? How much does it cost? –K.C.

A: I specialize in face and neck cosmetic surgery procedures only but do learn from my Beverly Hills colleagues who only perform body procedures. The loose skin on the abdomen may require a tummy tuck, or abdominoplasty. Stretch marks are very tough to loose unless they happen to be positioned within the excess tummy skin that is removed.

Regarding augmentation of the buttocks or hips, there is less history of great success in that department. Transferred fat is too often absorbed by the body. By the way, is 170 pounds your goal weight or do you intend to be leaner? Generally speaking, it’s best to be at your leanest possible weight before booking a first consultation with a cosmetic plastic surgeon who performs only body procedures.

Meanwhile, read the best book on the subject, “The Beverly Hills Body” by Stuart Linder, MD, FACS.