rhinoplasty Complaints, Reviews, & Information

Dec 11, 2011

Bad surgery

AN UNFAIR, INACCURATE, MALICIOUS AND VICIOUS ATTACK UPON THE PROFESSIONALISM OF
ROBERT KOTLER, MD, FACS.

TO “SET THE RECORD STRAIGHT”, EACH OF THE INACCURACIES AND UNTRUTHS ARE ADDRESSED AS “REBUTTALS”.

I approached Dr Kotler's clinic for a nose job about two years ago. I had a wide tip and a bit of a sunken nose and wanted the nose shaped and narrowed. I had no breathing problems. Dr Kotler is a very nice person and I have nothing against him personally, but he created an expensive problem for me and quite a bit of emotional misery and left me to carry the costs and hassles.

When I approached the clinic I was very persistent that Dr Kotler was particularly skilled with nose jobs. They assured me he was basically "the best" under the sun.

REBUTTAL: Our office is considered highly professional. While our staff has confidence in Dr. Kotler’s abilities and talent, we would never use the words “the best under the sun”. It is hard to define the best among a pool of very competent professionals. Dr. Kotler often reminds patients that there are many highly qualified nasal surgeons in Southern California. Today, no doctor or other professional can legitimately claim to be “the best”. There are many “best”.

Come consultation day, and we go through the improvements I need and how he would do the procedure. We even looked at morphed b/a pictures to get a clear visual understanding of the expected outcome. I was pleased with the pictures and Dr Kotler's assurance, so I agreed to the surgery and made a downpayment (they are very pushy about the payment and will keep pestering you for the entire sum in advance long before surgery).

REBUTTAL: Our practice is never “pushy” about payment. We do not “ pester”. If a patient wants our services, fine, if not, that is fine too. We don’t operate like a commission-driven used car lot.
As is the standard for cosmetic surgery, when a patient wishes to schedule surgery, a modest deposit is required to reserve the operating room space and the anesthesiologist. The remaining payment is due two weeks prior to surgery, and only after the patient has cleared a complete history and physical by his/her personal MD to be sure that their health is satisfactory for an elective surgery. Is that “in advance long before surgery?” Does that sound improper?

I asked several times if the pictures were a close resemblance of the outcome. Dr Kotler assured me the pictures showed a 90% accuracy what he could achieve.

REBUTTAL: This statement is emblematic of the fictional nature of this post. Dr. Kotler never predicts a percentage accuracy. That would be folly. What he does tell the patients that since 1989 the practice has provided computer imaging to nearly every patient and no patient has ever returned to the office and complained that their computer imaged, pre-op photo surgical result was not a reasonable depiction of the actual outcome. As Dr. Kotler has stated to patients and to his colleague when teaching: If a surgeon does not have the skill to deliver the result of the computer imaging, he will stop continuing to offer it because of a high rate of patient dissatisfaction. Our office and our website has many examples of so called “ triptychs”, the “ Before”, the computer generated, predicted “ After” and the actual “ After”. Such examples will fortify the validity of the concept of computer imaging. However, no ethical doctor will claim a “ 90%” or “ 85”” or any other such percentage number assignment of accuracy because that is impossible to quantitate.

He added that he had done several thousand rhinoplasties, and correctional procedures on others surgeons mistakes.

On surgery day, a friend who picked me up told me the surgery had not taken longer than about one hour to complete. We couldn't believe how much money I paid for an hours work.

REBUTTAL: Further evidence that this post is just malicious, libelous fiction. The time of an operation is not limited to the “ cutting and sewing”. By the standards of the all the world of surgery, operation time is the time spent in the operating room. This includes preparation before surgery, e.g. attaching heart, lung, blood pressure and pulse monitors. Starting an intravenous line. Sometimes applying leg anti-blood clotting pressure devices. Then there is time for the anesthesiologist to actually put the patient to sleep. Following that, the skin of the face and neck is prepared with antiseptic and the surgeon must inject local anesthesia mixed with a drug to reduce bleeding. For nasal surgery, nostrils must be specially prepared including trimming long nasal hairs and special disinfecting. The surgeon then packs the nose with medications to further anesthetize the interior and retard bleeding. Then the sterile drapes must be applies and the various instruments and devices set in place on the sterile field. Finally, the surgeon must remove the tampons placed within the nasal interior as part of the anesthesia deliverance. There must be a final check of all equipment, including suction lines. Further confirmation with the anesthesiologist that all is well in his or her department. Only then does the actual operation begin.

The above takes from 15-20 minutes. Only then does the operation begin. If the actual operating time for Dr. Kotler to complete a rhinoplasty is 45-60 minutes, which is reasonable, the operating room experience is still not over. First, Dr. Kotler must place his-designed nasal airway to provide the patient satisfactory breathing immediately after surgery and throughout the immediate post-operative period. That device must be checked by Dr. Kotler. Then, the nasal packing is inserted. Following that, the external protective dressing in placed.

Next, the anesthesiologist returns to the operative field to preside over removal of the anesthesia apparatus from the throat and to provide the usual chores in anticipation of awakening the patient. The actual awakening can take 5-10 minutes. The patient’s vital signs must be again re-assessed and a clear airway, without bleeding or mucus collection, must be assured. Then, the patient is transferred to a cart and leaves the operating room. All these activities and safety checks after Dr. Kotler places the last stitches, take anywhere from 15-20 minutes.

Add up the above time and you hardly get “no longer than an hour”. Absurb in its inaccuracy.

It would have been fine, except my surgery did not turn out well. When the covering came off it did not even have a 10% resemblance to the pictures.

REBUTTAL: This writer of fiction, claims that 90% of her nose was incorrectly operated upon? Come on! No such thing; impossible.

I ended with a prominent disfiguration that I never had before surgery which the doctor wanted to correct with injections (I only found out one year later that they were silicon injections). The silicon injections left my skin discolored. I went for silicon injections twice and it did nothing to improve the disfiguration. The discoloration became even more prominent over the months.

REBUTTAL: While any surgery can result in a minor imperfection, we have had no patient in our practice who could be responsibly described as having a “ prominent disfiguration”. Were there such a thing, which is nearly impossible with today’s established surgical techniques, there would have been no role for the office medical grade silicone injections. Such micro-drop fillers are appropriate only for minor dips and depressions. This “discoloration” alluded to is heretofore unknown in our practice. In 34 years of using the superb silicone product, I have witnessed any change in skin color. The writer cannot be relating reality.

I was very unhappy with the bad results but the doctor asked me to be patient and allow the nose to heal properly, which would take over a year. I agreed to be patient. After a year the results were getting even worse when the doctors mistakes became more prominent when the swelling went down. I contacted Dr Kotler. He responded right away and was very polite but his solution was more silicon injections and a possible revision. I was not keen to have corrections by the same man who created the problems in the first place. I went for a second opinion with a chief surgeon and a specialist on rhinoplasties. He told me to immediately stop the silicon injections since the red discoloration was a bad sign. I was told silicon injections can give permanent skin damage

REBUTTAL: I cannot comment on alleged statements from other professionals. I will say, however, that in that long, 34-year experience with micro-droplet injections of medical grade silicone, I have never seen such giving “ permanent skin damage”. I can refer the reader of this to several medical journal articles confirming the successes and safety of such injections. If they commonly caused “skin damage”, why would any of us use it? And, recall that this writer, at the beginning of this malignant and fictional rant, stated that she had a “ sunken nose”. Well, we tell patients –before surgery – that some of these depressions, dips and divots may not be corrected by surgery alone and that, as needed, after surgery, and with their agreement and consent, we can fill and thus correct such deformities. Fillers, of all kinds, are universally used in cosmetic offices worldwide.

and make a revision very complex. Many surgeons will not touch a patient with silicon injections due to potential tissue damage, I was told. I wanted the ugly disfigurations corrected and asked Dr Kotler to pay for the cost of a revision elsewhere to correct his mistake, by a surgeon of my choice. He found this suggestion over the top and refused.
A revision will cost me three times the original surgery. For this reason I was not able to have a revision.

REBUTTAL: More lies. No patient has asked me to pay for the cost of a revision surgery done by another surgeon. Since this “patient” claims her nasal surgery was within the past two years, were such a request made, within that recent time frame, I would recall it. As far as a revision surgery costing “ three times the original surgery”, I think the writer is not truthful. I know the costs of surgeries by nasal surgeons throughout the US. No one would charge three times an original surgical fee. It is not done.

The disfigurations from Dr Kotlers surgery remains and it has been a very sad and miserable experience for me.
The red discoloration is now permanent although it shows more during summer season. The entire nose, and the tip in particular, is in fact much bigger and wider today than before surgery. Today it is very shapeless and ugly. Results never resembled anything close to the pictures we had looked at.

REBUTTAL: Nearly every rhinoplasty or nasal cosmetic surgery is a “reduction” procedure. The net result is a smaller nose, not a larger nose. So, how does this writer claim her nose is “ bigger and wider”. Cannot be. I know my practice, I know my patients. After all, we don’t operate on thousands of patients a year, hundreds. We know every patient quite well, having spent time before and after surgery. Our practice just does not have anyone whose story matches what this malicious blog-poster is relating.

.

We need a serious change in regulations. I think it is very wrong that a surgeon is not responsible to stand for the cost of a revision, should a patient have bad results from his surgery and want to go elsewhere.
I also think plastic surgery patients should be given 3-years to report a complaint to the medical board. The doctor clearly told me it takes over a year to fully recover, while complaints to the medical board must be done within a year.
There is simply not justified patient support and protection from failed procedures. We are left to carry both scares and costs.

REBUTTAL: This is a rant, for reasons unknown to me or my staff. The writer has written falsehoods and fictions that are not verifiable. Even the above political commentary is inaccurate. The statement that it takes over a year to fully recover is one of the few correct statements this mischievous person has made. Yes, the nose ripens and matures over a period of time and at one year is often more refined than at 3-4 months which is the basic time frame for healing of any surgery anywhere in the body.

Excerpts from the Comments section relevant to this post

Surgeons should do a proper job and medical 'risks' is not the same as negligence. This was pure surgical negligence at my cost. And I never signed papers to be injected with non-FDA approved substances. The Med Board said this indeed involves malpractice. When I contacted the Med Board they told me a complaint would not help me get a refund. I would have to hire lawyers and spend even more money to demand a refund or the costs for a correctional procedure. So what's the point? Med Board complaints only lead to action against the doctors license. Dr Robert Kotler had the option to resolve the issue and have the procedure corrected, but opted to be a subject of bad reviews. It was his choice.

REBUTTAL: The writer declares, what I assume to be the medical grade silicone, “ non-FDA approved”. That is not true. The product is FDA-approved for use inside the eyeball to help correct a detached retina. Every licensed MD can use an FDA-approved device for other medical uses, as appropriate. The use of medical-grade liquid silicone, injected as micro-droplets, under the skin to correct small depressions is hardly dangerous. The product has been used for such purposes for nearly 50 years and as noted above, has proven itself invaluable to correct minor nasal imperfections otherwise requiring surgery.

As you read further, now you see the nature of the extortion attempt here. This writer, if she or she is a patient or not, seeking to harm our practice, suggests contacting government agencies to help with the extortion on his/her behalf. Since the Medical Board is not a willing partner in such extortion attempts, the writer now suggests visitors to this website abuse the mission of the site and use a negative post to expedite the extortion process. Note that it appears that our office was somehow given an office to either “ pay up” or be pilloried by a negative web review. The latter is the subject of my rebuttal.

Is this proper, is it fair? Is this what that the owners of this website intended it to be, a forum for tutorials on how to extort money from MDs? I doubt that.

FINAL COMMENT BY DR. KOTLER:

The vicious, cowardly author of this smear, hiding behind the anonymity of a web review site should be scorned. Were he or she to have signed his or her name, she would have already been served a major lawsuit for defamation and libel. But cowards don’t do that. They conduct a guerilla war, hoping to extort money or whatever from professionals who do take pride in their work and reputation in the community.

His or her day will come because we are expanding every effort to hunt down this miscreant and bring her to justice, whatever the price.

She speaks of “ regulations”. More? We have plenty. This country is drowning in regulation and laws. Do such prevent Governors from extorting money from the politically ambitious nor Wall Street people trading on insider information? More important then any
“ regulation” is the character and professionalism of the doctor. Most of us don’t need Sacramento, of all places, to tell us how to behave.

We MDs took an oath to do the right thing the day we graduated from medical school. We take the work serious. You know, the writer makes it sound like I am some kind of scoundrel. Well, a scoundrel doesn’t spent half a lifetime in education and training. I took as much training, including extra Fellowship training, as I could get. I did not open my own private practice until I was 36 years old! How many people make that kind of investment in their talents. What that should tell you is that I worked hard to be the best I could.

Now, if you really want to learn about me and our practice, read what other patients have said about us. Visit our website: www. robertkotlermd.com. When you digest all the other reviews on the various sites and see the dozens of appreciative letters on our website, you will get a clear picture of who we are and how we take care of patients.

Review my Professional Bio on our website. See our work. Read about a 34-year old practice that was built on satisfying patients.

It is very bothersome to have spent half a lifetime preparing myself to be a safe, competent and proficient physician and surgeon, and then spend the rest of that lifetime providing conscientious, attentive and successful care to patients and have someone try to public destroy a good and solid reputation earned for many years.

I would challenge any visitor to this site, who based on this one negative post, might have any qualms about my talent or abilities, to merely inquire of any cosmetic plastic surgeons office in Southern California and ask about my reputation among my peers and the general medical community.

That’s a lot more valuable than reading this venom, from some unknown source, rich in inaccuracies and innuendoes designed to damage me and my practice.

- Robert Kotler, MD, FACS
- Beverly Hills, CA
- www.robertkotlermd.com

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