Today we are interviewing two plastic surgeons who are partners in a plastic surgery clinic in Beverly Hills, Los Angeles. Dr. Jason Litner and Dr. Peyman Solieman are dedicated and board certified surgeons who specialize in facial plastic surgery and especially in rhinoplasty.

CM: Beverly Hills is probably the number one spot in the world for plastic surgeries per capita and for a famous and wealthy client list. Can you give us the inside scoop on what it's like to be a plastic surgeon in Beverly Hills?

Litner/Solieman: Have you seen the show Nip/Tuck? It's just like that but with even more beautiful women!

Got your attention?

The truth is that plastic surgery here is like nowhere else in the world. Whether our patients are famous or not, they are well-informed, beauty-oriented, and want to know which famous person we operated on recently... even though they know we can't say.

Most have heard all about (and think they want) the procedure of the moment, and because there are so many 'beauty doctors' in the area, they can generally find someone to do anything for them, whether it works or not. As a result, we probably get more unfortunate situations like the recent silicone injection disasters than other places do.

It is true that having famous patients can be a little tricky. While most of us try to get natural results because we know our patients and our work may end up in the public eye, we are always surprised when we see the number of proudly-overdone people at the parties we go to. And you can imagine what happens when people find out you're a plastic surgeon...

And, yes, plastic surgery is more than a little commercial here; heck, where else in the world are some of the surgeons as famous as the "celebrities" they operate on?

All in all, we can't think of a more fun and exciting place to be doing what we love.

CM: Why did you decide to specialize in rhinoplasty?

Litner/Solieman: For us rhinoplasty is a passion. The strange thing is that many plastic surgeons avoid this procedure because of its complexity; most will tell you that it is the most difficult cosmetic surgery to perform. Yet both of us were distinctly drawn to this procedure early on.

It's an amazing procedure- extremely delicate and nuanced, here the difference of a few millimeters can literally be the difference between a great and a catastrophic result.

The anatomy is complex and our work is always on display. Your nose is the central defining feature of your face, but a good nose is balanced and normally goes unnoticed. When it is not in harmony with other facial features, it can stick out like a sore thumb. So as crazy as it may sound, our best compliments are when people say that no one noticed; the change is so natural that people cannot picture you looking any different.

But most importantly, we love the dynamic we have with our patients who want rhinoplasty. For many, it has been a life-long source of anxiety and discomfort. You may remember that awkward 16 year-old you sat next to in high school, who never seemed to feel right sitting next to you. Somehow, something changed over the summer, you might have thought he or she just grew into his or her face, but all of a sudden they were smiling and had a new girlfriend/ boyfriend. It's an amazing feeling to be able to do that for people.

So for us, rhinoplasty is the ultimate challenge. We can literally spend 4 or 5 hours completely rebuilding a nose and, yet, the time flies. And the thing is, as we plan the surgery we have to think about everything from our patients' facial features, their ethnicity, their height, their goals, to whether we can use their anatomy to meet the challenge. But the work's not over because, while doing the surgery, we have to see what we really find, how each move affects the whole dynamic, and what the anatomy tells us about how to make the result last long-term. So we have to constantly learn more and adjust to make sure we give our patients exactly what they have been hoping for.

And that's why we love rhinoplasty. We could go on...

CM: So you think it's fine for teenagers to have plastic surgery?

Litner/Solieman: ... [Re] your question about plastic surgery in teenagers, we think it's procedure, patient, and development dependent.

There was a lot of news recently after the tragic death of an 18 year old girl who had complications arising from anesthesia while having breast implant surgery. Truth is we don't do that kind of work and it does not make a lot of sense to us, as many women continue to develop into their early 20s.

However, we are often asked to perform rhinoplasty in young adolescents.

Nasal surgery on children has long been a focus of discussion in the medical literature. In general, we think that discussion regarding nasal surgery in children has to be divided between functional surgery and cosmetic rhinoplasty.

When dealing with children with functional breathing problems, surgery such as septoplasty can be done as early as necessary in order to restore nasal function and to prevent the consequences that may arise due to misplaced anatomic structures. In these patients, extra care must be taken
to preserve as many structural supports and as much septal continuity as possible in order to insure normal nasal growth.

But your question probably relates more to pure cosmetic rhinoplasty. When considering cosmetic surgery of the nose, we generally believe surgery should be delayed until the nose is fully grown. This commonly means rhinoplasty can be done on girls when they have had their period for at least 2 years and in boys when they are at least 14 years old. Another good indicator of nasal growth is the patients’ height compared to their parents. If the patient is as tall as their tallest parent, then they are probably finished growing and so has their nose. Exceptions for younger children are made for those patients who have a significant anatomic deformity and a very strong desire for surgery to correct it.

The problem with operating on patients earlier than these target ages is that the nose may continue to grow in an unpredictable fashion. So, despite creating a balanced nose after the rhinoplasty, the continued nasal growth can distort the proportions that were created.

Finally and perhaps more important than the physical maturity, we also believe that all our adolescent patients must have the emotional maturity to deal with their surgery. It is very important that the patient himself/herself is interested in having the surgery and that it is not only being done because the parent wants surgery.

With all of this said, we believe that the psychological benefit that rhinoplasty can afford during puberty, a very critical time in emotional development, is significant and should be considered for the right patients. So, though care must be taken, in the appropriate patient some cosmetic surgery can make an enormous difference. Take the example of the kid we were talking about in the last note on rhinoplasty.

CM: Thanks very much for your time.

This completes Part 1 of our interview. Please look for two more juicier questions (as to how worry and anger may cause the face to age differently), in Part 2 to be posted here in June.

Check out the interesting Rhinoplasty in Beverly Hills blog here.