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One on One with Skin Care Expert Dr. Aaron Kosins

Dr. Aaron Kosins holds a dual Medical Degree (M.D.) and a Masters degree in Business Administration (MBA) in Entrepreneurship. He is a highly credentialed expert on skin care, cosmetic dermatology, plastic and cosmetic surgery and medical aesthetics. He is also highly regarded for his expertise in Rhinoplasty and Breast & Body Contouring and frequently attends prestigious conferences around the world to speak about new techniques and technologies. In addition to operating a thriving surgical practice in Newport Beach, California, Dr. Kosins has trained extensively with acclaimed skincare pioneer, Dr. Zein Obagi and is a co-owner of ZO Skin Centre at Fashion Island, Newport Beach.  MSM caught up with Dr. Kosins for an in depth interview about plastic surgery, the dos and don’ts, the hype and the facts about non-invasive treatments and much more.
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Why did you choose to become a plastic surgeon? 
I chose to become a Plastic Surgeon because when I was a student, the Plastic Surgeons did the most incredible surgeries I had ever seen.  During the first surgery I ever watched, there was a patient that had a cancer of his jaw bone.  After it was removed, the guy had almost no jaw.  Then, I watched the surgeons transfer a patient’s leg bone to become their part of their jaw!  I thought, “How cool was that?  I want to be able to do that.”
When women choose a plastic surgeon what are the key essentials to look out for?
The number one essential is to look at your Plastic Surgeon’s reputation.  It is one thing to get a referral from a friend, but you want to make sure that he/she has a good reputation in the community AND in the medical community.  You can go online, look at reviews, view his/her website, etc.  Second, you want to make sure that the surgeon is a specialist in the particular procedure that you want.  In my practice, I specialize in rhinoplasty as well as breast and body contouring.  You can go on my website and look at hundreds of before/after photos.  The surgeon should understand your wishes, be able to communicate well, and then show you dozens of patients that he/she has worked on with your same issues.
You are known as one of the best there is in the field of the so called “nose-job”. While the excellent ones can not even be spotted we see way too many bad ones or one that leaves the face more symmetrical but also more boring with no edge. What’s important about getting the right nose job and what is unique about your approach?
Rhinoplasty is a true specialty within Plastic Surgery.  It is the most difficult operation that we do, and every single nose has different features that require a more sophisticated way of creating a beautiful result.  If you are interested in getting a rhinoplasty, you need to do your homework and go to a rhinoplasty specialist – a surgeon who devotes more than 50% of his/her practice to this operation.  Look at the doctor’s before/after photos and credentials.  Make sure he/she is board certified.  Look at the educational piece, meaning that you want a surgeon that is on the cutting edge of the specialty.  I spend one week out of every month either lecturing nationally or internationally.  I then spend time with the best surgeon in that state or country.  Learning and improving is the most important thing a rhinoplasty surgeon can do.  He/she should also be an active participant in forwarding the specialty.  As the editor of the rhinoplasty section of the Aesthetic Surgery Journal, I see all the news advances coming across the board.  This is hugely beneficial in making sure that I keep getting better and better.
Two new things about my approach that are unique are Piezosurgery and the treatment of patients with difficult skin.  I no longer “break” my patients’ bones.  Piezosurgery is an existing technology that we have just now started to use in rhinoplasty.  Small saws are used that cut bone but not skin.  So I can move a patient’s bones (to narrow or straighten the nose) without trauma.  This is more accurate and causes less swelling and bruising.  Also this year I have been giving a lot of lectures on treating people who have thick and oily skin.  These patients often get suboptimal results because the skin acts like a thick blanket and little definition can be seen.  Using creams and sometimes medication I have been able to shrink the soft tissue/skin of the nose and this has been proven with ultrasound.  Both of these things are totally new and exciting to offer to my patients.
What about the non-surgical nose job many doctors offer now which only uses derma fillers to shape the nose?
I am not a fan of this for a few reasons.  First, the nose is full of blood vessels and in the wrong hands, filler can cause whole subunits of the nose to turn black and die!  At every rhinoplasty meeting I go to there is lectures on how to deal with filler complications.  Also, filler is soft and the nose consists of bone and cartilage.  The unique definition of the nose can’t really be achieved by injecting soft, gelatinous material.  Even in the best hands these procedures need to be repeated 2-3 times per year.  If you think about this, it is extremely expensive over time with suboptimal results.  Because of this, I have NEVER put filler in the nose.  In fact, I am seeing a whole new group of patients who need surgical rhinoplasty after having bad “non-surgical” or filler rhinoplasty.  I have to melt the filler (if possible) before surgery or remove it during surgery before I can create the ideal nose.
We all see there is a great push by beauty docs to get more biz by pushing non-suriginal procedures, some of those patients then later stay with that doc for surgical procedures. What is your take on this?
In general, I just don’t buy it.  The face ages in 3 ways – the skin ages, the skin falls with gravity, and we lose volume.  To make someone really look good, the doctor has to address all 3.  How often do you see a women with a 25 year old neck and 70 year old skin? It just doesn’t make any sense.  No one machine or non-surgical procedure can address this.  Non-surgical procedures do not tighten skin, at least not in the long term.  You may be able to get a marginally beneficial effect for a few months during the healing process.  However, these tretments are expensive, come with their own side effect profile, can be painful, and are often done by people that are not trained to do real procedures.  If you are not a surgeon, you will look for any way to do facial rejuvenation that does not involve surgery.  I am not saying that every patient needs surgery.  In fact, quite the contrary. However, certain things do.  For example, if you neck is loose, no machine, laser, peel, pill, magic water, etc is going to tighten it.
Many plastic surgeons and dermatologists are also heavily promoting the so called  “liquid lift”.
Can a true lifting effect be achieved via injections of bottom and fillers ? If yes, how do you approach it? (which fillers etc.)
There is a lot of confusion for patients.  Botox is used to treat wrinkles that you get from moving your face during normal conversation.  It does this by weakening the muscles.  Fillers are used to “fill” wrinkles or to add volume to parts of the face.  I’ve never been a big believer that fillers can lift the face.  Think about it.  How can something injected under the skin move the face north and work against gravity?  Filler can create projection meaning it can give the appearance of more volume, but it won’t actually lift skin.
Botox has become as common as a visit to the facialist – Do those patients who worry about the fact that in the end it is a toxin have a valid reason to question it? Is there any knowledge of any possible long term negative effects? Any alternatives to create similar results?
The short answer is no.  Botox is the most common non-surgical procedure and has been used for a long time in millions of patients.  If used incorrectly, it can cause short-term issues.  No long term side effects have been reported to my knowledge.
When we age gravity wants it’s way across the board and the gap between biplane and nose widens, hence lip lifts being the latest buzz. What’s your take on it?
I have never been a fan of the lip lift.  Although the procedure does a wonderful job at lifting the lip, it also involves a scar at the base of the nose.  If this scar does not heal absolutely perfectly, it is noticeable to every person that looks at your face.  Unfortunately the upper lip gets longer and flatter as we age.  Fillers is a great alternative that does not involve a scar.
You were just invited to  join the editorial board of the prestigious Aesthetic Surgery Journal. What will your focus be as the new contributor?
As the new editor, my focus is on my specialty – rhinoplasty.  The Aesthetic Surgery Journal is the most prestigious and widely read journal about Aesthetic Plastic Surgery in the world.  Because of this, Plastic Surgeons from around the globe submit new and innovative research.  My job is to read these articles as well as the opinions of our independent review board.  Based on their opinions as well as my own analysis, certain articles are chosen for publication.  Also, from time to time I submit my own original articles and ask for invited commentaries from experts in the field.  Overall I am super excited to be on the forefront of rhinoplasty surgery.
Plastic surgery in the US can be pricey and as a result there is a whole industry that caters to people who seek cheap but good surgery in other countries where the price is much more affordable, like South America or Asia. Smart or short-sighted?
I think it can be very shortsighted.  Not to say there is not good doctors in other countries.  On the contrary many great physicians come from other countries.  However, the average consumer of aesthetic services does not know who these doctors are or where to find them. In other countries the standards are usually not as high when it comes to quality, infection control, postoperative care, etc.  In fact, in Southern California I have taken care of a large number of patients who went to Mexico and Asia for surgery only to come back with issues that sometimes can take months to heal from.  I can remember a pair of sisters that had mineral oil injected into their buttocks in Tijuana.  Both died as a result after years of horrible infections, the inability to walk and finally sepsis.  Super sad.
While we love to use the term “timeless beauty” it seems what is considered ‘ideal beauty’ is constantly changing . What is the current most desired look and what about it do you feel is meant to stay?
Beauty really is in the eye of the beholder.  One thing I always do is to ask my patients to show me pictures of what he/she thinks is beautiful.  This starts an intelligent dialogue about his/her preferences.  We as doctors are not Leonardo DaVinci; meaning, I cannot chisel my idea of beauty into every person and expect them to feel the same way as me.  We each have our own preferences and ideals, and these need to be understood by the physician and patient – hence, the doctor-patient relationship.  If a woman shows me for example breasts that she think are pretty, the picture tells me a lot more than words like “bigger, fuller, natural, C cup.”
Do people still come to the office with pictures of a celebrity and tell you : “This nose please,” or “Those lips”?
Which celebrities do people often refer to and for which body part? What do you tell people who seem dead set on getting “Angelina Jolie’s nose” or “Irina Shayk’s lips”?
People show me all kinds of things every day.  Some are really pretty and some can be quite strange.  The key to making people happy is understanding what they want and then setting realistic expectations.  Also, I see a lot of patients of different ethnicities – Latin, Asian, Mediterranean, etc.  These patients also need to be clear about what they are looking for.  Some are looking to keep their ethnic traits and some want to completely abandon them.
There are some celebrities who come up again and again – for example, a lot of patients show me Emily Rajtakowski’s breasts.  Women seem to love there full yet natural look.  And by natural I mean no unnatural fullness in the upper part of the breast.  I see all kinds of noses and they usually come from women on Instagram.  The one thing I can say is that all people have their own unique set of preferences and my job is to help patients to paint a clear picture of their desires so I can visualize them and produce with surgery.
We all know that a healthy body is always the one that is the most beautiful. Which foods and supplements do you recommend to boost beauty from the inside? (like something for making skin glow or tighten skin…boost metabolism…help hair and nails etc… )
There are a lot of things I recommend.  A few tips on what I do on a daily basis to stay happy and healthy:
  • Avoid sugar to avoid insulin spikes, diabetes, storing fat, and energy drains
  • Eat lean meats for a lean, strong body
  • Stretch every day for 10 minutes before you get in the shower
  • Fish is amazing for the body
  • Acai is a Brazilian berry that I have included in my diet for over 15 years.  The Brazilians are on to something
  • Replenish yourself with lots of water.  Our body is 75% water!
  • Everyone needs a cheat day once a week.  I love cheese so that food is always part of it
  • Eat a handful of almonds every day – packed with energy, nonsaturated fat and goodness
  • Biotin is a great supplement for growth of hair and nails
What are the most rewarding aspects of your job today?
I love my job because I get “wins” every day.  Every day I am seeing new patients who want surgery, doing surgery, and/or seeing patients after.  That means every day I see happy people whose lives I have touched.  I love that and couldn’t imagine doing anything else.  Watching people walk out of my office with confidence and a smile on their face gives me all the satisfaction in the world.
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