Speaker 1 (00:02):
You're listening to another episode of Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Co-host Kirstin Jarvis.

Kirstin (00:15):
So I know that you are a worldwide traveler.

Dr. Koehler (00:20):
Not really, no.

Kirstin (00:21):
Well, I've heard that about you, Dr. Worldwide travels. Do people ever ask you what you do for a living? You rub elbow elbows with people on the airplane and they say, try to make small talk.

Dr. Koehler (00:32):
I usually try to pretend like I'm asleep actually at that point.

Kirstin (00:37):
Okay.

Dr. Koehler (00:39):
Occasionally, I mean, people ask me what I do, I'll let them know. And the problem is it sometimes opens up a conversation that lasts the entire flight. But I dunno. I think people just have a lot of questions. Some of them are about themselves personally, and I don't know, sometimes just curiosity. People have questions about what's the strangest thing you've ever seen? What do people come and ask you for? What's the weirdest request you've had? And typically, it's not all that weird. Of course. I mean, I guess at this point in my career, I think it all sounds normal, but it probably is all weird. But anyhow,

Kirstin (01:17):
When is the weirdest time in your life? Did you see the most gnarly things in residency or,

Dr. Koehler (01:24):
I mean, yeah. Usually the strange stuff that you see in your surgical training is some of the crazy things you see just because the trauma and the things that lead people to an emergency room for any emergency room physician or nurse that works in that environment will tell you that the stories that they have, you just can't make some of that stuff up. So real life is much more interesting than any made up story. But yeah, I mean, the crazy accidents and the really bad traumas and bad infections and that sort of thing. I mean, that typically comes to the university environment. So in my world, nowadays, I mean, we don't see the gruesome stuff so much. It's the elective and a little bit more enjoyable. A lot more enjoyable actually.

Kirstin (02:12):
Would you rather have things more benign like that and predictable?

Dr. Koehler (02:16):
Yeah, I mean, it's more the fact that when people come to see me, they're happy, they're excited, it's something they want to have done, which is a very different thing than when somebody shows up in an emergency room and that's the last place they want to be. So I think it's a different vibe. It feels better. And when you follow people through their journey, the anticipation, having something done and then the excitement, well, sometimes the stress in between is not so fun, but then there's the excitement that comes as the journey comes to an end and they've got the result they want.

Kirstin (02:53):
Is that what made you want to do a podcast? Or how did you kind of get here?

Dr. Koehler (02:58):
Well, actually it was from some encouragement from a friend of mine actually, who thought this would be a great way for me to reach out to patients, both my existing patients and people that haven't met me yet. It's hard sometimes to, I mean, convey your philosophy of practice, what you do, things you don't do, all those types of things. Sometimes it's a lot easier to convey that in this type of a scenario versus an advertisement or your website. So

Kirstin (03:31):
Yeah. Do you have specific things that you want people to be able to take away?

Dr. Koehler (03:37):
Yeah, I mean, we're trying to get information to people about various procedures that we do. Maybe give them some education as to what to expect in the journey that they would have if they decide to go down the road of cosmetic surgery. I think it's a way to just get to know myself and the office and what we're all about.

Kirstin (03:59):
Yeah. Okay. I know that your whole family pretty much is in Alabama.

Dr. Koehler (04:05):
Yes.

Kirstin (04:06):
But we heard that you're Canadian.

Dr. Koehler (04:08):
That's true. I was born in Canada, and I've lived actually more of my life here in the United States. But yeah, I grew up in the cold bitter north.

Kirstin (04:21):
And you found yourself at the beach?

Dr. Koehler (04:24):
Yes, I trained at University of Alabama in Birmingham. I did medical school there and residency. So this is home for me now and still hang on to some of my Canadian roots. I'm a hockey fan, but I also am a big college football fan, so haven't given up all the things that I enjoyed from Canada. So I still sort of travel to go to a hockey game every now and again since we don't have that locally.

Kirstin (04:49):
And okay, we want to hear about your cool birthday story.

Dr. Koehler (04:54):
So this may probably the most exciting birthday I've had, just kind of a weird turn of events, but I was going to watch my favorite hockey team, the Edmonton Oilers play, the Vegas Golden Knights in Stanley Cup playoff game. And so we're in Vegas, and it's a long story, I'll abbreviate it, but a friend of mine knows Wayne Gretzky, and I just ran into him and we were talking, and while we're talking, Wayne Gretzky walks over and introduces himself to me. And I didn't really have a whole lot to say at that point in time. That was really awesome to meet him. Anyhow, later that day before the game, this is before the hockey game, I had texted him, I said, man, I really wished I had asked to get a picture with Wayne, but I just met him and I felt stupid to do it. And he sent me a little video message back, and Wayne Gretzky said, well, tell your friend to come join us in our box to watch the game tonight. So that was my excitement for my birthday. And yeah, I got to watch some of the game with Wayne Gretzky in his box seats in Vegas. So yeah, thrill of a lifetime, was awesome.

Kirstin (06:08):
I think you should have played slots and games and all kinds of things after that. I hope you

Dr. Koehler (06:14):
No, when you hit it big like that, you don't play. You've won, you're done. You walk away.

Kirstin (06:19):
Okay, okay. I get it. Yeah. Alright. So you like hockey. What else do you like to do? You like hang out with the family?

Dr. Koehler (06:27):
Yeah. Well, I like college football. I like sports in general. I like watching my kids play sports. Both my boys play lacrosse, and so I enjoy going to those games. My daughter played soccer, boys ran cross country, so two of my kids are in college now, so I don't really get to watch them play anymore. They're busy studying, but I still have one in high school. So yeah, enjoy watching them play. And I like to go fishing, occasionally hunting. I mean, I'm up for anything. I like to do some different things, just keep life exciting. Yeah.

Kirstin (07:02):
What led you to aesthetics? How did you end up here?

Dr. Koehler (07:05):
Well, I really got exposed to a lot of trauma and residency and really sort of evolved from that because a lot of these trauma patients would come back and say, well, thank you for helping me with this injury. I'd like to make X, Y, Z look better, but while you're there, could you help me with this other issue? I've never liked my nose or whatever the case might be. And so some of the revision surgeries from trauma evolved into cosmetic procedures. And although we did some cosmetic surgery as part of our training, it was not the primary focus. And so it really was something that I enjoyed doing and it really kind of evolved from there. So I went on and did two fellowships in cosmetic surgery to really hone in and develop those skills. And again, it's something I really enjoy. I think probably primarily because it's something that patients want to have done, and there's something that really makes that appealing versus having something done to you when you really don't want to have it done.

Kirstin (08:08):
Is there a certain procedure that you just really love to do when you see it on the schedule? You're like, oh my gosh, yes, I'm so glad today's the day.

Dr. Koehler (08:16):
I don't know. I mean, I go through phases because I enjoy all the things that I do. I think variety is nice. So sometimes you're doing maybe a bunch of a certain type of procedure and that's fine, and you get in your groove and do it, but then you get to do something else that just gets you excited. So a different type of case, a more challenging case. So I can't think of something specific, but I really enjoy doing facelifts. I think that's a really transforming procedure. But I do a lot of mommy makeovers too, and those bring a lot of enjoyment to patients. So yeah, I mean, really, I think sometimes it's more about the individual too. You get excited for those people that are really excited about what you're doing for them, because we're not saving lives with this surgery, but you do make some big changes and big impacts on people's lives, and that part's exciting.

Kirstin (09:11):
Yeah, for sure. Is there anything that you would like patients to know about you, either as a physician or as a person?

Dr. Koehler (09:21):
I dunno. I think the thing that I would just like patients to know is that if you come and see me, I'm going to be pretty honest with you as far as what I feel like I can deliver and what I can't deliver. And hopefully get your expectations where they need to be. So if you want an honest opinion of what you can achieve, I feel like that's what I'm going to give patients. And there's so much out there in social media and just online in general. And I think expectations get built really high. And doctors were guilty of showing all of our best results, which we want to showcase. I mean, we want to showcase the things that are really awesome. But I also think along with that, it does sometimes build an expectation that every result is like that for every patient. And it's not so everybody's anatomy is different, their health is different, the way they heal is different. And so having those sometimes honest conversations to really say, Hey, yeah, we can help you, but the picture you're showing me, that's not possible. So that's what we're going to give you if you come and see us, is hopefully a really good assessment and build an expectation that you can count on.

Kirstin (10:30):
I feel like patients really appreciate that about you because there are tons of surgeons out there that we know have terrible bedside manner. You are very relatable with patients. They feel comfortable with you, but also you don't have to fake it. You're just like, you are who you are. And they come in and they're like, oh my gosh, Dr. Koehler's so amazing. And really, you are friendly. You're kind, and you're going to tell them the absolute truth and build their expectations to be what it's going to be. I think patients appreciate that.

Dr. Koehler (11:00):
Well, hopefully. I mean, it's all part of the process, the give and take of the interaction with the doctor and the patient, and we just try to get all the information, and again, just give people the best possible information back so that they can make an educated decision as to what they want to do. Yeah.

Kirstin (11:19):
Is there anything that you wish patients would research or know before they come see you or something that you like to teach them and make sure they know before they leave?

Dr. Koehler (11:32):
You want people to come to a consult with enough information that they understand what they're getting into. They understand where the incisions are, they understand what kinds of results are achievable. But sometimes people can kind of go into that rabbit hole a little too far, and they get into watching all the YouTube videos of the different types of surgeries. And I'm not saying that's a bad thing, because again, I think patients that come with good questions about the procedure, I mean, it makes for a better consult versus trying to explain the entire thing to the patient. But sometimes the information that you get can be overwhelming for somebody that doesn't really understand the relevance to their particular situation. So yeah, I don't know. I think coming with at least a baseline understanding of what you're wanting to have done makes for a better consultation.

Kirstin (12:29):
If I was a patient and wanted to do more research on my physician and chose a podcast, where could I listen to your podcast?

Dr. Koehler (12:38):
That's a good question. <laugh>I have no idea. 

Kirstin (12:43):
I know I didn't write the answer down. I don't know. <laugh>

Dr. Koehler (12:45):
I think it'll be on YouTube. It'll be on  

Kirstin (12:48):
Watch, on YouTube.

Dr. Koehler (12:48):
Apple podcast. I mean, I don't know. I'll put it on every medium I can put it on that they'll let me, but you'll see it on some snippets on Instagram, so we'll have some there too.

Kirstin (13:00):
We're going to try to put snippets on Instagram, Facebook, and TikTok.

Dr. Koehler (13:04):
TikTok. Okay.

Kirstin (13:06):
We're doing the Tik Tok. Okay. Oh, I see the answer. Watch on YouTube and listen anywhere you get your podcast.

Dr. Koehler (13:17):
There you go.

Kirstin (13:19):
If you go on vacation and go to the beach, is your mind constantly, wow, she could really use a breast lift. Don't see it.

Dr. Koehler (13:28):
No, I've had that question asked a little differently too, which is like, oh, when you see somebody, are you looking at all the things that you'd want to fix or change or whatever? I'm like, no, I really don't. The one thing that is important for people when they have a cosmetic surgery procedure is that they're doing it for the right reasons. They're doing it for them, and it's what bothers them. It's not what bothers me, it's what bothers them. So I mean, yeah, you can't help it. Sometimes there's things that just jump out and you're like, oh, yeah, I could really do something there. But if it doesn't bother them, then it's not a problem. And you look at some of these Hollywood figures, and there's some people that are very famous in Hollywood that have some features that are like, I'm sure a surgeon would be like, oh, I could fix that nose or do this or do that.

(14:25)
But those features also have made them, that's their image. And if you were to change that, it would totally take away from who they are as their Hollywood person. So I dunno, sometimes distinguishing features, although they may not be the norm, are totally fine. So okay, Owen Wilson, if he got his nose done, that would ruin his career. That's just a feature of his face. I don't think it's, again, I don't want to say it's a bad nose, but I mean, in the realm of what we do, we look at surgical norms, right? So it should be about this angle here, and it should project this far here. So you'd look at his and you go, well, it doesn't fit all the norms. It doesn't fit any of 'em. You need to do all these things. And if you did that, yeah, his nose would look more normal, but it would totally take away from his appearance. So it depends what the procedures are, but there are certain distinguishing features of certain people that I think if you take them away, it changes their appearance enough that it's not, I don't know. It may affect their careers. I'm not saying it would.

Kirstin (15:32):
I like it. You do have a patient that I knew before I came to work here that we were friends, and I don't normally look at people and see things wrong with them if they get a haircut. I don't really notice I, I'm not really observant in that way, but this particular person, I was like, oh my gosh, she has no chest at all. She's completely flat as board. And she, without any prompting from me, came to you and had surgery a while ago. And she looks absolutely amazing and wonderful, and it's something that she wanted to do for herself for years and years and years. And she finally, her kids were grown and she just did it for herself.

Dr. Koehler (16:10):
Yeah, I mean, I think sometimes people have those things done, and it's not like people think good, bad. It's just what it is. And then when somebody has something like that done, you're like, you notice them differently and you're like, oh, wow, yeah, she looks great. I feel like some of the really successful facelift results, people come back and they're like, people look at me and say, oh, I look like I've lost weight or this or that. They haven't quite been able to pinpoint, it's a natural result. It looks good. And they get confidence from people telling 'em how good they look, but they can't, it's not so obvious that they're like, oh yeah, you had a facelift. So those are kind of exciting results. I mean, I laugh sometimes. Some people are like, yeah, I really want my breast to look natural, but here's some pictures. I'd like 'em to look like this. I'm like, that's not natural. That's naturally huge. It's not natural.

(17:07)
But I mean, the key is, I think sometimes it's interesting when I go through and show people examples of my before and afters, I found it actually very interesting sometimes because I'll show a result that I'm like, I think this is a great result. And somebody will be like, oh yeah, no, see, I don't like this, this, and this. And I'd be like, Hmm, okay. And I'll show something else. And they'll be like, well, I don't like this about that result, or Would that happen to me? Or something like that. And so you can learn a lot from the things people say that they like and they don't like. And sometimes it can just help shape what we're really trying to achieve. And sometimes it just shapes the fact that this is not a patient you want to operate on, because these are things that our tastes are very different.

(17:53)
It's not even tastes, it's like what they're asking for is so maybe unrealistic. You can only work with the structure you have. For instance, we were talking about a nose, well, there's bone and cartilage that supports your nose to allow for you to breathe. And there's only so much that you can do with that. And so if you're born with a really big nose, you cannot have a little petite nose. Now if you've got a big hump on your nose or you've got a broad tip to your nose, yes, there's all sorts of refinements you can do, and you can see very dramatic before and afters on noses. But again, depends on what we're talking about. Certain things just cannot be done. It's not a piece of clay. You can't just shape it and make it what you want. You've got to preserve the function of a nose, which is very important.

(18:41)
You've got to be able to breathe out of it when it's all done. So those are the things that when you're talking to patients and they give you feedback or show you pictures, that can be helpful. Imaging can be useful, but it also is, I think it can be dangerous. I mean that in the way that I could take a picture of you and in Photoshop or whatever imaging, morphing app, I can do anything I want. It's an image. I can make your nose as small as I want. I could put your ears wherever. I can do all these sorts of things on a computer, but that doesn't mean that I can reproduce that surgically. So when you use these imaging programs, you've got to be, as the person doing the imaging, you got to make sure that you're being what you think realistic and what you can achieve.

(19:28)
So that's part of it. But even when you do it and you do it as realistically, you go, okay, I think I can maybe achieve this. If you've got somebody that looks at it and says, oh, no, no, that's not at all what I'm going for and what they're trying to get you to do, you do it with the imaging. You're like, yeah, that's not achievable. So then imaging can work for you then, because it's like, no, that's not a result that you can get. But yeah, it's a slippery slope. I've used it before for breast surgery, and again, I found it useful. So for instance, I used to use this software where it was like 3D, and you could look at your breasts and see what that implant looked like. And it was kind of cool. You could look down and go, oh, yeah, look at, those are the breasts that I have.

(20:12)
I want more cleavage than that. And then it was a useful tool because I was like, okay, well, your cleavage is determined by a lot of things. Your natural cleavage, the shape of your rib cage, your nipple position, the size of the implant. There's like all these things. So it did open up some discussion because then you're like, okay, this is why that size implant on your chest is not going to give you what you showed me in that picture. And so, yeah, imaging can be helpful, but sometimes if it's not used properly, it can build unrealistic expectations. I find it useful, but also harmful. It's time consuming too, because people will be like, well, can you change this by two degrees here? And then that's another thing with noses when people are like, can you just move it up a little bit more? That's not how surgery works.

(21:00)
It's precise, but you can't sit there and just move stuff back and forth like that. Yeah, I like to use my own before and after photos. First of all, as I mentioned earlier, just to show people examples of my work. And again, they might not like everything they see, and they have to realize not every patient's built the same. So sometimes people are like, oh, I don't like that result. She doesn't have as much cleavage as I'd like. And I'm like, well, you don't have to worry about that because you're not built like her. And that's one of the issues maybe with her particular result. So anyhow, I mean, it does open up discussion looking at before and afters of things that they like or don't like. I think it's useful for showing what can be realistically achieved. So I think that's a better tool than a software that's kind of simulating what we think might be able to happen.

(21:52)
So yeah, I mean, I think photos are very important. When I do consultations, I don't have hundreds and hundreds of photos there. And the reason is, is that if I did that and I'm trying to show pictures, I mean, I'll be scrolling, looking for particular photos. So I kind of keep a set of photos of things that I'd like to demonstrate or show. But yeah, I've got lots of pictures on my website that people can go to. You want to see examples. You look at any person's results, you go to any doctor's website, you're going to see some results. You're like, oh, wow, that's like a home run. That's awesome. And you'll see some others that are like, that's not bad. And you might see some, you're like, I'm not real fond of that. That's okay. But you want to see lots of examples. If you're buying a painting from an artist, you might not love every painting they have, but you get a feel for, I kind of like the artwork this guy does.

(22:42)
And then when you do find something you like, you're going to be like, I want that. But you got to get an impression of the body of work of what that person does. I always tell people when they're looking at before and after pictures, please don't show me a picture of when you show me a picture of somebody that doesn't look anything like you. I can just tell you no after result's, not going to look like you got to find somebody who looks like you before. So you can show me an after that looks like you. But sometimes people just show the, I had a lady today and she's like, well, if I showed you a picture of what I'm wanting, would you be? I'm like, no, no. It doesn't work like that. It's not like you go to my website and say, I'd like number 42. Please give me that one. That's the one I want. Because you got to look at people that are built like you that have similar skin, bone structure, muscle development, all those things.

Kirstin (23:30):
This ain't no chop shop.

Dr. Koehler (23:37):
<laugh> Thank you, Kirsten.

Speaker 1 (23:42):
Got a question for Dr. Koehler? Leave us a voicemail, Alabama the Beautiful podcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic Surgery, go to eastern shore cosmetic surgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram at Eastern Shore Cosmetic Surgery. Alabama the Beautiful is a production of The Axis, T H E A X I S. io.