Response to Reviews

Patients Review:
i travelled to miami from canada , so already i was very nervous . had a hard time deciding size the day before my surgery because it was a very big decision to me and i asked if the size i chose would make me look top heavy, hocshtein did not answer my question at all and told me ” its up to you and it shouldnt be the biggest decision of your life theyre just boobs “. also , its been 14 months since my surgery and i have yet to be contacted by him or his team in regards to recovery or post op . after the surgery i was woken up and put in a car and never spoke to again until my 3 day post op check up to remove the supportive tape . at this check up , i asked why my nipples were facing downwards and he said “its the tape, they will even out when they drop .’ they still face downwards to this day . my whole experience was not great , would i recommend him as a doctor , maybe … im very unhappy with my breasts and the position of my nipples but i can not get in contact with him to come up with a plan, so i guess he just took my money and paid the bills .

Dr. Hochstein’s Response:
I never pick the sizing for my patients however I give them the tools necessary to be able to make an informed decision and I have never, under any circumstance ever told a patient that it is not a big decision or that “they’re just boobs.” I take the decision seriously and give every patient as much time as they need to make the best decision for themselves. I will, however, never answer a question of them being too top heavy as that is a personal opinion and one only a patient can make. On the night of the surgery, I call every patient but if you do not pick up the phone I cannot speak to you. The reason the nipples were low at the first reason is two reasons but has nothing to do with the tape. Primarily it is because they were low to begin with as you can see in the pre-op pictures and because implants placed under the muscle are initially high riding and settle around the 4 month mark. Since this patient never bothered to send us any post op pictures like I asked at her post op appointment, I would have no way of commenting if there position is where they should be or if there is a problem. Based on the immediate post-op picture I did not see any issues but if a patient refuses to send us pictures or pick up the phone to tell us there is something they are unhappy with there is not much I can do.
Leonard M. Hochstein, MD

Google Review:

PLEASE READ!! Choose surgeon wisely: Awful experience (22 yo, Breast Reduction lift w/implant & Rhinoplasty) – Miami, FL
Where to begin…In August of 2015 I decided to have breast reduction surgery along with a rhinoplasty. I was 20 years old at the time and had 36DD saggy breasts, and had a small bump on the bridge of my nose. I decided to go with Dr. Hochstein because he had some of the best pictures online and his reviews on sites like this were all positive, and patients seemed to be content with their results. This surgery was a big deal to me. I had never been ill, never had any injuries or surgeries prior and was about to undergo a massive surgery that would forever change my life.

Right off the bat, during my first consultation, Dr. Hochstein was very distant and almost robotic in nature. I undressed, he assessed my breasts from at least 3 feet, and after perhaps 30 seconds stepped out to present me with his solution to my problems. He essentially just mentioned that I needed a breast reduction with a lift, and an implant would be wise and he would also reduce the size of the areola. All I needed from this step was to proceed with scheduling and payment, and bring in a picture of my ideal breasts and nose on the day of surgery.

Fast-foward a month or so, and it was surgery day. I was nervous and anxious, as anyone would be under the circumstances, and Dr. Hochstein did nothing to comfort me. He simply walked into the pre-op room, FOR THE FIRST TIME, physically touched my breast, to mark up incision sites, and was gone after 5 minutes. At no point did he reassure me that all was going to be fine. Fast forward, I went into surgery, came out, and I was sent out the door. He didn’t go see me after anesthesia wore off, or even tell my parents that the surgery went well.

The day after surgery, I had to go back to the office to remove the surgical dressing from my breasts, and so that he could remove the gauze that was stuffed inside my nose. As you can imagine, I was uncomfortable and in pain, and the nurse did not take this into consideration when removing the surgical dressing (she wasn’t gentle). To make matters worse, the doctor finally walked in to remove the gauze from the nose. He instructed me to lie straight on my back, and instead of assisting me, (because I was very sore and in extreme pain), he was almost rushing me as I was trying to lower myself without the use of my arms (post-op instructions) to help me lie on my back. He then, proceeded to literally RIP the gauze out of my nose, without any warning that it was going to be very painful. As you can imagine, I left that day in a lot of discomfort.

Seven days later, I had to return to the office to remove the casting from my nose. The removal wasn’t painful, and I have to say that I am truly content with my rhinoplasty results. That same day however, I asked the doctor a question about the appearance of my breasts. My breasts were very cone-ish with virtually no shape, and almost looked like pecs. I respectfully asked him if this was normal, and he flat out said that he didn’t understand my question. Instead of just further reassuring me that, this is expected a few days and weeks post op and that my implants will fall into place overtime, he just blatantly acted like he couldn’t see what I was seeing and that my breasts weren’t oddly shaped.

A few weeks pass, and my breasts were very irritated and warm, (turns out I was allergic to the surgical tape, to my discovery), and I was told not to come in, to send the pictures to the doctor. Per usual, the Dr. didn’t see anything wrong with my pictures, and I was not told to come in so that he could further assess the situation.

A week after that, I noticed a strange odor coming from my surgical tape. I realized that the incisions around BOTH my areolas had opened. One areola in particular, even had some breast tissue exposed. I once again contacted the office, was told to send the picture to the doctor and he would decide what to do. Once again, EVERYTHING was great and just to wash it multiple times a day etc.

Overtime, more incision sites opened up and I formed Keloids.

I do not blame Dr. H for the keloids that I formed or for the fact that my incisions opened. I understand that this could all be because the implant dropped too quickly, and I know that everyone’s body reacts differently, especially when a foreign object is placed. My problem with Dr. H is how he treats these matters and his patients.

I went to every post op check-up, and every time I asked him if it was normal that one breast was much larger than the other, that the ends of my incisions were lifted as if someone was pulling on them, that if it was ok that my nipples were placed too up, or that if there was anything I could do to help reduce the keloids that were developing.

EVERY SINGLE TIME I was treated as if I was unreasonably questioning his work of art, because after all, he is the “boob god”. He was condescending and would consistently tell me that there was nothing wrong. That he couldn’t see what I was seeing, as if I was blindly reaching these conclusions, to the point of trying to make me feel as if I was delusional. I’m assuming his approach is to repeatedly tell his patients that all is great, so that they can start to believe it as well. I’m not sure if perhaps Dr. Hochstein is the one that is deranged, but I am fully capable of assessing what is wrong with my body, beyond what is supposed to occur naturally vs something that is a result of the surgery. As a doctor and as one of “the best” he should be capable of holding himself accountable for his mistakes, or at least provide some sort of remedy to alleviate the keloids at least. There is nothing he can do now about lowering the placement of my nipples which are way too high, but he could’ve suggested something for the very noticeable difference in size of the breasts.

Every visit, I was told to give it a couple of months…well it is now a year and half later, and I have to undergo surgery once more (with another Dr.) to correct everything that went wrong with Dr. H. After various consultations with many doctors, I was told that Dr. H should have never even put an implant in the first place because I had more than enough breast tissue to work with, secondly, he removed WAY too much of my natural breast tissue. I am now left with implants that outweighs my breast tissue, and thus my breasts are sagging once again (and have been sagging since 6 months post op). Apart from this, based on how my muscle contracts, the implants have been pushed out and is no longer inside the sac under the muscle.

In conclusion, I had a horrible experience before, during, and after my surgery with Dr. Hochstein. His office is truly a surgical factory, where patients are just another number, another check in his bank account, and he has no care or consideration for the patients and their concerns before or after the surgeon . He’s not approachable, not comforting, almost programmed in speech, and has a superiority complex, that far outweighs any doctoral degree that he may have up on his wall. He comes off cold, rude and tries to be so formal and distant in something that is intensely personal, so personal that his hands will literally be molding your body. Dr. Hochstein may have a lot of medical knowledge and thousands of surgeries as experience, but he has to learn about person to person contact and interaction. A doctors bedside manner is crucial, especially when a patient is paying >$10k. You are paying for his expertise, his time, and his effort into achieving your desired outcome. To be treated as someone that is merely taking up his time, and is ludicrous in even asking him a question about his work of art, is not acceptable.

Although he was successful in fixing my nose, and even if he were successful in correcting some of my breast deformities, his approach to patient care and his bedside manner heavily negate any positive surgical outcome.

Please do your research, and consult with MANY doctors before setting your mind on just one, especially Dr. Hochstein.

Dr. Hochstein’s Response:

When reading a review like this I had to ask myself could these things really be true. It had been a while and I had no clear memory of this patient as apparently she never made me aware of how unhappy she was so I went back and reviewed the chart.

Based on my review I learned that the things she mentioned in the review were untrue but I would never ask anyone to take my word for it. I would like to explain what happened and will use the postoperative pictures to explain how the healing from the surgery should and did occur.

Let’s start from the beginning. I do understand that surgery is life changing and important. The way I approach my consultations is to be as professional as possible. It is not a time for joking. People come to me for straight answers and my recommendations based on over 22,000 breast implant surgeries. It is that experience that brings patients from all over the world for my advice. I take this responsibility very seriously. If you want a best friend I am not your surgeon but if you are looking for the best consistent results than you are in the right place.

Based on this case I recommended a breast lift with implants and a rhinoplasty (refer to pictures 7/15). On the day of surgery I personally speak to and mark my patients. I also take the time to explain the marks in front of a mirror. Writing that I did not specifically say “everything was going to be fine” seems a bit unfair. I assume that people choose me for my track record (0 malpractice suits and 0 penalties by the board of medicine) but I can assure that if she had asked I would have done more to reassure her, it’s simply that most people don’t request it. I do not visit patients in the recovery room routinely but I do call every patient the night of the surgery to check on them as I did in this case.

The next day this patient’s characterization could not be any less true. First, I place my hand on the patients back to gently support them as they lay back and the packing is gently, slowly, and smoothly removed. Ripping it out would have created potential damage and is something I have never nor would I ever do. The fact that she wrote this was my first clue that what was to follow would likely not be accurate. Fortunately the pictures will tell the full story. I routinely tell patients that the breasts will change over the next several months and never look good in the beginning so for her to say that I thought they looked normal from day 1 is not true.

The first picture post operative was roughly a month later is very clear. There is no rash or unusual redness as the person alleges. There is a small opening at the left areola which is consistent with a spitting stitch which is very common. There was no rash, there was no infection, and the wounds did not open. My advice of keeping everything clean without any further treatment was the correct diagnosis and treatment plan.

The rest of the review is just as accurate as the beginning. She showed up for only two other post op visits and actually skipped most of the appointments she had. I do not tell my patients that “everything is great all the time” but what I do tell them is that there are timelines to healing and breast evaluation.

The last set of pictures are the 3 month pictures as the patient did not show up for the latest post op visits and I will now give my assessment which was identical to the assessment I gave the patient. The scars: there are no keloids. On the contrary for 3 months they look terrific since the color and thinning of the scars can take 2 years.

Nipple position: exactly where they should be and symmetric (note the spitting stitch opening has healed and now there is not a sign that there was ever an issue. There is some mild stretching of the skin at the lower breasts and would likely need to be tightened which is certainly not unreasonable considering the amount of excess skin she had starting out but it is too early to do so. She had some minor dog ears at the outer parts of the breasts but at 3 months is likely to resolve on its own but if present at 6 months(not likely) it would have been corrected. She has a size asymmetry but at 3 months it is too early to tell and I would need to evaluate at 6 months to see if a revision there would be necessary. If there would have been an asymmetry at the 6 month mark (again not unreasonable considering how asymmetric her breasts were to begin) I would have performed the revision at no charge (written policy).

The remainders of the review are technique comments and I will address them. Using an implant is certainly optional but always gives a better result. Saying that she had enough breast tissue to work with simply shows a lack of understanding of breast surgery. Although she had plenty of breast tissue, it was mostly hanging down to the abdominal area. It cannot simply be repositioned. The only long term solution is removal and replacement with an implant. Any other option would have resulted in a terrible sag within a year of surgery. The implant itself was relatively small (only 339cc). Had there been a less sag, I would have removed less tissue. I tell all patients with implants to do no chest exercises and the last pictures I have show the implant pockets to be in perfect location. The only way they could have shifted is if the patient did not follow my recommendations.

It is true that I am serious about my work but I am there to answer any question at any time. This patient’s description about how I treat patients is as accurate as the rest of her review. Fortunately in this case the pictures tell a different story.

Leonard M Hochstein MD

Google Review: 
I wouldn’t recommend this doctor, I had nose and breast augmentation with him, my nose was ok I only wanted a smaller tip and nostrils and my breast was 450 I wanted 600 breast and nose came out botched and he try to say it wasn’t his fault well kinda true it was my fault for believing on his very well paid advertisement…. STAY AWAY!!!

Dr. Hochstein’s Response:
Actually she wanted 650cc which is exactly what was used. Here are the actual pictures. I have no idea why she would think this is “botched”but that is what pictures are for. Please judge for yourselves. I also do not advertise. Never have and never will so not sure what she is talking about.

Google Review:

Hackstein gets one star for the pleasantness of his staff; however if it were for his level of artistry and skill he would get negative. I am a cosmetic and Dermatologic Physician assistant and I never bash other providers; however, I am going out of my way to take the opportunity to do just that in this case rather than taking legal action against another provider. While I hear he does boobs well (who can really mess up boobs?), Whatever you do, do not let this guy touch your face. He took way too much from my nose and left my deviated septum visibly and undeniably hanging out of my nare. Had he been a careful and considerate surgeon and artist, he would have accounted for my individual anatomy and not pulled the tip up so much that the septum was left exposed. He had a horrible, condescending attitude afterward and explained “well, I don’t do internal work – that’s an ENT’s job” which showed his ignorance, lack of surgical planning and disgustingly overconfident attitude. The guy is a master of marketing, inaccountability and that’s about it.
As a result I was left with suboptimal circumstances and was forced to have a septoplasty and undergo an additional surgery and recovery which ended up being compromised and complicated. Thanks for nothing, buddy.

Dr. Hochstein’s Response:

Let me first include this person’s before and after pictures so that this review can be placed in proper perspective. As you can see from the before pictures this was a patient with a septal deviation, enlarged tip and nostrils with hanging cartilage below her nostrils prior to the operation. The post op pictures show an excellent result with near perfect correction of the septal deviation, beautiful gentle curve to the bridge, and a well defined tip. The hanging septum, which is what she is complaining about, is still present but I warned the patient prior to the surgery that her anatomy was such that I would not be able to raise it. I did, however, reduce the size of her nostrils in an attempt to camouflage it. This was a surgery I performed about 10 years ago. This patient came back to me about 5 years after the surgery with these complaints and my advice to her was not further surgery as I felt the risks outweighed the benefits but that if she insisted that she should find an ENT to do the procedure as this would be complex septal work far outside my expertise. This is not ignorance but rather good advice. I understand my limitations and would never perform a procedure I felt unqualified for. I am not surprised to read that there were complications from this other surgery she chose to have. I believe that when an unhealthy obsession occurs it leads people to have surgery that is risky and fraught with disaster. I think this is what this review nearly 10 years after the surgery is all about as I believe the next surgeon blamed me for whatever happened poorly in this latest operation. It is routine. When something goes wrong always blame the other guy. I never promise my patients something I cannot achieve and I make very clear at the initial consultation that I am a plastic surgeon. I can make a nose look more attractive. I can also do septal work to make it look straighter but that if breathing is your primary concern than you are in the wrong place.

Leonard M Hochstein MD

Patient Review:

Had a mommy makeover 5 years ago then a body lift 2 years ago. Right breast seems like it’s out of the socket. I brought it to his attention he said I always had uneven breast. Not true. Next my body lift was ok. One side is slightly done better than the other. Again I brought it to his attention and he said my pelvic bone is higher on one side. Not true. He just doesn’t want to take the time to repair his mistakes. Now I have to find someone else n pay more money to get this fixed. Please he and his wife a super pro Trump supporters. Vote for who u want but don’t let your mostly female customers know your political views. Complete turn off.

Dr. Hochstein’s Reponse:

These are the actual pictures. There is more fullness at the right waist area. This was present preoperatively but was accentuated after the liposuction. The bony pelvis was felt directly under the prominenece. No further liposuction would help this appearance. I have always placed my patients results above all else and would never take money to perform an operation that would not yield a positive result. I could never imagine that would ever upset anyone but i have learned that if you do enough surgery you are bound to upset someone no matter how much you care about their best interests.

Leonard M Hochstein MD

PLEASE READ!! Choose surgeon wisely: Awful experience (22 yo, Breast Reduction lift w/implant & Rhinoplasty) – Miami, FL
Where to begin…In August of 2015 I decided to have breast reduction surgery along with a rhinoplasty. I was 20 years old at the time and had 36DD saggy breasts, and had a small bump on the bridge of my nose. I decided to go with Dr. Hochstein because he had some of the best pictures online and his reviews on sites like this were all positive, and patients seemed to be content with their results. This surgery was a big deal to me. I had never been ill, never had any injuries or surgeries prior and was about to undergo a massive surgery that would forever change my life.

Right off the bat, during my first consultation, Dr. Hochstein was very distant and almost robotic in nature. I undressed, he assessed my breasts from at least 3 feet, and after perhaps 30 seconds stepped out to present me with his solution to my problems. He essentially just mentioned that I needed a breast reduction with a lift, and an implant would be wise and he would also reduce the size of the areola. All I needed from this step was to proceed with scheduling and payment, and bring in a picture of my ideal breasts and nose on the day of surgery.

Fast-foward a month or so, and it was surgery day. I was nervous and anxious, as anyone would be under the circumstances, and Dr. Hochstein did nothing to comfort me. He simply walked into the pre-op room, FOR THE FIRST TIME, physically touched my breast, to mark up incision sites, and was gone after 5 minutes. At no point did he reassure me that all was going to be fine. Fast forward, I went into surgery, came out, and I was sent out the door. He didn’t go see me after anesthesia wore off, or even tell my parents that the surgery went well.

The day after surgery, I had to go back to the office to remove the surgical dressing from my breasts, and so that he could remove the gauze that was stuffed inside my nose. As you can imagine, I was uncomfortable and in pain, and the nurse did not take this into consideration when removing the surgical dressing (she wasn’t gentle). To make matters worse, the doctor finally walked in to remove the gauze from the nose. He instructed me to lie straight on my back, and instead of assisting me, (because I was very sore and in extreme pain), he was almost rushing me as I was trying to lower myself without the use of my arms (post-op instructions) to help me lie on my back. He then, proceeded to literally RIP the gauze out of my nose, without any warning that it was going to be very painful. As you can imagine, I left that day in a lot of discomfort.

Seven days later, I had to return to the office to remove the casting from my nose. The removal wasn’t painful, and I have to say that I am truly content with my rhinoplasty results. That same day however, I asked the doctor a question about the appearance of my breasts. My breasts were very cone-ish with virtually no shape, and almost looked like pecs. I respectfully asked him if this was normal, and he flat out said that he didn’t understand my question. Instead of just further reassuring me that, this is expected a few days and weeks post op and that my implants will fall into place overtime, he just blatantly acted like he couldn’t see what I was seeing and that my breasts weren’t oddly shaped.

A few weeks pass, and my breasts were very irritated and warm, (turns out I was allergic to the surgical tape, to my discovery), and I was told not to come in, to send the pictures to the doctor. Per usual, the Dr. didn’t see anything wrong with my pictures, and I was not told to come in so that he could further assess the situation.

A week after that, I noticed a strange odor coming from my surgical tape. I realized that the incisions around BOTH my areolas had opened. One areola in particular, even had some breast tissue exposed. I once again contacted the office, was told to send the picture to the doctor and he would decide what to do. Once again, EVERYTHING was great and just to wash it multiple times a day etc.

Overtime, more incision sites opened up and I formed Keloids.

I do not blame Dr. H for the keloids that I formed or for the fact that my incisions opened. I understand that this could all be because the implant dropped too quickly, and I know that everyone’s body reacts differently, especially when a foreign object is placed. My problem with Dr. H is how he treats these matters and his patients.

I went to every post op check-up, and every time I asked him if it was normal that one breast was much larger than the other, that the ends of my incisions were lifted as if someone was pulling on them, that if it was ok that my nipples were placed too up, or that if there was anything I could do to help reduce the keloids that were developing.

EVERY SINGLE TIME I was treated as if I was unreasonably questioning his work of art, because after all, he is the “boob god”. He was condescending and would consistently tell me that there was nothing wrong. That he couldn’t see what I was seeing, as if I was blindly reaching these conclusions, to the point of trying to make me feel as if I was delusional. I’m assuming his approach is to repeatedly tell his patients that all is great, so that they can start to believe it as well. I’m not sure if perhaps Dr. Hochstein is the one that is deranged, but I am fully capable of assessing what is wrong with my body, beyond what is supposed to occur naturally vs something that is a result of the surgery. As a doctor and as one of “the best” he should be capable of holding himself accountable for his mistakes, or at least provide some sort of remedy to alleviate the keloids at least. There is nothing he can do now about lowering the placement of my nipples which are way too high, but he could’ve suggested something for the very noticeable difference in size of the breasts.

Every visit, I was told to give it a couple of months…well it is now a year and half later, and I have to undergo surgery once more (with another Dr.) to correct everything that went wrong with Dr. H. After various consultations with many doctors, I was told that Dr. H should have never even put an implant in the first place because I had more than enough breast tissue to work with, secondly, he removed WAY too much of my natural breast tissue. I am now left with implants that outweighs my breast tissue, and thus my breasts are sagging once again (and have been sagging since 6 months post op). Apart from this, based on how my muscle contracts, the implants have been pushed out and is no longer inside the sac under the muscle.

In conclusion, I had a horrible experience before, during, and after my surgery with Dr. Hochstein. His office is truly a surgical factory, where patients are just another number, another check in his bank account, and he has no care or consideration for the patients and their concerns before or after the surgeon . He’s not approachable, not comforting, almost programmed in speech, and has a superiority complex, that far outweighs any doctoral degree that he may have up on his wall. He comes off cold, rude and tries to be so formal and distant in something that is intensely personal, so personal that his hands will literally be molding your body. Dr. Hochstein may have a lot of medical knowledge and thousands of surgeries as experience, but he has to learn about person to person contact and interaction. A doctors bedside manner is crucial, especially when a patient is paying >$10k. You are paying for his expertise, his time, and his effort into achieving your desired outcome. To be treated as someone that is merely taking up his time, and is ludicrous in even asking him a question about his work of art, is not acceptable.

Although he was successful in fixing my nose, and even if he were successful in correcting some of my breast deformities, his approach to patient care and his bedside manner heavily negate any positive surgical outcome.

Please do your research, and consult with MANY doctors before setting your mind on just one, especially Dr. Hochstein.

Dr. Hochstein’s Reponse:

Dr. Hochstein’s Response:

When reading a review like this I had to ask myself could these things really be true. It had been a while and I had no clear memory of this patient as apparently she never made me aware of how unhappy she was so I went back and reviewed the chart.

Based on my review I learned that the things she mentioned in the review were untrue but I would never ask anyone to take my word for it. I would like to explain what happened and will use the postoperative pictures to explain how the healing from the surgery should and did occur.

Let’s start from the beginning. I do understand that surgery is life changing and important. The way I approach my consultations is to be as professional as possible. It is not a time for joking. People come to me for straight answers and my recommendations based on over 22,000 breast implant surgeries. It is that experience that brings patients from all over the world for my advice. I take this responsibility very seriously. If you want a best friend I am not your surgeon but if you are looking for the best consistent results than you are in the right place.

Based on this case I recommended a breast lift with implants and a rhinoplasty (refer to pictures 7/15). On the day of surgery I personally speak to and mark my patients. I also take the time to explain the marks in front of a mirror. Writing that I did not specifically say “everything was going to be fine” seems a bit unfair. I assume that people choose me for my track record (0 malpractice suits and 0 penalties by the board of medicine) but I can assure that if she had asked I would have done more to reassure her, it’s simply that most people don’t request it. I do not visit patients in the recovery room routinely but I do call every patient the night of the surgery to check on them as I did in this case.

The next day this patient’s characterization could not be any less true. First, I place my hand on the patients back to gently support them as they lay back and the packing is gently, slowly, and smoothly removed. Ripping it out would have created potential damage and is something I have never nor would I ever do. The fact that she wrote this was my first clue that what was to follow would likely not be accurate. Fortunately the pictures will tell the full story. I routinely tell patients that the breasts will change over the next several months and never look good in the beginning so for her to say that I thought they looked normal from day 1 is not true.

The first picture post operative was roughly a month later is very clear. There is no rash or unusual redness as the person alleges. There is a small opening at the left areola which is consistent with a spitting stitch which is very common. There was no rash, there was no infection, and the wounds did not open. My advice of keeping everything clean without any further treatment was the correct diagnosis and treatment plan.

The rest of the review is just as accurate as the beginning. She showed up for only two other post op visits and actually skipped most of the appointments she had. I do not tell my patients that “everything is great all the time” but what I do tell them is that there are timelines to healing and breast evaluation.

The last set of pictures are the 3 month pictures as the patient did not show up for the latest post op visits and I will now give my assessment which was identical to the assessment I gave the patient. The scars: there are no keloids. On the contrary for 3 months they look terrific since the color and thinning of the scars can take 2 years.

Nipple position: exactly where they should be and symmetric (note the spitting stitch opening has healed and now there is not a sign that there was ever an issue. There is some mild stretching of the skin at the lower breasts and would likely need to be tightened which is certainly not unreasonable considering the amount of excess skin she had starting out but it is too early to do so. She had some minor dog ears at the outer parts of the breasts but at 3 months is likely to resolve on its own but if present at 6 months(not likely) it would have been corrected. She has a size asymmetry but at 3 months it is too early to tell and I would need to evaluate at 6 months to see if a revision there would be necessary. If there would have been an asymmetry at the 6 month mark (again not unreasonable considering how asymmetric her breasts were to begin) I would have performed the revision at no charge (written policy).

The remainders of the review are technique comments and I will address them. Using an implant is certainly optional but always gives a better result. Saying that she had enough breast tissue to work with simply shows a lack of understanding of breast surgery. Although she had plenty of breast tissue, it was mostly hanging down to the abdominal area. It cannot simply be repositioned. The only long term solution is removal and replacement with an implant. Any other option would have resulted in a terrible sag within a year of surgery. The implant itself was relatively small (only 339cc). Had there been a less sag, I would have removed less tissue. I tell all patients with implants to do no chest exercises and the last pictures I have show the implant pockets to be in perfect location. The only way they could have shifted is if the patient did not follow my recommendations.

It is true that I am serious about my work but I am there to answer any question at any time. This patient’s description about how I treat patients is as accurate as the rest of her review. Fortunately in this case the pictures tell a different story.

Please view photos here:

Bad scar finish
I had a mommy make over which includes a tummy tuck, lipo on the sides and Brest lift. I am discontent with the scar finish of both the tummy and the lift. The skin on the sides seems like it was pinched. I initially contacted the office and I was told needed to wait 6 months and when I went again I was told it would go away after the 6 months. It’s been 2 years almost 3 and the scar looks exactly the same. I can’t wear a regular bathing suit top because the scar shows on both sides. I also had the tummy tuck which I loved the belly button and the appearance of the stomach but right under the belly button I have a bump which was also advised would go away and it has not. I have been told by other doctors that the bump is from liquid which was not drained properly and was only able to be removed with minor surgery to remove the liquid. I would like a scar repair and drainage removal.

Dr. Hochstein’s Response

We have reached out to this specific patient on several occasions to address her concerns. Up until recently, she finally has responded via email stating that it is rather hard for her to come in person to be further evaluated or treated. The only way that we can treat this patient is if she can physically come in to be evaluated, and as the offer always stands to all our patients, we never charge for any scar revision.
At her 3 month post op visit with us that she last came in, it was apparent that this patient had an excellent result and in fact she had no seroma of any sort present. She never once addressed any concerns with the scarring and or the results, in fact she told us she was happy with how everything progressed and has healed.
Please see below this patient’s before and after photos after just 3 months post operative and let me know if you would have handled this situation any differently.

I as surgeon would like you critique my results and give me your feedback on this specific result/case.

Leonard M. Hochstein, MD

Patient Review:
I had surgery with Dr Hochstein a couple years ago to switch out my implant size and would give anything to go back in time and choose another surgeon. I flew into Miami the day before I scheduled the surgery and met with him for my preop. At the time I had 300/315cc implants and was currently a size 30C. I told him I would like to be a smallD-regD. I emphasized that I did NOT want to be a full D or DD. I had done a lot of research prior to my surgery and went into the preop thinking that I wanted to get app 400cc implants. Dr H keeps stressing how that wasn’t going to be big enough to get from a small C to a reg D and how he would need to use a 500-550 implant to do so. I took his advice and went with the smaller recommendation of 500. He cleared me to fly back across the country one day after surgery and never did any kind of postop care after that. With the 500cc implant, I am popping out of 30DD bras!! My boobs are way out of proportion to my body and everything that I did not want. Like many other reviewers have said, if you are unhappy with your results HE CHARGES YOU TO FIX IT!! This is ridiculous. And whenever he speaks to you he is so condescending and arrogant and blames everything on the patient. After having an argument with him, he told me to find a board-certified plastic surgeon that would have done things differently and have them write a letter and he will refund my money. I went to 4 surgeons who all agreed they would have never used such a large implant on someone like me with such a small frame. But all said that it is against their code to write letters to other doctors saying that their work is wrong (guessing this is why Dr. H told me to do this). But I got documentation from a surgeon saying that my implants don’t fit my chest and go back to my side ribs. I also found a statement on RealSelf where a doctor stated that for patients with a 32-34 bra band, that it only takes 100ccs to go up one up size, so for me to go up 1-1.5 cup sizes I should have gone to 400-450 which is exactly what I went in there asking for and was saying I would not achieve my desired results. But of course, still no refund! Dr. H will be nice..UNTIL you contact him after the surgery with any concerns or anything you aren’t happy with. He will blame everything on the patient and accept no responsibility himself. Exact quote to me “whenever you grow up one day and become the best boob surgeon in the world, then you can tell me that Im wrong.” Just a very arrogant surgeon who doesn’t genuinely care about his patient’s happiness. When choosing a surgeon, find one that genuinely cares about the patient and making sure that the patient is happy with the end result. I am shock with the level of unprofessionalism shown by Dr. H. I am now going to have to pay double what I paid Dr. H for a surgeon to fix his mistake and have a more invasive surgery. There are so many really good surgeons out there. I had a great boob job for 10 years before going to see Dr. Hochstein. I regret that decision every day and wish I could change it, but decided I would at least try to help others to not have to go thru what Ive been through. If you have any questions or want to talk more in detail about what happened, I am more than happy to talk to anyone. Just message me !

Dr. Hochstein’s Response:

Every patient I consult with about breast augmentation I ask two questions. What size are you now and what size you would like to be. In this case the answer was starting as a small C and going to a mid D although from emails the desired goal was mid to full D. We agreed that this patient wanted to be 1 1/2 cups larger. My formula is that every cup size equals roughly 150cc of volume which is slightly less than the data based on cup size research. The link to the research is http://www.breastimplants4you.com/breast_implant_faq.htm . Since she thought her largest implant was 315cc I expected a 500 to 550cc implant would achieve this goal. The patient agreed to use the 500cc as the maximum sized implant regardless of her starting point. I believe this is dangerous as the implant fill volumes are not always what the patient thinks they are. In this case this turned out to be the case. The larger implant turned out to be 350cc, not the 315cc as she thought. I did not adjust to a larger size as I agreed not to go above 500cc. I saw the patient the next day at which point the result was excellent. She was cleared to fly home that next day which is the norm and I asked her to send another picture 2-3 weeks after the surgery to follow her progress. We continued our follow up by phone and had 5-6 interactions with her. At no point did she tells us that she was dissatisfied with any aspect of her surgery and she even talked to another patient about having surgery here. We did not hear from this patient again for about 3 years at which point she told me I made mistakes with her surgery and used the wrong implants and that I should have used 400cc implants and that because I did not I should redo them for free. I fully understand that patients can change their minds about their size and I offer to replace them for half price within a year but this call was almost 3 YEARS after the surgery without any prior complaints.. I tried to explain the rationale of the size and pointed out the pictures did not demonstrate a result that was more than 1 1/2 cup larger but this went about as well as you might expect. I ended the conversation that if she could get any plastic surgeon to agree that using an implant only 50cc greater than what she had starting out would give her a 1 1/2 cup size larger result I would refund her money. I knew this was impossible simply because it is a ridiculous statement, not that any surgeon would not agree to write it. She was able to find someone who wrote that each cup size is only 100cc. I do not agree with that figure but simply wrote back that if one cup was 100cc then 1 1/2 would have to be 150cc and if that is added to her 350cc implant what the implant size I should have used should be? I received no response to that question. Instead I got this review. I , too, regret that this patient came to me and I wish she would post the pictures of her result so that everyone could see what was done but that will never happen because the results are excellent. I have also never yelled at a patient and did not do so in this case. What would be the point? I would, however like to other patients. Should I have given her a refund? Let me know.

Leonard M Hochstein MD

Patient Review: I started out with an A cup I always wanted big…

29 Feb 2016 1 year post

I started out with an A cup I always wanted big boobs. Well I got what I was asking for! I just don’t like that they hang and now one implant is completely rippled really bad and the other is beginning to ripple. They also hang which I did not ask for. Waiting to have kids then get redone. I don’t hate but I don’t love them.

I have nothing negative to say about the Dr. He was great with answering my questions before surgery. Comforting. But upon calling the office about my implant rippling they told me to go see my physician and basically didn’t care. Which isn’t the doctors fault it’s the nurses but I thought that was rude. She told me it has nothing to do with them. The incision is not on the nipple as it should be so I am disappointed. The surgeon was friendly but I unfortunately don’t think I will be going back for revision.

Dr. Hochstein’s Response:
There are some very important point brought up here so I will try to address all of them. The first issue is the dreaded rippling. As much as every plastic surgeon would love implants not to ripple the fact is that they do. By placing them under the muscle and recommending silicone I address the only two factors I can control. What I cannot control is the amount of breast tissue each person has and the size of the implant they choose. If you are starting with an A cup and choose large implants rippling should not come as a surprise. You are basically asking the implant to be the breast and in these situations rippling will be significant. The other issue here is the drop or shape of the implants. I think there is a misconception about what breast implants do. The breast does not conform to the implant but rather the implant takes on the shape of the breast. In fact the implant amplifies the shape. In this case there was a small starting sag and thus it remained after. The right breast was also lower than the left to begin with but as you can see from my post op picture I was able to correct it but there is still some difference. There must have been some miscommunication as I doubt anyone at my office would tell a patient to go see their physician about the rippling, as I am the physician. Perhaps the patient stated that there was a lump or mass? In that situation we would recommend that the patient see their doctor for evaluation. This is always in the best interest of the patient. The last point is the incision. I place it at the lowermost portion of the pigment of the areola. This is the best place to put it because if you go into the areola it leaves a “bullseye” effect. I certainly do not expect any patient to know that but if the areola is not well defined it is always better to put it a little lower than higher. I take the incision very seriously and I can assure you I place a lot of thought as to where it needs to be placed for best camouflage

Leonard M Hochstein MD

Patient Review:

I am in the immediate post operative phase so I do not know how my breasts will look but I can say that Dr. Hochstein was extremely rude during the day of surgery, and post operative follow up. He never spoke with me or my husband after surgery or while I was recovering. My heart rate was 126bpm immediately before I was discharged and the highest that I was awake to read was 145bpm. The nurse never acknowledged it and the Dr never assessed me. I was wheeled out to the curb with discharge instructions shoved into my belonging bag with a follow up appointment card in my hand. I’ve never been more embarassed to have allowed such a person to be involved in my medical care. I wish more people would warn others of his medical practices. There are some many top rated plastic surgeons throughout the US. I suggest you use someone else. I wish I could take my money back and give it to a real human being, someone who cares about people. While I was waiting in the room for 20 minutes to get “marked” he was next door in his office speaking to his wife about cabinetry they were choosing for his new house. What a jerk this guy is.
I am recovering well, fully recovered, thank you. However, as you know and as we discussed I have a uniboob due to the augmentation you performed. I either have to live with it or have revised and It clearly isn’t a concern of yours based on our telephone conversations.

Dr. Hochstein’s Response:

I think the pictures say enough. If they do not,…

7 Nov 2015 11 months post

I think the pictures say enough. If they do not, you are seeing C.C. grade 4, deformed nipples, double bubble & plenty of scar tissue inside and obviously the nipples. Painful beyond belief. Dr. Hochstien scoffed at these photos, saying he did not see a thing wrong. He even went on to send me a more expensive quote w/ no mention of Allergen warranty of C.C..
I do not want to say anything more negative because I could go on & on. I had my revision last week & can’t get over how much better they feel (they were hard as rocks & so very painful) never mind the embarrassment. I am beyond grateful that this horror show is over. I feel fantastic, the ridiculous look of this mess is secondary to that. My revision took 4 hours to repair, bilateral capsulectomies with ADM, removal of excessive scar tissue inside and nipples scars repaired. Dr. Hochstien really did a number on me, the most painful year of my life.

Dr. Hochstein’s Response:

DR. HOCHSTEIN’S RESPONSE:

Let’s clear up a few things about the review. This patient did not have “very nice breasts, just a bit too large” The fact is they were droopy and assymetric to the point that they required a full (anchor type) lift. This operation involves scars that are much longer than what would be required for a breast augmentation. The quality of the scars, either positive or negative, cannot be attributed to the surgeon. The fact is that no surgeon can take credit for the scars, only the location of them. That being said this patient had good scar healing as the pictures demonstrate. The next day after surgery this patient had an expected color for both areola as they tend to darken after surgery for a few weeks. This was explained to the patient and I reassured her there would be no nipple loss and in spite of her writing about it I was right. There was no loss. It amazes me that someone who has never undergone such a surgery before would think she knows better about how things should look the next day better than me? This rarely happens as I do tell everyone what to expect but every once in a while someone seems to know better than me. The remainder of the review is most perplexing as she admits ” the symmetry is good, the size is exactly what I wanted and the shape is acceptable”. Basically what she is saying is that everything I could control came out perfectly but the scars, which I have no control over, are not. She also talks about overtightening of the skin as if she knows what that is. The answer is simple. If they are symmetric there is no overtightening but rather perfect tightening which is how a lift is performed. Her last jab about dog ears is a fabrication as the pictures clearly indicate there is no dog ear. If there is it would have been corrected at no charge as I do for all of my patients. As you can imagine by this review there were multiple interactions with this patient and although I believe she had a excellent result I did not believe she would be someone I would ever want to perform surgery on again and had her removed from our email list.

Here is a before and after photo of this patients surgery results to support my response.

Leonard M Hochstein MD

Horrible doctor! Not personable at all. Wait time was over an hour for every appointment I had. Oh and now have to spend another 10 grand to fix the botched job he did! He runs. Boob factory! Do not go to him!

Response:
“I have never tried to become best friends with my patients. I offer straight talk and straight answers. A patient of mine once wrote “If you want a best friend go somewhere else. If you want the best results go to Dr. Hochstein”. As far as the wait time I am always apologetic but since my practice is one of, if not, the busiest practices in the country there is often a wait to see me. It is not because I take breaks, or even a lunch break. I am working as hard as I possible can to see everyone but if wait time is an issue I can tell you there are about a thousand surgeons in south florida who will get you right in without any wait at all. As far as being botched? Far from it. Although the patient only came for two visits I have a picture from 3 weeks out with a link included. It shows excellent symmetry, cleavage and shape. Keep in mind that this is before the settling of the implants and that results never look great in the beginning. You would have to work very hard to mess up a result like this but in every surgery there must be a partnership. I will do the surgery but the patient is responsible to do the things necessary to heal.”

Leonard M Hochstein MD

Incision Wounds, Bottomed out 2 weeks after surgery

http://www.realself.com/review/miami-fl-breast-lift-bottomed-weeks-after-surgery

Please see Below for Before & After Photos

Patient Review: I went for a breast lift and new implants 3 weeks ago. Dr was finished w me in less than 2 hrs. From day one My left side had a tiny hole that would ooze yellow. I called Dr that evening he said it was normal. 2 weeks still oozing & getting bigger each day, Dr still said it was normal. He never mentioned me bottoming out at all. I told him I’m having pain in my ribs on my right side-hurts to twist & turn/ breath deep- He still didn’t seem concerned whatsoever. He does not respond to me directly he has his secretary email me when I have questions/concerns. I chose to go to a diff surgeon to get a 2nd opinion & he couldn’t believe the wound, said I have bottomed out on both sides, that my incisions were extremely long, looks like a rushed job, and I will need revision in future. He put me on antibiotic for infected wound/ cleaned it and the wound seems to be getting better each day.

I posted pics below to get more opinions. How long do I wait- with
Pain getting worse everyday in my ribs- to have a revision? Do I need to have internal bra for best results so this will not happen again? My incision line is from middle of my chest to armpit- can this be revised to a smaller incision later?

Any other advise is appreciated 

Dr. Hochstein’s Response:

This was a complicated case where the patient had a previous breast augmentation with a very poor result and significant asymmetry.

To create better symmetry we agreed that a full lift would be necessary and the surgery was performed without incident.  The pockets were adjusted to create more upper pole fullness and cleavage.  When placing the horizontal incision, I estimated the skin elasticity and placed it slightly below the fold as I know it will be pulled up slightly being careful not to overdo it as that would create a scar on the upper abdomen which would be very difficult to correct.  The early postoperative pictures show a horizontal scar that is above the new fold and a minor skin separation.  This is expected just weeks into the surgery but I want to be clear that there was no bottoming out or an infection.  All that would have been required was keeping the area clean and giving it proper time for further healing.

In the follow up picture which was taken a few weeks after this inflammatory post it is clear to see that the wounds are healing remarkably well for such a short period of time and is seen how the horizontal on the left side is near perfect position and the right is still above the fold but getting much closer but even more important to note is the amount of superior fullness.  Please compare this, as well as the symmetry, to the pre operative pictures.  Given enough time I would expect the right horizontal to get in line with the fold and I believe that within a year this would happen but if it did not the scar could be easily lowered as a minor procedure under local anesthesia.  I also understand that patients are not used to the changes that occur after surgery and I try to reassure them so that there is no over reaction, and contrary to what was written I spoke to this patient multiple times myself.  I believe that an excellent outcome here was achieved but it just did not happen quickly enough for this patient.

Leonard M. Hochstein

The actual facts of that occurrence differ significantly from what was posted on this specific review and I feel that it is always important to have the truth as a foundation for any discussion.

Dr. Hochstein Response: “I do not have a patient by the name of Mary Calexico.  I did, however, have a patient that had a similar scenario as described in the complaint on the website.  The actual facts of that occurrence differ significantly from what was posted and I feel that it is always important to have the truth as a foundation for any discussion.

It is typical for a nurse in my practice to call the person responsible for picking up the patient.  If they do not arrive within the time frame that we expect them it is not uncommon to call again.  However, there was surely no urgency for anybody, including this patient, to be picked up on that day or any day for that matter.  We have facilities that can handle patients who need to stay longer at our facility.

When the patient left our office she had what would be considered a typical amount of discomfort.  There was, however, no difficulty with breathing or any specific complaint of chest pain.  After returning the husband’s telephone call in a timely manner, he described to me what appeared to be a one sided chest pain.  At this point I said that this type of pain could not be explained by the surgery that was performed which is quite different from what he wrote in his blog.  This complaint of pain had nothing to do with any of the surgical procedures performed.

Since this type of pain was unusual and could not be explained by the surgery I urged this individual to take his wife to the hospital immediately for evaluation.  Again, this was due to the unusual nature of the pain and that fact that such pain could not be caused by anything that was done surgically in the office.  In response to my advice to take his wife to the hospital the husband responded that at that time he chose to call 911.  It is my understanding that when the paramedics arrived they evaluated the patient and subsequently called me.  What they described was somewhat different than what her earlier symptoms had appeared to be.  The paramedics noticed she had normal oxygenation and appeared to be breathing normally, in no distress and their recommendation was not to transport the patient to the hospital. Notwithstanding the paramedics advice, I felt, however, that her symptoms warranted an evaluation even though she appeared to be breathing normally and without distress to the paramedics.  It should be noted that when the patient was evaluated at the hospital it was found that she had a pneumothorax which does not necessarily mean a punctured lung.  In this particular case it means air in the chest cavity.  Had this been a traumatic injury there would have been a high likelihood of having at least some blood in the area.  It should be noted that the emergency room doctor agreed with this observation and conveyed that to the family.

The fact of the matter is that a pneumothorax can occur with patients simply walking down the street.  Heavy coughing, a more likely cause, is how this condition arose.Particularly troubling is the characterization by the individual writing the complaint that when he brought his wife in for follow up care I had an indifferent attitude.  It should be noted that while the patient was in the hospital I made sure to visit her or attempt to visit her everyday.  This was, however, stopped by the husband on my second attempted visit and was specifically asked by the husband not to visit his wife in the hospital.  I found this unfortunate since I take great pride in following up with all of my patients but honored the family’s wishes.  My plan would have been to visit everyday to be sure that things were being done in an appropriate manner but again felt obligated to respect the wishes of the family.There is also a notation that a nurse had been fired as a result of certain things that happened on the day of discharge.  I want to make it clear that that is absolutely false.  Another allegation was that we were attempting to rush this patient out of the office because we knew she had sustained complications and did not want to make an incident report to the State.  First, this type of issue is not required to be reported and second we would never, under any circumstances, rush a discharge of a patient.  Our patients are discharged when, and only when they have reached a point where it is safe to do so.

Again, I want to point out that it was primarily because of my concern and insistence that they take the patient to the hospital, notwithstanding the paramedics opinion that she was normal and did not need to be transported, that the issue was discovered, treated and resolved.  My commitment to take care of every patient from the initial conference through post op recovery makes the last statement that this practice neglected this particular patient particularly offensive.  In all I found this posting both disturbing and inaccurate and felt the need to address both issues.”

Leonard M. Hochstein 

I believe that it is clear that after the surgery her breasts are perky with appropriate sized and shaped areolas.  The right nipple is not lower than the left as the patient has her right shoulder positioned lower, which appears to make her breast look uneven. The TT surgery did not have a major or even a minor infection but had a normal healing phase.  Most patients do not give the properamount of time to heal and always expect the worse of any situation.  Unfortunately being a nurse does not give any insight as to how a TT scar heals.  I think the scars, even though they are less than a year old, show that no infection occurred.  The last lie that this patient states and which is one that truly hurts the most is that I declined any revision for her. I pride myself on doing any revisions that my patients ask for and was willing to do this free of charge for this patient even though her result were excellent already. The incident she described of her having to wait a long time for her revision that ended up being cancelled.  This has never happened before or since but some surgeries take longer than expected and I did not finish my surgeries that day until 10pm.  What she did not mention was the previous time I waited at the office over an hour for her to show up when instead of being in Miami she decided to go to the Keys.  I do not believe any surgeon could have given the time and compassion to this patient  as this breast reconstruction surgery was extremely complicated with many opposing forces which I was able to overcome.  It is regrettably true that sometimes the people you help the most appreciate it the least.  ”

Leonard M. Hochstein