Nearby, recovery hideaways take up entire floors of hotels. There, patients can recover in privacy, with transportation services and medical staff available around the clock. When the patients no longer need nurses, they move to a different floor so they can spend the rest of their vacation sitting by the pool and checking out the shops while they wait for their bruises to heal. They return home looking better without having to reveal their secret.

Daria Kowal, a clinical research auditor at a New Jersey hospital, needed surgery in the mid-1990s to fix a deviated septum and to remove polyps from inside her nose. While she was under the knife, she also had a small bump on her nose removed.

“[The doctors] shaved off too much,” Kowal says. “They made my nose look like a pug nose.”

She lived with the nose for almost 10 years, until she saw photos of herself during a trip to Las Vegas and decided she’d had enough. A fan of Dr. 90210, Kowal researched several doctors, read Kotler’s book, Secrets of a Beverly Hills Cosmetic Surgeon: The Expert’s Guide to Safe, Successful Surgery, and then called.

After a brief phone conversation with Kotler, she e-mailed him close-up photos of her nose from every possible angle.

“He knew right off the bat what was wrong,” she said. “He didn’t even have to see me in person.”

Rebuilding a nose that has already been operated on can be tricky because doctors cannot replace the cartilage and bone that have been removed, but Kotler worked with a graphic designer to show Kowal, 41, what he could do by adding silicone to her nose. Satisfied with the altered pictures, she booked her seven-day trip.

“We can do consultations across oceans,” Kotler says. “All the questions are answered. We can show patients predicted results on their home computers. The only thing we can’t do is touch the patients.”

In August 2007, Kowal arrived in Los Angeles. Her personal physician had approved her for surgery, and after a brief consultation, Kowal went under the knife in the surgery center right next to Kotler’s office.

Most operations take very little time, and the best plastic surgeons often work efficiently. Quick work means less swelling and less recovery time. In addition, recent advances in anesthesiology have made outpatient surgery common even for complex, five-hour surgeries.

“A lot of what we do now is because of anesthesia,” Kotler explains. “Patients wake up very quickly with very few side effects. Nausea and vomiting are things of the past.”

Kowal was chauffeured back to her hotel after the operation, and her sister stayed with her to make sure she recovered without problems. The morning after the surgery, she hit Rodeo Drive.

“I felt great, so I went out shopping,” she says. “I made a vacation out of it.”

There are plenty of makeup artists in Beverly Hills who can cover up the slight bruising that happens after facial reconstruction surgery, but Kowal says hiding her scars was unnecessary.

“Surgery is a badge of honor in Beverly Hills,” she says. “It’s fine to walk around with some kind of surgery mark. Everyone has had something done.”

The economic downturn has hit the cosmetic-surgery market. Kotler even appeared on The Daily Show with Jon Stewart in 2008 and poked fun at the influence the recession has had on the industry.

But the international appeal of Beverly Hills has provided a strong cushion for doctors who practice there. The weakness of the dollar has made the town an appealing destination for people traveling from outside the United States — even those from countries renowned for their own surgeons, like Switzerland. New technology has also kept prices from increasing.

For Kowal, the operation was worth every penny. Four days after the surgery, the bandages came off, and two days later, she flew home. Since then, Kotler has incrementally added small amounts of silicone to her nose until she was satisfied with the shape. When he travels, he lets his patients know where he’s going so that he can do touch-ups on those who live nearby. Kowal saw him twice in Los Angeles and once in Chicago, and then, finally, after a third silicone injection during one of Kotler’s trips to New York, her nose filled out perfectly.

“I couldn’t be happier with the end result,” she says. “It was the best decision I’ve ever made. Dr. Kotler has become like a friend. He’s coming back to New York in October, and I could get more silicone, but I’m very, very satisfied [as it is now].”