Dr. R James Koch


  • Stanford-trained Double Board Certified Facial Plastic Surgeon with over 20 years’ experience
  • Fellow of the American Academy of Facial Plastic and Reconstructive Surgery
  • Fellow of the American Academy of Otolaryngology-Head and Neck Surgery
  • Best known for minimally invasive procedures such as the in-office facelift, eye lift, and laser procedures, and has trained the most physicians in the in-office facelift procedure in the country


Fellowship in Facial Plastic & Reconstructive Surgery at Stanford University (1994-1995)
  • Stanford full time faculty until 2006
      • Associate Professor
      • Director of the Division of Facial Plastic Surgery
      • Director of the Fellowship for Advanced Facial Plastic & Reconstructive Surgery
      • Director, Wound Healing & Tissue Engineering Lab
  • Facial Cosmetic Surgery, Elite MD
  • Combined background in university hospital teaching, physician training, and private practice allow delivery of the most up-to-date and quality patient care


  • Facelift
  • Browlift
  • Necklift with liposuction
  • Eyelift (Blepharoplasty)
  • Laser Skin Peels and Skin Tightening
  • Ear Reshaping (Otoplasty)
  • Fat Grafting
  • Chin Implant
  • Mohs closures (face & neck)- esp. nose, ear, lips, and periorbital regions
  • Excision of benign facial lesions- including keloids
  • Facial Scar Revision

    *Performed in the office and without an IV


  • Nose Reshaping (Rhinoplasty)
        • Revision Rhinoplasty
  • Reduction of Nasal Fractures
  • Septoplasty/Turbinate Reduction

Brief Descriptions of Dr Koch's Procedures

A Facelift is a surgical procedure that improves the visible signs of aging in the face and neck.  It specifically targets the lower third of the face and neck where it can: improve jowls and tighten the jawline, remove loose skin and excess fat in the neck (“turkey neck”), improve vertical lines that extend from the outer corners of the mouth (“marionette lines”), and also improve the nasolabial folds that run from each side of the nose to the corners of the mouth (“smile lines” or “laugh lines”) in most patients.

Dr. Koch performs the state-of-the-art “Vertical SMAS Facelift” to fully address the aging lower face and neck.  He believes that there is no better treatment available for these aging issues.  He also performs a “Mini-Facelift” in select patients which has less downtime.  In either case, Dr. Koch performs these in the office setting with local anesthetic and oral sedation, and uses inconspicuous incisions while preserving the hair.  He also has significant experience doing male and revision facelifts. It should be noted that Dr. Koch has trained the most physicians in the in-office facelift in the country

A Necklift, also performed in the office setting, is a surgical procedure that improves the visible signs of aging in the neck.  Depending upon the patient’s condition and desires, it may include neck fat removal (liposuction), removal of loose skin (submentoplasty), or reducing the appearance of neck cords aka platysmal bands (platysmaplasty).

A Browlift is a surgical procedure that improves the visible signs of aging in the forehead and eyebrow.  It can: raise sagging brows that are hooding the upper eyelids, reduce the wrinkle lines that develop horizontally across the forehead and the vertical creases that develop between the eyebrows (“the elevens”), and places the eyebrows in a more alert and youthful position.  Dr. Koch performs all conventional browlift techniques including, Lateral/Temporal, Direct, Mid-Forehead, Coronal, and Endoscopic Browlift.  Some of the browlift techniques are performed in-office, and the one used depends upon the patient’s condition and desires.  

Blepharoplasty or eyelift, also performed in the office setting, is a surgical procedure to improve the appearance of the eyelids. Surgery can be performed on the upper lids, lower lids, or both where it can: remove loose or sagging eyelid skin which can lead to a tired appearance, remove fat deposits or lower eyelid bags, and improve fine wrinkles of the lower eyelid. Dr. Koch uses his vast experience to perform the appropriate technique for each patient.  This includes “transconjunctival blepharoplasty” which removes fat pads from the lower eyelids without any external incisions.

A Rhinoplasty or “nose reshaping” is a surgical procedure to improve the appearance of the nose. It can treat: size to achieve facial balance, profile with visible humps or depressions on the bridge, a tip that is enlarged or bulbous, drooping, upturned or hooked, and nostril position. It can also correct impaired breathing caused by structural defects in the nose such as a deviated septum (Septoplasty, Turbinate Reduction).  Dr. Koch performs both primary and revision rhinoplasties, and uses endonasal (all in the nose) and open techniques depending upon the patient’s conditions and desires.  Rhinoplasty and septoplasty are usually performed at the ambulatory surgery center where patients go home after the procedure.

Skin resurfacing and rejuvenation is a non-invasive procedure that utilizes various lasers and radiofrequency devices to achieve improvement in skin texture irregularities like wrinkles and acne scars, pigmentation changes like freckles and sunspots, or visible blood vessels. Also, as skin loses tone and becomes less firm with the aging process, these devices can stimulate new collagen, elastin, and hyaluronic acid production.  

These non-invasive procedures are performed in the office and are frequently done in conjunction with surgical procedures such as facelift and blepharoplasty.  Different treatment modalities are available to treat different aspects of skin damage, so the specific type of treatment is best determined after an in-person consultation.  Dr. Koch is a recognized expert in skin resurfacing and rejuvenation, and recently published the medical textbook “Non-Invasive Cosmetic Procedures.”

Dr. Koch also performs other facial cosmetic and reconstructive procedures, most of them in the office setting, and these include: Facial Scar Revision, Otoplasty (“Ear Pinning”), Facial Lesion Removal such as moles, Facial Skin Cancer Reconstruction, Facial Fat Grafting, and Earlobe Repair.

Procedures Routinely Performed by Dr. Koch

  1. Facelift (SMAS imbrication with vertical vectors and hair-sparing incisions)
    1. Including male facelifts and revisions
  2. Browlift
    1. Lateral Subcutaneous
    2. Direct
    3. Mid-Forehead
    4. Coronal
    5. Endoscopic
  3. Necklift
    1. Liposuction/ Laser Liposuction
    2. Submentoplasty
    3. Platysmaplasty
  4. Blepharoplasty
    1. Upper including double eyelid creation
    2. Lower including skin-muscle flap; transconjunctival with skin pinch or laser resurfacing; ectropion repair
  5. Facial Scar Revision
  6. Otoplasty
  7. Autologous Fat Grafting
  8. Rhinoplasty
    1. Primary and Revision
    2. Endonasal and Open Approaches
    3. Asian
  9. Reduction of Nasal Fractures
  10. Septoplasty and Turbinate Reduction
  11. Chin, Malar, and Submalar Implants
  12. Local Flap Facial Reconstruction
  13. Lasers & Radiofrequency
    1. CO2 Laser Skin Resurfacing
    2. IPL
    3. Vascular
    4. Tissue Tightening (Thermage)
    5. Fractional RF Microneedling