A plastic surgeon who had previously been fined $29,000 for sloppy record-keeping and rusty and dirty equipment at his Westport clinic was fined $10,000 on Tuesday by the state Medical Examining Board in connection with a 2009 rhinoplasty procedure.

Dr. Joel B. Singer also had his medical license placed on probation for two years. Under the memorandum of decision approved by the board, Singer must hire a licensed physician to monitor his practice and take courses in medical ethics, informed consent and medical record keeping.

Singer's lawyer, Mary Alice Moore Leonhardt of Hartford, had strongly objected in writing to the penalty, calling it "harsh," "draconian" and inconsistent with recent penalties the board had imposed on other doctors.

"The material facts of whether (Singer) can practice with skill and safety are not in issue and have never been an issue," Leonhardt wrote.

A hearing panel had also recommended that Singer's license be suspended for 60 days, but after some discussion, the board voted 8-5 to approve the fine, probation and monitoring without any suspension of Singer's license.

Last August, Singer closed his Center for Ambulatory Surgery, ending a string of disciplinary actions against the clinic. At the time, Singer said he had treated more than 8,000 patients in Connecticut and New York and "countless patients have been very pleased with the outcome of their procedures."

He said he developed one of the first in-office surgical facilities in the state and was the first plastic surgeon in Connecticut to perform liposuction.

In the latest case, Singer failed to obtain a patient's consent that another surgeon, Dr. Leo Otake, would participate in the operation on her nose on April 27, 2009, the memorandum states. The woman reported that Singer told her Otake would be "observing" the procedure.

The woman was not happy with the surgery and Singer and Otake operated to fix her nose on July 30, 2010, state records show.

Singer, a 1966 graduate of Yale University's medical school, has faced sanctions from the state dating back nearly 15 years.

In a July 1999 consent order, Singer agreed to one year's probation for inserting breast implants of different sizes into a patient.

In a May 2007 consent order, the state fined him $5,000 for a case of "incompetence/negligence" involving a patient who failed to heal properly after breast reduction surgery.

In 2011, his Westport clinic was fined $4,000 and Singer was fined $25,000 for several violations at the clinic, including having unqualified nurses, slipshod record keeping, improper sterilization procedures and unsanitary conditions.