Building the optimal in-office OR

Beverly Hills Surgical Center

Building the optimal in-office OR

By Lisette Hilton

1. Flow and Freedom of Movement

Beverly Hills-based plastic surgeon, Randal Haworth, M.D., says he needs to be comfortable and free to move in order to perform facial and body plastic surgery.

But space can be somewhat limited in an OR inside a boutique plastic surgery practice, he says.

“… so careful planning of the envisioned flow between patient, surgeon, scrub tech, circulating nurse and anesthesia provider must be done,” Dr. Haworth says. “In my case, I had to work with a rectangular operating room, in which case I first had to decide where the anesthesia machine would be situated, since its range of movement would be limited by the oxygen and vacuum hoses tethering it to the ceiling. Consequently, it was important for me to have a 180-degree turning radius for the operating table, so I could position it according to whether I am performing facial or body surgery. Of course, OR lights have to follow suit and must be very mobile and bright. My Trumpf LED [Trumpf Medical] system fits the bill nicely.”

2. A Quality Monitor and Sound System

Having a big monitor with a good sound system for music is not only a luxury but a necessity for the modern plastic surgeon. Having the monitor in constant view is a must, according to Dr. Haworth.

3. Intelligently Designed Cabinetry

Proper cabinetry, design to maximize space and efficiency, is essential, according to Dr. Haworth.

“You can never have too many cabinets from the get-go, since these promote organization and obviate the need for vulgar retrofits in the future,” he says. “When it comes to designing my clinic or the operating room, I think that creating and maximizing the feeling of unrestricted space is important for both the patient’s sense of security and the staffs’ sense of clarity.”

4. Don’t Cut Corners

Don’t cut expenses, when it comes to safety, according to Dr. Cohen.

5. Seek Expertise

Dr. Cohen says cosmetic surgeons should tap experts in designing operating rooms.

“Reach out to architects with experience in both the design and credentialing processes,” Dr. Cohen says. “Ultimately, certain third-party inspections may be required, and you don’t want to be caught off guard.”

Dos and Don’ts for the In-office OR

Erin Metelka, an interior designer with Studio Four Design, offers these design dos and don’ts.

OR Dos:

  • Use a sheet flooring, with heat welded seams and sanitary cove base.
  • Use bleach cleanable/non-porous products.
  • Use clean/calming colors.
  • Provide a variety of adjustable ambient lighting options.
  • Utilize floor patterns to designate the extents of the sterile zone and care-provider zones.
  • With the wide variety of procedures that occur in an operating room, often times, the table is moved in order to accommodate the most efficient workflow with the other equipment in the suite. The floor patterns can also be used to dimension the proper location of the table for these various scenarios.
  • When creating several operating rooms, utilize an identical layout (not mirrored). Often, physicians are moving into adjacent operating rooms for a procedure, while a room is being turned over and sterilized. Having identical layouts increases efficiency and reduces error.

OR Don’ts:

  • Do not have extraneous items of décor within the suite, such as artwork.
  • Do not utilize fabric of any kind such as curtains/draperies. If there are windows, create privacy with natural light by using integrated frosted glass. If an upholstery is required for a physician stool or other items, a bleach cleanable vinyl is a suitable alternative, ideally with a Crypton or nano-technology finish applied (these finishes work to prevent moisture penetration to the cushion and function as an antimicrobial).
  • Do not place any direct down-lighting, with the exception of the surgical boom, directly over the table.
Read the original article here!

Nostril narrowing through Weir excisions does not have to look fake

Wier excisions are very powerful tools to augment a rhinoplasty. This is a procedure that I usually perform at the conclusion of a nose job in order to refine and narrow the nostrils while controlling the flare when smiling. Most people and surgeons alike equate this procedure to simply narrowing the “floor” of the nostril by cutting out some skin but it is actually more nuanced than that. The design of the excision can be customized by changing the angulation, the position and the width of the cuts which, in turn, can change not only the dimensions but also the curvature of the actual nostril itself. A deep permanent suture is often used as well to prevent re-widening of the nostrils and reduce tension across the scar. Reducing tension across the scar as well as accurate angulation is important to achieve a nearly invisible scar. So many times I have seen obvious notching that is visible from 5 feet away and is a definite giveaway of having had a rhinoplasty. Weir excisions can be also be performed in conjunction with an upper lip lift adding to the complexity of the procedure. As a rhinoplasty and lip lift expert, I have performed hundreds of these combination techniques with excellent results. All facial plastic surgery, whether it’s primary or revisional, is challenging but taking the time to address all the details and plan them accordingly can maximize the aesthetic outcome that is not only beautiful but natural as well. The devil is in the details so to speak.
Poor rhinoplasty result with crooked , distorted tip and obvious nostril scarring after a Weir excision
Poor rhinoplasty result with crooked , distorted tip and obvious nostril scarring after a Weir excision
Again, note obvious nostril scarring from Weirs and tell-tale signs of a past rhinoplasty
Again, note obvious nostril scarring from Weirs and tell-tale signs of a past rhinoplasty
Before and after revision rhinoplasty and Weir excision as performed by Dr. RANDAL HAWORTH
Before and after revision rhinoplasty and Weir excision as performed by Dr. RANDAL HAWORTH
Primary rhinoplasty and Weir excision to narrow the nostrils in Asian patient. Note added tip projection and lack of notching
Primary rhinoplasty and Weir excision to narrow the nostrils in Asian patient. Note added tip projection and lack of notching
Primary rhinoplasty, Weir excision and concomitant upper lip lift as performed by Dr. Haworth
Primary rhinoplasty, Weir excision and concomitant upper lip lift as performed by Dr. Haworth

The Fallacy of “Stem Cell Facelifts”-the Verdict

In addition to  facial rejuvenation, buttock  and breast augmentation, stem cell marketing has reached such peaks that one may posit that they harbor the solution for global warming.

Postulated uses of stem cells
Postulated uses of stem cells
A recent study came out in our esteemed, peer-reviewed journal Plastic and Reconstructive Surgery addressing stem cell enriched fat transfer versus “regular” fat transfer  (PRS Journal: stem cell rich fat transfer). In essence, this study showed there was no difference in the effects of a fat transfer whether it was enriched with stem cells or not. This was essentially the same conclusion of a blog post I wrote a few years back. However, what makes this news different is that it comes from  a well-designed, randomized prospective study.

You may then ask yourself why are there so many doctors promoting  stem cell facelifts and fat transfers as being the chalice of youth or life’s elixir to immortality and aging. The simple answer is finance and marketing. By promoting your fat transfer as being different, labeling it with the trendy buzz prefix of “stem cell”, prospective patients will naturally think they are getting something better, longer-lasting and more natural.

You may then ask yourself why their before-and-after photos are impressive. The simple answer is that for every before-and-after photo of a stem cell-enriched fat transfer there are 10 equally-as-impressive before-and-after results from regular fat transfers. The bottom line is that one can achieve equivalent results from a regular, well-performed fat transfer-specifically, one in which the fat is appropriately harvested, cleaned and transferred by the physician with precision and artistry. Fat is basically serving as a filler, but one that is extraordinary. Extraordinary because it is not only permanent but is actually living as well-consequently it can grow or shrink depending if the patient gains or loses weight, respectively.

Stem cell embryonicStem cell science is in its infancy and we have much to learn. Indeed, many stem cell scientists now believe that the byproducts  of stem cells (cytokines, etc)  play a  far more important role in healing than the actual stem cells themselves.Fat is a rich source of stem cells but to assume that the stem cells, when transplanted into the face, can miraculously know how to uniquely reverse aging is pipe-dreaming at best.



Randal Haworth M.D., F.A.C.S.
Beverly Hills

The most obvious tell-tale sign of a facelift

Good plastic surgery is invisible but many people insist that they can always spot anyone who has had plastic surgery. For example, they claim they can always spot a celebrity with a facelift and list those with obviously sad results that garner all the press. You can refer to the three attached photographs as examples of such. (They go on to name others who have not had any plastic surgery and when I in turn correct them, they express bewildered disbelief.)
Joan Rivers with obvious plastic surgery and pixie-ear deformity
Joan Rivers with look-at-me pixie-ear deformity
 
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Bruce Jenner with a plain-as-day pixie-ear deformity after a facelift
Mickey Rourke sporting his obvious Pixie-ear and man-bun on the red carpet
Mickey Rourke sporting his obvious Pixie-ear and man-bun on the red carpet
However, this blog post is not about good plastic surgery, it is about the bad and the ugly. There are many signs that scream “facelift”:

1. Overly pulled face skin with diagonal grooves

2. Altered hairlines such as pulled-back sideburns

3. Widened, non-hair-bearing scars with step-offs in the natural hairline behind the ear

4. Distorted anatomy in front of the ear canal due to effacement of the delicate tragus cartilage and finally…

5.”Pixie ear”.

Most of these aforementioned problems stem from misplaced anchoring of the newly redraped skin flaps resulting in needlessly excessive tension across potentially visible scars. One immutable rule in plastic surgery dictates that such increased tension can create widened scars, hair loss and distorted anatomy. Yet, despite these well-documented problems, I unfortunately still see many patients who seek correction of these stigmata of ill-conceived facelifts.

Correcting these problems is not an easy task. Generally, a secondary facelift needs to be performed to release enough skin so that both scars can be removed and closure achieved in a tension-free matter. If it happens to be a lucky day, scars that were placed in front of the ear can even be moved more posteriorly to within the ear canal as in this example of a facelift I performed in order to not only make her look younger but also remove her telltale signs of past substandard surgery.

Pixie earlobe after a facelift. Note scar in front of the ear
After correction with revision facelift and tension realignment


Pixie ear deformity and tired appearance after previous facelift
Pixie ear deformity and tired appearance after previous facelift
Note correction of pixie-ear deformity after revision facelift. An endoscopic brow lift, fat transfer and upper lip lift along with a lower blepharoplasty were also performed
Note correction of pixie-ear deformity after revision facelift. An endoscopic brow lift, fat transfer, upper lip lift and a lower blepharoplasty were also performed

I don’t like comic-book butts and I cannot lie

Every ethnic group has certain predisposed notions of what ideal beauty is based upon their own genetic make up and cultural ideals. Cultural ideals are influenced by trends and therefore can change over the years (think of the beauties depicted in Ruben’s paintings). In terms of Kim Kardashian‘s genetic make up, she is partly Armenian and represents for many an ideal version of female pulchritude. Unfortunately, she is depicted on the cover of myriad top-tiered magazines as a cartoon representation of bottom-heavy female beauty and sexiness. The cover of Paper is no exception. Here, she has been clearly “Photoshopped” to exaggerate her waist-to-hip ratio and smooth out the buttock cellulite she most certainly possesses. In this case, add oil for good measure to flame some pubescent boy’s fantasy. She may have had one or more fat transfers to accentuate her already full bottom (which may or may not show up on x-ray as microcalcifications) but, who cares? This would all be harmless titillation were it not for the fact that many unsuspecting women will be easily influenced to attain their own version of Kim’s voluminous buttocks. Don’t get me wrong-I am the first to appreciate an hourglass figure and a well-balanced full bottom to complement a woman in-and-out of clothes. But full is different than big which in turn is different from a comic-book-big butt of a centaur. IMG_0239.JPG Often times buttock enhancement procedures may lead to immediate or even long-term disastrous consequences. Buttock augmentation can be performed with silicone implants, fat transfer, or injections with man-made substances ranging from PMMA to free silicone or other illicit compounds found in back alleys or mechanic shops. Buttock augmentation with silicone implants is generally considered a safe procedure but has a higher rate of infection as compared with other implants in the body and the results often feel unnaturally hard. I perform fat transfer which is very safe but the patient must have a enough fat to transfer in order to make the result a meaningful one. I am not a proponent of injecting free silicone or other man-made substances because of their inherent danger in terms of disfigurement and possible death. One must remember that we do not know of the long-term consequences of having such outrageously enhanced buttocks in regards to how they will look and droop as the patient ages. Drooping buttocks is a very difficult problem to treat for the plastic surgeon and the only solution would be a butt lift. Unfortunately, most buttock lifts produce mediocre results with unsightly scars. Contrast this to a breast lift, the result of which is often spectacular with minimal scarring. Those contemplating injections and other forms of untested ways to augment their derrière must do their homework and be prepared to roll dice. One must remember that even though one may not experience immediate complications, one must consider the long-term effects of having an extra 2 to 4 pounds of added junk in your trunk.

What It’s Really Like To Get Extreme Plastic Surgery, From A Former ‘Swan’ Contestant

The Huffington Post By Lauren Duca

In light of recent photos of Renee Zellweger, a conversation has begun about plastic surgery. (Zellweger responded to the uproar, telling People magazine, “I’m glad folks think I look different! I’m living a different, happy, more fulfilling life, and I’m thrilled that perhaps it shows.”) But whether or not Zellweger had plastic surgery is irrelevant, and the reality — and potential repercussions — of going under the knife is worth exploring in further discussion. We spoke to “The Swan” contestant Lorrie Arias about her experience to get a better handle on the reality of undergoing such extreme physical change. This is her story.



Ten years ago, at age 34, Lorrie Arias underwent approximately $300,000 worth of plastic surgery. In 1995, she lost 150 pounds; in 2002, her husband died; and, in 2004, she became a contestant on “The Swan.” The program, which Jennifer L. Pozner called “the most sadistic reality show of the decade“ in “Reality Bites Back,” took its title and premise from a literary fairy tale, “The Ugly Ducking.” Two women deemed to be “ugly” underwent a total transformation at the hands of a panel of specialists, including a plastic surgeon. At the end of each episode, one was eliminated and the other went on to compete in the pageant that ran as the show’s finale. It aired for two seasons in 2004, before being canceled in 2005 as a result of low ratings. After losing a significant amount of weight, the then-police department volunteer auditioned for the show in hopes of a tummy tuck. Arias was frustrated that she had worked so hard to get healthy and still had so much extra skin. As a result of her “sad story” the selection committee chose her for the show. Once Arias got to the set of “The Swan,” doctors and producers set up a much more intensive transformation than she had expected. Over two and a half months of filming, she had a tummy tuck, buttock lift, inner thigh lift, dual facelift, upper lip lift, upper and lower eye lift, endoscopic brow lift, rhinoplasty, breast augmentation and breast lift — the most procedures of any contestant on the show.



A decade later, she told HuffPost Entertainment she is depressed, bipolar, agoraphobic and believes she continues to suffer from body dysmorphic disorder. She has regained the weight she lost in 1995 and refuses to leave her home, save for trips to see her therapist every few months. There is relatively little research regarding the psychological fall out from plastic surgery, both because extreme alterations are rare and it is not in plastic surgeons’ best interest to participate in or fund such studies. Some work has been done on the effect of TV representations on adolescents’ body image and the ways in which unrealistic expectations can lead to disappointment following a cosmetic procedure. In terms of diagnoses, the topic most often discussed is body dysmorphic disorder. “That refers to essentially an over-focus on a certain body part as being deformed or problematic, to the point that the person becomes obsessed with it,” Dr. Paul Puri, a psychiatrist, said. “Many times an individual believes getting surgery will fix it. In the research and literature, this has not been show to be a solution. It can be a problem with self-esteem, anxiety or other underlying issues, and surgeries don’t typically solve those other issues.” Of course, sometimes, people get surgery later in life due to social pressures based on standards of beauty and youth. “Those are two largely different reasons as to why people get plastic surgery,” Puri clarified. In cases involving dysmorphic disorder, it tends to pre-exist the surgery and then be exacerbated when the results differ from what the person desires. “The case may be that if someone fixes all of their hopes on surgery, it can be extremely disappointing and actually worsen their anxiety if it is not fixed,” Puri said.



After appearing as a contestant on “The Swan,” Arias faced a lot of negative reactions from those who knew her before the surgery. “You get a lot of crap,” she said. Arias felt that some friends and family were “jealous,” and others uncertain of who she had become. The latter group included the eldest of her two sons, who said at the time, “she doesn’t look that much like my mom anymore.” “He has told me that he felt afraid,” Arias said. “That makes me feel guilty, because I realize that if the shoe were on the other foot, I would have freaked out too.” Perhaps the most unnerving reaction came from Arias herself. The reveal is set up as a surprise for the show’s contestants. Arias said she had caught a slight glimpse of her reflection in medical equipment, but all mirrors were covered in the two and a half months she spent undergoing her various surgeries. It was only on stage that Arias was given access to a mirror. She reacted with quiet surprise, only losing it once the cameras turned off. “I was screaming for the executive producer,” she said. “I was screaming, ‘I want my face back!’ That’s how freaked out I was. Intelligently, I knew that was impossible. But it was so weird. It was like looking at somebody else, but it was you.” That feeling has become less difficult to reconcile over time, but Arias was happier before the show. “I’ve had self-esteem issues all my life,” she said. “But before, I was functional. Then I go and have all this stuff done that people would give their leg for, and I’m confined inside.” Immediately following “The Swan,” Arias experienced what she calls a boost of confidence. “Going out gave me a little bit of self-esteem,” she said. “I liked my chest. My breasts were my badges of self-esteem. I would go out and wear low-cut tank tops and see women hit their husbands for looking at me. That was never the kind of thing I would do before. I would wear normal shirts.” Soon, though, those old feelings of insecurity came creeping back. Arias said the symptoms leading up to her current condition began shortly after filming ended, and have only worsened. She raved about her plastic surgeon, Dr. Randal Haworth — “I was blessed to have him” — but blamed the show for not providing adequate therapy to help process such an extreme change. While on “The Swan,” Arias did receive psychological care, though those sessions largely focused on loss of her husband. In February of 2013, she spoke to the Post citing a lack of follow-up as the cause for her mental health issues.



Arias kept the 150 pounds she lost off for nearly 10 years, and shed 10 more for the show. However, after “The Swan,” she says, she lost a sense of control over her body. “I started to yo-yo,” she said. “I was 155 on ‘The Swan,’ now I’m sitting here at 248. And I’m miserable.” To stop feeling that way, she would consider more surgery. “I would do it in a heart beat. If I had the money, I’d do the weight loss surgery first,” she said. “This is going to sound weird, because I’ve already had so much done. I would have a new breast augmentation. I would have another brow lift. I would have another facelift. I would get more liposuction. I would do all that and my arms.” Arias would also be willing to do the show all over. “Crazily enough, I would do it again,” she said. “Knowing what I know now, knowing I would gain weight again, and knowing I wouldn’t have that other face. At least I could be a big and pretty person. I can’t imagine myself any differently.” Arias acknowledged that stance might be incomprehensible for someone who hasn’t undergone such extreme plastic surgery. Despite wanting more surgery, she is able to recognize that her insecurities are internal. “I thought a tummy tuck would give me all the self-esteem in the world. Of course, it didn’t. All I want now is for my story to help others, so they won’t think that going under the knife is a cure-all,” she said. “For a while it may be, but everything still comes back up.” And yet, Arias still believes the upset over female celebrities and plastic surgery comes from an inherent desire all women have to change their appearances. “The uproar every time something like that comes up in the news is personal jealousy,” she said. “Most women would like to have something done, but maybe they’re afraid or they just can’t afford it.”

Original Article

IN TOUCH (2014) – KHLOÉ’S NOT A KARD

Khloé is a dead ringer for Lionel’s daughter!

Chloe is 14 years older than Lionel’s daughter Sofia, but the resemblance is uncanny. “They have the same hairline and forehead,” says LA plastic surgeon Dr. Randal Haworth. “Their skin tone is similar, their eye coloring is similar, their shape is similar,  their face shape is similar. Even the chin-to-lower-lip and the upper-lip-to-nose ratios are similar.”




HOLLYWOOD REPORTER (2014) – BEST PLASTIC SURGEONS OF LOS ANGELES 2014

These 484 elite go-to physicians keep the entertainment industry’s injuries and illnesses in check and at bay, whether from shoots gone wrong (CHARLIZE THERON’S herniated disc), performance fatigue (KISS’ Paul Stanley’s vocal cords, RINGO STARR’s drummer fingers), just plain accidents (talk to CHRIS ALBRECHT) or not-so-plain cancer. Not to mention the passage of time ( the ultimate villain- ask a dermatologist).

Industry Favorite

When industry clients arrive at his busy office, they enter what Dr. Haworth describes as “the bat cave,” a clandestine garage parking entrance through an alleyway, providing the utmost privacy for those who might not want to be photographed pre- or postsurgery. But with so many Hollywood patients, sometimes an in- office run-in can’t be avoided.

 “ Two very famous people were in rooms next door to each other, and they both knew each other, “ says the plastic surgeon, laughing. “The opened the doors at the same time and were so embarrassed.”  Haworth, who appeared on Fox’s The Swan, also is an artist, working in graphite and acrylic, and those skills heighten his work on sculpting skin.  “ With painting, you have to have a keen eye and the ability to ascertain microscopic detail and understand the power of a shadow versus a light reflection,” says Haworth.

 “ I’m able to imbue that into what I do with plastic surgery.” While he performs a wide variety of cosmetic surgeries, including facial rejuvenation, rhinoplasty, and breast enhancement, Haworth also serves actresses and models with nonsurgical treatments such as carbon dioxide laser treatments and Botox. “ He’s a rock star,” says former America’s Next Top Model contestant CariDee English.

 





NEW YORK POST (2014) – RENÉE ZELLWEGER’S NEW LOOK

Renée, René, Is that you?

Renée Zellweger stunned fans this week, unveiling a new face that makes the “Bridget Jones” actress look nothing like her old self. Plastic surgeon speculated Tuesday that Zellweger, 45, may have had a minor brow lift-that made her unrecognizable.

 “She had really small, squinty eyes-and that was her charm,” Beverly Hills plastic surgeon, Dr. RANDAL HAWORTH the post. “It seems radical only because this is her first time we’re seeing her eyes.”

New York plastic surgeon Dr. Steven Greer deadpanned that he’s not even sure photos of Zellweger at Elle’s 21st Annual “Women In Hollywood Awards in Beverly Hills on Monday were really her. “The surgeons remove too much skin,” Greer said. “They overdid it.” YA rep for Zellweger could not be immediately reached for comment on Tuesday.

 




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