Dr. Haworth's Blog

The trials, trade-offs and tribulations of upper lip lifts and other plastic surgery.

All plastic surgery has trade-offs.

By trade-offs, I am not referring to complications or risks.

By trade-offs I am referring to subtle and sometimes significant alterations in your appearance that will be incurred by undergoing a certain plastic surgical procedure. It is the doctor’s responsibility to inform the patient of these trade-offs (including risks of complications) while it is the patient’s responsibility to make an informed decision to proceed if he or she feels that the benefits of the surgery will outweigh the risks and trade-offs.

Examples of such trade-offs are the scars in and around the ear that result from a facelift. Even though they may be near invisible, they are scars nonetheless. The majority of patients feel that benefits of the facelift outweighed any of the associated trade-offs. Similarly, patients who undergo an abdominoplasty (tummy tuck), mastopexy (breast lift) or brachioplasty (arm lift) should be fully aware that they will develop scars from those procedures. Though the majority will heal well with very acceptable scars, most of the time the scars will be visible to some degree.
Patients who undergo a rhinoplasty must understand that their nose will be numb, stiff and hard for up to 3 months or more while swelling can persist for 1 to 2 years. Numbness from a facelift or a browlift can last many months as well. Despite understanding these trade-offs, the vast majority of patients have no problem undergoing these procedures once they have decided to do so.

Over the years, I have found it curious that a small minority of patients undergoing lip reshaping surgery in the form of upper lip lifts and V-Y plasties had unrealistic expectations in terms of their healing and results. They were surprised even angry that they experienced numbness, stiffness and associated scarring. Sometimes a very subtle change in the nostril position occurred after the surgery. These trade-offs may arise even though the result of the upper lip lift is successful from the aesthetic standpoint-in other words, the net benefit in the sensual-youthful-beauty quotient for the face has been increased. However, a few may consider the lip lift a failure if they have experienced even a slight degree in any of these trade-offs.

Though these trade-offs can mostly be successfully reversed, a patient should not elect to undergo such a procedure if he or she will not accept that these can be normal aspects of the procedure. If one thinks about it, an upper lip lift will have its trade-offs in the same way other procedures would have their own yet it perhaps gets more attention than other anatomical features of the face because the lips are expected to not only look beautiful but also function as well.
-and function they do- more than any other part of the face. Indeed, lips are used to express, emote, eat, kiss and speak-essentially they move millions of times a day! Because of these strong repetitive muscle forces around the nasal and oral region the plastic surgeon must create a strong upper lip lift that will resist these forces in order to achieve a result that is long-lasting, with minimal scarring and nasal distortion.

In fact, lip shaping procedures are the most challenging of all facial plastic surgeries, even rhinoplasties. Though the success of facelifts are measured in centimeters, brow lifts in increments of 2 to 4 mm and rhinoplasties in millimeters, lip reshaping surgery is measured in quarter-to-an-eighth of a millimeter! With those scales, one can almost consider this close to microsurgery.

In 2014, it would be a miracle to undergo an upper lip lift with an unequivocal guarantee of no scarring, nasal distortion, prolonged minor sensory changes and stiffness. If you are contemplating undergoing an upper lip lift but will not tolerate any of these tradeoffs, I suggest you avoid the procedure altogether and wait for that miracle to happen.

Lip Lift status for 2014 and beyond

Lip lifts for 2014

Patients often asked me what are the differences between a skin-only lip lift and my muscle hemming technique. To put it simply, longevity, scarring and nasal distortion.

Skin Only Lip Lift

Until the late 90′s, the only lip lift I knew how to do was the skin only type. I would perform this by excising a certain amount of skin below the nasal base and sewing the lower edge of the excision to the upper edge which happens to be the skin of the nose.  The only thing now supporting this entire weight of the upper lip (which happens to move millions of times a day, eating, kissing, expressing and speaking) is the freshly closed incision at the skin level.  One can imagine that this provides little support for all the action occurring around the upper mouth area.  Consequently, the longevity of the lip lift itself is lessened, the nostrils are more likely to be pulled downwards while the resulting scar is more likely to stretch and thicken.

The results of a skin-only lip lift. Notice the widdened scars, significant nostril distortion and recurrent long upper lip.

The results of a skin-only lip lift. Notice the widened scars, significant nostril distortion and recurrent long upper lip.

Muscle Hemming Lip Lift

After many years of observing the long-term results of skin-only lip lifts, I developed the muscle hemming technique.  By employing moderate principles of plastic surgery in which nip and tucks (such as a facelift) are improved by lifting and tightening the layers below the skin including muscle I have noted a significant benefit to my lip lifts in terms of scarring, longevity and less nasal distortion.  However, the recovery period was notably increased.  The muscle hemming technique involves placing slowly dissolvable sutures into the muscle layer below the skin and intern suturing that to the periosteum (lining) of the bone deep to the nose itself.  The lip lift is thus a solid one without relying on skin closure to achieve its  superior long-term results while lessening the chance of undesirable scarring and pulling around the nostrils.

Long upper lip with corner "apostrophe lips"

Long upper lip with corner “apostrophe lips”

After muscle-hemming lip lift. Note subtle nasal pull down and persistent nasolabial folds.

After muscle-hemming lip lift. Note subtle nasal pull down and persistent nasolabial folds.

Skin Flap Lip Lift

Which brings me to today.  For the last 3 years I have been employing a skin-flap technique which provides all the benefits of the muscle hemming technique but with half the recovery.  Suturing of the muscle is minimized in this technique but none of the longevity and superior scarring is sacrificed. The period of significant distortion and swelling has been halved from 2 weeks to less than 1.  Additionally, the results are “softer” in appearance with minimal to no distortion of the nostril area.

Patient with subliminal long upper lip with minimal upper toothshow

Patient with subliminal long upper lip with minimal upper tooth show

After skin -flap lip lift by Dr. Haworth of Beverly Hills. Notice significant improvement tooth show, natural shortening of the upper lip with minimal nasal distortion. Being a lip lift expert, he developed surgery during to further his evolutionary journey into perfecting the ideal upper lip lift. This new technique also produces softer results those from the skin-only at muscle-hemming  techniques.

After skin -flap lip lift by Dr. Haworth of Beverly Hills. Notice significant increase in tooth show and natural shortening of the upper lip with minimal nasal distortion. Being a lip lift expert, he developed this surgery to further his evolutionary journey into perfecting the ideal upper lip lift. This new technique also produces softer results those from the skin-only and muscle-hemming techniques.

Performing the modern lip lift with minimal-to-no-scarring and achieving a permanent beautiful result is challenging .  It requires attention to minute detail and appreciation of how the oral region plays a central role in facial harmony.  The vast majority of patients are thrilled with the subtle yet powerful results of this operation, but it has taken over 2 decades of  unwavering dedication and imagination to get this far.

You do not need to look surprised after a BrowLift

Better late than never! This is the second part of a blog I wrote almost one year ago about the upper blepharoplasties and brow lifts. Brow lifts are often confused and considered part of a facelift but they are not. A facelift deals with rejuvenating the areas below the lower eyelids including the midface, jowls, jawline and neck.

I am honored to be giving a talk to my esteemed plastic surgical colleagues at the California Society of Facial Plastic Surgeons annual meeting in Lake Tahoe this March. The purpose of my talk is to share my thoughts not only of brow elevation but also of controlling and creating the ideal brow shape. Ironically, as I write this, I am sitting in my hotel room having just listened to 6 hours’ worth of talks from other plastic surgeons about brow lifts and shaping as part of a meeting for the American Society of Aesthetic Plastic Surgeons. As always, I come back from these meetings with one or two pearls that I am keen to incorporate into my practice to provide the best possible results for my patients.

However, I think that most surgeons miss the point about brow reshaping. We all understand that we want the tail end of the brow to sweep upwards in a glamorous yet subtle arch without creating a surprised or malevolent/samurai look (think Carrot Top or Cruella DeVille). Unfortunately, the techniques to achieve that fall short of their stated goals. Surgeons apply tension through hidden incisions behind the temple hairline in a effort to raise the outside aspect of the eyebrow, but this is soon met with diminishing returns. As in all aspects of plastic surgery, simply applying more tension to a region that is resisting movement will not will not provide long lasting elevation. After a few weeks to months, mother nature wins and the structure (in this case the outside aspect of the brow) will fall down again.

Endoscopic brow lifts are beautifully elegant operations that are performed through 2 cm hidden incisions within the hair which do not involve shaving or cutting out skin. Most surgeons, as I mentioned, will attempt to lift up the outside aspect of the brow by angling the incisions outwards on the side of the head to apply upward tension through them. Unfortunately, much resistance is encountered and the results reflect that. In a counterintuitive move, I have angled the inner incisions towards the midline and have found that I can lift the outer aspect of the brows almost effortlessly with minimal tension. The results are long-lasting and more simulate the appealing eyebrow shape of a young cover girl.

Check out the following 31 year-old patient who underwent a brow lift along with fat transfer, chin implant and a minor rhinoplasty:

I feel that brow lifts are sometimes misunderstood creatures. They are under appreciated and when performed correctly provide extremely beautiful results that not only rejuvenate the forehead, reduce wrinkles, elevate and reshape the brows while rejuvenating the upper eyelids. 70% of patients that come to my office complaining of upper eyelid sagging and all they simply need is a well performed modern endoscopic brow lift.

 slightly weak chin and a subtle bulbous nasal tip

31-year-old female with noticeable facial asymmetry with low-set brows. Of note, she also had slightly weak chin and a subtle bulbous nasal tip

exquisite improvement in brow position and shape

Three month follow-up showing exquisite improvement in brow position and shape. Note how her face and eyes “open up”

Preoperative photograph showing the oblique view

Preoperative photograph showing the oblique view of the same patient.

 three-month follow-up of the same patient demonstrating the chin augmentation as well as the minor change to her nasal tip

A three-month follow-up of the same patient demonstrating the chin augmentation as well as the minor change to her nasal tip. Again, note the improved brow position and shape without any look of surprise.”

Now that you had surgery, drains are your new BFF?

At the risk of sounding like I’m standing on a soapbox, I shall repeat my mantra once again . . . how well you follow up with your post-op aftercare instructions is nearly as important as what we do in the OR. Following these protocols conscientiously can ensure a positive outcome just as ignoring them can sabotage your final results.

Remember, the doctor and the patients are a team.

This is particularly true of drains. When you wake up from surgeries involving deep incisions and dissections involving an appreciable amount of surface area such as of abdominoplasties (tummy Tucks), facelifts and browlifts you’ll likely have one, two or sometimes even three tubes coming out of small incisions, each attached a suction bulb drain. They’re unsightly, true. They’re inconvenient, yes. They can be messy, absolutely. But for the duration – and this can be anywhere from 1 to ten days – that you’ll be living with them, your drains are your new body’s BFF or at least very trusted ally!

Let’s back up a minute. When surgery is performed, it is a fact that the innumerable microscopic blood vessels and lymphatic channels are cut. As a result they leak fluid in the postoperative period. Consequently, any space that was surgically created (for example, between skin and deeper muscle layer) can fill up with this fluid as opposed to getting rapidly absorbed by the body. Drains are placed within this surgically created space in order to rapidly evacuate the fluid as it is produced. The fluid in your drain, which will diminish over time, is comprised of a physiological mixture of blood and serum. As you empty the drain twice a day, recording the amount of fluid tell us the rate of decreasing fluid production and how your body is healing.

The advantages of sporting your drains for the prescribed time cannot be underestimated. Removing drains too quickly can result in untoward fluid accumulation in a surgical space potentially necessitating uncomfortable intervention afterwards to remove it. Leaving drains in the body for the appropriate amount of time will actually decrease your healing time by minimizing fluid buildup and prolonged swelling by fostering rapid adherence of the various layers to close the surgical space.

Drain connected to a self suction "grenade" style collection chamber

Drain connected to a self suction “grenade” style collection chamber

So please keep these in mind during the initial phase of your recovery if you find yourself getting annoyed. Soon enough, you’ll be in the office and we’ll remove them. Meanwhile, if you can view your drains in a positive light rather than as an unpleasant burden, it’ll make all the difference in the world.

Can plastic surgery buy you happiness (especially if you are on Adderall) :)?

 

“Plastic surgery won’t make you happy, but it can make you happier”

I think most sentient human beings will agree that the world it’s becoming a crazier place in which to live. We are constantly bombarded by negative imagery, negative stories, negative experiences, negative people while reminded that we are not good enough to fit the ideal as embodied by the media’s ambassadorial cadre of celebrities and certain reality stars. In more recent years, I am seeing an uptick in the amount of negative patients in my practice. I have learned to better recognize them and avoid operating on them as best I can.

Why do I do this?

The answer is simple. I avoid operating on them to better serve them . My staff and I at the Haworth Institute adhere to a basic principle of delivering the best service possible in order to maximally satisfy our patients. Yet, even if I perform the most exemplary plastic surgery and the patient is not happy with the results, then I have failed. In other words, the objective assessment of the surgical results does not match the subjective one of the patient. There are reasons for this break from reality, such as body dysmorphic syndrome and a patient’s own internal anger, discontentment, strife or call it what you will. There is much written about body dysmorphia but little is discussed about the latter situation-the angry, malcontent. Many times, these people come to a plastic surgeon seeking out surgical transformation for the wrong reasons, thinking that the surgery itself will bring a positive change in their life. When that doesn’t transpire and the patient realizes that they are still the same unhappy soul, all hell can break loose for both patient and caregiver because of unrealistic expectations. This may become a greater incendiary situation when a patient is taking Adderall or some other amphetamine-related prescription medication. Consequently, plastic surgeons should be aware of this heretofore anecdotal correlation prior to operating on anyone taking Adderall or equivalent since this may be a predictor of both disproportionate patient disappointment and anger.

I now have come up with the following saying within the last month which resonates with both my staff and myself:  “Plastic surgery will not make you happy, but it can make you happier.” In simple terms, this allows me to assess whether a patient is fundamentally happy and balanced prior to operating on them. I’m sure that there will be a few patients that still slip through the cracks, so to speak, but if I can manage to avoid operating on the majority of angry, unhappy patients then I know in my heart that I did serve them well.

Coincidently, this article just came out today about plastic surgery and happiness:

C’mon get happy! Plastic surgery can help :)

Dr. HAWORTH is a board-certified (American Board of Plastic Surgery) plastic surgeon located in Beverly Hills. His specialties include all aspects of aesthetic facial and breast plastic surgery, including rhinoplasty, revision rhinoplasty, facelifts, lip reshaping and breast augmentation. For further information go to drhaworth.com

Tattoos and Cancer

Tattoos are meant to be party fun and expressive… Cancer and infections are such a buzz kill!

To each his own, but I have always been rather impartial to tattoos. Unlike a fine wine, I simply don’t think they age very well and they look especially out of place on a doting grandmother or father (unless they’re a member of a famous rock group and had a bank account to go along with it).

Anyway, onto more pressing matters such as how tattoos can kill you.

As a Beverly Hills plastic surgeon board-certified by the American Board of Plastic Surgery, I am always aware I am a doctor first and a plastic surgeon second. It is for this reason I address subjects such as this to inform the public of potentially dangerous trends they embrace. More is written about how tattoos are associated with resistant bacterial infections and skin cancers, especially that the American FDA is applying its investigative microscope to the issue. More ominously, because of hepatitis C transmission, tattoos are associated with liver cancer and the possible necessity of liver transplantation. That is some virulent ink to say the least!

You might read this and think that you’re better off undergoing laser tattoo removal. Unfortunately, while the tattoo might be removed by the laser, blasting away that pigment might release it into the body a second time.

If you’re thinking about getting a tattoo maybe consider using a safer pigment such as InfiniteInk . This does not contain toxins and can be easily removed. It may cost more, but wouldn’t you want a pigment that was developed to color medicines, rather than paints?

To read more about this unsettling topic click here:

http://www.dailymail.co.uk/health/article-2032696/Now-tattoos-cancer-U-S-regulator-probes-fears-inks-contain-carcinogenic-chemicals.html

http://dawn.com/2013/01/25/tattoos-linked-to-hepatitis-c-study/

 

R.D. Haworth M.D., F.A.C.S.

 

The Unknown Risks of Facial Dermal Fillers

In 2011, total cosmetic procedures as reported to the American Society of Plastic Surgeons have increased by 5%. While the majority of that rise has been attributed to the increasing use of noninvasive treatments which include Botox, lasers and fillers, actual surgical procedures have decreased somewhat. This may be more reflective of a rather anemic economy than an actual trend per se. Soft tissue fillers like Hyaluronic acid (Restylane®, Juvederm Ultra®, etc.), calcium hydroxyapatite (Radiesse®), and fat injections experienced some of the largest growth in the minimally-invasive market during 2011. More than 1.3 million hylauronic acid procedures were performed in 2011, up 9 percent; 286,000 calcium hydroxyapatite procedures, up 36 percent; and 68,000 fat injections, up 19 percent. However, in my practice I have noticed a shift back towards surgical procedures such as facelifts-perhaps this is because seasoned, sophisticated patients have come to realize firsthand the limitations of noninvasive treatments.

 

With the ever expanding embrace of fillers by the population, people are increasingly equating them to a manicure and pedicure. Doctors, Nurses and patients alike rarely think twice about their application and often times are not aware of their potentially serious risks. However, even a recent study has shown that seven out of 10 British doctors have experienced complications with the use of fillers (http://www.inquisitr.com/432110/wrinkles-dermal-fillers-can-cause-blue-skin-and-blindness-report/).

 

Among the fillers approved for use within the United States include many hyaluronic acids-HA (Juvéderm®, Restyane®, Perlane®, etc.), calcium hydroxyapatite (Radiesse®), PMMA (Artefill®), Sculptra® and fat. The HA’s are associated with their own unique side effects such as the Tyndall effect (a bluish gray swelling that imparts a puffy look to the lower eyes) while Radiesse®, Sculptra® and Artefill® can induce granulomas. However, all of these fillers have been associated with a few extremely rare but potentially devastating complications. Among these are skin necrosis (death of soft tissue) and vision loss. These problems result from a highly unlikely, unforeseen introduction of a minuscule amount of material into a microscopic branch of a facial blood vessel. A very small amount of filler injected into a peripheral vessel around the forehead, nose, nasolabial fold and even lip can result in these aforementioned complications. It is important to note that not only filler, but fat from a facial fat transfer and even a simple steroid injection have been implicated in both tissue and vision loss.

 

Once in the bloodstream, the filler in turn can travel downstream through the labyrinth of interconnecting blood vessels and if, in the highly unlikely event, it makes a wrong turn, it can end up in one of the blood vessels supplying the retina of the eye. Recently, I was devastated to discover that a patient of mine suffered one sided vision loss because of this very issue. Ironically, she showed no signs of external injury and still appears as a beautiful woman. A few ways for doctors to diminish the chances of such terrible occurrences are to use blunt tip cannulas instead of sharp-tipped needles whenever possible and to inject small amounts while withdrawing the syringe. Though I employ these two techniques routinely even under magnification, there is no absolute guarantee that these complications can be avoided. It is important that patients are made aware of these risks, albeit fleetingly small, in order that they can make an informed decision as to whether to proceed.

“We cannot estimate the incidence of these devastating complications among recipients to filler injections. It must be extremely rare, but it does happen,” Dr. Woo from Seoul National University’s Bundang Hospital told Medscape Medical News. The likelihood of such a devastating event is probably less than being struck by lightning

Odds of being struck by lightning in a given year (reported deaths + injuries)              1/1,000,000
Odds of being struck by lightning in a given year (estimated total deaths + injuries)      1/775,000
Odds of being struck in your lifetime (Est. 80 years)                                                           1/10,000

 

and certainly less than being injured in a car accident. Even though we are aware of the risks of driving and probably know a few people may have been seriously injured or even killed in a motor vehicle accident, few of us think twice about getting into a an automobile, turning on its ignition and driving.

A good summary of this tragic problem written from an objective standpoint can be accessed here http://www.lipostructure.com/wp-content/uploads/2012/08/Avoidence.pdf

 

 

R.D. Haworth M.D., F.A.C.S.

 

Ironically, two weeks after I wrote this blog, I was involved in a motor vehicle accident  (1 week ago, today being March 12, 2013). Fortunately, noone was seriously injured.

Brow Lift or Blepharoplasty? That is the Question

You are complaining of saggy upper eyelids.

You go to your plastic surgeon.The question is: “Brow lift or blepharoplasty? Or both?”

 

About 70% of patients coming to me requesting rejuvenation of their upper eyelids have no aging problems with their upper eyelids at all. Instead, what they are really manifesting is a pseudo excess of eyelid skin caused by a sagging of their forehead and its associated eyebrows ( brow ptosis). The skin between the eyebrows and the upper eyelashes is now compressed into folds, giving the impression age- related excess eyelid skin.
It is imperative from an aesthetic and functional standpoint that the plastic surgeon makes the correct diagnosis, differentiating brow ptosis from true excess eyelid skin. Sometimes the two conditions can coexist like in Kenny Rogers pre-surgery.

Kenny Roders Before any surgery. Note how he has a combination of heavy brows and excess eyelid skin.

Kenny Rodgers Before any surgery. Note how he has a combination of heavy brows and excess eyelid skin.

The treatment for brow ptosis is an endoscopic Browlift (which I will discuss in a future blog post and how to avoid the “surprised-look”) while that for excess eyelid skin is an upper blepharoplasty. Sometimes strategic fat transfer or filler injection above and into the brow can help reversed brow ptosis to a moderate degree.
I have seen many unfortunate results of upper eyelid surgery or blepharoplasty, stemming not from poorly performed surgery, but simply from a wrong diagnosis. In other words, the wrong surgery was correctly performed for the wrong diagnosis. I have also seen the correct surgery performed but carried out too aggressively such as in the case of Mr Rogers. If you compare his presurgical picture to the post surgical picture, one could see that his eyes are too recessed because too much fat and skin was removed.

Note the overaggressive brow lift and upper blepharoplasty leaving him with unnaturally hollow upper eyelids.

Note the overaggressive brow lift and upper blepharoplasty leaving him with unnaturally hollow upper eyelids.

Unnaturally deep recessed eyes as seen in these male celebrities can result- the upper eyes are bizarrely punched out in a feminized fashion not usually seen in nature. Yes , the upper lids are clean, but they are too sculpted and when placed adjacent to a still sagging brow, they results are just plain unattractively weird.

Wayne Newton before any plastic surgery.

Wayne Newton before any plastic surgery.

 

Wayne Newton after an overaggressive upper blepharoplasty. He probably would've been best served by a subtle brow lift alone

Wayne Newton after an overaggressive upper blepharoplasty. He probably would’ve been best served by a subtle brow lift alone

Don’t confuse this condition with people who have naturally deep set eyes such as Jeremy Irons.

Jeremy Irons has naturally deep set eyes. This is who he is and it looks completely natural.

Jeremy Irons has naturally deep set eyes. This is who he is and it looks completely natural.

Mr. Irons still has his natural character embedded in his countenance, whereas the aforementioned public figures who have had overly aggressive brow and eyelid surgery seem to had their essence extracted from their face.

 

For further information or to make a consultation with Dr. Randal Haworth, a Beverly Hills plastic surgeon and specialist in eyelid and browlift surgery,call 310 273 3000 or visit him at www.drhaworth.com.

This New Blunt-Tip Needle Screws the Bruise! Dermasculpt

What is Beverly Hills Plastic Surgeon, Dr Randal Haworth’s, latest tool to minimize bruising with injections?

Injection techniques to place filler into the face to correct lines, folds and wrinkles have became even more advanced with the use of blunt tip cannulae, such as Dermasculpt.
These are similar to needles except that they are not sharp and therefore are less prone to cut the tiny diameter blood vessels in and below the skin.

20130103-020716.jpg

What does this mean for the patient?

-Markedly less bruising
-Generally significant less discomfort
-Greater safety profile

I don’t employ them to treat all areas of the face, since certain anatomical facial features require extremely precise placement of filler not afforded by blunt tip cannulae. They are ideal to inject larger areas which require generalized plumping or filling such as the temples, cheek hollows, brows and jawline.

I have injected most types of filler through them including Juvederm, Restylane, Belotero, Artefill, Aquamid and Radiesse.

Be prepared to hear some minor crackling noise, however, for the first minute or so similar to lettuce being cut!

“The Lifestyle Lift”-LSL . Does that really stand for the long scar lift?

 

The myths and realities of the Lifestyle Lift

As with any service industry, there are convenience stop businesses and destination businesses. You see that with restaurants (think of McDonald’s or Chili’s versus French Laundry, one of the best restaurants in the United States) and you see this concept applicable to the plastic surgery business. I stress the term business  and not medical field for a reason in this essay. I can safely say that most people that pursue higher education in any country do so to seek a better life, better pay and have more opportunities come their way. Of course, most scrupulous doctors experience immense satisfaction from treating their patients as well and, cynically speaking, are not simply in it for the financial award.

Like all professionals, doctors do seek out (and deserve) a certain financial reward for all the years of dedication, study, stress and life sacrifice they undergo in order to carry out their profession and deliver the best care they can to their patients. However, in this day and age of increasing competition and commoditisation in all aspects of health care including plastic surgery, surgeons are forced to perform more surgeries at lower costs and possibly increased medical risk to patients. This alarming trend can especially be seen in plastic surgery where the end results of a hastily performed surgery are not hidden within a body cavity but are plainly visible on the face. Some of my colleagues brag about the speed at which they perform a surgery citing the many corners that they “cut” during an operation as unnecessary steps (no pun intended). I suppose they feel more akin to a Usain Bolt than that of a gifted watchmaker.

This brings me to the title of this blog post-The Lifestyle Lift. To the unsuspecting public this facelift is heavily marketed as a viable, simpler, safer, faster quality facelift at a fraction of the price. In fact, this facelift is an overly simplified distillation of pre-existing ideas wrapped in a new packaging as something brand-new and revolutionary. The one aspect that is revolutionary about this facelift is that it is one of the first surgeries that has been rebranded and marketed directly to the “consumer”. The company then refers the “consumer’ to one of their participating surgeons in the network to become a patient. Unfortunately, as a Beverly Hills plastic surgeon board-certified by the American Board of plastic surgery, I have seen many results of this “Lifestyle Lift” that reek “cookie-cutter surgery” in which performance is measured in terms of speed and not quality.

I have seen many unacceptable, hideously widened scars most probably stemming from the fact that the surgeon did not perform a wide enough dissection to allow a tension-free closure (which is tantamount to a good scar). I have also consulted with many patients who were dismayed by how the “Lifestyle Lift” failed to meet their expected goals with incomplete treatment of their jowls, neck and midface.

While it is true that all surgeons have their small subset of unhappy patients either because of unrealistic expectations, sub-optimal results or unexpected complications, the large percentage of unhappy patients complaining of their “Lifestyle Lift” is too hard to ignore. For a good article on the subject that appeared in Plastic Surgery Practice.