Archive for the ‘Fat Transfer’ Category

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 his 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.

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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.

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.

Fat transfer to the lower eyelid hollows/dark circles

Fat transfer is a brilliant way in order to fill up the lower eyelid circles which gradually appear with age as the mid facial fat sags southwards. Though one can inject any number of temporary and permanent fillers into the area with magnification (such as Juvederm®, Restylane®, Artefill®, Belotero®, etc.), one must remember that fat is an excellent solution. By filling out this dark circle/hollow, a smooth beautiful interface is created between the lower eyelid and the upper portion of the cheek. The harsh defining ledge of the lower bony orbit is smoothed out.

Here is a classic example of a strategic fat transfer to the lower lid. The results are permanent and natural appearing.

Note the harsh shadowing around the lower eyelid interface with her upper portion of her cheek. This is called the “tear trough” and worsens with age.

Note the smooth result that was obtained by softening the shadowing and ledge that defined her lower eyelid hollow. Fat transfer was performed in order to obtain this result.

Obviously, as we continue to age, the cheeks descends further thereby widening the “tear trough” or lower eyelid Hollow/dark circle. The fat that worked perfectly to bridge the gap is now inadequate since the gap has widened. The results of fat transfer should be permanent, however, as long as the surgeon adheres to proper fat harvest and transfer techniques.

 

For further information into how Dr. Randal Haworth of Beverly Hills(Certified by the American Board of Plastic Surgery), Call 310-273-3000

 

The Bulbous Nasal Tip In Rhinoplasty

Dr. Haworth of Beverly Hills gained much of his advanced experience as both a primary and revision rhinoplasty specialist back in the Middle East. He performed literally hundreds of nose jobs there on patients from all walks of life. One of the most common complaints there are boxy and bulbous nasal tips.

What constitutes a bulbous nasal tip?

The bulbous nasal tip is most likely caused by thick alar cartilages (see accompanying diagram)and/or alar cartilages that are splayed out instead of shaped in a neat triangular formation.

beverly hills nosejob, beverly hills rhinoplasty
This anatomic situation can be exacerbated by a thick layer of oily, sebaceous nasal tip skin. Think of the latter as a sleeping bag as opposed to a thin silk sheet., draped over delicate structures

How does an experienced plastic surgeon correct the thick bulbous nasal tip during a nose job?

In my hands, I prefer performing a rhinoplasty utilizing an “open” approach because it affords me vital binocular vision so I can assess up to half-a-millimeter asymmetries that otherwise I would would be unable to appreciate utilizing a closed approach. The closed approach is one where the incisions are solely confined to the inner rims of the nostril, whereas an open approach utilizes the same aforementioned incisions in addition to a small hidden incision below the columella (that fleshy partition that separate the left and right nostril). The open approach allows me to see both the left and right nasal tip cartilages simultaneously so that any maneuver I would perform on the other can be immediately assessed with its opposite counterpart. Sutures are meticulously placed in a strategic fashion in order to change the shape of the cartilages from a round convex shape into more of a triangular one which, in turn, will translate to a more refined, elegant nasal tip. Think of assembling a ship in a bottle via strings, so to speak. The rhinoplasty surgeon cannot just bend cartridges, he must utilize sutures in order to shape them. This is part of the stock-in-trade of nasal tip/nasal cartilage manipulation.

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Of course, some cartilage is removed as the surgeon sees fit. The importance of not being too aggressive cannot be overemphasized since doing so could result in an unsightly “pinched tip”. Finally, it is more often than not necessary to “defat” the under surface of the thick sebaceous nasal skin that would accompany such a bulbous tip. This allows the thick “sleeping bag” to redrape more fluidly over the newly reconstructed nasal cartilages.

Swelling of the nose may take many months to even a couple of years to fully disappear. This does not mean that the patient would not enjoy the effects of a rhinoplasty before then. It is just that the skin can remain slightly swollen for prolonged periods of time. The last area for swelling to dissipate is at the nasal tip area. So even though great of a 95% of my patients love their nose at the 21st day postoperatively, some will say that they would like their nasal tip to become further defined. I may either inject some Cortizone underneath the skin to turbocharge the swelling to go away quicker or just recommend patients. Sometimes that’s the hardest thing for inpatient to digest.

For more information, click here and here

See the following example:

beverly hills nosejob, beverly hills rhinoplasty
BEFORE AFTER
beverly hills nosejob, beverly hills rhinoplasty
Bulbous nasal tip with long upper lip and facial atrophy After a rhinoplasty (tip plasty), upper lip lift and complex facial fat transfer

Another example of an isolated bulbous tip with thin skin:

beverly hills nosejob, beverly hills rhinoplasty
A classic bulbous tip with rather thin skinAfter a tip plasty utilizing suture cartilage molding as well as cartilage reduction. After a tip plasty utilizing suture cartilage molding as well as cartilage reduction, Note the smooth nasal tip contour without any distracting shadowing.
beverly hills nosejob, beverly hills rhinoplasty
Patient with a Bulbous tip
and thin skin coverage
After tip plasty/rhinoplasty

5 years after rhinoplasty, facial fat transfer and upper lip lift