Archive for the ‘Wrinkles’ Category

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.”

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!

Needle Away your Concerns about Stretch Marks and Sagging Body Parts

Needling treatment also known as CIT (which stands for collagen induction therapy) has actually been around for quite a long while now. It is truly a low-tech device but it has found a new place in my bag of aesthetic tricks.

Why? Simply because it works. It seems to be the most effective procedure in this day and age to reduce stretch marks (striae distensiae), firm and elevate  tissue(knees, elbows, buttocks etc.), reduce scars (including acne ones), reduce hyperpigmentation-all in all it seems to result in a healthy, more youthful appearing skin.

How does it work?

The patient starts applying fat-soluble vitamins A and C antioxidant oils to the skin two weeks prior to the planned procedure date. The fat solubility of these vitamin oils allow them to penetrate human epidermis and dermis far more effectively that many of the other available competing products. These in turn stimulate the skin to produce more collagen and rejuvenate their elastin component. The device (which is basically a roller with approximately 200 needles attached to it perpendicularly) is then utilized to produce tens of thousands of small needle marks penetrating into the dermis. This in turn, induces a cascade of collagen production, the effect of which is amplified by the combined use of the antioxidant vitamins. In a way, the roller is not only producing a controlled injury to the skin but also acting as a very efficient drug delivery system.

I generally recommend a number of treatments to get the most optimal results. Here’s just one example of the fairly dramatic effect one could achieve by this methodology. The woman had undergone myriad laser treatments to reduce her stretch marks, but to no avail. After just two Roller treatments, she achieved the following result.

Abdominal Stretch Marks

This woman had a previous abdominoplasty in order to help reduce her stretch marks. She was dissatisfied with the result and had many laser treatments to reduce her stretch marks. They are still very obvious in width and depth.

 

 

After Needling/CIT

She underwent two rounds of Needling/CIT. Note the dramatic reduction in stretch marks both in terms of width and depth.

 

For further information about CIT, needling therapy, call the office of Dr. Randal Haworth (310 273 3000) located in the Haworth Institute.

 

The Perfect Lower Eyelid-No Wrinkles, No Hollow Circles

 

What is the perfect lower eyelid?

We all want to have the eyelids when we were 20  with minimal-to-no wrinkles, no bags, no dark circles and a smooth transition from the lower eyelid into a nice full elevated cheekbone.

But life tends to throw us a curveball. As we get wiser, our wrinkles get proportionately deeper.

80% of this is hardwired into our genetics while 20% is in our hands. In other words, genetics is our gun and the environment is our trigger.

The best treatment is prevention by avoiding environmental toxins-tobacco smoke, harsh chemicals and sun exposure are the three main culprits that come to mind.

The second treatment is maintenance through the use of hygiene, moisturizers and strategic use of topical antioxidant therapy. Among the latter is a dizzying and bewildering array of botanicals, herbals, vitamins, roots, vegetables, nutritional supplements and berries! But the two most singularly effective treatments are the use of vitamin A (derivatives of retinol, Retin-A, etc.) and fat-soluble vitamin C. The early use of these substances goes a long way in helping to prevent and diminish the wrinkles in the first place. I know many 60+ year old patients who have virtually no crows feet (without the use of Botox™) because they have been using a derivative of Retin-A for close to 20 years.

The third and final treatment is direct physical intervention through the use of either lasers, Botox™/Xeomen™, fillers (Restylane®, Juvederm®, etc) and/or plastic surgery. Plastic surgery on the lower eyelid is called blepharoplasty and can consist of any combination of skin removal, fat bag reduction and eradicating the dark circles/hollows that frame the lower eyelid from the cheek.

As a Beverly Hills plastic surgeon dealing with the most discerning of patients, I perform lower eyelid rejuvenation every day in my practice. Any blepharoplasty specialist is well aware of the potential pitfalls of performing surgery on the lower eyelid. The most dreaded complication that patients are fearful of is a changed lower eyelid shape (that “pulled down” look that was so frequent in surgery before the 1990s).

In the vast majority of cases I do remove skin through what I call a lower lid pinch technique utilizing one single stitch. This minimizes any chance of lower eyelid retraction. This scar basically heals as an invisible one, one which needs a magnifying glass to visualize. Though I still reduce protruding fat bags on occasion, the frequency with which I do perform this has dropped precipitously in the last 10 years. In the majority of cases, transferring fat with extreme sensitivity and appreciation of the delicate eyelid anatomy, will not only significantly diminish the dark circles but also hide any protruding fat pockets around the lower eyelid.

Fat transfer, if properly performed, is by-and-large permanent around the lower eyelid and should be performed by extremely experienced plastic surgeons. While adhering to this principle, the incidence of lower eyelid irregularity and small bumps can be vastly diminished.

Oblique view of aging lower eyelid   After a lower blepharoplasty (eyelid tuck)
Wall, aging lower eyelid showing crepey lower eyelid skin, bags and mild hollowing   After a lower blepharoplasty (eyelid tuck) removing excess skin, excess protruding fat bags and performing strategic fat transfer into the lower eyelid circles (hollows)
 
An alternative view of this patient with aging lower eyelids   After a lower blepharoplasty performed by Dr. Randal Haworth in Beverly Hills
This patient has the classic signs of lower eyelid aging including excess eyelid skin with wrinkles, protruding fat bag and mild hollowing (dark circles)   After lower blepharoplasty (eyelid tuck) performed by Dr. Randal Haworth of Beverly Hills. In the surgery, he removed excess eyelid skin, reduce the excess bags of fat and performed judicious fat transfer in the dark circles

Contact The Haworth Institute for further information.

Eradication of Horizontal Neck Lines


Dr Randal Haworth of Beverly Hills had discovered an incredibly effective way of diminishing those troublesome horizontal neck lines.

Only until recently has an effective method to erase horizontal neck lines or groves if you will been developed. Plastic surgeons have only offered neck lifts as a way to smooth these lines out and despite their efficacy in restoring youthful jawline and correct a “turkey neck”, they feel short in terms of treating those aging horizontal neck lines. As an alternative Botulinum toxin (Botox™, Dysport™, Xeomen™) can be injected into the platysmal bands of the neck and though it can “lift” the neck and lessen the aging cords of the neck, it does little to nothing to remove the horizontal lines.

I have found that judicious use of a filler strategically injected under magnification into the precise layer below the horizontal grooves can dramatically decrease or even erase the stubborn lines. I usually start with a temporary filler such as Juvederm™ or Radiesse™ and once the patient is satisfied, I can then graduate to a permanent filler such as Artefill™., one the former substances dissipate .

Here is a typical example of a before and after of a filler to the horizontal lines to the neck:

Horizontal Neck Lines, beverly hills nosejob, beverly hills rhinoplasty   Horizontal Neck Lines, beverly hills nosejob, beverly hills rhinoplasty
Notice moderately deep horizontal necklace lines or rings   Note the dramatic improvement of the Necklace Rings