Posts Tagged ‘rhinoplasty’

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.

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

What is Natural Plastic Surgery?

What is Natural?

The Challenging Question in Modern Plastic Surgery

 

“I am fearful about plastic surgery.  “Whenever I am in , Beverly Hills, LA or New York, I see people with bad work looking so fake.  Their lips are and breasts are so out of proportion!”

 

I , as a Board Certified plastic surgeon in Beverly Hills, hear this time and time again in conversation at dinner or in my clinic. “I don’t want to look like Michael Jackson!” is another common proclamation of patients during nasal surgery consultations. Instead of getting frustrated with these opinions, I agree with them. It is because I understand their source. It is simple; “good” plastic surgery is invisible, while so called “bad” plastic surgery is not.

 

Bad plastic surgery (whether it be a rhinoplasty, facelift or breast augmentation) can result from any of the following three scenarios. The first is poor performance of a procedure. Fortunately, this is a rare occurrence when a properly trained surgeon certified by the American Board of Plastic Surgery performs the surgery. The second is poor healing by the patient, perhaps complicated by infection. Again, this is infrequent especially in healthy, well-selected patients. Finally, the third issue is the question of aesthetic taste. No amount of plastic surgical training will guarantee appreciation of balanced facial form and pulchritude. By way of analogy, not all self-professed artists who attend the same art school will emerge as equally talented artists.

 

What makes for good plastic surgery then?  It is the fruit of a surgeon who’s not only technically proficient, but also possessive of a keen eye and aesthetic sense. A beautiful and youthful face reflects visual harmony between facial structures. With age, harmony turns into visual dissonance as youth cues disappear.  As a surgeon, it’s my job to serve as a conductor to bring these diverging aging elements together again. Youth cues  are lost as wrinkles, folds and sagging facial features arise. Most plastic surgical training emphasizes the re-establishment of major youth cues while overlooking the  minor ones.   In order to re create the major youth cues, I eradicate jowls; I soften the nasolabial folds, (the fatty accumulation that runs from the bottom corner of the nostril to the corner of the mouth,) contouring a strong jaw line and a firm neck and rejuvenating the eyelids through a combination of endoscopic brow lifting and blepharoplasty (eyelid tucks.)

 

In order to paint a convincing portrait of somebody in their youth, the surgeon should not only recreate the major youth cues, but also the minor ones. To do so, the surgeon must address the hollows underneath the eyes, the drooping corners of the mouth, the elongated upper lip (hiding the upper teeth), the sagging lower lip (exposing the lower teeth) and the elongated ear lobes. True visual choreography is required.

 

I’m excited by the array of minor youth cue procedures now developed. Most are relatively minimal in scope. Among these are the Endotine  ST and B mid-face lift, the first vertical and reliable mid-face lift that not only addresses the hollows under the eyes, but also softens the nasolabial folds. All in all, it provides a more natural  and subtle rejuvenation, avoiding that “pulled back” look. The procedure takes forty minutes when combined with a blepharoplasty (“eyelift” ).   This technique is made possible by the development of a new absorbable device placed via the eyelid to elevate the cheek fat pad back to it’s position of youth.

 

There are other minor youth cues  and I addres them as well – by performing upper lip lifts with a hidden incision inside and around the nose, as well as corner lip lifts and earlobe reductions as necessary.  The upper lip lift shortens the distance between the nose and the lip, allowing the upper teeth to be seen.  One only has to peruse the fashion magazines to see how this look is indicative of a fresh and youthful lip region.

 

The before and after photos included below, are good examples of the above principals put to use.  This 28-year-old girl has premature signs of aging from massive weight loss. Both major and minor youth cues need to be established to achieve harmonious balance.  Consequently, I performed an endoscopic brow lift, lower blepharoplasties with fat transfer, an Endotine mid face-lift, liposuction of  the neck, upper lip lift and fat transfer.

 

midfacelift, browlift, blepharoplasty, upper ,lip lift, fat transfer to lips

There are artists who have become doctors and doctors who have become artists. Since I have started painting as a little child and have graduated to exhibit my later work in respected galleries, I consider myself as one of the former. I am fortunate that my background has imbued me with an artist’s eye, which translates into my work.  Regardless of Beverly Hills, New York or other urban center, Plastic surgeons should always strive to deliver to their patients not only the best technological advances in plastic surgery, but also in a way that reflects passion and inspiration with an aesthetic sensibility.

The Classic Reduction rhinoplasty

The Simple Reduction Rhinoplasty

As a primary and revision rhinoplasty specialist, Dr. Randal Haworth of Beverly Hills excels with all types of complicated nose jobs, but sometimes it is a simple pleasure to be confronted with a classic reduction rhinoplasty. Though these are relatively simple in concept, all nosejobs (or rhinoplasties) must be handled with utmost care and dedication to excellence.

Why does a prospective patient consult with me requesting a nosejob?

  • Is it that their nose is asymmetrical, twisted, dented and scarred from a past rhinoplasty gone wrong?
  • Is it that their nose is too small for their face with a flat bridge and wide flat tip perhaps due to Asian heritage?
  • Is it that their nose is too wide with a bulbous tip?
  • Or is it that their nose is too big, with an associated hump, wide bones and big, drooping tip (especially when smiling)?

Well, most come to me with the latter concerns such as: “Doc, my nose is just too big for my face”, “I always hated my hump”, “My tip is falling like a bird’s beak”, etc., etc.

Upon examination, the nose will usually manifest the aforementioned undesirable characteristics to varying degrees:

  1. Is there a hump? Check
  2. Is it comprised of bone and cartilage? Check
  3. Does the nasal tip droop (with an acute angle between the upper lip and bottom of the nose/columella) especially with smiling? Check
  4. Is the nasal tip wide and/or bulbous? Check
  5. Are the nasal bones wide (where they emerge from the cheeks to form the bridge)? Check

If this common checklist is mainly affirmative, then the patient will need a classic reduction rhinoplasty. In this surgery, the tip is made narrow with either tip grafts (composed of cartilage usually invisibly harvested from the patient’s own septum), strategic suturing or both. The nasal hump is either chiseled or filed down and finally the nasal bones are narrowed by delicately in-fracturing them (“breaking the bones”). If this latter maneuver is bypassed, then an”open roof” deformity may likely arise in which the nasal bridge will look artificially flat and wide itself. Therefore the nasal bones (which comprise the sidewalls of the nose) are carefully angled inwards towards the midline in order to close the open roof which resulted from the hump removal in the first place.

Check out this patient, who underwent a classic reduction rhinoplasty on the Swan.

Here is a typical example of a classic reduction rhinoplasty,even though only subtle changes were performed. Note that a radix graft (to raise the nasal frontal angle) was placed to add  height and therefore elegance to her nose.

For a more general overview of rhinoplasty, go to: http://www.drhaworth.com/rhinoplasty/

beverly hills nosejob, beverly hills rhinoplasty beverly hills nosejob, beverly hills rhinoplasty
Preoperative appearance of an attractive woman seeking only refinement of her nose Postoperative results after classic rhinoplasty

The Injectable Nosejob

In the era of Twitter, Facebook, texting, rapid- fire music video editing, etc. everyone (including those not diagnosed with ADD) wants instant results. So what is unusual with wanting an instant nose job or rhinoplasty? Absolutely nothing. An instant nosejob is performed by strategically injecting a pre-chosen filler just below the nasal skin in an aesthetically sensitive manner.Temporary fillers such as Hyaluronic acids (Restylane™, Perlane™, Juvederm™, etc.) and calcium hydroxyappatite (Radiesse™) may be used as a “dress rehearsal” to confirm if the patients like their result. If so, many will then opt for a more permanent filler, either in the form of fat, Artefil ™ or Aquamid ™ (which is not yet FDA approved). The appeal is obvious: less bruising, less prolonged swelling, less initial expense, less scary for the wary and more predictable (in the proper hands) with less risks. However, the injectable technique cannot be used to correct all types of cosmetic nasal problems and deformities. This is especially true for noses that need to be reduced in size and refined in shape. One does not need to be a genius to realize that fillers may do little to make a nose smaller by removing humps, refining tips and narrowing bones, no matter how well injected they are. The ideal candidate for an injectable rhinoplasty is the nose that needs to be augmented, either via it’s bridge (or dorsum) or it’s tip or both. A drooping tip can be elevated only to a subtle degree with filler. Filler is also a great solution to those noses that have minor irregularities stemming from prior rhinoplasties. Filler will generally not help breathing problems. To learn more about this elegant solution to a rather common problem, check out these videos:

1.Extra Injectable NoseJob

2.Today Show Injectable NoseJob

3.Extra Artefill Injectable revision rhinoplasty

Dr Randal Haworth of Beverly Hills counts primary and revision rhinoplasty as one of his specialties  of plastic surgery