After more than two decades of commitment to delivering the best of what plastic surgery can deliver in terms of aesthetic results and quality-of-life improvement, top Beverly Hills plastic surgeon, Randal Haworth, found it time to expand his philosophy into an adjacent arena. That arena is the nonsurgical approach to optimize the patient’s aesthetic wellness. Dr. Haworth has maintained that future advances in plastic surgery will not lie solely in the operatory but more in the laboratory. Specifically, advances in lasers, injectables, light and genomic therapy will take precedence over any evolutionary steps in surgical technique. Currently, non-surgical cosmetic procedures are rapidly evolving to meet the expectations, budgets and lifestyles of patients of all backgrounds and consequently, their popularity is exponentially increasing every year.
As a world-renowned expert in facial plastic surgery (including rhinoplasty, lip lifts, face lifts, eye lifts and even bodywork such as breast augmentation) Dr. Haworth has come to a point where he need not confine his artistry mainly to the syringe and scalpel but also safely and reliably imbue it into noninvasive aesthetic medicine. Consequently, he and his team at the Haworth Institute have founded Self-Centered Aesthetics, a center devoted to optimum physical appearance, through the safest, most reliable state-of-the-art technology.
Self-Centered Aesthetics (SLF-CA)will be catering to the vast majority of patients’ aesthetic needs.
Among the services SLF-CA will be offering are:
3. Removal of wrinkles, fine lines and sagging folds via a variety of methods including essentially all fillers, microneedling with PRP, Botox and lasers (Spectra®, Encore® Active and Deep FX™ fractionated CO2, ResurFX® fractionated erbium and IPL® Photofacial)
4. Treatment of brown spots, brown patches, red discolorations and spider veinsutilizing proven laser technology (IPL® Photofacial and Spectra®)
5. Tattoo removal(Spectra® and other lasers)
6. Noninvasive body fat reduction through SculpSure®, a laser designed to achieve up to 20% fat reduction in 25 minutes with virtually no discomfort and absolutely no incisions.
7. Facial feature improvementthrough the selective use of fillers and Botox®. With refined aesthetic sensibility and an astute artistic sensitivity, fillers (both temporary and permanent), can enhance all aspects of the face. However, to maximize the beauty of a result without artifice or outward fakery requires customized planning to balance patients’ needs with their individual expectations. From a flat forehead with hollow temples to sunken cheeks and dark eyelid circles to thin lips and an ill-defined jawline, the professionals at SLF-CA under the auspices of Dr. Haworth dedicate themselves to make you look your very best!
Additionally, our CENTER will offer aesthetician services to maintain and fine-tune your SELF and your AESTHETIC results.
Self-Centered Aesthetics™ will be coming soon. www.selfcenteredaesthetics.com
I was exchanging breast implants and performing a capsulectomy the other day (to treat a breast encapsulation) when my anesthesia provider expressed surprise at my method. Specifically, she had commented that she has never worked with a breast implant revision specialist, especially one in Beverly Hills or California, who had removed the WHOLE collagenous capsule when treating a breast encapsulation. Apparently she has only seen plastic surgeons either make slits in capsules (capsulotomy) or only partially remove them.
Evidently, she was part of a growing support group of women who had their breast implants removed for mainly medical reasons and were firm believers that any associated capsules needed to be removed in their entirety during the same operation. Up to now I had no idea that performing a total capsulectomy is “a thing” and supposedly I am among a minority who do this par for the course.
One of the leading theories for breast encapsulation relates to bacteria and their byproduct, biofilm (a type of organic shield, if you will), surrounding the surface of the breast implant itself. One can safely assume that if a breast implant is supposedly contaminated by bacteria so is its associated surrounding capsule. Therefore, it is only logical to remove the collagen capsule in its entirety when removing or exchanging a breast implant, whether it be silicone or saline.
I created this video below to help patients better understand the vexing process of breast encapsulation and methods to treat it. Though breast augmentation is one of the most popular plastic surgical procedures performed today, it is also one of the most capricious or unpredictable because breasts often times have a mind of their own and do not behave in the way we would like them to.
Dr Haworth 2017
“Time is a cruel thief to rob us of our former selves. We lose as much to life as we do to death.” Elizabeth Forsythe Hailey
Living in the modern world becomes more complex and harder as life in the 21st-century becomes faster and faster. We are burdened with responsibilities and distracted by an interminable onslaught of media in all forms including the capricious internet. It seems as if everything is competing for our attention in one way, shape or form while stealing precious time we could otherwise devote to family, friends and simply to our own selves. Therefore, when it comes to saving time, the need to heal quickly after any cosmetic procedure is almost rapacious.
Unfortunately, there is no magic pill or formula to bypass the post operative inflammation of bruising, swelling and discomfort at this current time. As one of the top plastic surgeons in Beverly Hills, Dr. HAWORTH has seen a thing or two about how patients heal after the thousands of surgeries he has performed over two decades. As a facial plastic surgery expert, he has performed thousands of primary and revision rhinoplasties, brow lift, facelifts and blepharoplasties not to mention the breast implant operations throughout his career and has realized there are things you can do both at home and in the clinical setting to accelerate your healing.
First of all, it is a good idea to focus on whole foods as much as possible while avoiding processed ones as the former will contain the highest levels of vitamins and amino acids your body will need for a speedy recovery. Amino acids help wounds heal faster and obviously, these are found in chicken, meats, egg whites, fish, brown rice, healthy nuts like walnuts and almonds or sunflower seeds. Taking supplemental vitamin C in your diet while increasing zinc in your diet can be helpful. Instead of taking vitamin C for a bottle, you can eat strawberries, papayas and citrus fruits which are great sources of vitamin C. 500-1000mg is the usual amount that is taken. Zinc is found in oysters which have one of the highest levels of zinc found in any food. If you are going to take a supplement, 15 mg of zinc daily is the recommended amount but you can increase your zinc intake to 30–50 mg for 2 weeks before and 2 weeks after surgery, using zinc picolinate.
Beverly Hills plastic surgeon Dr. Haworth also recommends these useful supplements to take in preparation for your surgery include:
B12 and Iron – Iron and B12 both aid bone marrow in forming new blood cells, so incorporate foods like fish and eggs.
Vitamin B6250mg, twice a day for a week, starting 3 days after surgery. This helps reduce post-surgical fluid retention, such as swelling of the face, hands, feet or legs. With B6, you can experience substantial reduction within 24 to 48 hours.
CoQ10- Surgical trauma (particularly from cardiac surgery) causes an increase in free radicals, which damage cellular function. For this reason alone, you should take at least 50 mg of CoQ10 as part of your daily routine before your cosmetic surgery and 100–200 mg/day for at least 4 weeks after.
Fiber and probiotics – This combination helps boost the immune system and also keeps your digestive tract moving along. Eating yogurt with granola is just one easy way to get a serving of both fiber and probiotics! When choosing a probiotic, consider one that contains acidophilus and bifida bacteria (follow label instructions for dosage). Surgical patients often receive oral or intravenous antibiotics in the hospital, which creates the potential for yeast infections, digestive disturbances and diarrhea. A probiotic may help counteract these problems.
One amino acid that has been shown to speed with healing is glutamine and a study from Harvard and Dave showed that it shortened healing by about four days. Apart from supplements, glutamine can be found in beef, chicken and all types of fish. Dairy products such as cheese, milk, yogurt and eggs contain glutamine with ricotta and cottage cheese being the two richest sources. Vegetarians can find glutamine in beans and lentils.
For most of his patients, facial plastic surgery specialist Haworth recommends supplemental Arnica Montana, Bromelain/ Bromezyme (this pineapple enzyme helps prevent blood clots, aids digestion while decreasing inflammation and pain after surgery) and Pycnogenol/Pine bark. This triumvirate is aimed at reducing bruising, soreness and inflammatory edema.
Apart from the above, many patients inquire about any other additional medications, exercises or procedures that can be done to maximally reduce their healing times after surgery. Of course, all patients should ask their individual physicians or surgeons about their own personalized recommendations to speed up recovery which is beyond the scope of this post.
Bioptron® Light employs a combination of polarized infrared and visible light (480nm-3400nm) considered beneficial in the treatment of wound problems and injuries by exerting its effect at the cellular level. Bioptron® therapy has a low energy density (fluency) of 2.4 J/cm2 at a distance of 10 cm and can penetrate the skin up to 2.5 cm.
It has been used effectively in the treatment of burns, pressure sores, leg ulcers, wounds, pain and recently, postoperative healing. Dr Haworth have found it very useful in his clinic to reduce both swelling and bruising. Supporting his experience, other plastic surgeons here and abroad have noted decreased resolution times of eccymosis and edema following surgery by over 33% with Bioptron®. Indeed, it has been used to also reverse the course of cutaneous necrosis as well as accelerate granulation of open wounds, either alone or in conjunction with hyperbaric oxygen therapy (HBOT).
Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. It is a well-established treatment for decompression sickness, a hazard of scuba diving. Other conditions treated with HBOT include serious infections, bubbles of air in blood vessels and non-healing wounds as a result of diabetes or radiation injury.
In a HBOT chamber, the air pressure is increased to 3 times higher than normal air pressure and under these conditions, your lungs can gather more oxygen than would be possible breathing pure oxygen at normal air pressure. However, there is some confusion about what actually is “true” HBOT. Those employing “soft” tent like enclosures are essentially useless since they are unable to obtain a true hyperbaric environment of 2 to 4 atmospheres absolute (ATA). In fact, these personal or home-use “hyperbaric” tent enclosures can usually only attain a pressure of 1.3 ATA. There is a debate as to how much and how many treatments are necessary to speed up recovery after plastic surgery. While most plastic surgeons perhaps recommend one preoperatively and at least 3 to 5 postoperatively, experts in the field say one needs at least 15 to 20 treatments in order to see significant results. In my experience, 3 to 5 treatments are all that is necessary to achieve the more modest goals of reducing edema, bruising and discomfort resulting from elective plastic surgery.
After certain surgeries, body contouring plastic surgery expert Dr Randal Haworth may also recommend selective lymphatic massage/drainage to resolve edema (swelling) of the extremities, particularly after liposuction or liposculpture.
The above aforementioned vitamins, nutritional supplements and clinical interventions may not be the panacea to surgical healing which comes in a pill form, but they certainly are a step in the right direction in making recovery from any procedure as smooth as possible in 2017.
What is wrong with this revision breast implant and lift surgery I performed?
According to this patient, apparently everything!
At first, this patient came to me with ostensibly straightforward requests to “make” her breasts smaller and “better-shaped” in accordance with her body frame. Of note, she had undergone a previous “above the muscle” breast augmentation which, in my humble opinion, left her with a net result of breasts which were too big, too round and too fake. In essence, her breasts did not lend to a pulchritudinous appearance and that is why she sought my expertise in the first place. Indeed, she wanted to get remarried after having children and was seeking “christian boobs” to attract a decent husband. So I did what any self-respecting, honest and aesthetically minded board certified plastic surgeon would do and that was to perform a capsulectomy (remove her collagenous scar capsules), substitute her overfilled saline implants with smooth Memory Silicone Gel implants placed “under the muscle” and conclude with a bilateral mastopexy (breast lift). I thought the surgery was an unqualified success and, further punctuated by her exceptional healing vis-à-vis scarring.
So why was she unhappy? I was thoroughly puzzled since we both had extensive discussions prior to the surgery about the usual risks, alternatives and benefits including what she exactly wanted from the surgery. I know she wanted to go smaller (check), she wanted to be natural (check), she wanted to appear more youthful and perky (check) and indeed she conceded that I did achieve these goals. However,she also expected her breasts to be firm and more round –she felt that her result was too natural, both in look and to touch and therefore something went wrong.
But after further, protracted postoperative conversations with her, I realized where the disconnect was. I did not give her what she exactly wanted from the surgery because I gave her what she askedfor and not what she wanted. In essence, this was a story of missed and unrealistic expectations.
More and more of these situations arise in a plastic surgery practice simply because unrealistic expectations are instilled in us 24/7 by social media. The main platforms culpable for this insidious brainwashing are the mobile apps Instagram, Snapchat and YouTube with their interminable repository of Photoshopped/FaceTuned manipulated models and instructional contouring videos. Young women come to me wanting cheekbones, buttocks or breasts like Abigail or Jocelyn Instastar simply because they are famous and therefore more popular and loved.
Indeed, one patient requested Bella Hadid’s nose even though, in my opinion her rhinoplasty ended up with an “inverted V” deformity and a somewhat pinched, boxy tip. However, it did not matter to her because she considered Bella her idol andwas willing to accept a possible substandard result with potential nasal obstruction. Ah, the power of celebrity!
Recently, I had the experience of operating on another young woman who had beautifully shaped breasts with a natural cleavage. She wanted to go only slightly bigger yet have a bigger gap between her breasts. The surgery went flawlessly but the patient was dissatisfied. She agreed her breasts were fuller with a wider cleavage but she now voiced that I should have known all along she wanted her breasts to look fake, round and hard! After this perplexing conversation, I sat down and pondered the meaning of what I really do.
It is one thing to make abnormalities such as unnatural breasts look natural but it’s another thing altogether to make natural looking breasts look deliberately unnatural and possibly unappealing. For decades, I have endeavored to create natural results by making the deformed normal and the normal beautiful but now a new aesthetic standard has emerged in our culture and ultimately, it may not have positive consequences.
But who am I to judge? Fake is the new real.
Randal Haworth MD, FACS
As being one of the leading breast augmentation and implant revision specialists in Beverly Hills, Dr. Randal Haworth has noted how important a part posture plays in enhancing the breast appearance. Women with rounded shoulders impart a bigger, heavier look to their breasts, almost matronly if you will. By squaring off the shoulders, not only does a silicone or saline breast augmentation look more perky and youthful, but also a heightened feminine self-confidence is implied.
Certainly not a “slacker” look 😉
How rounded shoulders associated with bad posture can change breast augmentation results
Note How Good posture Enhances the Breast Augmentation Result
I am frequently asked when breast implants should be “changed out” or replaced for safety’s sake. Accompanying such queries are oft paraphrased references to an article in “Allure” or similar pulp magazine (masquerading as an authority ) stating that implants should be changed every ten years. Not only is this erroneous in my opinion but also bad medicine, since such articles carelessly promote unnecessary operations. We all know that unnecessary surgery can lead to avoidable complications, but it is little known that silicone breast implants are the MOST studied medical device in the whole history of medicine!
There is basically no statistically significant evidence implicating silicone implants as causal to autoimmune disease (such as rheumatoid arthritis, lupus pr scleroderma) or any other medical conditions for that matter. Indeed, an article published in our peer-reviewed journal, Plastic and Reconstructive Surgery (vol. 114, no. 1) states that “implant rupture is a relatively harmless condition”, that does not lead to the formation of autoimmune disease.
Then why is there a continuing controversy fueled by a minor, but vocal minority? To state that this polemic is fueled by a political and not a scientific issue is an understatement.
As a testament to the times we live in, the FDA in its infinite wisdom bows down to such nonsense. The “organization” has recently vindicated silicone gel implants but only with certain caveats. The FDA recommends that patients with silicone breast implants get an expensive MRI study to detect any silicone implant leaks as early as three years after initial implantation and every other year thereafter. For what purpose, I don’t know. Modern silicone gel implants have rupture rates of less than 1% per year (based on old data) and MRI studies are quite fallible in detecting true leaks. Hence, many unnecessary and costly studies would be performed to little or no avail. Patients will foot the bills since insurance companies will rarely cover such softly-indicated exams. To add insult to injury, the FDA recommends that only women over the age of 22 are qualified to undergo breast implantation utilizing silicone gel implants.
What is the mystique surrounding the age of 22? Teens over 16 can drive cars, those over 18 can fight and kill in the armed forces (which is decidedly unhealthy in my opinion) and indeed 18 year olds can legally participate in unprotected sex in pornographic films! But are they mature enough to decide whether they can have silicone breast implants? God forbid no, according to the pious FDA! What is their reasoning behind their conclusions?
The FDA claims that women are not mature enough to decide whether they should undergo silicone breast augmentation and that their breasts are still actively changing during the late teen-to-early twenty period. We, as plastic surgeons, know that this argument holds no water since women’s breasts change throughout their lifetime! Breast enlarge and deflate with weight change, pregnancy and nursing yet the FDA thinks that placing silicone gel implants within these women (who are over 22) is fine.
I just loathe the stupid hypocrisy of all of our institutions under which we are governed. A certain Dr Thomas Wiener of Houston has written a succinct letter which he distributes to all of his patients seeking silicone breast augmentation. I have included it here for your reference.
MRI Recommmdation After Silicone Gel Breast Augmentation
1) The FDA has recommended an MRl of the breasts at three years post-op and every two
years after. You are currently at one of these postoperative time frames.
2) Most sIlicone gel implant ruptures are silent. In other words, there are no symptoms.
3) MRI is not 100 percent accurate. Some intact implants wll appear ruptured, and some ruptured implants will appear intact.
This is not a fault of the radiologist or the MRl – this is the limitation of the technology.
4) Over many years of research, there is no indication that a ruptured implant will cause any disease.
5) If an MRI indicates a ruptured implant but at surgery it is found to be intact, for Allergan implants, the manufacturer’s full warranty still applies. For Mentor implants, the manufacturer will provide the implant replacement but no financial assistance.
6) You must understand that because of the limits of MRl technology, you may have surgery for an implant that is found to be intact, but you will still have undergone the possible risks and complimtions of surgery.
7) In most countries outside of the United States, the equivalent of the FDA does not recommend routine follow-up MRl.
8) The cost of the MRl is your responsibility.
Your insurance company and the implant manufacturer will not pay for this.
The decision to proceed with a postoperative MRI must be made by you, the patient, based on the above information and the information provided to you prior to surgery in the manufacturer’s FDA brochure.
Women who are seeking to undergo breast augmentation basically fall into one of three categories:
1. Women who are seeking balance-these patients never had the ideal aesthetic balance between your shoulders and hips and breasts. Indeed, they always considered their breast to be underdeveloped to the point where they could never find a proper fitting bra.
2. Women who are seeking rejuvenation-this group aims to replace breast tissue which was lost to the ravages of gravity, pregnancy and nursing. Even though many members of this group often state that their breasts were perfect when they were in their early 20s, others claim that they never were well endowed at an early age. this latter subset actually are a combination of those seeking balance (1.) and those seeking rejuvenation (2.).
3. Women seeking breast enhancement to garner more attention in the sexual point of view. Although most women within this group want larger than average breasts, most still demand to have a natural, teardrop shaped and soft result that will fool even the most discriminating of observers. I do not perform breast augmentation on patients deliberately demanding a “fake” look or those wanting to achieve results bordering on the comically hideous in terms of size and shape.
All of these three aforementioned groups have legitimate reasons to undergo breast augmentation utilizing either saline or silicone gel implants. I will perform the surgery on those who have realistic expectations of what breast implant surgery can do for them as well as understand the risks of placing an implant within your body. While getting bigger breasts can enhance one’s physical appearance and perhaps even boost one’s self-confidence, it will not necessarily bring about the perfect body or change people’s perceptions or the way one will be treated.
According to Dr. Randal Haworth of The Haworth Institute, the best candidates for the aesthetic surgical procedure are healthy women with realistic expectations. People who are looking for improvement rather than perfection in the way they look, as well as those who wish to get breast implants to rectify some form of breast disfigurement.
At The Haworth Institute located at Beverly Hills, Dr. Haworth along with professional practitioners from The Beverly Hills Surgical Center and The Beverly Hills Skin Lab provides safe aesthetic and reconstructive surgical services including breast augmentation. Visit Dr.Haworth.com or call 310-273-3000 for more information.