Self-Centered Aesthetics

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:

1. Laser hair removal with our virtually painless Light Sheer Duet vacuum laser technology

2. Eyelash and eyebrow treatments

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 veins utilizing 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 improvement through 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

Follow up: Kim is the Butt of the Jokes

Well… as I originally predicted in a blog post at the time Kim Kardashian’s champagne-glass-bottom graced the cover of Paper magazine, there would be “fall out” to the story. Judging by active reaction to recent un-retouched photographs of Kim’s derrière in the media by both fellow plastic surgeons and public alike, comments have generally been less than flattering. 
Fortunate aftermath of wanton Buttock enlargement without consideration of body proportions and pulchritude
My blog post was essentially a warning to those seeking to “maxi-size” their assets in response to media’s insidiously pervasive influence on the public’s impressionable collective psyche.  A copy of my original blog post is here:
I don’t like comic book butts and I cannot lie
Not to say that the images in question expose overtly ireversible droop of Kim’s buttocks, they do unquestionably reveal the dimpling, pitting and bulging of exaggerated cellulite. Furthermore, there is no way  to predict how these artificially corpulent gluteals will age with further time. Unfortunately in 2017, there is little to be convincingly done to remedy such a situation. Lest this be a caveat for those seeking buttock super-sizing regardless of the method employed. Dr. Haworth 2017

Healing after Plastic Surgery; State-of-the-Art for 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 B6  250mg, 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.
This patient had impending skin necrosis around her here after a facelift. Only 7 days of Bioptron ® light therapy were administered and notice the rapid improvement in reversing the damage.
After 5 days of Bioptron® therapy to resolve bruising resulting from lower eyelid procedure to treat her dark circles/tear troughs.
After 3 days of Bioptron® light therapy to accelerate the resolution of bruising and skin injury after a breast reduction by Dr. HAWORTH.

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.

Dr Randal Haworth

2017 Beverly Hills

       

2016 State-of-the-art lip shaping-Dr. HAWORTH on the “Doctors’ show

Very few surgeons in the world understand aesthetics to the point where they can be a  true hyperaesthetic facial plastic surgeon specialist. A hyperesthetic specialist is similar to the conductor of an orchestra-he or she needs to know all the instruments better than the individual players in order to “orchestrate” them to create melodious harmony without dissonance. One of the keys to create visual harmony in the face is mastering lip rejuvenation surgery-it’s not just about adding volume (which is essentially what most practitioners and patients equate with lip enhancement), it’s about mastering the shape of both the upper and lower lip. Patients travel  from all corners of the globe to top Beverly Hills plastic surgeon and lip augmentation specialist, Dr Haworth to undergo hyperesthetic change, which may include any number of surgical art performances including a high-profile facelift, endoscopic brow lift, blepharoplasty, rhinoplasty or his lip reshaping signature surgery! https://youtu.be/cI3nEq5R3x8

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.”

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 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.