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

Drastic or Fantastic Plastic Boob Job?

 
Fake pre-pectoral breast implants
Artificially round and hard appearing breasts after an overfilled “above the muscle” breast implant augmentation. The patient desired a more natural and smaller pair of breasts to match her frame
Natural, conservative result after breast implant revision and breast lift perform simultaneously.
Natural result afterexchange of her overfilled implants to memory gel silicone implants “under the muscle” along with a mastopexy (breast lift).
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.  
Fake pre-pectoral breast implants
BEFORE: Artificially round and hard appearing breasts after an overfilled “above the muscle” breast implant augmentation. The patient desired a more natural and smaller pair of breasts to match her frame
Natural, conservative result after breast implant revision and breast lift perform simultaneously.
AFTER:Natural result after exchange of her overfilled implants to memory gel silicone implants “under the muscle” along with a mastopexy (breast lift).
Fake pre-pectoral breast implants
BEFORE
Natural, conservative result after breast implant revision and breast lift perform simultaneously.
AFTER
                      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 asked for 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.    
Social media and Instagram star Abigail Ratchford
Social media and Instagram star Abigail Ratchford
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.
Social media and Instagram star, Joselyn Cano.
Social media and Instagram star, Joselyn Cano.
    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

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

Know your nose job options:

Know your nose job options: knife or needle?

So you had a nose job and you don’t like the result.   Now what are you going to do?   You can always do nothing and live with the result. That’s OK. That’s your decision.   You can go back to the original surgeon or to a new one (of course, one who is board certified by the American Board of Plastic Surgery). This plastic surgeon may feel you’re a good candidate and give you two options: surgery (secondary or revision rhinoplasty) or non-surgery. In essence, the knife or the needle. Before your meeting with the plastic surgeon, you may think your only option at this point is a revision rhinoplasty with its attendant cost and recovery. However, this plastic surgeon rhinoplasty expert whom you chose to get a secondary opinion with, surprised you with his honesty, suggesting an altogether different approach to your nagging problem. He offered you a solution that involves less recovery, costs a good deal less and fixes your main concern…

  …and it doesn’t involve surgery.

  Your new plastic surgeon offered to inject filler into your nose to camouflage the irregularities, smooth and even out your bridge and even give you more of a chic tip. From the front view, by strategically injecting the filler to alter the light reflex and  control shadows your deviated nose can even be made to appear straight. He/she offers you a temporary or permanent filler. The temporary ones can serve as a dress rehearsal, so to speak, if you are unsure as to whether this is a good idea or not. Temporary ones such as hyaluronic acid  (e.g., Juvederm ®, Restylane ®, Voluma ®) or calcium hydroxyapatite (Radiesse ®)are good choices. Permanent ones such as Bellafill ®, Aquamid ® (not FDA approved) or fat transfer (a living transplant from your own body) are all excellent fillers in my opinion. You decide to go for it but you must be counseled to have realistic expectations. Fillers definitely cost less and involve less recovery (a few days of swelling and perhaps minor bruising at worst). However, the filler solution will: 1.  Neither help breathing problems 2.  Nor  will they treat all forms of aesthetic deformities such as this:
distorted medial crura of the alar cartilages
Significantly distorted medial crura of the alar cartilages
So the next time you’re considering altering the shape of your nose with a rhinoplasty of some sort, you may ask your plastic surgeon (hopefully,  board certified by the American Board of Plastic Surgery) about the filler option. Albeit,  it cannot match the power of an actual surgical rhinoplasty, the non-surgical, filler rhinoplasty can be an excellent alternative to actual scalpel- based surgery in many select circumstances. In these cases, the needle can be more powerful than the knife as one can see below:
Bellafill injectable , non-surgical rhinoplasty
This lady had a distorted nose after a previous rhinoplasty. Her cartilages were visible through her extremely thin skin and were twisted. After Bellafill ® Treatment.
Bellafill injectable , non-surgical rhinoplasty
Note the improvement of her inverted V deformity and how the nose appears straighter
OLYMPUS DIGITAL CAMERA
Note how her nasal rims have been dramatically lowered with the off-the-shelf filler. Of course, individual results may vary.

Is Yelp Contributing To Opiate Drug Addiction?

doid_yelpI recently came across this article by Jonathan Kaplan, and it struck a chord with me. The Yelp review is something that doctors have become accustomed to in recent years, but not always by choice. While Yelp can be a great way for patients to find new doctors, it also poses a lot of problems for the medical community. The care of a doctor is very different from the service you might get at a restaurant, so why would you review the two using the same system? It is much more difficult for patients to review their health care objectively. Their opinions are often based on their emotions and the pain they are feeling. In his article, Kaplan suggests that Yelp reviews might be contributing the opioid crisis in America. A patient in a great deal of discomfort may ask for more pain killers. Their doctor is trained to know the proper dosage to give them, and will often deny them anything more than what is necessary. However, more recently, patients who do not feel their pain has been sufficiently addressed have taken to Yelp to voice their anger. A bad Yelp review can really make things difficult on a practice, so more and more often, doctors find themselves giving in to these requests in order to avoid the negative reviews. I can’t count how many doctors, not just plastic surgeons, who been held hostage by their misguided patients threatening to post misleading if not blatantly false reviews if they do not get what they want. Consequently, these online reviews can be inherently biased, arising from personal agendas and not  from impartial reporting of facts. It’s not hard to imagine how this can also harm the unsuspecting public who, prompted by a malevolent post, may seek alternative treatment from a less qualified professional. This was unfortunately the case when my friends daughter was booked for a liver transplant for a congenital condition to be performed by one of the worlds preeminent liver transplant surgeons here in Los Angeles. After reading a negative online review, she canceled her surgery and ended up getting surgery elsewhere. Tragically her operation was bungled because of a negligent mismatch which resulted in her ultimate death. This could’ve been avoided if she did not read the deliberately misleading online review by the disgruntled patient (who I later came to find out was denied further Vicodin pain medication for her own good since it contains acetaminophen, a known tocsin to the liver). Like in any profession, doctors have patients that are wonderful and compliant, but they can also come across others that can be difficult to work with. The review of one difficult person should not affect an entire medical practice. Furthermore, the fear of negative reviews can not and should not lead doctors to over prescribe medication and put the health of their patients at risk.

ANGELINO (2015)

Anti-aging treatments
The latest in treatments, fillers and procedures help keep you beautifully radiant-at any age. Here’s the inside track on what to do, and who to go to, to put your best self forward. Among those esteem practitioners interviewed by Angelina, Dr. Randal Haworth MD was honored to be included among them. Anti-aging treatments
scan-9“Botox plays in important role in keeping fine lines at bay”, says plastic surgeon Dr. Randal Haworth MD renowned for achieving naturally beautiful results. Haworth suggests conservative use of Botox (from $500, the Haworth Institute) in the 30s to diminish fine lines and crows feet. Beverly Hills plastic surgeon Dr. Randal Haworth MD Bellafill ($1200, The Haworth Institute) to permanently diminish deep folds and fill out eyelid hollows.

Nostril narrowing through Weir excisions does not have to look fake

Wier excisions are very powerful tools to augment a rhinoplasty. This is a procedure that I usually perform at the conclusion of a nose job in order to refine and narrow the nostrils while controlling the flare when smiling. Most people and surgeons alike equate this procedure to simply narrowing the “floor” of the nostril by cutting out some skin but it is actually more nuanced than that. The design of the excision can be customized by changing the angulation, the position and the width of the cuts which, in turn, can change not only the dimensions but also the curvature of the actual nostril itself. A deep permanent suture is often used as well to prevent re-widening of the nostrils and reduce tension across the scar. Reducing tension across the scar as well as accurate angulation is important to achieve a nearly invisible scar. So many times I have seen obvious notching that is visible from 5 feet away and is a definite giveaway of having had a rhinoplasty. Weir excisions can be also be performed in conjunction with an upper lip lift adding to the complexity of the procedure. As a rhinoplasty and lip lift expert, I have performed hundreds of these combination techniques with excellent results. All facial plastic surgery, whether it’s primary or revisional, is challenging but taking the time to address all the details and plan them accordingly can maximize the aesthetic outcome that is not only beautiful but natural as well. The devil is in the details so to speak.
Poor rhinoplasty result with crooked , distorted tip and obvious nostril scarring after a Weir excision
Poor rhinoplasty result with crooked , distorted tip and obvious nostril scarring after a Weir excision
Again, note obvious nostril scarring from Weirs and tell-tale signs of a past rhinoplasty
Again, note obvious nostril scarring from Weirs and tell-tale signs of a past rhinoplasty
Before and after revision rhinoplasty and Weir excision as performed by Dr. RANDAL HAWORTH
Before and after revision rhinoplasty and Weir excision as performed by Dr. RANDAL HAWORTH
Primary rhinoplasty and Weir excision to narrow the nostrils in Asian patient. Note added tip projection and lack of notching
Primary rhinoplasty and Weir excision to narrow the nostrils in Asian patient. Note added tip projection and lack of notching
Primary rhinoplasty, Weir excision and concomitant upper lip lift as performed by Dr. Haworth
Primary rhinoplasty, Weir excision and concomitant upper lip lift as performed by Dr. Haworth

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

Tattoos and Cancer

Tattoos are meant to be party fun and expressive… Cancer and infections are such a buzz kill!

To each his own, but I have always been rather impartial to tattoos. Unlike a fine wine, I simply don’t think they age very well and they look especially out of place on a doting grandmother or father (unless they’re a member of a famous rock group and had a bank account to go along with it).

Anyway, onto more pressing matters such as how tattoos can kill you.

As a Beverly Hills plastic surgeon board-certified by the American Board of Plastic Surgery, I am always aware I am a doctor first and a plastic surgeon second. It is for this reason I address subjects such as this to inform the public of potentially dangerous trends they embrace. More is written about how tattoos are associated with resistant bacterial infections and skin cancers, especially that the American FDA is applying its investigative microscope to the issue. More ominously, because of hepatitis C transmission, tattoos are associated with liver cancer and the possible necessity of liver transplantation. That is some virulent ink to say the least!

You might read this and think that you’re better off undergoing laser tattoo removal. Unfortunately, while the tattoo might be removed by the laser, blasting away that pigment might release it into the body a second time.

If you’re thinking about getting a tattoo maybe consider using a safer pigment such as InfiniteInk . This does not contain toxins and can be easily removed. It may cost more, but wouldn’t you want a pigment that was developed to color medicines, rather than paints?

To read more about this unsettling topic click here:

http://www.dailymail.co.uk/health/article-2032696/Now-tattoos-cancer-U-S-regulator-probes-fears-inks-contain-carcinogenic-chemicals.html

http://dawn.com/2013/01/25/tattoos-linked-to-hepatitis-c-study/

R.D. Haworth M.D., F.A.C.S.

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 address 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.

Page 1 of 2
1 2