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Procedure: Beverly Hills Rhinoplasty Surgeon



Beverly Hills Rhinoplasty Surgeon

Dr. Randal Haworth Dr. Randal Haworth is considered one of the world's foremost rhinoplasty specialists, dealing with both primary and revision rhinoplasty. Located in Beverly Hills, Dr. Haworth brings his artistry and experience to the practice of facial plastic surgery. Among the traits possessed by the world's top rhinoplasty specialists is an advanced understanding of the nasal anatomy and functionality as well as an exceptional surgical skill to perform both primary and revision rhinoplasty properly. Dr. Randal Haworth says:

"Even though a high level of technical skill is needed to translate intention into form with rhinoplasty surgery, an artistic vision with keen aesthetic sensibility is necessary to allow a result to transcend from good to great. This is why I am so passionate about performing rhinoplasty - I consider it a constant challenge, prompting me to always critically evaluate myself and become better at what I do."

Dr. Haworth can create noses ranging from the classically attractive and elegant to the "California Cute" nose, both of which require different techniques. Sometimes one or the other aesthetically accompanies a face more appropriately, similar to an integral instrument in a world class orchestra!

Rhinoplasty can be used for a wide range of adjustments in the shape of your nose. It can increase or decrease the size, alter the tip or bridge or nostrils, or even modify the angle between your nose and upper lip. Rhinoplasty is not only useful for aesthetic purposes, but can be used for more practical and essential corrections. In the hands of a Beverly Hills rhinoplasty expert such as Dr. Haworth, nasal birth defects, injuries and even breathing complications can be resolved.

Unique Philosophy to Fit a Unique You

As a rhinoplasty specialist, Dr. Haworth is renowned for his results because he is one of the few with the skills to meld beauty with simplicity. First, he analyzes a nose to formulate a surgical plan. Second, in the operating room, he strives to not only reshape it into a beautiful feature but also artistically scale it to the rest of the face.

As rhinoplasty surgeon with a keen artist's eye, Dr Haworth understands that this takes extra time and sensitivity. His goal is to impart the impression one was actually born with the ideal nose others would envy. Consequently, his rhinoplasties take longer to perform than in years past. Not only does he build the ideal nose in terms of projection, angles, shape and size but then he methodically erases most evidence that surgery has been performed in the first place by employing advanced surgical maneuvers. In general too, nose surgery has become significantly more sophisticated than in generations past, resulting in a far more subtle, natural outcomes than ever before.

These breakthroughs include:

One size does not fit all: Top rhinoplasty surgeons employ modern suturing and grafting techniques in accordance with patients' goals and particular anatomy. Not only is the placement of each suture critical but also is the force with which it is tied. Dr. Haworth says, "Great surgery is measured in millimeters, not centimeters, but in the case of rhinoplasty surgery it is more accurately measured in fractions of a millimeter!"

Greater appreciation of the potential problems: As a rhinoplasty specialist, Dr. Haworth is well aware of situations (such as nasal obstruction) which may arise after certain surgical methods. Consequently, as an experienced rhinoplasty surgeon takes into account such possibilities and knows how to avoid them with specific surgical moves.

State-of-the-art technology: Uncomfortable "packing the nose" after surgery used to be standard post-operating procedure. This isn't necessarily true any more. Dr. Haworth's patients' postoperative experiences are better than ever than any other rhinoplasty specialists in terms of comfort and healing.

Rhinoplasty Procedure Information

All rhinoplasties are generally performed on an outpatient basis using sedative or general anesthesia. To gain access to the nasal bone and cartilage, Dr. Haworth creates hidden incisions inside of the nose where they cannot be seen. He then reshapes and resizes the nose after a detailed consultation with the patient to determine their individual goals and what may look best to suit their overall facial appearance.

To perform your rhinoplasty, Dr. Haworth begins by making the necessary incisions in and around the nose. Dr. Randal Haworth, a specialist in rhinoplasty in Beverly Hills has the skills and eye for detail that can effectively enhance the appearance and/or the functionality of the nose. Usually, Dr. Haworth employs the patients' own nasal cartilage for support to the nose that has previously been weakened by surgery and/or to enhance the aesthetic appearance and/or improve breathing.

Most often cartilage is obtained from the patient's septum because of its strength, availability and generally ample supply. When that is not available ear cartilage is a second choice but it is often not ideal for many uses in the nose because of its inherent curvature. Rib cartilage may also be used, but this too is not ideal because of the need to operate on the chest.

Dr. Randal Haworth, a specialist in rhinoplasty in Beverly Hills and Los Angeles, goes on to say,

"Since every patient is unique, rhinoplasty has to be strategically and precisely tailored to each individual. In certain circumstances, when septal or ear cartilage are unavailable and the patient does not want to have an operation on their chest to harvest rib, I have no hesitation to use a synthetic implant with a long history of use and safety in medicine. My preferred synthetic implant is Gore-Tex® and I've been using it for over 15 years in rhinoplasty. When used in the appropriate circumstances, contrary to some reports, it has an excellent safety profile with a very low complication rate, including infections."

Gore-Tex® Synthetic Material Gore-Tex® is a synthetic material that has been used in plastic, general and cardiac surgery for many years. It now allows the rhinoplasty surgeon to reconstruct a nose without the need to harvest cartilage from the ear or rib, thereby decreasing surgical time and lessening the morbidity of the procedure. Gore-Tex® integrates with the surrounding tissue and has no potential for human rejection (not including infection).

Even though harvesting ear or rib cartilage is well tolerated by patients, any opportunity to avoid creating extra incisions and performing extra dissections on the body, the patient benefits. Therefore, Gore-Tex® provides an excellent synthetic material for primary and revision rhinoplasty when septal cartilage is unavailable. Fortunately, it is becoming more widely accepted as a grafting material as its safety profile is being discovered.

Revision Rhinoplasty Procedure Information

The majority of revision rhinoplasty procedures are performed using the open rhinoplasty technique because of the increased visualization and control it affords the rhinoplasty surgeon. However, there are certain few specific instances in which Dr. Haworth will use the closed technique, depending on the specific problem and whether it is minor or not. Dr. Haworth is an expert at strengthening the weakened underlying structure of the nose to not only to make the nose look great but to make it function as well (to maximize breathing ability).

Dr. Randal Haworth says, "The secret behind the best-looking noses are often strong triangularly sculpted cartilages that exert enough counter pressure on the overlying nasal skin in a delicate balance to impart elegant beauty. However, the integrity and strength of the nasal cartilages are often lost when a rhinoplasty was not performed correctly. A majority of the time those noses that look the best also function correctly for breathing purposes."

Dr. Haworth is exceptionally gifted and experienced in creating and applying every form of cartilage grafts including columella struts, lateral crural strut, caudal septal extension, spreader, tip shield, alar battan, dorsal, and alar rim grafts. Indeed, some of the most complicated revision procedures require utilization of most if not all of those aforementioned grafts, including crushed cartilage to maximize smoothness of the final result.

Terminology Notes

Open Vs. Closed Rhinoplasty

Dr. Haworth used to perform 80% of his rhinoplasties closed to avoid the theoretical scar across the columella (the narrow strip of tissue that separates the nostrils) as well as prolonged swelling. However, he found that these supposed advantages to the closed method were not always true. The closed method tended to result in less accurate suture placement, shifted cartilage grafts and less consistent results; therefore, Dr Haworth has shifted his approach to an open one in over 85% of rhinoplasty procedures based upon practicality, reliability, safety and ultimately, patient satisfaction. For detailed information on the differences between open and closed rhinnoplasty procedures, please read Dr. Haworth's blog post.

Medical Definitions

To acheive the ideal nose, Dr. Haworth employs many different techniques. As you broswe Dr. Haworth's image gallery of before and after results, note the different techniques applied to each individual's rhinoplasty procedure. Any rhinoplasty procedure, whether revision or primary, is uniquely composed of one or more of the following:

  • Hump reduction of either cartilage and/or bone, osteotomies to reduce the size both in profile and frontal view. The image to the left describes the region typically reduced using this technique

  • Cartilage, bone and fascia grafts to build up a nose

  • Septoplasty, turbinectomies, spreader and batten cartilage grafts to correct breathing problems


  • Cartilage grafts and suture techniques to modify the shape of the nasal tip (e.g., to improve a bulbous,boxy, drooping, hooked or upturned tip)

  • Cartilage strut grafts and suture techniques to change the angle between the nose and upper lip

  • Weir excisions to narrow the nostril span. The image to the right displays regions typically reduced or removed using this technique

  • Modified techniques to correct a birth defect

  • Rib, ear or cranial bone grafts to reconstruct after an accident or a previous rhinoplasty

Depending on the individual's case, Dr. Haworth may apply a few or many of these surgical concepts during the same surgery.

Rhinoplasty Candidates

Dr. Haworth makes a point of serving each individual patient's needs and defining overall expectations from any plastic surgery procedure. As Dr. Haworth states in his blog, " '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."

The best candidates for rhinoplasty or revision rhinoplasty procedures are:
  • At least 14 years old for young women, 16 for young men
  • Older patients with a nose that has started to hang or with an increasingly drooping tip
  • Patients who have a congenitally crooked nose or one that has been deviated because of trauma
  • Those who suffer from nasal obstruction from a anatomical problem of the nose
  • Those who need to correct a cleft lip-nasal deformity
  • Patients with realistic expectations about how they want their nose to be changed in shape and size to compliment their other facial features
  • Those with nasal skin which is neither too thick or too thin
  • Those with unsatisfactory, unnatural-looking results from a previous rhinoplasty that may include (but are not necessarily restricted to) a pinched tip, irregular profile, collapsed sidewalls ("Inverted V Deformity"), "Saddle Nose deformity", crooked appearance, asymmetrical retracted nostril shape, etc.
  • Those with unsatisfactory functional results in breathing or nasal airflow due to tissue damage or undesirable healing
  • Those needing to get the results of a previous rhinoplasty improved while having realistic expectations of the results
Neither rhinoplasty nor revision rhinoplasty can:
  • Create an exact replica of another person's nose, celebrity or otherwise, from your preexisting nose
  • Completely correct severe deformities of the nose from either trauma or past surgery 100% of the time.
  • Narrow a nose to an unrealistic or unattractive degree
  • Alleviate personal problems (social or psychological) in your life

Compatible Procedures

As expert rhinoplasty surgeon, Dr. Haworth's primary goal – as it is with any procedure he performs – is to balance the features to look perfectly natural...and naturally perfect. Consequently, it is not uncommon to combine surgical procedures for optimum results.

Chin implant — As a rhinoplasty specialist, by far and away the most common procedure done in conjunction with nasal surgery is a chin implant. This is because the nose and chin are the most prominent features of the face in profile and when the two are balanced in size and shape, facial harmony is greatly enhanced. This is a classic example of the final result being greater than the sum of its individual parts.

Face and/or Neck Lift — With age, in addition to sagging in the lower half of the face, the nose can grow larger, more bulbous or begin to droop at the tip. Therefore, a combination rhinoplasty plus facelift is superb in restoring more pleasing, proportional features.

Lip Lift — Dr. Haworth is unique among rhinoplasty specialists because he is also a pioneer in the lip lift surgeries, having developed his own signature lip lift techniques. Often, a lip lift in conjunction with a rhinoplasty offers a more pleasing result because in frontal view, facial harmony and youthful appearance are greatly heightened.

Consultation and Appointments

Your successful rhinoplasty surgery will require a number of appointments to ensure maximum health and safety.

1. Pre-Op Consultation
The pre-operative consultation is where you meet with Dr. Haworth and our staff to review your health, finalize the details of your procedures, order appropriate tests, prescribe medications, discuss your aftercare and answer any questions you may have.

CRITICAL PRE-OP CAUTIONARY NOTE

It is absolutely essential that that you avoid all aspirin, aspirin-related, ibuprofen or blood-thinning medications for 2 full weeks prior to your surgery. In your pre-op consultation, we will give you a complete list of these drugs. For our patients, we also provide a password-protected link allowing you to download the list onto your computer. If in doubt about a specific medication, do not take it, call the office first and ask if it is on the forbidden list.

2. Medical Records

  • Any appropriate health records related to the list of conditions noted above
  • Any radiological test results including regular Xrays and CAT scans that may have
  • For patients over 45, we may also require that you provide the following:
    • - Full medical clearance
    • - EKG

If you haven't got these records or haven't been tested lately, the rhinoplasty consultants in our office can coordinate these appointments for you.

3. Prescriptions
You will want to fill any and all prescriptions well in advance of your rhinoplasty surgery, particularly since some of them need to be taken for several days before the procedure.

4. Day of Surgery
Your rhinoplasty surgery will be performed at our surgical center in Beverly Hills. You will come in at the appointed time. Be sure to wear loose clothing that buttons or zips and does not need to be pulled over your head. Your ride will be instructed when to pick you up or can call in to find out when you'll be ready. We cannot release you without a responsible adult to drive you home and spend the first post-op night with you.

If you are going to an aftercare facility, we can coordinate the transportation for you.

5. First Night Post-Op
Dr. Haworth is a rhinoplasty specialist that wants to make sure you feel safe and secure every step of the way. That evening after your surgery, he will call you to check in. You'll want to make sure that you sleep with your head slightly elevated and only on your back, NOT on your side or face.

6. 1st Day Post-Op
Dr. Haworth will remove the small nasal pack at which time you will feel immediately better in terms of the slight pressure experienced immediately after surgery.

7. 7th Day Post-Op
Dr. Haworth and his assistants will remove the cast and stitches. 80% of his patients are impressed with their rhinoplasty results by the seventh to eighth day. However, the results will only improve time!

8. 10-14 Days Post-Op
Dr. Haworth may inject a dilute kenalog solution into the nasal tip to "turbocharge" the resolution of swelling. 95% of his patients already love their results by the end of the third week.

Logistics and Specifics

Nasal Surgery Specifics

Surgery duration: 1.5 - 4 hours. Rhinoplasty, especially if revisional in nature, may take longer than anticipated due to the deformity encountered and the complexity of surgery needed to correct it.

Anesthesia: Sedated.

Sutures and cast removed: 5-7 days

As you wake up from surgery, you will feel mild pressure in your nose similar to what you feel when you have a cold but without the total body symptoms which normally accompany it. However, prescription painkillers will easily control the discomfort. You will most likely have a cast or tape over your nose to control bruising and swelling, while stabilizing the new shape of your nose in the immediate postoperative period.

POST-OP CARE

You will need to keep your activities to a minimum for at least 7 days.

In person and in your post-op information packet, we shall explain everything you need to know for your aftercare at home that will include:

  • Medications (prescription and homeopathic)
  • Cleaning incision sites
  • Utilizing a humidifier in your room while you sleep.
  • Employing nasal saline rinses (Neil Med) to accelerate the healing process while minimizing complications.

Expect to tire easily for awhile. To aid your recovery you'll want to rest as much as possible and:

  • Avoid wearing eyeglasses and sunglasses for 6 to 8 weeks. The pressure and weight of the frames on your nose could distort your final results and interfere with your healing if you wear your glasses too soon after surgery. If you absolutely must wear prescription eyeglasses to function, tape them securely to your forehead with surgical tape.
  • Treat your face and hair gently, since your skin will be both tender and numb
  • Keep your head elevated above the level of your heart - even while sleeping - for about 2-3 weeks after surgery
  • Avoid strenuous activity - including exercise, sex and heavy housework - for at least 2-3 weeks.
  • Avoid steam baths, and saunas for at least 6 weeks or until the doctor gives you the OK
  • Avoid alcohol and aspirin products for 2 weeks after surgery
  • If you don't feel dizzy, slow walking and mild stretching are fine as long as you keep your head above your knees

To optimize and accelerate healing, we also recommend coming into the office for hyperbaric oxygen treatments and Bioptron™ polarized light therapy. Both of these modalites can reduce swelling and bruising by up to 5-7 days. Addtionally, these exhibit signicant healing properties upon slow-healing incisions and injured skin.

Recovery

By the end of the second week, you'll look and feel much better. Most patients are back at work about one to two weeks after surgery. If you need it, special camouflage makeup can mask most bruising that remains.

Gradually, you will be able to resume to your normal activities:

  • 1-3 days read or watch television
  • 7 days resume wearing makeup (most bruising will be gone). However, you will most likely still be swollen.
  • 7-14 days be out in public, back to work and take long strolls
  • 2-3 weeks begin moderate and work up to vigorous exercise.

Minimizing Scars

Dr. Haworth Beverly Hills Skin Care Products
As a top rhinoplasty surgeon, Dr. Haworth keeps up to date on optimal, scar-free healing. Scars resulting from a rhinoplasty are minor and generally hidden. Where there is a trace of a hairline scar across the columella, Scar Gard, Kelocote or similar silicone gel treatments can be somewhat effective in decreasing scar visibility faster. Or, if the patient wishes about six months after nasal surgery, Dr. Haworth can use resurfacing lasers to render an already light scar virtually indefectible.

Risks & Challenges

Conditions that make nose surgery of a challenge and may require additional consent/consultation include:

  • Thick, sebaceous or very thin skin
  • Past nasal surgery
  • Severely crooked nose
  • Presence of a septal perforation
  • Preexisting scars or a tendency to form excessive scars
  • Active sinus infections
  • Cocaine abuse
  • Uncontrolled high blood pressure
  • Blood clotting problems
  • Smoking

No surgery is entirely risk-free. However, both our staff and facilities have the highest possible qualifications to produce a happy outcome. While risks and complications are extremely rare, be aware that those for nose surgery can include:

  • Missed aesthetic expectations
  • Worsening of nasal breathing
  • Persistent septal deviation
  • Altered sense of smell (uncommon)
  • Prolonged pain (very rare)
  • Numbness or stiffness despite a great aesthetic outcome
  • Infection (rare)

Additional treatment of either a surgical or non-surgical nature may be required to alleviate these problems and additional costs may apply.