Difference between Bad Surgery and Good with a Complication.

As trifling as it may seem to the layperson, aesthetic surgery is serious business. Apart from obvious cosmetic ramifications, the seriousness becomes understandable when one considers that the surgeon must first make a healthy patient temporarily unwell in order to make he or she look better in the end. It is for this very reason plastic surgeons have an added unique responsibility which surgeons of other specialties simply do not bear. Choosing to undergo elective surgery is a series of decisions made by both the surgeon and the patient. As with all aspects of medicine, nothing is absolute, it is about controlling probability.

In this day and age, patients increasingly view plastic surgery as nothing more than a haircut with a short recovery, let alone one with a complication. Even under the best of hands, a complication can arise for any number of reasons and if it does, acting as a team with your surgeon is crucial.  Whether following a facelift, rhinoplasty or any plastic surgery for that matter, almost all complications can be fixed in the end, even if multiple surgical revisions are needed.

It is normal for the layman to consider surgical results as either “good” or “bad”,  but those adjectives can be misleading and are certainly inadequate in revealing the true story behind the result.

“Good” surgery with a complication is not the same as “bad” surgery per se. In other words, complications do not all come from “bad” surgeons and indeed, “bad” surgeons may have  successfully completed an operation without encountering obvious complications. I think it fair to say most patients consider themselves as good people and if a complication happens to them, they will perceive themselves as victims of a bad surgery and by extension, a bad surgeon. So what is the difference between “bad” surgery and a “good” surgery with a complication?

Look at it this way… in any profession, there are the “good”, the “bad” and the “excellent”. For the sake of this discussion, let’s just oversimplify the comparison between “good” and the “bad”. Since plastic surgery is as much an art (or at least an artisanal craft) as it is a science, whereby results are measured both objectively and subjectively, it is not unreasonable to compare a plastic surgeon to any artist or craftsman, including sculptors, painters and woodworkers. Artists filter their talent and vision through years of experience to not only earn but continually solidify their reputation as either being “good” or “bad”. Moreover, good artists become respected by not just producing one “good” piece but doing so consistently, whereas the “bad” consistently create sub par results as judged by the median consensus.

However, all artists, whether good or bad, are limited by the quality of material with which they work. It is known that Michelangelo’s David has been deteriorating at a far more rapid pace than would be expected because of the poor quality of its marble composition. Bernini also broke a piece of marble in half through chiseling into an unexpected vein in the stone causing him to start all over with a brand-new block. Does that make him a bad artist? Hardly not.

In other words, complications happen and that’s why there are consents to protect not only the doctor but also the patient. Consents should ensure the patients are informed as to the shared risk both they and the surgeon take when undergoing surgery.

Many complications are avoidable. Both doctors and patients must do their part to optimize a certain outcome and minimize the risk of complications. Patients must avoid certain medications that may promote bleeding, cease all smoking for optimal circulation, follow instructions and take medications as prescribed. Otherwise, surgery may be self-sabotaged. On the other hand, surgeons must do their part in educating and performing the proper operation in the right patient with skill and dedication.

Other complications are unavoidable and just because they may be explainable in hindsight does not mean they were avoidable within the context they occurred. This is why it is paramount that patients disclose all of their medical history and follow their surgeon’s instructions to a T in order to minimize unexpected situations such as abnormal bleeding, poor wound healing, etc..

What spurred me to write this particular blog was a recent experience having performed a complex revision rhinoplasty on a dear friend of mine of 20 years. Unfortunately, this advanced detailed nasal reconstruction was exacerbated by unexpected physiological conditions including excessive bleeding and poor tissue characteristics. The next day, the patient presented with so much swelling underneath the pressure cast that it was being pushed off the face. The swelling was a hematoma which I immediately evacuated from under the skin (it was 4 1/2 mL, being the largest nasal hematoma encountered by either my colleagues or myself). Accompanying this was necrosis (death) of the columellar skin (the partition separating his left and right nostrils). This was particularly disappointing to say the least because the surgical results in terms of nasal shape, symmetry, tip definition and projection were otherwise excellent. Yet losing coverage over the columella would have serious ramifications.

Despite attempts to bring vascularized tissue using local intraoral flaps, my friend eventually needed the help of a certain specialist to bring fresh tissue to the columella below the nasal tip with a temporary forehead flap.

The arrows on the drawing illustrate that portion of the nasal skin (overlying the columella) that was necrotic. Replacement is required through vascularized tissue flaps

Albeit exceedingly rare, this 1.5 x 1.2 cm skin loss was enough to eradicate not only their trust in me as a surgeon but also our long term friendship. Most patients understandably experience a spectrum of emotions including panic, sadness, denial, anger and ultimately acceptance from a complication such as this. However, nothing could prepare me for the degree of ongoing vengeful anger and hostility the patient and their partner have directed towards me including threats to go to the press and ruin my reputation.

Anger is not only destructive but also lacks focus, therefore it can be especially counterproductive to both healing and a good result (not to mention friendship!). Premature castigations of blame fuel brash, illogical decisions which actually complicate the original complication.

Understanding the differences between “bad” and “good” surgery and “good” surgery with a complication can certainly help put things in perspective. When a patient concedes the net surgical aesthetic result, at least in terms of shape and symmetry, as good if not excellent, he or she is less likely to question, and more likely trust, their original choice of surgeon. Whether their breast lift incision opened or, as in this case, a small but strategic portion of nasal skin died, the affected patient will see the “bigger picture” and believe their surgeon will  do the right thing by having their best interests at heart. This same patient understands that they were not necessarily a victim or unjustifiably punished by “bad” surgery. Instead, they will accept things for what they are, learn patience and develop a sense of optimism to set themselves up for the best possible outcome in the future.

The majority of complications concern wound healing and minor infections. For these, possible antibiotics and the “tincture of time” for healing to occur are required. Other times, simple, clinical interventions such as laser treatment, injections, the occasional scar revision and creams are all that are needed.

Other complications require more invasive solutions. Depending on the type of complication, an expeditious trip to the operatory maybe all that is required (e.g.,to drain a hematoma) whereas staged surgical revisions may be undertaken in the extremely rare case of tissue loss.

Most surgeons will recognize if a particular complication is beyond their level of expertise. A patient should not feel abandoned or simply passed off if they are referred to another expert if a complication warrants it. It is important to recognize that medicine is team work and the referral is simply a reflection of the original surgeon’s dedication to the best outcome possible.

Emotional advice after a complication

Watch out for advice with an agenda. It is understandable that if a complication does arise, fear and anxiety will prompt you to seek solace and advice from friends and family members. While this is wholeheartedly encouraged, it is important to remember that not all the advice given is good especially considering that those giving advice are not often doctors nor do they know the intricate details of the patient’s particular case. Though most advice is well-meaning in intent, some may be motivated by guilt, jealousy, personality disorders or just plain ignorance. Furthermore, the advice a patient may obtain from elsewhere may be counterproductive because it may only increase their level of anxiety.

Stay optimistic and avoid jumping to any pessimistic conclusions. It is not unheard of that acute anxiety will provoke a patient to impatiently reach for the help of an alternative plastic surgeon. Unfortunately, some plastic surgeons may be unscrupulous and advise the fragile, highly suggestible patient into unnecessary and ill-timed surgery claiming it is urgently needed to prevent some permanent deformity. Always keep a line of communication open with the original plastic surgeon to not only help allay personal fears but also be guided in the right direction with a second opinion if necessary.

“A good patient is an educated patient”-

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

Board Certified Plastic Surgeon

Beverly Hills

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

The Importance of Total Capsulectomy in Treating Breast Implant Problems.

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

Open or Closed? the Pitfalls of a Cookie-Cutter Rhinoplasty.

New techniques always emerge which supplant the old. The same is true with the plastic surgical procedure called rhinoplasty, or in common parlance, nose job. A nose is basically composed of three materials: overlying skin with associated fat, bone and cartilage.


A rhinoplasty involves:

  1. changing the shape and slant of the bones through selective filing and cutting
  2. changing the shape of the cartilages through removal, adding and reshaping with sutures and
  3. in selected cases, “defatting” the skin to allow the shape of the cartilages and bone to “shine through”.  

In order to perform the rhinoplasty, the surgeon must gain access to the underlying bone and cartilage through either through a closed or open technique. The former involves making incisions confined to within the nostrils and performing the surgery through the limited exposure that these incisions thus provide.  The latter, open technique, involves making the same incisions within the nostrils but joining them across the columella (the fleshy partition that separates the left and right nostril at the base of the nose).

I am frankly surprised and amused that in 2017, some plastic surgeons still insist that the closed technique, when “performed properly”,  provides equal or even superior results than those obtained with an open one. These same surgeons cite a few old masters of closed rhinoplasty from  the 1970s and 80s to support their contention that the closed method is superior. However, the best results from these old Masters do not parallel those obtained from top rhinoplasty surgeons today. Whether you like it or not, progress is inevitable and the new masters of today produce better results than the masters of yore.

I recently attended two conferences  hosting some of the top thought leaders in rhinoplasty surgery. As expected, there was not one expert in the room who would consider closed rhinoplasty an option to achieve the delicate and precise results expected by their patients.  Indeed, even in their hands they  felt that a closed rhinoplasty generally leads to a subpar result. Imagine having to work on the engine of your car only through the left and right front wheel wells. Without opening the hood to gain full unimpeded access to the engine, your ability to effectively work is exceedingly hampered.

The results of any plastic surgery should be measured by the end visual result and not by the process to achieve it. 

Those who promote closed rhinoplasty as better invariably cite less swelling and no potentially visible scar as their main selling point,  but this is a fallacious argument. When properly performed, as a top Beverly Hills rhinoplasty expert, Dr Randal Haworth has seen minimal to no difference in postoperative swelling between the open and closed methods and the scars essentially become invisible whether you are a young model or a 70-year-old person. The proponents of closed rhinoplasty  proudly display their early smooth and symmetrical results as being superior. However, in the early postoperative period, it is the very swelling that the closed proponents claim is not there that may be masking inaccurate nasal construction below. This can be seen in the many examples of  famous noses heralded in their early postoperative period but turn out poorly constructed when their swelling dissipated. Generally avoidable deformities such as inverted V deformities, pinched tips and crooked noses become unavoidably visible no matter how much makeup contouring and good lighting is available.

Famous Noses and  Deformities via Closed Techniques:

After closed rhinoplasty with obvious ‘inverted V” deformity, pinched tip and lack of harmony between the upper and lower portion of the nose
Bella Hadid with nasal deformities after closed rhinoplasty
Note the lack of continuity between the upper bony portion of the nose and the lower cartilaginous portion. An obvious “inverted V” deformity and pinched tip do not help the situation.
Ashlee Simpson with nasal deformities after closed rhinoplasty
After a closed rhinoplasty, note crooked appearance, asymmetrical and drooping pinch tip
                         

Examples of Complex Rhinoplasties Performed through the Open Technique:

Open rhinoplasty
Significant congenital asymmetry of the nostrils. After an open rhinoplasty-note significantly improved symmetry with minimal scar that a closed rhinoplasty technique can’t achieve
Unfortunate result from a closed rhinoplasty with “inverted V” deformity and asymmetrical, bulbous tip. An open rhinoplasty was performed with significant improvement of the nose
Unfortunate result from a closed rhinoplasty with “inverted V” deformity, retracted nostrils and asymmetrical, bulbous tip. An open rhinoplasty was performed with significant improvement of the nose
Unfortunate result from a closed rhinoplasty with “inverted V” deformity, retracted nostrils and asymmetrical, bulbous tip. An open rhinoplasty was performed with significant improvement of the nose
Another example of noticeable congenital asymmetry of the nostrils. After an open rhinoplasty-note significantly improved symmetry with minimal scar that a closed rhinoplasty technique can’t achieve

When precise control over the shape and symmetry of the nose is required as well as control over the subtle light reflexes and shadows embodying the beauty of a nose, nothing beats an experienced surgeon with a precise touch, an aesthetic sensibility and an open rhinoplasty technique.

Dr.Randal Haworth

2017

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

Kybella ® vs. liposuction for a double chin

While we in the cosmetic industry are getting better and better at delivering the results that patients expect, I still hold fast that 60 to 70% of modern high-tech materials and devices in plastic surgery over promise and under deliver ! Considering that the future of plastic surgery will be less about actual surgery as more more and more technological advances are made in the lab (think genetic engineering, better fillers, better lasers, etc.), this 60-70% statistic is rather disappointing. What makes this all the more egregious is the fact that doctors are forced to pay an arm and a leg for such underperforming technologies (Ulthera ® Thermage®, etc.). In light of the fact you can get a state-of-the-art Tesla  with all the bells and whistles for around $100,000, paying $150,000 or more for a machine that just delivers fuddy-duddy ultrasound technology through a wand to aid in liposuction is frankly outrageous. However, the medical tech companies can’t be solely blamed for this-they are basically governed by the FDA’s policies which, in turn, are a response to precedents extrapolated to an absurd degree by  lawyers. Unfortunately, I have seen it all too many times – a new plastic surgery technology coming out amidst a flurry of media only to fade into relatively rapid obscurity. This is similar to a Billboard chart topper only to turn out to be a one-hit wonder! In my opinion the latest overhyped snakeoil is Kybella® from the big pharma conglomerate Allergan®, proud makers of Latisse®, Botox®, Voluma®, Juvéderm®, etc. I was glad to hear from some of my esteemed colleagues at the recent American Society of Plastic Surgery meeting in Los Angeles that their thoughts on Kybella ® echoed mine.   Taking into account Kybella’s negative points, which include: 1.  relative risk of damaging important facial nerves, 2.  cost (though one treatment is less expensive than liposuction, more often than not multiple treatments are necessary and these, of course, add up), 3.  associated pain, 4.  longer recovery (which, ironically, is worse than surgical liposuction since remarkable swelling can occur after every injection session) and 5.  inferior results to those obtained  with aesthetically and skillfully performed liposuction …there is little to no advantage in utilizing Kybella® for my patients except perhaps for its superior multi-million dollar marketing campaign! Indeed, micro liposuction can provide unprecedented control in removing  fat to treat a double chin while refining the jawline and addressing the jowls as well-all with less downtime and more economically so in the end. Case in point:
Dramatic perioral rejuvenation including improvement of the jowl and chin utilizing a combination micro liposculpture and fat transfer
Dramatic perioral rejuvenation including improvement of the jowl and chin utilizing a combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.
Dramatic perioral rejuvenation including improvement of the jowl and chin utilizing a combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.
After combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.
After combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.

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.

Shloop or Droop? How to protect your breasts 24/7

The idea of wearing a bra to bed is nothing new. I estimate approximately 6% of women already realize the benefit sleeping in a bra either because they were advised to do so by a buxom relative with ample bosom or are clever enough to understand how the laws of physics will affect their breasts in the long run. Breasts without bras BREASTS WITHOUT BRAS Breasts are affected by gravity just in the same way that Sir Isaac Newton noted that an apple is. If the apple is not prevented from dropping to the ground, it will do so and often get damaged in the process. During the day, breasts get pulled towards the earth in the same way and if no support is provided to counteract this force, breasts will eventually elongate and narrow complemented often times with downward facing nipples.

After examining thousands of breasts throughout  my 20 years of private practice, I have come to realize that those who sleep in a brassiere generally have perky breasts than those who don’t. Specifically, those who wear a bra during the day and not one at night tend to have breasts which are wider, yet flatter and concave on top with their nipples still point upwards.
Oblique cross-section of breast showing inner anatomy including Cooper's suspensory ligament's.Oblique cross-section of breast showing inner anatomy including Cooper’s suspensory ligament’s.
Apart from being blessed with good genetics to imbue your breasts with strong Cooper’s ligaments, collagen and skin there is nothing one can do to to protect your breasts from drooping except good old fashion commonsense prevention – and that comes in the form of a bra.

There is no muscle in the breasts therefore neither exercise nor yoga positions will help. There’s even poorly conceived research stating that wearing a bra creates more drooping of the breast because “they limit the growth of supporting breast tissue, leaving the breast to wither away and degrade more quickly”! In other words, they imply that the stress of gravity is good for the breast, training it like a muscle. If that were the case, patients could simply gain and lose excessive weight repeatedly in order to” train the skin” so that stretch marks can be avoided. OK…but I then wonder why pregnancy results in abdominal stretch marks…hmmmm? the-breast-7-638 My job as a plastic surgeon is to not just simply do the surgery and wish my patients all the best as they fade into the sunset. I feel it is my responsibility to also provide an “instruction manual” so to speak on how to manage their aesthetic wellness outside of my clinic and operating room.

For example, after facial surgery I recommend specialized skin care regimens and after body sculpting, certain diet and exercise. However, after breast surgery, few if any plastic surgeons recommend long term breast care except for incision/scar management, implant massage and mammograms. You only have one set of breasts and whether or not you choose to undergo plastic surgery, it is equally important to invest time and not just money in protecting their aesthetic wellness as appropriately early as you can. As soon as a young woman’s breasts are large enough to fall off the side of their chest when they are lying down is the ideal time to prevent them from doing so! In the same way that gravity exerts an affect on a woman’s breasts when she stands, it also profoundly affects them when she lies down. However, wearing a regular, daytime bra to bed simply did not provide the specialized support that was needed when on one’s back and side. When calling the support specialized, I am referring specifically to secure lateral outside support to keep the breasts from falling off to the side in addition to inner or middle support to prevent the upper breast from falling onto the lower during side sleeping. There were no bras on the market that addressed these important issues. It is for that reason that I developed NightLift ®. It had to fill three criteria: 1. First and foremost, it had to be comfortable, like a second skin if you will. Despite providing unparalleled support, no underwires exist within this bra. 2. It had to work. 48 prototypes were developed over several years to ensure ultimate support without wire or compression. We call  this technology B.U.S.T. ® (bilateral uplift support technology). 3. It has to be stylish and sexy so a woman not only feels fabulous but also looks great, whether she’s alone or with her partner. Whether a woman has undergone breast surgery or not, I recommend night list to all of my patients if she is concerned with aesthetic wellness of her breasts. After breast surgery (including breast augmentation, mastopexy or breast reduction) I fit my patients in NL a week after surgery when most swelling has dissipated. Since NL provides incredibly comfortable support without hurtful underwire, patients fall in love with this and it soon becomes a staple within their lingerie collection.   Randal Haworth MD   To learn more, go to Nightlift.com

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.

Too Busy to Stay Healthy? The Soup Diet

Dr. Haworth - Beverly Hills Plastic SurgeryAs busy humans striving to balance family life, successful work habits, exercise and relaxation, life can be very difficult indeed. And when these become out of balance, mental incertitude arises leading to stress and further imbalance.

It is easy to blow off exercise till another day and just curl up in front of the TV with your partner, while eating your favorite comfort foods. While this can be rewarding on the occasional night off, a pattern of this is a one way street to middle-age spread!.

Beverly Hills Plastic Surgeon, Dr Haworth has a few simple tips to help break the “comfort habit.”

http://myp3r.wordpress.com/2012/03/30/be-good-to-yourself-dr-haworths-healthy-living-tips/

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