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

The most obvious tell-tale sign of a facelift

Good plastic surgery is invisible but many people insist that they can always spot anyone who has had plastic surgery. For example, they claim they can always spot a celebrity with a facelift and list those with obviously sad results that garner all the press. You can refer to the three attached photographs as examples of such. (They go on to name others who have not had any plastic surgery and when I in turn correct them, they express bewildered disbelief.)
Joan Rivers with obvious plastic surgery and pixie-ear deformity
Joan Rivers with look-at-me pixie-ear deformity
 
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Bruce Jenner with a plain-as-day pixie-ear deformity after a facelift
Mickey Rourke sporting his obvious Pixie-ear and man-bun on the red carpet
Mickey Rourke sporting his obvious Pixie-ear and man-bun on the red carpet
However, this blog post is not about good plastic surgery, it is about the bad and the ugly. There are many signs that scream “facelift”:

1. Overly pulled face skin with diagonal grooves

2. Altered hairlines such as pulled-back sideburns

3. Widened, non-hair-bearing scars with step-offs in the natural hairline behind the ear

4. Distorted anatomy in front of the ear canal due to effacement of the delicate tragus cartilage and finally…

5.”Pixie ear”.

Most of these aforementioned problems stem from misplaced anchoring of the newly redraped skin flaps resulting in needlessly excessive tension across potentially visible scars. One immutable rule in plastic surgery dictates that such increased tension can create widened scars, hair loss and distorted anatomy. Yet, despite these well-documented problems, I unfortunately still see many patients who seek correction of these stigmata of ill-conceived facelifts.

Correcting these problems is not an easy task. Generally, a secondary facelift needs to be performed to release enough skin so that both scars can be removed and closure achieved in a tension-free matter. If it happens to be a lucky day, scars that were placed in front of the ear can even be moved more posteriorly to within the ear canal as in this example of a facelift I performed in order to not only make her look younger but also remove her telltale signs of past substandard surgery.

Pixie earlobe after a facelift. Note scar in front of the ear
After correction with revision facelift and tension realignment


Pixie ear deformity and tired appearance after previous facelift
Pixie ear deformity and tired appearance after previous facelift
Note correction of pixie-ear deformity after revision facelift. An endoscopic brow lift, fat transfer and upper lip lift along with a lower blepharoplasty were also performed
Note correction of pixie-ear deformity after revision facelift. An endoscopic brow lift, fat transfer, upper lip lift and a lower blepharoplasty were also performed

The trials, trade-offs and tribulations of upper lip lifts and other plastic surgery.

All plastic surgery has trade-offs.

By trade-offs, I am not referring to complications or risks.

By trade-offs I am referring to subtle and sometimes significant alterations in your appearance that will be incurred by undergoing a certain plastic surgical procedure. It is the doctor’s responsibility to inform the patient of these trade-offs (including risks of complications) while it is the patient’s responsibility to make an informed decision to proceed if he or she feels that the benefits of the surgery will outweigh the risks and trade-offs.

Examples of such trade-offs are the scars in and around the ear that result from a facelift. Even though they may be near invisible, they are scars nonetheless. The majority of patients feel that benefits of the facelift outweighed any of the associated trade-offs. Similarly, patients who undergo an abdominoplasty (tummy tuck), mastopexy (breast lift) or brachioplasty (arm lift) should be fully aware that they will develop scars from those procedures. Though the majority will heal well with very acceptable scars, most of the time the scars will be visible to some degree.

Patients who undergo a rhinoplasty must understand that their nose will be numb, stiff and hard for up to 3 months or more while swelling can persist for 1 to 2 years. Numbness from a facelift or a browlift can last many months as well. Despite understanding these trade-offs, the vast majority of patients have no problem undergoing these procedures once they have decided to do so.

Over the years, I have found it curious that a small minority of patients undergoing lip reshaping surgery in the form of upper lip lifts and V-Y plasties had unrealistic expectations in terms of their healing and results. They were surprised even angry that they experienced numbness, stiffness and associated scarring. Sometimes a very subtle change in the nostril position occurred after the surgery. These trade-offs may arise even though the result of the upper lip lift is successful from the aesthetic standpoint-in other words, the net benefit in the sensual-youthful-beauty quotient for the face has been increased. However, a few may consider the lip lift a failure if they have experienced even a slight degree in any of these trade-offs.

Though these trade-offs can mostly be successfully reversed, a patient should not elect to undergo such a procedure if he or she will not accept that these can be normal aspects of the procedure. If one thinks about it, an upper lip lift will have its trade-offs in the same way other procedures would have their own yet it perhaps gets more attention than other anatomical features of the face because the lips are expected to not only look beautiful but also function as well.

And function they do, more than any other part of the face. Indeed, lips are used to express, emote, eat, kiss and speak-essentially they move millions of times a day! Because of these strong repetitive muscle forces around the nasal and oral region the plastic surgeon must create a strong upper lip lift that will resist these forces in order to achieve a result that is long-lasting, with minimal scarring and nasal distortion.

In fact, lip shaping procedures are the most challenging of all facial plastic surgeries, even rhinoplasties. Though the success of facelifts are measured in centimeters, brow lifts in increments of 2 to 4 mm and rhinoplasties in millimeters, lip reshaping surgery is measured in quarter-to-an-eighth of a millimeter! With those scales, one can almost consider this close to microsurgery.

In 2014, it would be a miracle to undergo an upper lip lift with an unequivocal guarantee of no scarring, nasal distortion, prolonged minor sensory changes and stiffness. If you are contemplating undergoing an upper lip lift but will not tolerate any of these tradeoffs, I suggest you avoid the procedure altogether and wait for that miracle to happen.

“The Lifestyle Lift”-LSL . Does that really stand for the long scar lift?

  The myths and realities of the Lifestyle Lift

As with any service industry, there are convenience stop businesses and destination businesses. You see that with restaurants (think of McDonald’s or Chili’s versus French Laundry, one of the best restaurants in the United States) and you see this concept applicable to the plastic surgery business. I stress the term business  and not medical field for a reason in this essay. I can safely say that most people that pursue higher education in any country do so to seek a better life, better pay and have more opportunities come their way. Of course, most scrupulous doctors experience immense satisfaction from treating their patients as well and, cynically speaking, are not simply in it for the financial award.

Like all professionals, doctors do seek out (and deserve) a certain financial reward for all the years of dedication, study, stress and life sacrifice they undergo in order to carry out their profession and deliver the best care they can to their patients. However, in this day and age of increasing competition and commoditization in all aspects of health care including plastic surgery, surgeons are forced to perform more surgeries at lower costs and possibly increased medical risk to patients. This alarming trend can especially be seen in plastic surgery where the end results of a hastily performed surgery are not hidden within a body cavity but are plainly visible on the face. Some of my colleagues brag about the speed at which they perform a surgery citing the many corners that they “cut” during an operation as unnecessary steps (no pun intended). I suppose they feel more akin to a Usain Bolt than that of a gifted watchmaker.

This brings me to the title of this blog post-The Lifestyle Lift. To the unsuspecting public this facelift is heavily marketed as a viable, simpler, safer, faster quality facelift at a fraction of the price. In fact, this facelift is an overly simplified distillation of pre-existing ideas wrapped in a new packaging as something brand-new and revolutionary. The one aspect that is revolutionary about this facelift is that it is one of the first surgeries that has been rebranded and marketed directly to the “consumer”. The company then refers the “consumer’ to one of their participating surgeons in the network to become a patient. Unfortunately, as a Beverly Hills plastic surgeon board-certified by the American Board of plastic surgery, I have seen many results of this “Lifestyle Lift” that reek “cookie-cutter surgery” in which performance is measured in terms of speed and not quality.

I have seen many unacceptable, hideously widened scars most probably stemming from the fact that the surgeon did not perform a wide enough dissection to allow a tension-free closure (which is tantamount to a good scar). I have also consulted with many patients who were dismayed by how the “Lifestyle Lift” failed to meet their expected goals with incomplete treatment of their jowls, neck and midface.

While it is true that all surgeons have their small subset of unhappy patients either because of unrealistic expectations, sub-optimal results or unexpected complications, the large percentage of unhappy patients complaining of their “Lifestyle Lift” is too hard to ignore. For a good article on the subject that appeared in Plastic Surgery Practice.

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.