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

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

Healing after Plastic Surgery; State-of-the-Art for 2017.

“Time is a cruel thief to rob us of our former selves. We lose as much to life as we do to death.” Elizabeth Forsythe Hailey

Living in the modern world becomes more complex and harder as life in the 21st-century becomes faster and faster. We are burdened with responsibilities and distracted by an interminable onslaught of media in all forms including the capricious internet. It seems as if everything is competing for our attention in one way, shape or form while stealing precious time we could otherwise devote to family, friends and simply to our  own selves. Therefore, when it comes to saving time, the need to heal quickly after any cosmetic procedure is almost rapacious.

Unfortunately, there is no magic pill or formula to bypass the post operative inflammation of  bruising, swelling and discomfort at this current time. As one of the top plastic surgeons in Beverly Hills, Dr. HAWORTH has seen a thing or two about how patients heal after the thousands of surgeries he has performed over two decades. As a facial plastic surgery expert, he has performed thousands of primary and revision rhinoplasties, brow lift, facelifts and blepharoplasties not to mention the breast implant operations throughout his career and has realized there are things you can do both at home and in the clinical setting to accelerate your healing.

First of all, it is a good idea to focus on whole foods as much as possible while avoiding processed ones as the former will contain the highest levels of vitamins and amino acids your body will need for a speedy recovery.  Amino acids help wounds heal faster and obviously, these are found in  chicken, meats, egg whites, fish, brown rice, healthy nuts like walnuts and almonds or sunflower seeds. Taking supplemental vitamin C in your diet while increasing zinc in your diet can be helpful. Instead of taking vitamin C for a bottle, you can eat strawberries, papayas and citrus fruits which are great sources of vitamin C.  500-1000mg  is the usual amount that is taken. Zinc is found in oysters which have one of the highest levels of zinc found in any food. If you are going to take a supplement, 15 mg of zinc daily is the recommended amount but you can increase your zinc intake to 30–50 mg for 2 weeks before and 2 weeks after surgery, using zinc picolinate.

Beverly Hills plastic surgeon Dr. Haworth also recommends these useful supplements to take in preparation for your surgery include:

B12 and Iron – Iron and B12 both aid bone marrow in forming new blood cells, so incorporate foods like fish and eggs.

Vitamin B6  250mg, twice a day for a week, starting 3 days after surgery. This helps reduce post-surgical fluid retention, such as swelling of the face, hands, feet or legs. With B6, you can experience substantial reduction within 24 to 48 hours.

CoQ10- Surgical trauma (particularly from cardiac surgery) causes an increase in free radicals, which  damage cellular function. For this reason alone, you should take at least 50 mg of CoQ10 as part of your daily routine before your cosmetic surgery and 100–200 mg/day for at least 4 weeks after.

Fiber and probiotics – This combination helps boost the immune system and also keeps your digestive tract moving along. Eating yogurt with granola is just one easy way to get a serving of both fiber and probiotics! When choosing a probiotic, consider one that contains acidophilus and bifida bacteria (follow label instructions for dosage). Surgical patients often receive oral or intravenous antibiotics in the hospital, which creates the potential for  yeast infections, digestive disturbances and diarrhea. A probiotic may help counteract these problems.

One amino acid that has been shown to speed with healing is glutamine and a study from Harvard and Dave showed that it shortened healing by about four days. Apart from supplements, glutamine can be found in beef, chicken and all types of fish. Dairy products such as cheese, milk, yogurt and eggs contain glutamine with ricotta and cottage cheese being the two richest sources. Vegetarians can find glutamine in beans and lentils. For most of his patients, facial plastic surgery specialist Haworth recommends supplemental Arnica Montana, Bromelain/ Bromezyme (this pineapple enzyme helps prevent blood clots, aids digestion while decreasing inflammation and pain after surgery) and Pycnogenol/Pine bark. This triumvirate is aimed at reducing bruising, soreness and inflammatory edema. Apart from the above, many patients inquire about any other additional medications, exercises or procedures that can be done to maximally reduce their healing times after surgery. Of course, all patients should ask their individual physicians or surgeons about their own personalized recommendations to speed up recovery which is beyond the scope of this post.  
Bioptron® Light employs a combination of polarized infrared and visible light (480nm-3400nm) considered beneficial in the treatment of wound problems and injuries by exerting its effect at the cellular level. Bioptron® therapy has a low energy density (fluency) of 2.4 J/cm2 at a distance of 10 cm and can penetrate the skin up to 2.5 cm.
This patient had impending skin necrosis around her here after a facelift. Only 7 days of Bioptron ® light therapy were administered and notice the rapid improvement in reversing the damage.
After 5 days of Bioptron® therapy to resolve bruising resulting from lower eyelid procedure to treat her dark circles/tear troughs.
After 3 days of Bioptron® light therapy to accelerate the resolution of bruising and skin injury after a breast reduction by Dr. HAWORTH.

It has been used effectively in the treatment of burns, pressure sores, leg ulcers, wounds, pain and recently, postoperative healing. Dr Haworth have found it very useful in his clinic to reduce both swelling and bruising. Supporting his experience, other plastic surgeons here and abroad have noted decreased resolution times of eccymosis and edema following surgery by over 33% with Bioptron®. Indeed, it has been used to also reverse the course of cutaneous necrosis as well as accelerate granulation of open wounds, either alone or in conjunction with hyperbaric oxygen therapy (HBOT).

Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized room or tube. It is a well-established treatment for decompression sickness, a hazard of scuba diving. Other conditions treated with HBOT include serious infections, bubbles of air in blood vessels and non-healing wounds as a result of diabetes or radiation injury.

In a HBOT chamber, the air pressure is increased to 3 times higher than normal air pressure and under these conditions, your lungs can gather more oxygen than would be possible breathing pure oxygen at normal air pressure. However, there is some confusion about what actually is “true” HBOT. Those employing “soft” tent like enclosures are essentially useless since they are unable to obtain a true hyperbaric environment of 2 to 4 atmospheres absolute (ATA). In fact, these personal or home-use “hyperbaric”  tent enclosures can usually only attain a pressure of 1.3 ATA. There is a debate as to how much and how many treatments are necessary to speed up recovery after plastic surgery. While most plastic surgeons perhaps recommend one preoperatively and at least 3 to 5 postoperatively, experts in the field say one needs at least 15 to 20 treatments in order to see significant results. In my experience, 3 to 5 treatments are all that is necessary to achieve the more modest goals of reducing edema, bruising and discomfort resulting from elective  plastic surgery.

After certain surgeries, body contouring plastic surgery expert Dr Randal Haworth may also recommend selective lymphatic massage/drainage to resolve edema (swelling)  of the extremities, particularly after liposuction or liposculpture.

The above aforementioned vitamins, nutritional supplements and clinical interventions may not be the panacea to surgical healing which comes in a pill form, but they certainly are a step in the right direction in making recovery from any procedure as smooth as possible in 2017.

Dr Randal Haworth

2017 Beverly Hills

       

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.

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

Needle Away your Concerns about Stretch Marks and Sagging Body Parts

Needling treatment also known as CIT (which stands for collagen induction therapy) has actually been around for quite a long while now. It is truly a low-tech device but it has found a new place in my bag of aesthetic tricks.

Why? Simply because it works. It seems to be the most effective procedure in this day and age to reduce stretch marks (striae distensiae), firm and elevate  tissue(knees, elbows, buttocks etc.), reduce scars (including acne ones), reduce hyperpigmentation-all in all it seems to result in a healthy, more youthful appearing skin.

How does it work?

The patient starts applying fat-soluble vitamins A and C antioxidant oils to the skin two weeks prior to the planned procedure date. The fat solubility of these vitamin oils allow them to penetrate human epidermis and dermis far more effectively that many of the other available competing products. These in turn stimulate the skin to produce more collagen and rejuvenate their elastin component. The device (which is basically a roller with approximately 200 needles attached to it perpendicularly) is then utilized to produce tens of thousands of small needle marks penetrating into the dermis. This in turn, induces a cascade of collagen production, the effect of which is amplified by the combined use of the antioxidant vitamins. In a way, the roller is not only producing a controlled injury to the skin but also acting as a very efficient drug delivery system.

I generally recommend a number of treatments to get the most optimal results. Here’s just one example of the fairly dramatic effect one could achieve by this methodology. The woman had undergone myriad laser treatments to reduce her stretch marks, but to no avail. After just two Roller treatments, she achieved the following result.

Abdominal Stretch Marks
This woman had a previous abdominoplasty in order to help reduce her stretch marks. She was dissatisfied with the result and had many laser treatments to reduce her stretch marks. They are still very obvious in width and depth.


After Needling/CIT
She underwent two rounds of Needling/CIT. Note the dramatic reduction in stretch marks both in terms of width and depth.


For further information about CIT, needling therapy, call the office of Dr. Randal Haworth (310 273 3000) located in the Haworth Institute.