Building the optimal in-office ORBy Lisette Hilton
1. Flow and Freedom of Movement
Beverly Hills-based plastic surgeon, Randal Haworth, M.D., says he needs to be comfortable and free to move in order to perform facial and body plastic surgery.
But space can be somewhat limited in an OR inside a boutique plastic surgery practice, he says.
“… so careful planning of the envisioned flow between patient, surgeon, scrub tech, circulating nurse and anesthesia provider must be done,” Dr. Haworth says. “In my case, I had to work with a rectangular operating room, in which case I first had to decide where the anesthesia machine would be situated, since its range of movement would be limited by the oxygen and vacuum hoses tethering it to the ceiling. Consequently, it was important for me to have a 180-degree turning radius for the operating table, so I could position it according to whether I am performing facial or body surgery. Of course, OR lights have to follow suit and must be very mobile and bright. My Trumpf LED [Trumpf Medical] system fits the bill nicely.”
2. A Quality Monitor and Sound System
Having a big monitor with a good sound system for music is not only a luxury but a necessity for the modern plastic surgeon. Having the monitor in constant view is a must, according to Dr. Haworth.
3. Intelligently Designed Cabinetry
Proper cabinetry, design to maximize space and efficiency, is essential, according to Dr. Haworth.
“You can never have too many cabinets from the get-go, since these promote organization and obviate the need for vulgar retrofits in the future,” he says. “When it comes to designing my clinic or the operating room, I think that creating and maximizing the feeling of unrestricted space is important for both the patient’s sense of security and the staffs’ sense of clarity.”
4. Don’t Cut Corners
Don’t cut expenses, when it comes to safety, according to Dr. Cohen.
5. Seek Expertise
Dr. Cohen says cosmetic surgeons should tap experts in designing operating rooms.
“Reach out to architects with experience in both the design and credentialing processes,” Dr. Cohen says. “Ultimately, certain third-party inspections may be required, and you don’t want to be caught off guard.”
Dos and Don’ts for the In-office OR
Erin Metelka, an interior designer with Studio Four Design, offers these design dos and don’ts.
- Use a sheet flooring, with heat welded seams and sanitary cove base.
- Use bleach cleanable/non-porous products.
- Use clean/calming colors.
- Provide a variety of adjustable ambient lighting options.
- Utilize floor patterns to designate the extents of the sterile zone and care-provider zones.
- With the wide variety of procedures that occur in an operating room, often times, the table is moved in order to accommodate the most efficient workflow with the other equipment in the suite. The floor patterns can also be used to dimension the proper location of the table for these various scenarios.
- When creating several operating rooms, utilize an identical layout (not mirrored). Often, physicians are moving into adjacent operating rooms for a procedure, while a room is being turned over and sterilized. Having identical layouts increases efficiency and reduces error.
- Do not have extraneous items of décor within the suite, such as artwork.
- Do not utilize fabric of any kind such as curtains/draperies. If there are windows, create privacy with natural light by using integrated frosted glass. If an upholstery is required for a physician stool or other items, a bleach cleanable vinyl is a suitable alternative, ideally with a Crypton or nano-technology finish applied (these finishes work to prevent moisture penetration to the cushion and function as an antimicrobial).
- Do not place any direct down-lighting, with the exception of the surgical boom, directly over the table.
“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.
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
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:
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.
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? 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
A recent study came out in our esteemed, peer-reviewed journal Plastic and Reconstructive Surgery addressing stem cell enriched fat transfer versus “regular” fat transfer (PRS Journal: stem cell rich fat transfer). In essence, this study showed there was no difference in the effects of a fat transfer whether it was enriched with stem cells or not. This was essentially the same conclusion of a blog post I wrote a few years back. However, what makes this news different is that it comes from a well-designed, randomized prospective study.
You may then ask yourself why are there so many doctors promoting stem cell facelifts and fat transfers as being the chalice of youth or life’s elixir to immortality and aging. The simple answer is finance and marketing. By promoting your fat transfer as being different, labeling it with the trendy buzz prefix of “stem cell”, prospective patients will naturally think they are getting something better, longer-lasting and more natural.
You may then ask yourself why their before-and-after photos are impressive. The simple answer is that for every before-and-after photo of a stem cell-enriched fat transfer there are 10 equally-as-impressive before-and-after results from regular fat transfers. The bottom line is that one can achieve equivalent results from a regular, well-performed fat transfer-specifically, one in which the fat is appropriately harvested, cleaned and transferred by the physician with precision and artistry. Fat is basically serving as a filler, but one that is extraordinary. Extraordinary because it is not only permanent but is actually living as well-consequently it can grow or shrink depending if the patient gains or loses weight, respectively.
Stem cell science is in its infancy and we have much to learn. Indeed, many stem cell scientists now believe that the byproducts of stem cells (cytokines, etc) play a far more important role in healing than the actual stem cells themselves.Fat is a rich source of stem cells but to assume that the stem cells, when transplanted into the face, can miraculously know how to uniquely reverse aging is pipe-dreaming at best.
Randal Haworth M.D., F.A.C.S.
In light of recent photos of Renee Zellweger, a conversation has begun about plastic surgery. (Zellweger responded to the uproar, telling People magazine, “I’m glad folks think I look different! I’m living a different, happy, more fulfilling life, and I’m thrilled that perhaps it shows.”) But whether or not Zellweger had plastic surgery is irrelevant, and the reality — and potential repercussions — of going under the knife is worth exploring in further discussion. We spoke to “The Swan” contestant Lorrie Arias about her experience to get a better handle on the reality of undergoing such extreme physical change. This is her story.
Ten years ago, at age 34, Lorrie Arias underwent approximately $300,000 worth of plastic surgery. In 1995, she lost 150 pounds; in 2002, her husband died; and, in 2004, she became a contestant on “The Swan.” The program, which Jennifer L. Pozner called “the most sadistic reality show of the decade“ in “Reality Bites Back,” took its title and premise from a literary fairy tale, “The Ugly Ducking.” Two women deemed to be “ugly” underwent a total transformation at the hands of a panel of specialists, including a plastic surgeon. At the end of each episode, one was eliminated and the other went on to compete in the pageant that ran as the show’s finale. It aired for two seasons in 2004, before being canceled in 2005 as a result of low ratings. After losing a significant amount of weight, the then-police department volunteer auditioned for the show in hopes of a tummy tuck. Arias was frustrated that she had worked so hard to get healthy and still had so much extra skin. As a result of her “sad story” the selection committee chose her for the show. Once Arias got to the set of “The Swan,” doctors and producers set up a much more intensive transformation than she had expected. Over two and a half months of filming, she had a tummy tuck, buttock lift, inner thigh lift, dual facelift, upper lip lift, upper and lower eye lift, endoscopic brow lift, rhinoplasty, breast augmentation and breast lift — the most procedures of any contestant on the show.
A decade later, she told HuffPost Entertainment she is depressed, bipolar, agoraphobic and believes she continues to suffer from body dysmorphic disorder. She has regained the weight she lost in 1995 and refuses to leave her home, save for trips to see her therapist every few months. There is relatively little research regarding the psychological fall out from plastic surgery, both because extreme alterations are rare and it is not in plastic surgeons’ best interest to participate in or fund such studies. Some work has been done on the effect of TV representations on adolescents’ body image and the ways in which unrealistic expectations can lead to disappointment following a cosmetic procedure. In terms of diagnoses, the topic most often discussed is body dysmorphic disorder. “That refers to essentially an over-focus on a certain body part as being deformed or problematic, to the point that the person becomes obsessed with it,” Dr. Paul Puri, a psychiatrist, said. “Many times an individual believes getting surgery will fix it. In the research and literature, this has not been show to be a solution. It can be a problem with self-esteem, anxiety or other underlying issues, and surgeries don’t typically solve those other issues.” Of course, sometimes, people get surgery later in life due to social pressures based on standards of beauty and youth. “Those are two largely different reasons as to why people get plastic surgery,” Puri clarified. In cases involving dysmorphic disorder, it tends to pre-exist the surgery and then be exacerbated when the results differ from what the person desires. “The case may be that if someone fixes all of their hopes on surgery, it can be extremely disappointing and actually worsen their anxiety if it is not fixed,” Puri said.
After appearing as a contestant on “The Swan,” Arias faced a lot of negative reactions from those who knew her before the surgery. “You get a lot of crap,” she said. Arias felt that some friends and family were “jealous,” and others uncertain of who she had become. The latter group included the eldest of her two sons, who said at the time, “she doesn’t look that much like my mom anymore.” “He has told me that he felt afraid,” Arias said. “That makes me feel guilty, because I realize that if the shoe were on the other foot, I would have freaked out too.” Perhaps the most unnerving reaction came from Arias herself. The reveal is set up as a surprise for the show’s contestants. Arias said she had caught a slight glimpse of her reflection in medical equipment, but all mirrors were covered in the two and a half months she spent undergoing her various surgeries. It was only on stage that Arias was given access to a mirror. She reacted with quiet surprise, only losing it once the cameras turned off. “I was screaming for the executive producer,” she said. “I was screaming, ‘I want my face back!’ That’s how freaked out I was. Intelligently, I knew that was impossible. But it was so weird. It was like looking at somebody else, but it was you.” That feeling has become less difficult to reconcile over time, but Arias was happier before the show. “I’ve had self-esteem issues all my life,” she said. “But before, I was functional. Then I go and have all this stuff done that people would give their leg for, and I’m confined inside.” Immediately following “The Swan,” Arias experienced what she calls a boost of confidence. “Going out gave me a little bit of self-esteem,” she said. “I liked my chest. My breasts were my badges of self-esteem. I would go out and wear low-cut tank tops and see women hit their husbands for looking at me. That was never the kind of thing I would do before. I would wear normal shirts.” Soon, though, those old feelings of insecurity came creeping back. Arias said the symptoms leading up to her current condition began shortly after filming ended, and have only worsened. She raved about her plastic surgeon, Dr. Randal Haworth — “I was blessed to have him” — but blamed the show for not providing adequate therapy to help process such an extreme change. While on “The Swan,” Arias did receive psychological care, though those sessions largely focused on loss of her husband. In February of 2013, she spoke to the Post citing a lack of follow-up as the cause for her mental health issues.
Arias kept the 150 pounds she lost off for nearly 10 years, and shed 10 more for the show. However, after “The Swan,” she says, she lost a sense of control over her body. “I started to yo-yo,” she said. “I was 155 on ‘The Swan,’ now I’m sitting here at 248. And I’m miserable.” To stop feeling that way, she would consider more surgery. “I would do it in a heart beat. If I had the money, I’d do the weight loss surgery first,” she said. “This is going to sound weird, because I’ve already had so much done. I would have a new breast augmentation. I would have another brow lift. I would have another facelift. I would get more liposuction. I would do all that and my arms.” Arias would also be willing to do the show all over. “Crazily enough, I would do it again,” she said. “Knowing what I know now, knowing I would gain weight again, and knowing I wouldn’t have that other face. At least I could be a big and pretty person. I can’t imagine myself any differently.” Arias acknowledged that stance might be incomprehensible for someone who hasn’t undergone such extreme plastic surgery. Despite wanting more surgery, she is able to recognize that her insecurities are internal. “I thought a tummy tuck would give me all the self-esteem in the world. Of course, it didn’t. All I want now is for my story to help others, so they won’t think that going under the knife is a cure-all,” she said. “For a while it may be, but everything still comes back up.” And yet, Arias still believes the upset over female celebrities and plastic surgery comes from an inherent desire all women have to change their appearances. “The uproar every time something like that comes up in the news is personal jealousy,” she said. “Most women would like to have something done, but maybe they’re afraid or they just can’t afford it.”
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.