“I have breast implants and I have pain Doc.”

As a  plastic surgeon treating breast implant associated deformities and illnesses for over 25 years, I have seen many patients such as Dolly Parton who now complain of pain associated with the breast augmentation. For example, I treated award winning actress Sally Kirkland back in the late 90s for breast implant related pain. I removed her implants and their associated encasing collagen capsules and corrected her resultant “empty breast” via a mastopexy or breast lift in common parlance.

Actual breast pain tends to be more frequent in patients with very large (i.e. heavy) implants. especially in conjunction with thin, stretched-out overlying breast tissue. Indeed, the implant itself becomes the main culprit responsible for the thinning;  essentially, a vicious cycle  develops taking the patient down a one-way street of pain.

Heavy implants especially in delicately framed women can also contribute to cervical, deltoid and upper back pain. Again, this could simply be represent the long term effects of heavy implants upon the upper body. The only way to alleviate this painful ball-and-chain effect is to either reduce the implant size or just remove them completely. A breast lift is often done in conjunction with implant removal to tighten the excess loose skin left behind.

Capsular contracture is another reason for breast pain extending to the shoulder like a vice, limiting one’s range of motion . When implants are placed in a pocket under the breast  a capsule composed of your body‘s natural collagen develops to line the pocket. This capsule can have a mind of its own and decide to shrink down tightly around the implant causing distortion and in some cases significant pain. This can be torturous and removal of the scar tissue is the only way to effectively treat the problem.

Left Baker’s Grade IV breast implant associated capsular contracture
Right mild Baker’s III encapsulation
(Grade I -Normal
Grade II- Hard & stiff, but fairly normal appearance
Grade III- Hard & distorted
Grade IV- Hard, distorted with pain)
Postoperative results after Dr Haworth, a foremost breast implant revision specialist, performed a bilateral total capsulectomy and implant exchange “under the muscle”

Finally,  many patients suffering from breast implant-related pain have attributed their problems to auto immune disease caused by the very implants  themselves. Often times, these patients may complain of other systemic painful symptoms including fibromyalgia and fatigue. Though few doctors question their pain, there has been little  scientific proof that there’s a link between painful auto immune disease such as fibromyalgia and breast implants.

Most women end up loving their breast augmentation  and even accept mild discomfort in order to maintain their new cleavage. However, for the unfortunate minority  who experience severe pain, parting ways with their breast implants may be their only solution. 

Plastic Surgery-The Male Factor

Man running
Exercise is hard work

For the last eight years or so, I, as one of the foremost cosmetic injection experts in Beverly Hills, have noticed an increasing number of men seeking aesthetic improvement outside of diet and exercise. However, I see this growth as less a trend and more of a real shift in the industry.

This growth is spurred on by society’s reliance on visual rather than written communication and its unabashed obsession with youth and beauty over old-fashioned wisdom and experience. The eruption of social media, including Instagram and the like, has only heightened the problem. It has awakened our once dormant  narcissism into the self-perpetuating collective contagion that it is today. 

Consequently, there is less social stigma for men to seek out ways to better their appearance in this highly competitive world. In 2018, more aesthetic technologies are finally delivering on their promises to reduce wrinkles, firm faces, reverse atrophy and sculpt bodies without hair. The armamentarium used includes Botox, Jeuveau( or #Newtox), Juvederm, Vollure, Restylane, Radiesse,Voluma, Bellafill, IP, laser hair removal and other lasers to treat brown discoloration, and red patches. Men are not only seeking out ways to keep themselves looking young and competitive but also non-surgical ways to actually enhance their features; these include filler/liquid nosejobs (rhinoplasties), cheek and chin augmentations and jawline defining and even laser induced fat burning with SculpSure..

All done with the expert hands of a board certified plastic surgeon or his personally trained expert nurse injectors (such as Katherine Braun, R.N. helming The Haworth Institute’s own medispa, Self-Centered Aesthetics™), results which are both significant and, most importantly, natural.  This is ideal for men wanting their appearance to be on point in order to compliment their skill set at work.

No cutting, no stitches, less recovery, less expense- what’s there not to like for those men who simply want to look good with minimal expense and time? 

Plastic Surgeon and the Anesthetist

How do I chose local, regional, sedation or general?

General generally means endotracheal tubes

Essentially there are three types of anesthesia:

1. Local anesthesia-the type a dentist gives you while you’re totally awake

2. IV sedation or “twilight sleep“. A sedative is administered intravenously to induce a deep state of sedation. 

3. General anesthesia-Sedative agents are administered both intravenously as well as through endotracheal breathing tube into the lungs.

Though the most consider IV anesthesia as being safer, ironically it can be more dangerous. Unlike general anesthesia, IV sedation does not use a breathing tube to prevent a patient’s airway from closing if sedation gets too deep. Actually, this can happen many times during an operation and that is why the anesthesia provider must stay hypervigilant to deliver enough sedation to maintain a patient’s unconscious state but not enough to stop them breathing on their own.

There are two types of patients when it comes to anesthesia-those who are very wary of any anesthesia, let alone general and those who want full general anesthesia without hesitation. Obviously, the choice as to what type of anesthesia is used during plastic surgery is a collaboration between the patient and the surgeon. 

As a Beverly Hills plastic surgeon, creating human artwork involves deep concentration, precise technique, a painstaking attention to detail and unlimited patience. Therefore I want my patient to be perfectly still, comfortable and safe so I can do my very best without being distracted,  even if the surgery is only “skin deep”. This is why I, as a facelift expert in Beverly Hills, perform my facelifts and detailed hyperaesthetic facial surgery under general anesthesia. I feel I can deliver the best results I can while the patient is comfortable and safe.

I utilize general anesthesia for most of my high-definition body-sculpting, abdominoplasties and breast enhancements to enable me to go that “extra mile”. It’s all too often I hear patients complain about their underwhelming results from surgery performed under IV twilight sleep. This is because surgeons are constrained in what they can fully achieve by a moving, uncomfortable patient. In Beverly Hills, standards are high and patients expect the best and this is why they come to my clinic from across the world for their results and not for the type of anesthesia they receive.

However, there are many situations in which I feel IV sedation is better for the patient. Those requiring modest amounts of work where pain control can be easily supplemented by injected local anesthesia are best served with twilight sleep. Generally, shorter surgeries of the skin and subcutaneous tissue but above muscle fall into this category.

endotracheal tube passing through the vocal cords
An image of the endotracheal tube passing through a patient’s vocal cords

In the end, it all boils down to the concerns and expectations of the patient and how best the surgeon is able to fulfill them. However, most honest surgeons, whether in Beverly Hills or anywhere else for that matter, would agree that their most detailed and precise work was performed under general anesthesia

Lip Dysmorphia-It’s a Thing

Who’s Running the Asylum ?

The participants of “Married at First Sight Australia” all have one thing in common-lips preposterously out of proportion with their face. Like a loud out-of-tune instrument in an otherwise beautiful orchestra, these overinflated lips resemble baboon bottoms in heat and do no one any favours.

"Married at first sight Australia" overinflated lips so commonly seen
The characteristic overinflated lips so commonly seen nowadays in the social media age

The mistake made by the many so-called practitioners of aesthetic medicine, is to allow their own aesthetic judgment to be hijacked by the social media influencers. This encourages tunnel vision in doctors and nurse injectors alike, focusing only on  lip volume and not on shape. Instead of enhancing facial sensuality,  overly plumped lips tend to do the opposite and even age the face in a strange way. For example,  the exaggerated lips of Jessika Power only serve to distract from her natural beauty while the lips of Martha Kalfatidis just draw attention to her other churlish facial plastic surgery including her rhinoplasty.

THIS IS A CLASSIC CASE WHERE THE INMATES RUN THE ASYLUM

As a renowned lip reshaping expert, I can say it is not just the  lips but also the surgically and “filter enhanced” faces and bodies that send a bad message to young people. It breeds insecurity, narcissism, depression and bland conformity whereby everyone starts to look the same.

Hot Lips, Cold Sores

 Stress, weather, chemicals and injury to the lip can all awaken the virus in your body. But needle punctures can be particularly triggering for cold sores.   As one of the Beverly Hills top lip injector of fillers, Plastic Surgeon Dr Randal Haworth does see the occasional cold sore erupt 1-2 days after a treatment. It is for that reason, Dr Haworth recommends antiviral prophylaxis is select cases.

Cold sore herpes Simplex Type I of the lips
Cold sore herpes Simplex Type I which can occur after any lip procedure.

Of course, you can be prone to cold sores, get a lip filler and have no sign of an outbreak. But it’s good practice to be precautious and minimize the risk.

Dr Haworth notes that any cosmetic procedure which causes stress to your skin has the potential to stimulate cold sore recurrence. Cold sores are a prevalent affliction and are generally due to herpes virus (HSV) type one particular (generally oral herpes), with the minority (10%) being due to HSV type 2 (usually genital).

Many main infections of HSV-1 are asymptomatic, while recurrent infections can present as fever blisters at the vermillion border. Although cold sores may well not cause any long-term skin damage, they do possess the potential to cause scarring at the contaminated area.

Roughly two-thirds of a global population under 55 are infected with HSV-1. Primary illness develops in childhood through non-sexual contact usually, for example by sharing utensils or towels, but it is regularly assumed to be solely caused by kissing. If symptoms do present with primary infection, they take place two to 20 days after direct exposure.

Aesthetic procedures such as for example lasers, injectables, microneedling and chemical peeling often require limited or deliberate, manipulated trauma to skin, which includes the potential to trigger cold sore recurrence. Dr Haworth, the world’s foremost lip reshaping expert (including upper lip and corner lip lifts) will even warn his patients that his signature lip enhancements can trigger a herpes simplex outbreak. When a fever blister shows up after an aesthetic treatment, it could be devastating for the individual due to distress, pain and potential skin damage of a cosmetically very sensitive area. You will find a particular likelihood of scarring after ablative types of procedures (lasers, peels).

Cold sore prophylaxis can be recommended in the subsequent circumstances:

-More than three spontaneous occurrences every yea
-Previous eruption at any time, as a result of a procedure
-Lip augmentation and HSV eruption regardless of date or time
-Facial resurfacing procedures; anything that breaches skin carrier, and especially medium or deep peels, facial skin lasabrasion, microneedling and microdermabrasion

Immunocompromised patients

Prophylaxis Dr Haworth recommends includes predosing with Valtrex 500mg daily for 2 days to continue for 3 after the procedure. He’ll substitute 1000 mg daily in particularly susceptible individuals.

Randal Haworth MD, FACS

Michelle Bridges

According to Dr Haworth, 47-year-old fitness guru Michelle Bridges may have undergone a transformation in recent years thanks to cosmetic enhancements.

‘It appears Michelle’s striking facial change came from an enthusiastic use of fillers and Botox,’ he told Daily Mail Australia

‘I have a small suspicion Botox was also injected in and around her chin because her smile in recent pictures seems somewhat restricted and stiff.’

While Michelle is yet to confirm whether she has indulged in these treatments, she has previously supported the use of non-surgical enhancements.

In 2014, she said of cosmetic work such as Botox: ‘I am a fan of anything that makes a person feel good about themselves and more confident.’

Transformed: Michelle Bridges may have undergone a transformation in recent years thanks to cosmetic enhancements. Pictured left: Michelle in 2007, and right: in 2018  

Elle Macpherson

After inspecting recent photographs of Elle Macpherson, Dr Haworth believes that she may have had a subtle rhinoplasty in her thirties, resulting in ‘a squared nasal tip flanked by vertical grooves extending down to her nostril rims’.

He also claims that she may have gone under the needle to enhance her already-striking visage.

However, Elle has long been an advocate of natural beauty, crediting an active lifestyle and a plant-based diet as the secrets behind her age-defying appearance

She told This Morning in June: ‘I haven’t done any plastic surgery, not that I have any judgement – it just hasn’t been my choice. I like a natural looking face.’ 

But in 2016, Elle admitted to People magazine that she had experimented with cosmetic procedures to fight wrinkles.

‘Of course I think about lines. There have been times in my life when I have tried really hard to get rid of them [such as with fillers], and it doesn’t work. So I tend to leave all that alone as much as possible,’ she said.

Observations: After inspecting recent photographs of Elle Macpherson, Dr Haworth believes she may have had a subtle rhinoplasty in her thirties, resulting in ‘a squared nasal tip flanked by vertical grooves extending down to her nostril rims’. Left: Elle in 2002, and right: in 2018

Ada Nicodemou

Dr Haworth claims Home and Away star Ada Nicodemou, 41, has stayed ‘on point’ in her career thanks to ‘various non-surgical cosmetic treatments’.

However, he also believes the mother-of-one has undergone a breast augmentation, in addition to using fillers and Botox.

While Ada is yet to reveal whether she has gone under the needle, she has previously supported the use of enhancements in an interview with Daily Mail Australia.

‘I just think everyone should do whatever makes them feel good… I have no judgement on [Botox] whatsoever,’ she said.

Ageless: Dr Haworth claims Home and Away star Ada Nicodemou, 41, has stayed ‘on point’ in her career thanks to ‘various non-surgical cosmetic treatments’. Left: in 2008. Right: in 2017

Ian Thorpe In October, it was speculated that former Olympic swimmer Ian Thorpe had undergone a nose job – an assessment Dr Haworth agrees with.

‘It is clear as day that Mr. Thorpe had a rhinoplasty,’ he said.

‘The dorsal hump of his bridge has been significantly lowered so that his tip now overprojects from his face.’

It is clear as day’: In October, it was speculated that Olympian Ian Thorpe had undergone a nose job – an assessment Dr Haworth agrees with. Pictured left: Ian in 2012, and right: in 2018  

From Sophie Monk’s fillers to Ada Nicodemou’s boob job and Elle Macpherson’s ‘subtle rhinoplasty’: A Beverly Hills doctor reveals Australian stars’ ‘cosmetic surgery secrets’

It seems that Australia’s brightest stars never seem to age.

And according to Beverly Hills-based cosmetic surgeon Dr Randal Haworth, some of these celebrities may have had a little extra help achieving their youthful looks.

From Sophie Monk‘s fillers to Ada Nicodemou’s ‘breast augmentation’ and Elle Macpherson’s ‘subtle rhinoplasty’, Dr Haworth pulls no punches when it comes to his professional assessments.

Just fillers! Dr Haworth believes Sophie Monk has not gone under the knife per se, and instead has indulged in non-surgical options such as cheek and lip fillers. Left: in 2002. Right: in 2011

Sophie Monk 

Dr Haworth believes Sophie has not gone under the knife per se, but instead has indulged in some non-surgical options.

‘Lips get smaller with age not bigger but Sophie has defied that natural phenomenon, probably with the help of an injectable filler – such as Juvéderm, Restylane or even fat which is permanent,’ he said.

‘I also believe another filler such as Voluma or Restylane Lyft is responsible for her more sculpted and elevated cheekbones.’

Sophie, who hails from Queensland’s Gold Coast, has admitted to having filler to her top lip in the past, following the botched removal of a cyst.

‘Half of my lip was removed with the cyst, and I was advised to get filler in my top lip to help balance it out,’ she told Who magazine in early 2011.

 
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