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.

 

According to Beverly Hills-based plastic surgeon Dr Randal Haworth, Tammy seems to have achieved a flat stomach naturally.

 

How Instagram sensation Tammy Hembrow, 24, achieved a flat stomach after giving birth without a tummy tuck

She’s the Australian Instagram sensation who built her own fitness empire from the ground up.

And so it comes as no surprise that Tammy Hembrow has an incredible figure and washboard abs – even after having two children.

But many fans will be surprised to discover the 24-year-old was able to achieve her post-baby physique without the help of a tummy tuck.

   

According to Beverly Hills-based plastic surgeon Dr Randal Haworth, Tammy seems to have achieved a flat stomach naturally.

The main reason the businesswoman was able to bounce back so well is because of her relatively young age, he claimed.

‘Some are blessed with better genetics than others. It also doesn’t hurt to have youth on your side,’ Dr. Haworth said.

‘It may be hard to believe but I have seen a number of patients similar to Tammy who have rebounded remarkably well after a pregnancy without the help of plastic surgery.’

Expert opinion: The main reason the businesswoman was able to bounce back so well is because of her relatively young age, Dr Haworth claimed

He added: ‘Their abdominal musculature regains its strength and the skin tightens with little-to-no stretch marks.

‘Indeed, the only thing which has remained after Tammy’s pregnancy is her umbilical hernia.’

Tammy shares two children with her ex-fiancé Reece Hawkins: two-year-old daughter Saskia and son Wolf, three.

  Family: Tammy shares two children with her ex-fiancé Reece Hawkins: two-year-old daughter Saskia and son Wolf, three

Busy mum! Tammy revealed last year that it can sometimes be hard to find time to exercise

Tammy told New Idea last year that it can be hard to find time to exercise.

However, she suggested that busy mothers should try and squeeze in lounge room workouts whenever they can.

‘I honestly feel better when I get my workout in, less sluggish and I find it easier to keep up with my kids,’ she said at the time.

‘Whether it’s a gym workout or HIIT home workout I always try to fit it in when I can.’

‘I honestly feel better when I get my workout in’: However, she suggested that busy mothers should try and squeeze in lounge room workouts whenever they can .

‘It’s clear as day he’s had a nose job’: Celebrity plastic surgeon exposes the clues that imply Ian Thorpe has gone under the knife

As one of Australia’s most recognizable Olympians, Ian Thorpe turned heads when he seemed to debut a new nose last week. While the 36-year-old has yet to comment on his ‘new’ look, celebrity plastic surgeon Dr Randal Haworth believes it’s clear that the star has gone under the knife.

‘It is clear as day that Mr. Thorpe had a rhinoplasty,’ Dr Haworth exclusively to Daily Mail Australia on Tuesday. Dr Haworth went on to explain what he thinks are tell-tale signs Ian has had a rhinoplasty. ‘The dorsal hump of his bridge has been significantly lowered so that his tip now over projects from his face,’ he claimed. He also perceived that Ian’s nose displays ‘an obvious inverted V deformity’ on its bridge and a ‘step off from the nasal bones onto the cartilage portions below.’

‘Usually, this is associated with some breathing obstruction in his nose and is more often than not caused by a rhinoplasty performed through a ‘closed’ technique,’ he said, adding: ‘This is where a plastic surgeon performs the nose job solely through incisions confined to the inside the nose.’ Dr Haworth went on to reveal that an ‘open’ technique allows the surgeon better visualization and direction over both the shape of the nose and its use of breathing.

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