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.
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 includingfibromyalgia 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.
efore making a name for herself on Instagram, Tammy Hembrow starred in an outrageous hip-hop music video.
A newly-unearthed YouTube video shows the now 24-year-old letting lose in the clip for underground Aussie hip-hop band Mr Hill & Rahjconkas’ 2014 single, Non Stop.
The video was uploaded in April 2014, and five years later, Tammy is virtually unrecognisable from her former self.
Now and then: Before making a name for herself on Instagram Tammy Hembrow was starring in rap music videos. Pictured left in a 2014 music video, and right on Monday Compared to her current appearance, Tammy’s face appeared to be much fresher, bearing classic girl-next-door good looks.
Her lips appear smaller, her face is less full, and her nose looks much different.
Even Tammy’s hair is a different hue, having once been a golden blonde compared to the platinum she’s known for now.
In an interview with Daily Mail Australia in August 2018, Beverly Hills plastic surgeon Dr Randal Haworth claimed Tammy may have undergone a nose job, liposuction and dermal fillers to achieve her bombshell look.
‘Based on what I presume to be filtered photos, she has undergone a striking transformation of not only her facial features but also of her facial shape,’ Dr Haworth claimed at the time.
He added: ‘Specifically, her jawline is more defined into a “V-line”. I would even venture to say her chin has been shortened and narrowed compared to her teenage years.’
Dr Haworth also believes her V-line chin could have been achieved through either ‘liposuction or bony chin modification’.
He also acknowledged that ‘losing her “baby fat” may have been a contributing factor’ to the visible changes in Tammy’s jawline.
Furthermore, Dr Haworth claimed that Tammy may have undergone a rhinoplasty to fine-tune her look, saying: ‘A subtle, balanced rhinoplasty to narrow her nasal bones and refine her tip may have been carried out.’
He also suggested that Tammy’s cheekbones look more sculpted and angled upwards in recent photos, while her eye-hollows appear less apparent.
Both of these changes are likely to have been carried out with a filler such as Voluma or Restylane Lyft, or even achieved via fat transfer.
According to Dr Haworth, Tammy’s lips have also almost certainly been enhanced due to their ‘overly plumped’ appearance.
He claimed: ‘Like Kylie Jenner, Tammy has been originally inspired by the Angelina Jolie lip variety. Paradoxically, lips oversized for a face can mature the visage beyond its years.’
In the music video, Tammy can be seen puffing on a cigarette while swigging back drinks.
At one stage, she’s seen licking the screen of her iPhone, before another girl squirts a liquid out of her mouth into Tammy’s open mouth.
As trifling as it may seem to the layperson, aesthetic surgery is serious business. Apart from obvious cosmetic ramifications, the seriousness becomes understandable when one considers that the surgeon must first make a healthy patient temporarily unwell in order to make he or she look better in the end. It is for this very reason plastic surgeons have an added unique responsibility which surgeons of other specialties simply do not bear. Choosing to undergo elective surgery is a series of decisions made by both the surgeon and the patient. As with all aspects of medicine, nothing is absolute, it is about controlling probability.
In this day and age, patients increasingly view plastic surgery as nothing more than a haircut with a short recovery, let alone one with a complication. Even under the best of hands, a complication can arise for any number of reasons and if it does, acting as a team with your surgeon is crucial. Whether following a facelift, rhinoplasty or any plastic surgery for that matter, almost all complications can be fixed in the end, even if multiple surgical revisions are needed.
It is normal for the layman to consider surgical results as either “good” or “bad”, but those adjectives can be misleading and are certainly inadequate in revealing the true story behind the result.
“Good” surgery with a complication is not the same as “bad” surgery per se. In other words, complications do not all come from “bad” surgeons and indeed, “bad” surgeons may have successfully completed an operation without encountering obvious complications. I think it fair to say most patients consider themselves as good people and if a complication happens to them, they will perceive themselves as victims of a bad surgery and by extension, a bad surgeon. So what is the difference between “bad” surgery and a “good” surgery with a complication?
Look at it this way… in any profession, there are the “good”, the “bad” and the “excellent”. For the sake of this discussion, let’s just oversimplify the comparison between “good” and the “bad”. Since plastic surgery is as much an art (or at least an artisanal craft) as it is a science, whereby results are measured both objectively and subjectively, it is not unreasonable to compare a plastic surgeon to any artist or craftsman, including sculptors, painters and woodworkers. Artists filter their talent and vision through years of experience to not only earn but continually solidify their reputation as either being “good” or “bad”. Moreover, good artists become respected by not just producing one “good” piece but doing so consistently, whereas the “bad” consistently create sub par results as judged by the median consensus.
However, all artists, whether good or bad, are limited by the quality of material with which they work. It is known that Michelangelo’s David has been deteriorating at a far more rapid pace than would be expected because of the poor quality of its marble composition. Bernini also broke a piece of marble in half through chiseling into an unexpected vein in the stone causing him to start all over with a brand-new block. Does that make him a bad artist? Hardly not.
In other words, complications happen and that’s why there are consents to protect not only the doctor but also the patient. Consents should ensure the patients are informed as to the shared risk both they and the surgeon take when undergoing surgery.
Many complications are avoidable. Both doctors and patients must do their part to optimize a certain outcome and minimize the risk of complications. Patients must avoid certain medications that may promote bleeding, cease all smoking for optimal circulation, follow instructions and take medications as prescribed. Otherwise, surgery may be self-sabotaged. On the other hand, surgeons must do their part in educating and performing the proper operation in the right patient with skill and dedication.
Other complications are unavoidable and just because they may be explainable in hindsight does not mean they were avoidable within the context they occurred. This is why it is paramount that patients disclose all of their medical history and follow their surgeon’s instructions to a T in order to minimize unexpected situations such as abnormal bleeding, poor wound healing, etc..
What spurred me to write this particular blog was a recent experience having performed a complex revision rhinoplasty on a dear friend of mine of 20 years. Unfortunately, this advanced detailed nasal reconstruction was exacerbated by unexpected physiological conditions including excessive bleeding and poor tissue characteristics. The next day, the patient presented with so much swelling underneath the pressure cast that it was being pushed off the face. The swelling was a hematoma which I immediately evacuated from under the skin (it was 4 1/2 mL, being the largest nasal hematoma encountered by either my colleagues or myself). Accompanying this was necrosis (death) of the columellar skin (the partition separating his left and right nostrils). This was particularly disappointing to say the least because the surgical results in terms of nasal shape, symmetry, tip definition and projection were otherwise excellent. Yet losing coverage over the columella would have serious ramifications.
Despite attempts to bring vascularized tissue using local intraoral flaps, my friend eventually needed the help of a certain specialist to bring fresh tissue to the columella below the nasal tip with a temporary forehead flap.
Albeit exceedingly rare, this 1.5 x 1.2 cm skin loss was enough to eradicate not only their trust in me as a surgeon but also our long term friendship. Most patients understandably experience a spectrum of emotions including panic, sadness, denial, anger and ultimately acceptance from a complication such as this. However, nothing could prepare me for the degree of ongoing vengeful anger and hostility the patient and their partner have directed towards me including threats to go to the press and ruin my reputation.
Anger is not only destructive but also lacks focus, therefore it can be especially counterproductive to both healing and a good result (not to mention friendship!). Premature castigations of blame fuel brash, illogical decisions which actually complicate the original complication.
Understanding the differences between “bad” and “good” surgery and “good” surgery with a complication can certainly help put things in perspective. When a patient concedes the net surgical aesthetic result, at least in terms of shape and symmetry, as good if not excellent, he or she is less likely to question, and more likely trust, their original choice of surgeon. Whether their breast lift incision opened or, as in this case, a small but strategic portion of nasal skin died, the affected patient will see the “bigger picture” and believe their surgeon will do the right thing by having their best interests at heart. This same patient understands that they were not necessarily a victim or unjustifiably punished by “bad” surgery. Instead, they will accept things for what they are, learn patience and develop a sense of optimism to set themselves up for the best possible outcome in the future.
The majority of complications concern wound healing and minor infections. For these, possible antibiotics and the “tincture of time” for healing to occur are required. Other times, simple, clinical interventions such as laser treatment, injections, the occasional scar revision and creams are all that are needed.
Other complications require more invasive solutions. Depending on the type of complication, an expeditious trip to the operatory maybe all that is required (e.g.,to drain a hematoma) whereas staged surgical revisions may be undertaken in the extremely rare case of tissue loss.
Most surgeons will recognize if a particular complication is beyond their level of expertise. A patient should not feel abandoned or simply passed off if they are referred to another expert if a complication warrants it. It is important to recognize that medicine is team work and the referral is simply a reflection of the original surgeon’s dedication to the best outcome possible.
Emotional advice after a complication
–Watch out for advice with an agenda. It is understandable that if a complication does arise, fear and anxiety will prompt you to seek solace and advice from friends and family members. While this is wholeheartedly encouraged, it is important to remember that not all the advice given is good especially considering that those giving advice are not often doctors nor do they know the intricate details of the patient’s particular case. Though most advice is well-meaning in intent, some may be motivated by guilt, jealousy, personality disorders or just plain ignorance. Furthermore, the advice a patient may obtain from elsewhere may be counterproductive because it may only increase their level of anxiety.
–Stay optimistic and avoid jumping to any pessimistic conclusions. It is not unheard of that acute anxiety will provoke a patient to impatiently reach for the help of an alternative plastic surgeon. Unfortunately, some plastic surgeons may be unscrupulous and advise the fragile, highly suggestible patient into unnecessary and ill-timed surgery claiming it is urgently needed to prevent some permanent deformity. Always keep a line of communication open with the original plastic surgeon to not only help allay personal fears but also be guided in the right direction with a second opinion if necessary.
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:
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 veinsutilizing 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 improvementthrough 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
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
What is wrong with this revision breast implant and lift surgery I performed?
According to this patient, apparently everything!
At first, this patient came to me with ostensibly straightforward requests to “make” her breasts smaller and “better-shaped” in accordance with her body frame. Of note, she had undergone a previous “above the muscle” breast augmentation which, in my humble opinion, left her with a net result of breasts which were too big, too round and too fake. In essence, her breasts did not lend to a pulchritudinous appearance and that is why she sought my expertise in the first place. Indeed, she wanted to get remarried after having children and was seeking “christian boobs” to attract a decent husband. So I did what any self-respecting, honest and aesthetically minded board certified plastic surgeon would do and that was to perform a capsulectomy (remove her collagenous scar capsules), substitute her overfilled saline implants with smooth Memory Silicone Gel implants placed “under the muscle” and conclude with a bilateral mastopexy (breast lift). I thought the surgery was an unqualified success and, further punctuated by her exceptional healing vis-à-vis scarring.
So why was she unhappy? I was thoroughly puzzled since we both had extensive discussions prior to the surgery about the usual risks, alternatives and benefits including what she exactly wanted from the surgery. I know she wanted to go smaller (check), she wanted to be natural (check), she wanted to appear more youthful and perky (check) and indeed she conceded that I did achieve these goals. However,she also expected her breasts to be firm and more round –she felt that her result was too natural, both in look and to touch and therefore something went wrong.
But after further, protracted postoperative conversations with her, I realized where the disconnect was. I did not give her what she exactly wanted from the surgery because I gave her what she askedfor and not what she wanted. In essence, this was a story of missed and unrealistic expectations.
More and more of these situations arise in a plastic surgery practice simply because unrealistic expectations are instilled in us 24/7 by social media. The main platforms culpable for this insidious brainwashing are the mobile apps Instagram, Snapchat and YouTube with their interminable repository of Photoshopped/FaceTuned manipulated models and instructional contouring videos. Young women come to me wanting cheekbones, buttocks or breasts like Abigail or Jocelyn Instastar simply because they are famous and therefore more popular and loved.
Indeed, one patient requested Bella Hadid’s nose even though, in my opinion her rhinoplasty ended up with an “inverted V” deformity and a somewhat pinched, boxy tip. However, it did not matter to her because she considered Bella her idol andwas willing to accept a possible substandard result with potential nasal obstruction. Ah, the power of celebrity!
Recently, I had the experience of operating on another young woman who had beautifully shaped breasts with a natural cleavage. She wanted to go only slightly bigger yet have a bigger gap between her breasts. The surgery went flawlessly but the patient was dissatisfied. She agreed her breasts were fuller with a wider cleavage but she now voiced that I should have known all along she wanted her breasts to look fake, round and hard! After this perplexing conversation, I sat down and pondered the meaning of what I really do.
It is one thing to make abnormalities such as unnatural breasts look natural but it’s another thing altogether to make natural looking breasts look deliberately unnatural and possibly unappealing. For decades, I have endeavored to create natural results by making the deformed normal and the normal beautiful but now a new aesthetic standard has emerged in our culture and ultimately, it may not have positive consequences.
But who am I to judge? Fake is the new real.
Randal Haworth MD, FACS