REVEALED: Shane Warne, 49, debuts his whopping ’15kg weight loss’ – achieved via a series of VERY unorthodox methods

Spin king Shane Warne, 49, has lost a whopping 15 kilograms by following a number of unorthodox methods.

Woman’s Day magazine reported on the father-of-three’s impressive achievement on Monday, breaking down the cricket legend’s keys to success.

According to the publication, Shane credits alternative wellness products, fasting, and even Channel Nine personality Eddie McGuire, for his slim-down.

Slim Spin king! Shane Warne, 49, has lost a whopping 15 kilograms by following a number of unorthodox methods 

The retired icon reportedly underwent a dramatic fasting diet inspired by friend Eddie McGuire’s ‘101 Wellbeing’ Program. 

He has also been indulging in detoxifying Chinese green tea and a ‘liquid herbal supplement,’ the magazine reports.

Shane’s weight has fluctuated dramatically over the years, with a significant weight gain back in 2017 the last to be widely reported on.

Alternative wellness! According to a new report, Shane is using detoxifying Chinese green tea and a ‘liquid herbal supplement’ to shed the kilos. (L) In 2017. (R) Last week 

Shane openly joked about his weight at the time  – notably during an idyllic vacation with his children in Spain.

‘Auditioning for the Baywatch with big bellies movie hahah,’ part of his post read. 

But weight loss isn’t the only well documented cosmetic struggle the retiree has encountered over the years. 

Health and fitness:  The retired icon also reportedly credits a dramatic fasting diet inspired by his friend Eddie McGuire’s ‘101 Wellbeing’ Program

It’s long been speculated that Shane dabbled in cosmetic surgery, including injectibles such as Botox and filler.

Speaking to Daily Mail Australia in July last year, Beverly Hills cosmetic surgeon Dr. Randal Haworth suspected he had enlisted a little help.  

‘I suspect that he has dabbled with Botox and perhaps some fillers here and there,’ he exclusively told Daily Mail Australia.

‘While women’s faces tend to look younger and softer with the right amount of fat, men’s faces tend to look better with weight loss,’ he said. 


A little help? But weight loss isn’t the only well documented cosmetic struggle the retiree has encountered over the years – Shane has long been accused of cosmetic work


‘Shane’s is no exception – his face has become more chiseled, defined and handsome,’ he added.   

Shane has always denied all allegations of cosmetic surgery, with one such denial airing on I’m A Celebrity… Get Me Out Of Here! in 2016. 

 ‘Everyone says, “look what Warne’s done to his face. What’s he done to his head? Lay off the Botox. Get rid of the facelifts. He’s had fillers” and I’m like if I wanted to have some, I would have no issue and if someone asked, I’d say, ‘Yep, I’ve had some. But until then…”‘ 

Rumour has it: He previously sparked surgery speculation when he appeared to have undergone a major physical transformation while dating Elizabeth Hurley (R) 

‘How many facelifts has he had?’ Fans accuse Alex Perry of having MORE plastic surgery – as he looks noticeably puffy on The Kyle and Jackie O Show

Fashion designer Alex Perry has made no secret of the fact he relies on fillers and Botox to achieve his unique appearance.

And during an interview with The Kyle and Jackie O Show on Monday, the 56-year-old raised eyebrows when he displayed a noticeably puffy visage.

After in-studio footage was shared to Instagram, KIIS FM listeners soon began accusing Alex of overdoing the cosmetic work and having one too many ‘facelifts’.

‘How many facelifts has he had?’ Fans have accused Alex Perry of having more plastic surgery, after he looked noticeably puffy during a radio interview on Monday (right). Left: Alex in 2018

‘How many facelifts has he had?’ one fan asked, prompting another to comment: ‘He looks like an old sock.’

It comes after a leading plastic surgeon accused the fashionista of ‘excessive’ use of anti-wrinkle injections last year. 

Dr. Randal Haworth observed that Alex looks remarkably different in before and after photos and may have taken things too far. 

The Beverly Hills-based surgeon also claimed that Alex’s face now looks rather ‘crowded’ as a result of ‘too much’ filler.

That’s gotta hurt! After footage of Alex’s interview with The Kyle and Jackie O Show was shared to Instagram, fans soon began accusing him of having one too many ‘facelifts’

Candid: Alex (pictured on Kyle and Jackie O) has made no secret of the fact he relies on fillers and Botox to achieve his unique appearance

‘There is no denying that Mr. Perry has undergone significant change to his countenance,’ Dr. Haworth said at the time.

‘Compared to his younger self, his face is now “crowded”, making his eyes appear smaller and closer set.

‘Most likely, a generous recipe of injected filler and more than a drizzle of Botox in and around his forehead, brows and temples contributed to this look.’

‘Compared to his younger self, his face is now crowded’: Last year, plastic surgeon Dr. Randal Haworth criticised Alex’s ‘excessive’ use of Botox and fillers. Pictured left: Alex in March 2002, and right:in September 2017

‘Additionally, his mid-face (the area between his lower eyes and upper lip) has been amply plumped to attain the “apple cheek”, a feature I feel is best left flatter in men,’ he added.

Dr. Haworth went on to say that it’s hard to determine whether Alex’s cosmetic work is permanent or temporary.

‘Hopefully the fillers used to obtain Mr. Perry’s current look are absorbable and therefore temporary,’ he said. ‘However, if fat was used (which is a permanent, living filler) his options, unfortunately, will be more limited.

Alex, whose celebrity fans include Rihanna and Kim Kardashian, told Yahoo Lifestyle in 2013 that he is not ashamed of using fillers and Botox.

‘There is nothing not real, there are a few fillers and there is a bit of Botox but that’s that. That’s normal, right?… It’s all real. It’s all real,’ he said.

In 2016, the Australia’s Next Top Model judge was criticised for his appearance by one of the show’s contestants, Kassidy Ure.

After Alex criticised one of her photos, she sniped back: ‘At least my lips are real!’ 

Unashamed: Alex, whose fans include Rihanna and Kim Kardashian, said in 2013 he is not ashamed of using fillers and Botox. Pictured left in March 2005

Born to be wild! Tammy Hembrow looks unrecognisable in a newly unearthed hip-hop music video from 2014 – which shows the fitness model smoking and drinking

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.

Wild child: In the music video, Tammy can be seen puffing on a cigarette while swigging back drinks

Natural beauty: Compared to her current appearance, Tammy’s face appeared much more natural looking, bearing classic girl-next-door good looks

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.’

Golden girl: Even Tammy’s hair is a different hue, having once been a golden blonde compared to the platinum she’s known for now

Helping hand: 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

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.’

Finger licking good: At one stage in the music video, she’s seen seductively licking the screen of her iPhone

Sharing is caring: Another scene from the music video shows a girl squirting a liquid out of her own mouth and into Tammy’s open mouth

‘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 told Daily Mail Australia

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.

Giving cheek: Dr Haworth has also suggested that Tammy’s cheekbones look more sculpted and angled upwards in recent photos, while her eye-hollows appear less apparent

Drink up: The hard partying music video shows Tammy having drinks poured directly into her open mouth

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.  

Lip service: According to Dr Haworth, Tammy’s lips have also almost certainly been enhanced due to their ‘overly plumped’ appearance

MADONNA’S transformation



Who’s that girl ?”

Buffaloed by father time and rattled by the success of her nemesis Lady Gaga, insiders dished Madonna has invested in a massive cosmetic makeover to word off a crippling to experts , the “crazy for you ” singer has gone crazy for youth-enhancing procedures , and likely gone under  the knife for an eye lift , brown lift and face- lift plus filler injections ” she looks completely unrecognizable ! tattled a source close to the 60 year old material granny “.

“Madonna has had a ton of work done , but it hasn’t been flattering . she’d do better to just grow old gracefully !!”

Leading celebrity plastic surgeon Dr .Randal Haworth agreed. “No mere mortal would look as smooth and tight as Madonna appears without cosmetic intervention” said the Beverly Hills – based surgeon known for the reality TV  series “The Swan”. “The outer edge of her lower eyelid has been lifted and pulled away from the socket. This was done to tighten and elevate the lower lid into a tilted almond shape. I also suspect a brow lift to accentuate her outer eyebrow arch.”

“The outer edge of her lower eyelid has been lifted and pulled away from the socket. This was done to tighten and elevate the lower lid into a tilted almond shape. I also suspect a brow lift to accentuate her outer eyebrow arch.”

Dr . Matthew Schulman ,a new York – based board – certified plastic surgeon , estimates the ” like a virgin ” singer spends upward of 10,000$ on her face each month , thanks to a regular battery of filler injections !

Dr . Haworth also noted the entire shape of Madonna’s face has been altered , saying : “it’s more slender and definitely tighter with a conspicuous absence of jowls and natural folds ! these are the signs of a face – lift! “

The former blond bombshell has also dyed her hair and opted for a new hairstyle that ” conveniently hides her face – lift scars ,” he added . recently the national enquirer revealed the matronly star was sporting a Colossal new caboose –with Dr . Anthony Youn pointing out that the excess junk in Madonna’s trunk was due to either butt implants or massive pads in her pants !

The “into the  groove ” singer has even given herself a new  pair of hands , as enquirer readers learned last summer ! her mitts look ” smoother and more youthful  than they have in years ! ” said Dr . Youn .

The insider sniffed : ” its all part of an effort on her  part to try to find the fountain of youth ”

Bride Reba’s

Bride Reba’s 275$ g

Body makeover!

Beaming bride –to-be Reba McEntire is getting fancy for her big day with a brand – new face and body!

The redheaded country queen , 63 bounced back from heartache last year with Anthony “Skeeter ” Lasuzzo , after the collapse of her 26- year marriage to Narvel Blackstock in 2015 .

Now insiders say the 68 year –old retired geologist has popped the question – and Reba wants to look nothing short of perfect when they tie the knot !

The rumor has it singer stopped believing in happy endings , according to pals . but now she’s changed – in more ways than one !

” Reba looks like a new woman ” dishes an insider .

“she is positively glowing – and that’s not just from her happiness alone !”

Plastic surgeon Dr . Randal Haworth, who hasn’t treated the star, tells Globe: ” it’s clear she underwent a rhinoplasty to refine her nose .”He also observes her eyebrows appear to be higher than before and notes, “this could have been done with Botox or more likely an actual surgical brow lift !”

Country queen wants to look perfect on big day

Dr . Haworth believes changes in her lower lids are the result of eye tucks and pinpointed ” tell tale”  signs she had a facelift, including “subtle scars and unnatural folds in front of her ear.” The Beverly hills –based surgeon says Reba’s ” fuller face” could be the work of injectable fillers and noted a tummy tuck would add as much as 25,000$ to her massive makeover tally .

And Reba’s curvy new figure could also be the work of an expert , according plastic surgeon Dr . Yoel Shahar , who says , ” I believe she’s had breast augmentation .she has a fullness now that was absent before “

“Reba really didn’t believe she’d find true love again .”

Dishes a friend ” now I’ve never seen her more excited about the future !”

EXCLUSIVE: ‘Her features are sublime’: Beverly Hills cosmetic surgeon claims Kyly Clarke may have had a little help achieving her flawless appearance

She is one of Australia’s most glamorous women, but has Kyly Clarke (née Boldy) had a little help achieving her flawless appearance?

According to Beverly Hills plastic surgeon Dr Randal Haworth, the cricket WAG, 37, has seemingly undergone subtle changes over the years.

Speaking exclusively to Daily Mail Australia, Dr Haworth claimed that Kyly appears to have invested in non-surgical lip fillers.

EXCLUSIVE: ‘Her features are sublime’: A Beverly Hills cosmetic surgeon has claimed Kyly Clarke may have had a little help achieving her flawless appearance. Pictured left: in an old Captain Snooze commercial, and right: in a recent Instagram photo ‘Kyly, needless to say, is a very attractive young woman, and the envy of both men and women alike,’ Dr Haworth began.

‘Her features are sublime with a defined jawline, classic cheekbones and the most alluring of feline eyes.’

He observed: ‘Certain photographs of Kyly suggest she may have had her lips plumped with a filler of sort, most likely a hyaluronic acid such as Juvéderm.’

Plump pout: Speaking exclusively to Daily Mail Australia, Dr Randal Haworth claimed that Kyly appears to have undergone non-surgical lip fillers. Pictured in a recent Instagram photo Changes: Dr Haworth observed, ‘Certain photographs of Kyly suggest she may have had her lips plumped with a filler of sort, most likely a hyaluronic acid such as Juvéderm’. Pictured left: in a KFC commercial from circa 2010, and right: in a recent Instagram photo

‘Hopefully this is just lighting and lip gloss because Kyly’s lips need no help in the beauty department!’ he added.

Last year, another cosmetic expert, Dr Meaghan Heckenberg, told Woman’s Day she ‘suspect[ed] Kyly had some jaw slimming with Botox’.

Kyly has never admitted to having plastic surgery, but she told Daily Mail Australia in an April 2016 interview that she was open to the idea.

Refined features: Last year, another cosmetic expert, Dr Meaghan Heckenberg, told Woman’s Day she ‘suspect[ed] Kyly had some jaw slimming with Botox’. Pictured recently on Instagram

‘I think at the end of the day, each to their own. I don’t knock anyone for doing whatever they choose to do. If that’s what you want to do with your life, that’s okay,’ she said at the time.

She added that her Maltese heritage was the secret behind her ageless complexion: ‘I am lucky with my skin. My mum is Maltese and she has really really good skin.’

Kyly, who is a former model, has been married to retired cricketer Michael Clarke, 37, since 2012.

Never say never! Kyly has never admitted to having plastic surgery, but she told Daily Mail Australia in an April 2016 interview that she was open to the idea


Birthday girl Ellen

Gets new $1m face!

Talk show queen Ellen Degeneres has gifted herself with a new million – dollar face for her 61st birthday in January. Terrified she ‘ll be dumped by her 15- years – younger wife Portia de Rossi , Ellen has erased the ravages of time with extensive plastic surgery , sources say .

Now top doctors tell Globe the Funny Gal looks younger than ever !

“It’s quite obvious she underwent a full face lift ___ and everything else , as well !” noted new York plastic surgeon  Dr. Yoel S. Shahar dishes to Globe .

He believes the chat-fest diva has also had a neck lift , forehead lift, brow lift, eyelid  surgery, fillers and a chemical peel to smooth out the area around her lips.

” She’s had almost everything done that can be done __ and  I suspect a nose  job, too , ” adds  Dr. Shahar, who has not treated Ellen .

Top Beverly Hills plastic surgeon Dr. Randal Haworth says the hint of scars around Ellen’s ears indicates a face-lift .

” Her smooth facial appearance firm firm jawline  and barely there jowls are unusual for a person of Ellen’s age and provide further evidence that she had a face-lift ” says Dr. Haworth, who has not treated her .

Dr. Shahar estimates Ellen coughed up close to 50000$ on her most recent cosmetic tweaks __ and that’s on top of previous pricey procedures !!

The former stand- up comic reportedly went under the knife in 2014 and had even more work done in 2015 !

“The noticeable scars on her neck are most likely a result of a face –lift and / or neck lift “

Renowned New York City plastic surgeon Dr. Ramtin Kassir , who has not treated Ellen , said at the time. ” Her neck and jawline appear rejuvenated and defined. She doesn’t  have sagging skin  and her skin appears smooth and wrinkle-free “.

Adds  a source: “Over time , Ellen has spent at least 1$ million on her face alone !

” She ‘s very much aware of the age difference between her and Portia. She’ll do anything to turn back the hands of time – and money is no object!”

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  

Beautiful Upper Lip Lifts without scars?

When we choose to undergo a plastic surgical procedure, we do so to get a beautiful result which is balanced for the face and one that is as permanent as possible and one which doesn’t interfere with function. I don’t think anyone would argue with the above. Lips are a unique anatomical future. They connote youth, beauty and sexuality. However, their job is not only to look beautiful, they have to also function. This is contrast to a nose or an ear which have no moving parts. And as a plastic surgeon helping to advance the field of lip reshaping surgery (LRS), this is where the challenge lays. When a patient asks me to make them a beautiful set of lips, I have to ensure:
  • a. A beautiful upper lip
  • b. A beautiful lower lip
  • c. Both upper and lower lips harmonize with each other
  • d. The harmonizing upper and lower lips harmonize with the surrounding face in terms of shape and scale (volume)
  • e. The upper and lower lips continue to harmonize well into the future (akin to a long-lasting result)
  • f. Scars are as imperceptible as they can be
  • g. The chance of nasal distortion and other complications are kept to a bare minimum
  • h. Lip function is retained (perhaps even improved with the new found confidence!)
  • i. Recovery is minimized whenever possible
  • j. A patient’s expectations are aligned with reality.
(Of course, “j.” should be at the top of the list. If a patient has unrealistic expectations, then no matter how successful a surgery is, if a patient in the end is dissatisfied, the surgery is a failure to them). One of the cornerstones of lip reshaping surgery is the upper lip lift. Most of us appreciate that beauty is mostly conferred through shape and less so by colour and volume. The lips are no exception. An upper lip that is considered beautiful on a primal, instinctual level is one comprised of a short nose-to-lip distance, a beautiful “O” arch, a visible vermilion balanced with the size of the lower and, of course, an appropriate upper tooth exposure. Sexy After performing thousands of upper, corner and lower lip lifts, the secret to unparalleled longevity and a naturally beautiful lip shape is stability. One must understand that, like the hands, the lips move hundreds of thousands of times a day- eating, talking, expressing and other things that shall go unmentioned in this post. Therefore, for an upper lip lift to be successful in terms of beauty and longevity, it should not only resist the downward pull of gravity but also be stabilized against everyday movement (which contributes to re-stretching of the lip, obvious wide scarring and downward pull on the nose). The OOS (Orbicularis Oris Suspension) superficial muscle technique provides this very stabilization by anchoring the superficial layer of Orbicularis Oris just below the dermis to the periosteum (or lining of the bone) below the nose. (The Orbicularis Oris is the circumferential, sphincter muscle that surrounds the oral aperture). By stabilizing the lip in two directions bilaterally I am able to customize the curl and expression of the upper lip to make it not only youthful but sensual as well. The two direction approach is analogous to the way a marionette can come to life by the hands and strings which control it. The skin-only lip lift is a far simpler operation to perform and solely involves removing skin and sewing the skin edge of the lip to that of the bottom of the nose. The only thing holding the skin-only lip lift in position are the dissolvable stitches in the dermis which are no match against constant daily mouth movement and gravity’s pull. As a result, there is a far greater likelihood of the nostrils being pulled downwards, obvious scarring, significantly decreased longevity and suboptimal aesthetics.
After a "modified "upper lip lift
After a “modified “upper lip lift by another Beverly Hills Plastic surgeon, which is basically a skin-only lip lift marketed as something other than it really is. Note severe right nostril pulldown with bizarre pleat along with an “A frame” deformity and an exacerbation of her downward slanting can’t of her upper lips.
I can personally attest to the dramatically decreased longevity, unremarkable results, worse scarring and nasal distortion from the thousand or so skin-only lip lifts I performed in the 90s. Though the skin-only  recovery is easier, the current version of the OOS upper lip lift may allow the patient to appreciate results as early as 10 days. Not only does the OOS technique shorten the distance between the nose and lip but it also allows upper tooth show( that goes without saying really), subtle added rollout of the upper lip’s pink vermilion, welcomed narrowing of the aperture of the mouth (that gets wider with age) and even noticeable reduction in the nasolabial folds. Contrary to some misperceptions, no muscle is removed and no cases of permanent numbness or any paralysis ever encountered.
After an OOS upper lip lift by Dr Haworth. Note minimal scar and no nostril descent
Upper lip lift enhancement
After an OOS upper lip lift by Dr Haworth. Note minimal scar and no nostril descent
More and more people are realizing that the upper lip lift( and other LRS techniques) may play as important a role as a facelift and eyelid surgery in facial rejuvenation. Choosing proper techniques, performing them well and understanding how all elements of the lip work together can be the ultimate magic trick to transform a face from “Meh to Mwah”! Dr Haworth July 2018

Difference between Bad Surgery and Good with a Complication.

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.

The arrows on the drawing illustrate that portion of the nasal skin (overlying the columella) that was necrotic. Replacement is required through vascularized tissue flaps

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.

“A good patient is an educated patient”-

Randal D. Haworth M.D., F.A.C.S.

Board Certified Plastic Surgeon

Beverly Hills

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