Has the Upper Lip Lift gone Mainstream?

Blanketing Instagram may be the pout of the moment: an ample, upturned mouth revealing front pearly whites. It’s a look that has generated a fresh trend in cosmetic surgery: the lip lift. “Social media is driving a whole lot of esthetic selections,” says Andrew Jacono, a Park Avenue cosmetic surgeon, but “the voluptuous lip is not something you may get with injections. Filling lips only makes them appear to be sausages but doesn’t change their condition. Only the upper lip lift can naturally turnthe lip up and out.” The 30-minute office procedure excises tissue from just underneath the nose to shorten the distance between nose and mouth, causing the top lip to relax a bit, exposing more teeth, or “tooth show.” In Gen Z’ers and young millennials, it gives an ideal selfie pout; in older candidates, it can shave up to 7 years from the countenance ($3,000-$10,000).

As upper lips age, they elongate to eventually hide the upper teeth, while lower lips drop to expose the bottom teeth. Beverly Hills plastic surgeon Randal Haworth says lips, like breasts, go over time south. “When Angelina [Jolie] was 19, she had an insouciant mouth and had the Bardot upper tooth exposure ,” he says. “Nowadays her lip is starting to hide her teeth. It is the same with Jane Fonda.” Jacono offers that face-lifts improve the corners of the mouth but don’t address the problem: “Shortening the top lip is probably the most effective esthetic procedures I really do.”

Some surgeons will work with dentists to coordinate how much teeth to show.

“Showing 2 millimeters of tooth while you are at rest is ideal,says Manhattan esthetic dental professional Lana Rozenberg, who claims patients once requested heavier veneers to push away the lip for pout.

Now the Bugs Rabbit look can’t be avoided can be avoided, with surgeons just like NYC’s Oren Tepper working with esthetic dentist Jonathan Levine to open LipSync. “Ten years past, there was an ‘aha’ moment when hands were an era giveaway. Now we realize the mouth is a lot more telling, ” says Tepper.

A before and after of a conservative upper lip liftA before and after of a conservative upper lip lift
A conservative upper lip lift result accompanying the Hollywood reporter article, performed by another plastic surgeon. result accompanying the Hollywood reporter article, performed by another plastic surgeon.

There is one disadvantage to a lip lift; its scar. “You can hide part of the incision inside the nostrils, but there is usually always some visibility at the bottom edge of the nasal area, ” says Beverly Hills cosmetic surgeon Leif Rogers, adding “If not done properly, it can change the look of the nose. “

Dr. Haworth acknowledged this as a problem about 15 years ago, ever since patients began complaining of this subtle nasal change. He realized there were two factors playing a part in this:

  1. Excess tension around the incision line where the upper lip attaches to the nose and …
  2. When the incision is made into the nose in a good faith attempt to hide the scar.

This led him to evolve his methods as a necessity to meet the increasingly discerning tastes of his patients. “Cutting into the nasal still can be a disaster even though it is motivated by goodwill towards the patients. By cutting into the nose, it breaks the circular stability of the nostril itself thus allowing it to “unfurl” and migrate inferiorly.

Another thing I have discovered is that when a lip lift is performed, it mustn’t just resist the downward forces of gravity but it must also resist the hundreds of thousands of mouth movements that occur per day. That’s why I needed to develop the OOS Upper Lip Lift which involves securing the upper lip to the strong lining of the bone around the base of the nose (periosteum). This technique is clearly superior to any skin-only lip lift whether it is modified or not. This results in a superior results in terms of beauty, scarring, lack of nasal distortion and longevity.

http://upperliplift.com

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

‘What’s happened to her face?’ The Voice fans accuse Delta Goodrem, 34, of getting cosmetic work – after she displayed a VERY plump pout and smooth skin on launch night

She has refused to comment on plastic surgery speculation over the years.

But Delta Goodrem came under scrutiny yet again on Sunday, when viewers accused The Voice coach of undergoing ‘cosmetic work’ after seeing her on launch night. 

Fans flocked to Twitter to claim that the 34-year-old singer has had ‘too much work’ done to her face, with one person observing she has a fuller top lip. 

‘What’s happened to her face?’ The Voice fans have accused Delta Goodrem, 34, of getting cosmetic work after she displayed a very polish appearance on launch night. Pictured left: on The Voice, and right: in 2007

‘Delta has had more work done. Can’t work it out… she doesn’t need to do anything she’s beautiful!’ another added. 

‘Top lip? Was thinking that,’ wrote a third eagle-eyed fan, before somebody else asked: ‘What happened to Delta’s face? #toomuchworknow.’

Speculation: Bewildered fans flocked to Twitter after Sunday’s episode of The Voice to claim that Delta ‘has had more work done’

It’s not the first time Delta has sparked cosmetic surgery speculation. 

Last year, a leading plastic surgeon speculated that the Born To Try hitmaker may have invested in some cosmetic tweaks over the years.

Dr. Randal Haworth told Daily Mail Australia he had a ‘strong hunch’ Delta may have undergone a rhinoplasty, as well as cheek and lip fillers.

Claims: Last year, a leading plastic surgeon claimed that Delta may have undergone a nose job in addition to cheek and lip fillers. Pictured left: on The Voice, and right: in April 2003

‘Certain angles may be more revealing than others, but I have a strong hunch she has undergone a rhinoplasty because the shape of her tip is more demarcated from the rest of her nose while her bridge is noticeably narrowed,’ he said at the time.

‘These are the types of characteristics that would make any plastic surgeon suspicious,’ he added. 

Dr. Haworth also believes the songstress may have indulged in some other non-surgical cosmetic procedures.

Hmm! ‘I find it apparent that both her cheekbones and her lips have been enhanced with a temporary filler,’ Dr. Randal Haworth said. Pictured left: on The Voice, and right: in 2003

He claimed Delta’s full cheeks and plump pout could be the result of temporary filler.

‘I find it apparent that both her cheekbones and her lips have been enhanced with a temporary filler, most likely of a hyaluronic acid variety such as Juvéderm or Restylane,’ he said.

‘Celebrities with busy schedules oftentimes can’t afford the recovery time needed to undergo fat transfer for more permanent results,’ he explained.

Daily Mail Australia has contacted Delta Goodrem’s management for comment. 

Could it be? Delta sparked speculation with her plump lips and incredibly smooth complexion 

Married At First Sight’s Jessika Power looks like a human Barbie doll as she poses in racy lingerie… after splashing out $25,000 on cosmetic treatments

She recently confessed to spending $25,000 in a cosmetic surgery binge.

And Married At First Sight’s Jessika Power looked like a human Barbie doll in a video shared to Instagram on Tuesday night.

The 27-year-old flaunted her plump lips and hourglass figure in throwback footage from her recent NW magazine photo shoot.


Plastic fantastic! Married At First Sight’s Jessika Power looked like a human Barbie doll in a video shared to Instagram on Tuesday night

Posing in the makeup chair, the platinum blonde bombshell cast a sultry gaze at the camera before revealing her lacy white lingerie. 

On Monday, Jessika confirmed she had spent $25,000 on a new set of veneers, two rounds of dental work, cheek and lip fillers, Botox and a brow lift.

After undergoing the cosmetic procedures in quick succession, she looks almost unrecognisable today compared to photos taken just a few years ago.


Showing off: Posing in the makeup chair, the platinum blonde bombshell cast a sultry gaze at the camera before revealing her lacy white lingerie

Transformed: On Monday, Jessika confirmed she had spent $25,000 on a new set of veneers, cheek and lip fillers, Botox and a brow lift. Pictured right: in April 2019, and left: in August 2017

She told NW magazine that relentless trolling about her appearance on MAFS left her feeling ‘shaken to the core’. 

‘I’m a confident girl, but having thousands of people criticise me each day has shaken me to the core. I felt like I had heaps wrong with me afterwards,’ she said.

The Perth-born model added that she felt insecure about her looks partly because of the man she was previosuly dating: Daniel Webb.


‘I felt like I had heaps wrong with me’: Jessika told NW magazine that constant trolling about her appearance during MAFS made her feel ugly and insecure

‘Dan’s exes were all beautiful, including a Playboy bunny. I looked at pictures of her, then looked at myself and thought, “I look boring”,’ she confessed.

‘He would get Botox done on his forehead too and I felt I had to keep up with him.’

While Jessika is clearly pleased with her new look, not everybody is impressed.

My, how you’ve changed! Jessika was no stranger to cosmetic procedures before her debut on MAFS, having already undergone lip fillers. Pictured left: in 2017, and right: in 2018

Earlier this week, Beverly Hills-based plastic surgeon Dr. Randal Haworth said that Jessika’s excessively filled pout ‘resembles a baboon’s bottom in heat’.

‘Instead of enhancing facial sensuality, overly plumped lips tend to do the opposite and even age the face in a strange way,’ Dr. Haworth told Daily Mail Australia.

‘Jessika’s exaggerated lips only serve to distract from her natural beauty.’


She’s not finished yet! As for Jessika’s next procedures, she revealed that a non-surgical nose job and lipo-sculpture on her thighs and buttocks are next on the list. Pictured in April 2019

‘Their lips are preposterously out of proportion!’ MAFS brides Jessika Power and Ines Basic ‘are destroying their looks with facial fillers’, says a leading cosmetic surgeon

A renowned plastic surgeon has delivered a withering assessment of this year’s Married At First Sight stars, saying they are too dependent on fillers.

Beverly Hills-based Dr. Randal Haworth says the latest crop of brides have ‘over-inflated lips’ that sit uncomfortably with their faces and ‘don’t do them any favours’.

Speaking exclusively to Daily Mail Australia, the CEO of DrHaworth.com also claimed that reality TV stars more generally are sending a harmful message to young fans by excessively plumping up their features.

‘Their lips are preposterously out of proportion!’ MAFS brides Jessika Power and Ines Basic ‘are destroying their looks with facial fillers’, says a leading cosmetic surgeon. Pictured left: Jessika pre-2017, and right: in 2019

After being shown before-and-after photos of Jessika Power, Martha Kalifatidis and Ines Basic, Dr. Haworth didn’t hold back.

‘Like a loud out-of-tune instrument in an otherwise beautiful orchestra, these over-inflated lips resemble baboon bottoms in heat and do no one any favours,’ he said.

Speaking about reality stars generally, he said there is a risk they are projecting unrealistic beauty standards on to a young generation of women. 

He added: ‘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 and bland conformity whereby everyone starts to look the same.’

‘These over-inflated lips resemble baboon bottoms in heat’: After being shown before-and-after photos of several Married At First Sight stars, Dr. Randal Haworth didn’t hold back. Pictured left: an undated photo of Martha Kalifatidis from several years ago, and right: in 2019

Several MAFS contestants, including single mother Susie Bradley, have admitted to using off-the-shelf lip fillers, such as Juvéderm.

In photos taken before their cosmetic transformations, the reality stars are almost unrecognisable compared to how they look today.

But Dr. Haworth believes that facial fillers have not necessarily improved or complemented the brides’ natural features.

‘Instead of enhancing facial sensuality, overly plumped lips tend to do the opposite and even age the face in a strange way,’ he observed.

Plump pouts: Several MAFS contestants, including Ines Basic, have admitted to regularly getting lip fillers. Pictured left: Ines in September 2018, and right: on April 18, 2019

‘The exaggerated lips of Jessika only serve to distract from her natural beauty’: Dr. Haworth told Daily Mail Australia that ‘overly plumped lips tend to age the face in a strange way’. Pictured: Jessika before and after having lip fillers

He added: ‘For example, the exaggerated lips of Jessika only serve to distract from her natural beauty, while the lips of Martha just draw attention to her other churlish facial plastic surgery, including her rhinoplasty.’

Dr. Haworth went on to say that ‘so-called practitioners’ of cosmetic enhancements are allowing ‘their own aesthetic judgment to be hijacked by social media influencers’ and reality stars like the Kardashians.

‘This [fixation] encourages tunnel vision in doctors and nurse injectors alike, focusing only on lip volume and not on shape,’ he said. 

‘Doctors and nurse injectors alike focus only on lip volume and not on shape’: Dr. Haworth wasn’t a fan of Martha Kalifatidis’ cosmetic enhancements. Pictured before and after she underwent facial fillers

Speaking to NW magazine on Monday, Jessika confirmed she has spent $25,000 on her cosmetic transformation so far – and has no plans to slow down. 

Last month, Ines also admitted she has been getting lip fillers ‘for years’. 

Furthermore, Martha has acknowledged having Botox and facial fillers in addition to undergoing a rhinoplasty and breast enlargement.

Mummy makeover: Susie Bradley underwent extensive cosmetic work after having her first child. Pictured left: Susie in 2015, and right: earlier this year

Leading Plastic Surgeon Discusses Biggest Loser star Michelle Bridges’ “enthusiastic use of fillers and Botox”

The Biggest Loser star Michelle Bridges has helped thousands of people with her fitness program.

According to Beverly Hills-based plastic surgeon Dr. Randal Haworth, she may have undergone her own transformation.

‘It appears Michelle’s striking facial change came from an enthusiastic use of fillers and Botox. Unfortunately, the manner in which they were used tends to detract from her natural facial harmony rather than enhance it.’ said Dr. Haworth.

Dr. Haworth went on to describe the tell-tale signs of Michelle’s supposed cosmetic work.

Blair Thomas‘Her eyebrows are a tad too elevated into a pointed arch similar to Captain Spock, which is most likely the result of Botox. Ironically, this shape can be softened with a further small shot of Botox above each arch. 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,’ he explained.

Dr. Haworth also described how Michelle appears to have used a filler such as Juvéderm to plump her lips and under-eye hollows.

‘In certain angles, the filler seems to have accentuated her long upper lip which is a sign of aging. A tell-tale sign that filler was used to treat under-eye hollows is bulging below her lower eyes next to the nose. I can see Michelle has those when she is smiling in recent photographs.’

Original Article

Self-Centered Aesthetics™

Embracing Artistry

By Inga Hansen

Photography by Cory Sorensen

Plastic surgeon Randal Haworth, MD, is taking the next step in his career with the launch of a stylish, comprehensive aesthetic care facility.

Randal Haworth, MD, made a name for himself in aesthetics in the early 2000s when he joined Fox television’s reality show, “The Swan.” On the program, he was part of a team of plastic surgeons, stylists and makeup artists who dramatically transformed participants’ appearances, Earlier this year, he transformed his own Beverly Hills, California-based practice when he moved to a new, custom-designed facility that incorporates a full range of aesthetic services—from facials and nutritional services to fillers, lasers and surgical procedures.

Dr. Haworth’s design philosophy for the new Haworth Institute was nature meets high-tech.

“It’s a beautiful place, and all our services are under one roof—the surgical center, my clinic and our new noninvasive center, Self Centered Aesthetics,” says Dr. Haworth. “Patients always asked us, ‘What else can you do?’ ‘How do I maintain this?’ It just doesn’t make sense nowadays not to offer the full-range of aesthetic treatments.”

In addition to laser treatments and injectables performed by Dr. Haworth and his R.N., celebrity esthetician John Tew performs signature facials and naturopathic doctor Matea Polisoto, who goes by “Dr. Matea,” offers IV therapy and nutrition counseling. “Like John, she has a very big following in Beverly Hills and beyond,” says Dr. Haworth. “She is involved with IV therapy, which helps augment the pre- and postoperative surgical experience, and optimizes healing.

“The people working with me are just as important as the surgeon—it’s all about having a team,” he says.

The Frustrated Artist

Born in Los Angeles and educated in England, Dr. Haworth has a somewhat unusual background for a Beverly Hills plastic surgeon. “My dad was English and spent World War Il in London selling bootleg whiskey during the Blitzkrieg. My mother and her family lived in Holland during the German occupation,” he says.

Following the war, both of his parents immigrated to the United States seeking opportunities, of which there were few in post-war Europe. “They met, and I was born in Los Angeles. But my dad always wanted me to be in England eventually,” says Dr. Haworth.

When he was 9 years old, he and his parents drove to Central America and boarded a cargo ship to England. During his school years in London, Dr. Haworth became enamored with the arts. “l always drew—and I was very good at a young age. In University I joined band. I was really into the arts, and that’s what I wanted to pursue,” he says. “But my parents, being war babies, wanted a doctor in the family and I was their only child.”

During a road trip prior to his final year at the university, he shared his goals with his parents. “We were in a VW bus and they said, ‘We’ll disown you if you become an artist. Make your decision’—it was really bizarre,” he says. His mind flashed back to a BBC interview of Kurt Wagner, MD, he had seen when he was 13. “l said, ‘Then I’ll be a plastic surgeon,’ having no idea what was involved in that.”

He came back to the U.S. and enrolled in medical school at the University of Southern California. Following graduation, he completed a five-year general surgery residency at Cornell Medical Center in New York. Dr. Haworth made his way back to the West coast for his plastic surgery residency at the University of California, Los Angeles.

“After my residency, I had no money so I was anxious to go into practice. I thought, well then I have to goto Beverly Hills because that’s where successful plastic surgeons go,” he says.

Another surgeon offered to rent him a space in his clinic’s kitchen, which was housed in one of the most desirable medical buildings in Beverly Hills. “He had a little pocket door in front of the kitchen so I stayed in there,” says Dr. Haworth. “During my clinic days, I would take his diplomas off the walls in the two little exam rooms and put mine up, and that’s how it started.

“l look back fondly on those days now, but it was horrible at the time. If I had two surgeries in a month, it was a great month.

Finding His Niche

During his UCLA residency, Dr. Haworth won a plastic surgery research prize for his lip surgeries, which provided a unique niche with which to build his practice, More than 20 years later, he has patients from all over the world who travel to the Haworth Institute for their lip surgeries.

“You can be the best doctor in the world, but if you don’t have marketing, no one will know about you,” he says. “So I leveraged that award and started getting known for lips, even though my favorite surgeries are noses, mid- facelifts and what I call hyperaesthetic surgeries where we change everything. The lips are what I was known for, and now I get jazzed by that because there’s really no competi- tion in the world for these surgeries.”

He offers upper, lower and corner lip lifting procedures as well fat transfer and F.A.T.M.A. (fat transfer & mucosal advancement). “l do many types of lip lifts because it is shape before volume; there are many things that fillers alone cannot do,” he says.

Embracing and Investigating New Technologies

Despite the limitations of traditional filling techniques, Dr. Haworth has embraced dermal fillers as effective tools to perfect his patients’ lips. In some cases the new, less invasive procedures are even surpassing what he can achieve in the O.R.

“Our mouths get wider as we age and our lower teeth become visible,” he says. “People will often just fill the lower lip horizontally, which won’t help with these concerns.”

In his surgical center, he performs lower lip V-Y plasty procedures to narrow the mouth, lift the bottom lip and pout out the middle third of the lower lip. But, due to the minimal improvement, he recently became interested in the idea of using vertical filler injections to lift and shape the lower lip.

“About three months ago, I started injecting vertically into the lower lip. I place my long cannula or a long needle vertically from the bottom of the prejowl sulcus all the way to where I see the needle blanching on the vermillion on the back of the lower lip on the sides. Then I inject vertically as I pull the needle out,” he says. “l am seeing such dramatic elevation of not just the lower lip but the whole corner of the mouth—the marionette folds are dramatically reduced and the labiomental sulcus opens up.”

He is calling this the Caisson technique after Caisson beams in construction. “The patients are three months out now, and the results are far better than what we see with the lower V-Y plasty in hiding the lower teeth,” he says.

Dr. Haworth is investigating new ways to augment and lift lips using dermal fillers.

“l love doing surgery, but plastic surgery is in some ways a dying field,” he continues. “The future of plastic surgery lies in the lab, not the operating room. Eventually they are going to know how to stop senescence. In the meantime, the future of aesthetics is laying more and more in lasers and newer, better fillers, and I want to stay on the forefront of that.”

His biggest challenge is determining which new technologies and procedures live up to the hype—and resisting the urge to bring in every new device about which patients inquire. “Sixty to seventy percent of all new medical cosmetic technologies overpromise and under deliver,” he says. “First it’s a big ‘Wow!’ Then results are ‘operator-dependent,’ then it’s gathering dust, so I vet all these technologies and only offer the ones I believe are proven to work.

“What I want to offer my patients with the Haworth Institute and Self Centered Aesthetics is more than one-stop aesthetics, It’s the tools and knowledge to deliver the absolute best treatments for their individual concerns and lifestyles,” continues Dr. Haworth. “We have a turbocharged armamentarium of proven noninvasive treatments to carry on the philosophy that I espouse in my surgeries, which is really detailed aesthetic work.”

Self-Centered Aesthetics

Recently, I was honored to be featured on the cover of the highly popular regarded trade magazine of the noninvasive aesthetic industry, MedEsthetics. Here is the article. We at Self-Centered Aesthetics ™are super excited to be off to such a great, auspicious start. We are aiming to deliver the best, state of the art noninvasive treatment to all patients, under one roof with my philosophy of beauty. Embracing Artistry By Inga Hansen Photography by Cory Sorensen Plastic surgeon Randal Haworth, MD, is taking the next step in his career with the launch of a stylish, comprehensive aesthetic care facility. Randal Haworth, MD, made a name for himself in aesthetics in the early 2000s when he joined Fox television’s reality show, “The Swan.” On the program, he was part of a team of plastic surgeons, stylists and makeup artists who dramatically transformed participants’ appearances, Earlier this year, he transformed his own Beverly Hills, California-based practice when he moved to a new, custom-designed facility that incorporates a full range of aesthetic services—from facials and nutritional services to fillers, lasers and surgical procedures. Dr. Haworth’s design philosophy for the new Haworth Institute was nature meets high-tech. “It’s a beautiful place, and all our services are under one roof—the surgical center, my clinic and our new noninvasive center, Self Centered Aesthetics,” says Dr. Haworth. “Patients always asked us, ‘What else can you do?’ ‘How do I maintain this?’ It just doesn’t make sense nowadays not to offer the full-range of aesthetic treatments.” In addition to laser treatments and injectables performed by Dr. Haworth and his R.N., celebrity esthetician John Tew performs signature facials and naturopathic doctor Matea Polisoto, who goes by “Dr. Matea,” offers IV therapy and nutrition counseling. “Like John, she has a very big following in Beverly Hills and beyond,” says Dr. Haworth. “She is involved with IV therapy, which helps augment the pre- and postoperative surgical experience, and optimizes healing. “The people working with me are just as important as the surgeon—it’s all about having a team,” he says. The Frustrated Artist Born in Los Angeles and educated in England, Dr. Haworth has a somewhat unusual background for a Beverly Hills plastic surgeon. “My dad was English and spent World War Il in London selling bootleg whiskey during the Blitzkrieg. My mother and her family lived in Holland during the German occupation,” he says. Following the war, both of his parents immigrated to the United States seeking opportunities, of which there were few in post-war Europe. “They met, and I was born in Los Angeles. But my dad always wanted me to be in England eventually,” says Dr. Haworth. When he was 9 years old, he and his parents drove to Central America and boarded a cargo ship to England. During his school years in London, Dr. Haworth became enamored with the arts. “l always drew—and I was very good at a young age. In University I joined band. I was really into the arts, and that’s what I wanted to pursue,” he says. “But my parents, being war babies, wanted a doctor in the family and I was their only child.” During a road trip prior to his final year at the university, he shared his goals with his parents. “We were in a VW bus and they said, ‘We’ll disown you if you become an artist. Make your decision’—it was really bizarre,” he says. His mind flashed back to a BBC interview of Kurt Wagner, MD, he had seen when he was 13. “l said, ‘Then I’ll be a plastic surgeon,’ having no idea what was involved in that.” He came back to the U.S. and enrolled in medical school at the University of Southern California. Following graduation, he completed a five-year general surgery residency at Cornell Medical Center in New York. Dr. Haworth made his way back to the West coast for his plastic surgery residency at the University of California, Los Angeles. “After my residency, I had no money so I was anxious to go into practice. I thought, well then I have to goto Beverly Hills because that’s where successful plastic surgeons go,” he says. Another surgeon offered to rent him a space in his clinic’s kitchen, which was housed in one of the most desirable medical buildings in Beverly Hills. “He had a little pocket door in front of the kitchen so I stayed in there,” says Dr. Haworth. “During my clinic days, I would take his diplomas off the walls in the two little exam rooms and put mine up, and that’s how it started. “l look back fondly on those days now, but it was horrible at the time. If I had two surgeries in a month, it was a great month,” he says. Finding His Niche During his UCLA residency, Dr. Haworth won a plastic surgery research prize for his lip surgeries, which provided a unique niche with which to build his practice, More than 20 years later, he has patients from all over the world who travel to the Haworth Institute for their lip surgeries. “You can be the best doctor in the world, but if you don’t have marketing, no one will know about you,” he says. “So I leveraged that award and started getting known for lips, even though my favorite surgeries are noses, mid- facelifts and what I call hyperaesthetic surgeries where we change everything. The lips are what I was known for, and now I get jazzed by that because there’s really no competi- tion in the world for these surgeries.” He offers upper, lower and corner lip lifting procedures as well fat transfer and F.A.T.M.A. (fat transfer & mucosal advancement). “l do many types of lip lifts because it is shape before volume; there are many things that fillers alone cannot do,” he says. Embracing and Investigating New TechnologiesDespite the limitations of traditional filling techniques, Dr. Haworth has embraced dermal fillers as effective tools to perfect his patients’ lips. In some cases the new, less invasive procedures are even surpassing what he can achieve in the O.R.”Our mouths get wider as we age and our lower teeth become visible,” he says. “People will often just fill the lower lip horizontally, which won’t help with these concerns.”In his surgical center, he performs lower lip V-Y plasty procedures to narrow the mouth, lift the bottom lip and pout out the middle third of the lower lip. But, due to the minimal improvement, he recently became interested in the idea of using vertical filler injections to lift and shape the lower lip.”About three months ago, I started injecting vertically into the lower lip. I place my long cannula or a long needle vertically from the bottom of the prejowl sulcus all the way to where I see the needle blanching on the vermillion on the back of the lower lip on the sides. Then I inject vertically as I pull the needle out,” he says. “l am seeing such dramatic elevation of not just the lower lip but the whole corner of the mouth—the marionette folds are dramatically reduced and the labiomental sulcus opens up.”He is calling this the Caisson technique after Caisson beams in construction. “The patients are three months out now, and the results are far better than what we see with the lower V-Y plasty in hiding the lower teeth,” he says.Dr. Haworth is investigating new ways to augment and lift lips using dermal fillers.”l love doing surgery, but plastic surgery is in some ways a dying field,” he continues. “The future of plastic surgery lies in the lab, not the operating room. Eventually they are going to know how to stop senescence. In the meantime, the future of aesthetics is laying more and more in lasers and newer, better fillers, and I want to stay on the forefront of that.”His biggest challenge is determining which new technologies and procedures live up to the hype—and resisting the urge to bring in every new device about which patients inquire. “Sixty to seventy percent of all new medical cosmetic technologies overpromise and under deliver,” he says. “First, it’s a big ‘Wow!’ Then results are ‘operator-dependent,’ then it’s gathering dust, so I vet all these technologies and only offer the ones I believe are proven to work.”What I want to offer my patients with the Haworth Institute and Self Centered Aesthetics is more than one-stop aesthetics, It’s the tools and knowledge to deliver the absolute best treatments for their individual concerns and lifestyles,” continues Dr. Haworth. “We have a turbocharged armamentarium of proven noninvasive treatments to carry on the philosophy that I espouse in my surgeries, which is really detailed aesthetic work.”

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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