For the last eight years or so, I, as one of the foremost cosmetic injection experts in Beverly Hills, have noticed an increasing number of men seeking aesthetic improvement outside of diet and exercise. However, I see this growth as less a trend and more of a real shift in the industry.
This growth is spurred on by society’s reliance on visual rather than written communication and its unabashed obsession with youth and beauty over old-fashioned wisdom and experience. The eruption of social media, including Instagram and the like, has only heightened the problem. It has awakened our once dormant narcissism into the self-perpetuating collective contagion that it is today.
Consequently, there is less social stigma for men to seek out ways to better their appearance in this highly competitive world. In 2018, more aesthetic technologies are finally delivering on their promises to reduce wrinkles, firm faces, reverse atrophy and sculpt bodies without hair. The armamentarium used includes Botox, Jeuveau( or #Newtox), Juvederm, Vollure, Restylane, Radiesse,Voluma, Bellafill, IP, laser hair removal and other lasers to treat brown discoloration, and red patches. Men are not only seeking out ways to keep themselves looking young and competitive but also non-surgical ways to actually enhance their features; these include filler/liquid nosejobs (rhinoplasties), cheek and chin augmentations and jawline defining and even laser induced fat burning with SculpSure..
All done with the expert hands of a board certified plastic surgeon or his personally trained expert nurse injectors (such as Katherine Braun, R.N. helming The Haworth Institute’s own medispa, Self-Centered Aesthetics™), results which are both significant and, most importantly, natural. This is ideal for men wanting their appearance to be on point in order to compliment their skill set at work.
No cutting, no stitches, less recovery, less expense- what’s there not to like for those men who simply want to look good with minimal expense and time?
Plastic surgeon 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.”
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
Very few surgeons in the world understand aesthetics to the point where they can be a true hyperaesthetic facial plastic surgeon specialist. A hyperesthetic specialist is similar to the conductor of an orchestra-he or she needs to know all the instruments better than the individual players in order to “orchestrate” them to create melodious harmony without dissonance. One of the keys to create visual harmony in the face is mastering lip rejuvenation surgery-it’s not just about adding volume (which is essentially what most practitioners and patients equate with lip enhancement), it’s about mastering the shape of both the upper and lower lip. Patients travel from all corners of the globe to top Beverly Hills plastic surgeon and lip augmentation specialist, Dr Haworth to undergo hyperesthetic change, which may include any number of surgical art performances including a high-profile facelift, endoscopic brow lift, blepharoplasty, rhinoplasty or his lip reshaping signature surgery! https://youtu.be/cI3nEq5R3x8