Celebrity Buttocks Augmentation Rumors Confirmed

Beverly Hills Plastic Surgeon, Dr Randal Haworth weighs in on these celebrity lifts in this article featured on Zwivel.

In terms of Hollywood beauty standards, the butt holds a hallowed place. Look no further than the pages of your favorite gossip mags to find butt augmentation examples.

Big-bootied ladies who are pioneers in the posterior procedure include Kim K. and Heidi Montag. While some of these augmentations are impressive feats of cosmetic surgery, others have fallen flat. In this piece, we weigh in on different celebrity cases and tell you if they got it right.

The Rise of the Butt Augmentation

According to the American Society of Plastic Surgeons (ASPS), buttock augmentations are on the rise. In 2016, buttock fat grafting rose in popularity by 26% from the year before while the number of butt implants grew by some 18% in the same time span.

Whether it’s the Brazilian butt lift, implants, or illegal filler injections, celebrity cases can teach us a valuable lesson on the importance of choosing a good plastic surgeon.

“Whereas years ago buttock augmentation was uncommonly performed, it has become a popular, ‘mainstream’ cosmetic surgery procedure in the past half-decade,” notes Layton, UT plastic surgeon Dr. York Yates. “Although a good result in plastic surgery always starts with the achievement of the patient’s goals, there are some concerns with the long-term effects of extreme volume enhancement on the stability of the skin and soft tissue,” he warns.

In addition, fads change and in this plastic surgeon’s opinion it is only a matter of time before the extremely large buttock is again viewed as ‘overweight’ rather than curvy.

The Pull to Plump the Derriere

Novel procedures often translate into hot trends and butt augmentations are no exception. Surgeons are honing their skills to create plumper backsides that are more natural-looking every day.

Fat grafting procedures are probably the reason why Kim Kardashian’s behind appeared natural when visualized using an X-ray. With results like that, it’s no wonder this procedure is on the rise. To sweeten the deal with grafting, the fat inserted into the butt is usually taken from the tummy. Data shows that these procedures are gaining popularity with patients who want a two-for-one lipo and augmentation procedure.

Recipe for Success

According to the plastic surgeons we talked to, there’s no one-size-fits-all answer to the perfect butt lift — it’s all about meeting patients’ expectations.

“A good butt lift or augmentation can mean different things to different people,” explains Murrieta, CA plastic surgeon Dr. Brian Eichenberg. “There are some common themes. Big, round, full and healthy looking are almost always good, but too big can draw too much attention because at some point it will not look natural. Of course, for some women, looking augmented or extra-large is the idea.”

Massachusetts-based plastic surgeon Dr. Joseph A. Russo agrees. “I think celebrities with the most well-done augmentations are the ones that are not blatantly obvious or oversized,” he said. “Celebs with great shape and proportions… Basically, the ones you may not realize have had it done but simply look great.”

Kailyn Lowry

“Teen Mom 2” reality star and mother of three Kailyn Lowry went under the knife in 2016 at the hands of the famed Dr. Miami (Dr. Michael Salzhauer of Bal Harbour Plastic Surgery in Miami). Lowry documented her Brazilian butt lift on social media, noting that she has long struggled with body image issues and that the procedure helped her be at peace with her body.

Dr. Randal Haworth cites Lowry’s case as a good example of a lift gone right. “A Brazilian butt lift or butt augmentation with good results will make the waist and thighs look smaller, which in turn also brings the torso into more harmonious proportions. It also can make the buttocks appear rounder and more toned or reduce any drooping or sagging,” he says.

Jenna Jameson

The world’s best-known adult entertainer does not shy away from discussing taboo plastic surgery procedures. The Queen of Porn has had plenty of surgical hiccups that include implant removals and a botched vaginoplasty. She admitted to her castmates on “Celebrity Big Brother” that she had “a little somethin’-somethin’” done to her butt, but we don’t have details on the procedure. Dr. Haworth points to Jameson’s case as an example of not-so-great surgical handiwork, along with Blac Chyna and former Playboy Playmates Kristina and Karissa Shannon.

“When the results of a buttock augmentation, whether via fat or implants, are so exaggerated as to result in disharmony with the surrounding torso, the net visual effect can be downright bizarre,” Haworth cautions. “For example, if your bottom is overly round and big, you can actually look shorter than you really are. Additionally, we as plastic surgeons do not have long-term data as to how these comically large buttocks may age and sag over time.”

Business Interview in USA Weekly with Dr. Haworth

Starting a business is a big achievement for many entrepreneurs, but maintaining one is the larger challenge. There are many standard challenges that face every business whether they are large or small. It is not easy running a company, especially in a fast-paced, ever-changing business world. Technology advances, new hiring strategies, and now, political changes coming with the new administration, all add to the existing business challenges that entrepreneurs, business owners, and executives have to deal with.

Maximizing profits, minimizing expenses and finding talented staff to keep things moving seem to be top challenges for both SMBs and large corporations. We have been interviewing companies from around the world to discover what challenges they are facing in their businesses. We also asked each company to share business advice they would give to a younger version of themselves.

Below is our interview with Randal Haworth M.D., CEO at The Haworth Instiute:

What does your company do?

Though technically a company, I don’t consider us a company in the traditional sense. This is simply because I consider our clients not as consumers but as patients first and foremost. We do not sell them goods per se, our patients buy a specific medical service which I consider to be among the best aesthetic plastic surgery available. The Haworth Institute provides both surgical and nonsurgical aesthetic procedures employing the latest RF and laser technology for removal of both hair as well as wrinkles, skin tightening and appearance.

What is your role? What do you enjoy most about your role?

I am the surgical director of the Haworth Institute which is comprised of both my clinical practice in Beverly Hills as well as a surgical center and Self-Centered Aesthetics, my nonsurgical medi-spa, helmed by the very talented Katherine Braun RN. The most gratifying part of my work is what I call the circle of change. This circle starts when our team greets our patients from all walks of life around the globe and make them feel right at home. Needless to say, the technical aspects of plastic surgery are immensely satisfying. When I am able to meet their original aesthetic goals, the circle of change is complete and that is the best part of all.

What are the biggest challenges in your business right now?

Running a busy plastic surgical practice is very demanding to say the least. What is particularly challenging is to remain on point at all times. This involves not only creating beautiful results in the very competitive environment of Beverly Hills but also to screen out a sizable number of people seeking unrealistic results and those with problematic personality disorders. Believe me, in this day and age driven by media and litigation, hiring the wrong employee or operating on a patient wanting surgery for all the wrong reasons can be disastrous.

If you could go back in time, what business advice would you give to a younger version of yourself?

The number one thing with business is to have trusted my gut, especially before hiring employees. Obviously plastic surgery involves a lot more than that but running the business side of things is a different matter. Some people are better than that others and it does require discipline in order to bypass your cerebral side. As with any business, having a passion for your work is a must for success but it is not the only thing. It is akin to just looking at your feet when you walk. Having a clearly defined long-term goal is akin to also seeing the horizon-this requires disciplined work habits and structure which I wish I learned earlier on in my career.

Read The Original Article

Building the optimal in-office OR

Beverly Hills Surgical Center

Building the optimal in-office OR

By Lisette Hilton

1. Flow and Freedom of Movement

Beverly Hills-based plastic surgeon, Randal Haworth, M.D., says he needs to be comfortable and free to move in order to perform facial and body plastic surgery.

But space can be somewhat limited in an OR inside a boutique plastic surgery practice, he says.

“… so careful planning of the envisioned flow between patient, surgeon, scrub tech, circulating nurse and anesthesia provider must be done,” Dr. Haworth says. “In my case, I had to work with a rectangular operating room, in which case I first had to decide where the anesthesia machine would be situated, since its range of movement would be limited by the oxygen and vacuum hoses tethering it to the ceiling. Consequently, it was important for me to have a 180-degree turning radius for the operating table, so I could position it according to whether I am performing facial or body surgery. Of course, OR lights have to follow suit and must be very mobile and bright. My Trumpf LED [Trumpf Medical] system fits the bill nicely.”

2. A Quality Monitor and Sound System

Having a big monitor with a good sound system for music is not only a luxury but a necessity for the modern plastic surgeon. Having the monitor in constant view is a must, according to Dr. Haworth.

3. Intelligently Designed Cabinetry

Proper cabinetry, design to maximize space and efficiency, is essential, according to Dr. Haworth.

“You can never have too many cabinets from the get-go, since these promote organization and obviate the need for vulgar retrofits in the future,” he says. “When it comes to designing my clinic or the operating room, I think that creating and maximizing the feeling of unrestricted space is important for both the patient’s sense of security and the staffs’ sense of clarity.”

4. Don’t Cut Corners

Don’t cut expenses, when it comes to safety, according to Dr. Cohen.

5. Seek Expertise

Dr. Cohen says cosmetic surgeons should tap experts in designing operating rooms.

“Reach out to architects with experience in both the design and credentialing processes,” Dr. Cohen says. “Ultimately, certain third-party inspections may be required, and you don’t want to be caught off guard.”

Dos and Don’ts for the In-office OR

Erin Metelka, an interior designer with Studio Four Design, offers these design dos and don’ts.

OR Dos:

  • Use a sheet flooring, with heat welded seams and sanitary cove base.
  • Use bleach cleanable/non-porous products.
  • Use clean/calming colors.
  • Provide a variety of adjustable ambient lighting options.
  • Utilize floor patterns to designate the extents of the sterile zone and care-provider zones.
  • With the wide variety of procedures that occur in an operating room, often times, the table is moved in order to accommodate the most efficient workflow with the other equipment in the suite. The floor patterns can also be used to dimension the proper location of the table for these various scenarios.
  • When creating several operating rooms, utilize an identical layout (not mirrored). Often, physicians are moving into adjacent operating rooms for a procedure, while a room is being turned over and sterilized. Having identical layouts increases efficiency and reduces error.

OR Don’ts:

  • Do not have extraneous items of décor within the suite, such as artwork.
  • Do not utilize fabric of any kind such as curtains/draperies. If there are windows, create privacy with natural light by using integrated frosted glass. If an upholstery is required for a physician stool or other items, a bleach cleanable vinyl is a suitable alternative, ideally with a Crypton or nano-technology finish applied (these finishes work to prevent moisture penetration to the cushion and function as an antimicrobial).
  • Do not place any direct down-lighting, with the exception of the surgical boom, directly over the table.
Read the original article here!

2016 State-of-the-art lip shaping-Dr. HAWORTH on the “Doctors’ show

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

Dr Haworth in Hollywood Reporter’s plastic surgeon list 2015

I’ve come to find out that I am included for the 2nd year in Hollywood Reporter’s top doctor list of 2015. The reason why this is such an honor is that all categories including the Plastic Surgeons’ are vetted by Castle Connolly, an independent institution specializing in such matters. In other words, no doctor can pay or influence to be included in this list. All plastic surgeons must be board-certified and are considered unparalleled in their respective fields as judged by objective monitors.
Hollywood Reporter's Best Plastic Surgeons 2015
Hollywood Reporter’s Best Plastic Surgeons 2015
It is my innate philosophy to provide the most honest and compassionate care possible while striving for aesthetic excellence which can only be achieved by sensitivity, technical precision, a critical eye and self-criticism.

Read the original article about Dr. Randal Haworth here:
Hollywood Reporter Best Doctors 2015

The most obvious tell-tale sign of a facelift

Good plastic surgery is invisible but many people insist that they can always spot anyone who has had plastic surgery. For example, they claim they can always spot a celebrity with a facelift and list those with obviously sad results that garner all the press. You can refer to the three attached photographs as examples of such. (They go on to name others who have not had any plastic surgery and when I in turn correct them, they express bewildered disbelief.)
Joan Rivers with obvious plastic surgery and pixie-ear deformity
Joan Rivers with look-at-me pixie-ear deformity
 
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Bruce Jenner with a plain-as-day pixie-ear deformity after a facelift
Mickey Rourke sporting his obvious Pixie-ear and man-bun on the red carpet
Mickey Rourke sporting his obvious Pixie-ear and man-bun on the red carpet
However, this blog post is not about good plastic surgery, it is about the bad and the ugly. There are many signs that scream “facelift”:

1. Overly pulled face skin with diagonal grooves

2. Altered hairlines such as pulled-back sideburns

3. Widened, non-hair-bearing scars with step-offs in the natural hairline behind the ear

4. Distorted anatomy in front of the ear canal due to effacement of the delicate tragus cartilage and finally…

5.”Pixie ear”.

Most of these aforementioned problems stem from misplaced anchoring of the newly redraped skin flaps resulting in needlessly excessive tension across potentially visible scars. One immutable rule in plastic surgery dictates that such increased tension can create widened scars, hair loss and distorted anatomy. Yet, despite these well-documented problems, I unfortunately still see many patients who seek correction of these stigmata of ill-conceived facelifts.

Correcting these problems is not an easy task. Generally, a secondary facelift needs to be performed to release enough skin so that both scars can be removed and closure achieved in a tension-free matter. If it happens to be a lucky day, scars that were placed in front of the ear can even be moved more posteriorly to within the ear canal as in this example of a facelift I performed in order to not only make her look younger but also remove her telltale signs of past substandard surgery.

Pixie earlobe after a facelift. Note scar in front of the ear
After correction with revision facelift and tension realignment


Pixie ear deformity and tired appearance after previous facelift
Pixie ear deformity and tired appearance after previous facelift
Note correction of pixie-ear deformity after revision facelift. An endoscopic brow lift, fat transfer and upper lip lift along with a lower blepharoplasty were also performed
Note correction of pixie-ear deformity after revision facelift. An endoscopic brow lift, fat transfer, upper lip lift and a lower blepharoplasty were also performed

What It’s Really Like To Get Extreme Plastic Surgery, From A Former ‘Swan’ Contestant

The Huffington Post By Lauren Duca

In light of recent photos of Renee Zellweger, a conversation has begun about plastic surgery. (Zellweger responded to the uproar, telling People magazine, “I’m glad folks think I look different! I’m living a different, happy, more fulfilling life, and I’m thrilled that perhaps it shows.”) But whether or not Zellweger had plastic surgery is irrelevant, and the reality — and potential repercussions — of going under the knife is worth exploring in further discussion. We spoke to “The Swan” contestant Lorrie Arias about her experience to get a better handle on the reality of undergoing such extreme physical change. This is her story.



Ten years ago, at age 34, Lorrie Arias underwent approximately $300,000 worth of plastic surgery. In 1995, she lost 150 pounds; in 2002, her husband died; and, in 2004, she became a contestant on “The Swan.” The program, which Jennifer L. Pozner called “the most sadistic reality show of the decade“ in “Reality Bites Back,” took its title and premise from a literary fairy tale, “The Ugly Ducking.” Two women deemed to be “ugly” underwent a total transformation at the hands of a panel of specialists, including a plastic surgeon. At the end of each episode, one was eliminated and the other went on to compete in the pageant that ran as the show’s finale. It aired for two seasons in 2004, before being canceled in 2005 as a result of low ratings. After losing a significant amount of weight, the then-police department volunteer auditioned for the show in hopes of a tummy tuck. Arias was frustrated that she had worked so hard to get healthy and still had so much extra skin. As a result of her “sad story” the selection committee chose her for the show. Once Arias got to the set of “The Swan,” doctors and producers set up a much more intensive transformation than she had expected. Over two and a half months of filming, she had a tummy tuck, buttock lift, inner thigh lift, dual facelift, upper lip lift, upper and lower eye lift, endoscopic brow lift, rhinoplasty, breast augmentation and breast lift — the most procedures of any contestant on the show.



A decade later, she told HuffPost Entertainment she is depressed, bipolar, agoraphobic and believes she continues to suffer from body dysmorphic disorder. She has regained the weight she lost in 1995 and refuses to leave her home, save for trips to see her therapist every few months. There is relatively little research regarding the psychological fall out from plastic surgery, both because extreme alterations are rare and it is not in plastic surgeons’ best interest to participate in or fund such studies. Some work has been done on the effect of TV representations on adolescents’ body image and the ways in which unrealistic expectations can lead to disappointment following a cosmetic procedure. In terms of diagnoses, the topic most often discussed is body dysmorphic disorder. “That refers to essentially an over-focus on a certain body part as being deformed or problematic, to the point that the person becomes obsessed with it,” Dr. Paul Puri, a psychiatrist, said. “Many times an individual believes getting surgery will fix it. In the research and literature, this has not been show to be a solution. It can be a problem with self-esteem, anxiety or other underlying issues, and surgeries don’t typically solve those other issues.” Of course, sometimes, people get surgery later in life due to social pressures based on standards of beauty and youth. “Those are two largely different reasons as to why people get plastic surgery,” Puri clarified. In cases involving dysmorphic disorder, it tends to pre-exist the surgery and then be exacerbated when the results differ from what the person desires. “The case may be that if someone fixes all of their hopes on surgery, it can be extremely disappointing and actually worsen their anxiety if it is not fixed,” Puri said.



After appearing as a contestant on “The Swan,” Arias faced a lot of negative reactions from those who knew her before the surgery. “You get a lot of crap,” she said. Arias felt that some friends and family were “jealous,” and others uncertain of who she had become. The latter group included the eldest of her two sons, who said at the time, “she doesn’t look that much like my mom anymore.” “He has told me that he felt afraid,” Arias said. “That makes me feel guilty, because I realize that if the shoe were on the other foot, I would have freaked out too.” Perhaps the most unnerving reaction came from Arias herself. The reveal is set up as a surprise for the show’s contestants. Arias said she had caught a slight glimpse of her reflection in medical equipment, but all mirrors were covered in the two and a half months she spent undergoing her various surgeries. It was only on stage that Arias was given access to a mirror. She reacted with quiet surprise, only losing it once the cameras turned off. “I was screaming for the executive producer,” she said. “I was screaming, ‘I want my face back!’ That’s how freaked out I was. Intelligently, I knew that was impossible. But it was so weird. It was like looking at somebody else, but it was you.” That feeling has become less difficult to reconcile over time, but Arias was happier before the show. “I’ve had self-esteem issues all my life,” she said. “But before, I was functional. Then I go and have all this stuff done that people would give their leg for, and I’m confined inside.” Immediately following “The Swan,” Arias experienced what she calls a boost of confidence. “Going out gave me a little bit of self-esteem,” she said. “I liked my chest. My breasts were my badges of self-esteem. I would go out and wear low-cut tank tops and see women hit their husbands for looking at me. That was never the kind of thing I would do before. I would wear normal shirts.” Soon, though, those old feelings of insecurity came creeping back. Arias said the symptoms leading up to her current condition began shortly after filming ended, and have only worsened. She raved about her plastic surgeon, Dr. Randal Haworth — “I was blessed to have him” — but blamed the show for not providing adequate therapy to help process such an extreme change. While on “The Swan,” Arias did receive psychological care, though those sessions largely focused on loss of her husband. In February of 2013, she spoke to the Post citing a lack of follow-up as the cause for her mental health issues.



Arias kept the 150 pounds she lost off for nearly 10 years, and shed 10 more for the show. However, after “The Swan,” she says, she lost a sense of control over her body. “I started to yo-yo,” she said. “I was 155 on ‘The Swan,’ now I’m sitting here at 248. And I’m miserable.” To stop feeling that way, she would consider more surgery. “I would do it in a heart beat. If I had the money, I’d do the weight loss surgery first,” she said. “This is going to sound weird, because I’ve already had so much done. I would have a new breast augmentation. I would have another brow lift. I would have another facelift. I would get more liposuction. I would do all that and my arms.” Arias would also be willing to do the show all over. “Crazily enough, I would do it again,” she said. “Knowing what I know now, knowing I would gain weight again, and knowing I wouldn’t have that other face. At least I could be a big and pretty person. I can’t imagine myself any differently.” Arias acknowledged that stance might be incomprehensible for someone who hasn’t undergone such extreme plastic surgery. Despite wanting more surgery, she is able to recognize that her insecurities are internal. “I thought a tummy tuck would give me all the self-esteem in the world. Of course, it didn’t. All I want now is for my story to help others, so they won’t think that going under the knife is a cure-all,” she said. “For a while it may be, but everything still comes back up.” And yet, Arias still believes the upset over female celebrities and plastic surgery comes from an inherent desire all women have to change their appearances. “The uproar every time something like that comes up in the news is personal jealousy,” she said. “Most women would like to have something done, but maybe they’re afraid or they just can’t afford it.”

Original Article

The trials, trade-offs and tribulations of upper lip lifts and other plastic surgery.

All plastic surgery has trade-offs.

By trade-offs, I am not referring to complications or risks.

By trade-offs I am referring to subtle and sometimes significant alterations in your appearance that will be incurred by undergoing a certain plastic surgical procedure. It is the doctor’s responsibility to inform the patient of these trade-offs (including risks of complications) while it is the patient’s responsibility to make an informed decision to proceed if he or she feels that the benefits of the surgery will outweigh the risks and trade-offs.

Examples of such trade-offs are the scars in and around the ear that result from a facelift. Even though they may be near invisible, they are scars nonetheless. The majority of patients feel that benefits of the facelift outweighed any of the associated trade-offs. Similarly, patients who undergo an abdominoplasty (tummy tuck), mastopexy (breast lift) or brachioplasty (arm lift) should be fully aware that they will develop scars from those procedures. Though the majority will heal well with very acceptable scars, most of the time the scars will be visible to some degree.

Patients who undergo a rhinoplasty must understand that their nose will be numb, stiff and hard for up to 3 months or more while swelling can persist for 1 to 2 years. Numbness from a facelift or a browlift can last many months as well. Despite understanding these trade-offs, the vast majority of patients have no problem undergoing these procedures once they have decided to do so.

Over the years, I have found it curious that a small minority of patients undergoing lip reshaping surgery in the form of upper lip lifts and V-Y plasties had unrealistic expectations in terms of their healing and results. They were surprised even angry that they experienced numbness, stiffness and associated scarring. Sometimes a very subtle change in the nostril position occurred after the surgery. These trade-offs may arise even though the result of the upper lip lift is successful from the aesthetic standpoint-in other words, the net benefit in the sensual-youthful-beauty quotient for the face has been increased. However, a few may consider the lip lift a failure if they have experienced even a slight degree in any of these trade-offs.

Though these trade-offs can mostly be successfully reversed, a patient should not elect to undergo such a procedure if he or she will not accept that these can be normal aspects of the procedure. If one thinks about it, an upper lip lift will have its trade-offs in the same way other procedures would have their own yet it perhaps gets more attention than other anatomical features of the face because the lips are expected to not only look beautiful but also function as well.

And function they do, more than any other part of the face. Indeed, lips are used to express, emote, eat, kiss and speak-essentially they move millions of times a day! Because of these strong repetitive muscle forces around the nasal and oral region the plastic surgeon must create a strong upper lip lift that will resist these forces in order to achieve a result that is long-lasting, with minimal scarring and nasal distortion.

In fact, lip shaping procedures are the most challenging of all facial plastic surgeries, even rhinoplasties. Though the success of facelifts are measured in centimeters, brow lifts in increments of 2 to 4 mm and rhinoplasties in millimeters, lip reshaping surgery is measured in quarter-to-an-eighth of a millimeter! With those scales, one can almost consider this close to microsurgery.

In 2014, it would be a miracle to undergo an upper lip lift with an unequivocal guarantee of no scarring, nasal distortion, prolonged minor sensory changes and stiffness. If you are contemplating undergoing an upper lip lift but will not tolerate any of these tradeoffs, I suggest you avoid the procedure altogether and wait for that miracle to happen.

You do not need to look surprised after a BrowLift

Better late than never! This is the second part of a blog I wrote almost one year ago about the upper blepharoplasties and brow lifts. Brow lifts are often confused and considered part of a facelift but they are not. A facelift deals with rejuvenating the areas below the lower eyelids including the midface, jowls, jawline and neck.

I am honored to be giving a talk to my esteemed plastic surgical colleagues at the California Society of Facial Plastic Surgeons annual meeting in Lake Tahoe this March. The purpose of my talk is to share my thoughts not only of brow elevation but also of controlling and creating the ideal brow shape. Ironically, as I write this, I am sitting in my hotel room having just listened to 6 hours’ worth of talks from other plastic surgeons about brow lifts and shaping as part of a meeting for the American Society of Aesthetic Plastic Surgeons. As always, I come back from these meetings with one or two pearls that I am keen to incorporate into my practice to provide the best possible results for my patients.

However, I think that most surgeons miss the point about brow reshaping. We all understand that we want the tail end of the brow to sweep upwards in a glamorous yet subtle arch without creating a surprised or malevolent/samurai look (think Carrot Top or Cruella DeVille). Unfortunately, the techniques to achieve that fall short of their stated goals. Surgeons apply tension through hidden incisions behind the temple hairline in a effort to raise the outside aspect of the eyebrow, but this is soon met with diminishing returns. As in all aspects of plastic surgery, simply applying more tension to a region that is resisting movement will not will not provide long lasting elevation. After a few weeks to months, mother nature wins and the structure (in this case the outside aspect of the brow) will fall down again.

Endoscopic brow lifts are beautifully elegant operations that are performed through 2 cm hidden incisions within the hair which do not involve shaving or cutting out skin. Most surgeons, as I mentioned, will attempt to lift up the outside aspect of the brow by angling the incisions outwards on the side of the head to apply upward tension through them. Unfortunately, much resistance is encountered and the results reflect that. In a counterintuitive move, I have angled the inner incisions towards the midline and have found that I can lift the outer aspect of the brows almost effortlessly with minimal tension. The results are long-lasting and more simulate the appealing eyebrow shape of a young cover girl.

Check out the following 31 year-old patient who underwent a brow lift along with fat transfer, chin implant and a minor rhinoplasty:

I feel that brow lifts are sometimes misunderstood creatures. They are under appreciated and when performed correctly provide extremely beautiful results that not only rejuvenate the forehead, reduce wrinkles, elevate and reshape the brows while rejuvenating the upper eyelids. 70% of patients that come to my office complaining of upper eyelid sagging and all they simply need is a well performed modern endoscopic brow lift.

 slightly weak chin and a subtle bulbous nasal tip

31-year-old female with noticeable facial asymmetry with low-set brows. Of note, she also had slightly weak chin and a subtle bulbous nasal tip

exquisite improvement in brow position and shape

Three month follow-up showing exquisite improvement in brow position and shape. Note how her face and eyes “open up”

Preoperative photograph showing the oblique view

Preoperative photograph showing the oblique view of the same patient.

 three-month follow-up of the same patient demonstrating the chin augmentation as well as the minor change to her nasal tip

A three-month follow-up of the same patient demonstrating the chin augmentation as well as the minor change to her nasal tip. Again, note the improved brow position and shape without any look of surprise.”

Now that you had surgery, drains are your new BFF?

At the risk of sounding like I’m standing on a soapbox, I shall repeat my mantra once again . . . how well you follow up with your post-op aftercare instructions is nearly as important as what we do in the OR. Following these protocols conscientiously can ensure a positive outcome just as ignoring them can sabotage your final results.

Remember, the doctor and the patients are a team.

This is particularly true of drains. When you wake up from surgeries involving deep incisions and dissections involving an appreciable amount of surface area such as of abdominoplasties (tummy Tucks), facelifts and browlifts you’ll likely have one, two or sometimes even three tubes coming out of small incisions, each attached a suction bulb drain. They’re unsightly, true. They’re inconvenient, yes. They can be messy, absolutely. But for the duration – and this can be anywhere from 1 to ten days – that you’ll be living with them, your drains are your new body’s BFF or at least very trusted ally!

Let’s back up a minute. When surgery is performed, it is a fact that the innumerable microscopic blood vessels and lymphatic channels are cut. As a result they leak fluid in the postoperative period. Consequently, any space that was surgically created (for example, between skin and deeper muscle layer) can fill up with this fluid as opposed to getting rapidly absorbed by the body. Drains are placed within this surgically created space in order to rapidly evacuate the fluid as it is produced. The fluid in your drain, which will diminish over time, is comprised of a physiological mixture of blood and serum. As you empty the drain twice a day, recording the amount of fluid tell us the rate of decreasing fluid production and how your body is healing.

The advantages of sporting your drains for the prescribed time cannot be underestimated. Removing drains too quickly can result in untoward fluid accumulation in a surgical space potentially necessitating uncomfortable intervention afterwards to remove it. Leaving drains in the body for the appropriate amount of time will actually decrease your healing time by minimizing fluid buildup and prolonged swelling by fostering rapid adherence of the various layers to close the surgical space.

Drain connected to a self suction "grenade" style collection chamber
Drain connected to a self suction “grenade” style collection chamber
So please keep these in mind during the initial phase of your recovery if you find yourself getting annoyed. Soon enough, you’ll be in the office and we’ll remove them. Meanwhile, if you can view your drains in a positive light rather than as an unpleasant burden, it’ll make all the difference in the world.
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