Sophie Monk’s physical transformation

It would be easy to assume that the changes to Sophie Monk’s face over the years were the result of surgical intervention. According to Beverly Hills plastic surgeon Dr. Randal Haworth, she has not actually gone under the knife. ‘It is human nature for people to jump to conclusions when a celebrity has even the slightest change in appearance. Suspicions and speculations about plastic surgery run wild and I believe Sophie Monk is among the accused!’ the CEO of DrHaworth.com told Daily Mail Australia on Tuesday.

Sophie MonkDr. Haworth stated: ‘Though critics have insisted she had a rhinoplasty or brow lift, I believe she may not have had actual surgery at all. Instead, I sense she took full advantage of some non-surgical cosmetic options. For example, the fact that her forehead is smooth and devoid of normal wrinkles while her outside eyebrows are now higher indicates she was treated with Botox. When applied selectively, Botox not only minimizes wrinkles but can also lift certain facial features such as the eyebrow and the corner of the lips.’ He also turned his attention to Sophie’s plump lips, absence of hollowing under her eyes and prominent cheeks – all signs of non-surgical intervention.

Sophie, who hails from Queensland’s Gold Coast, has admitted to having filler to her top lip in the past, following the botched removal of a cyst. ‘Half of my lip was removed with the cyst, and I was advised to get filler in my top lip to help balance it out,’ she told Who magazine in early 2011.

Original Article

Beautiful Upper Lip Lifts without scars?

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

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.

Lip Lift status for 2014 and beyond

Lip lifts for 2014

Patients often asked me what are the differences between a skin-only lip lift and my muscle hemming technique. To put it simply, longevity, scarring and nasal distortion.

Skin Only Lip Lift

Until the late 90’s, the only lip lift I knew how to do was the skin only type. I would perform this by excising a certain amount of skin below the nasal base and sewing the lower edge of the excision to the upper edge which happens to be the skin of the nose.  The only thing now supporting this entire weight of the upper lip (which happens to move millions of times a day, eating, kissing, expressing and speaking) is the freshly closed incision at the skin level.  One can imagine that this provides little support for all the action occurring around the upper mouth area.  Consequently, the longevity of the lip lift itself is lessened, the nostrils are more likely to be pulled downwards while the resulting scar is more likely to stretch and thicken.

The results of a skin-only lip lift. Notice the widened scars, significant nostril distortion and recurrent long upper lip.
The results of a skin-only lip lift. Notice the widened scars, significant nostril distortion and recurrent long upper lip.

Muscle Hemming Lip Lift

After many years of observing the long-term results of skin-only lip lifts, I developed the muscle hemming technique.  By employing moderate principles of plastic surgery in which nip and tucks (such as a facelift) are improved by lifting and tightening the layers below the skin including muscle I have noted a significant benefit to my lip lifts in terms of scarring, longevity and less nasal distortion.  However, the recovery period was notably increased.  The muscle hemming technique involves placing slowly dissolvable sutures into the muscle layer below the skin and intern suturing that to the periosteum (lining) of the bone deep to the nose itself.  The lip lift is thus a solid one without relying on skin closure to achieve its  superior long-term results while lessening the chance of undesirable scarring and pulling around the nostrils.

Skin Flap Lip Lift

Which brings me to today.  For the last 3 years I have been employing a skin-flap technique which provides all the benefits of the muscle hemming technique but with half the recovery.  Suturing of the muscle is minimized in this technique but none of the longevity and superior scarring is sacrificed. The period of significant distortion and swelling has been halved from 2 weeks to less than 1.  Additionally, the results are “softer” in appearance with minimal to no distortion of the nostril area.

Patient with subliminal long upper lip with minimal upper toothshow
Patient with subliminal long upper lip with minimal upper tooth show
After skin -flap lip lift by Dr. Haworth of Beverly Hills. Notice significant improvement tooth show, natural shortening of the upper lip with minimal nasal distortion. Being a lip lift expert, he developed surgery during to further his evolutionary journey into perfecting the ideal upper lip lift. This new technique also produces softer results those from the skin-only at muscle-hemming  techniques.
After skin -flap lip lift by Dr. Haworth of Beverly Hills. Notice significant increase in tooth show and natural shortening of the upper lip with minimal nasal distortion. Being a lip lift expert, he developed this surgery to further his evolutionary journey into perfecting the ideal upper lip lift. This new technique also produces softer results those from the skin-only and muscle-hemming techniques.

Performing the modern lip lift with minimal-to-no-scarring and achieving a permanent beautiful result is challenging .  It requires attention to minute detail and appreciation of how the oral region plays a central role in facial harmony.  The vast majority of patients are thrilled with the subtle yet powerful results of this operation, but it has taken over 2 decades of  unwavering dedication and imagination to get this far.