Dr. Haworth of Beverly Hills gained much of his advanced experience as both a primary and revision rhinoplasty specialist back in the Middle East. He performed literally hundreds of nose jobs there on patients from all walks of life. One of the most common complaints there are boxy and bulbous nasal tips.
What constitutes a bulbous nasal tip?The bulbous nasal tip is most likely caused by thick alar cartilages (see accompanying diagram)and/or alar cartilages that are splayed out instead of shaped in a neat triangular formation. |
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This anatomic situation can be exacerbated by a thick layer of oily, sebaceous nasal tip skin. Think of the latter as a sleeping bag as opposed to a thin silk sheet., draped over delicate structures
How does an experienced plastic surgeon correct the thick bulbous nasal tip during a nose job?In my hands, I prefer performing a rhinoplasty utilizing an “open” approach because it affords me vital binocular vision so I can assess up to half-a-millimeter asymmetries that otherwise I would would be unable to appreciate utilizing a closed approach. The closed approach is one where the incisions are solely confined to the inner rims of the nostril, whereas an open approach utilizes the same aforementioned incisions in addition to a small hidden incision below the columella (that fleshy partition that separate the left and right nostril). The open approach allows me to see both the left and right nasal tip cartilages simultaneously so that any maneuver I would perform on the other can be immediately assessed with its opposite counterpart. Sutures are meticulously placed in a strategic fashion in order to change the shape of the cartilages from a round convex shape into more of a triangular one which, in turn, will translate to a more refined, elegant nasal tip. Think of assembling a ship in a bottle via strings, so to speak. The rhinoplasty surgeon cannot just bend cartridges, he must utilize sutures in order to shape them. This is part of the stock-in-trade of nasal tip/nasal cartilage manipulation. |
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Of course, some cartilage is removed as the surgeon sees fit. The importance of not being too aggressive cannot be overemphasized since doing so could result in an unsightly “pinched tip”. Finally, it is more often than not necessary to “defat” the under surface of the thick sebaceous nasal skin that would accompany such a bulbous tip. This allows the thick “sleeping bag” to redrape more fluidly over the newly reconstructed nasal cartilages.
Swelling of the nose may take many months to even a couple of years to fully disappear. This does not mean that the patient would not enjoy the effects of a rhinoplasty before then. It is just that the skin can remain slightly swollen for prolonged periods of time. The last area for swelling to dissipate is at the nasal tip area. So even though great of a 95% of my patients love their nose at the 21st day postoperatively, some will say that they would like their nasal tip to become further defined. I may either inject some Cortizone underneath the skin to turbocharge the swelling to go away quicker or just recommend patients. Sometimes that’s the hardest thing for inpatient to digest. For more information, click here and here See the following example: |
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Another example of an isolated bulbous tip with thin skin: |
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Author: omnispear
Too Busy to Stay Healthy? The Soup Diet
It is easy to blow off exercise till another day and just curl up in front of the TV with your partner, while eating your favorite comfort foods. While this can be rewarding on the occasional night off, a pattern of this is a one way street to middle-age spread!.
Beverly Hills Plastic Surgeon, Dr Haworth has a few simple tips to help break the “comfort habit.”
http://myp3r.wordpress.com/
Rhinoplasty – The rib graft mafia
Over the last 3 to 4 years I, as a primary and revision rhinoplasty specialist, have noticed an increasing and disturbing trend being practiced amongst those facial and classic plastic surgeons in my immediate community of Beverly Hills and other cities. This trend revolves around the use of rib grafts for not only revision but also primary rhinoplasty (!) (or in common parlance, nose job).
A good number of rhinoplasties require cartilage in order to achieve exemplary results. Cartilage is used to either build a bridge, fill depressions, augment or support the nasal tip. It is mainly harvested from the septum (that partition that exists in the midline of the nose which separates the left and right nostril) or the ear. Though I am fully trained general surgeon and am comfortable operating in and around the lungs and heart, I rarely employ rid graft as a source of cartilage. For most, it is generally a last resort when absolutely no other cartilage source is available. Admittedly, rib provides a strong support and is generally in plentiful supply. However, a number of downsides arise when rib is harvested: a permanent visible scar is created below the breast. Additionally, significant pain can arise from the harvesting as well as a small chance of creating a pneumothorax (or a collapsed lung) . Finally, rib can be notorious for warping thereby creating a nose that is crooked. Despite these drawbacks, I will use rib when there is a collapsed nasal septum (or dorsum creating a saddle nose deformity) or when plentiful cartilage is needed while other sources are exhausted. See the accompanying photos. |
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I always use cartilage to highlight and augment the nasal tip, however, when there is not enough cartilage present and I only need to build the bridge by a small amount, I do not hesitate to employ some artificial material such as Goretex®. I utilize this only when the chance of infection is remote. When patients are properly selected for utilizing Goretex®, the chance of infection extremely minimal in my experience. Unfortunately, the surgeons who habitually use rib grafts will scare the bejesus out of their patients into choosing the rib graft method by overstating the chance of infection and poor outcome if Goretex® is used.
So if I am writing that rib grafts are over utilized, then why do the rib graft cartel tell their patients otherwise? I feel it is simply a matter of finance. When a rib graft is harvested, the surgeon can charge a lot more for both his services and the operating room, especially if insurance is billed. Most patients will not question their surgeon’s motivated choices and indeed, feel that they have no choice at all, believing that the rib-graft-mafia method is their only solution. What is especially unsettling is that these doctors who are members of the rib graft cartel are now utilizing rib grafts for primary rhinoplasties (first time nose jobs). This is very puzzling because there is plenty of prime cartilage graft material available from the septum and ear and there is little to no reason to subject the patient to a rib surgery. All I can say is that this is a dangerous trend which introduces unnecessary risk and morbidity to the operation. A good patient is an educated patient and the purpose of my blog is to merely propagate information in the most objective way possible so that patients can make their own decisions as sentient adults. To learn more about primary and revision rhinoplasty , you can click here. Dr Randal Haworth Beverly Hills, California |
Eradication of Horizontal Neck Lines
Dr Randal Haworth of Beverly Hills had discovered an incredibly effective way of diminishing those troublesome horizontal neck lines.Only until recently has an effective method to erase horizontal neck lines or groves if you will been developed. Plastic surgeons have only offered neck lifts as a way to smooth these lines out and despite their efficacy in restoring youthful jawline and correct a “turkey neck”, they feel short in terms of treating those aging horizontal neck lines. As an alternative Botulinum toxin (Botox™, Dysport™, Xeomen™) can be injected into the platysmal bands of the neck and though it can “lift” the neck and lessen the aging cords of the neck, it does little to nothing to remove the horizontal lines. I have found that judicious use of a filler strategically injected under magnification into the precise layer below the horizontal grooves can dramatically decrease or even erase the stubborn lines. I usually start with a temporary filler such as Juvederm™ or Radiesse™ and once the patient is satisfied, I can then graduate to a permanent filler such as Artefill™., one the former substances dissipate . Here is a typical example of a before and after of a filler to the horizontal lines to the neck: |
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10% weight loss in 10 days
Yes, it is true. Men can lose up to 10% of their total body weight in 10 days while women can lose up to 7%!I have been so impressed with the results that I am now offering this weight loss program at The Haworth Institute in Beverly Hills as part of our commitment to not only human aesthetics but also health and well being.
These results are achieved with what nutritionists and other scientists refer to as a ketogenic diet, one in which only body fat and no muscle mass is lost. Pure liquid protein is fed via a minute clear feeding tube and this, in turn, induces one’s body to first burn off the 48 hour glycogen reserve within the liver, after which time the body re calibrates itself to burn off pure fat. During this process, ketones are concomitantly released and expelled in the urine (which can be measured via dip “sticks” we provide), indicating that the body is in ketosis and fat is being efficiently burned.
The diet is divided into cycles, each of which last 10 days. As aforementioned, men can lose 10% of the body weight within one cycle while women can lose 7%. After a diet phase is complete, the patient is referred under the guidance of our nutritionist. After 10 days, a second cycle of the 10 Pro-Ten may be initiated during which time men can lose another 10% while women can lose, not 7, but 10% of their body weight .
Think of it-after 30 days, a patient can lose an unprecedented 20% of their total body weight. By way of example, a 200 lb man will lose 20 lbs after 10 day cycle then , after waiting 10 days may lose another 18 lbs (10% of 180 lbs),resulting in a total weight loss of 38 lbs in 30 days!.
To get started on this program, Dr Haworth or one of his associates will evaluate your suitability for the 10 Pro-Ten diet and , if you are deemed eligible, then some basic blood tests are drawn for analysis. Once cleared, the patient has a micro feeding tube inserted via the nose into the stomach. This sounds far worse than it is. There is virtually no discomfort with this very quick maneuver. The tube is then connected to a mini high-tech pump which infuses the protein mix and a constant rate, 20 hours a day. This pump and associated protein are situated within a small backpack which one carries around with them for the 10 days of the cycle. One can detach the tube from the pump in order to shower or exercise.Sleep should not be a problem.
There is little to no hunger with this program thus minimizing any temptation to “cheat”, unlike conventional dietary regimens.
To summarize the advantages of the 10 Pro-Ten diet:
- Fat loss, not muscle
- Relative low cost
- No surgery
- Very safe
- Little to no hunger, thus maximizing compliance
- Last but not least, extremely effective with up to 10% body weight loss in 10 days
The Classic Reduction Rhinoplasty
As a primary and revision rhinoplasty specialist, Dr. Randal Haworth of Beverly Hills excels with all types of complicated nose jobs, but sometimes it is a simple pleasure to be confronted with a classic reduction rhinoplasty. Though these are relatively simple in concept, all nosejobs (or rhinoplasties) must be handled with utmost care and dedication to excellence.
Why does a prospective patient consult with me requesting a nosejob?
Well, most come to me with the latter concerns such as: “Doc, my nose is just too big for my face”, “I always hated my hump”, “My tip is falling like a bird’s beak”, etc., etc. Upon examination, the nose will usually manifest the aforementioned undesirable characteristics to varying degrees:
Check out this patient, who underwent a classic reduction rhinoplasty on the Swan. Here is a typical example of a classic reduction rhinoplasty,even though only subtle changes were performed. Note that a radix graft (to raise the nasal frontal angle) was placed to add height and therefore elegance to her nose. For a more general overview of rhinoplasty, go to: http://www.drhaworth.com/rhinoplasty/ |
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The Radix Graft in Rhinoplasty
This lesser known anatomic point of the nose is often purposely overlooked by rhinoplasty specialist surgeons because of the challenges it poses to those attempting to alter it. It is represented by the angle formed by the uppermost portion of the nose as it blends into the forehead proper. Yes, altering this area does have a subtle, yet profound influence upon the final appearance of a nose job- it can differentiate an excellent result from a “so-so” one. The surgeon can raise the radix so that the nose blends into the forehead at a higher latitude as well as softly elevate the natural valley that can exist at this are if it is too deep. Furthermore, one can deepen the radix if too much bone is present between the eyeball and the bridge on profile view.
The ideal position of the radix lies approximately at the latitude of the upper eyelash/upper eyelid crease. Beverly Hills plastic surgeon, Dr Randal Haworth can raise it by placing a precisely shaped softened cartilage graft (usually harvested from the nasal septum or ear) with beveled edges onto the bone of the radix area. Alternatively the radix or nasion can be rasped or chiseled with specialized delicate instruments to a lower, deeper position. Why does raising a radix from a low position improve the final appearance of a nose? Well, imagine two noses which are identical in shape and forward projection except that one has a low radix while the other has a high one. The one with the low radix is shorter compared to the one with the high. Now imagine two men, both with the same 34 inch waist, but one is short while the other tall. Who appears fatter? The short person does, of course. This same optical illusion applies to the nose with a low radix-it appears as it projects further out from the face as compared with the one with the higher radix and not necessarily in an attractive way. The following photos represent a beautiful result of a corner lip lift and concomitant rhinoplasty in which the radix was raised. |
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Work here results in some extra swelling localized to the space between the eyebrows in the sense that it lasts a few days longer. Dr Haworth at the Haworth Institute has a few tricks up his sleeve to accelerate the resolution of the nasal swelling by injecting a dilute mix of Kenalog under the skin (and it is relatively painless) two weeks out. This “turbocharges” the swelling to go away! Of course, the radix can also be augmented with a filler of some sort, such as fat, Radiesse, Juvederm, Aquamid and Artefill. | |||||||
Botox for wrinkles, lips, necks and more….
The chin can also by smoothed out by ridding it of that aging cobblestone appearance when grimacing, while pore size can be reduced by selectively placing Botox™ into the dermis of the skin only. With this latter technique (when injected into the forehead), the patient can still move their brows but their wrinkles are vastly reduced as well as their pore size- that frozen look is avoided which is especially important for my actor patients. Xeomen™ is a new substitute for Botox and has a number of advantages.
For further information, check out these Extra™ LifeChanger features on the very subject:
The Injectable Nosejob
The appeal is obvious: less bruising, less prolonged swelling, less initial expense, less scary for the wary and more predictable (in the proper hands) with less risks. However, the injectable technique cannot be used to correct all types of cosmetic nasal problems and deformities. This is especially true for noses that need to be reduced in size and refined in shape. One does not need to be a genius to realize that fillers may do little to make a nose smaller by removing humps, refining tips and narrowing bones, no matter how well injected they are. The ideal candidate for an injectable rhinoplasty is the nose that needs to be augmented, either via it’s bridge (or dorsum) or it’s tip or both. A drooping tip can be elevated only to a subtle degree with filler.
Filler is also a great solution to those noses that have minor irregularities stemming from prior rhinoplasties. Filler will generally not help breathing problems. To learn more about this elegant solution to a rather common problem, check out these videos:
1.Extra Injectable NoseJob
2.Today Show Injectable NoseJob
3.Extra Artefill Injectable revision rhinoplasty
Dr Randal Haworth of Beverly Hills counts primary and revision rhinoplasty as one of his specialties of plastic surgery
The pinched nose; the rhinoplasty gone “wrong”
Among the more common complications that occur from a rhinoplasty are asymmetry, difficulty breathing, incompetent internal nasal valves (inverted V deformity) and a pinched tip. Modern rhinoplasty techniques involve far more subtle maneuvers than old-fashioned cutting out cartilage and breaking bones. Since the shape of the nasal tip is determined both by skin thickness and the underlying shape of the nasal cartilages, it used to be taught that to avoid a pinched nasal tip, all the surgeon has to do is avoid cutting out too much cartilage. Otherwise, the nostrils will loose the supportive function of the cartridges and collapse upon themselves thus leading to a “pinch tip” appearance. In actuality, the situation is more complicated than that. While it is indeed important to leave enough catilage as support, modern techniques of rhinoplasty involve delicately placing precise sutures in order to control the tip and projection of the nasal tip. If the knots are tied ever so slightly tighter than normal, the supportive nature of the cartilage may be overcome by the scar tissue that will develop in the postoperative period. The cartilages will then become concave in appearance thus leading to a pinched tip as seen in the accompanying photo.
Preoperative nasal deformity after previous rhinoplasty. Note inverted “V” deformity, asymmetry and pinched tip
Also seen in this photo is an inverted “V” deformity. This occurs when the upper lateral cartridges separate away from the midline septum as well as the upper nasal bones. This results in an irregularly appearing nose along its bridge on full frontal view including an altered brow-tip curvilinear line.
Both a pinch tip and an inverted “V” deformity can result in difficulty breathing through the nose. Correction as part of a revision rhinoplasty involves carefully separating the cartilage from the surrounding scar (which may appear deceptively similar in texture and look during surgery) and carefully placing precisely defined cartilage grafts on to the pre-existing weakened cartilage as support. Spreader grafts are needed to correct an inverted “V” deformity. These are small strips of cartilage fashioned from either the septum or ear which are secured between the midline septum and the inner border of the upper lateral cartilage is-in effect, reconstructing the middle vault up the nose. If this remains uncorrected, not only does the visual deformity processed, but nasal obstruction will also occur upon inspiration. This occurs in a similar fashion to a loose canvas roof of a tent which gets sucked in by high mountain winds.
The postoperative photo of the same patient clearly demonstrates the correction of the pinched tip and inverted “V” deformity via cartilage placement, scar removal and judicious fracture of the nasal bones. I also be rotated the tip in order to make the nose look “less done”.
This video shows how a pinched tip can be successfully repaired:
For further information about what one may expect after a rhinoplasty click here
For further information go to www.drhaworth.com or call his office in Beverly Hills to schedule a consultation.