Of course, there are other ways to improve your body. Dr. Randal Haworth , who plumps some of the famous lips and breasts in this town, reports that the latest wishes of teens to 40-something women are for sexy, pouty lips, C-cup breasts and natural looking noses.

Dr. Randal Haworth , also of Beverly Hills, would provide treatment for a “complete rejuvenation,” while keeping Parker Bowles from looking plastic. Besides Camilla’s fair skin, well proportioned nose and good bone structure, “I think underneath it all she’s got nice eyes,” Haworth adds, “and I’m told that her personality is one of her strong points.”

Sally Kirkland: Bad experience with her implants

Question:
I’m tired of seeing so much cleavage at the showbiz awards shows. Has everyone in Hollywood had breast implants? What happened to the health concerns about silicone?

Answer:
“Silicone has been eclipsed by the safer saline-filled implants,” says Dr. Randal Haworth , a Beverly Hills platic surgeon who recently reconstructed actress Sally Kirkland’s breasts after complications from her implants. He thinks the desire for big breasts is related to California’s beach culture. But the tide may be changing. Former Baywatch babe Pamela Anderson had her implants removed last month, explaining: “I just wanted my natural body back.” (She was surprised to learn that one side had been leaking.)

“Carré Otis recommended Randal D. Haworth, M.D., I see him for zapping broken blood vessels.”

A Visit to One Of Beverly Hills Top Surgeons “Success in face lifts is detail orientation, art and craft. It is a great technical exercise to design a face lift. I liken surgery to painting. In fact it has helped me greatly that I studied art and always wanted to be an artist.” -Randal D. Haworth

Let’s face it-in L.A., having a nip doesn’t always mean a cocktail. An informal poll of plastic surgeons and their patients revealed a rough consensus of who does what best…..Dr. Randal Haworth creates aesthetic lip shapes instead of merely pumping them up with volume enhancers.

You may well have seen Dr. Randal Haworth on Entertainment Tonight or other national television programs. He is a celebrated plastic surgeon who invented the Haworth Lip Technique, boasts a clientele of celebrities and socialites from around the world, and was recently named one of the best eight in his field by Los Angeles magazine. Dr. Haworth’s office (which includes full operating facilities) is a perfect reflection of his brand. “It is important for a plastic surgeon to show prospective patients the aesthetic side of his personality without going too far over the edge,” he notes. “I am, after all, a board-certified surgeon, and would thus not want to be perceived as a ‘fringe personality.’ ” This doctor’s office strikes an excellent balance: the reception area is warm and welcoming, while the inner offices maintain the requisite clinical feel. Of special note is the fact that Dr. Haworth’s own painting are exhibited through the office and examination rooms. “Part of my brand,” Dr. Haworth explains, “is that I am not only a highly trained plastic surgeon, but a man with highly developed aesthetic sense. In fact,” he continues, “I will be exhibiting my work at Bergamot Station (one of Los Angeles’s most respected art venues) later this year. This tells patients not only that I have a strong sense of aesthetics and composition, but that I am a well-rounded individual, with interests that extend far beyond the realm of my medical practice.”

Facial rejuvenation is like making a bed. It is a two step process. First, one needs to start with clean, freshly ironed sheets. Secondly, the actual bed is made by carefully draping, rearranging, folding and finally tucking these sheets into place. The final results is a soft, harmonious and good looking arrangement that invites company rather than rejects it. How does this analogy applies to the face? We need to imagine our skin as our sheets. The ideal skin should be clean, opalescent and smooth. The skin should be relatively free of disconcerting wrinkles and folds. The skin should be adherent to the underlying facial structures in a natural fashion, free of redundancy and looseness.

In order to iron our sheets, peels in various fashions or lasers can be applied to render the skin smooth in both maintenance skin hygiene and facials to keep the skin clean and free of toxic buildup. Finally, to actually make the bed, a well performed facelift with fastidious bent towards detail can be utilized in a natural way. The successfully rejuvenated face should attract rather than detract. Unlike cosmetic nasal surgery, performing a facelift (synonyms include rhytidoplasty, meloplasty or rhytidectomy) does not require an innate aesthetic eye. However, it does require a surgeon with a keen eye for details, since it is a surgery of minute details – needed to avoid the tell tale signs of a facelift. This is key to achieving the natural look. Among these tip-off signs are raised, altered hairline, a distorted tragus (the cartilage in front of your ear canal), a “pixie ear” (where the earlobe is attached to the facial skin at the jawline), a widened mouth, obvious scars and tension bands across the face (from pulling too tight and removing too much fat).

What is the difference between a mini lift and a full face lift? A mini facelift deals with jowls and facial laxity only; the neck needs minimal or no treatment and the incisions behind the ear are consequently minimized. A full facelift, on the other hand, addresses both the facial looseness and tackles the aging neck and “turkey gobble.” Wait. The situation gets more complicated. Does your surgeon propose a regular skin lift, a skin lift with SMAS (SubMuscular Aponeurotic System “tightening the facial muscles”), a deep plane lift, a composite lift, a biplanar lift or just an everyday subperiosteal midface lift? It depends on the individual surgeon’s philosophy, which has most probably been influenced by his/her training.

The pendulum is swinging back towards the simpler skin lifts combined with or without some form of SMAS tightening. The more sexy and complicated, deeper facelifts (deep plane and composite) classically produce more swelling with more complications and questionably better results at best.

Long term follow-up studies as judged by independent panels of Plastic Surgeons have failed to demonstrate and difference in outcome and longevity between the techniques.

Where to go from here? Do your homework! There are many Plastic Surgery “practitioners” who masquerade as fully trained Plastic Surgeons eager to offer you their expertise at a great seasonal discount. Ask about their techniques, their “before and afters,” their board certification (The American Board of Plastic Surgery) and the specific training.

Keep in mind, however, that patients must be realistic in their expectation and the surgeon must underscore this. Remember, plastic surgery reverses time but time still marches on.

Dr. Haworth is a Board Certified Plastic Surgeon who practices in Beverly Hills.

Memo to All Boomers: How is It That You’ve Transformed the Rite of Turning 50 Into a Celebration of your So-Called Youth?
By Denis Romero
TIMES STAFF WRITER

So you’re turning 50.

Hahaha. Er, take that back. Maybe the joke’s on us.

You would think all those yuppie-haters out there would be laughing at the prospect of Dockers-wearing baby boomers going Grecian, power walking instead of jogging, taking Depends breaks in between puffs of their Arturo Fuentes.

But oh, no. Just the opposite.

Just as in the past, you have managed to turn a traditional passage of doom into a celebration of your youth and culture-yet another opportunity to party in the pages of the media that you so glamorously control. Oldstock?

The Beatles are No. 1 (again yawn). Everybody wants to sell you a miracle drug. Hollywood chronicles your every breath (from “The Graduate” to “Forest Gump”). And one thing’s for sure: As the 76 million of you begin to hit 50 at the rate of one every 7 1/2 seconds this year, you will change the concept of aging as much as aging will change you. You are, after all, so vain.

What used to be old will be young-a feat only you boomers could accomplish. From a new vocabulary (can you imagine calling Cher a senior?) to age -sensitive marketing (Act Young. Drink Pepsi!) to new products (girdles for a new generation), the world will bend over backward to make you feel like lads and lassies (though you will go through more life changes than an Oliver Stone plot).

“Fifty is still an age where you can still have one foot in youth,” insists 43 they’ve even invented a new name for middle aged . They call it “mid-youth,” Mister. “No one here talks about middle aged people,” says Alison Kaar, spokeswoman for Lens Crafters. “We call them emerging presbyopes.” “Presbyopes” refers to the farsighted, as far as we can see.

“The story in marketing is not selling to how old people are,” Kamins says, “but the age people think they are.”

And boomers measure themselves as much as 15 years younger than their chronological age, experts say. Or as Gail Sheehy put it in “The New Passages,” (Random House, 1995) her paean to incessant self-improvement, “Fifty is now what 40 used to be.” Mercedes-Benz is hip to that. In a twist of advertising irony, the German car company is invoking a famous line from ’60s singer Janis Joplin: “Oh Lord, won’t you buy me a Mercedes-Benz.” Redkin hair, skin and body products have a new motto: “To Preserve and Protect.” And Revlon is using a beautiful Melanie Griffith, 37, to promote “Age Defying Makeup.”

Then there’s the Circuit City commercial that portrays a suited yuppie out-blasting a grunge rocker in a park-bench boom box battle. (As if.) Or the Caffeine Free Diet Coke commercial that has an older woman boxing a younger man and winning. A Coca-Cola marketing spokesman is proud to say, “It’s the first ad campaign in the soft-drink industry dedicated to the 40-plus market. No caffeine. No sugar. No limits.”

Will you ever age? “What we can look forward to is people who not too long ago were staring at lava lamps, smoking dope and listening to Iron Butterfly – they’re basically going to be in diapers,” says Bob Garfield, editor at large for Advertising Age magazine. “How are advertisers going to reach those people? I don’t think its going to be pretty. I can actually envision Jimi Hendrix being invoked to sell Arthritis Pain Formula. It’s going to be a laugh riot.”

Even girdle and butt-pads, the untouchable domain of grannies, are being marketed as Slenderizing Manshape Undergarments, Super Shaper Briefs and Bottoms Up Corsets.

(If these don’t work, sagging body parts will no doubt be the next big thing. You’ll call it skin relaxation-and twentysomthings will be stretching their chins and cheeks just so they can fit in.)

Plastic surgery is at an all-time high among boomer men, according to the American Society of Plastic and Reconstructive surgeons. Dr. Randal Haworth, a Beverly Hills plastic surgeon, estimates that one out of four of his patients is male–and most of those are boomers. “What’s so ironic,” says the 34 year old, is that these are the same people who espoused protest and 30 years later are succumbing to modern pressure, the antithesis of what the ’60s stood for.”

Punk.

But he’s right. Pectoral and penile implants are in. Breasts are back. And everybody wants a nip-and-tuck (though they don’t call them face lifts anymore, of course: “facial rejuvenation” is the proper term).

By MILT FREUDENHEIM
Published: August 24, 1996

Dr. Phillip Haeck, a Seattle plastic surgeon, used to spend half his working hours rebuilding the breasts of cancer patients and performing other reconstructive procedures. Then managed-care companies started to cut his fees by 60 percent or more.

So Dr. Haeck switched to cosmetic procedures that insurers do not cover, like breast enlargement. No longer restricted to the $1,980 fee that insurers allowed him for a six- to eight-hour breast restoration, he can now earn $3,800 for inserting saline breast implants, which takes two hours or less.

He was surprised by how many women were willing to pay. His income has already recovered, he said, and his working day now ends an hour earlier because he deals with far fewer insurance forms.

Just as Dr. Haeck has done, thousands of doctors, frustrated by the price controls, red tape and sometimes intrusive oversight of managed care, have begun building lucrative practices in fields like cosmetic surgery, correcting myopia with lasers, and infertility treatment, where patients will pay even when insurers will not.

Insurance companies refuse to pay for many of these elective procedures, arguing that they are not medically necessary or are still experimental. But a growing number of Americans are willing to spring for them — at handsome prices. Indeed, while it used to be assumed that a doctor could charge a higher fee when an insurer was helping to foot the bill, the opposite is now true in many cases. Fees are often far higher than those doctors can charge under managed care for work requiring comparable skill and time.

The doctors increasing their emphasis on such procedures include:

*Physicians doing more cosmetic surgery, including plastic surgeons, dermatologists, ophthalmologists, ear, nose and throat specialists, dentists, gynecologists and general practitioners. Among the most common procedures are breast enlargement; removal of wrinkles, furrows and bags under the eyes; face lifts; nose jobs; hair transplants for men; vein surgery; chemical peels of unsightly skin, and liposuction to remove fatty tissue. The fee for such procedures can range from a few hundred dollars to more than $20,000.

*Ophthalmologists, who typically receive less than half the $2,000 that they used to get for each lens implant for cataract patients, shifting to a new surgery that uses lasers to correct nearsightedness — and charging $1,500 to $2,000 an eye.

*Some ear, nose and throat specialists — whose fees have been cut 40 percent to 60 percent under managed care — now capitalizing on a new technique: using lasers to eliminate snoring by removing tissue from the uvula at the back of the tongue. A typical fee is $2,500.

*Some obstetrician-gynecologists with special training in infertility services now averaging $2,000 and more for in vitro fertilizations.

*Some urologists, whose surgical fees have dropped to $600 from $1,400 for treating enlarged prostate glands, now making a business of penis-enlargement surgery. Those fees range from $4,800 to $7,000.

To be sure, the overwhelming majority of the nation’s 650,000 physicians are still deeply enmeshed in managed care and are not reaching out for more lucrative niches like these. But there is wide agreement in the medical community that as the number of procedures that do not qualify for insurance coverage — and the popularity of such procedures — grow, a rising number of doctors are making the most of this.

One reason that these specialists can find enough takers paying out of their own pockets is the stunning increase in family income of the wealthiest Americans. The average income for the top 20 percent of households grew to $105,945 in 1994 from $73,754 in 1968, a jump of 44 percent after adjusting for inflation, according to the Census Bureau. That has occurred even as the number of uninsured people grows and as many people see their own medical benefits reduced.

Also, some doctors and patients have found imaginative ways to get insurers to pay part of the bill. Nose jobs can get some insurance coverage if the doctor indicates that the patient has had trouble breathing. Some dermatologists who remove spider veins can get insurers to pay by calling them artery-blocking varicose veins.

The physicians’ rush to such procedures is not surprising. Managed care has been cutting the flow of patients and sharply reducing fees for many specialists, notably dermatologists, ophthalmologists, ear, nose and throat specialists, general surgeons, cardiac and vascular surgeons, cardiologists, anesthesiologists and gastroenterologists, said Dr. Richard Doyle, a management consultant in St. Louis with the Milliman & Robertson consulting firm.

No one tracks the number of doctors performing procedures not covered by insurance or how that number has changed, but there are many indications that it is growing. For example, the number of board-certified plastic surgeons rose 75 percent, to 5,200 in 1994, from 2,980 in 1980, according to the latest available surveys by the American Medical Association. And last year 40 percent of plastic surgeons said cosmetic work was now their main business, up from 32 percent in 1991, according to the American Society of Plastic and Reconstructive Surgeons.

The American Academy of Cosmetic Surgery said the number of commonly performed cosmetic procedures doubled, to 1.09 million, between 1990 and 1994, the latest available year.

Dr. Randal Haworth, a Beverly Hills, Calif., plastic surgeon, said that by concentrating on cosmetic surgery, ”We are not held fiscal and emotional hostage by these people in managed care; secondly, by refusing to join their plan, you are not obligated to accept what they pay.”

Dr. Haeck, the Seattle plastic surgeon, said he shifted to 90 percent cosmetic surgery from a practice that was half cosmetic and half reconstructive, after price-cutting insurers threatened to reduce his income by 30 percent. For instance, he said, his share of fees for breast reconstruction after cancer surgery dropped to $1,980 from $3,800.

Dr. Haeck resigned from eight managed-care networks, freeing more time for breast-enlargement procedures that he said bring in around $3,800 each.

He hired a marketing expert to, as he put it, ”ramp up that side of the business.” Dr. Haeck also began giving seminars at a local athletic club and appearing on local television, and he changed his advertisements to feature his cosmetic services.

Dr. Gwendolyn Maxwell Davis, a cosmetic surgeon in Tucson, Ariz., took one look at the field of plastic surgery when she finished her training and decided to devote herself exclusively to cosmetic procedures. She charges $6,000 for a face lift, $4,500 for breast enlargement, and $4,500 for a ”tummy tuck.” All told, she expects to net $450,000 this year, after only two years in practice.

Another fast-growing niche is infertility treatment. The American Society for Reproductive Medicine reported 32,000 cycles of in vitro fertilization were initiated in 1993, the most recent year for which numbers were available, up 76 percent from 1989. And physicians say that the number has grown significantly since then.

”From a purely financial point of view, I’d rather not have managed care involved,” said Dr. Ira Charlip, a San Francisco urologist who specializes in infertility. ”I can charge the patient a reasonable amount and they pay 100 percent of it.”

Advances in laser technology have opened numerous new medical opportunities as well, many not covered by insurance. Some are cosmetic, like burning off tattoos and age spots, zapping wrinkles and removing hair.

Other procedures, which some insurers cover, include removal of disfiguring birthmarks. New laser procedures are growing much faster than older procedures covered by managed care, Irving Arons, managing director of Spectrum Consulting in Peabody, Mass., said.

”Doctors are looking for new ways of generating revenue,” said Larry Haimovitch, a medical technology consultant in San Francisco. ”If they can buy a laser machine and pay it back quickly, they do it.”

Some of the newest lasers are used to treat myopia by changing the shape of the eyeball. Dr. Frank O’Donnell, a St. Louis ophthalmologist, had encountered big reductions in what insurers allowed for cataract surgery. ”It’s pretty hard to scramble to replace a 50 percent reduction in reimbursement,” he said.

Now, Dr. O’Donnell specializes in laser treatments for myopia at $1,500 to $2,000 an eye. He is also chairman of Lasersight Inc., a start-up company that he said was testing a second-generation laser for myopia.

Dr. O’Donnell laments the changes in the medical business brought on by managed care, and says he worries about whether the most talented doctors will flee to other professions.

”Ophthalmology has gone from being an exciting, very valued specialty to something that is not very desirable anymore,” he said. ”It’s painful — we used to be able to attract some of the very best doctors.”

Mr. Arons of Spectrum Consulting said that there were at least 50 laser vision centers in the country, each with several physicians. He projects 200 centers by the end of the year and a million procedures a year by 2000 at $1,000 each as the price of the equipment comes down — a $1 billion market.

Dr. Roy Geronemus, director of the Laser and Skin Center of New York, which does both insured and uninsured procedures, said attendance had increased sharply for his course in new laser techniques at New York University Medical Center. Some of his students, he said, are physicians ”who are looking for ways to circumvent the constraints on medical practice.”