Fat transfer to the lower eyelid hollows/dark circles

Posted on November 5, 2012August 23, 2016 by omnispear

Fat transfer is a brilliant way in order to fill up the lower eyelid circles which gradually appear with age as the mid facial fat sags southwards. Though one can inject any number of temporary and permanent fillers into the area with magnification (such as Juvederm®, Restylane®, Artefill®, Belotero®, etc.), one must remember that fat is an excellent solution. By filling out this dark circle/hollow, a smooth beautiful interface is created between the lower eyelid and the upper portion of the cheek. The harsh defining ledge of the lower bony orbit is smoothed out.

Here is a classic example of a strategic fat transfer to the lower lid. The results are permanent and natural appearing.

JL-eye-pre-lat — Note the harsh shadowing around the lower eyelid interface with her upper portion of her cheek. This is called the “tear trough” and worsens with age.

JL-eye-post-lat — Note the smooth result that was obtained by softening the shadowing and ledge that defined her lower eyelid hollow. Fat transfer was performed in order to obtain this result.

Obviously, as we continue to age, the cheeks descends further thereby widening the “tear trough” or lower eyelid Hollow/dark circle. The fat that worked perfectly to bridge the gap is now inadequate since the gap has widened. The results of fat transfer should be permanent, however, as long as the surgeon adheres to proper fat harvest and transfer techniques.

For further information into how Dr. Randal Haworth of Beverly Hills(Certified by the American Board of Plastic Surgery), Call 310-273-3000

Needle Away your Concerns about Stretch Marks and Sagging Body Parts

Posted on October 31, 2012August 9, 2016 by omnispear

Needling treatment also known as CIT (which stands for collagen induction therapy) has actually been around for quite a long while now. It is truly a low-tech device but it has found a new place in my bag of aesthetic tricks.

Why? Simply because it works. It seems to be the most effective procedure in this day and age to reduce stretch marks (striae distensiae), firm and elevate tissue(knees, elbows, buttocks etc.), reduce scars (including acne ones), reduce hyperpigmentation-all in all it seems to result in a healthy, more youthful appearing skin.

How does it work?

The patient starts applying fat-soluble vitamins A and C antioxidant oils to the skin two weeks prior to the planned procedure date. The fat solubility of these vitamin oils allow them to penetrate human epidermis and dermis far more effectively that many of the other available competing products. These in turn stimulate the skin to produce more collagen and rejuvenate their elastin component. The device (which is basically a roller with approximately 200 needles attached to it perpendicularly) is then utilized to produce tens of thousands of small needle marks penetrating into the dermis. This in turn, induces a cascade of collagen production, the effect of which is amplified by the combined use of the antioxidant vitamins. In a way, the roller is not only producing a controlled injury to the skin but also acting as a very efficient drug delivery system.

I generally recommend a number of treatments to get the most optimal results. Here’s just one example of the fairly dramatic effect one could achieve by this methodology. The woman had undergone myriad laser treatments to reduce her stretch marks, but to no avail. After just two Roller treatments, she achieved the following result.

Abdominal Stretch Marks — This woman had a previous abdominoplasty in order to help reduce her stretch marks. She was dissatisfied with the result and had many laser treatments to reduce her stretch marks. They are still very obvious in width and depth.

After Needling/CIT — She underwent two rounds of Needling/CIT. Note the dramatic reduction in stretch marks both in terms of width and depth.

For further information about CIT, needling therapy, call the office of Dr. Randal Haworth (310 273 3000) located in the Haworth Institute.

Rhinoplasty – “Samurai Nostrils”?

Posted on October 2, 2012August 9, 2016 by omnispear

As one of the leading rhinoplasty specialists in the United States, Dr. Randal Haworth continues to challenge himself to be the best he can be. By constantly questioning his results and asking himself how he can do things better, he feels he is subjecting himself to the highest quality assurance and delivering the best possible outcomes in plastic surgery .

Performing rhinoplasties are one of my favorite specialty since the nose place such a central role in the total harmony of the face. Consider it like one of the leading instruments in the orchestra. Though most plastic surgeons and patients alike obsess on nasal humps, wide bones as well as drooping, boxy, pinched and ill-defined tips and, of course, the width of the nostrils, little attention is paid to the actual shape of the nostrils. In other words, a surgeon should not only assess whether the nostrils are wide at their base, but also whether they are arched, pointy, thick or sigmoid in shape.

One of the most common and unflattering nostril shape is that of the “samurai nostril”. Look at the following two photographs and you will see what I mean.

Seven samurai — Another example of these flared nostrils that may look appropriate as a menacing sign but not a flattering one for beautiful woman

Flared nostrils of the nose before a rhinoplasty — A samurai mask manifesting the flared, aggressive shaped nostrils that are unappealing in a woman

There are a few ways to correct this but probably the most reliable is to harvest a “composite” graft from the hidden portion of one’s ear. This detailed surgery involves insinuating this graft between an incision made on the inside of the nose, corresponding to the actual width of the retracted portion of the nostril. This graft is then sutured into place with the skin side facing the actual inside of the nostril to maintain the continuity of it’s lining. One can lower the nostril about 3 to 4 mm with this technique. Of course, some resorption of the graft occurs so it is best to over-correct this.

Other techniques involve strategic V-Y plasties, which are essentially internal tissue rearrangements of the inner aspect of the nostril in order to lower its rim, cartilage grafts in the actual substance of the nostril to help correct pinched tips while lowering the rim and, finally, filler. These latter techniques, though successful to some degree, are not as effective as an ear “composite” graft.

Note the following two cases in which “composite” grafts were taken from the ear and placed within the nostril to lower them. Of note, simultaneous upper lip lifts to further enhance a feminine appearance were performed.

Preoperative transgender patient with retracted nostrils — Transgender patient was retracted nostrils, long upper lip and droopy corners of the lip

Transgender patient after composite grafts to lower the nostril rims and an upper lip lift with DAO release — Dr. HAWORTH performed a modified rhinoplasty by lowering the nasal arched “samurai” rims (nostrils) as well as an upper lip lift and DAO release to lift up the droopy corners of the mouth

Patient with a long upper lip and retracted "Samurai"nostrils after a previous rhinoplasty — Patient with a long upper lip and retracted “Samurai”nostrils after a previous rhinoplasty by another surgeon

Dr. Haworth performed an upper lip lit along with nostril rim lowering and fat transfer to the lips — Dr. Haworth performed an upper lip lift along with nostril rim lowering via a composite graft from the ear. Fat transfer was also performed into the upper and lower lips. Notice the more feminine harmony

What is Natural Plastic Surgery?

Posted on August 21, 2012August 9, 2016 by omnispear

What is Natural?

The Challenging Question in Modern Plastic Surgery

“I am fearful about plastic surgery. “Whenever I am in , Beverly Hills, LA or New York, I see people with bad work looking so fake. Their lips are and breasts are so out of proportion!”

I , as a Board Certified plastic surgeon in Beverly Hills, hear this time and time again in conversation at dinner or in my clinic. “I don’t want to look like Michael Jackson!” is another common proclamation of patients during nasal surgery consultations. Instead of getting frustrated with these opinions, I agree with them. It is because I understand their source. It is simple; “good” plastic surgery is invisible, while so called “bad” plastic surgery is not.

Bad plastic surgery (whether it be a rhinoplasty, facelift or breast augmentation) can result from any of the following three scenarios. The first is poor performance of a procedure. Fortunately, this is a rare occurrence when a properly trained surgeon certified by the American Board of Plastic Surgery performs the surgery. The second is poor healing by the patient, perhaps complicated by infection. Again, this is infrequent especially in healthy, well-selected patients. Finally, the third issue is the question of aesthetic taste. No amount of plastic surgical training will guarantee appreciation of balanced facial form and pulchritude. By way of analogy, not all self-professed artists who attend the same art school will emerge as equally talented artists.

What makes for good plastic surgery then? It is the fruit of a surgeon who’s not only technically proficient, but also possessive of a keen eye and aesthetic sense. A beautiful and youthful face reflects visual harmony between facial structures. With age, harmony turns into visual dissonance as youth cues disappear. As a surgeon, it’s my job to serve as a conductor to bring these diverging aging elements together again. Youth cues are lost as wrinkles, folds and sagging facial features arise. Most plastic surgical training emphasizes the re-establishment of major youth cues while overlooking the minor ones. In order to re create the major youth cues, I eradicate jowls; I soften the nasolabial folds, (the fatty accumulation that runs from the bottom corner of the nostril to the corner of the mouth,) contouring a strong jaw line and a firm neck and rejuvenating the eyelids through a combination of endoscopic brow lifting and blepharoplasty (eyelid tucks.)

In order to paint a convincing portrait of somebody in their youth, the surgeon should not only recreate the major youth cues, but also the minor ones. To do so, the surgeon must address the hollows underneath the eyes, the drooping corners of the mouth, the elongated upper lip (hiding the upper teeth), the sagging lower lip (exposing the lower teeth) and the elongated ear lobes. True visual choreography is required.

I’m excited by the array of minor youth cue procedures now developed. Most are relatively minimal in scope. Among these are the Endotine ST and B mid-face lift, the first vertical and reliable mid-face lift that not only addresses the hollows under the eyes, but also softens the nasolabial folds. All in all, it provides a more natural and subtle rejuvenation, avoiding that “pulled back” look. The procedure takes forty minutes when combined with a blepharoplasty (“eyelift” ). This technique is made possible by the development of a new absorbable device placed via the eyelid to elevate the cheek fat pad back to it’s position of youth.

There are other minor youth cues and I address them as well – by performing upper lip lifts with a hidden incision inside and around the nose, as well as corner lip lifts and earlobe reductions as necessary. The upper lip lift shortens the distance between the nose and the lip, allowing the upper teeth to be seen. One only has to peruse the fashion magazines to see how this look is indicative of a fresh and youthful lip region.

The before and after photos included below, are good examples of the above principals put to use. This 28-year-old girl has premature signs of aging from massive weight loss. Both major and minor youth cues need to be established to achieve harmonious balance. Consequently, I performed an endoscopic brow lift, lower blepharoplasties with fat transfer, an Endotine mid face-lift, liposuction of the neck, upper lip lift and fat transfer.

midfacelift, browlift, blepharoplasty, upper ,lip lift, fat transfer to lips

midfacelift, browlift, blepharoplasty, upper ,lip lift, fat transfer to lips

There are artists who have become doctors and doctors who have become artists. Since I have started painting as a little child and have graduated to exhibit my later work in respected galleries, I consider myself as one of the former. I am fortunate that my background has imbued me with an artist’s eye, which translates into my work. Regardless of Beverly Hills, New York or other urban center, Plastic surgeons should always strive to deliver to their patients not only the best technological advances in plastic surgery, but also in a way that reflects passion and inspiration with an aesthetic sensibility.

Botox® for Depression?

Posted on July 23, 2012April 14, 2016 by omnispear

Botox may soon be used to treat psychological depression. We know that it can help alleviate the symptoms of migraines in many.

Dr. Randal Haworth Beverly Hills is an expert specialist in facial plastic surgery including maintenance therapy through fillers and paralytic agents such as Botox®, Dysport® and Xeomen®.

Botulinum toxin A seems to do far more than just block the transmission of acetylcholine (the neurotransmitter chemical released from nerve endings to affect change in muscle, glands etc.).

There is new evidence to suggest that Botulinum toxin type A can be used to treat depression which was first reported in 2006 by two American doctors (Finzi E, Wasserman E “treatment of depression with botulinum toxin A: a case series, Dermatol Surg 2006; 32 (five): 645-649). Based on this small study, a much larger study with careful patient assessment has shown that a single treatment of the glabellar lines (the dreaded “11” frown lines) with botulinum toxin resulted in a significant and sustained benefit for depressed patients (Wollmer MA, de Boer C, Kalak N, et al. “facing depression with botulinum toxin: a randomized controlled trial,” Journal of psychiatric research May 2012; 46 (five): 574-581).

Therefore, one can conclude that Botox®, through control of facial expression, seems to have the ability to control patient mood. However, is this an effect of increased self-confidence on the patient’s part or is this a result of hormone or regulatory peptide secretion as well?

Who knows at this time, but this is intriguing nonetheless. Dr. Haworth of Beverly Hills, however, is still not offering this treatment for depression even though many do say that aesthetic plastic surgery can be surgical psychiatry when performed in properly selected patients! Is this why there are so many ostensibly happy people in Beverly Hills and and its environs? 😉

For further information click on this link to body language.net

The Perfect Lower Eyelid-No Wrinkles, No Hollow Circles

Posted on July 11, 2012August 9, 2016 by omnispear

What is the perfect lower eyelid?

We all want to have the eyelids when we were 20 with minimal-to-no wrinkles, no bags, no dark circles and a smooth transition from the lower eyelid into a nice full elevated cheekbone.

But life tends to throw us a curveball. As we get wiser, our wrinkles get proportionately deeper.

80% of this is hardwired into our genetics while 20% is in our hands. In other words, genetics is our gun and the environment is our trigger.

The best treatment is prevention by avoiding environmental toxins-tobacco smoke, harsh chemicals and sun exposure are the three main culprits that come to mind.

The second treatment is maintenance through the use of hygiene, moisturizers and strategic use of topical antioxidant therapy. Among the latter is a dizzying and bewildering array of botanicals, herbals, vitamins, roots, vegetables, nutritional supplements and berries! But the two most singularly effective treatments are the use of vitamin A (derivatives of retinol, Retin-A, etc.) and fat-soluble vitamin C. The early use of these substances goes a long way in helping to prevent and diminish the wrinkles in the first place. I know many 60+ year old patients who have virtually no crows feet (without the use of Botox™) because they have been using a derivative of Retin-A for close to 20 years.

The third and final treatment is direct physical intervention through the use of either lasers, Botox™/Xeomen™, fillers (Restylane®, Juvederm®, etc) and/or plastic surgery. Plastic surgery on the lower eyelid is called blepharoplasty and can consist of any combination of skin removal, fat bag reduction and eradicating the dark circles/hollows that frame the lower eyelid from the cheek.

As a Beverly Hills plastic surgeon dealing with the most discerning of patients, I perform lower eyelid rejuvenation every day in my practice. Any blepharoplasty specialist is well aware of the potential pitfalls of performing surgery on the lower eyelid. The most dreaded complication that patients are fearful of is a changed lower eyelid shape (that “pulled down” look that was so frequent in surgery before the 1990s).

In the vast majority of cases I do remove skin through what I call a lower lid pinch technique utilizing one single stitch. This minimizes any chance of lower eyelid retraction. This scar basically heals as an invisible one, one which needs a magnifying glass to visualize. Though I still reduce protruding fat bags on occasion, the frequency with which I do perform this has dropped precipitously in the last 10 years. In the majority of cases, transferring fat with extreme sensitivity and appreciation of the delicate eyelid anatomy, will not only significantly diminish the dark circles but also hide any protruding fat pockets around the lower eyelid.

Fat transfer, if properly performed, is by-and-large permanent around the lower eyelid and should be performed by extremely experienced plastic surgeons. While adhering to this principle, the incidence of lower eyelid irregularity and small bumps can be vastly diminished.


Wall, aging lower eyelid showing crepey lower eyelid skin, bags and mild hollowing		After a lower blepharoplasty (eyelid tuck) removing excess skin, excess protruding fat bags and performing strategic fat transfer into the lower eyelid circles (hollows)


This patient has the classic signs of lower eyelid aging including excess eyelid skin with wrinkles, protruding fat bag and mild hollowing (dark circles)		After lower blepharoplasty (eyelid tuck) performed by Dr. Randal Haworth of Beverly Hills. In the surgery, he removed excess eyelid skin, reduce the excess bags of fat and performed judicious fat transfer in the dark circles

Contact The Haworth Institute for further information.

Bad Posture = Droopy Breast Augmentation

Posted on July 6, 2012August 9, 2016 by omnispear

As being one of the leading breast augmentation and implant revision specialists in Beverly Hills, Dr. Randal Haworth has noted how important a part posture plays in enhancing the breast appearance. Women with rounded shoulders impart a bigger, heavier look to their breasts, almost matronly if you will. By squaring off the shoulders, not only does a silicone or saline breast augmentation look more perky and youthful, but also a heightened feminine self-confidence is implied. Certainly not a “slacker” look 😉


How rounded shoulders associated with bad posture can change breast augmentation results		Note How Good posture Enhances the Breast Augmentation Result

For further information, go to http://www.drhaworth.com/breast-augmentation/ Follow Dr Haworth on Twitter: @drhaworth

Tricky Lindsay. How Lohan is changing her looks

Posted on June 12, 2012September 27, 2016 by omnispear

People seem to always ask me which celebrity did what and why would they do that. Sometimes that is frustrating.

A close friend of mine who is a fine art photographer tells me she can always spot if someone had plastic surgery to which I reply, “No you can’t”…

That is because good plastic surgery is invisible. Therefore, by logical extension, the only plastic surgery she or anybody can recognise is visible. Most would concur that visible plastic surgery is less ideal than invisible surgery, but this is not always the case. Think Christy Turlington and her obvious rhinoplasty as a reminder of how visible plastic surgery can elevate a face to another worldly, ethereal level and you will get my point.

Recently Extra asked me to comment what Lindsay had done to herself based on photographs.


Lindsay Lohan in better days		Lindsay Lohan in less better but recent days

This is similar to expecting a detective to know who committed a crime based solely on showing him some iPhone photos. I can only surmise what Lindsay had done. I feel assured to say she definitely had fillers in the past (just look how her lips and cheeks have changed over the years) and a breast augmentation. But recently, the poor woman has undergone more severe change and not for the better.

She looks swollen and has an obvious “double chin”. This to me is a salient clue –

1. Is she simply bloated from substance abuse or withdrawal?

2. Has she gained weight for any number of reasons (in preparation for playing Elizabeth Taylor in Liz and Dick?)

3. Is she swollen after undergoing some involved facial surgery?

Who knows? I am simply a detective here and would need to visit the crime scene, so to speak. I would need to ask questions and perform an examination!

Dr Haworth has no professional affiliation with Lindsay Lohan

Open vs Closed Rhinoplasty in Beverly Hills

Posted on May 11, 2012August 19, 2015 by omnispear

In order to perform a nose job or rhinoplasty whether in Beverly Hills, Los Angeles or wherever, the plastic surgeon must be physically able to manipulate only two things under the nasal skin-cartilages and bone, Well, the debate rages on and on as to what is the best of the two methods in gaining access to the internal cartilaginous and bony structures of the nose. The two methods are the “closed” and “open” techniques.

The “closed” technique involves creating incisions confined solely to within the actual nose (usually located just within the nostrils proper) whereas the “open” utilizes the same incisions as the “closed” but also incorporates a small additional one across the columella (the fleshy partition separating the left and right nostril at the bottom of the nose).

In this age of less invasive surgery afforded by modern technology through the use of endoscopes, modern radiology, etc. one would think that the “closed” technique represents a newer evolution in rhinoplasty surgery, but surprisingly, the opposite is true. The “closed” technique is the more traditional approach while the “open” evolved and gained in popularity as both patient and surgeons expectations grew. Perhaps unrealistically, patients increasingly expect perfection and in their quest to deliver the acme of results, surgeons need as much control as possible when performing the surgery. Control involves extremely accurate symmetrical suture placement (to reshape cartilage), hemostasis (to minimize bleeding), strategic cartilage graft location and stabilization among other factors. In order to gain the most control as possible, visibility must be maximized and this is where the “open” method far surpasses the”closed”.

Proponents of the “closed” technique cite prolonged swelling and a potentially visible scar across the columella as two distinct disadvantages to the “open”. However, in proper hands these supposed shortcomings can almost always be avoided. I, as a rhinoplasty specialist, used to perform 80% of my rhinoplasties as “closed”, but now I carry out 90% as “open” and I can safely say that over 95% of my rhinoplasty patients are delighted with their new nose by the end of the second week. If the surgery is carefully undertaken, I have seen essentially no difference in swelling between the “closed” and “open” techniques. However, the one difference I have seen are the clearly superior results afforded by the “open” method.

To see many “open” rhinoplasty results, click here and here for revision rhinoplasty.

Dr Randal Haworth can be contacted at 310 273 3000 and Is a Board Certified Plastic Surgeon (American Board of Plastic Surgery) who practices at The Haworth Institute in Beverly Hills.

The Bulbous Nasal Tip In Rhinoplasty

Posted on May 4, 2012April 14, 2016 by omnispear

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.

beverly hills nosejob, beverly hills rhinoplasty

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.

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:


BEFORE		AFTER


Bulbous nasal tip with long upper lip and facial atrophy		After a rhinoplasty (tip plasty), upper lip lift and complex facial fat transfer

Another example of an isolated bulbous tip with thin skin:


A classic bulbous tip with rather thin skinAfter a tip plasty utilizing suture cartilage molding as well as cartilage reduction.		After a tip plasty utilizing suture cartilage molding as well as cartilage reduction, Note the smooth nasal tip contour without any distracting shadowing.


Patient with a Bulbous tip and thin skin coverage		After tip plasty/rhinoplasty 5 years after rhinoplasty, facial fat transfer and upper lip lift

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