Too Busy to Stay Healthy? The Soup Diet

Posted on by omnispear
Dr. Haworth - Beverly Hills Plastic SurgeryAs busy humans striving to balance family life, successful work habits, exercise and relaxation, life can be very difficult indeed. And when these become out of balance, mental incertitude arises leading to stress and further imbalance.

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/2012/03/30/be-good-to-yourself-dr-haworths-healthy-living-tips/

Rhinoplasty – The rib graft mafia

Posted on by omnispear
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.
beverly hills nosejob, beverly hills rhinoplasty beverly hills nosejob, beverly hills rhinoplasty
A Collapsed Nasal Bridge or Saddle-Nose Deformity After a Revision Rhinoplasty Utilizing Rib Graft
beverly hills nosejob, beverly hills rhinoplasty beverly hills nosejob, beverly hills rhinoplasty
A Severe Saddle-nose Deformity after Infection After Rib Graft Reconstruction
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

Posted on by omnispear

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:

Horizontal Neck Lines, beverly hills nosejob, beverly hills rhinoplasty   Horizontal Neck Lines, beverly hills nosejob, beverly hills rhinoplasty
Notice moderately deep horizontal necklace lines or rings   Note the dramatic improvement of the Necklace Rings
 

10% weight loss in 10 days

Posted on by omnispear
Dr Randal Haworth of Beverly Hills discusses one of the most effective diets to hit the US.

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:

  1. Fat loss, not muscle
  2. Relative low  cost
  3. No surgery
  4. Very safe
  5. Little to no hunger, thus maximizing compliance
  6. Last but not least, extremely effective with up to 10% body weight loss in 10 days
The one disadvantage is the feeding tube but experience from Italy (where this concept was popularized) reveals a very high patient satisfaction rate for both “obese” patients and those requiring a small “tune up” before a special occasion, the holidays or a photo shoot whereby a patient needs to lose a certain amount of body fat quickly and safely. Cost for a 10 day cycle approaches $1500.00 at the time of this writing.
For further information call 310 273 3000
   

The Classic Reduction Rhinoplasty

Posted on by omnispear
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?

  • Is it that their nose is asymmetrical, twisted, dented and scarred from a past rhinoplasty gone wrong?
  • Is it that their nose is too small for their face with a flat bridge and wide flat tip perhaps due to Asian heritage?
  • Is it that their nose is too wide with a bulbous tip?
  • Or is it that their nose is too big, with an associated hump, wide bones and big, drooping tip (especially when smiling)?


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:

  1. Is there a hump? Check
  2. Is it comprised of bone and cartilage? Check
  3. Does the nasal tip droop (with an acute angle between the upper lip and bottom of the nose/columella) especially with smiling? Check
  4. Is the nasal tip wide and/or bulbous? Check
  5. Are the nasal bones wide (where they emerge from the cheeks to form the bridge)? Check
If this common checklist is mainly affirmative, then the patient will need a classic reduction rhinoplasty. In this surgery, the tip is made narrow with either tip grafts (composed of cartilage usually invisibly harvested from the patient’s own septum), strategic suturing or both. The nasal hump is either chiseled or filed down and finally the nasal bones are narrowed by delicately in-fracturing them (“breaking the bones”). If this latter maneuver is bypassed, then an”open roof” deformity may likely arise in which the nasal bridge will look artificially flat and wide itself. Therefore the nasal bones (which comprise the sidewalls of the nose) are carefully angled inwards towards the midline in order to close the open roof which resulted from the hump removal in the first place.

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/
beverly hills nosejob, beverly hills rhinoplasty beverly hills nosejob, beverly hills rhinoplasty
Preoperative appearance of an attractive woman seeking only refinement of her nose Postoperative results after classic rhinoplasty

The Radix Graft in Rhinoplasty

Posted on by omnispear
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.
beverly hills nosejob, beverly hills rhinoplasty beverly hills nosejob, beverly hills rhinoplasty
Note where her radix point lies. It is lower than the level of her eyelash, making the nose look more projecting than it really is. The result after a corner lip lift and a rhinoplasty with Radix enhancement.
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….

Posted on by omnispear
I have been using Botox™ for close to 16 years now and have successfully applied it to not only erase forehead  and eye region wrinkles, but also to improve the oral area and neck. By strategically injecting small amounts of Botox™ into the upper lip I can help curl out the upper lip by emphasizing the “white roll” or vermillion border as well as soften the stubborn wrinkles there. Also I can elevate the otherwise sad, downturned corners of the mouth by injecting into the depressor anguli oris muscle (DAO) and produce a minor facelift by injecting the platysma muscle of the neck.

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

Posted on by omnispear
In the era of Twitter, Facebook, texting, rapid- fire music video editing, etc. everyone (including those not diagnosed with ADD) wants instant results. So what is unusual with wanting an instant nose job or rhinoplasty? Absolutely nothing. An instant nosejob is performed by strategically injecting a pre-chosen filler just below the nasal skin in an aesthetically sensitive manner. Temporary fillers such as Hyaluronic acids (Restylane™, Perlane™, Juvederm™, etc.) and calcium hydroxyappatite (Radiesse™) may be used as a “dress rehearsal” to confirm if the patients like their result. If so, many will then opt for a more permanent filler, either in the form of fat, Artefil ™ or Aquamid ™ (which is not yet FDA approved).

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”

Posted on by omnispear
Everyone undergoing elective cosmetic surgery truly expects their results to be exemplary and rarely contemplate what they will do if something does not turn out as they expected. Rhinoplasty, or nose job surgery, is one of the most challenging sub specialties in aesthetic plastic surgery and Dr Randal Haworth is one of the leading specialists in revision rhinoplasty. Despite the fact that the nasal area  is generally less than 2″ x 1″ x 1 ” in  dimension, a  small amount of unpredictability always exists in terms of obtaining the “perfect result”. Of course, the more experienced and better the nasal surgeon is, the more he or she is able to harness that unpredictability and secure an excellent result.

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.

Diagram showing severe nasal deformity after a previous nosejob


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”.

After revision rhinoplasty by Dr Haworth, including placement of spreader and lateral crural strut grafts

To cut a long story short, added support in the  form of cartilage is needed to correct  the weakness in the form and function resulting from a rhinoplasty gone awry. Rhinoplasty is similar to a chess game. It is the only surgery  that takes me longer to perform than I did 10 years ago. This is because I recognize and  deal with any potential pitfalls that may result during the initial surgery. I have to think several steps ahead similar to a game of chess. Finally, not only do I have to make the nose look beautiful, but I have to erase all evidence that anything had been performed by a human hand. this takes time, aesthetic sensibility and patience.

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.

ZenTox™East meets West cosmetic treatment

Posted on by omnispear
For the last three years, I have been  grafting certain concepts of Oriental philosophy and medicine onto my Occidental plastic surgical practice. Some  of these  chimeric treatments have really resonated with my patients, one especially in particular. This involves the simultaneous application of hot and cold jade stones during my administration of Botox ™(botulinum toxin type A.). Alternatively, this concept could also be used for  injections of Dysport™ and Xeomen™,  both new FDA approved paralytic substances for cosmetic use. I have coined  Zen-Tox as a readily identifiable term describing  the novel use of distraction from pain via temperature.

To read more about this unique procedure which actively decreases the discomfort experienced during facial injections, refer to  Dr. Randal Haworth’s recent interview in Ocean magazine by clicking the following link.

Zentox

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