Artificially round and hard appearing breasts after an overfilled “above the muscle” breast implant augmentation. The patient desired a more natural and smaller pair of breasts to match her frameNatural result afterexchange of her overfilled implants to memory gel silicone implants “under the muscle” along with a mastopexy (breast lift).
What is wrong with this revision breast implant and lift surgery I performed?
According to this patient, apparently everything!
At first, this patient came to me with ostensibly straightforward requests to “make” her breasts smaller and “better-shaped” in accordance with her body frame. Of note, she had undergone a previous “above the muscle” breast augmentation which, in my humble opinion, left her with a net result of breasts which were too big, too round and too fake. In essence, her breasts did not lend to a pulchritudinous appearance and that is why she sought my expertise in the first place. Indeed, she wanted to get remarried after having children and was seeking “christian boobs” to attract a decent husband. So I did what any self-respecting, honest and aesthetically minded board certified plastic surgeon would do and that was to perform a capsulectomy (remove her collagenous scar capsules), substitute her overfilled saline implants with smooth Memory Silicone Gel implants placed “under the muscle” and conclude with a bilateral mastopexy (breast lift). I thought the surgery was an unqualified success and, further punctuated by her exceptional healing vis-à-vis scarring.
So why was she unhappy? I was thoroughly puzzled since we both had extensive discussions prior to the surgery about the usual risks, alternatives and benefits including what she exactly wanted from the surgery. I know she wanted to go smaller (check), she wanted to be natural (check), she wanted to appear more youthful and perky (check) and indeed she conceded that I did achieve these goals. However,she also expected her breasts to be firm and more round –she felt that her result was too natural, both in look and to touch and therefore something went wrong.
BEFORE: Artificially round and hard appearing breasts after an overfilled “above the muscle” breast implant augmentation. The patient desired a more natural and smaller pair of breasts to match her frameAFTER:Natural result after exchange of her overfilled implants to memory gel silicone implants “under the muscle” along with a mastopexy (breast lift).BEFOREAFTER
But after further, protracted postoperative conversations with her, I realized where the disconnect was. I did not give her what she exactly wanted from the surgery because I gave her what she askedfor and not what she wanted. In essence, this was a story of missed and unrealistic expectations.
More and more of these situations arise in a plastic surgery practice simply because unrealistic expectations are instilled in us 24/7 by social media. The main platforms culpable for this insidious brainwashing are the mobile apps Instagram, Snapchat and YouTube with their interminable repository of Photoshopped/FaceTuned manipulated models and instructional contouring videos. Young women come to me wanting cheekbones, buttocks or breasts like Abigail or Jocelyn Instastar simply because they are famous and therefore more popular and loved.
Social media and Instagram star Abigail Ratchford
Indeed, one patient requested Bella Hadid’s nose even though, in my opinion her rhinoplasty ended up with an “inverted V” deformity and a somewhat pinched, boxy tip. However, it did not matter to her because she considered Bella her idol andwas willing to accept a possible substandard result with potential nasal obstruction. Ah, the power of celebrity!
Recently, I had the experience of operating on another young woman who had beautifully shaped breasts with a natural cleavage. She wanted to go only slightly bigger yet have a bigger gap between her breasts. The surgery went flawlessly but the patient was dissatisfied. She agreed her breasts were fuller with a wider cleavage but she now voiced that I should have known all along she wanted her breasts to look fake, round and hard! After this perplexing conversation, I sat down and pondered the meaning of what I really do.
Social media and Instagram star, Joselyn Cano.
It is one thing to make abnormalities such as unnatural breasts look natural but it’s another thing altogether to make natural looking breasts look deliberately unnatural and possibly unappealing. For decades, I have endeavored to create natural results by making the deformed normal and the normal beautiful but now a new aesthetic standard has emerged in our culture and ultimately, it may not have positive consequences.
But who am I to judge? Fake is the new real.
Randal Haworth MD, FACS
Very few surgeons in the world understand aesthetics to the point where they can be a true hyperaesthetic facial plastic surgeon specialist. A hyperesthetic specialist is similar to the conductor of an orchestra-he or she needs to know all the instruments better than the individual players in order to “orchestrate” them to create melodious harmony without dissonance. One of the keys to create visual harmony in the face is mastering lip rejuvenation surgery-it’s not just about adding volume (which is essentially what most practitioners and patients equate with lip enhancement), it’s about mastering the shape of both the upper and lower lip. Patients travel from all corners of the globe to top Beverly Hills plastic surgeon and lip augmentation specialist, Dr Haworth to undergo hyperesthetic change, which may include any number of surgical art performances including a high-profile facelift, endoscopic brow lift, blepharoplasty, rhinoplasty or his lip reshaping signature surgery! https://youtu.be/cI3nEq5R3x8
While we in the cosmetic industry are getting better and better at delivering the results that patients expect, I still hold fast that 60 to 70% of modern high-tech materials and devices in plastic surgery over promise and under deliver !
Considering that the future of plastic surgery will be less about actual surgery as more more and more technological advances are made in the lab (think genetic engineering, better fillers, better lasers, etc.), this 60-70% statistic is rather disappointing. What makes this all the more egregious is the fact that doctors are forced to pay an arm and a leg for such underperforming technologies (Ulthera ® Thermage®, etc.). In light of the fact you can get a state-of-the-art Tesla with all the bells and whistles for around $100,000, paying $150,000 or more for a machine that just delivers fuddy-duddy ultrasound technology through a wand to aid in liposuction is frankly outrageous. However, the medical tech companies can’t be solely blamed for this-they are basically governed by the FDA’s policies which, in turn, are a response to precedents extrapolated to an absurd degree by lawyers.
Unfortunately, I have seen it all too many times – a new plastic surgery technology coming out amidst a flurry of media only to fade into relatively rapid obscurity. This is similar to a Billboard chart topper only to turn out to be a one-hit wonder!
In my opinion the latest overhyped snakeoil is Kybella® from the big pharma conglomerate Allergan®, proud makers of Latisse®, Botox®, Voluma®, Juvéderm®, etc.
I was glad to hear from some of my esteemed colleagues at the recent American Society of Plastic Surgery meeting in Los Angeles that their thoughts on Kybella ® echoed mine.
Taking into account Kybella’s negative points, which include:
1. relative risk of damaging important facial nerves,
2. cost (though one treatment is less expensive than liposuction, more often than not multiple treatments are necessary and these, of course, add up),
3. associated pain,
4. longer recovery (which, ironically, is worse than surgical liposuction since remarkable swelling can occur after every injection session)
and
5. inferior results to those obtained with aesthetically and skillfully performed liposuction
…there is little to no advantage in utilizing Kybella® for my patients except perhaps for its superior multi-million dollar marketing campaign! Indeed, micro liposuction can provide unprecedented control in removing fat to treat a double chin while refining the jawline and addressing the jowls as well-all with less downtime and more economically so in the end.
Case in point:
Dramatic perioral rejuvenation including improvement of the jowl and chin utilizing a combination micro liposculpture and fat transferDramatic perioral rejuvenation including improvement of the jowl and chin utilizing a combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.After combination micro liposculpture and fat transfer. Note the smoother jawline and submental (chin) region all performed with delicate no scar facial surgery without a face or neck lift.
I’ve come to find out that I am included for the 2nd year in Hollywood Reporter’s top doctor list of 2015. The reason why this is such an honor is that all categories including the Plastic Surgeons’ are vetted by Castle Connolly, an independent institution specializing in such matters. In other words, no doctor can pay or influence to be included in this list. All plastic surgeons must be board-certified and are considered unparalleled in their respective fields as judged by objective monitors.
Hollywood Reporter’s Best Plastic Surgeons 2015
It is my innate philosophy to provide the most honest and compassionate care possible while striving for aesthetic excellence which can only be achieved by sensitivity, technical precision, a critical eye and self-criticism.
The idea of wearing a bra to bed is nothing new. I estimate approximately 6% of women already realize the benefit sleeping in a bra either because they were advised to do so by a buxom relative with ample bosom or are clever enough to understand how the laws of physics will affect their breasts in the long run.
BREASTS WITHOUT BRAS
Breasts are affected by gravity just in the same way that Sir Isaac Newton noted that an apple is. If the apple is not prevented from dropping to the ground, it will do so and often get damaged in the process. During the day, breasts get pulled towards the earth in the same way and if no support is provided to counteract this force, breasts will eventually elongate and narrow complemented often times with downward facing nipples.
After examining thousands of breasts throughout my 20 years of private practice, I have come to realize that those who sleep in a brassiere generally have perky breasts than those who don’t. Specifically, those who wear a bra during the day and not one at night tend to have breasts which are wider, yet flatter and concave on top with their nipples still point upwards.
Oblique cross-section of breast showing inner anatomy including Cooper’s suspensory ligament’s.
Apart from being blessed with good genetics to imbue your breasts with strong Cooper’s ligaments, collagen and skin there is nothing one can do to to protect your breasts from drooping except good old fashion commonsense prevention – and that comes in the form of a bra.
There is no muscle in the breasts therefore neither exercise nor yoga positions will help. There’s even poorly conceived research stating that wearing a bra creates more drooping of the breast because “they limit the growth of supporting breast tissue, leaving the breast to wither away and degrade more quickly”! In other words, they imply that the stress of gravity is good for the breast, training it like a muscle. If that were the case, patients could simply gain and lose excessive weight repeatedly in order to” train the skin” so that stretch marks can be avoided. OK…but I then wonder why pregnancy results in abdominal stretch marks…hmmmm?
My job as a plastic surgeon is to not just simply do the surgery and wish my patients all the best as they fade into the sunset. I feel it is my responsibility to also provide an “instruction manual” so to speak on how to manage their aesthetic wellness outside of my clinic and operating room.
For example, after facial surgery I recommend specialized skin care regimens and after body sculpting, certain diet and exercise. However, after breast surgery, few if any plastic surgeons recommend long term breast care except for incision/scar management, implant massage and mammograms. You only have one set of breasts and whether or not you choose to undergo plastic surgery, it is equally important to invest time and not just money in protecting their aesthetic wellness as appropriately early as you can. As soon as a young woman’s breasts are large enough to fall off the side of their chest when they are lying down is the ideal time to prevent them from doing so!
In the same way that gravity exerts an affect on a woman’s breasts when she stands, it also profoundly affects them when she lies down. However, wearing a regular, daytime bra to bed simply did not provide the specialized support that was needed when on one’s back and side. When calling the support specialized, I am referring specifically to secure lateral outside support to keep the breasts from falling off to the side in addition to inner or middle support to prevent the upper breast from falling onto the lower during side sleeping.
There were no bras on the market that addressed these important issues. It is for that reason that I developed NightLift ®. It had to fill three criteria:1. First and foremost, it had to be comfortable, like a second skin if you will. Despite providing unparalleled support, no underwires exist within this bra.
2. It had to work. 48 prototypes were developed over several years to ensure ultimate support without wire or compression. We call this technology B.U.S.T. ® (bilateral uplift support technology).
3. It has to be stylish and sexy so a woman not only feels fabulous but also looks great, whether she’s alone or with her partner.
Whether a woman has undergone breast surgery or not, I recommend night list to all of my patients if she is concerned with aesthetic wellness of her breasts. After breast surgery (including breast augmentation, mastopexy or breast reduction) I fit my patients in NL a week after surgery when most swelling has dissipated. Since NL provides incredibly comfortable support without hurtful underwire, patients fall in love with this and it soon becomes a staple within their lingerie collection.
Randal Haworth MD
To learn more, go to Nightlift.com
Every ethnic group has certain predisposed notions of what ideal beauty is based upon their own genetic make up and cultural ideals. Cultural ideals are influenced by trends and therefore can change over the years (think of the beauties depicted in Ruben’s paintings).
In terms of Kim Kardashian‘s genetic make up, she is partly Armenian and represents for many an ideal version of female pulchritude.
Unfortunately, she is depicted on the cover of myriad top-tiered magazines as a cartoon representation of bottom-heavy female beauty and sexiness.
The cover of Paper is no exception.
Here, she has been clearly “Photoshopped” to exaggerate her waist-to-hip ratio and smooth out the buttock cellulite she most certainly possesses. In this case, add oil for good measure to flame some pubescent boy’s fantasy. She may have had one or more fat transfers to accentuate her already full bottom (which may or may not show up on x-ray as microcalcifications) but, who cares?
This would all be harmless titillation were it not for the fact that many unsuspecting women will be easily influenced to attain their own version of Kim’s voluminous buttocks. Don’t get me wrong-I am the first to appreciate an hourglass figure and a well-balanced full bottom to complement a woman in-and-out of clothes. But full is different than big which in turn is different from a comic-book-big butt of a centaur.
Often times buttock enhancement procedures may lead to immediate or even long-term disastrous consequences. Buttock augmentation can be performed with silicone implants, fat transfer, or injections with man-made substances ranging from PMMA to free silicone or other illicit compounds found in back alleys or mechanic shops.
Buttock augmentation with silicone implants is generally considered a safe procedure but has a higher rate of infection as compared with other implants in the body and the results often feel unnaturally hard. I perform fat transfer which is very safe but the patient must have a enough fat to transfer in order to make the result a meaningful one. I am not a proponent of injecting free silicone or other man-made substances because of their inherent danger in terms of disfigurement and possible death.
One must remember that we do not know of the long-term consequences of having such outrageously enhanced buttocks in regards to how they will look and droop as the patient ages. Drooping buttocks is a very difficult problem to treat for the plastic surgeon and the only solution would be a butt lift.
Unfortunately, most buttock lifts produce mediocre results with unsightly scars. Contrast this to a breast lift, the result of which is often spectacular with minimal scarring.
Those contemplating injections and other forms of untested ways to augment their derrière must do their homework and be prepared to roll dice. One must remember that even though one may not experience immediate complications, one must consider the long-term effects of having an extra 2 to 4 pounds of added junk in your trunk.
In light of recent photos of Renee Zellweger, a conversation has begun about plastic surgery. (Zellweger responded to the uproar, telling People magazine, “I’m glad folks think I look different! I’m living a different, happy, more fulfilling life, and I’m thrilled that perhaps it shows.”) But whether or not Zellweger had plastic surgery is irrelevant, and the reality — and potential repercussions — of going under the knife is worth exploring in further discussion. We spoke to “The Swan” contestant Lorrie Arias about her experience to get a better handle on the reality of undergoing such extreme physical change. This is her story.
Ten years ago, at age 34, Lorrie Arias underwent approximately $300,000 worth of plastic surgery. In 1995, she lost 150 pounds; in 2002, her husband died; and, in 2004, she became a contestant on “The Swan.”
The program, which Jennifer L. Pozner called “the most sadistic reality show of the decade“ in “Reality Bites Back,” took its title and premise from a literary fairy tale, “The Ugly Ducking.” Two women deemed to be “ugly” underwent a total transformation at the hands of a panel of specialists, including a plastic surgeon. At the end of each episode, one was eliminated and the other went on to compete in the pageant that ran as the show’s finale. It aired for two seasons in 2004, before being canceled in 2005 as a result of low ratings.
After losing a significant amount of weight, the then-police department volunteer auditioned for the show in hopes of a tummy tuck. Arias was frustrated that she had worked so hard to get healthy and still had so much extra skin. As a result of her “sad story” the selection committee chose her for the show.
Once Arias got to the set of “The Swan,” doctors and producers set up a much more intensive transformation than she had expected. Over two and a half months of filming, she had a tummy tuck, buttock lift, inner thigh lift, dual facelift, upper lip lift, upper and lower eye lift, endoscopic brow lift, rhinoplasty, breast augmentation and breast lift — the most procedures of any contestant on the show.
A decade later, she told HuffPost Entertainment she is depressed, bipolar, agoraphobic and believes she continues to suffer from body dysmorphic disorder. She has regained the weight she lost in 1995 and refuses to leave her home, save for trips to see her therapist every few months.
There is relatively little research regarding the psychological fall out from plastic surgery, both because extreme alterations are rare and it is not in plastic surgeons’ best interest to participate in or fund such studies. Some work has been done on the effect of TV representations on adolescents’ body image and the ways in which unrealistic expectations can lead to disappointment following a cosmetic procedure. In terms of diagnoses, the topic most often discussed is body dysmorphic disorder.
“That refers to essentially an over-focus on a certain body part as being deformed or problematic, to the point that the person becomes obsessed with it,” Dr. Paul Puri, a psychiatrist, said. “Many times an individual believes getting surgery will fix it. In the research and literature, this has not been show to be a solution. It can be a problem with self-esteem, anxiety or other underlying issues, and surgeries don’t typically solve those other issues.”
Of course, sometimes, people get surgery later in life due to social pressures based on standards of beauty and youth. “Those are two largely different reasons as to why people get plastic surgery,” Puri clarified. In cases involving dysmorphic disorder, it tends to pre-exist the surgery and then be exacerbated when the results differ from what the person desires. “The case may be that if someone fixes all of their hopes on surgery, it can be extremely disappointing and actually worsen their anxiety if it is not fixed,” Puri said.
After appearing as a contestant on “The Swan,” Arias faced a lot of negative reactions from those who knew her before the surgery. “You get a lot of crap,” she said. Arias felt that some friends and family were “jealous,” and others uncertain of who she had become. The latter group included the eldest of her two sons, who said at the time, “she doesn’t look that much like my mom anymore.”
“He has told me that he felt afraid,” Arias said. “That makes me feel guilty, because I realize that if the shoe were on the other foot, I would have freaked out too.”
Perhaps the most unnerving reaction came from Arias herself. The reveal is set up as a surprise for the show’s contestants. Arias said she had caught a slight glimpse of her reflection in medical equipment, but all mirrors were covered in the two and a half months she spent undergoing her various surgeries. It was only on stage that Arias was given access to a mirror. She reacted with quiet surprise, only losing it once the cameras turned off.
“I was screaming for the executive producer,” she said. “I was screaming, ‘I want my face back!’ That’s how freaked out I was. Intelligently, I knew that was impossible. But it was so weird. It was like looking at somebody else, but it was you.”
That feeling has become less difficult to reconcile over time, but Arias was happier before the show. “I’ve had self-esteem issues all my life,” she said. “But before, I was functional. Then I go and have all this stuff done that people would give their leg for, and I’m confined inside.”
Immediately following “The Swan,” Arias experienced what she calls a boost of confidence. “Going out gave me a little bit of self-esteem,” she said. “I liked my chest. My breasts were my badges of self-esteem. I would go out and wear low-cut tank tops and see women hit their husbands for looking at me. That was never the kind of thing I would do before. I would wear normal shirts.”
Soon, though, those old feelings of insecurity came creeping back. Arias said the symptoms leading up to her current condition began shortly after filming ended, and have only worsened. She raved about her plastic surgeon, Dr. Randal Haworth — “I was blessed to have him” — but blamed the show for not providing adequate therapy to help process such an extreme change.
While on “The Swan,” Arias did receive psychological care, though those sessions largely focused on loss of her husband. In February of 2013, she spoke to the Post citing a lack of follow-up as the cause for her mental health issues.
Arias kept the 150 pounds she lost off for nearly 10 years, and shed 10 more for the show. However, after “The Swan,” she says, she lost a sense of control over her body. “I started to yo-yo,” she said. “I was 155 on ‘The Swan,’ now I’m sitting here at 248. And I’m miserable.”
To stop feeling that way, she would consider more surgery. “I would do it in a heart beat. If I had the money, I’d do the weight loss surgery first,” she said. “This is going to sound weird, because I’ve already had so much done. I would have a new breast augmentation. I would have another brow lift. I would have another facelift. I would get more liposuction. I would do all that and my arms.”
Arias would also be willing to do the show all over. “Crazily enough, I would do it again,” she said. “Knowing what I know now, knowing I would gain weight again, and knowing I wouldn’t have that other face. At least I could be a big and pretty person. I can’t imagine myself any differently.”
Arias acknowledged that stance might be incomprehensible for someone who hasn’t undergone such extreme plastic surgery. Despite wanting more surgery, she is able to recognize that her insecurities are internal. “I thought a tummy tuck would give me all the self-esteem in the world. Of course, it didn’t. All I want now is for my story to help others, so they won’t think that going under the knife is a cure-all,” she said. “For a while it may be, but everything still comes back up.”
And yet, Arias still believes the upset over female celebrities and plastic surgery comes from an inherent desire all women have to change their appearances. “The uproar every time something like that comes up in the news is personal jealousy,” she said. “Most women would like to have something done, but maybe they’re afraid or they just can’t afford it.”
Tattoos are meant to be party fun and expressive… Cancer and infections are such a buzz kill!
To each his own, but I have always been rather impartial to tattoos. Unlike a fine wine, I simply don’t think they age very well and they look especially out of place on a doting grandmother or father (unless they’re a member of a famous rock group and had a bank account to go along with it).
Anyway, onto more pressing matters such as how tattoos can kill you.
As a Beverly Hills plastic surgeon board-certified by the American Board of Plastic Surgery, I am always aware I am a doctor first and a plastic surgeon second. It is for this reason I address subjects such as this to inform the public of potentially dangerous trends they embrace. More is written about how tattoos are associated with resistant bacterial infections and skin cancers, especially that the American FDA is applying its investigative microscope to the issue. More ominously, because of hepatitis C transmission, tattoos are associated with liver cancer and the possible necessity of liver transplantation. That is some virulent ink to say the least!
You might read this and think that you’re better off undergoing laser tattoo removal. Unfortunately, while the tattoo might be removed by the laser, blasting away that pigment might release it into the body a second time.
If you’re thinking about getting a tattoo maybe consider using a safer pigment such as InfiniteInk . This does not contain toxins and can be easily removed. It may cost more, but wouldn’t you want a pigment that was developed to color medicines, rather than paints?
To read more about this unsettling topic click here:
As 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!.
In order to maintain the highly esteemed status of being “Board Certified” by the American Board of Plastic Surgery, Inc. a plastic surgeon must maintain his or her credentials throughout their career. Not only does the plastic surgeon need to continuously attend courses while embracing the highest ethical standards, he or she must also pass a rigorous board recertification exam every ten years. Dr Haworth scored 100%, the best score a plastic surgeon can obtain in the United States. Dr Haworth is proud to be a board certified plastic surgeon.
BREASTS WITHOUT BRAS
Breasts are affected by gravity just in the same way that Sir Isaac Newton noted that an apple is. If the apple is not prevented from dropping to the ground, it will do so and often get damaged in the process. During the day, breasts get pulled towards the earth in the same way and if no support is provided to counteract this force, breasts will eventually elongate and narrow complemented often times with downward facing nipples.
Oblique cross-section of breast showing inner anatomy including Cooper’s suspensory ligament’s.
Apart from being blessed with good genetics to imbue your breasts with strong Cooper’s ligaments, collagen and skin there is nothing one can do to to protect your breasts from drooping except good old fashion commonsense prevention – and that comes in the form of a bra.
My job as a plastic surgeon is to not just simply do the surgery and wish my patients all the best as they fade into the sunset. I feel it is my responsibility to also provide an “instruction manual” so to speak on how to manage their aesthetic wellness outside of my clinic and operating room.
Often times buttock enhancement procedures may lead to immediate or even long-term disastrous consequences. Buttock augmentation can be performed with silicone implants, fat transfer, or injections with man-made substances ranging from PMMA to free silicone or other illicit compounds found in back alleys or mechanic shops.
Buttock augmentation with silicone implants is generally considered a safe procedure but has a higher rate of infection as compared with other implants in the body and the results often feel unnaturally hard. I perform fat transfer which is very safe but the patient must have a enough fat to transfer in order to make the result a meaningful one. I am not a proponent of injecting free silicone or other man-made substances because of their inherent danger in terms of disfigurement and possible death.
One must remember that we do not know of the long-term consequences of having such outrageously enhanced buttocks in regards to how they will look and droop as the patient ages. Drooping buttocks is a very difficult problem to treat for the plastic surgeon and the only solution would be a butt lift.
Unfortunately, most buttock lifts produce mediocre results with unsightly scars. Contrast this to a breast lift, the result of which is often spectacular with minimal scarring.
Those contemplating injections and other forms of untested ways to augment their derrière must do their homework and be prepared to roll dice. One must remember that even though one may not experience immediate complications, one must consider the long-term effects of having an extra 2 to 4 pounds of added junk in your trunk.
As 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.
