Hot Lips, Cold Sores

 Stress, weather, chemicals and injury to the lip can all awaken the virus in your body. But needle punctures can be particularly triggering for cold sores.   As one of the Beverly Hills top lip injector of fillers, Plastic Surgeon Dr Randal Haworth does see the occasional cold sore erupt 1-2 days after a treatment. It is for that reason, Dr Haworth recommends antiviral prophylaxis is select cases.

Cold sore herpes Simplex Type I of the lips
Cold sore herpes Simplex Type I which can occur after any lip procedure.

Of course, you can be prone to cold sores, get a lip filler and have no sign of an outbreak. But it’s good practice to be precautious and minimize the risk.

Dr Haworth notes that any cosmetic procedure which causes stress to your skin has the potential to stimulate cold sore recurrence. Cold sores are a prevalent affliction and are generally due to herpes virus (HSV) type one particular (generally oral herpes), with the minority (10%) being due to HSV type 2 (usually genital).

Many main infections of HSV-1 are asymptomatic, while recurrent infections can present as fever blisters at the vermillion border. Although cold sores may well not cause any long-term skin damage, they do possess the potential to cause scarring at the contaminated area.

Roughly two-thirds of a global population under 55 are infected with HSV-1. Primary illness develops in childhood through non-sexual contact usually, for example by sharing utensils or towels, but it is regularly assumed to be solely caused by kissing. If symptoms do present with primary infection, they take place two to 20 days after direct exposure.

Aesthetic procedures such as for example lasers, injectables, microneedling and chemical peeling often require limited or deliberate, manipulated trauma to skin, which includes the potential to trigger cold sore recurrence. Dr Haworth, the world’s foremost lip reshaping expert (including upper lip and corner lip lifts) will even warn his patients that his signature lip enhancements can trigger a herpes simplex outbreak. When a fever blister shows up after an aesthetic treatment, it could be devastating for the individual due to distress, pain and potential skin damage of a cosmetically very sensitive area. You will find a particular likelihood of scarring after ablative types of procedures (lasers, peels).

Cold sore prophylaxis can be recommended in the subsequent circumstances:

-More than three spontaneous occurrences every yea
-Previous eruption at any time, as a result of a procedure
-Lip augmentation and HSV eruption regardless of date or time
-Facial resurfacing procedures; anything that breaches skin carrier, and especially medium or deep peels, facial skin lasabrasion, microneedling and microdermabrasion

Immunocompromised patients

Prophylaxis Dr Haworth recommends includes predosing with Valtrex 500mg daily for 2 days to continue for 3 after the procedure. He’ll substitute 1000 mg daily in particularly susceptible individuals.

Randal Haworth MD, FACS

DailyMail – June 2018

Schapelle Corby spent nearly a decade behind bars in Bali’s most notorious jail after being convicted of trafficking marijuana in 2005. But she has transformed her appearance since being released on parole four years ago, sparking rumors of cosmetic enhancements. Beverly Hills plastic surgeon Dr. Randal Haworth told Daily Mail Australia on Tuesday that he believes Schapelle Corby may have invested in some ‘non-invasive work’ to achieve her youthful looks. ‘The most obvious changes are to her lips and cheeks,’ Dr. Haworth observed, he believes ‘her lips and cheeks have been well augmented, most likely with injectable fillers such as Juvéderm or equivalent.’ Dr. Randal Haworth claimed he had a ‘sneaking suspicion’ that she may have had ‘injections such as Botox to smooth out the lines and wrinkles around her eyes’ after studying before-and-after photos of Corby Schapelle. Schapelle Corby Before and After ‘A stint in an Indonesian prison would be a less than welcome holiday, so it’s understandable that anyone would want a fresh start after that,’ he said. ‘It seems as if Ms Corby is no exception to that rule.’ Earlier this year, Schapelle denied having Botox injections or fillers. She told Woman’s Day in March: ‘No fillers, no Botox. I just use Snapchat and Instagram filters! I look at a photo of me and think, “Gee, that’s ugly,” and then I put a filter on it and think, “Actually, it’s pretty good!” ‘With the additional aid of Snapchat filters, her appearance is certainly one for the better,’ Dr. Haworth concluded. Original Article

Rhinoplasty – “Samurai Nostrils”?

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