Élan Institute for Plastic Surgery 2010 East First Street, Suite 270 Santa Ana, CA 92705
March 12th, 2010 Michael A. Jazayeri, M.D.
As an Orange County plastic surgeon, I have many patients who request tummy tuck (abdominoplasty) to improve the loose skin and stretch marks around the abdomen area.
The question always arises with elective, cosmetic surgery: should you, the patient, spend thousands of dollars for a medically unnecessary procedure which makes you feel and look bad for a few weeks, so that you can look and feel good in the future?
The answer is yes, if and only if you have realistic expectations, are a good candidate for the procedure and are doing the surgery for yourself and no one else.
The ideal candidate for tummy tuck surgery is someone who is healthy or has medical issues which are under control. The patient can be within 10-15 pounds of their ideal weight and still obtain a good result, if the fat above the umbilicus (belly button) is thin and the skin is loose. If the fat is thick and the skin “stuck”, there is no way the skin and fat can be moved down to cover the area where the loose skin was removed. Even if it can be moved down, the thick fat will bulge out and the result will not be ideal.
Tummy tuck (abdominoplasty) can be combined with breast augmentation and lift in patients who have had children. This procedure is now commonly known as Mommy Makeover.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in central Orange County. If you like to schedule a complimentary consultation, please call 714-834-0101.
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March 12th, 2010 Michael A. Jazayeri, M.D.
Brachioplasty (arm lift) is a procedure which removes excess skin from the arm area. As an Orange County plastic surgeon, this procedure is mostly requested for patients who have had major weight loss. However, there are patients who normally have loose skin in the arm area because of genetics or age.
Two types of brachioplasty (arm lift) technique are used. The traditional technique leaves the incision along the entire inner arm. The scar typically starts at the arm-pit and extends close to the elbow area. The scar is inside the arm and is hidden, unless the patient raises their arms. This procedure is used for patients who have excessive loose skin along the entire length of the arm. As with other elective cosmetic surgery procedures, the risk of significant or noticeable scar formation is minimal, if proper surgical technique is used.
The modified arm lift procedure is used in patients who have minimal loose skin and the majority of looseness is next to the axilla (arm-pit). The incision is vertical and is at the junction of the axilla with the arm. The scar is well-hidden and difficult to detect.
I have attached photos to demonstrate the effectiveness of the arm lift procedure. The first photo is the traditional arm-lift and the second photo is the modified version.
Traditional Arm lift technique
Modified Arm Lift Technique
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.
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March 2nd, 2010 Michael A. Jazayeri, M.D.
As an Orange County breast augmentation surgeon with over ten years of experience, I have performed hundreds of breast augmentation procedures. Many surgeons use the term “specialist”, so I won’t use that term. However, I can confidently consider my self a “seasoned” breast augmentation surgeon.
So, is breast augmentation worth it? Remember, you as a patient are going to pay thousands of dollars, temporarily feel bad and look bad, for the hope that your breasts will look better after surgery!
Well, the answer is “it depends”. If you have realistic expectations and are doing the surgery for yourself and yourself only, then the satisfaction rate is very high. Although I haven’t done an actual survey, the satisfaction rate for breast augmentation seems to be greater than 90% in my practice. Realself.com, a reliable web-site, lists a satisfaction rate of 78% amongst respondents who had breast augmentation. Perhaps the difference is due to patients having unrealistic expectations and/or not achieving the result hoped for. As I have mentioned previously, selection of your surgeon is critical. He/she should be board certified in plastic surgery, and have before and after photo gallery either in the office or on-line (preferably both). It is important you feel comfortable with this person operating on you and like the result of his/her work.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.
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February 26th, 2010 Michael A. Jazayeri, M.D.
Brachioplasty (arm lift) is a procedure which removes excess skin from the arm area. As an Orange County plastic surgeon, this procedure is mostly requested for patients who have had major weight loss. However, there are patients who normally have loose skin in the arm area because of genetics or age.
Two types of brachioplasty (arm lift) technique are used. The traditional technique leaves the incision along the entire inner arm. The scar typically starts at the arm-pit and extends close to the elbow area. The scar is inside the arm and is hidden, unless the patient raises their arms. This procedure is used for patients who have excessive loose skin along the entire length of the arm. As with other elective cosmetic surgery procedures, the risk of significant or noticeable scar formation is minimal, if proper surgical technique is used.
The modified arm lift procedure is used in patients who have minimal loose skin and the majority of looseness is next to the axilla (arm-pit). The incision is vertical and is at the junction of the axilla with the arm. The scar is well-hidden and difficult to detect.
I have attached photos to demonstrate the effectiveness of the arm lift procedure. The first photo is the traditional arm-lift and the second photo is the modified version.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.
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February 17th, 2010 Michael A. Jazayeri, M.D.
Although not common, as an Orange County plastic surgeon, I have to be aware of body dysmorphic disorder (BDD) amongst my patients.
BDD is defined in the DSM-IV-TR (psychiatric classification) as:
Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).
If you feel you may have BDD or know of someone who may, these screening questions may be helpful:
Engaging in repetitive and time-consuming behaviors, such as looking in a mirror, picking at the skin, and trying to hide or cover up the perceived defect.
Constantly asking for reassurance that the “defect” is not visible or too obvious.
Measuring or touching the perceived defect.
Problems at work, school, or relationship due to inability to stop focusing about the perceived defect.
Feeling self-conscious and not wanting to go out in public, or feeling anxious when around people.
Repeated consultations with medical specialists to improve appearance.
Multiple procedures on the same area to fix the perceived defect.
The final diagnosis, of course, must be made by a qualified psychologist or psychiatrist.
Unfortunately, patients who suffer from BDD are often seen as vain or shallow. It is important to be sympathetic and understand the person’s inability to control their thoughts. The difficult part is convincing the patient he/she has a psychiatric condition which requires professional assistance. Many patients simply refuse to see a specialist and instead undergo multiple procedures, often resulting in “bizarre” or over-operated look on their face.
It is, nevertheless, up to the plastic surgeon to say no at some point. If a patient has unrealistic expectations or wants more surgery in an area which has already been improved, it is the ethical and professional responsibility of the surgeon to consider what the best interest of the patient is.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.
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February 9th, 2010 Michael A. Jazayeri, M.D.
As many of you are aware, health care has been a hot topic recently, and will remain a discussed and debated topic for months to come. Many experts expect a toned-down version of the health care bill to pass this summer.
Instead of boring you with analytical detail, I am going to give you my practical view of where medicine is heading in the future. Unfortunately, my vision is not bright.
Let us start from the beginning. When I was a medical student at University of Southern California, the tuition fee was $12,000 for the first year and increased to $16,000 during my fourth year. Currently, the tuition fee is $44,800! This means from 1986 to 2010, a 24 year period, the tuition fee has increased 272%. This translates to an average annual increase of 11.4%, which is significantly more than the inflation rate. Remember, this does not include cost of living, transportation, etc.
The data shows the income of physicians has not increased and in some specialties has slightly decreased over the past ten years. Therefore, medical students are graduating with a larger and larger debt, with an income which is not even keeping up with inflation, let alone cost of education.
Then there is malpractice insurance, which is mandatory for all physicians, if they plan to work at a hospital or perform surgery at a surgery center. The average insurance cost for a plastic surgeon in California with a “clean” record is around $25,000-30,000/year. The rate for an OB/Gyn doctor is $50,000-60,000 or more. This is equivalent to the annual salary of the average American family! Why are the rates so high? Part of the problem, if not all, is the ease with which law suits can be filed and the ability or inability of a jury to correctly asses the data. I know of a case where the jury awarded $70, 0000,000 to a patient for inability to have sex after a tummy tuck surgery! This is not a typo and I will confirm the award: $70,000,000. Having said this, I have read of cases where the surgeon was clearly at fault and the jury did not award the patient. The point is I do not believe a jury of lay people has the capability of adequately assessing complicated medical lawsuits.
Furthermore, many of these cases take years to resolve. Why do we have such an inefficient legal system is not clear to me. Common sense, however, tells me if an attorney charges by the hour, why would you want to have an efficient system?
Another issue is Medicare’s plan to reduce payment to physicians by 21%. This probably has nothing to do with reducing the cost of health care as much as balancing the budget. Unfortunately, PPO and HMO companies adjust their payments by using Medicare fees as a base-line.
There is now increased government intrusion (some of it good, most of it extra paperwork for less payment). The new big thing is pay for performance, meaning physicians will be awarded for being efficient and cost effective in their delivery of health care. Why not do the same to the judicial system? Can you imagine the amount of money and time which will be saved? Why not have all medical lawsuits screened by an experienced panel (may be two physicians and two judges). The decision to pursue the lawsuit should be unanimous and the final decision should be unanimous as well. I urge you to write your representative in congress about changing the legal system. Even writing to your local newspaper to cover a story about the “hidden” legal cost of health care can’t hurt. The problem is trial attorneys pour an annual budget of $6.5 million to lobby at Congress. The change may never happen, but it is worth a try.
What about universal health care? I think it is important for every one to have coverage for basic and emergency medical care. However, please note this will not equate to increased income for the hospitals or the physicians. With the budget deficit as it is, the payment for the newly insured will come from decreasing payments from Medicare and other programs. In other words, the hospitals and the doctors will have to see more patients with no increase in re-imbursement. This has to affect quality of care at some point. I wish I had an answer how to cover every one without financial sacrifice, both from the medical side and from you, the tax payer.
What does all of this mean? Well, the number of applicants to medical schools has dropped 20%. I know of two people who got accepted into medical school this year and decided to pursue other careers. If this trend continues, medical schools have two options: either lower the standard of admission or accept foreign medical graduates. Outsourcing of medicine has the advantage of hiring these doctors after residency training with less pay. Many of these graduates will have a better quality of life than in their own country, even with lower salaries. The question is how to pick the “cream of the crop” and will the “cream of the crop” be as good as the medical applicants from this country? Either way, I see a potential decrease in the quality of applicants and, therefore, quality of care.
Many of you may say “Oh, here is another doctor who whines all the time. He probably plays golf all the time and makes millions.” Yes, this statement was true in the 1970’s, the so called “golden age of medicine”. My generation is more like the “cubic zirconium” age of medicine!
But to put things in perspective, a plastic surgeon goes to four years of college, four years of medical school, and 6-8 years of residency after that. That is 14-16 years of education beyond high school. An attorney goes to 3 years of law school and can practice after passing the Bar. The cheapest attorney fee I have seen is $250/hour, and the attorney charges by the hour. The insurance companies, however, reimburse physicians by the procedure code they use to describe what was performed. The payment is fixed, regardless of the time of surgery. What about a basketball player with college or high school education? How about getting paid $200,000-1,000,000 a month to throw a ball through a hoop! How much do you think it is worth allowing a surgeon to cut you open, take things out or re-arrange things and then put every thing back together so that you are better off after surgery?
Michael A. Jazayeri, M.D. is a board certified plastic surgeon and a member of American Society of Plastic Surgeons. His office is located in Central Orange County. If you like to schedule a complimentary consultation, please call 714-834-0101.
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February 1st, 2010 Michael A. Jazayeri, M.D.
BREAST AUGMENTATION SURGERY ORANGE COUNTY
After breast augmentation, the breasts will be swollen for 3-6 months, although the majority of the swelling will be resolved by 3 months. Support, therefore, is critical to minimize discomfort.
It is important a sports bra be worn for the first three months, which opens in the front. It will be very difficult to reach back and close a bra with painful, swollen breasts!
At the time of consultation, I measure the patient’s chest diameter and recommend three sizes to be purchased. It is very difficult to know the exact bra size which will fit properly after surgery, since every patient will have varying degrees of swelling. It is critical for the sports bra not to be tight, as it will push the implants up (in effect acting like a push-up bra). During the first three months, it is important to make sure the implants are not pushed up as the surgical pocket created may close and the implant will stay up permanently. The only correction is additional surgery!
Many patients are impatient and want to show their new breasts as soon as possible. Usually, this is accomplished by wearing a push-up bra. Patience is rewarded if one can resist the temptation during the first three months.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.
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January 25th, 2010 Michael A. Jazayeri, M.D.
BREAST IMPLANT SPECIALIST ORANGE COUNTY
As an Orange County breast augmentation surgeon, many patients are curious about the differences between saline and silicone implants.
I want to focus on the life span of these implants. It is important to accept the fact no implant will last forever. When the implant will leak is unknown. Fortunately, with the current generation of breast implants, many patients will have intact implants for many years.
As I stated in a previous blog, although both implant manufacturing companies have a life time warranty on breast implants, the company provides financial assistance towards the procedure only up to ten years from the time of surgery. This means if your implant should fail after ten years, the company will replace the breast implant free of charge, but no assistance will be provided to cover cost of surgery.
Since silicone breast implants contain silicone gel, when the implant fails, the gel is unable to be absorbed by the body. As long as the breast shape and feel is unchanged, therefore, a patient with a leaked silicone implant will not be aware of it.
For this reason, I always recommend this group of patients to obtain a MRI, which is the gold standard currently for silicone breast implant leak, a few days before their ten year “warranty” has expired. Yes, it is a nuisance and yes, it will cost money. However, what if at 11 years post breast augmentation, you should find out one or both implants have leaked? Since there is no proof when the leak actually happened, the company is under no legal obligation to provide financial assistance towards your surgery.
Of course the safest way is to follow the current recommendation by FDA regarding silicone breast implant. The FDA recommends a MRI three years after surgery, and every other year after the initial study. This is not mandatory, and it is up to the patient to follow this suggestion.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.
Posted in Breast Augmentation, Breast Implants, Home | 1 Comment »
January 23rd, 2010 Michael A. Jazayeri, M.D.
BREAST AUGMENTATION ORANGE COUNTY
As an Orange County breast augmentation surgeon, a common question is: “How long do my implants last?”
No breast implant is permanent. Eventually, with time, the shell or other parts of the implant will break down resulting in an implant leak. When this happens is not known. Rarely, the leak can occur early (I have had one patient at 18 months after surgery). For most patients, it will take many years before the implant fails.
Mentor and Allergan are the only FDA approved breast implant manufacturing companies in the United States. The good news is both companies have a life time warranty if the implant should fail or leak. This means if your breast implants should leak at any time, the company will replace the implant(s) free of charge. Both companies also have a limited payment policy towards covering some or all the cost of the surgery. Up to ten years from the time of implantation, both companies will pay a certain amount towards your surgery. More information can be obtained through each company web-site.
The ten year time period, at least in my opinion, means the risk of implant failure is low enough that the company is willing to accept the risk and pay a portion towards the surgery. This does not mean all breast implants are going to leak right after the 10 year period! With newer generation breast implants currently in the market, these implants last longer than older ones.
BREAST AUGMENTATION ORANGE COUNTY
How do you know if your implant has leaked? In case of saline breast implants, the leaked saline (salt water) will be absorbed by the body. The patient can see and feel the difference in the affected breast. With silicone breast implant, the leak may not be detectable, since silicone is not absorbed by the body. Silicone is not dangerous and no study has found a link between silicone implants and disease process. Currently, the gold standard for detecting a leak for silicone breast implant is an MRI. The FDA has recommended all patients with silicone breast implants have an MRI three years after surgery and every two years after the initial MRI. It is up to the patient to follow this protocol and is not mandatory.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.
Posted in Breast Augmentation, Breast Implants, Home | 1 Comment »
January 15th, 2010 Michael A. Jazayeri, M.D.
About 4 years ago, a young gentleman walked into my office for a liposuction consultation. I did my routine evaluation, asking him about his health, past medical history, medications he may be taking, drug allergies, previous surgeries, etc. After I performed my clinical examination and made my recommendation, he said: “Doctor, to be honest with you, I saw another surgeon before you. He was referred to me by a friend. He walked into the room, quickly looked at me and said I am a good candidate for liposuction and Cindy will see me now to schedule the surgery. He then left the room.”
Wow! Prior to January 1, 2010, operating on a patient for aesthetic reasons without a physical exam was considered below the standard of care. Now, at least in California, it is also breaking the law.
The so called “Donda West Law” dictates any patient undergoing cosmetic surgery must have a physical examination and be cleared for surgery by a physician. Will this law significantly change the way any responsible and safe surgeon practices? No, since this protocol was already being followed.
Donda West, as many of you may know, was Kanye West’s mother. She passed away the next day from complications related to her cosmetic surgery. Donda had multiple medical issues, and was previously rejected by another plastic surgeon unless her medical condition was addressed by an internist. She was operated by another plastic surgeon, who was not board certified, without a medical clearance. The autopsy report suggested the cause of death as a combination of pre-existing medical issues combined with prolonged surgery time.
So please remember: If a surgeon decides to operate on you, without any history or physical exam, he/she is breaking the law! If you have medical issues, they must be addressed and controlled prior to your surgery.
This article is not meant to scare you. A recent study found the risk of death from outpatient elective surgery to be 1:50,000. The risk of dying while driving is 1:5,000. This means you have a 10 times more chance of dying from driving than from routine elective surgery!
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in Orange County, California. To schedule a complimentary consultation, please call 714-834-0101.
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