As many of my regular blog readers know, I am a big believer of having diversification in life.  I have written about the benefits of exercise and music in previous blogs.  Today, I want to write about classical guitar music.  My hope is to open your “musical palate” and perhaps get you interested in picking up a musical instrument as a hobby.

I have chosen pieces which I consider important for their respective musical period.  All of these pieces have withstood the test of time, and are among the “top hits” if you will.

For those of you who are “into” classical guitar music, some clarification is in order.  First, I have only chosen pieces which were written for the classical guitar or its predecessors, the lute or other guitar like instruments.  Transcriptions from other instruments have been omitted.  Second, I have limited my selection to pieces which were written prior to 1930.  The reason being the dramatic increase in composition for the guitar since then as well as the inability to evaluate these pieces in the context of time (will these pieces withstand the test of time?) Third, please do not comment on why I chose this performance versus the other! I am fully aware of all performances on You Tube, but due to limitations in space and time, on this day, these are the videos I chose.  I can assure the readers these are top notch performances.

Classical music is serious music!  To fully appreciate these compositions, please do not watch these videos while putting on make-up,  while drinking and eating with friends or playing with your children or pet, etc.  Set some quite time and watch them alone.  If anything, I hope you will at least be mesmerized by the complexity of these pieces and the superb playing of the performers.  As an amateur classical guitar player, I can attest to the technical difficulties of these pieces.

RENAISSANCE

The renaissance was a fruitful era for the lute, and many great pieces were written.

The first piece of I have chosen is Guardame Las Vacas by Luis de Narvaez.  It is one of the first printed examples of theme and variations, which is the essence of renaissance lute music.  As one listens, one can pick up the “theme” followed by the variations on the theme which follows.  This is a fun piece to play!

Fantasia Number 10 by Alonso Mudarra!  To this day, I am still amazed this piece was written some 500 years ago! The piece starts fairly standard for renaissance, and then it suddenly shifts gear and becomes contemporary in sound.  Towards the end, it shows perhaps the best example of counter-point I have ever heard.  Close your eyes and listen! It sounds like two separate instruments playing! The technical difficulty of the piece lies in timing the notes precisely so that illusion becomes reality.

How can I ignore John Dowland while mentioning the Renaissance?  Dowland, an Englishman, was to lute what Shakespeare was to literature.  Even the pop artist Sting recorded an entire album of Dowland’s music recently!

Although he composed many superb and well-known pieces, I have chosen his Fantasia, since it is his most complex work. It starts slowly and builds up to an exciting finale.

BAROQUE

Many great pieces were written for the lute during this period.  However, if I had to pick a few, these are the ones I would choose.

When one mentions Baroque, perhaps J.S. Bach is the first name which comes to mind.  Bach owned this era!  I have chosen his magnificent Prelude, Fugue, and Allegro written for the lute.  Bach was a religious man and although he specifically did not address these pieces to honor God, his allegro is truly a religious experience.

Although Bach did not play the lute, he was so inspired by his contemporary Silvius Leopold Weiss, it is said he composed his entire Lute Suite to honor Weiss.  That is some recommendation!  Unfortunately, the music of Weiss suffered neglect for many years, and I still think his music is underrated.  I have chosen his Fantasia (a fun and exciting piece to play!) and Chaconne here.

CLASSICAL

During the classical era, the classical guitar (a smaller version of today’s guitar) gained popularity.  The most famous player, Fernando Sor, was Spanish.  Unfortunately, most of the pieces were written in the standard Viennese style, thus the music lacks ethnicity.

I cannot mention this period and omit Sor.  Sor was the most important figure of this period and his music is standard repertoire even today.  I have chosen his Theme and Variation on Mozart’s The Magic Flute to illustrate his mastery of this instrument.

This may be a surprising choice for those of you who are into classical guitar.  The second piece I have chosen is the Rondo by Dionisio Aguado.  Aguado’s style was very technical and as a result his compositions lacked the musical charm which made his contemporaries more famous.  However the Rondo is where technique and musicality find each other.  This piece is a fire cracker and a tour de force!  I hope one day I can play this (in my dream???).

ROMANTIC

Francisco Tarrega.  We owe a lot to Tarrega.  Tarrega became blind from an eye infection when he was a child.  Thus his achievements are even more amazing.  Tarrega was responsible for the current version of classical guitar.  As his popularity increased, he required larger concert halls to perform.  As a result he asked guitar builders to make his guitar larger and deeper in body, so that the sound could travel farther.

He is also responsible for one of the finest pieces written for the guitar involving the tremolo technique.  The tremolo involves rapid alteration of the ring, middle, and index finger on the same string, thus giving the illusion of a sustained note.  This is a difficult technique to master.  It amazes me he developed this technique without the gift of sight.

I have chosen his Recuerdos de la Alhambra as it relies entirely on the tremolo.  According to Frederick Noad, “This original composition is a musical memory of the famous Alhambra palace in Granada, a magnificent relic of the splendor and grace of court life during the Moorish occupation of Spain.  The rippling tremolo melody is evocative of the fountain and running water that are to be found everywhere in the palace and its gardens.”  This piece may sound familiar to you as a synthesizer version of it was used by the British composer Mike Oldfield in the Oscar winning movie The Killing Fields.

TWENTIETH CENTURY

Many of you may be surprised I have not chose Segovia here.  There is no question Andres Segovia was the “turbo engine” which propelled the classical guitar as a legitimate concert instrument.  He tirelessly transcribed music for the guitar and many composers composed music for the guitar because of him.  However, surprisingly, Segovia was never famous as a composer.  I have not heard many compositions from him, and the one I found on You Tube is average at best (sorry Andres!)

The composer-guitarist I have chosen comes from a country not usually associated with classical guitar:  Paraguay.  Paraguay is a small country in South America.

Agustin Barrios Mangore was a contemporary of Segovia.  It has been said Segovia was very jealous of Mangore and had tried to sabotage his career.  However, even Segovia admitted he liked the piece I have chosen, La Cathedral.  Mangore, like Bach, was a religious man and also admired Bach.  La Cathedral is written in the style of Bach (compare it to the Prelude, Fugue and Allegro chosen earlier).  The first two movements depict the peace and tranquility of being in a church (cathedral), while the last movement, Allegro Solemne, depicts the hustle and noise of the city as one leaves the church.

BONUS PIECES

I have chosen these two pieces to inspire you to pick up the classical guitar.  Given 6-12 months of diligent practice, these pieces should be within the grasp of every one.

The first, Etude in B Minor, is by Fernando Sor.  A relatively simple yet charming piece to play; it allows a lot of room for musical expression.  The key to this piece is to bring out the melody.  Take this piece seriously!  The great Julian Bream has played it as an encore piece during his concerts.

The second piece is very famous.  You have heard different versions of it somewhere.  It is called Romance (or Spanish Romance) and it is composed by……….Anonymous!  I bet the person who wrote this piece is turning in their grave as to why they didn’t put their name on the original composition.  Frederick Noad, in his excellent book Solo Guitar Playing 1, accurately states “From its sound this is always supposed to be a fairly easy piece.  In fact it needs considerable practice, but this will result in a strengthening and general improvement of the left hand.”

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.

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.

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.

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.

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.

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.

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.

Many of you have heard about resveratrol, this supposedly miraculous compound which is found in red wine.  But how much do you really know about this topic?

A while ago, there was a television program about the “French paradox”.  The French diet is full of saturated fat and yet the risk of heart attack is much lower than the United States.  The theory, at that time, was that the regular consumption of red wine somehow contributed to this disparity.

There is now concrete evidence resveratrol does have a protective effect in the laboratory.  It probably has the same effect in the body as well.

Resveratrol is a natural compound produced by the red grape to protect itself from fungal infection.  Therefore, the level of resveratrol will vary significantly, depending on how the wine is produced.

Biodynamic or organic wines contain 30-40 mg of resveratrol in a standard bottle.  Wines which are made non-biodynamically, and are exposed to pesticides, have a resveratrol content of only 2-3 mg per bottle.  That is a huge difference.

However, the amount of resveratrol used in studies has been around 1000mg!  This is equivalent to a person drinking 30 bottles of biodynamically grown wine each day!

One can take a daily supplement of resveratrol.  It can’t hurt.  However, we really do not know how much of synthetic resveratrol will be absorbed by the body.

The critical question, which has not been answered yet, is the lowest level of resveratrol which will produce a protective effect in the body.

Does this mean you should skip that 3-4 ounce glass of wine, 3-4 times a week as recommended?  Nonsense!

Wine is a social drink.  Therefore, make it a social event.  A nice bottle of wine with a nice meal and good company will elevate your mood, reduce your stress and probably has some benefit from the resveratrol.  The French paradox probably has less to do with resveratrol as it has with the more relaxed life-style of the French.  Just remember to limit your intake and drink responsibly.

By the way, if you like to try biodynamic wines, there are many out there.  However, the grand-daddy of them all, probably the one who started it all, is Nicolas Joly from France.  You can watch him speak in a two part series at http://tv.winelibrary.com/2009/02/23/talking-biodynamics-with-nicholas-joly-part-i-episode-628/

If you live in a metropolitan area, finding Joly wines should not be too difficult.  In Orange County, I recommend Hi-Time wine cellars (www.hitimewine.net) and Wine Exchange (www.winex.com).

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.

As an Orange County liposuction surgeon, many patients ask about the recovery period.

Depending on the patient, the area and amount of liposuction required, the procedure may be performed in the office under local anesthesia.  In other cases, the procedure is performed in an outpatient surgery center using general anesthesia.

After liposuction, the patient wears his/her compression garment, depending on the area of procedure.  For the abdomen, a binder is used.  For the inner and outer thigh, a “biker” type garment is worn.  Other areas have their own type of garment.  The purpose of the garment is to minimize swelling, and to allow the skin to retract properly to the underlying tissue.

The patient is seen 24-48 hours after surgery.  The areas are inspected to make sure there is no bleeding or infection and that the compression garments are fitting properly.

The next visit is one week after surgery.  At this visit, the sutures (if placed) are removed.  At this time there may be bruising in some or all areas of liposuction, which will resolve in the next few weeks.  There will also be swelling.  It is important for the patient to realize during the first three months it will difficult to asses the final result due to swelling.  The final shape realistically begins after three months.  The patient is instructed to continue wearing the garment and to avoid any exercise or activity which will move the area of liposuction.

The patient returns for his/her one month follow-up.  If the healing process is proceeding normally, the patient may start exercising.  The garment may or may not be worn at this time.

At the three month follow-up, the swelling has improved dramatically and the final contour is beginning to show.  In some patients, the swelling may take longer to resolve.

The six month follow-up has arrived!  By this time, the swelling is resolved and the final shape has been reached.  It is very common to have areas of numbness where liposuction was performed.  The numbness may take up to one year or longer to completely resolve.

Liposuction typically removes 85% of fat cells from the area.  This means out of every 100 fat cells, 15 remain.  Therefore, liposuction is not a substitute for proper diet and exercise.

This is a typical recovery for a patient undergoing liposuction surgery.  Not every one will have the same experience and, rarely, complications do occur.

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.

Many of my Orange County rhinoplasty patients are concerned about post-op recovery.

In majority of my cases, a full rhinoplasty is required.  This means the hump is reduced, the tip is refined, the septum and the inside of the nose are addressed, and the bones are narrowed.

For such cases, I have been using the open rhinoplasty technique for over 10 years, since it allows better visualization of the entire nasal anatomy, thus resulting in a more predictable result.  The trade-off is slightly more swelling, especially in the tip area, which may take longer to resolve.

Orange County Rhinoplasty Specialist

Dr. Michael Jazayeri Board Certified Plastic Surgeon

After surgery, the patient will have a splint on the nose for protection and nasal packing.  Some surgeons prefer to use internal splints rather than packing.  This is a personal preference.  In my hand, I have had better consistency with packing as I can modify the amount on each side.   The patient breathes through his/her mouth until the packing is removed.  It is critical for the patient to keep the head elevated to minimize swelling, and to avoid sneezing or blowing the nose.

The patient is seen 24-48 hours after surgery.  Most patients are surprised the amount of pain is less than expected.  I have had a few patients who have had breast augmentation and rhinoplasty.  All agree the pain of breast augmentation was worse than rhinoplasty.  At this time, the splint and packing are inspected to make sure every thing is in place, and the patient has no bleeding.  The patient should not wear any glasses.

The next follow-up visit is 7-8 days after surgery.  At this time, the splint and packing are removed.  For open rhinoplasty, I use absorbable sutures at the base of the columella, and no removal is required.  I always warn the patient although the nose has improved, there may be significant swelling at this time.  The patient should avoid blowing the nose or sneeze forcefully.  No glasses are to be worn unless they can be fitted so there is no pressure on the bridge of the nose.  If the patient has dry nose, over the counter salt water sprays can be used as often as needed.  No exercise or heavy activity is permitted.

The patient returns for their one month visit.  The patient is concerned about the swelling, especially in the tip area.  Although the swelling has improved, it is still present.  I remind patient the swelling usually starts improving at 3 months.  However, the final shape of the nose may take 6-12 months.  During the first three months, it is common for the nose to go through cycles of less and more swelling.  The patient may start exercising and wearing glasses.  Obviously, I do not recommend contact sports at this time!

The three month follow-up has arrived.  The nose is beginning to take its shape and the patient is happier.  I have noticed a metamorphosis in many of my patients at this 3 month follow-up.  At the time of consultation, most patients are somewhat shy.  At this follow-up, they walk and act more confidently.  Many of my female patients have make-up on with nice clothes.  It is a joy to see this change!

At the six month follow-up, the swelling in the nose is minimal to none.  The patient is pleased with the result.  They still walk and act confidently!

One year follow-up has arrived.  The nose has achieved its final shape.  However, over the coming years, minor changes will occur in the shape of the nose, which are detectable only by comparing photos.

This is a typical recovery for a rhinoplasty patient.  Not everyone will have the same experience and, rarely, complications do occur.

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.