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.

Orange County, Santa Ana, Newport Beach

A friend of mine once said “Physicians are just nerds trying to be cool.”  The title above is my feeble attempt to sound hip!

But joking aside, when a patient presents to me for improvement of the abdominal area, the question arises which procedure is best: liposuction or tummy tuck (abdominoplasty)?

If a patient has no stretch marks or loose skin and the only issue is excess fat under the skin, the decision is easy:   liposuction will remove excess fat and since the patient has normal skin tone and elasticity, the skin will retract properly.  If on the other hand, the patient has hanging skin over the pubic area and a hanging shelf of skin above the umbilicus (belly button), then a tummy tuck will give the best result.

What about the patient who is borderline though?  There are patients who have borderline skin elasticity, may or may not have some stretch marks and are in that gray area between liposuction and tummy tuck.  This is where patient’s concerns and expectations are important to asses.

First of all, is the patient terrified of having general anesthesia, despite the safety of general anesthesia in healthy individuals?  In a recent article by the American Society of Plastic Surgeons, the risk of death from elective out patient surgery was 1:50,000 versus 1:5,000 from driving.  This means the risk of dying while driving is TEN times more than having elective outpatient surgery!  Are they concerned about the increased incisions and recovery time after a tummy tuck?  Is cost a factor?  What are the patient’s expectations?  Is he/she expecting a flat stomach with little or no stretch marks or is the patient looking for some improvement only?  It is critical the patient is honest with him/herself and with the surgeon, and adequately addresses their concerns and expectations.  Liposuction is a very effective procedure for patients who have borderline skin tone, as long as the above issues are adequately addressed.

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.

My method is not scientific at all but based on experience, having performed hundreds of breast augmentation surgeries over the past ten years.

I measure the patient’s chest before surgery to come up with bra size.  It is amazing how many of my breast augmentation patients are wearing the wrong size!  Whatever the bra size is, I add 4 and 6 to that number.  For example, if a patient has a bra size of 32, I have the patient purchase a 36 and 38 sports bra (most sports bras come in C cups).

The reason I have the patient purchase two sizes is that every patient will have different degrees of swelling after surgery.  There is no way to accurately predict this pre-operatively.  The two sizes allow me to properly fit the patient with a support bra which is not too tight and not too loose.

With this simple “technique”, more than 90% of my breast augmentation patients have chosen a sports bra which fits properly.

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.

However, I never forget what happened one night when I was a second year general surgery resident rotating at the intensive care unit (ICU).  One evening, I received news about an 18 year old female who was pregnant with her first child.  During or after delivery and the details were not clear, she stopped breathing and sustained several minutes of oxygen deprivation to the brain.  She was subsequently intubated and transferred to the ICU.  Fortunately the child was healthy.  Over the next two days, due to the unknown time of oxygen deprivation and since the patient did not respond appropriately to external stimuli, multiple studies were performed to asses her brain function.   All studies came to the same conclusion:   brain death.

In the evening, when the last set of test results was noted, I approached the family regarding organ donation.  I explained to them her brain damage was severe and irreversible and she will never be able to function or breathe on her own.  The family deliberated for 30 minutes in a private room and decided against organ donation.  They asked me to disconnect her from the breathing machine.

While they were in the room, I hoped the family chose organ donation, since I did not want to face her death.  She was so young!  It also would have benefited another patient who desperately was in need of an organ donor.

With the family in the room, holding hands and with their heads down in prayer mode, I disconnected her from the breathing machine.  It was eight or nine o’clock at night and the ICU was quiet.  This time it was eerily silent.  Although I could have left the room, I did not.  Here was a family I hardly knew, a patient I had known for two days.  After tonight, I probably would never see any of them again.  Yet, I couldn’t leave.  It didn’t feel right for me to leave.

Here I was, a second year surgical resident, helpless.  Neither surgery nor medical technology could save this patient now.  I watched the monitor showing her heart beat gradually slowing down….3 beats per minute…2 beats per minute…one beat per minute…flat line.

No words were spoken to me, but I knew the family appreciated my presence.  I left the room and went to the bathroom and started crying.

I realized something no medical school book or teacher could have taught me.  I was given the privilege and power not only to save lives, but to take life away.  I better not mess up and I better take my responsibilities seriously!

I often think of this patient, just to make sure I don’t forget what it means to be a physician.

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 have been stated in my previous blog, mommy makeover surgery addresses the changes which occur after pregnancy.  These changes primarily affect the breast and the abdomen.

The breast can be enhanced with an implant (breast augmentation) with or without a breast lift.  A breast lift may be required to reposition the nipple and tighten the loose skin.

Although some patients are lucky enough only to require liposuction, most patients will require a tummy tuck (abdominoplasty) to address the loose skin, stretch marks, and the weakened abdominal muscles which occur after pregnancy.

So, can both surgeries be combined together?  The answer, in most cases, is yes!

There are two limiting factors preventing both procedures to be performed at the same time: the patient’s financial situation, and the total time the patient is under anesthesia.

Mommy Makeover surgery is among the more expensive procedures performed by plastic surgeons.  The surgery may take 4-6 hours and the cost of anesthesia/operating room, implant and surgeon’s fee will add up quickly.  Having said this, if the patient can afford the cost, there are many benefits to having the procedures combined.  First, there is one recovery period, both from anesthesia and from the surgery.  For patients who work, one recovery period is financially advantageous.  Second, combining both surgeries will result in a 10-15% reduction in overall cost.  Surgery centers typically charge more the first hour and the price decreases after that.  Therefore, staging the surgeries will result in more added cost to the patient.

The second limiting factor is the anticipated anesthesia time.  The current recommendation by the American Society of Plastic Surgeons is to limit anesthesia time for elective, outpatient surgery to six hours.   Therefore, if the surgeon feels the surgery may take longer, it is best to stage the procedures.

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 with all elective cosmetic surgery, the question arises: should you spend thousands of dollars to have your nose done, look and feel bad for a few weeks, for the hope that you will look and feel better in the future?

The answer, as always is yes if you have realistic expectations, are doing the surgery for you and yourself only, and understand the limitations of what can be achieved given your anatomy.

Often patients bring me photos of celebrities asking if I can make their nose look like the person on the picture.  It is important to understand the idea is the same: to make the nose more refined and balanced.  However, there is no way to produce a nose exactly like some one else’s.

For example, if a patient has very thick, oily nasal skin, he or she cannot expect to achieve a final result like someone who has delicate cartilage and thinner skin (such as Natalie Portman or Keira Knightley).  There is a limitation to how much cartilage I can remove and shape.   Furthermore, regardless of how much can be done with the nasal bones and cartilage, once the thick nasal skin drapes over the framework, the result will be different.

The same concept applies to someone who has very thin nasal skin.  Although I can perform a very nice rhinoplasty, I have no control over the patient’s healing.  Occasionally excess scarring may occur which may be noticeable under a thin nasal skin, but not be visible otherwise.

Having said all of the above, rhinoplasty, if done properly and for the appropriate patient, has a very high satisfaction rate.  I am always pleased to see the before and after “personality change” of my patients.  It is not just the new hair cut, make-up and clothes, but also the way he/she carries himself/herself!

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.

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.

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.

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.

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.