Élan Institute for Plastic Surgery 2010 East First Street, Suite 270 Santa Ana, CA 92705
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.
Posted in Breast Augmentation, Breast Implants | 1 Comment »
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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January 14th, 2010 Michael A. Jazayeri, M.D.
IS RED WINE GOOD FOR YOUR HEALTH?
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.
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January 13th, 2010 Michael A. Jazayeri, M.D.
Orange County Liposuction Specialist
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.
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January 8th, 2010 Michael A. Jazayeri, M.D.
Nose Surgery Orange County
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.
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January 5th, 2010 Michael A. Jazayeri, M.D.
Tummy Tuck Orange County
As an Orange County mommy makeover surgeon, tummy tuck surgery is one of our most popular procedures. But what happens after the surgery?
Tummy tuck surgery is an out-patient procedure, meaning the patient will go home after the procedure. In rare instances, the patient may be kept in the surgery center over-night.
After surgery, the patient will have 2-3 drains placed under the abdominal skin. The drains will collect any excess fluid which the body produces as the result of surgery. Typically these drains are removed in 7-9 days, depending on their output. The patient’s family or provider will be instructed on how to empty and record the outputs separately on a piece of paper. If the patient has chosen to have a pain pump catheter (which I highly recommend) these catheters will be placed under the abdominal skin as well. These catheters are removed 3 days after surgery. The patient will be instructed on removal, there is no need to return to the office for their removal.
After surgery, it is important for the patient to sleep with their knees or hips bent to avoid any tension on the skin closure. Most of my patients are able to walk fairly straight after the first week of surgery. However, they must sleep in a slightly flexed position for 2-3 more weeks.
The patient will be seen in the office 24-48 hours after the procedure. The dressings will be changed and new ones placed. I instruct the patient and care-giver on how to properly apply and adjust the abdominal binder which was placed at the end of the procedure. The purpose of the binder is to provide support and minimize swelling. It must be worn for 4 weeks. It is important for the binder to fit well and be firm but not too tight. As a general rule, the binder should be as tight as the patient can comfortably tolerate.
The patient will return 7-9 days after surgery. Depending on the drain outputs, the drains may or may not be removed. If the drains are removed too early, the fluid will collect under the skin. This is called a seroma. The patient has to return to the clinic at least once a week to have the seroma “sucked out” with a needle and syringe. This is not fun! It is also critical for the patient to refrain from too much activity for one week after drain removal. It is the movement and rubbing of the abdominal skin against the abdominal wall which produces seroma. If the patient has a “desk job”, they may return to work after the second visit, provided no lifting or bending is permitted.
Minor wound issues, such as small skin sloughs right at the edge of the incision is fairly common after tummy tuck surgery. I would say 30% of patients will have some minor wound break-down which usually heal with antibiotic ointment and daily dressing changes.
The patient returns for a follow-up one month after surgery. Although the swelling has improved, it will take 2-4 more months for the swelling to completely resolve. At this time the patient may chose to remove the binder. Some patients, however, feel more comfortable wearing the abdominal binder. The patient may start light exercises such as walking on a flat surface or light weight lifting. The patient should refrain from sit-ups or abdominal exercises for 6 months. As part of the tummy tuck, the weakness of the abdominal muscles has been corrected with sutures. It takes approximately six months for the repair to be strong enough to allow abdominal exercises.
The patient returns for their 3 month follow-up. At this point, most patients have obtained their final shape. However, in some cases, it may take longer for the swelling to completely resolve. Depending on the patient’s skin color, the incisions may be darker than the surrounding skin. It may take up to one year for the incisions to lighten. Many patients also are concerned about numbness in their skin. It may take one year or longer for the sensation to return to all areas of the abdominal skin.
The last clinic visit is 6 months after surgery. At this time, the patient may resume abdominal exercise as tolerated. The patient should avoid any sun tanning to the abdominal skin for one year after surgery. The skin is very sensitive and even a sun-burn may cause significant damage to the skin.
This is a typical recovery for a patient undergoing abdominoplasty 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.
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