Élan Institute for Plastic Surgery 2010 East First Street, Suite 270 Santa Ana, CA 92705
September 20th, 2011 Michael A. Jazayeri M.D.
Some of my Orange County plastic surgery patients are worried about general anesthesia. This is a legitimate concern, but needs to be put in perspective.
A recent review published in Plastic and Reconstructive Surgery, arguably the most recognized journal of plastic surgery in the world, found the risk of death from out patient surgery to be approximately 1 in 50,000 patients. Assume a plastic surgeon performs 500 cases a year under general anesthesia (this equates to 42 cases per month). I do not know of any plastic surgeon who operates that much. It will take this plastic surgeon one hundred years to reach 50,000 patients! As one can see, the risk of death from general anesthesia is very low.
In comparison, the risk of death while driving is 1 in 5,000. There fore, a person, on the average, has a ten times risk of dying while driving than from general anesthesia.
To achieve this low risk, however, requires the patient to be healthy or have a medical condition(s) which is well-controlled, the surgery center is accredited and either a board certified anesthesiologist or CRNA is administrating the anesthesia. Of course, the surgeon must be well-trained and safe as well.
I hope this will put your mind at ease when going under general anesthesia!
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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August 25th, 2011 Michael A. Jazayeri M.D.
Multiple Plastic Surgery Procedures, In One Surgery
Sometimes patients come to me for a plastic surgery/cosmetic procedure, not realizing to obtain the best result, an additional procedure or procedures may be recommended. This is not “selling” or “car salesman ship” for a lack of a better word.
The classic example of combining procedures is the Mommy Makeover surgery. A woman who has flat, deflated breasts and loose skin with stretch marks on her abdomen, will obtain the best harmony of her body by having breast augmentation with or without a lift and an abdominoplasty (tummy tuck). Certainly, one can do one surgery alone. However, the operated body part will “stick out” and the natural balance may be lost.
Another example is a patient with all the signs of facial aging (droopy eye lids, bags under the lower eyes, jowls, and loose skin of the neck). If a patient only does a neck lift, the face will look unnatural since the natural balance (symmetrical aging) is lost.
A classic combination is a patient with a large nose and a small chin. No matter how good the rhinoplasty result is, a small chin will make the nose look larger, especially from the side view. Therefore, a chin augmentation with the rhinoplasty will provide the best balance.
Most patients with excess fat of the abdomen also have fat around the love handles (flanks). If liposuction of the abdomen is done alone, the excess bulge from the flank fat may be noticeable and combining both areas will achieve the best result. The same idea applies for a tummy tuck patient with excess fat of the flanks.
Therefore, if your surgeon recommends additional procedures other than your main concern, listen to his/her advise, and if it makes sense, follow the recommendation!
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, Face, Home, Mommy Makeover | 1 Comment »
August 12th, 2011 Michael A. Jazayeri M.D.
Plastic/Cosmetic Surgery Performed Under Local Anesthesia
When I finished my plastic surgery residency in 1999, my impression was most cosmetic and reconstructive plastic surgery had to be performed under general anesthesia. May be my attendings chose this method of anesthesia for convenience, or simply lack of information at the time.
However, many cosmetic and reconstructive procedures can be done under local anesthesia.
The advantage of such anesthesia is a higher safety level and less cost to the patient, while still maintaining the quality of work.
Over the past two years, I have performed many procedures under local/regional anesthesia without any complications or degradation in the quality of work or patient satisfaction.
The patient is given an oral medication, usually Valium with or without Vicodin. The area(s) to be operated on is then anesthetized and the procedure is performed. An example of cosmetic and reconstructive procedures which can be done are: upper and lower eye lid surgery, mole or skin lesion removal (local anesthesia only), otoplasty (ear set-back), liposuction, chin augmentation, mid and lower face and neck lift, breast lift or small volume breast reduction.
Examples of reconstructive procedures are: tendon repair of fingers, small lesions or cyst of the hand, local skin flaps for coverage of a shallow defect, some breast reductions.
Regarding breast augmentation and abdominoplasty (tummy tuck), I am aware of these procedures being done without general anesthesia. However, almost all patients require some form of intravenous sedation. This significantly alters the safety margin, as the patient may become overly sedated and require intubation (general anesthesia). For intravenous sedation, a board certified anesthesiologist or CRNA must administer the medication and the procedure should be performed in an accredited surgical center. I am constantly thinking of ways these procedures can be done safely without intravenous sedation. When I find a solution, I will definitely blog about it!
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. To schedule a complimentary consultation, please call 714-834-0101.
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July 8th, 2011 Michael A. Jazayeri M.D.
Breast Implant Leak
I occasionally receive frantic phone calls from patients, usually after hours, where the patient is in stress because she feels her breast implant has deflated.
Stay calm! An implant leak, whether saline or silicone, is not dangerous to your health. In case of a saline implant deflation, the body will absorb the saline (which is the same fluid which is placed in your IV when one goes to the hospital). For silicone implants, the silicone may leak (the newer silicone implants have cohesive gel and the leakage rate is much less than before) and will stay around the implant. Silicone is ubiquitous in nature. In fact, if we randomly biopsy a piece of our tissue, we will all test positive for silicone.
The timing of the implant change is really up to the patient. Obviously the sooner the implant is replaced, the sooner the breast symmetry will occur.
If your surgeon used Mentor or Allergan breast implants over the past 4-5 years, the company will have a life-time warranty on the implant. The company will also pay a certain amount towards the cost of the procedure, if the implant deflation occurred within ten years from date of surgery. If your implant is older than 4-5 years, I recommend calling the company for exact details on your warranty.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience in both cosmetic and reconstructive surgery. His office is located in Orange County, California. To schedule a consultation, please call 714-834-0101.
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June 27th, 2011 Michael A. Jazayeri M.D.
Orange County Laser Resurfacing
I am sure many of you have heard of CO2 lasers for treating wrinkles of the face. The traditional CO2 laser causes thermal (heat) damage to the entire area of skin treated. This is a controlled damage and the depth of thermal injury is controlled by the machine and the operator. In effect, a very superficial burn results and after healing newer, more refined skin is the result. When I was doing my burn rotation during residency, I had two patients who sustained flash burns to their face, resulting in superficial burn to the face. After healing, their skin looked much smoother than before. Of course, I do not recommend this method of treatment!
The downside to traditional CO2 laser resurfacing is the longer recovery period (the burn may take 7-10 days to completely heal), slightly higher risk of infection and more importantly, the color of the lasered skin is usually lighter than the non-treated area. In some patients with darker skin, there is also a higher risk of hypo or hyper pigmentation of the skin and or prolonged redness of the skin, which may take months to resolve. However, if the patient has deep, static, facial lines and significant sun damage to the skin, the traditional CO2 laser may be the best option for this patient.
For others who have fine wrinkles, mild hyper pigmentation and or mild acne/acne scars, my choice is the Mixto Laser. The Mixto laser is a CO2 laser and, if the settings are changed, it can act as a traditional CO2 laser. However, in most cases, the laser is used as a Fraxel type laser. This means the laser causes thermal damage to some parts of the skin but leaves small areas of skin intact. This results in even more superficial heat damage than the traditional CO2 laser. The advantage of this method of laser resurfacing is less down-time (typically 4-5 days of swelling and crusting on the skin), and less chance of infection, hypo or hyper pigmentation. Also, the Mixto laser procedure can be performed in the office with topical numbing cream on the skin, whereas the traditional CO2 laser requires either intravenous sedation or general anesthesia. On the other hand, since the level of damage is less, the result is not as dramatic as the traditional CO2 laser. This means patient selection and patient expectation is important.
I recommend this type of laser to patients who have fine wrinkles on the face, mild to moderate sun damage and spotty brown spots on the face. It is also helpful for patients who have scattered actinic keratosis on the face (these are rough spots on the face due to sun damage). The Mixto laser can also be used on the neck, chest, and hands. The indication for treatment is the same in these areas.
The Mixto laser is not a magic bullet. It will cause some shrinkage of the skin, but do not expect a face lift!
The good news is, in almost all patients only one treatment is needed to see improvement, compared to other lasers which may require 3-5 sessions. The patient, of course, can get more than one treatment if required and a maintenance program every 1-3 years may be used, depending on the patient skin type and life style.
Like every thing else, the Mixto laser is only the beginning. The patient must avoid sun (or use sun block with UVA and UVB protection) religiously, avoid tanning beds, smoking, etc. in order to maximize the benefit and longetivity of the treatment.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience in both cosmetic and reconstructive surgery. His office is located in Orange County, California. To schedule a consultation, please call 714-834-0101.
Posted in Home, Laser Treatments | No Comments »
April 25th, 2011 Michael A. Jazayeri M.D.
My daughter, Lena, was born on April 15th at 3:04 AM.
We wish her health, happiness, and a refund check from the I.R.S. on her birthdays!
But seriously, yesterday, as I was going on my usual walk with our dog, I started thinking about what can I do to be a good parent. I came to the conclusion my goal should be to prepare her so she makes more “good decisions” than “bad” ones in life, and to prepare her for “survival” during the bad times.
This requires preparation and the sooner the better. This means judicious discipline, frequent pep talks, and spending enough time with her so she feels comfortable discussing her “issues” with us.
When I was much younger, I was a pretty good chess player. I haven’t played in years, mainly due to time limitations, and more interest in other hobbies. However, what I learned was a good chess game is the accumulation of small, but calculated moves, combined with occasional risks (if the opportunity should arise). Of course, playing against a human, there is always an element of luck, and we hope the other side will make a mistake so we can capitalize on it. Life is also like chess, in that success in life is rarely due to sheer luck (such as winning the lottery). If you have not done the “small steps”, winning the lottery may not necessarily mean happiness, as you will be unprepared for this dramatic change.
I have also learned the value of patience. When I was much younger, I was impatient and sometimes arrogant. It took a good “verbal beating” by a girl to whip me into shape! I have realized rash decisions rarely lead to anything good. I have also learned to try to think before I open my mouth, especially when angry. Fortunately, I rarely become angry! I think these are valuable lessons for my daughter.
Ultimately, I hope my daughter will learn from her mistakes and set-backs and evolves into a better human being. Unfortunately, there are people out there who are born as a donkey and die as a mule! They are stubborn, never admit to their mistakes and as a result never improve. I hope she is not one of them!
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience in both cosmetic and reconstructive surgery. His office is located in Orange County, California. To schedule a consultation, please call 714-834-0101.
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February 13th, 2011 Michael A. Jazayeri M.D.
VALENTINE’S DAY AND A SERENADE BY PHILIP ROSHEGER
On the 14th of every February, we celebrate Valentine’s Day…the day of love and loving.
I thought it fitting to post “Serenade “by Philip Rosheger on such a day. Philip Rosheger is an American classical guitarist and composer. In my opinion, he is not as well-known as he deserves to be, especially considering some of his compositions have been played by the great David Russell.
It is unfortunate the same billions of neurons composing such beautiful music are also capable of lying, cheating, stealing, raping and killing.
I, however, choose to seek beauty in man kind. Let us be honest, humans are the ultimate virus infecting this planet, and if we are not careful, we will choke this planet to death. On the other hand, we are also capable of amazing acts of kindness, courage, and intellect. This gives me hope.
So on this day, I would like you to:
Love yourself (not selfishly, but respectfully)
Love this planet (it is the only one we have)…at the least, recycle!
Love and show love to people who are important to you…they will not be here forever
While you are at it…why not do the above every day? Seriously, can you come up with a good reason not to????
I have posted “Serenade” by Philip Rosheger below. It is ironic, since Philips’ most famous piece of composition is a mutation of some sort. The original “Serenade” is simpler in its arrangement. Guitarist James Kline added several variations to the original piece, creating a hauntingly beautiful composition. In my opinion, his version on You tube is still the gold standard. Unfortunately, his version cannot be played by most guitarists, since it is arranged for the 11 string “arch” guitar (how many of those do you see lying around??) We are fortunate, as Philips’ friend, Tim Hall, re-arranged James Kline’s version for the six string guitar, thus adding to its popularity.
On this day, Valentine’s Day, I like to dedicate this piece to my wife and best friend, who has stood besides me through thick and thin (mostly thin!), but most importantly, for making me a better person.
I apologize for a few mistakes here and there. Believe me, it is not easy playing in front of someone or something (in this case a pocket video camera!)
The link below is a love story about a poor boy and a rich girl…Afro-American style. This is one of my all-time favorites and a good example of the human race at its finest. Why can’t we act this way every day?
http://www.youtube.com/watch?v=OafqYNCzq5U
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 27th, 2011 Michael A. Jazayeri M.D.
The FDA has issued a communication to inform health care practitioners and the public about a possible association between breast implants and anaplastic large cell lymphoma (ALCL).
Is this cause for panic and concern, especially if you already have breast implants? In my opinion, absolutely not!
The American Society of Plastic Surgeons (ASPS) has actively become involved to provide correct information to its members and to the public. I have provided the link for consumers below. The important point is that ALCL is an extremely rare type of cancer. Of the estimated 10 million breast implants placed since 1989, only 34 cases of ALCL has been reported. This translates to an approximate risk of 1 in 300,000. For comparison, the risk of death from anesthesia in an out-patient surgery center is 1 in 50,000 and the risk of death from driving is 1 in 5000.
So, if you already have breast implants or are contemplating getting one, I do not feel the above data justifies concern.
Here is the ASPS site link for consumers regarding breast implants and ALCL:
http://www.plasticsurgery.org/x10998.xml
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, 2011 Michael A. Jazayeri M.D.
The past few years there has been a lot of emphasis on using evidence (published data) to improve the care of the patient. This is called evidence based medicine.
We, as plastic surgeons, can also benefit from this approach. I am glad to find many of my ideas and approaches to breast augmentation are also supported by published data. My incision for making the implant pocket, placement of the implant, and use of post-operative and intra-operative medication for pain control have been supported by evidence based medicine.
No body is perfect, however! I have modified my practice slightly in order to provide even better care to my breast augmentation patients.
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 | No Comments »
January 11th, 2011 Michael A. Jazayeri M.D.
Please read my first two blogs regarding vitamin D before reading this.
I just reviewed the latest recommendations regarding vitamin D levels and intake according to the Pharmacist’s Letter (January 2011-Volume 27-Number 270102).
As always, if the blood level of 25(OH)D (calcidiol) is below 20 ng/ml, vitamin D deficiency exists and must be corrected. The general consensus is levels between 20-30 ng/ml are considered adequate. This is in contrast to the first blog, which recommended optimal levels of 35-55 ng/ml. However, the article seems to promote a level0f 30 ng/ml as optimal. Therefore, as I recommended in my second blog, the goal should be to achieve a calcidiol blood level in the high twenties or low thirties (ng/ml).
The final recommendation is 800 IU of vitamin D for patients over age of 70 and 600 IU daily for younger adults and children over one year of age. This is NOT the recommended dose for patients with vitamin D deficiency, as much higher doses are needed. Since most patients take in 100-200 IU of vitamin D regularly, the usual supplemental dose of 400 IU should be adequate (such as seen in Centrum, etc.) It is important to follow the blood levels of vitamin D, as each person may respond differently.
I also wanted to mention the timing of taking most vitamin supplements. Tea, coffee, beverages containing caffeine, alcohol, and some medication may affect the absorption of vitamins. Therefore, it is important to leave at least 30 minutes gap between taking your vitamins and ingesting any of the above.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience in both cosmetic and reconstructive surgery. His office is located in Orange County, California. To schedule a consultation, please call 714-834-0101.
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