Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person, because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet The Doctor. Welcome to the Meet The Doctor podcast. My name is Eva Sheie and my guest today is Dr. Aria, who has given me permission not to try to mispronounce his last name. Why don't you tell us?

Dr. Aria Vazirnia (00:45):
Dr. Aria Vazirnia, last name, Vazirnia.

Eva Sheie (00:48):
Well, that's not so bad.

Dr. Aria Vazirnia (00:49):
Thanks for having me, Eva.

Eva Sheie (00:51):
You're welcome. It's my pleasure. So let's just start with a really tough question. Why don't you tell us a little bit about yourself and your specialty?

Dr. Aria Vazirnia (01:00):
Okay. So I am a dermatologic surgeon. I grew up in Southern California, spent most of my life here in Los Angeles area where I went to school, college. Lived in San Diego for a long time for medical school and my residency training. And then I wanted to escape for a year, so I escaped to Boston for a year and then tried to get a little East Coast experience, and then I came back. And now I work as a dermatologic surgeon, which means that I deal with the whole spectrum of all skin related diseases and conditions. Anything from medical to surgical, so skin cancers to aesthetics. So all the many different types of aesthetic procedures, lasers, injectables, such as fillers. And then I did additional training in tumescent liposuction surgery, where now that I've focused in it as a niche to treat and diagnose patients who have lipedema, which is a poorly understood fat storage condition that a lot of people don't know about.

(02:05):
And I have a family experience. My grandmother had it. A lot of people didn't know what she had. And so it was only later in life after all the years of schooling and education that I happened to do a rotation with Dr. David Amron, and he's a lipedema specialist. And it opened my eyes to this condition and it got me really interested in getting involved and learning his specialized technique and liposuction surgery. And I spent a long time with him. And now, I am focusing on offering treatments and talking to patients and being more of an advocate for a lot of patients who have it. And so that's one of my big goals as a physician going forward.

Eva Sheie (02:53):
What would your symptoms be if you were someone who was starting to suffer from lipedema?

Dr. Aria Vazirnia (03:00):
Lipedema is a progressive condition. It starts in the early teenage years with fullness in the lower extremities, in the legs. So many times, patients or people in general notice that they have larger legs and then they try to exercise, they try to go on diets, but they notice that there's a disproportionate enlargement of the legs compared to the rest of the body. And that's the first symptoms that people tend to first experience, just this disproportionate larger legs. But then with time, there's associated swelling, associated pain and tenderness, this discomfort with pushing down on the legs. And that gradually gets worse with time.

(03:44):
And it gets worse and worse throughout someone's lifetime. And decades later, it starts to involve the arms as well. And the upper arms start to develop this fullness and this pain and sensitivity. And it tends to get worse throughout times of hormonal change, so pregnancy. Tends to swell during pregnancy, during OB GYN surgeries, during menopause. So anytime that there is significant hormonal fluctuation, it tends to get worse. It actually affects about 11 percent of women worldwide. So it is pretty common, but it's just a poorly understood condition. I think it's probably because it sounds so much like lymphedema that people forget they forgot about lipedema, that it's an actual entity.

Eva Sheie (04:30):
That's an unfortunate coincidence that they sound the same.

Dr. Aria Vazirnia (04:33):
Yeah.

Eva Sheie (04:33):
And they actually affect the same.

Dr. Aria Vazirnia (04:35):
And they can overlap.

Eva Sheie (04:36):
Yeah. So it only affects women?

Dr. Aria Vazirnia (04:41):
Primarily affects women.

Eva Sheie (04:43):
If we were, for instance, watching TV, what show might we see someone with this condition on?

Dr. Aria Vazirnia (04:52):
That's a very difficult question. It's very prevalent. So you would see the condition and on many different shows. Many times when we see people who are, and I don't want to use the word obesity, but when we see people who have obesity, it's not necessarily true obesity. Many times, they have lipedema. It's a very characteristic distribution of enlargement in the legs and the arms. And then once you see more and more of it, it starts to trigger this pattern recognition. You see it in more people, but it is very common.

Eva Sheie (05:25):
So losing weight doesn't actually improve the condition?

Dr. Aria Vazirnia (05:30):
Losing weight improves areas, such as the torso, the abdominal area. But when it comes down to the legs and the arms, those areas are very recalcitrant. They do not really budge as much as the torso area in losing the pounds. So not really, unfortunately.

Eva Sheie (05:48):
So how did you happen to team up with Dr. Amron and start focusing on this condition?

Dr. Aria Vazirnia (05:57):
I think there was an element of that personal experience with my grandmother. But when I saw how much of an impact he made in people's lives, Dr. Amron is an amazing person. He truly cares about his patients and he wants to always be there from the beginning to the end of this journey that patients go through in diagnosing them and in treating them. So the connection I saw that he had for patients and the impact that he made in their lives was phenomenal. And that is what I'm seeking. As a physician, we're trying to make meaningful changes in people's lives, and I saw that.

(06:32):
And it has been a remarkable experience and seeing these life-changing moments with people. A lot of patients with lipedema, there's a lot of difficulty with quality of life. And there's a lot of pain, there's a lot of difficulty with movement. And so when you see these life-changing experiences where people are able to, you decrease people's pain and their quality of life goes up and they're able to spend time with families and engage in activities with families and you see them flourish at work, it's very humbling and it's very meaningful. And that's what powers me to do what I do.

Eva Sheie (07:16):
So the treatment for this condition is, you said earlier, tumescent liposuction. Is it really that simple?

Dr. Aria Vazirnia (07:23):
Liposuction is the gold standard treatment for lipedema. And a part of it is because it's not just fat. It's fat, there's scar tissue, there's swelling. You want to break apart a lot of that scar tissue. So medical management can only go so far. And then medical management means certain dietary strategies. And I don't mean necessarily dieting, but I mean there's certain foods to avoid, such as gluten. Compression therapy can be important too. But at the end of the day, for lipedema, liposuction is the gold standard. And the thing that makes tumescent liposuction a good and safe option is that that tumescent technique allows the liposuction surgeon to always remain in the safe plane.

(08:05):
And the safe plane is basically that safety area where you're between skin and all the places you don't want to be, such as muscle. So you create that safety plane and it helps anesthetize the tissues when you want to treat it. And it also helps squeeze the blood out of the field, so it's a less bloody procedure. So in terms of safety, in terms of recovery, and in terms of results, I feel that tumescent anesthesia and tumescent liposuction greatly is superior than traditional liposuction and lipedema surgery.

Eva Sheie (08:38):
Is there anything that you, or Dr. Amron or both of you are working on, on the research front, then, since you're seeing so many of these patients?

Dr. Aria Vazirnia (08:47):
There's more and more research coming from centers that treat lipedema patients. And it's an area that is growing, the research is growing. In terms of the genetics of it, in terms of the basic science of it, and in terms of the clinical research, it is definitely growing. Now that we're seeing more and more patients, we want to open it up to research projects. And that is something that Dr. Amron and I are starting to work on.

Eva Sheie (09:11):
How much of your time is focused on lipedema versus the other side of your practice, which is maybe more skincare and cosmetic?

Dr. Aria Vazirnia (09:22):
Lipedema liposuction is the only type of liposuction that I do. Half of my profession is dedicated to lipedema. The other half of my profession is dedicated to all the other aspects of dermatology and dermatologic surgery. So any condition that involves the skin I do see and I do treat. Anywhere from rashes to skin cancer, all the way to lipedema surgeries.

Eva Sheie (09:45):
So you have a superman suit and you just change between offices, is that how that works?

Dr. Aria Vazirnia (09:50):
I wear different hats, but I enjoy what I do. And seeing all the different types of patients who I can treat definitely makes it worthwhile.

Eva Sheie (10:00):
Aside from lipedema, what procedures do you love to do and why?

Dr. Aria Vazirnia (10:07):
As a dermatologist and dermatologic surgeon, we were trained to do a lot of different procedures. There's a lot of variety in the field. We do a lot of skin cancer surgeries, so we treat basal cell carcinoma, squamous cell carcinomas, melanomas. And with the increasing rates of skin cancers, we do a lot of skin cancer surgeries. Part of my practice is also dedicated to more of the aesthetic side. So I do a lot of the injectables, what you see, the Botox fillers, but also laser resurfacing. And I did a fellowship on the East Coast at Harvard Medical School where I trained with Dr. Rox Anderson, who's the inventor of laser hair removal. He's the inventor of CoolSculpting.

(10:47):
A lot of the aesthetic devices on the market right now were invented at Massachusetts General Hospital, one of the Harvard Medical School hospitals. And I did my training under him. So when it comes down to laser resurfacing, and by that I mean scar revision, laser scar revisions on the face, various vascular lesions such as port-wine stains, things such as rosacea, hemangiomas in kids. So I treat all those things with lasers. And it's gratifying to see a sudden quick fix or a sudden quick change with the use of a laser. So that's another part of my practice.

Eva Sheie (11:27):
Is there anything coming on the laser front that you're particularly excited about?

Dr. Aria Vazirnia (11:33):
There are a lot of new things that are always stemming from Massachusetts General Hospital. There's a new device that came out. It's not a laser, it's what's called micro-coring. It's a device called the Ellacor, which takes miniature columns of skin out of the face or anywhere you want to treat. So if somebody has jowls, and instead of looking into a facelift you just want to remove that skin that makes the jowl of the cheek, then there's a device called the Ellacor that removes these small microscopic columns of skin and essentially heals it with no scarring. And then that skin contraction then leads to the improvement, for example, of the jowls. So that's the newest technology that just came out of Massachusetts General Hospital.

Eva Sheie (12:17):
My mind is boggled. So it's like micro-needling and fractional resurfacing, but it's actually just coring out a tiny little section of the skin?

Dr. Aria Vazirnia (12:31):
That's a very good question. It's a fractional treatment. So such as fractional resurfacing where you're using a laser to treat a fraction of the skin. And the reason to treat only a fraction of the skin is because there's less healing time. The skin heals faster when you don't treat the entire skin in one session. This device takes out a fraction of the skin, takes it out. It removes it physically. And then as your skin heals, there's this natural contraction that happens, this tightening that happens as the skin heals with the collagen remodeling, with that healing process. And it makes sense. You're removing skin, so there's less surface area, there's less skin there. So there's this contraction that happens. And that's the latest in terms of rejuvenation, the latest in terms of wrinkle reduction, latest in terms of jowl improvement and skin tightening. So that is the next big thing now on the market.

Eva Sheie (13:29):
Do you think that's the kind of treatment that people other than surgeons will be able to perform?

Dr. Aria Vazirnia (13:35):
With every treatment, there are improvements, there are benefits, there are some risks involved. Right now, it's in the hands of physicians mostly, but it's hard to say who's going to be operating the device. But right now, mostly physicians are operating it.

Eva Sheie (13:50):
What have you heard about the pain level and the recovery time for that?

Dr. Aria Vazirnia (13:54):
With the appropriate numbing, with the appropriate topical anesthesia, sometimes people do nerve blocks. It's tolerated very well. The recovery period is a matter of a few days.

Eva Sheie (14:03):
Maybe even better than some lasers.

Dr. Aria Vazirnia (14:05):
It can be.

Eva Sheie (14:06):
Yeah. Wow, that's interesting. Well, let's switch gears and talk about patients. Is there anything that you can think of in particular that you've learned from listening to your patients that you didn't learn in medical school?

Dr. Aria Vazirnia (14:21):
I think most physicians learn the most from their patients. So symptoms, the process, healing, all these little nuances you learn from your patients. You can't learn it from a textbook. The textbooks only tell you the main ideas, the pertinence. But when it comes down to all the little nuances, that's the only thing you learn from your patients. So that's just the technical medical side of things. But in general, it's important to be present. It's important to listen. It's important to be somebody who advocates. It's important to not dismiss any symptom or any feeling that a patient has that just doesn't match up with the textbook. So if a patient says something and it just doesn't match up with the textbook, that's not a position to dismiss a symptom. It's a position to learn and grow and really listen and try to help. But as just being in practice, the most important thing is we try to be an advocate for our patients. We try to really understand what they're going through. And honestly, we always just want to listen to them going forward. Those are things that you don't learn from textbooks.

Eva Sheie (15:30):
We're all so rushed these days. And I wonder, what can patients expect when they come to see you for the first time in terms of having time to be heard and be listened to? What does that look like?

Dr. Aria Vazirnia (15:46):
Every time a patient comes to see me, I just open up the forum for them to talk. I just listen. I mean, we talk about the childhood, we talk about, and this is specifically many times for my lipedema patients too, but we talk about childhood, we talk about their work, where they're living. And then freely, they open up about all the medical things. So the medical things just flow through, the symptoms when they started having symptoms. And I just listen. And then I try to piece things together for them. And many times, patients don't know if they have, for example, lipedema, since focus for today is lipedema.

(16:25):
Many times, patients don't know if they have lipedema. So I'm trying to piece their symptoms and their history together. But I create this forum where they just can speak freely and speak their mind. And then after that, then we go over just the diagnostic criteria. And I try to piece things together between what the diagnostic criteria is and what the symptoms that they're experiencing are. And then many times, patients have an aha moment where things just make sense. That's how I usually start my talks with my patients or my interviews with my patients.

Eva Sheie (16:58):
People are coming to you from all over the world, right?

Dr. Aria Vazirnia (17:02):
Yes.

Eva Sheie (17:03):
And so are you also meeting people on Zoom for the first time?

Dr. Aria Vazirnia (17:07):
Many times. Most of the meetings I have with patients are on Zoom.

Eva Sheie (17:11):
And are they holding their legs up to the camera to show you?

Dr. Aria Vazirnia (17:15):
So many times, even before the video, we have photographs that are taken, standardized photographs. And they're sent to the office before I even have the Zoom meeting. So I review the photographs beforehand. We give a packet, an introductory packet to patients. And they list their symptoms, they list all the different aspects of what's bothering them or what's concerning to them. And I put those side by side with the photos. And then I have that in front of me and then we have our video session.

Eva Sheie (17:44):
What would you like patients to know about you?

Dr. Aria Vazirnia (17:49):
That myself and Dr. Amron, we truly care. We want to make sure that we're an advocate. We don't want to dismiss anybody's symptoms. We both have personal connections to patients who have lipedema, so it is very important to us. And we're not just there to do liposuction and say bye-bye. We're there to take your hand from the beginning to help you through the entire process in terms of nutrition, in terms of management at home, in terms of work, and then also, of course, the surgical process and the healing itself. But it's just more than that. We want to make sure that our patients are comfortable. We have patients who have to take time off from work. We facilitate that. Sometimes we're in communication with employers and we have to make sure that the patients are having that appropriate environment for healing. So we sometimes have to speak with their employers. So we want to make sure that the entire journey is the right one and that we are there with them the entire time.

Eva Sheie (18:48):
We know you're in Los Angeles. You told us that you grew up in California. What kinds of things do you like to do outside the office?

Dr. Aria Vazirnia (18:57):
I like to play music, I like to play guitar, I like to record, I like to play tennis. I think tennis is my favorite after clinic activity. So after a long day of work, I actually have a coach and I go and I play tennis three times a week if I can. But I've been playing music since I was six. I used to take piano lessons from six to 18, and so I write music for piano. I picked up guitar when I was in high school. I write music for guitar now too. And so those are my hobbies outside of work. And I do like spending time with my family, making time for them. And I like restaurants too. I like eating as well.

Eva Sheie (19:37):
So LA, yeah.

Dr. Aria Vazirnia (19:37):
La. Yes, yes.

Eva Sheie (19:40):
Well, thank you for sharing your story with us.

Dr. Aria Vazirnia (19:42):
Thank you. Thanks for listening.

Eva Sheie (19:44):
If somebody is interested in finding you, reaching out to you, or learning more about either your dermatologic surgery practice or your lipedema practice, where can they find you?

Dr. Aria Vazirnia (19:56):
They can find me on our social media networks or platforms. So they can find me on my own social media, @DrAriaMD. They can find us through, specifically for lipedema, they can find us through the lipedema Instagram page, the Advanced Lipedema Treatment, ALT program, their own Instagram page. And then our own website too. But I think when it comes down to it, just Google searching and that'll open doors too.

Eva Sheie (20:25):
That website is AdvancedLipedemaTreatment.com?

Dr. Aria Vazirnia (20:29):
Yes.

Eva Sheie (20:29):
And we'll put all those links in the show notes for you. Thank you, Dr. Aria.

Dr. Aria Vazirnia (20:33):
Thank you so much again. Thanks for having me.

Eva Sheie (20:38):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet The Doctor podcast. Check the show notes for links, including the doctor's website and Instagram, to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet The Doctor podcast? Book your free recording session at MeetTheDoctorPodcast.com. Meet The Doctor is Made with Love in Austin, Texas, and is a production of The Axis.