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. Today on Meet the Doctor, my guest is Dr. Bahman Guyuron from Lyndhurst, Ohio. Welcome to the podcast, Dr. Guyuron.

Dr. Guyuron (00:41):
Good morning. Thank you.

Eva Sheie (00:42):
So tell us a little bit about yourself.

Dr. Guyuron (00:45):
I was born in Iran and, uh, did my medical school from 1964 to 1971. Finished the medical school there, then came to the United States in 1973. Uh, did my internship in New York, then residency in general surgery, uh, in Boston. Then, uh, I did a plastic surgery training at the Cleveland Clinic, and I did another fellowship specializing in the face area in Toronto University. And practiced in Cleveland Clinic for a few years as the chief of plastic facial surgery there, and became a, the chief of plastic surgery at Mount Sinai Hospital for 15 years. Then, uh, I was the chairman of the Department of Plastic Surgery at Case Western Reserve University for 10 years. Now I'm in private practice. My practice is limited to the face, and I used to do everything in a plastic surgery, but now I mainly do facial procedures.

Eva Sheie (01:59):
It sounds like you've been everywhere.

Dr. Guyuron (02:01):
<laugh>. I've been to in New York, Boston, Toronto, Cleveland. Yes, I have.

Eva Sheie (02:08):
I wonder if you can tell us a little bit more about leaving Iran. That's a really interesting path to get to being a plastic surgeon in the United States.

Dr. Guyuron (02:20):
I came for, for the education and there is no country where the medical education even today, anywhere in comparison to what it is in the United States. So I came for education. At the time, I really don't, didn't know that I'm going to become a plastic surgeon. In fact, uh, when I finished my general surgery, I was very interested in neurosurgery. And what happened is, uh, I started neurosurgery residency and my patients wouldn't talk to me because many of them had accident or they're, they're in coma and they, at the time, neurosurgery wasn't what it is today. So I didn't think that that really is kind of life that I'm gonna be happy with. So I immediately changed the general surgery, then became plastic surgeon because I conceded results immediately. I, I enjoy the fact that plastic surgery is about combination of art and medicine, and that intrigued me and that's how I chose plastic surgery.

Eva Sheie (03:30):
Do you still, even after all these years, enjoy the part of your job, which is talking to the patients?

Dr. Guyuron (03:37):
Well, I do actually. I do. Um, about, there are occasions that the conversation is not, uh, a hundred percent what I want to see, but, but I will say overwhelming majority of conversation with the patient is positive and they're happy with, with about what we do. And one of the things that I do, and I discovered actually two over 23 years ago, is, uh, surgical treatment for migraine headaches. And that's one of the things that, uh, really gets me going because patient after patient tells me that I've changed their lives. And not only I do that surgery now, I have trained a lot of people internationally that they do that procedure and they're the happiest group of our patients. Unfortunately, I've been lucky to have a lot of happy patients internationally. I get a lot of patients from all over the world, but, uh, for a variety of reasons, rhinoplasty, particularly rhinoplasty, which is, uh, one of my passions, one of the two passions. My rhinoplasty, uh, migraine surgery are the two, uh, procedures that, uh, I enjoy doing the most. I do all of the facial procedure and I like them all, but those two I have focused on for a long, been focused on written, uh, articles, books, uh, book chapters, and taught a lot of people.

Eva Sheie (05:07):
Have you ever noticed anything that the rhinoplasty patient and the migraine headache patient might have in common?

Dr. Guyuron (05:16):
Oh, absolutely. Actually, a good number of rhinoplasty patients have headaches and headaches that originate from behind the eyes. Those patients can actually be helped with doing the rhinoplasty. What is triggering headaches? There is deviated septum, which is a wall in the center of the nose that can be shifted to one side or the other that touching other elements inside the nose, and that can trigger headaches. So we do rhinoplasty and septum surgery on those, or majority of patients. We do septoplasty when we do a rhinoplasty, and that can help the headaches also. So that is the main common grounds that I see.

Eva Sheie (06:02):
When you have a patient like this and are able to successfully resolve what's happening to them, what kinds of things do they say to you when they come back later?

Dr. Guyuron (06:13):
The most common term that I hear from a lot of patients, which is like they have rehearsed, is I have gained control of my life. Imagine, I don't know if you have had any, have migraine headaches or not, but people have migraine, have no control of their lives. They can have a wedding, their wedding, and they can, uh, migraine they can hit, they may not be able to participate in their, their own wedding in a way that they are otherwise, otherwise would, or their children's events they can't go to because they have headache. They can never control their schedule this way, whether when the headaches are gone, they know that they have gained the control of their lives. That's the most common statement that I hear. The second most common here statement, you have changed my life. That's the second most common statement that I hear from the patients.

Eva Sheie (07:14):
So one of the questions I was going to ask you was what kind of patient do you love to help the most? And I think that it's probably this one. Is that, is that accurate?

Dr. Guyuron (07:25):
Exactly. And also obviously any patient who is realistic, appreciates what we do for them. And yes, again, they understand that, um, surgery medicine is not a hundred percent, we don't control every aspect of it, including the healing that neither one of us, neither patient nor us can control. Those are the patients that I, I enjoy, uh, taking care of. And in fact, fortunately again, it constitutes a majority of my, my patients that I take care of.

Eva Sheie (07:59):
What led you to the place where you started to figure out that you could correct migraines with surgery?

Dr. Guyuron (08:07):
Uh, it was actually a merely coincidence. A patient on whom I had done a forehead lift came for a follow up six months later. She, her statement was not only, I'm very happy about the way my forehead looks. I haven't had migraine headaches since you operated on me. I thought that there was a coincidence. Two weeks later, another patient told me the same thing. It didn't sound like a coincidence, but I am fortunate enough to have research team around me all the time. Even today in private practice, we, I do a lot of research and, uh, I activated my research team and we went back and reviewed 314 patients who had forehead lift. 39 of them had migraine headaches, and 31 of them had either complete elimination or, uh, significant improvement. And that was the beginning. So I, one of the things that I lecture about is listening to the patients, not dismissing even the most unusual things. And this was the beginning. And we have done many studies, or we have, I've published over 44 articles about migraine headaches is, and we have done research after research and, uh, we have proven that unquestionably works. Not only I have proven multiple centers have, uh, proven the same thing over and over.

Eva Sheie (09:33):
Was this something that was in the, the standard forehead lift or brow lift technique and that you just noticed the pattern or were you doing something in your forehead lift that was different from what most people were doing?

Dr. Guyuron (09:44):
No, it was actually standard forehead lift that I didn't know. Actually, it is ironic actually soon after I published the first article, a lot of doctors stopped me and said, you know what? My patient told me the same thing. I didn't, didn't make anything out of it. So it became, uh, a repeated again re statements that I could hear, but I put at the, at the same time, uh, soon after I discovered this, uh, we heard that Botox, actually I was participating in the studies. Botox works for migraine headaches, and I put the two and two together. I knew what is the common ground, some are between the two of the events, my meaning Botox injection and surgery, which was elimination of the muscles, uh, at the time. But it was, um, that was more simplistic way of, uh, thinking about it. And since then I have discovered a lot of other things that goes with it that increases the success rate besides removing the, I mean, today we remove those muscles to help the patients with migraine headaches, but also vessels are factors and constriction bands and other things that are irritating nerves are factors. We have also done the studies to see what's really causes migraine headaches were, which is fascinating going back to origin of, uh, surgical treatment of migraine headaches and Oh, why, why some people have migraines, some, some people don't.

Eva Sheie (11:15):
Do we know why?

Dr. Guyuron (11:16):
Yes. Uh, actually, uh, the, the variety of reasons. Some patients, most patients have migraine headaches. We got genetic, we have proven that genetically they are missing what is called myelin. Myelin is a membrane or on the nerve that acts like an insulation protects the nerve, if that is damaged as a result of genetics, disposition or, uh, injury surgery can result in migraine headaches. And what we are doing and elements that, for example, vessels, muscles that usually are around the nerve do not irritate the nerve when the myelin is missing, that contraction of the muscle, pulsation of the vessel irritates the nerves. So what we do is just remove those vessels and muscles, uh, elements that are again, irritating the nerves to eliminate the headaches.

Eva Sheie (12:14):
Do people notice instantly after they have the surgery that they feel better?

Dr. Guyuron (12:19):
Most do. In fact, the night of surgery, they may have migraine because I, I've been around the nerves and h take the nerve, but they usually today after the surgery, the headaches go away, improve significantly. There are some places like if the headaches are arising from behind the eyes and we do septum surgery, terminate surgery, that may take a little bit longer for some of the patients, uh, to realize the improvement or elimination of the headaches. But, uh, in most incidences, the headaches go away in a day or two.

Eva Sheie (12:55):
It's maybe kind of a random question, and we can certainly cut it if it's terrible, but do you feel like people who have migraines generally start to figure out that this is what's causing it, or does the general public still think it's a mystery? Like do they go straight to medication? Do they, are they starting to realize that this is an option? I guess that's where I'm going.

Dr. Guyuron (13:17):
Yeah. Um, what is, yeah, uh, that's a good question. Unfortunately, the neurologists in the beginning and for, for a long time, even today, some neurologists, uh, believe that surgery is just a placebo effect, and we are proving that that's not the case. In fact, there is a very repeatable, uh, bio neurobiologist from Harvard that is proving today what I have said 23 years ago, that migraine headaches start from irritation of nerves in the periphery, meaning end branches and extends as a cascade of events that begin in the end branches of the nerves and can extend to the brain and cause nausea or vomiting all the symptoms that patients experienced. So they're coming around there. That was the biggest block because when patients go to their neurologist saying, I'm considering surgery, you know, the answer was, no, it is, it is a placebo if it cannot be, because not that they were, they were lying. It was ingrained in their minds where scientifically they believe that this is, starts from the brain and you can't manipulate the brain from the wipe operating on the surface. While they didn't realize at the time again that this constellation of symptoms are the consequence of what happens in the periphery,

Eva Sheie (14:49):
Is that frustrating to you that they didn't believe you?

Dr. Guyuron (14:53):
<laugh>? You know what, in, in medicine we can't get frustrated, but I have loved the things to be different. Uh, for the patient's sake, the answer is yes, but I never gave up. One of one of my fortunate abuses is, uh, I'm tenacious. I don't, I don't give up so easily. So I wasn't dissuaded by a neurologist, uh, even disparaging remarks, and I continue doing what I did and I trained the people and my most, fortunately, most patients, had a good response and believed in what we do. And today, again, this is the type of surgery that is done in most cities, most countries internationally.

Eva Sheie (15:39):
You mentioned earlier that research is a huge component of what you're doing. Tell us what the most impactful research that you've done in the past has been, but I'd also love to hear kind of what you're working on next. Where, where are you going in the future?

Dr. Guyuron (15:55):
The migraine, uh, discovery migraine research unquestionably, uh, is, uh, the, the most important research that I have done, and particularly this study that, uh, we did to prove that actually the origin of the headaches are related to the mild, uh, deficiency by comparing the nerves of the patients who have migraine headaches to those who do not have, uh, ed headaches sort of created a foundation for all of what I do. But, uh, getting back to second part, part of the equation, and when we think that everything is perfect, that means that we are not really analyzing enough. So I am continuously doing the study to see how else we can improve the migraine surgery, no surgery and other things. One of the things that I, I'm working on, and we have been doing it and we have been, as I've been working, is simplifying some of the migraine procedures that making them less invasive.

(16:57)
I can tell you that over half of my patients that I operate with a prestigious, done through a tiny incision under local anesthesia patients actually can go back to work the same day or the next day. I can't tell you that every procedure is like that, but I'm trying to find simpler way of helping these patients. So my future hope is that we'll be able to do some of these procedures is actually percutaneous without even making the incision. We are working on variety of ways to do that. So, uh, there are actually no, essentially no cuts to do the surgery, and those are my future goals.

Eva Sheie (17:39):
If a patient's listening to this and they want to participate in this research effort, is there a way to do that? Is there a, a channel to volunteer?

Dr. Guyuron (17:48):
The research that we do actually doesn't need, it is not sort of a research that it is all experimental. Uh, it, it is continuation of the technique with some minor refinements that, uh, we implement. So the patients can actually call my office for surgery, but this is an integral part of what we do, just, just the refinement of what we do. It is not beginning something that it has not been done previously and it is going to require major IRB approval or

Eva Sheie (18:24):
You're not volunteering for studies.

Dr. Guyuron (18:26):
<laugh>. Yeah, right, exactly.

Eva Sheie (18:28):
I would think a lot of people would wonder if they can do that if they're having this problem. I was wondering, so that's why I asked, this is so fascinating. What would you like patients to know about you?

Dr. Guyuron (18:42):
Uh, that I'm passionate about. What I do have a compassion for the patients. I care for them. And, um, my mission in life has been to, uh, help the patients to improve their quality of life when it is through migraine surgery, nose surgery, facelift, and that many patients actually think that I'm a little bit too serious when I encounter them, but it is not really that it is. Um, most of the time I'm focused and when you are focused, you look like you are too serious. It is not really that I, I do joke around with the patients when the writer, uh, the occasion is right and, um, uh, I enjoy communicating with the patients about, uh, non-medical issues, uh, and, uh, topics. But again, um, then the surface, uh, I may seem rigid, but I really am not. I, I enjoy life and, uh, I take care of the patients the way I, I take care of my family.

Eva Sheie (19:57):
Well said. What things do you like to do outside the office for fun? Like how do you unwind?

Dr. Guyuron (20:04):
I play tennis. I play golf, I do yoga, and I travel a great deal, mostly for speaking engagements, but, uh, almost invariably a portion of that is going to be playing golf of, uh, site visits, things like that. I always, and people invite me know how much I enjoy playing golf, so that almost invariably is a part of it.

Eva Sheie (20:33):
Tell me something good about Ohio.

Dr. Guyuron (20:36):
Oh, the culture in Ohio is, um, unbelievable. It's a, is a wonderful place to raise a family, and that really is one of the main reasons that I, I'm, I'm in Ohio. Yeah, the weather may not be ideal, but, uh, people are sincere about their relationships, their, um, there's no duplicity, there's no, um, statements are really candid and, uh, relationships are strong, particularly family relation. I'm fortunate enough, uh, to have three sons and all three of them are married and we have seven grandchildren and all in Cleveland, as you can imagine, you have to win a lottery for that to happen. 

Eva Sheie (21:27):
Yes, you do. 

Dr. Guyuron (21:29):
So, we have won lottery and our family or entire family, uh, immediate family is in Cleveland.

Eva Sheie (21:36):
If someone's listening today and they want to find out more about you, where should they go?

Dr. Guyuron (21:42):
They can go to my website, dr bahman guyuron.com. It is one word, and or call my office. Uh, and then the phone number is (440) 461-7999.

Eva Sheie (22:00):
Thank you so much for sharing your stories with us today.

Dr. Guyuron (22:04):
Thank you.

Eva Sheie (22:11):
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 Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, t h e a x i s.io.