Author Topic: Revision  (Read 9286 times)

Offline AleMB81

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Revision
« on: August 30, 2011, 01:07:26 PM »
Good morning,

first of all I wanna thank you for the time you spent in giving us precious advices. However, as many, I'm here to ask you an opinion in relation with a revision of an otoplasty made 10 years ago.

I looked at the photo of this guy published on your website ( newbielink:http://www.plasticsurgery4u.com/procedure_folder/ears/protruding_ear_picture.html [nonactive]) and I think it reflects exactly my case.

However I’m not so happy of the result cause I want my ears to be closer to my head. Far from being critic on your work, I don’t like the fact that after several months my ears sticked out again. In my opinion the ears of this guy (as mine) sticked out quite after  5 months and they are not so nice as they were after 3 weeks; moreover are still very visible if you see his face. Probably each person has different standards however I’d like to have ears closer to my head since my ears are too protunding in the upper part (as in this photo). In your opinion, if you had to make a revision on this guy, how would you operate to make the upper part closer to the head since the upper part sticks out more than the lobe?

I hope you won’t read my email as a critic but only as an expression on different point of views and doubts.

Regards



Offline DrBermant

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Re: Revision
« Reply #1 on: September 20, 2011, 03:37:15 PM »
Good morning,

first of all I wanna thank you for the time you spent in giving us precious advices. However, as many, I'm here to ask you an opinion in relation with a revision of an otoplasty made 10 years ago.

I looked at the photo of this guy published on your website (http://www.plasticsurgery4u.com/procedure_folder/ears/protruding_ear_picture.html) and I think it reflects exactly my case.

However I’m not so happy of the result cause I want my ears to be closer to my head. Far from being critic on your work, I don’t like the fact that after several months my ears sticked out again. In my opinion the ears of this guy (as mine) sticked out quite after  5 months and they are not so nice as they were after 3 weeks; moreover are still very visible if you see his face. Probably each person has different standards however I’d like to have ears closer to my head since my ears are too protunding in the upper part (as in this photo). In your opinion, if you had to make a revision on this guy, how would you operate to make the upper part closer to the head since the upper part sticks out more than the lobe?

I hope you won’t read my email as a critic but only as an expression on different point of views and doubts.

Regards

Welcome to our forum. Why not put up Standard Otoplasty Pictures so that others can better understand your concerns.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon, so I am no longer an option for your potential Revision Otoplasty. But picking your surgeon is like picking an artist. If you do not like that artist's work, don't go to him / her. However, there are limitations about just how accurate ear surgery can be. The issue here is the fickle nature of the underlying structure: cartilage. I could put my patients' ear structures just where I wanted them. Beyond that, how the tissue heals is partly due to how variable this tissue reacts to injury. Better surgeons take the time to educate their patients about such issues and limitations of this surgery.

I occasionally had requests to put ears too close to the head, a very unnatural look. That was something I just refused to offer. Just because somebody wanted to look a certain way does not mean I was willing to offer the surgery if I did not agree. I did have quite a few of such patients come back to me after some other surgeon did do the surgery that way. The patients then asked if I could fix the mess I predicted. Usually I could not, the defect was beyond repair.

That is why taking the time to learn about the deformity, surgical options, and skills of the surgeon are so critical before considering surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Otoplasty Ear Surgery
Michael Bermant, MD
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Offline AleMB81

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Re: Revision
« Reply #2 on: April 22, 2012, 07:21:07 AM »
Dear Doctor,

you are more than right when you say that there is someone with ears too close to head who are not happy at all. However i think that everyone should look for a result which fits him or her (of course if it's not something crazy or weird). However if you don't mind I could post my photos on this forum in order to get an advice from you. Please note that I don't have before op.

Moreoever I'd like to give us a suggestion to all the people who are looking for a good MD for a revision otoplasty. As long as I've been searching I noticed that the best plastic surgeon to get a revision from are the ones who operates in the microtia field. Since being able to work on tissues which have already been operated, i suggest to look for a surgeon used to "work" with ears everyday.

That's my personal opinion, I don't know if you share.

Regards

Offline DrBermant

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Re: Revision
« Reply #3 on: April 22, 2012, 11:17:28 AM »
Dear Doctor,

you are more than right when you say that there is someone with ears too close to head who are not happy at all. However i think that everyone should look for a result which fits him or her (of course if it's not something crazy or weird). However if you don't mind I could post my photos on this forum in order to get an advice from you. Please note that I don't have before op.

Moreoever I'd like to give us a suggestion to all the people who are looking for a good MD for a revision otoplasty. As long as I've been searching I noticed that the best plastic surgeon to get a revision from are the ones who operates in the microtia field. Since being able to work on tissues which have already been operated, i suggest to look for a surgeon used to "work" with ears everyday.

That's my personal opinion, I don't know if you share.

Regards

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon and no longer offer specific medical advice. I do share my general experience in answers to questions.

The public is welcome to share photos here on the forum, that is what it has been built for. We have Standard Pictures for Otoplasty Ear Documentation that details views to show the critical nature of ear contours.

We also have guides on How to Pick an Otoplasty Surgeon that go way beyond just looking for a microtia surgeon. Checking a surgeon's skills in a particular subspecialty of ear deformity has value. I personally did not like microtia surgery other than the variants of Cup Ear Deformity, since I felt medical technology has yet to catch up producing a natural enough result to my satisfaction as of when I retired. The difference is that in this variant, there are adequate local tissues present. The problem comes up with the extreme cases needing rib grafting and creating of ear cartilage skin interface. Current state of the art can leave bulky less than natural structures. That is why I have always been interested in tissue engineering at the time science fiction discussed here on this post Reconstructive Ear Otoplasty Forum - Building Ears With 3D Printing Progress.

That is why one needs to check a critical selection of images about a particular problem, surgical sculpture, or surgeon.

Hope this helps,

Michael Bermant, MD
Learn More About Otoplasty Ear Surgery
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Offline AleMB81

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Re: Revision
« Reply #4 on: May 26, 2012, 12:58:29 PM »
Dear Doctor,

thank you so much for the time given to us. I read your pages paying attention to all the infos and I like the way you think and act.

In relation with the microtia surgeons what i said is due to the fact that it's very hard to understand in a few minutes interview how a doctor is able to make his work.

First of all not so many doctors have a book with their photos so it's hard to judge their surgeries. Moreover I saw that they usually show their easiest cases and not how they are able to correct really over protrunding ears or ears that need a revision. I don't know if you share my idea but even on internet you can see this: they always show you the best cases ever.
Another thing I noticed is that is hard to understand what is really "normal": if you see on internet it seems that the ears should be as more attached to the head as possible while, as you can see on your site, some ears should be still visible after a surgery! and when I asked 3 different surgeon for a revision one told me my ears were ok, one told me that my ears were still prominent (but I really did not like how he spoke cause it seemed I must have another surgery) and another one was like "ok your upper part is promient so we can make it better".

I'll post my photo on this forum when i have time but I have to admit that it's very hard to find a good surgeon cause many of them are more used to make breasts and noses than ears

Offline DrBermant

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Re: Revision
« Reply #5 on: May 26, 2012, 01:44:55 PM »
Dear Doctor,

thank you so much for the time given to us. I read your pages paying attention to all the infos and I like the way you think and act.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Thank you for your kind words.

Quote
In relation with the microtia surgeons what i said is due to the fact that it's very hard to understand in a few minutes interview how a doctor is able to make his work.

First of all not so many doctors have a book with their photos so it's hard to judge their surgeries. Moreover I saw that they usually show their easiest cases and not how they are able to correct really over protrunding ears or ears that need a revision. I don't know if you share my idea but even on internet you can see this: they always show you the best cases ever.

I agree. I gave up on the in office "book" of images very early in my career as ineffective and wasteful of my time with my patient. Spending hours with each patient in the office for each consult was not practical. Yet, patients could comfortably spend hours on my site in the comfort of their homes before traveling to see me or have a Preliminary Remote Discussion.

There is so much to learn and understand from a patient's perspective, that i felt each had to spend time on my internet site before coming to my office for elective surgery. If someone came to the office without such learning, they were asked to return after they spent time on the web. I needed my patient already aware of the basic issues as presented on my site, so I could take that individual to a new level beyond the basics. This permitted a patient to participate in their discussion and empowered them in the decision process.

Quote
Another thing I noticed is that is hard to understand what is really "normal": if you see on internet it seems that the ears should be as more attached to the head as possible while, as you can see on your site, some ears should be still visible after a surgery! and when I asked 3 different surgeon for a revision one told me my ears were ok, one told me that my ears were still prominent (but I really did not like how he spoke cause it seemed I must have another surgery) and another one was like "ok your upper part is promient so we can make it better".

Just what defines the Natural Look or Beautiful Ear depends on the eye of the beholder. One shape ear does not fit all faces. I spent years studying ears in art and people watching and decided to demonstrate my own opinion online so that people could understand my values before having surgery done by me. Otherwise it is a guessing game as to what a surgeon might be offering.

Quote
I'll post my photo on this forum when i have time but I have to admit that it's very hard to find a good surgeon cause many of them are more used to make breasts and noses than ears

This is the power of the Internet. A surgeon, like myself, who had a passion for ear surgery, could offer a gallery of sculpture to show why someone might want to come a great distance for my artistry. I have been honored by my Plastic Surgeons for my pioneering work in this public education. As other who have such skills learn to use such tools, other resources should become available. It is a matter of education and a learning process. This forum and my site are tools for the public, a museum of sorts, to bring others to show the possibilities of what can be done.

We look forward to seeing your pictures. Consider using our Standard Pictures for Ears and Otoplasty which evolved as a tool to document and analyze ear contours. Carefully follow the instructions to make the images a good tool to help others understand the issues involved.

Hope this helps,

Michael Bermant, MD
Learn More About Otoplasty Ear Surgery
Michael Bermant, MD
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Offline DrBermant

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Re: Revision
« Reply #6 on: June 05, 2012, 12:14:01 PM »
Quote
Dear DrBermant,

I'm trying to catch some photos of my ears in order to send you the pics as promised. I'd like to know if taking photos by myself can corrupt the final result of the pics (I mean a realistic vision of the problem). As you may understand I don't have anyone else who could help me in taking photos since it's hard to tell anyone about my problems and ask them to help me in taking photos.

Many thanks for your hard work (especially cause you've already left your job for retirement!)

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Sorry since retirement, I no longer review photos sent to me by email or private messages.

I do try to share my general knowledge and experience in places like this forum.

The best way to get the ear images is using the methods outlined on our Standard Otoplasty Picture resource asking someone to help take the images.

Other options include using tripod to hold the camera. I just tried using an iPhone, and the new Apple 4s lens does not distort the ear and makes a nice usable series of images. There are a number of phone adapters for tripods, I was trying this iStabilizer Flex Smartphone Flexible Leg Tripod I found on Amazon:




There are apps that permit use of the computer or other device like iphone, ipad to act as remote controls that see the image of the camera on the tripod. I was experimenting with:



Remote Shutter and that worked fine. There are also remote camera triggers that link the computer with camera such as

DSLR Remote

that work if you have the right camera and a computer.


Timers alone are not enough because of framing issues.

I hope to make a page demonstrating taking such images solo with the new technology now available.

Hope this helps,

Michael Bermant, MD
Learn More About Otoplasty Ear Surgery
« Last Edit: July 02, 2012, 03:02:12 PM by DrBermant »
Michael Bermant, MD
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