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Messages - DrBermant

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1
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Hello Dr. Bermant,

I'm searching for a gynecomastia surgeon in the Richmond area.  I'm willing to also make a drive to see someone experienced that you may recommend.  I had come across your website and felt very comfortable about contacting your office based on your experience and before/after pictures...before I saw the retirement notice.  Happy retirement!

So, I have gynecomastia only on the right side of my chest.  I had originally had surgery back in 2001 in Virginia Beach at - - - (whose practice seems to have disbanded).  It has since grown back.  It actually had grown back within 5 years after surgery (and hasn't changed much since).  I originally had the surgery at age 18 (I am now 30).  For me, it's more a discomfort issue (as it can be painful and very sensitive).  I however can appreciate a doctor who also cares about esthetics.

Do you have any surgeons you could refer me to?

Thank you for your time.

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

When I was in still in practice I cautioned my patients that surgery does not prevent regrowth. This was part of my Red Flag System and is detailed here:

Gynecomastia Revision Forum - Should Surgery Prevent Recurrence? Growing Again.

There is quite a bit of information on that post with many links to validate my position and passion why I did not offer surgery to those with tenderness or other signs of unstable gynecomastia. When I thought that the discomfort was part of a hormonal imbalance, I had my patients evaluated by an experienced Endocrinologist, stabilized and then surgery could be offered. You are welcome to join the forum, use our resources here on learning how to evaluate surgeons, their works. Consider posting your own standard pictures and if you have them, the before surgery, the after surgery, and the regrowth to add to the collection of cases I have posted on the site and forums for public education on this issue.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Revision Gynecomastia and Chest Surgery

2
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Contact through Forum Mail


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

Welcome to our forum and discussion group.

There is quite a bit more to Picking a Plastic Surgeon than someone saying their hospital is famous, professional and successful. While public endorsements have merit, how does one verify who you are, your ability to give advice or refer? Seeing actual surgery for specific problems is a much more powerful meaning to a surgeon's skill.

Sorry to be blunt but there are so many forum spamming services with fake attestations, we like to learn more.

Tell us more about yourself and how this surgeon fits the many factors discussed in the many resources we have here about finding doctors who have a passion for their work. Even better, have the doctor post their experiences and answer questions here to let the public understand the doctor's specializations and passions. Our forum however is in English.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Plastic Surgery

3
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Dr. Bermant I have a couple questions:
 
1.       I have a deviated septum and was told by my local ENT that one option would be to have have a septoplasty. One curious thing He said to me thou was to AVOID using medications like Flonase to improve nasal congestion and made the claim that it can Actually make things worse. To me this didn’t make much sense? What are your thoughts? I’m not completely blocked so he Said the procedure would be optional, the only downside to not doing it would be sinus infections and PND. Which leads Me to #2
 
2.       Here’s the second, and hopefully more interesting question. Last year I was diagnosed with Laryngopharangyeal Reflux. I was recently Reviewing the literature on LPR and came across THIS which I thought was MOST interesting http://www.medscape.com/viewarticle/778052
 
This was the part that jumped out at me “If the patient needs to see an allergist, refer the patient to an allergist. If the patient doesn't have adequate postnasal drip control, that needs to be addressed.”
 
There is also mention of primary postnasal drip mentioned here as well:

http://www.ccjm.org/content/77/5/327.full
 
“In patients who show no improvement, other causes of symptoms should be explored. Diseases that can mimic LPR include postnasal drip, allergies, sinus inflammation, and various pulmonary diseases.”
 
 
Any thoughts you have would be appreciated!

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

Minor mechanical airway obstruction can become major with surgery narrowing the nose or making a big nose smaller. Fixing such issues became part of the required surgical planning if a patient wanted to have their nose shape changed.

For my patients considering Rhinoplasty and Nasal Obstruction, I managed the cosmetic and mechanical obstruction issues and deferred medical management issues to doctors who specialized in such treatments. Each of my Rhinoplasty patients had extensive history forms to complete and I carefully examined each patient including endoscopic evaluation. Those with active irritated or boggy nasal linings were not accepted for my surgery nor treatment due to potential healing and comfort issues.

Sorry, I will defer both questions to others who specialized managing those conditions.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Rhinoplasty, Septoplasty, and Sculpture

4
This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Pocket Body (iPad and iPhone)

is an Anatomy application. A human body drawing featuring 9 layers that you can scroll through and view. There is 360 degree rotation along the vertical axis only. You can zoom in and out for a detailed look. The full body view zooms out to about 2/3 of the body.

A layer slider builds or subtracts layers. Your only option had been to scroll through the layers as the slider moves. New versions now include just having one layer turned on: Circulatory System or Lymphatic. The end two layers from the slider are skin and bone. Other than that, the reveal or hide are limited to the linear progression set by the slider.

Other views include a Cranial View or Plantar view which have limited application as your view is stuck at the top or bottom of the body. You cannot scroll up or down the body to see this view from inside.

Once you get beyond the skin, pins describe anatomic features. Each pin can contain
Anatomy
Function
Supply
Clinical
Notes where the user can write notes.

The clinical component is the weakest of the applications features.

All content is on the application, limiting its power not using linking to offer a better user experience. While there is an advantage of not needing the Internet to supply the content, the user is severely limited to what connectivity could offer in both video, animation, and clinical details beyond the applications very limited offerings.

Looking at the abdomen:

then compare to this clinical application of my Anatomy of a Tummy Tuck. A clinical link option to that page would open up the issues of what happens to the structures when loose after pregnancy or weight loss and how surgery can repair the structures.

A pin menu permits selecting what layers pins show and permit the user to add a new pin. There is a quiz (also limited), and search for pin / glossary, and share options on both versions. Sharing can be of screen shots or pins / notes created.

The interface is different iphone vs ipad. The Ipad offers a drawing layer of value when teaching or discussing issues with others. A position option and rotation tools are highlighted on full body view, lymphatic, and circulation. The position tool would be nice to have on the plantar or cranial view to look at this view inside the body. The ipad help option labels each icon, nice when starting out.

The price is $19.99. Compare this to more conventional anatomy textbooks:

Search Amazon for Anatomy Textbooks

What this app offers is picking your own view perspective and seeing the 3d aspect. What is lacks is the additional details offered by the anatomy textbook. There is just not enough detail in this app for surgical or detailed clinical use such as understanding flaps or surgical options. But as a pull out of the pocket discussion tool for patient education, it can have some possible use. For an introduction to anatomy, this does nicely. But do not expect the details to see details needed for surgery.

If a larger version would have clinical anatomy such as for our various cutaneous or musculocutaneous flap anatomy, and we could see the 3d relationships with more sophisticated navigation, that would have been so much easier to learn from for a surgeon, but too much detail for the average person trying to understand basic anatomy.

I have enjoyed browsing through the applications on both the iphone and ipad and look  forward to their continued evolution of the app.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Plastic Surgery

5
This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

I was in the process of reviewing new versions of Pocket Anatomy when I was not finding powerful option of clinical education with links to selected resources.

I was reading a clinical note on the orbicularis oris mentioned rare missing portion of muscle causing asymmetry on crying or smile.  It misses much more common congenital defect of Cleft Lip the animation abnormality is just amazing and the repair critical for restoration of speech. Macrostomia is cleft lip at the oral commisures and looks like the Jack Nickolson Joker make up. In real life the animation of which is a major issue for repair. Sorry, I have not published those images / videos. Cinically much more critical is acquired defect such as stroke or trauma to nerve supply resulting in drooping lip or poor animation as in injured nerve from trauma or surgery such as face lift.

Pocket Anatomy

Is a neat tool that is so interesting but misses so much physician surgical detail to make it tempting but frustrating to see clinical anatomy issues. As an introduction it permits inspection of a 3D relationship to a degree. Too many restrictions to peal away or leave behind for some inspections. But at the price, a fraction of what my many Anatomy Atlases were. They announced a:



But I fear they are stepping into a can of worms about what is male or female. I would like them to consider not falling into the trap fog the male breast. All male mammals have some gland component. It is small but exists in every male.

Gynecomastia Anatomy  the male breast for clinical.

here is what gland looks like Gynecomastia Gland Gallery. I would suggest starting at the Body Builders section. The first series of photos shows the gland component and the fat fibrous tissue of the sagging male breast after major weight loss. I think such photos add reality to anatomy discussions and dispel misconceptions artists have distorted reality. That is why links to my drawings have value to such a tool.

And here is Normal Female Breast Anatomy

In the body, breast gland (male and female) is white. The red color may be correct for a surgeon who has a bloody field. My drawings were the first I could find using the real color of white for the gland and connective tissue. That is why I drew them that way.

There are pages on Normal Nipple Anatomy and Inverted Nipple Anatomyfor both male and female and other clinical pages Pocket Anatomy Readers could benefit from.

You are also missing the elements of the ear:
Ear Anatomy that could be linked to on your body part.

There are quite a few clinical situations that could be used on other parts of the atlas if interested.

Am still reviewing last release but posting this as requested.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Plastic Surgery

6
Liposuction / Re: fort lauderdale lipo
« on: April 30, 2013, 08:34:40 AM »
Hello guys,
I  23 years old and i am overweight ..I am interest in liposuction .Can anyone here recommend me its price.Please help me.Thanks.

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

Cost of Liposuction varies depending on what needs to be done, skill of surgeon, and around the world. However, Liposuction is not an alternative to weight loss. When overweight, there is typically a global fat problem that liposuction does not manage. Here is a post I discuss that topic:

Liposuction Forum - Is It Safe? Want Advice

Liposuction Is Not For Weight Loss. Read my Liposuction Important Information
Quote
Liposuction is a refinement technique and not an alternative to losing weight.
. Be careful when someone claims it is. Look for good documentation. Even with dangerous Large Volume Liposuction, very little total weight is removed. Here is another page I wrote on that topic: Tumescent liposuction is not a good way to lose weight..

If someone is to document such issues, they would need good Standardized Pictures for Liposuction. This method of documentation can also be used to document weight loss and body shaping by other methods. Also check for Body Fat Analysis and Scales for careful documentation of weight, when it was lost or changed.

If you are going to show any advantage to a method, why not post pictures. Use our standard images and chart your weight and body fat measurements. Record your methods. Let others better understand what you are accomplishing. 



I have seen patients with very strange body shapes from other doctors' attempts at liposuction when there was a global fat contour component that looked like this ancient statue. 

Liposuction Forum - Liposuction Not Alternative for Global Fat Issues

and yet another discussion: Liposuction Forum - Do You Have to be a Certain Weight to Have Liposuction?

points to other similar discussions on this topic. When I was in practice, I advised my patients that surgery was rarely a good starting point for global fat issues.

Consider learning about Weight Loss Forum - Discussion Wi-Fi Scales and Body Fat Analyzers that monitor weight, fat, BMI calculation and helped my patients with motivation. I compare the different devices here: Body Fat Analyzer Scale Review.




Fitbit FB201W Aria Wi-fi Smart Scale 



Withings Wifi Body Scale

Beyond the numbers, tracking the body contours, loose skin shrinking, and other visual factors is a discussion found here:

Standard Weight Loss Pictures, Losing Weight Photos, and Training Photographs Programs Critical Concepts and Evolving Ideas

Why not consider posting your weight, body fat percentage and standard photos and share your concerns about your contour that you are seeking liposuction to address?

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Liposuction Body Contouring

7
Welcome to aBodyBeautiful / Re: Hello
« on: April 30, 2013, 07:38:43 AM »
Hello guys,
 i am newbie here...just want to say hello to all members here...Hope u all enjoy ur stay her.Thanks

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

Welcome to our discussion group. Hope we can help answer your questions.

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Plastic Surgery

8
Welcome to aBodyBeautiful / Re: Hello I am new here....!!
« on: April 30, 2013, 07:37:13 AM »
Hello
 i am also newbie welcome to this communtiy

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

Welcome to our discussion group.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Plastic Surgery

9
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This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

As a Plastic Surgeon who saw unhappy patients from around the world, I have been helping with complications of other surgeons' operations for many years. I have put many examples online.  I have posted examples of various problems on my Encyclopedia that can be found on the various Revision Surgery sections such as Revision Gynecomastia Surgery or Revision Tummy Tuck Surgery.

Patients with disasters like Large Areola Complication from Bad Gynecomastia Surgery, Big Belly Button Complication Revision Tummy Tuck are some of the many examples where I have dedicated myself to public education to minimize such future problems. Some complications I came up with my own names like the Crater Deformity where a hole is left instead of the Gynecomastia contour. Television offers ability to show how tissues move. I have been capturing videos as part of my analysis now for years. There are many examples online, but I need to go back to the HD original digital captures to bring that part of the site up to date.

Over the years I have been approached by Television programs asking for direct access to these patients. Retired, I no longer offer direct patient access for interviews that could reopen healed emotional scars.

You have posted an advertisement without asking permission. I prefer to better understand what is being done before permitting your post to remain. There is a great deal of emotion involved with a patient who had trusted a surgeon only to find a nightmare needing further surgery. Please show us direct video links so I can better understand how your show manages such sensitive issues as well as the problem documentation, analysis of what was wrong, and then surgical solution.

This forum is dedicated to finding solutions, public education, complication prevention, and sharing stories. I am concerned about sensationalizing suffering for commercial programing.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Blepharoplasty Eyelid Surgery

10
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Hello,
 
I am wondering if you know of someone in the Boston area or in Southern California who could help with a poor outcome from otoplasty done 16 years ago.  One side was severely overcorrected, leaving me with a pointy ear.  The surgeon did a revision, achieving a normally rounded shape, however the helical rim is odd looking -- it does not fold over in some areas.
 
I am hoping some type of implantable material could be used to give the helical rim a normal shape, or a cartilage graft.
 
Thank you for any recommendations.
 
Regards,

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

There are many possible complications with Plastic Surgery of the Ear. Outcome depends on the original problem, what was done, skill of the surgeon, after surgery are, patient healing, and many other factors. Complications can be of multiple types. They can actually look like some congenital problems such as the Pointed Ear or Constricted Ear. Different elements can be part of the over correction as in this Repeat Otoplasty for Over Folded Antihelix.

Revision Otoplasty is an art form. Seeing just how a surgeon manages different deformities and typical results can help demonstrate sculpture skills. That is why I added that element as a significant aspect of How to Pick Your Otoplasty Surgeon and How to Evaluate Otoplasty Before After Photographs. . Seeing examples of how the surgeon manages revision problems may be more relevant than just how they manage different issues.

You are welcome to use our resources to learn and or post your images here on the forum to better define your concerns and deformity. I developed my Standard Otoplasty Pictures to define ears contour problems and results. There are surgeons with a passion for problem solving. Posting pictures puts a contour to the words.

There are also limitations as to what surgery can realistically offer. If you decide to join the forum and post your questions, then I will extend my answer about the use of implants cartilage and other such options generically. This is a field of great future potential in the process of evolving.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Otoplasty Ear Surgery



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@DrBermant I hve a problm in posting on ur forum.. i hve brought 2 bras n i wearing it frm 2 weeks.

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

If your problem is leaning how to use the forum, here is the help section:

http://www.abodybeautiful.com/forum/index.php?action=help

If you just do not want to use the forum, sorry, that is where I share my knowledge and experience. Tweets are too limited.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Plastic Surgery

12
Tummy Tuck Abdominoplasty / Re: Liposuction mistakes
« on: April 22, 2013, 11:17:38 AM »
Does anybody know any reliable Texas Plastic Surgeon that does liposuction and fixes liposuction mistakes of other plastic surgeon?

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

Welcome to our forum. What sorts of mistakes? What was the original problem and what happened that you feel comfortable sharing?

Liposuction was always a component of my Tummy Tuck surgery, a surgical sculpting refinement tool. The resources on How to Pick Your Tummy Tuck Surgeon would both apply for liposuction alone. A key element is seeing just what that surgeon sculpture is like. How to Evaluate a Surgeon's Before After Tummy Tuck Pictures and in particular how the tissues move are factors that can demonstrate specific skills. Finding examples similar to the current problem can be quite helpful. Liposuction was also an element of all of my Gynecomastia Dynamic Technique. There are similar resources for Gynecomastia on evaluating photos, videos, and how to pick surgeons.

Retired, I am no longer an option but here are some examples I posted of my work Tummy Tuck Revision Surgery including complications of other surgeons' liposuction. I had many requests for help from unhappy individuals after liposuction gynecomastia surgery, I started dividing them by where they came from. Correcting Complaints After Gynecomastia Texas - Unhappy After Liposuction Alone You can see some of the other questions posted on the group of pages. Gynecomastia Revision Surgery has several examples of my documenting the problem, and then the results of my surgery.

There are also examples showing specific issues as to why seeing videos and how tissues move can be important in assessing a surgeons skills such as:
Flexing Failure Crater Deformity After Revision by New York Surgeon - Original Gynecomastia Surgery Done in New Jersey. The defect after the revision surgery attempt, no longer had resources left to rebuild. For that last link, the patient came to me initially with resources that I thought I would be able to rebuild. However, he needed the gynecomastia stabilized first. He returned after having a revision elsewhere, no longer with the resources then removed. Options then depend on the the original problem, what was done, and the current problem.

Posting standard pictures and video can demonstrate the extent of the problem. I have several different standard picture versions depending on part of the body involved. However, seeing how tissues move is something that really is important if looking critically at problems or results. Here is the basic How to Use Before and After Pictures

The point of talking about my examples and methods is that patients traveled from around the world for my skills. One option is to extend a search beyond doctors close to home. That is what I set up for my patients with methods to minimize travel costs as part of our Preliminary Remote Discussion. However, it is always nice to have local surgeons who are options.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Liposuction Body Contouring

13
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hi. . @DrBermant i'm from indonesia, i have big problem with my nipple, can u help me ?

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon. I no longer offer surgery nor specific medical advice. However, I try to answer questions and share my experiences and knowledge here on our forum. Tweets too short for adequate discussion. Join to post questions or experiences.

Are you referring to Puffy Nipple Gynecomastia?

I have build extended resources that many have told me explained issues about male breast enlargement and how to find doctors skilled with this problem.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Gynecomastia and Male Breast Reduction

14
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@DrBermant in consult, i would want to know & see skills of the surgeon; as a patient i want documentation of my tummy tuck surgery...

@DrBermant - i understand the concern for patient privacy, but i would still be concerned if dr wouldnt document work through pics

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

Thank you for your reply. Why not join us to expand your concerns. Tweets, are so limited in scope, yet can be used to spread the core issues directing to the discussion about Before After Photographs.

Privacy issues were easy for still photos. Obscuring the head on the videos was more or a challenge. We messed out the powerful tool of facial expressions. I remember the fantastic and powerful smiles and facial emotions that privacy issues did not permit me to share. T here was also a great performance of a belly dancer after her surgery. She sent me the video, but i could not share it. What a superb demonstration of recovery. The power of the surgical sculpture enabling the emotional comfort of a patient's art form of dance, brings back fond memories. While not the performance video, Tummy Tuck Belly Dancer. Start on that page for the sitll images, then see each subsequent page including the videos for comprehensive documentation of problem, result and recovery path to get there.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Plastic Surgery

15
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When I hear a statement like this three things come to mind 1. The limited experience of the person making that statement 2. What is the standard of an acceptable aesthetic outcome for the person making this statement. 3.What level of compensation does the author receive from the company promoting this technology. In my estimation "Mistakes are the usual bridge between inexperience and wisdom.”

from Linkedin Comment

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

Thank you for your comment. Why not post here in this forum with links to details like my post? Links are the power of the Internet and can put the documentation behind what others just say with words. I have seen many cases and posted quite a few cases from other surgeons' misadventures with scars that just did not move well, but the tissue was "tighter."

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
Learn More About Liposuction Body Contouring

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