Bulletin Board for Patient's Questions and Answers
Miscellaneous Topics

Explore what others have to say about plastic and reconstructive surgery with answers by Dr. Michael Bermant, MD.

Michael Bermant, MD
Board Certified by the American Board of Plastic Surgery

Reconstructive Reconstructive Surgery Hand Hand and Nerve Cosmetic Cosmetic aesthetic Congenital Breast Breast Breast Head & Neck plastic surgeon Skin Cancer skin cancer Microsurgery

This is the page where you can review questions and stories from patients, view the opinions of lay persons, and see answers from Dr. Bermant and other physicians. Do you want to ask a question, post an answer, or make a comment? Information E-mailed to me will be considered for posting.

  • Why did you choose to have the surgery?
  • How did you choose your doctor?
  • How much did it cost?
  • Was the final cost the same as what you were told before the surgery?
  • How was the recovery?
  • Were there any complications? How were they resolved?
  • How do you feel about the results?
  • Did it have any effect on your life
    • emotionally
    • socially
    • sexually
    • professionally
  • How did others react to your surgery?
  • Did you learn any lessons?
  • What would you advise others?

Information posted in this section does not necessarily reflect the opinion of Dr. Bermant.

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Miscellaneous topics

Subj: Re: sun protective clothing

I was curious if you have heard of a company called Sun Precautions and whether you think that there product is valid? I find it rather expensive and to me it doesn't seem like any thing other than nylon fabric. I have a friend who was burned in a fire and is very sensitive to the sun, are there any other options you know of besides this pricey clothing? Any info you have would be most appreciated....thanks

This should not be construed as medical advice. I am a Board Certified Plastic Surgeon. My comments do not constitute any endorsement of products.

Any form of sun protection is better than exposure. I try to educate my patients about sun protection. We are seeing an epidemic of skin cancers from sun worshipers and changes to the atmosphere. Fine weave fabrics designed for UV protection are a relatively new item in our arsenal. I like the shirt I bought from Solumbra. Not only does it have such fabric but also was designed to be comfortable in very hot weather. Yes it was expensive but it feels good. How does it compare to other companies with sun protective fabrics, I do not know. When the company sends us copies of their catalogue, we hand the catalogues to our patients as a form of education. Those patients who have purchased such sun protective clothing, have told me they liked their purchases enough to buy others for friends.

There are other companies who claim fine weave sun protection. I have not seen other catalogues. If other company catalogues were available, we would also distribute them. I plan to add links to my web page as I find them on the internet.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737.

Michael Bermant, MD

Subj: Re: earlobe reconstruction

I JUST READ YOUR E-MAIL PAGE REGARDING EAR LOB PLASTIC SURGERY. I UNDERSTAND THIS IS THE LATEST TREND IN PLASTIC SURGERY. I HAVE THICK EAR LOBES AND WOULD LIKE THEM TO BE RESHAPED. IF YOU CAN DO THIS PROCEDURES,

Dr. Bermant responds:

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

Ear lobe reconstruction is most frequently performed for trauma, tumor reconstruction, and to repair the damage from ear rings. The same techniques however can be used to reshape the contour / thickness for cosmetic appearance. This is done under local anesthesia.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. We are there Monday - Friday usually 9:00 - 5:00 with extended hours by arrangement.

Michael Bermant, MD


Subj: Re: Question about square chin

I want my jaw two be more square. So I was wondering how that would be done and the ballpark cost of the surgery. Please reply

Dr. Bermant responds:

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

There are many ways to "make a jaw more square". Adding some material over the bone can add some detail that creates a less rounded contour. Cutting the bone and remodeling it is another option. Costs depend on the technique used. The surgeons fee can vary from $2000 to $10,000. There are additional charges for the operating room and anesthesia (depending on the type of surgery).

An evaluation by a competent surgeon is necessary to find out if such surgery is indicated for you. Realistic expectations are the key to success. The risks may not outweigh the benefits.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737.

Michael Bermant, MD

Subj: Re: cheekbones

What can be done to enhance the jaw line, to create a sunken cheek bone appearance, if anything?

Dr. Bermant responds:

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

Implants of bone or other material can augment the jaw. Sometimes the jaw bones can be moved to reshape them. Most patients asking for such modification have retrusive or underdeveloped jaws. Not all patients are candidates for such surgery. The position and alignment of the teeth become a major factor in such analysis.

Consultation by computer mail/bulletin board is not safe nor appropriate. There is too much information missing. My typical evaluation takes 30-60 minutes face to face. Depending on the problem, the evaluation may take much more time. You really should see a board certified surgeon.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

Subj: Re: gynecomastia

Hello Doctor,

I am a seventeen y.o. boy who refuses to0go swimming, to the beach, wear just a tee shirt, etc.

I am planning to have gynecomastia surgery early in the summer. Since I will be attending college in the fall, I am anxious to end this physical nightmare at this opportune time. My questions are: Can you recommend a good doctor in the Beverly Hills area? Perhaps one who specializes in this type of surgery? Also, my parents and I were considering pectoral implants also during surgery. Is this medically out of the question? Stupid? Possible but dangerous?

I assume that I am an excellent candidate for this procedure and hope you agree. I am nervously excited about getting this procedure rolling!

Thank you!

Dr. Bermant responds:

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

Your concerns are typical for a patient with gynecomastia. Enlarged male breasts severely limit social activities for many. Patients with enlarged breasts rarely ask me to enlarge the breast with pectoral implants. I do not like pectoral implants for cosmetic concerns and only use them in cases of traumatic, congenital, or tumor reconstruction. Insurance companies are making it hard enough to get the appropriate medical care for gynecomastia without clouding the picture with bilateral pectoral implants.

The American Society of Plastic Surgeons can be reached by calling 1-800 635-0635. They will send some preliminary information and a list of board certified surgeons in your region.

I hope this information proves of some use. We try to accommodate our patients who travel for our services. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737.

Michael Bermant, MD


Subj: Re: dog bite
In a message you wrote:

Dear Doctor, my best friend's daughter was bitten by our dog today. The dog is part sooner and part lab. She has nipped before when provoked, but nothing this serious. She is 9 yrs. old and the little girl is 10. She was just playing with her and got in her face, and my dog scratched her face and tore her ear lobe. She was taken to the doctor and then I was notified by animal control and the Sheriff's dept. she is okay though. My question is, could my dog be put to sleep due to this incident? All of her shots are up to date...... in NC

thanks for your help

Dr. Bermant responds:
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

I am sorry, I just do not know the answer to your question. My brochure is designed to minimize this type of accident. I love dogs but taking the patient and family through the plastic surgical repair and reconstruction is never easy.

Michael Bermant, MD


Subj: Re: Saw Your Web Page

Hello Dr. Bermant,

I was doing a general search of plastic surgery procedures and for the first time saw your web page. I'm writing to tell you that I like it. It's creative, informative, and well thought out. And I like your logo (better than the hands/butterflies, flowers, etc. that some use).

I have been a plastic surgery patient twice, first as a kid and later as an adult (I'm 40 now). The kid stuff was for facial repair from a serious auto accident and the adult was for lipsuction. My results have been excellent. I was a motivated liposuction patient largely because I had a good experience while young....I can remember sitting in my surgeon's waiting room and being fascinated by patients who were there for face lifts. The experience was painful and difficult in some ways (due to the facial trauma) but I learned a lot and it made me a more open minded adult.

I had liposuction, twice. I have an outstanding health profile, the best of my life. But as you have probably heard many times, I had diet and exercise resistant fat. The more I exercised the worse it got; in fact, I experienced exercise weight gain. My muscles were toned but the fat just stuck out more. Although I had what one person called a "cute figure", I wanted to improve. I did not hate my shape, was not self conscious, and I was generally proud of my health improvements. But I wanted to be proportionate and concave at the waist. No amount of work was going to get me there.

My surgeon was board certified and he was a five-year general surgeon plus two for plastic surgery. I did not realize at the time that plastic surgeons train the longest, so I was pleased later with this combination of credentials. I cannot criticize any aspect of the surgery, even though I required a little touch up and scar revision (due to tattooing) three months after the initial surgery. I had about ten pounds of fat removed from my upper waist down to my knees, and in the following six months lost ten more pounds on my own. I dropped from 135 to 115 pounds, and have managed to keep it off. For a 5' 4" , 40-year old, that's not bad. People guess that I am much younger.

Sorry this is getting so long. I really admire the sensitivity that shows in your home page. You reassured a patient with an arm problem that his communication was not rambling. Your care and concern for injured children is evident. I did not mind looking at the "graphic" pic of the girl with the facial injury, though thanks for the warning. I looked worse than that once. The greatest thing about plastic surgery is waking up in the morning and seeing just a little bit more progress. It is cumulative, of course. I love that part.

I did want you to know something. Perhaps an experienced surgeon with your insight would understand this. My relationship with the surgeon who did my liposuction was excellent. He said I was an easy patient because I followed all the instructions and got good results. But I did not say what I was feeling to him. There were reasons why. One is that I felt rushed in his office. Another is that he allowed his staff to interrupt him with needs of other patients and their doctors. During my time there I did not want to think about the other patients except than to look through the book of befores and afters.

I learned that there is a physical and psychological dimension to cosmetic improvement that is not necessarily logical or rational. I wanted to discuss this with my doctor but couldn't find the right way. How could I possibly be a shapely 115 pounds and feel any distress? I did! One reason is that very few others knew about my surgery (and of those the most common reaction was "...you're doing what??"). I didn't require reinforcement for my decision but it would have helped.

So, reasonable or unreasonable, I silently looked to the surgeon and staff for small signs of support. Imagine my disappointment when I was put to sleep in the operating room before my surgeon arrived. Waking up with the surgeon gone. No one to tell me what to expect or how things went (my thoughts: how did the surgery go? How long did it take? How much fat was removed?) I stayed overnight at the surgical center and the next morning learned that I was to visit the surgeon's office for a dressing change. What, dripping blood? In public? (again, my thoughts: I wasn't expecting this! What happened to rounds? I'm a cash patient, even my HMO doctor calls to see how I'm doing!)

Dr. Bermant, my reason in writing is that is is possible to have a good surgical result yet struggle long after with the physical and psychological dimensions of surgery. I'm getting there slowly, but since I've chosen to tell only a few it is a mostly solitary. I never expected this and I'm very surprised. There is a book which I happened across in the bookstore the other day which I devoured and which helped me a lot. It is entitled What Your Doctor Can't Tell You About Cosmetic Surgery, by Joyce D. Nash. She was a face lift patient and describes pretty well the conflicting feelings I have experienced.

Something tells me you will understand what I'm writing and be sensitive to the possibility in your patients. This is an opportunity I did not have....what a loss. Maybe it's something you could research and present in a professional forum? You have quite an impressive list of research topics. Not everyone could do this.

Thank you for your fine home page and the positive impression that it creates. I'm glad you want to receive E-mail and are open to patients' perspective.

L

Dr. Bermant responds:

Thank you for insights. We strive in our office to cater to the entire patient, trying to address the emotional, educational, as well as plastic surgical needs.

Michael Bermant, MD


Subj: Re: RE: Saw Your Web Page

Good! How exactly do you address the needs of the whole patient? What should I look for as evidence of this should I decide to have another procedure? It seems that all doctors say this, but not all practice it. For example, my surgeon advertised a "whole person" approach emphasizing nutrition and exercise along with surgery, but not one word was mentioned about diet or exercise in my consultations. I asked for height/weight guidelines and they were not available. Yet I was there for surgery, and I got surgery.....

I am interested in your perspective on what you do or say that suggests a whole person approach. Do you ask a patient how they are feeling? Do you put down your chart and pay close attention if the patient seems to need extra time? Do you ask for feedback in the form of evaluations on how the patient viewed their experience? Of what could be done differently? Please let me know. Just a few indicators from your perspective are fine.

Again, L

Dr. Bermant responds:

No I am not a primary care physician but a plastic surgeon. I advise my patients to work with their regular internist on general medical issues. I just talk about the areas affecting my particular operation - not whole body nutrition etc.

We spend extra time with our patients who need the time, listen and try to help as much as possible. It seems to satisfy my patients, I do not know what you are looking for. From the patients who have switched from other plastic surgeons, they tell me I spend more time with them than their prior doctors. But is this enough for you? We have had many letters from patients thanking for what we do and how we do it. Some of my followup forms have feedback issues, but no there is no form only for feedback.

Michael Bermant, MD


Subj: Re: Communicating with a plastic surgeon

I am about to undergo abdominoplasty because of severe diastasis recti and liposuction of the upper thighs. I am a medical transcriptionist and have known the plastic surgeon who will be performing the surgery for approximately 4 years. The plastic surgeon is very good, the only negative remarks I have ever heard is that he is sometimes "too conservative". I believe that I have explained my expectations to him, but still, I am afraid that he may be a little too conservative and I do not want to have to undergo a second procedure later because of this. Would you have any suggestions on communicating with him in regards to his "conservative" nature and how I should approach this with him to be sure that he "really does understand my expectations". In other words, how do I ask him not to be "too conservative" with these procedures without hurting his feelings. We do have a good working relationship and I also consider him a friend and somewhat of a father type figure and I would never consider going to anyone else for these procedures. Do you have any advice for me. Please e-mail me ASAP. Thanks

Dr. Bermant responds:
This should not be construed as medical advice. I am a Board Certified Plastic Surgeon.

Conservatism is not bad. This can make us safer surgeons with less complications. Perhaps such conservatism is your doctor's way of protecting the patients. Over conservatism can mean a higher revision rate.

Just saying what you said to me in this letter would work for me. However there are many types of egos in medicine. You know your doctor best. Perhaps there is no way to pass such information to your doctor without causing difficulty.

Good luck,

Michael Bermant, MD


Subj: Re: Bell's palsy

Thank you--

I feel like my Drs are kind of stumped, they want to DO something, and I'm not convinced that this is not just a reaction to the taxol I was on. I just don't want to get drawn into a medical whirlpool of tests and trying to fix something when it will be fixed best by time. Not that I am comfortable with this condition--it is damned annoying, but I guess it is fairly mild--most people would never notice it, except that my smile is crooked. My Drs (family practioner & oncologist) are both great, I don't have a problem communicating, but you know, after an appointment, I find myself thinking of all the things I still want to know. I will see onc. on Thurs, so I have been trying to gather up ?'s and thoughts.

But today I am ok. J

Just take a piece of paper and a pen, keep them in your pocket book. Each time you think of a question (preferably not while driving etc) write them down. Take these notes to your doctor to help with your memory.

Michael Bermant, MD

Subj: Re: eyebrow hair2

Dear Doctor Bermant:

Thank you for your response to my E-mail. I asked the question about the feasability of scar tissue being able to support transplanted hair grow because I may want to have some work done. My specific problem is that I was hit in the face as a young boy will a baseball. This left me with an eyebrow which lacks several hair follicles. I was wondering if this type of injury is repairable with hair transplant surgery even though some scar tissue is evident in this area. If it is possible would you recommend that I visit with you or don't you do this type of work. also if you are skilled in this area of surgery could you give me an idea of what the fee would be for you to restore hair to the eyebrow area.

Thank You Very Much;

DC

Dr. Bermant responds:

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

Eyebrow reconstruction advice needs an evaluation and examination. There are several methods that may offer improvement. We sometimes excise the non-hair bearing section, other times we insert a section of scalp hair. This section of new hair may be by graft or by flap as mentioned in the prior response. Scalp hair still grows like scalp hair. Using such a donor site means that the patient in inconvenienced with constantly trimming these hairs. You will need a consultation for a better answer.

I hope this information proves of some use. If my office can be of further assistance, please let us know. We can be reached at: (804) 748-7737. My staff and I try to ensure the comfort of our out of town guests during their consultations and procedures.

Michael Bermant, MD

 

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