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
Bulletin Board for
Patient's Questions and Answers
Hand 
