FW: HSC Plastic Surgery InfoCentre

[Guest guest]

here is the link again..... you must first go to " microtia services " ...then

to " photo albumn " - you just have to look around!

HSC Plastic Surgery InfoCentre

this link states that reconstruction to the ear " is usually started between

2 or 3 years of age " !!

services>>microtia services>>reconstructive surgery

Reconstructive Surgery

The reconstructive surgery option involves only the plastic surgeon, and the plastics health care team. The first stage in microtia repairs is generally a rib cartilage graft to the ear. This is usually started between 2 to 3 years of age. Second stage repair, a cartilage outset with skin graft from the groin, is completed at least 6 months after the cartilage graft.

First Stage Repair

Second Stage Repair

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Last updated: Thursday, July 26, 2001

Disclaimer Copyright

The Hospital for Sick Children is a

health care, teaching and research centre

dedicated exclusively to children;

affiliated with the University of Toronto

Copyright © 1999 - 2002 The Hospital for Sick Children.

All rights reserved.

[Guest guest]

<< http://www.sickkids.on.ca/plasticsurgery/services/microtia_surgery.asp >>

I took a look at the photos on this web site. Can I ask are those considered

good results on the finished ear? I personally didn't think they looked that

great. Is it just me?

Autumn

[Guest guest]

Hello our son was born with unilateral

microtia. I was looking into this web site and it

was telling about the rib graft surgery.. them doing

at 2-3 years of age? I havent heard of anyone doing

it at that young of age. besides Dr. Reinisch in

calif. but he uses the synthetic material.. Anyway i

was just surprised and was wondering where is this

hospital? Is it in Toronto and where is Toronto?

Thankyou,

--- kellyf@...> wrote:

>

> here is the link again..... you must first go to

> " microtia services " ...then

> to " photo albumn " - you just have to look around!

>

>

> HSC Plastic Surgery InfoCentre

>

>

> this link states that reconstruction to the ear " is

> usually started between

> 2 or 3 years of age " !!

>

http://www.sickkids.on.ca/plasticsurgery/services/microtia_surgery.asp " >

HSC: Plastic Surgery InfoCentre

services>>microtia

services>>reconstructive surgery

Reconstructive

Surgery

The reconstructive

surgery option involves only the plastic

surgeon, and the plastics

health care team. The first stage in

microtia repairs is generally

a rib cartilage graft to the ear. This

is usually started between

2 to 3 years of age. Second stage

repair, a cartilage outset with

skin graft from the groin, is completed

at least 6 months after

the cartilage graft.

First

Stage Repair

Second

Stage Repair

Back

to top

Last

updated: Thursday, July 26, 2001

Disclaimer

& Copyright

The Hospital for Sick Children is a

health care, teaching and research

centre

dedicated exclusively to children;

affiliated with the http://www.toronto.edu/ " >University

of Toronto

Copyright © 1999 - 2002 The Hospital for

Sick Children.

All rights reserved.

__________________________________________________

[Guest guest]

Different surgeons will of course yeild different results. This is why it

is soooooo important for anyone to view before and after results from

surgeons you are considering. Some will yeild results that are far better

(or worse) than these. My personal opinion is that these results are poor,

but this is what's out there and being performed everyday. Now go to Dr.

Brent's site and Dr. Romo's and Dr. Thorne's, and research Dr.

Nagata.....etc. and choose what's best for you or your child.

Love, beth

>From: FACTBERTE@...

>Reply-To: AtresiaMicrotia

>To: AtresiaMicrotia

>Subject: Re: FW: HSC Plastic Surgery InfoCentre

>Date: Sat, 24 Aug 2002 22:16:16 EDT

>

>

>

>

><< http://www.sickkids.on.ca/plasticsurgery/services/microtia_surgery.asp

> >>

>

>I took a look at the photos on this web site. Can I ask are those

>considered

>good results on the finished ear? I personally didn't think they looked

>that

>great. Is it just me?

>Autumn

_________________________________________________________________

Join the world’s largest e-mail service with MSN Hotmail.

http://www.hotmail.com

[Guest guest]

<< thanks for agreeing autumn! i think they look awful - to be honest!!! >>

Okay . I thought it was just me. I'm thinking if that's it I'm fine

with what is there now.

Autumn

[Guest guest]

hi tracy...toronto is in canada! where about do you live?

kelly (s.a.)

HSC Plastic Surgery InfoCentre

>

>

> this link states that reconstruction to the ear " is

> usually started between

> 2 or 3 years of age " !!

>

http://www.sickkids.on.ca/plasticsurgery/services/microtia_surgery.asp

" >

HSC: Plastic Surgery InfoCentre

services>>microtia

services>>reconstructive surgery

Reconstructive

Surgery

The reconstructive

surgery option involves only the plastic

surgeon, and the plastics

health care team. The first stage in

microtia repairs is generally

a rib cartilage graft to the ear. This

is usually started between

2 to 3 years of age. Second stage

repair, a cartilage outset with

skin graft from the groin, is completed

at least 6 months after

the cartilage graft.

First

Stage Repair

Second

Stage Repair

Back

to top

Last

updated: Thursday, July 26, 2001

Disclaimer

& Copyright

The Hospital for Sick Children is a

health care, teaching and research

centre

dedicated exclusively to children;

affiliated with the http://www.toronto.edu/ " >University

of Toronto

Copyright ) 1999 - 2002 The Hospital for

Sick Children.

All rights reserved.

__________________________________________________

[Guest guest]

thanks for agreeing autumn! i think they look awful - to be honest!!!

kelly

Re: FW: HSC Plastic Surgery InfoCentre

<< http://www.sickkids.on.ca/plasticsurgery/services/microtia_surgery.asp >>

I took a look at the photos on this web site. Can I ask are those

considered

good results on the finished ear? I personally didn't think they looked

that

great. Is it just me?

Autumn

[Guest guest]

Well, after spending 20 minutes looking for the pictures, I finally

found them! Anyway, I must agree, I'm not pleased with what I saw

either. To be perfectly honest, I have been telling Dr. Romo since the

day his website debuted that some of HIS pictures didn't look that good

either!. Many of them are quite old and do not truly depict the quality

of Dr. Romo's talents as they appear now. I have always said that Evan

could be on that page because if I was a parent checking out the

pictures and I saw Evan's ear, I would be impressed (he keeps telling me

that'll happen when he updates it! LOL) No ear is going to look

perfect, these doctor's aren't God, but they should at least somewhat

resemble the shape of the ear and be free of excess amounts of visible

scar tissue. The final results also depend on what you have to work

with in the first place. I know some children who have other syndromes

in addition to microtia are not as easy to operate on as a child with no

other syndrome. Again, it is SOOOO very important to view before and

after pictures of the doctor that you are considering!!!

Lynne

FACTBERTE@... wrote:

>

>

>

> <<

> http://www.sickkids.on.ca/plasticsurgery/services/microtia_surgery.asp

> >>

>

> I took a look at the photos on this web site. Can I ask are those

> considered

> good results on the finished ear? I personally didn't think they

> looked that

> great. Is it just me?

> Autumn

>

>

[Guest guest]

I am in Northern Idaho. Thanks for the info.

--- kellyf@...> wrote:

> hi tracy...toronto is in canada! where about do you

> live?

>

> kelly (s.a.)

>

> HSC Plastic Surgery InfoCentre

> >

> >

> > this link states that reconstruction to the ear

> " is

> > usually started between

> > 2 or 3 years of age " !!

> >

>

>

HREF= " http://www.sickkids.on.ca/plasticsurgery/services/microtia_surgery.asp

> " >

>

>

>

> HSC: Plastic Surgery InfoCentre

>

>

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=== message truncated ===

__________________________________________________

[Guest guest]

Hi everyone,

I have read of many people having ear reconstruction by Drs. Brent (rib

cartilage harvessting) and Romo (polyethylene). Two questions: Does anyone

have experience with Dr. Thorne? And does Dr. Brent place the chest tubes

in himself or does he have a pediatric cardiothoracic surgeon involved with

these operations?

OK - I actually have another question: Who does Dr. Nagata work with in TX

and ?MA? I can't recall the other state that he trains people in.

Thanks!

Lili (mom of , bilateral microtia/atresia)

Re: FW: HSC Plastic Surgery InfoCentre

> >Date: Sat, 24 Aug 2002 22:16:16 EDT

> >

> >

> >

> >

> ><< http://www.sickkids.on.ca/plasticsurgery/services/microtia_surgery.asp

> > >>

> >

> >I took a look at the photos on this web site. Can I ask are those

> >considered

> >good results on the finished ear? I personally didn't think they looked

> >that

> >great. Is it just me?

> >Autumn

>

>

>

>

> _________________________________________________________________

> Join the world's largest e-mail service with MSN Hotmail.

> http://www.hotmail.com

>

>

>

>

[Guest guest]

I have read of many people having ear reconstruction by Drs. Brent (rib

cartilage harvessting) and Romo (polyethylene). Two questions: Does anyone

have experience with Dr. Thorne? And does Dr. Brent place the chest tubes

in himself or does he have a pediatric cardiothoracic surgeon involved with

these operations?

hi lili

there are no chest tubes in dr brent's surgery.

he harvests some cartilage, the stuff between the ribs, from which he sculpts the new ear. he uses cartilage because...thats what ears are made of!

he uses the patient's OWN cartilage so there is no problem with rejection.

the scar becomes quite invisible in a couple of years. there are NO after effects of some missing rib cartilage.

jack

[Guest guest]

Hi Lili,

Josh had his ear reconstreucted by Dr. Brent, however, I cannot answer your

question as I have no idea. Not sure if that's good or bad If you call

or e-mail him, I'm sure he will respond.

Love, beth

>

>Reply-To: AtresiaMicrotia

>To: AtresiaMicrotia >

>Subject: Re: FW: HSC Plastic Surgery InfoCentre

>Date: Mon, 26 Aug 2002 04:20:04 -0400

>

>Hi everyone,

>

>I have read of many people having ear reconstruction by Drs. Brent (rib

>cartilage harvessting) and Romo (polyethylene). Two questions: Does

>anyone

>have experience with Dr. Thorne? And does Dr. Brent place the chest tubes

>in himself or does he have a pediatric cardiothoracic surgeon involved with

>these operations?

>OK - I actually have another question: Who does Dr. Nagata work with in TX

>and ?MA? I can't recall the other state that he trains people in.

>

>Thanks!

>

>Lili (mom of , bilateral microtia/atresia)

>

> Re: FW: HSC Plastic Surgery InfoCentre

> > >Date: Sat, 24 Aug 2002 22:16:16 EDT

> > >

> > >

> > >

> > >

> > ><<

>http://www.sickkids.on.ca/plasticsurgery/services/microtia_surgery.asp

> > > >>

> > >

> > >I took a look at the photos on this web site. Can I ask are those

> > >considered

> > >good results on the finished ear? I personally didn't think they

>looked

> > >that

> > >great. Is it just me?

> > >Autumn

> >

> >

> >

> >

> > _________________________________________________________________

> > Join the world's largest e-mail service with MSN Hotmail.

> > http://www.hotmail.com

> >

> >

> >

> >

[Guest guest]

i agree whole-heartedly!!!

Re: FW: HSC Plastic Surgery InfoCentre

<< thanks for agreeing autumn! i think they look awful - to be honest!!! >>

Okay . I thought it was just me. I'm thinking if that's it I'm fine

with what is there now.

Autumn

[Guest guest]

Hi Lili...

Are you talking about the tubes that are used for suction in the ear area.

Dominic did not have any chest tubes in place but did have 2 suction tubes

placed near the ear lobe to prevent any complications like a blood clot.

ez Mother to Dominic 6 unilateral microtia/atresia, stage I

just completed with Dr. Brent 6/2002.

>From: GrossInsCo@...

>Reply-To: AtresiaMicrotia

>To: AtresiaMicrotia

>Subject: Re: FW: HSC Plastic Surgery InfoCentre

>Date: Mon, 26 Aug 2002 11:55:31 EDT

>

>In a message dated 08/26/2002 4:17:20 AM Eastern Daylight Time,

>lili_linz@... writes:

>

>

> > I have read of many people having ear reconstruction by Drs. Brent (rib

> > cartilage harvessting) and Romo (polyethylene). Two questions: Does

> > anyone

> > have experience with Dr. Thorne? And does Dr. Brent place the chest

>tubes

> > in himself or does he have a pediatric cardiothoracic surgeon involved

>with

> > these operations?

> >

>

>hi lili

>there are no chest tubes in dr brent's surgery.

>he harvests some cartilage, the stuff between the ribs, from which he

>sculpts

>the new ear. he uses cartilage because...thats what ears are made of!

>he uses the patient's OWN cartilage so there is no problem with rejection.

>the scar becomes quite invisible in a couple of years. there are NO after

>effects of some missing rib cartilage.

>jack

_________________________________________________________________

MSN Photos is the easiest way to share and print your photos:

http://photos.msn.com/support/worldwide.aspx

[Guest guest]

Hi

Lili!

You

can e-mail Dr. Nagata at  NagataS7133@...

and ask him your questions. He is very nice to respond immediately at some length.

(mom of Bogdan, 4, HFM, left microtia/atresia)

-----Original

Message-----

From: Lili Shiau

Sent: Monday, August 26, 2002 11:20 AM

To: AtresiaMicrotia

Subject: Re: FW:

HSC Plastic Surgery InfoCentre

Hi everyone,

I have read of many people having ear

reconstruction by Drs. Brent (rib

cartilage harvessting) and Romo

(polyethylene). Two questions: Does anyone

have experience with Dr. Thorne? And does

Dr. Brent place the chest tubes

in himself or does he have a pediatric

cardiothoracic surgeon involved with

these operations?

OK - I actually have another question: Who

does Dr. Nagata work with in TX

and ?MA? I can't recall the other state that

he trains people in.

Thanks!

Lili (mom of , bilateral microtia/atresia)

..

[Guest guest]

Jack,

Thanks for the info. We just sent photos of to Dr. Brent, and we're anxiously waiting to hear from him. has some cartilage on his right ear, and we're hoping that Dr. Brent will be able to use some of it. Who knows.

You mentioned that your son had the surgeries done over 20 years ago. How did he tolerate the operations?

judah did great!

his mom and i were WRECKS for 10 years!!!!!

haha!

jack

Lili

[Guest guest]

Jack,

Thanks for the info. We just sent photos of to Dr. Brent, and we're anxiously waiting to hear from him. has some cartilage on his right ear, and we're hoping that Dr. Brent will be able to use some of it. Who knows.

You mentioned that your son had the surgeries done over 20 years ago. How did he tolerate the operations?

Lili (mother of , bilateral microtia/atresia)

Re: FW: HSC Plastic Surgery InfoCentre

I have read of many people having ear reconstruction by Drs. Brent (ribcartilage harvessting) and Romo (polyethylene). Two questions: Does anyonehave experience with Dr. Thorne? And does Dr. Brent place the chest tubesin himself or does he have a pediatric cardiothoracic surgeon involved withthese operations?hi lilithere are no chest tubes in dr brent's surgery.he harvests some cartilage, the stuff between the ribs, from which he sculpts the new ear. he uses cartilage because...thats what ears are made of!he uses the patient's OWN cartilage so there is no problem with rejection.the scar becomes quite invisible in a couple of years. there are NO after effects of some missing rib cartilage.jack

[Guest guest]

,

Thanks for the e-mail addres!!! I'm going to write to him soon. Did Bogdan have his surgery done by Dr. Nagata?

Lili

RE: FW: HSC Plastic Surgery InfoCentre

Hi Lili!

You can e-mail Dr. Nagata at NagataS7133@... and ask him your questions. He is very nice to respond immediately at some length.

(mom of Bogdan, 4, HFM, left microtia/atresia)

-----Original Message-----From: Lili Shiau Sent: Monday, August 26, 2002 11:20 AMTo: AtresiaMicrotia Subject: Re: FW: HSC Plastic Surgery InfoCentre

Hi everyone,I have read of many people having ear reconstruction by Drs. Brent (ribcartilage harvessting) and Romo (polyethylene). Two questions: Does anyonehave experience with Dr. Thorne? And does Dr. Brent place the chest tubesin himself or does he have a pediatric cardiothoracic surgeon involved withthese operations?OK - I actually have another question: Who does Dr. Nagata work with in TXand ?MA? I can't recall the other state that he trains people in.Thanks!Lili (mom of , bilateral microtia/atresia).

[Guest guest]

<< and 25 days in hospital stay for each of two stages >>

Do you know why the hospital stay is so long? That seems really long.

Autumn

[Guest guest]

Lili,

Bogdan is only 4 years old and his surgery is not yet down. I have contacted

Dr. Nagata because I was impressed by the before/after pictures in his

web-site. They are the best that I have seen. But Dr. Nagata start at 10 years

and not before, need one preoperative visit in Japan one year before the

surgery, and 25 days in hospital stay for each of two stages. The costs are very

impressing too.  I think Dr. Nagata’s results

are really good, and I would like have him as Bogdan’s

surgeon, but I don’t think this may happen.

Warm

Regards,

-----Original

Message-----

From: Lili Shiau

Sent: Tuesday, August 27, 2002 8:59 PM

To:

AtresiaMicrotia

Subject: Re: FW:

HSC Plastic Surgery InfoCentre

,

Thanks for the e-mail

addres!!! I'm going to write to him soon. Did Bogdan have his

surgery done by Dr. Nagata?

Lili

Re: FW:

HSC Plastic Surgery InfoCentre

Hi everyone,

I have read of many people having ear

reconstruction by Drs. Brent (rib

cartilage harvessting) and Romo

(polyethylene). Two questions: Does anyone

have experience with Dr. Thorne? And does

Dr. Brent place the chest tubes

in himself or does he have a pediatric

cardiothoracic surgeon involved with

these operations?

OK - I actually have another question: Who

does Dr. Nagata work with in TX

and ?MA? I can't recall the other state that

he trains people in.

Thanks!

Lili (mom of , bilateral microtia/atresia)

..

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unsubscribe from this group, send an email to:

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To

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[Guest guest]

I

think because he is Japan = perfectionist. For post-surgical care. I don't know.

I

attach his letter:

Mr. Ivan and Mrs., Kaltchevi,

First of all, I would like to inform you that this is the official and

finalized letter to you after reviewing the photographs and my diagnosis for

Bogdan Ivanov Kaltchevi is as follows:

Diagnosis: 1. Left Microtia

with Low Hairline

2.

Left Hemifacial Microsomia (HFM)

The surgical schedule that I recommend my patients with similar condition is to

have the auricular reconstruction first then to have the craniofacial surgery

after the auricle has been reconstructed.

Please note, that if you decide for me to perform the surgery for your son, I

would like to examine your son at the earliest possible date in which you may

be able to come to Japan so that I may be able to conduct a physical

examination and evaluation to give you the exact details and to make the

necessary schedule for your son.

The surgical procedures I will be performing for your son's auricular

reconstruction are as follows for the " First Stage Operation (fabrication

and grafting of the three-dimensional costal cartilage framework (3-D frame)

<and for your son's low hairline epilation is necessary): "

1. Preparation of the surgical site for the grafting of the 3-D frame.

A) Determination of the proper anatomical

location to reconstruct the auricle in

reference to

the severity of HFM.

Construction of skin flaps and skin pocket for

grafting the fabricated 3-D frame.

C) Harvesting of the ultra-delicate

split-thickness scalp skin (UDSTS, utilized for low

hairline

cases during the first stage operation).

D) Elevation of the temporoparietal fascia flap

(TPF, utilized for low hairline cases during

the

first stage operation).

E) Epilation (excision of the hair bearing

layer).

2. Harvesting of the costal cartilages from the left chest.

3. Fabrication of the 3-D frame.

4. Grafting of the 3-D frame to the surgical site.

5. Closure and dressing of reconstructed auricle.

The hospitalization schedule for the first stage operation:

1. Patients are requested to be admitted at least

10 days in advance for pre-surgical

work-up

(examination).

2. One whole day for surgery.

3. Patients are hospitalized for at least 25 days

after surgery for post-surgical care.

*Note, we have been able to secure housing for patients, parents and/or

guardians to stay during the patient's hospitalization at economical prices

where a family up to 5 members can sleep and cook. Please keep in mind that

this is not a hotel but a facility where people can cook and sleep. The price

per day is about one thousand yen (\1,000***).

**It is of major importance for me to see the patient between the first and

second stage operation to determine and evaluate the post-surgical course

(prognosis). As for the domestic cases, I see the patients on monthly basis

(once a month) but for foreign patients, I see the at least 2 or 3 time between

surgery. Since you have informed me on financial matters in Bulgaria, I would

like to see your son at least once between the first and second stage

operation, most ideal will be at 3 months after the first stage operation.

The second stage operation (projection of the reconstructed auricle <and for

your son's case, reconstruction of the missing left sideburn is necessary>)

is performed 6 months after the first stage operation.

1. Preparation of the surgical site for auricular projection.

A) Preparation of surgical site for auricular

projection.

Harvesting of the ultra-delicate

split-thickness scalp skin.

C) Elevation of the deep temporoparietal fascia

flap.

D) Reconstruction of the missing sideburn.

2. Harvesting of the costal cartilage from the left chest.

3. Fabrication of costal cartilage block.

4. Grafting of the costal cartilage block to the posterior aspect of the

reconstructed

auricle.

5. Closure and dressing of reconstructed and projected auricle.

The hospitalization schedule for the second stage operation:

1. Patients are requested to be admitted at least

10 days in advance for pre-surgical

work-up

(examination) and final evaluation.

2. One whole day for surgery.

3. Patients are hospitalized for at least 25 days

after surgery for post-surgical care.

* This is a brief summary of what you may expect for your son's corrective

surgery for microtia.

** Points of precaution for your son's case:

1. Proper anatomical location for auricular reconstruction in reference to the

severity of

HFM requires intensive preoperative

planning (much experience is required).

Problem: There appears to be a

lot of lack of experience in reconstructing auricles for HFM cases since many

surgeons will tend to sacrifice auricular reconstruction since there are many

postoperative complications and the results attained are not satisfactory.

Answer: I have performed numerous

secondary auricular reconstruction for unfavorable primary reconstruction

results in HFM cases. Therefore, we were able to reconstruct the auricle in the

most appropriate location in reference to the severity of HFM and presents more

than satisfactory results have been attained.

2. The superior helical rim (upper portion of the auricle) to be reconstructed

will be located

in the hair bearing skin. Thus the skin

surface area will be insufficient.

Problem: In most microtia cases

with HFM and further complicated with low hairline the surgeon will try to

avoid the low hairli.ne and reconstruct the auricle in an inferior location. -OR-

The surgeon will reconstruct the auricle anterior to the proper location to

avoid the hairline, which is where the sideburn is usually located. In either

case, the symmetrical balance is offset.

Answer: I will not make any

sacrifices or compromises when asked to reconstruct the auricle for the

patient. I will reconstruct the auricle in its appropriate anatomical location

and will perform epilation to eliminate the problem of unwanted hair growth.

There will be no mismatch in color of skin since I utilize the UDSTS.

Consistent and favorable results are attained with symmetry.

3. The superior pole (upper half) of the remnant vestige is flat, therefore the

skin surface

area will increase in insufficiency.

Answer: The UDSTS is utilized to

solve this problem.

I have been to negotiate to make a package price for your son's surgical and

hospitalization costs (fees) for both the first and second stage operations.

The total price of auricular reconstruction is Seven Million Yen

(|\7,000,000**). This will cover the above mentioned condition except for the

housing and cooking facility which is required to be paid by each family. This

fee will cover the surgical, hospitalization, surgeon's fee, translation and

interpretation fees.

Please forward any questions to me an I will definitely see what I can do to be

of help.

Sincerely yours,

Satoru Nagata, MD, PhD

Department Director

-----Original

Message-----

From: FACTBERTE@...

Sent: Wednesday, August 28, 2002 6:20 PM

To:

AtresiaMicrotia

Subject: Re: FW:

HSC Plastic Surgery InfoCentre

In a message dated 8/28/02 5:39:21 AM,

mkaltcheva@... writes:

<< and 25 days in hospital stay for

each of two stages >>

Do you know why the hospital stay is so

long? That seems really long.

Autumn

[Guest guest]

WOW - I'm amazed!!!!

RE: FW: HSC Plastic Surgery InfoCentre

I think because he is Japan = perfectionist. For post-surgical care. I don't know.

I attach his letter:

Mr. Ivan and Mrs., Kaltchevi, First of all, I would like to inform you that this is the official and finalized letter to you after reviewing the photographs and my diagnosis for Bogdan Ivanov Kaltchevi is as follows: Diagnosis: 1. Left Microtia with Low Hairline 2. Left Hemifacial Microsomia (HFM) The surgical schedule that I recommend my patients with similar condition is to have the auricular reconstruction first then to have the craniofacial surgery after the auricle has been reconstructed. Please note, that if you decide for me to perform the surgery for your son, I would like to examine your son at the earliest possible date in which you may be able to come to Japan so that I may be able to conduct a physical examination and evaluation to give you the exact details and to make the necessary schedule for your son. The surgical procedures I will be performing for your son's auricular reconstruction are as follows for the "First Stage Operation (fabrication and grafting of the three-dimensional costal cartilage framework (3-D frame) <and for your son's low hairline epilation is necessary):" 1. Preparation of the surgical site for the grafting of the 3-D frame. A) Determination of the proper anatomical location to reconstruct the auricle in reference to the severity of HFM. Construction of skin flaps and skin pocket for grafting the fabricated 3-D frame. C) Harvesting of the ultra-delicate split-thickness scalp skin (UDSTS, utilized for low hairline cases during the first stage operation). D) Elevation of the temporoparietal fascia flap (TPF, utilized for low hairline cases during the first stage operation). E) Epilation (excision of the hair bearing layer). 2. Harvesting of the costal cartilages from the left chest. 3. Fabrication of the 3-D frame. 4. Grafting of the 3-D frame to the surgical site. 5. Closure and dressing of reconstructed auricle. The hospitalization schedule for the first stage operation: 1. Patients are requested to be admitted at least 10 days in advance for pre-surgical work-up (examination). 2. One whole day for surgery. 3. Patients are hospitalized for at least 25 days after surgery for post-surgical care. *Note, we have been able to secure housing for patients, parents and/or guardians to stay during the patient's hospitalization at economical prices where a family up to 5 members can sleep and cook. Please keep in mind that this is not a hotel but a facility where people can cook and sleep. The price per day is about one thousand yen (\1,000***). **It is of major importance for me to see the patient between the first and second stage operation to determine and evaluate the post-surgical course (prognosis). As for the domestic cases, I see the patients on monthly basis (once a month) but for foreign patients, I see the at least 2 or 3 time between surgery. Since you have informed me on financial matters in Bulgaria, I would like to see your son at least once between the first and second stage operation, most ideal will be at 3 months after the first stage operation. The second stage operation (projection of the reconstructed auricle <and for your son's case, reconstruction of the missing left sideburn is necessary>) is performed 6 months after the first stage operation. 1. Preparation of the surgical site for auricular projection. A) Preparation of surgical site for auricular projection. Harvesting of the ultra-delicate split-thickness scalp skin. C) Elevation of the deep temporoparietal fascia flap. D) Reconstruction of the missing sideburn. 2. Harvesting of the costal cartilage from the left chest. 3. Fabrication of costal cartilage block. 4. Grafting of the costal cartilage block to the posterior aspect of the reconstructed auricle. 5. Closure and dressing of reconstructed and projected auricle. The hospitalization schedule for the second stage operation: 1. Patients are requested to be admitted at least 10 days in advance for pre-surgical work-up (examination) and final evaluation. 2. One whole day for surgery. 3. Patients are hospitalized for at least 25 days after surgery for post-surgical care. * This is a brief summary of what you may expect for your son's corrective surgery for microtia. ** Points of precaution for your son's case: 1. Proper anatomical location for auricular reconstruction in reference to the severity of HFM requires intensive preoperative planning (much experience is required). Problem: There appears to be a lot of lack of experience in reconstructing auricles for HFM cases since many surgeons will tend to sacrifice auricular reconstruction since there are many postoperative complications and the results attained are not satisfactory. Answer: I have performed numerous secondary auricular reconstruction for unfavorable primary reconstruction results in HFM cases. Therefore, we were able to reconstruct the auricle in the most appropriate location in reference to the severity of HFM and presents more than satisfactory results have been attained. 2. The superior helical rim (upper portion of the auricle) to be reconstructed will be located in the hair bearing skin. Thus the skin surface area will be insufficient. Problem: In most microtia cases with HFM and further complicated with low hairline the surgeon will try to avoid the low hairli.ne and reconstruct the auricle in an inferior location. -OR- The surgeon will reconstruct the auricle anterior to the proper location to avoid the hairline, which is where the sideburn is usually located. In either case, the symmetrical balance is offset. Answer: I will not make any sacrifices or compromises when asked to reconstruct the auricle for the patient. I will reconstruct the auricle in its appropriate anatomical location and will perform epilation to eliminate the problem of unwanted hair growth. There will be no mismatch in color of skin since I utilize the UDSTS. Consistent and favorable results are attained with symmetry. 3. The superior pole (upper half) of the remnant vestige is flat, therefore the skin surface area will increase in insufficiency. Answer: The UDSTS is utilized to solve this problem. I have been to negotiate to make a package price for your son's surgical and hospitalization costs (fees) for both the first and second stage operations. The total price of auricular reconstruction is Seven Million Yen (|\7,000,000**). This will cover the above mentioned condition except for the housing and cooking facility which is required to be paid by each family. This fee will cover the surgical, hospitalization, surgeon's fee, translation and interpretation fees. Please forward any questions to me an I will definitely see what I can do to be of help. Sincerely yours, Satoru Nagata, MD, PhD Department Director

-----Original Message-----From: FACTBERTE@... Sent: Wednesday, August 28, 2002 6:20 PMTo: AtresiaMicrotia Subject: Re: FW: HSC Plastic Surgery InfoCentre

<< and 25 days in hospital stay for each of two stages >>Do you know why the hospital stay is so long? That seems really long.Autumn

[Guest guest]

I think because he is Japan = perfectionist. For post-surgical care. I don't know.

I attach his letter:

Mr. Ivan and Mrs., Kaltchevi,

First of all, I would like to inform you that this is the official and finalized letter to you after reviewing the photographs and my diagnosis for Bogdan Ivanov Kaltchevi is as follows:

....

The hospitalization schedule for the first stage operation:

1. Patients are requested to be admitted at least 10 days in advance for pre-surgical

work-up (examination).

2. One whole day for surgery.

3. Patients are hospitalized for at least 25 days after surgery for post-surgical care.

*Note, we have been able to secure housing for patients, parents and/or guardians to stay during the patient's hospitalization at economical prices where a family up to 5 members can sleep and cook. Please keep in mind that this is not a hotel but a facility where people can cook and sleep. The price per day is about one thousand yen (\1,000***).

**It is of major importance for me to see the patient between the first and second stage operation to determine and evaluate the post-surgical course (prognosis). As for the domestic cases, I see the patients on monthly basis (once a month) but for foreign patients, I see the at least 2 or 3 time between surgery.

The hospitalization schedule for the second stage operation:

....

1. Patients are requested to be admitted at least 10 days in advance for pre-surgical

work-up (examination) and final evaluation.

2. One whole day for surgery.

3. Patients are hospitalized for at least 25 days after surgery for post-surgical care.

hey autumn...

i'm with YOU...

i cannot iMAGine such an unwarranted , interminable (IMHO) 25 day hospital stay!

JACK

[Guest guest]

would an american insurance company cover reconstructive surgery with dr. nagata? i know he sometimes operates out of houston and canada - but is he on staff there?

RE: FW: HSC Plastic Surgery InfoCentre

I think because he is Japan = perfectionist. For post-surgical care. I don't know.

I attach his letter:

Mr. Ivan and Mrs., Kaltchevi, First of all, I would like to inform you that this is the official and finalized letter to you after reviewing the photographs and my diagnosis for Bogdan Ivanov Kaltchevi is as follows: Diagnosis: 1. Left Microtia with Low Hairline 2. Left Hemifacial Microsomia (HFM) The surgical schedule that I recommend my patients with similar condition is to have the auricular reconstruction first then to have the craniofacial surgery after the auricle has been reconstructed. Please note, that if you decide for me to perform the surgery for your son, I would like to examine your son at the earliest possible date in which you may be able to come to Japan so that I may be able to conduct a physical examination and evaluation to give you the exact details and to make the necessary schedule for your son. The surgical procedures I will be performing for your son's auricular reconstruction are as follows for the "First Stage Operation (fabrication and grafting of the three-dimensional costal cartilage framework (3-D frame) <and for your son's low hairline epilation is necessary):" 1. Preparation of the surgical site for the grafting of the 3-D frame. A) Determination of the proper anatomical location to reconstruct the auricle in reference to the severity of HFM. Construction of skin flaps and skin pocket for grafting the fabricated 3-D frame. C) Harvesting of the ultra-delicate split-thickness scalp skin (UDSTS, utilized for low hairline cases during the first stage operation). D) Elevation of the temporoparietal fascia flap (TPF, utilized for low hairline cases during the first stage operation). E) Epilation (excision of the hair bearing layer). 2. Harvesting of the costal cartilages from the left chest. 3. Fabrication of the 3-D frame. 4. Grafting of the 3-D frame to the surgical site. 5. Closure and dressing of reconstructed auricle. The hospitalization schedule for the first stage operation: 1. Patients are requested to be admitted at least 10 days in advance for pre-surgical work-up (examination). 2. One whole day for surgery. 3. Patients are hospitalized for at least 25 days after surgery for post-surgical care. *Note, we have been able to secure housing for patients, parents and/or guardians to stay during the patient's hospitalization at economical prices where a family up to 5 members can sleep and cook. Please keep in mind that this is not a hotel but a facility where people can cook and sleep. The price per day is about one thousand yen (\1,000***). **It is of major importance for me to see the patient between the first and second stage operation to determine and evaluate the post-surgical course (prognosis). As for the domestic cases, I see the patients on monthly basis (once a month) but for foreign patients, I see the at least 2 or 3 time between surgery. Since you have informed me on financial matters in Bulgaria, I would like to see your son at least once between the first and second stage operation, most ideal will be at 3 months after the first stage operation. The second stage operation (projection of the reconstructed auricle <and for your son's case, reconstruction of the missing left sideburn is necessary>) is performed 6 months after the first stage operation. 1. Preparation of the surgical site for auricular projection. A) Preparation of surgical site for auricular projection. Harvesting of the ultra-delicate split-thickness scalp skin. C) Elevation of the deep temporoparietal fascia flap. D) Reconstruction of the missing sideburn. 2. Harvesting of the costal cartilage from the left chest. 3. Fabrication of costal cartilage block. 4. Grafting of the costal cartilage block to the posterior aspect of the reconstructed auricle. 5. Closure and dressing of reconstructed and projected auricle. The hospitalization schedule for the second stage operation: 1. Patients are requested to be admitted at least 10 days in advance for pre-surgical work-up (examination) and final evaluation. 2. One whole day for surgery. 3. Patients are hospitalized for at least 25 days after surgery for post-surgical care. * This is a brief summary of what you may expect for your son's corrective surgery for microtia. ** Points of precaution for your son's case: 1. Proper anatomical location for auricular reconstruction in reference to the severity of HFM requires intensive preoperative planning (much experience is required). Problem: There appears to be a lot of lack of experience in reconstructing auricles for HFM cases since many surgeons will tend to sacrifice auricular reconstruction since there are many postoperative complications and the results attained are not satisfactory. Answer: I have performed numerous secondary auricular reconstruction for unfavorable primary reconstruction results in HFM cases. Therefore, we were able to reconstruct the auricle in the most appropriate location in reference to the severity of HFM and presents more than satisfactory results have been attained. 2. The superior helical rim (upper portion of the auricle) to be reconstructed will be located in the hair bearing skin. Thus the skin surface area will be insufficient. Problem: In most microtia cases with HFM and further complicated with low hairline the surgeon will try to avoid the low hairli.ne and reconstruct the auricle in an inferior location. -OR- The surgeon will reconstruct the auricle anterior to the proper location to avoid the hairline, which is where the sideburn is usually located. In either case, the symmetrical balance is offset. Answer: I will not make any sacrifices or compromises when asked to reconstruct the auricle for the patient. I will reconstruct the auricle in its appropriate anatomical location and will perform epilation to eliminate the problem of unwanted hair growth. There will be no mismatch in color of skin since I utilize the UDSTS. Consistent and favorable results are attained with symmetry. 3. The superior pole (upper half) of the remnant vestige is flat, therefore the skin surface area will increase in insufficiency. Answer: The UDSTS is utilized to solve this problem. I have been to negotiate to make a package price for your son's surgical and hospitalization costs (fees) for both the first and second stage operations. The total price of auricular reconstruction is Seven Million Yen (|\7,000,000**). This will cover the above mentioned condition except for the housing and cooking facility which is required to be paid by each family. This fee will cover the surgical, hospitalization, surgeon's fee, translation and interpretation fees. Please forward any questions to me an I will definitely see what I can do to be of help. Sincerely yours, Satoru Nagata, MD, PhD Department Director

-----Original Message-----From: FACTBERTE@... Sent: Wednesday, August 28, 2002 6:20 PMTo: AtresiaMicrotia Subject: Re: FW: HSC Plastic Surgery InfoCentre

<< and 25 days in hospital stay for each of two stages >>Do you know why the hospital stay is so long? That seems really long.Autumn