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dr merck method

Re: dr merck method

Postby Dr.Merck » Wed Dec 23, 2009 2:06 pm

I am Dr. Merck and operated the patient with the pseudonym "sunshinegirlie".
I remember her well. It is not true that her operation resulted in "twisted"
and "scarred" ears. This is not possible with my method.

After the operation, this patient's ears stood slightly asymmetrical. I
therefore offered to exchange a thread in the one ear so as to create better
symmetry. The patient did not believe me that this was possible and had all
threads removed from both ears instead. She then had the ears which she had
before the operation, without visible signs of the second measure. As an
unusual occurrence, voices were raised because she had cursed at my
secretary and given her a hard time. I see it as my responsibility to defend
my always very friendly staff against unjustified attacks.

Best regards,
Dr. Waldemar Merck
Dr.Merck
 
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Re: dr merck method

Postby aaron168 » Mon Nov 08, 2010 12:28 pm

Dear Dr. Merck
I have taken this procedure in 2007; I have been very pleased with the results. But I do want to remove the permanent stitching as a personal preference, as the site has said that the cartilage will reform to the appropriate position I want to remove the stitching.
Please could you respond to my request with details?

Kind Regards,

Aaron Lam
aaron168
 
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Re: dr merck method

Postby Merck456 » Sat Mar 05, 2011 6:54 am

Dear aaron168

It can be observed with elderly nuns that the wearing of a nun veil over decades changes the shape of the ear cartilage to such an extent that the ears lie flat against the head. The threads I insert more or less take on the function of the nun's veil: except that I of course do not position the ears flat against the head but at a natural distance to the head. As with the nun's veils, I assume that after several years after my method, the cartilage also reshapes with the result that the threads are no longer needed. However, I do not know how many years it takes until the cartilage has changed after my method. That's because the threads I insert under the skin (where they remain, non-visible) are normally so well tolerated by my patients that they do not cause any symptoms or discomfort. Therefore, patients do not request removal of the threads. That is why I do not know how many years it takes exactly until the cartilage has changed to such an extent that the threads are no longer needed.

I therefore advise you not to have threads removed that are not causing any discomfort or symptoms. I cannot know whether your ear cartilage has sufficiently reshaped yet. If the threads are removed, your ears may return to their original, protruding position. That's something you shouldn't risk.

Best regards
Priv.Doz.Dr. med. Waldemark Merck, Konstanz, Germany
Merck456
 
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Re: dr merck method

Postby egyman » Thu Jul 14, 2011 4:14 am

Dear Dr. Merck,

My ears were very prominent ears and i decided to go for Otoplasty 2 years ago. The space between the ears and my head was aroun 3.7 cm and came down to 1.5 right after the surgery, but after a year later it ended at 2.5 cm. A month ago, i felt that some revisions are needed and my surgeon decided on the stitches method, but the ears came back to the initial position after 2 weeks from the surgery. His excuse was that my cartirdge is very thick. Can this be corrected by any means possible? I really need your advise on this matter.
egyman
 
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Re: dr merck method

Postby gregmc21 » Mon Jul 18, 2011 6:31 am

Dear Dr Merck

My ears were quite prominent which prompted me to have an otoplasty on them last summer. The result was excellent on the right ear but the left ear was very over corrected that you could only see the antihelix (every day I curse the fact that I didn't go to see you first!). I underwent a revision last week where the surgeon released the middle part of my ear although I thought releasing the bottom part would have given a better result. Now my left ear sticks out more at the top part than the right. I know I will have to wait some months for my ear to properly heal but if I wanted to take in the top part of my left ear by just a couple of millimeters, could this be achieved with your method? Thanks
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Re: dr merck method

Postby 2timeOtoplasty » Thu Jul 28, 2011 4:59 pm

Hi gregmc21,

I'm very interested to hear that you had the middle part of your ear pinback released - I've been told by some surgeons this not possible once the scar tissue has formed. Could you please tell me where you get this down and how they achieved it?

Was there a reason why they couldn't release the bottom of the ear?

Thanks :)
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Re: dr merck method

Postby gregmc21 » Wed Aug 03, 2011 3:47 pm

Hi 2timeOtoplasty

I had the procedure done by Dr Greg O'Toole in London, I believe he released the middle part of my ear by releasing the stitches that had been used for my previous operation he charged around £3,000 which I thought was quite good since I hear most revisions are nearer the £10,000 he did mention that my ear had been stitched in really tight from my previous operation (even though the left ear was done fine!). But he didn't have to take cartlidge from my rib or anything like that. I honestly don't know why he didn't release the lower third more and the middle third less I think I'm just unlucky! Hope this helps.
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Re: dr merck method

Postby Merck456 » Wed Nov 30, 2011 3:38 pm

egyman wrote:Dear Dr. Merck,

My ears were very prominent ears and i decided to go for Otoplasty 2 years ago. The space between the ears and my head was aroun 3.7 cm and came down to 1.5 right after the surgery, but after a year later it ended at 2.5 cm. A month ago, i felt that some revisions are needed and my surgeon decided on the stitches method, but the ears came back to the initial position after 2 weeks from the surgery. His excuse was that my cartirdge is very thick. Can this be corrected by any means possible? I really need your advise on this matter.


Dear "egyman"

With my Stitch Method, all ears can be corrected, no matter how thick or hard the cartilage is. If you would like, we will gladly correct your ears for you. Contact details can be found on our website.http://www.ear-clinic.com/
Best regards
Priv.Doz.Dr.med.W. Merck, Constance, Germany
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Re: dr merck method

Postby Merck456 » Wed Nov 30, 2011 3:44 pm

gregmc21 wrote:Dear Dr Merck
My ears were quite prominent which prompted me to have an otoplasty on them last summer. The result was excellent on the right ear but the left ear was very over corrected that you could only see the antihelix (every day I curse the fact that I didn't go to see you first!). I underwent a revision last week where the surgeon released the middle part of my ear although I thought releasing the bottom part would have given a better result. Now my left ear sticks out more at the top part than the right. I know I will have to wait some months for my ear to properly heal but if I wanted to take in the top part of my left ear by just a couple of millimeters, could this be achieved with your method? Thanks


Dear "gregmc21"
It would not be a problem for me to pin the top part of your left ear closer to your head. The results cannot only be checked, but also determined by you during and at the end of the operation with a hand-held mirror.

Best regards
Priv.Doz.Dr.med.W.Merck, Constance, Germany
Merck456
 
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Re: dr merck method

Postby Merck456 » Tue Oct 22, 2013 2:03 pm

Hello MissJ521,
I regret that the other thread on the makemeheal forum, that can be found under the following link: otoplasty-ear-surgery/merck-stitch-method-t160774.html, was locked after your discussion with “bikeboy”. However, you expressed a very good idea on this thread. Since you advised the following in your last posting on 17 October 2013, on the locked thread:

"As to defending methods where an incision is placed behind the ear, I would encourage patients to consult with doctors using that incision to address any fears they may have about it in addition to doctors who don't use an incision behind the ear (or use BOTH or either) when gathering information needed to make an informed choice. This is because differing opinions are part of the process of gathering information" ,
I’d like to make a posting in which the risks of the Merck Stitch Method are explained and the risks of the traditional methods are quoted from the medical literature, so that a patient can form an opinion on both methods without having to consult several surgeons:

First of all, I’d like to say that I’m happy that you received a pleasing result and no complications with your otoplasty that was carried out with the traditional method. You can gather from my following contribution that an ear-pinning operation with the traditional method can also proceed differently to yours. So that the readers of this forum are comprehensively informed, not just through individual reports, I have taken the liberty of writing the following article on this topic:

Comparison of the Risks of the Merck Stitch Method to the Risks of the Traditional Methods.

Merck Stitch Method:

There are only a few possible harmless complications with the Merck Stitch Method. These have been ascertained in the last 17 years from more than 8000 ears that were pinned by me and my colleague, Dr Bern, with the Merck Stitch Method. Thus, this involves long-term data:

Light or stronger pain in the first hours or days after the operation.

Rare occurrence of thread intolerability with rejection of the thread (a rejected thread can be replaced by another thread as quickly and as minimally invasively as with the first operation).

In rare exceptional cases, the ears may protrude again by a few millimeters, in even rarer cases, more.

In the first 3 - 7 days after the operation, there may be swelling to varying degrees. Only in exceptional cases does the swelling persist some days longer.

Extremely rare and harmless bleeding from one of the stitch points.

Very minimal risk of infection, since the only wounds are the stitch points and the maximally 2- to 3-mm long stab incisions in the skin.

Traditional Methods:

In comparison, there are numerous risks of an otoplasty with the traditional methods. Some of these complications are irreversible. A list of these can be found in" GMS Current Topics in Otorhinolaryngology - Head and Neck Surgery" titled" Otoplasty – techniques, characteristics and risks" .Published online 2008 March 14. The link to this article is: http://www.egms.de/static/de/journals/c ... 0038.shtml

I quote the following from it:

"6. Complications of otoplasty

In principle, it can be differentiated between early and late complications of otoplasty [23], [53], [56], [57], [66]. Early complications include haematomas, wound infections, which may be associated with perichondritis, pain, postoperative bleeding, allergic reactions, and, most devastatingly, cartilage-skin necroses. In contrast, hypertrophic scars, keloids, suture material rejection with fistula formation, hypaesthesia or paraesthesia, auricular deformities or a recurrence occur as late complications (Table 1 [Tab. 1]). For the early detection of complications, regular follow-up examinations and care are strongly recommended and should be performed by the surgeon. Haematomas are more frequently associated with cartilage- weakening methods of antihelix plasty, such as incision and/or scoring techniques. Each otoplastic intervention carries the risk of perichondritis which, in extreme cases, may result in cartilage-skin necrosis with cosmetically unsatisfactory auricular deformity. Pain during the first postoperative days may herald complications and require immediate attention, including examination and change of dressing. Significant local pruritus at the ear may indicate an allergic reaction to the suture material or the dressing material, and further clarification should be attempted. Since late complications, such as hypertrophic scars or keloids, may occur even months after otoplasty, follow-up examinations at longer intervals up to one year are recommended. If the patient has a history of hypertrophic scars or keloids, he or she should be informed about the associated increased risk and the potential at required. In addition, these patients should apply a scar ointment, which inhibits excessive collagen synthesis in the region of the scar. Fistula formation may indicate rejection of the suture material or the presence of knots too superficially placed underneath the retroauricular skin, and requires fistelectomy and removal of the originally used suture material. Even if the surgical technique is correctly performed, a recurrence with renew protrusion of the ears may occur. Therefore, already during the first appointment or, at the latest, during the informed consent discussion, the patient or the parents of the child should be comprehensively informed about the associated risks and possible complications and be asked about their expectations regarding the outcome of the intervention. In-depth knowledge of suitable surgical techniques and the correct performance of the otoplasty procedures are crucial for a good cosmetic result."

In this list, you can see “rejection of the suture material” what “requires removal of the originally used suture material" cannot only happen with my Stitch method, but also with the traditional methods, so that this is not a specific disadvantage of my Stitch Method, as you asserted in your posting. Under the following link, you can find numerous articles by other surgeons that also report on „suture complications“ of the traditional methods:

http://www.realself.com/question/otopla ... on-sutures

The numerous recomended "follow-up examinations at longer intervals up to one year" for operations with the traditional method are not necessary with the Merck stitch method.

A further link on the risks of the traditional methods with numerous photos of more possible complications: recurrences; abscesses; chronically indurated scar-like thickened old othaematoma -‘ring ear'; pressure ulcer; telephone ear; excessive edge formation; over-correction with excessively close fit; massive retroauricular keloids; collapsed ear with complete destruction of the ear cartilage structure is:

http://pubmedcentralcanada.ca/pmcc/articles/PMC3199843/

Naturally, it also depends on whether the otoplasty (regardless of whether it is with the traditional method or the Merck Stitch Method) is carried out by an experienced top doc (as in your case) or by an inexperienced surgeon. However, even an experienced surgeon can’t always avoid the possible complications, i.e. the risks of the traditional methods.

Did you consider, when you advised people, in your postings on the locked thread, to let themselves be operated on by an experienced surgeon, that a patient doesn’t usually know which surgeon is an experienced „top doc“, and that these „top docs“, like many other surgeons, also once had to begin „small“, i.e. inexperienced with otoplasty, in order to later become an experienced top surgeon? And how do you believe a young inexperienced doctor today can have the chance of learning your recommended traditional method, if you advise patients who are interested in an ear-pinning operation to only let themselves be operated on by experienced surgeons ? You think the traditional method is recommendable because nothing happened in your case. I’d like to make the following analogy: Would you advise a young soldier that he can go to war without any worries, just because there are soldiers that returned from war without any injuries? This is similar to your recommendation, that patients should be operated on with the traditional method. Of course, one can make such a recommendation, but one must also state what risks a patient takes, and that these can’t be ruled out by any doctor, not even by an experienced one. I presume that you were informed of the above-mentioned risks of the traditional method by your surgeon when you had your ear pinned, but for unknown reasons keep silent about these when recommending the traditional method. In case your surgeon didn’t explain the risks to you, then he was violating his obligation to inform his patient, and was certainly not a top doctor.

You state that a patient doesn’t have to have any fear of an incision behind the ear that is made with the traditional method. In doing so, you are playing down the traumatic side of the traditional method, since not only is there a long incision in the skin of the ear, but a large area of the cartilage is exposed, which is then also worked into varying shapes, with either scoring, or deeper incisions, or also excisions of the cartilage. The numerous risks of the traditional method are attributable to this. Take a look about this in a video on the traditional method. You can find one, if you click on the following link:

http://www.ear-clinic.com/otoplasty/the ... ethod.html

( It is only with the so-called Mustardé method, that the cartilage is not worked on, but it is exposed over a large area. Due to its high relapse rate, this method did not become established for the operating of protruding ears, and it is not suitable for all ears).

I can‘t understand why you, in face of the traumatic procedures of the traditional method and it’s many possible risks, could write in your posting on Sep. 26, 2013 on this thread: "In essence, an otoplasty where they make the incision in back of the ear and refold/reshape the cartilage is a pretty straight forward procedure" And I also can’t understand that you wrote the following about the traditional method: "it's hard for me to fathom WHY people are wanting to AVOID that. To me, it seems like avoidance of a very straight forward method in favor of some esoteric one should be reconsidered". If a doctor, who knows nothing but the traditional method writes something like this, then it could be more or less understandable. However, it is not understandable, that a patient would write something like that, when everyone today knows that the „trend“ in modern surgery has long gone in the direction of the minimally invasive methods, and every sensible patient wants to be operated on as minimally invasively as possible.

As I already mentioned in another posting on the locked thread: Prof. Weerda made a statement about the Merck stitch method in „ The Surgery of the Auricle. Part 1: The Surgery of Ear Malformations. An Introduction with Clinical Examples“), Prof. Weerda states on page 9 : “A very interesting closed, minimally invasive operative procedure is the Merck’s “Stitch Method” (2000). Through tiny stab incisions on the back of the ear, the ear is folded by the placement of about 5 rows of subcutaneous and transcartilaginous mattress sutures”.

By the way, I find your idea of naming my stitch method „ the avoidance method“ actually quite applicable, considering that with my method, not only a big incision, but also big wounds, treatment of cartilage ( scoring, incisions or excisions of cartilage) and the numerous risks of the traditional methods are avoided.

Kind regards,
Priv.Doz.Dr.med.W.Merck, Constance, Germany
Last edited by Merck456 on Tue Aug 25, 2015 3:03 pm, edited 2 times in total.
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Re: dr merck method

Postby MissJ521@aol.com » Tue Oct 22, 2013 5:30 pm

Dr. Merck,

The patient message boards are meant for patients to correspond and get advice, experience or 'take' from other patients. Patients always have the option of being a 'captive audience' to the material they find on a doctor's website or if they wish to limit their research to only what the doctors says or contends. They come to the patient boards at MMH because they are looking for feedback from the patient population. Basically, in search for info or opinions that are not 'controlled' by the doctor.

The patient boards are not really for doctors to come on to use as a 'spring board' to promote their particular method or services. To continually do so tethers a fine line of 'solicitation'. (However, MMH has an 'Ask an Expert' section when docs wish to promote their method when giving advice.

As a moderator, I have been quite liberal regarding some of your entries which I feel go a bit 'too far' regarding intimidating patients from giving feedback and painting all other methods OTHER than yours as 'inferior' to yours. For example, you're on record for denying one patients experience by insisting that they 'don't exist' unless they send you photos. With another, you relay info about the patient which in the US would be considered a HIPAA violation of patient confidentiality. That type of 'presence' from you tends toward squelching patient feedback and also towards using the boards to promote your own method.

Yet another example is this very entry of yours. One in which you elect to carry on with an argument which was locked in another thread. In particular my entry on the other thread and while doing so, once again, using the MMH PATIENT boards (otoplasty board is a patient board) to demote all other methods and promote yours in the process. I shall not indulge you in furthering a locked thread.

Be informed that I am not going to feel a 'guilt trip' for giving my opinion on the other thread. I have no vested financial interest in giving a positive experience regarding method/s other than your signature surgery. Nor any 'obligation' implied or otherwise to promote your particular method of surgery or to 'defend' my stance. Readers may elect to take my entry with a 'grain of salt' if they like.

Again, patients come to the MMH patient boards to seek 'alternative commentary' from that contained on a doctor's website. I would advise that you respect that as to not use entries here to further promote your own method. In fact, it is quite unusual for doctors to get on here to promote their services with each 'circumspect' entry of a patient about them or with each patient who conveys they have not been entirely happy with a method. It's also a 'red flag' to me when a doctor gets on here to paint all other methods as 'inferior' to theirs as to elicit AVOIDANCE of all other methods in an attempt to 'channel' patients that way to their services.

I'm sorry if alternative opinions, whether by doctors themselves (which are found on other websites too) or by patients don't resolve to promoting your method. But you need to be mindful as to not use alternative opinions as a 'spring board' to promote your own method.
You, have your OWN message board where you can promote your surgery all you like.

As to your procedure which I have called an "avoidance" method, I have referred to it as such because you MARKET it with the spirit of AVOIDING other methods. In actuality, I classify methods using sutures (usually mattress sutures) with no incision behind the ear as "External Mustarde Suture Technique". This is a GENERIC name for patients looking for a technique that does not involve an incision behind the ear. It is not 'marketed' by exploiting 'avoidance' in the patient population and is practiced by some doctors who do both the incision behind the ear and without one depending on the case of the patient.

I have no critique about the surgical particulars of your method. My critique is the methodology you use to market it.

Edited to add:

edited to add:

1: I have reviewed your video on your site where you perform your surgery. Over 90% of it is 'fluff' (marketing). My advice to you would be to simply SHOW the surgery being done as to not blank out all the parts of how the surgery is actually done. You've got a 30 min video on your site where virtually very little is devoted to SHOWING the actual surgery as you do it. In contrast, the video of the Fritch procedure (incisionless otoplasty) shows the doc doing the surgery. I think it would behoove you to SHOW the surgery as you perform it, stitch by stitch and hitch. Patients and doctors like to see demonstrations when considering methods or advising about methods, respectively. Yet you go through great efforts to blank out the parts, (full demonstration of the surgery) so that it's not actually seen.

2: I also read your statement to the effect that there is no follow up protocol. So, if your surgery is one where you actually DON'T follow up many patients who get it, I really don't understand how you can advise patients as to how successful it is over the long term. A doctors ability to properly inform a patient about a procedure is really contingent on the doctor having a follow up protocol where he keeps track of a large number of patients over time. If there is 'no need' for them to come back to you for a follow up and you don't have a protocol in place where they do, how do you properly inform potential patients regarding success or failure rates of your technique? A doctor's ability to properly inform a patient as to the success of a type of surgery or technique (that he/she performs) is only as good as the doctor's follow up protocol.

"The numerous recomended "follow-up examinations at longer intervals up to one year" for operations with the traditional method are not necessary with the Merck stitch method." Merck

3: You differentiate your method from the Mustarde technique (matress sutures) by claiming that the Mustarde technique often involves an incision behind the ear. Although many doctors do use Mustard sutures after they open the ear to place them, there is really no limitation where Mustarde technique of using mattress sutures precludes use of term: "Mustard technique" when the doc elects to place those sutures externally without placing an incision behind the ear. In FACT, the Mustarde technique CAN be used externally. It's classified as "External Mustarde technique". If you are using mattress sutures to create an anti-helix fold with the aim of bringing the ears closer to the head and introducing them EXTERNALLY, your using an External Mustarde Technique . Hence, the technique you use fits into that general category of techniques.
Please Note: NO PMs please.

Private correspondence with me concerning questions highly specific to your situation is not an extension of my open participation on the boards.
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Re: dr merck method

Postby Merck456 » Tue Oct 29, 2013 2:52 pm

Hello MissJ521,
Thank you for your detailed reply on Tues, Oct 22, 2013.

I’m pleased that you have watched the video on my web site. Since you have remarked that there is very little of my procedure to be seen and have advised me to make a video in which the exact details of the technique can be clearly seen, I’d like to inform you that many patients have also seen this video and have never asked me why the technique is not shown exactly. This video was made for patients and not for the training of doctors. From my experience, patients don’t place great value on being exactly informed about each of the individual steps of the operation.
Additionally, the numerous films made by various television stations in Germany, Switzerland and Spain about my method, and which I had no influence as to what and how much of my technique was to be shown, don’t show the details of the technique, because these films were also made for patients and not for doctors. By the way, so that you can’t accuse me again of marketing intentions, I’d like to remark that all the television programs on my method were not commissioned by me. They were made according to the wishes of the television stations themselves; I didn’t pay a cent for them. Thus, I can’t be accused of having prompted these television programs to be made for marketing purposes, because I couldn’t have paid for them since they would’ve cost me a fortune.
Doctors, who are interested in my method, will be able to inform themselves in detail about it in a publication that will soon appear in a renowned German medical journal. In it, I have reported on the long-term results of thousands of ears operated on by me in detail. If, in comparison, you look at the publications that report on the results of the traditional method, you will find that these only ever report on a few hundred cases that only go back a few years. Real long-term evaluations are unfortunately never reported in these publications.

From the information I imparted regarding no follow-up examinations being necessary with my method, you have drawn the conclusion that I’m thus also not in a position to report on long-term results. For this you have to know that all patients operated on by us are informed that in the case of a complication occurring, regardless of what it is, they should, as a rule, get in touch with us and email us photos in which the complication can be seen, or send the same by post. Today each patient can do this easily and quickly, particularly by email. When threads are rejected, our patients are obligated to come back to us to have them removed, and if they can’t come for some reason, then they have to inform us how we can contact their local doctor, so that he can remove the threads instead of us. This doctor receives instructions from us, either by telephone or written, on how he can correctly and completely remove an exposed thread.
In our “Documented information for patients – basic information from the consultation otoplasty” the patient receives the following instruction on page two: “Should the thread become exposed (perforate the skin), it must be removed by Dr Merck or Dr. Bern”. Each patient must confirm that he has received and understood this information by signing the document.
Thus, we are always able to monitor how frequently threads are rejected or other complications occur.

You do me an injustice when you think I’m promoting my own method with my commentaries on the threads of the MMH site. Read through all my postings and you will find that I have done nothing other than answer questions from patients that were directed at me, and that I informed Dr Yang on another MMH thread that the "Dr Merck’s Stitch Method" is not the "Incisionless otoplasty of Fritsch" that he originally stated in this forum under the link: george-yang-doctor/question-merck-method-incisionless-otoplasty-t84434-15.html
I also took the liberty of pointing out to Dr Yang that the widely held belief among surgeons, that the wounds, or their later scars, resulting from the traditional methods are necessary for the fixation of the ears and the prevention of a relapse, is incorrect. In my opinion, this is all within the terms of a necessary exchange of information between doctors who, like me, have also posted commentaries on MMH. You should thus not accuse me of having marketing intentions.

I feel that I did not go too far when I defended myself against a user, as in the case of “Treadcarefully” who alleged that he was unsuccessfully operated on by me twice but, from his description of the post-operative course of development, it was clear to me that this was not correct. When I asked this patient to show me photos of what he meant by a bad result, this had nothing to do with intimidating, but rather followed the general instructions of MMH in its Message Board Posting Guidelines, in which the following can be read:
” Not to post any false information about yourself or pretend to be another person in an attempt to mislead others about your identity…… If you would like to educate people and caution them about the physician, you can provide a link to your photos or post them on the message board (or otherwise offer a way for individuals and users to contact you to see your pictures) and let Message Board users form their own opinions about this surgeon's work as a result of seeing the pictures”.
There is a further reason why I asked „Treadcarefully“ to send me photos in which the anonymity could be maintained, by either sending them directly to my practice, or making them first unrecognisable by blacking out the eyes before placing them in the MMH forum: My long experience with operated patients has shown me that every now and again patients write to say that their ears are protruding again. In such cases we always request photos to be sent to us. When we compare these photos to the ones taken pre-operatively, then it can be seen that the ears have only moved outwards by a few millimetres, and are still far from being protruding ears again. In these instances, the patients had forgotten how their ears looked before the operation and were satisfied when I sent them the pre-operative photos for comparison.

You are not incorrect in thinking my method is classified as an “External Mustardé Technique”. However, you must consider the following differences between the Merck stitch method and the Mustardé technique: The Mustardé method is an open and bloody method, in which a big cut is made in the skin on the rear of the ear and the cartilage exposed over a large area. It has not proved its worth and is not applicable for every ear, especially if the cartilage is thick and strong. The Dr. Merck Stitch Method has nothing to do with the Mustardé Method, because it is a closed, almost bloodless method, in which no cutting of the skin nor exposure of cartilage is made. It is, in contrast to Mustardé and other methods, applicable to every ear, regardless of its shape and size, and how thick and resistant its cartilage is. The reason being, that with the aid of a new, closed and very special technique of moving the needle in and out, it is possible to completely surround the front and rear side of the antihelix cartilage with the threads, which are also anchored there, without having to cut open the ear at all. Thus, a more effective bending of the cartilage is possible than with the Mustardé sewing method, and wounds or their scars later, are no longer necessary for holding the ears. By the way, lately we have not been using mattress sutures anymore. We have developed our own new method of stitching with which we can reduce the rate of complications, and which I am going to report about in another publication.

Since you correctly believe that before having an otoplasty, it’s good to have a consultation with a doctor who has experience of both the traditional method as well as the minimally invasive method of operating, I’d like to inform you that this doctor’s criteria applies to me too. Before I came up with the idea of my stitch method, I pinned ears with the traditional method for 18 years. Additionally, in my previous position as a senior physician in the ENT department of the University Clinic of Freiburg im Breisgau in Germany, I taught young trainee doctors how to pin ears with the traditional method.

In making an assessment of an operating method, a patient as well as a doctor is guided by the possible risks, the results and the invasiveness of the particular method in question. In my opinion, this has nothing to do with using the MMH “to demote all other methods and promote yours in the process”, and there are also no commercial propositions or solicitations involved, when I point out the differences between the traditional methods and my method concerning these 3 important points. Each patient can thus decide himself whether he would like to be operated on with a traditional method, or with my method as a possible alternative to the traditional methods.

Finally I’d like to say to you that I’m very grateful for the discussions on otoplasty, regardless of whether they are about the traditional methods or my method, and I would be pleased to hear still more of your opinion on my method and also on the traditional methods.

Kind regards,
Priv.Doz.Dr.med.W.Merck, Constance, Germany
Merck456
 
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Re: dr merck method

Postby MissJ521@aol.com » Tue Oct 29, 2013 4:42 pm

Hi Dr. Merck,

I understand you have a protocol in order in the event the patient has the threads poke through or cause a problem later down the line which is for them to tell you about that and/or come back for assistance. What I was referring to was a follow up protocol where all the problems with it (when they arise) are looked at statistically as to calculate a risk profile; the act of documenting a large number of outcomes of a control group where the number of successes vs the number of problems result in a calculation likelihood that such and such a problem could occur. For example, something like: "In a group of 100 (or what ever number) patients with whom we followed up for a period of X years, Y percent had 'no problems' and Z percent had 'problems'. Basically something to convey a statistical likelihood of having the problem of 'Z'. The act of conveying to the patient and also to peers the likelihood of having a problem for which they would need to come back for correction. That's different from telling the patients to come back only if they have a problem.
Hence a follow up protocol for a statistically significant number of patients where they are to come back or report so you can track both the successes and problems and in such a way that conforms to the guidelines of peer reviewed journals.

I say this because, to the best of my knowledge (well in 2012), one of your peers, when asked about your method said it was 'not recognized' (due to lack of presentation to support the claims):

"....Evidence on this matter is still lacking for doctors and patients​​.
In international professional circles, this surgical technique is therefore not recognised. There are still no reputable publications. On relevant science platforms such as med-pilot.de or pubmed.gov, no publications are available, which could have documented the comprehensible results."


Here is the link to that in the event you wish to counter his statement on his blog:
http://www.praxis-me.com/2012/10/06/sti ... orrection/

Regarding your mention of Dr. Yang on your board where you mentioned you 'corrected' one of his assumptions: Since Dr. Yang housed the link to your board on his, I would just suggest you add a link to his board on your board to the discussion with him in which you mention him.

Now as to the videos which I call 'fluff' which are going to be "fluff" when the MEDIA does them or things just aimed at patients, I will tell you that there are doctors who show how they do an operation where the videos are indeed meant for other doctors to see BUT for which patients can view them if they like. For example that Fritch video. It was aimed at doctors seeing it because he was showing the technique. But patients so curious to watch the operation being done were not precluded from doing so just because they were patients. I will tell you that on You Tube, I find videos by doctors who have presented same in doctor symposiums to their peers showing how they do the surgery. Yet they also, later post same on You Tube.
Although they might not post it directly on their website aimed at patients (it can be assumed that most patients are not going to want to look at a surgery video), for some patients, who do want to see the same stuff docs show other docs, they can find it. (Similar to how patients can find the Fritch video where he's showing doctors how he does it.)

As to 'treadcarefully', it just seemed like he was mentioning he experienced an outcome that is or would be possible. It's not a thing where we can assume he really did not have the outcome he mentioned 'because' he did not send you his photos. Pragmatically speaking, showing photos applies to patients who start to veer into defamation or start getting outrageous with some claims. There is some 'slack' for those who are in venue of saying they were unhappy with something because this or that happened (where this or that could very well be a risk inherent with the surgery). However, readers can elect to 'take with a grain of salt' some claims not backed by photos. With regard to people "impersonating" another, that refers to when they say they are someone they are not--like pretend to be a known person (like with known name) as to impersonate. A screen name that is a phrase (like "tread carfully") by selection of said phrase is not viewed as someone trying to "impersonate" another.

I realize that the Mustarde technique (which I think was presented in journals in 1963?) involved an incision behind the ear so that the sutures could be placed to shape the cartilage folds. But I also recognize that there are a variety of methods where similar can be achieved externally. Hence: "External Mustarde Techique". There is a doctor in Spain; Dr. A. de la Fuente who has published:
"Minimally invasive otoplasty: technical details and long-term results."
http://www.ncbi.nlm.nih.gov/pubmed/21638165

There are also others who have their own 'way' of doing minimally invasive otoplasties that fall under general 'family' of External Mustarde Techniques.

It's just that when patients are interested in "minimally invasive" otoplasties, the opportunity for them to gather more information about them arises when they look for a more GENERIC phrase as umbrella term where they can find many different citations regarding the the general category. In that way, it will kick up citations for how Fritch does it, how de la Fuente does it and how other doctors (including yourself) do it. This is preferable to lumping together "traditional methods" and comparing them to only ONE trademark or signature surgery method. So here the comparison to look for would be among other External Mustarde Techniques.

Please keep me updated to the journal citation where more about your method can be read there.
Please Note: NO PMs please.

Private correspondence with me concerning questions highly specific to your situation is not an extension of my open participation on the boards.
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Re: dr merck method

Postby Merck456 » Sat Nov 02, 2013 1:34 pm

Hallo MissJ521

I’m going to send you now an abstract of my publication in advance:

Abstract
Dr Merck’s stitch method is the first operative method for the correction of protruding ears which is really minimally invasive and closed, as the ear is no longer opened by incisions and tunnelled at any point, and the cartilage is no longer scored. The slight traumatization merely comprises tiny retroauricular stab incisions and needle stitch points through the skin and the cartilage. The name stitch method was derived from the fact that the stitches are the only shaping and stabilizing elements of the ears. Furthermore, due to a special suture technique Dr Merck’s stitch method is the first minimally invasive method with which all ears and also earlobes can be corrected. This was not possible with previous, less invasive methods. A large cavum conchae is reduced in size, only by the medialization of the anthelix whereby rotation and excision of cartilage are no longer necessary. Dispensing with work on the cartilage does not result in the ears protruding more frequently than with the open, less invasive methods previously used. The relapse quota is even lower, which is attributable to the improvement in the suture technique. The number of possible complications compared with the established methods has been considerably reduced and severe, irreversible complications no longer occur. Formations of edges, indentations and scars along the anthelix belong completely to the past. Aesthetic, round anthelix folds with a natural appearance always result. The desire to have protruding ears corrected has considerably increased as a result of the low postoperative impairments and numerous other advantages are demonstrated in this publication. Based on the documented results of this method on more than 7,000 ears, the stitch method has been shown to be an alternative to all open and closed methods previously used.

Kind regards,
Priv.Doz.Dr.med.W.Merck, Constance, Germany
Last edited by Merck456 on Sat Nov 02, 2013 4:38 pm, edited 1 time in total.
Merck456
 
Posts: 28
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Re: dr merck method

Postby Merck456 » Sat Nov 02, 2013 2:19 pm

Hallo MissJ521

Thanks for pointing out to me that I could remove the 2 duplicates myself.
Kind regards,

Priv.Doz.Dr.W.Merck, Constance, Germany
Last edited by Merck456 on Sun Nov 03, 2013 6:14 am, edited 1 time in total.
Merck456
 
Posts: 28
Joined: Wed Mar 02, 2011 5:58 pm



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