Surgery scars

Following a cervicofacialplasty revision with Dr....

Following a cervicofacialplasty revision with Dr. Oscar Ramirez, unfortunately I was left with stretched scars in front of my ear, tension in the temple area and a sweep over the jawline. Thusfar Dr. Ramirez did not offer any solutions. The signs of surgery are difficult to cover up, and as such the experience has been rather stressful. It has been difficult to obtain operative notes.

Pictures

Earlobes moved forward/downwards, which are telltale signs of surgery. The sweep is better, however, you see that the skin is bunching up towards the ear and I lost all definition in the jaw angle, scars are a bit better, but still stretched and visible. All over it is just very visible that a facelift was performed once if I don't cover up my ears completely.

Conversation,

Permanent suture poking through skin

Well, talking about coincidence, but a new issue of the surgery developed. A permanent suture that was apparently used at the back of the ear, has come up. I had a small wound and some irritation/hotness/swelling developing at the back of my ear the past month. I didn't think too much of it, until I realized this morning it was rather big. When I touched the area, I could feel something and heard a sound. I realized then already it was a permanent suture.

I realized since I had this experience before after surgery with Dr. Ramirez. I then asked if he could not use permanent sutures, and where they were located. I still have his reply per email, which was that in the decades he had performed surgery he had never had any patient question his use of sutures. Well, that was that. I feel I didn't question his use of sutures, I did ask what the side-effect of those permanent sutures could be, however, and felt I had reason to ask.

Problematic is that the suture is quite long, and when I carefully pull on it to see if it will come out, I can feel tension/slight pain that seems to travel towards the lower part of the ear. By lack of better means (finances) I've visited the weekend physician, who thought the area needs to be opened up completely to get the suture out. In fact, he said given my previous experience, most likely all need to come out. He said I need the medical records to know better where the suture was used - but Dr. Ramirez has refused to give part of my medical records for a year as mentioned, so that makes things certainly more difficult. Problematic in addition is that I don't have enough skin to open up and close again, and that I don't have the finances to see a good PS, let alone one who could open this up and use a tissue expander to close the skin again - although the tissue expander would have to be used before opening up, and my physician is worried I might get an infection if the suture is not removed on short notice.

All in all, I'm not content, worried and I wish sincerely I could turn back time, before I underwent surgery with Dr. Ramirez. All the comments I have received that this would not be my own pictures, posters subscribing to a forum to moments later discredit my experience and so on, make this all the more challenging and stressful. I hope those that do post those negative comments will realize that.

Suture poking through skin

1+ year post-op

As mentioned, I felt intimidated by the fact a member would specifically sign up to post discrediting comments about my experience and me. An experience I had before when I posted pictures - up until statements the pictures would not be mine. It results in stress, next to a problematic result, reason I took down my pictures. However, I feel I should be able to post them.

Legal

I received another email from Dr. Ramirez' attorney. Perhaps not a surprise given the fact I have been posting here about what I encountered.
In the court files it is visible what is going on in detail. I've felt forced not to state what happened with Dr. Ramirez, since Dr. Ramirez has threatened to sue me if I do. Dr. Ramirez has stated I have defamed him with the mentioned comments; I claim they were the truth.
In addition I received an email of Dr. Ramirez ex-wife. For privacy reasons I will not mention her name here. She has stated we have never communicated after a brief and friendly conversation in 2013. And that if I was haunted with defaming comments, as I said I am, perhaps someone else might have posted them 'using my name" (i.e.: her name).
Yet, she sent me an email February 5th 2014, in which she discussed my comments on the internet, stating things would 'end bad' , and referring multiple times to "karma", and 'what goes around comes around', as she now did again. This was the same night that some comments appeared on the internet, defaming me, when I posted about a problematic result of Dr. Ramirez' surgery searching for answers and solutions.
I've felt depressed the past years given Dr. Ramirez' approach, and that continues. I wish I was never recommended to undergo surgery with him by his girlfriend (who as mentioned was posting on the internet and emailed me personally as being 'just his patient') and regret my decision a lot.

Email

This is the email I received from Dr. Ramirez' ex-wife, Feb. 5th 2014. (As mentioned, for privacy concerns I erased part of her personal information). I received her email the same night defaming comments had been posted about me on the internet, when I had posted about problems I experienced after surgery with Dr. Ramirez.
Yet, she mentioned in a recent email we had never communicated per email/on the internet - with the exception of a friendly email conversation in 2013. In this email she states Dr. Ramirez did not know she was writing me. Yet, she gave information in her email that she could have never known. Personal as well as patient information only Dr. Ramirez knew.

As mentioned, this will end in a legal case, and I believe the goal is to ensure I can't post about what happened and Dr. Ramirez' conduct. I am determined to tell what happened, however, and involve media if I get silenced. Since I've encountered many things I never expected to encounter - all the conduct I ran into with any surgeon, that I feel at moments entailed dangerous and worrisome conduct, and was in conflict with regulations.

Surgery

Hospital staff abroad seems to be unaware Dr. Ramirez performed surgery in their own hospital (!)and does not want to acknowledge Dr. Ramirez performed surgery.

Update

Text follows. Just I warn anyone to reconsider if you'd want to use Dr. Ramirez. I can't even phantom what happened with this surgeon. And if I say anything I'm threatened. He didn't lose his license in Maryland without a reason I feel now. Will write the complete story. I feel so threatened, as I felt the past years.

Update

Patient deaths

There is also some worrisome information about the clinic where Dr. Ramirez holds his practice, Alyne Medical Rejuvenation. As mentioned Dr. Ramirez lost his license following the death of two patients in Maryland. Alyne Medical, the clinic where he holds his practice, lost a malpractice suit. Another surgeon that used to practice in Alyne Medical, lost his license too following the death of two patients. And Alyne Medical was one of the defendants in the malpractice suit, given an alleged breach in the standard of care. If you search for Dr. "Alberto Sant Antonio", "Alyne Medical Rejuvenation" and "Kellee J. Lee-Howard" (one of the patient's that died), and "malpractice", you will find that two patients died, one of which was claimed following poly-drug toxicity. Now, the partner of Dr. Sant Antonio, Lynne Ulevich, is still running the clinic where Dr. Ramirez holds his practice. I find the malpractice suit raises questions about the ethical standards of the clinic Alyne Medical Rejuvenation. And not only that:

There is currently, next to Dr. Ramirez one other plastic surgeon working in the clinic Alyne Medical as far as the website of the DOH shows. That is Dr. Paul Goldberg. Relevant might be that Dr. Ramirez, in the final order of the Florida Medical Board states that he will not perform surgeries exceeding the time frame of 6 hours. He also states that he would always have another surgeon present that does have hospital privileges (since Dr. Ramirez doesn't have any), when using anesthesia. According to the info of the DOH, the only surgeon with hospital privileges that could be present, would have to be Dr. Paul Goldberg. And Dr. Paul Goldberg is the third surgeon working/having worked in Alyne Medical Rejuvenation facing (potential) penalties of the Medical Board... since one of his patients died when he worked in Strax clinic, allegedly after he administered anesthesia himself ..
I will not express my opinion, but 1+1+1 =

Issue permanent suture, following surgery Dr. Oscar Ramirez

I mentioned briefly, however, the visible scars/fact the ears moved forward aside, I'm having issues with the permanent suture starting 1+ year out of surgery. It was poking through the skin at the back of the right ear. I was warned the entire suture needs to come out on short notice and that my surgeon should inform me where exactly my sutures are - aside the fact I should receive all operative notes. The area from the back of my ear to my neck looks swollen and at the back of the ear fluid is leaking out every day - from the place where the suture was poking through the skin. As mentioned, the issue is that I don't have enough skin to open the entire incision up again, and close it after Dr. Ramirez performed surgery. The scars are already stretched and there already is a lot of skin tension. Yesterday, I could feel a small wound at the front of my right ear, with what seemed to be a fleece on top of it. When I touched it carefully to see what was going on, it started to bleed. The front of the ear feels painful too. I still don't know where exactly the sutures are located, I still don't have all my medical records (and I doubt I will ever get them). The suture is inflamed, whether it is infected, I don't know. I developed a bruise at the back of my right ear before. Allover I'm worried.

Letter from Dr. Ramirez to patients - with regard to the revocation of his license

I will also want to post a copy of a letter, provided by Dr. Ramirez to several (prospective) patients. He sent the letter to me too. In the letter he elaborates about the revocation of his license in Maryland, following the death of two of his patients. My text will show why I feel it is relevant.

There are a few aspects in this letter that draw attention, imho. One is the following comment Dr. Ramirez made: "The second patient (patient B) died, at home, 3 days postoperatively probably from a withdrawal from her addiction to prescribed medications that was undisclosed to me or to my staff preoperatively. This was the opinion of my expert witness Dr. Leroy Young. "
That is quite a sharp comment to make - suggesting the diseased patient suffered from an addiction to medication and listing that as the reason of her death - days following an almost 10-hour long surgery. Not in the least since Dr. Ramirez might have used it in his defense, but it has not been acknowledged as factual information in any documentation - not by the medical board, neither in court. As such it is a rather hurtful assumption, that one would hope is drawn based upon solid facts. That is not acknowledged in the court case.

Dr. Ramirez didn't have a transfer agreement with a hospital, was one of the accusations of the medical board. Dr. Ramirez' defense was that he had an "oral agreement", a defense he also expressed in an interview that can be found at Youtube with ABC2 news, and again in this letter. Dr. Ramirez used that argument (i.e.: an oral agreement is as good as a written agreement), on several occasions. In addition, it was confirmed by Dr. Orlando that there was merely an oral agreement, according to the documents of the Medical board in MD: "Dr. Orlando admitted that their agreement was not in writing, but “was actually a handshake agreement.” In addition the medical board concluded Dr. Ramirez did not contact Dr. Orlando in case of emergency, but in fact another hospital nearby, where he did not have any written, nor an oral agreement.
Yet, when in Oct. 14th 2014 the medical board of MD denied Dr. Ramirez' request to get his license reinstated, now Dr. Ramirez made another statement. In this request, after several lost appeals and years later, Dr. Ramirez now states he did in fact have a written agreement, but it got lost. That seems in contrast with any earlier statement made both by Dr. Ramirez, and Dr. Orlando.

Another statement of Dr. Ramirez in this letter: "In doing so, the Board held that the surgery center, although accredited for over 5 years as the highest level ambulatory surgery center, was in fact NOT an ambulatory surgery center!" With this statement Dr. Ramirez expresses his surprise with regard to the fact his accredited surgery center was in fact not an ambulatory surgery center. Which would raise the question if Dr. Ramirez was really not informed that when he ended his malpractice insurance in 2003 he also lost his hospital privileges - and that his was in fact one of the main requirements to get the accreditations for the ambulatory surgery center. And whether he forget to mention this fact (that he had ended his malpractice insurance and with that lost his hospital privileges), when trying to obtain these accreditations, while acknowledging to the medical board it was one of the main requirements to get these accreditations.

Dr. Ramirez mentions in this letter that the length of surgery did not increase the risk the patients were exposed to. He is also referring to research to illustrate that suggestion - Raataataa also referred to research to illustrate exactly the same suggestion. Raataataa is the patient that started posting here instantly denigrating my experience - and as I stated, this happened before, with patients showing up stating these would not be my own pictures, and so on. Obviously not being a healthcare professional, I could and would not want to comment about the potential increased risks, however, this is not what the medical board stated. In addition those statements seem in conflict with Dr. Ramirez' own statements in the medical records of both diseased patients - according to the documents of the medical board in MD: "For both patients, disclaimers in Dr. Ramirez’s operative notes acknowledged that the lengthy duration of the procedures would increase the risks to the patients." His suggestions, are conflicting his own statements in his operative notes.

Dr. Ramirez also states other surgeons lost their license for "much more serious" allegations, in one of his statements, referring to sexual misconduct (I assume this would refer to relationships with patient(s) until they are emotionally broken? Or, perhaps, performing surgery without the required license?)

Dr. Ramirez refers to the injustice and travesty that was done to him, suggesting: "I wonder if I am a victim of a personal vendetta or racial discrimination." This patient Raataataa that came here discrediting me and my experience, expressed exactly the same suggestion: "I think the revocation of Ramirez' license was unfair. Was it racist? That's a question, not an accusation." And, Raataataa made another statement, closely resembling Dr. Ramirez' statements in his letter: "So Goddess A, I suggest you take 24 hours to consider the wisdom of using the Maryland Board's decision as fodder for your vendetta.... " A "personal vendetta" with regard to the prosecution of the medical board according to Dr. Ramirez, a "vendetta" from my side according to Raataataa. (Please see Raataataa's page where you can find all the statements I cited here).
A coincidence this self-declared "neutral" patient is repeating several of Dr. Ramirez' arguments - referring to research with regard to 'lengthy surgery' (as did Dr. Ramirez in his letter), and referring to discrimination with regard to the license revocation (as did Dr. Ramire in his letter), and then referring to "a vendetta" (as did Dr. Ramirez in his letter)? In addition to threatening emails I received the past years?

My personal reply to that question posed both by Dr. Ramirez and by Raataataa, would be that in this complete letter, it seems to have been forgotten that two patients have tragically died. That Dr. Ramirez did not have hospital privileges, yet stated he did when obtaining the accreditations for his "ambulatory surgery center". That patient A died after a nearly 10 hour long surgery, and patient B after a 12 hour long surgery - within a 6 month time frame. That still, Dr. Ramirez performed lengthy surgeries after that in the same surgery center (as multiple patient statements can confirm).
That Dr. Ramirez wrote in the medical records of both patients that the length of these surgery came with increased risks. That, still, in this letter, he states it would not impose any risk to perform lengthy surgery. Yet, this is not what he stated in the final order of the medical board in Florida when defending himself and his patient care - stating he was aware of risks and would only perform surgery within a 6-hour time frame.
That after the settlement with patient's A family, Dr. Ramirez according to the court documents of the medical board "declared himself bankrupt and left for Florida", and according to ABC2 news 'within months after reaching the settlement'. I have letters in my mailbox from Dr. Ramirez, referring to the hundreds of thousands he paid in legal fees to appeal several times against the decision of the medical board of MD - and although I feel I'm not in the position to do so ,I can't help but wonder in the back of my mind: yet there was not a chance to ensure the family that lost their mother and wife at least got part of their settlement?
That, as mentioned, the hospital in Istanbul seemed unaware Dr. Ramirez performed surgery there - neither does staff want to acknowledge he did. What happens if a patient experiences any emergency if the hospital staff is not aware a surgeon from abroad is performing surgery there or does not want to acknowledge he did - or, let's say, for example when performing surgery in Madrid? And this after the tragic events that happened in 2004 and 2005, resulting in the revocation of Dr. Ramirez' license. And I could go on with more serious issues, but I won't in this post. Where does it stop? And what if it concerned your family member? That would be my question in reply, also to all those people trying to keep me from telling everything what really happened and the threats from them in my mailbox: from one ex-partner, to the current partner of Dr. Ramirez, to another ex-partner enabling Dr. Ramirez could perform surgery in a Turkish hospital without the staff being aware. Etcetera.

defense

defense

Upset about the threats, everything

Upset about the threats, everything

upset about all the threats, everything

Can this even be solved?

This is the back of the ear (the one without the infected suture). It looks really obviously, well bad, in my opinion. I did not include the scar extending along the hairline, which is white and wide, and somehow extending into the hair, where part of the hair was removed for the scar - and does not grow back so there is a bald spot now. If I'm up to it, I will post a picture later - it makes me unhappy to see everything myself and I try to not think about it or look at it most of the time.

I used to wear my hair up a lot since I danced a lot. I have *never* worn my hair up anymore since the surgery: not once. The opinion of that patient popping up "Raataataa"stating I could simply get a tissue expander (after stating the results didn't look bad), and another patient showing up stating it was easily resolvabe with a simple scar revision, after patients in the past popping up stating I would not be posting my own pictures. Well, their opinions appear to be wrong. I was adviced by several surgeons they don't use tissue expanders anymore, since they can not let a patient walk around with that (for so long). It bothers me that a patient ''popping up'' online, that I believe to be related to Dr. Ramirez (and I have argued why) would advice me that. Not in the least since Dr. Ramirez himself has not even been willing to give me all of my surgery records for 1,5 years now or have any questions answered about infected sutures and all the issues.

If I look at the scars, I'm simply not sure if this can ever be solved. I was entering my thirties when I had the surgery. I don't want to date anymore - I mean, imagine someone trying to kiss your ear. And given the situation with Dr. Ramirez the combination feels very difficult, because I really want to move away from this. The bald spots in the hair: I was recommended to get hair transplants to resolve that. This would be an incredibly expensive saga, and I can't even get the (what appears to be) infected suture out to start with for now. But can such scars behind the ear even ever be solved? I am not sure. I want to close this off one day.
Dr. Oscar Ramirez

1 out of 5 stars Overall rating
1 out of 5 stars Doctor's bedside manner
1 out of 5 stars Answered my questions
1 out of 5 stars After care follow-up
3 out of 5 stars Time spent with me
1 out of 5 stars Phone or email responsiveness
1 out of 5 stars Staff professionalism & courtesy
3 out of 5 stars Payment process
1 out of 5 stars Wait times
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