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Introducing the EarFold to Ireland

We are delighted to announce that EarFold, the new minimally invasive technique for prominent ear correction, is now available for the first time in Ireland at Blackrock Clinic!

The procedure is done under local anaesthetic using a small incision in front of the ear to insert the small titanium clip, and takes about 30 minutes to complete.

No incision behind the ear, no head bandages, less down time and less side effects than with a traditional otoplasty.

Developed by renowned plastic surgeon Mr Norbert Kang and now part of the excellent Allergan range of products, this is a very exciting development in ear surgery and fits in beautifully with my preferred small scar, limited downtime approach to surgical procedures*.

Prices start at  2500 Euro for 1 device

See www.earfold.com or contact us for further information or to arrange a consultation.

Procedure video:

 

*Only available from EarFold trained consultant surgeons

Tongue Tied no more…

 

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So my first blog post – it had to be this topic..

I have been brewing a fair few blog posts in my mind on this subject over the last year or so. Quite cathartic to have a forum to vent (sorry all those of you who have been in with your beautiful babies and heard me on a rant about any one of these parts of the politics and pathology of tongue tie treatment in Ireland!)

Tongue tie classification

Currently the classification system for tongue tie that we hear can go from the mild-moderate-severe as a grading system, but oddly with this one, we only ever hear “mild” on referrals – which is most interesting; if I was to ever collect this data as I can be sure that if “mild” is mentioned, the baby will always have a complete tongue tie..

The current accepted classification system that we all use classifies the ties into anterior (or close to the front of the mouth) and posterior (closer to the back).

Currently the descriptive terms are generally accepted as follows:

  • Anterior type 1 – accepted as 100% tie to the tip
  • Anterior Type 2 – slightly behind the tip
  • Anterior type 3- further back – some include this as a posterior tie
  • Posterior type 4- under the mucosa/ the invisible, palpable tie

But why do some in one type do well, while others do not?

Well, what the current classification does not address are:

  1. The attachment to the tip of the tongue,
  2. The attachment to the floor of the mouth
  3. The position of the muscle (genioglossus) underneath the tie.

I think the latter has more of an impact than we realise on the outcome of a frenotomy, and what I have found is that one seems to dictate the other.

These three components are all hugely variable between babies, but there is still a pattern if you look (and feel!).

These anatomical features are also critical to outcome prediction.

The more tongue ties I see, the more I think that the anatomy is what dictates function, and therefore the function post release, as well as the concept of “reattachment” (dreadful term; next blog!)

So why don’t we use anatomy instead? Well, why not!? Just because an old system exists is no reason to plod on with the same old system. Time moves on, and education and experience improves both our understanding and patient care.

So how should we classify them?

Tongue ties need to be classified and descriptively rather than anterior and posterior types (which doesn’t make sense given what these terms mean). I have broken it down into 3 concepts.

1.Rebrand.

Anterior should be thought of as “Classic”

Posterior should be thought of as “Submucosal”

2. Think bidimensionally!

Don’t think of ties in one dimension. When looking at a tie what matters most is whether the tie is vertical or oblique – I think this is what dictates the outcome.

Oblique attachments inevitably have the genioglossus muscle right behind the tie, not leaving a whole lot of room for division as I am limited by the presence of the muscle (no, we don’t divide the muscle!). (Think the “Eiffel tower” type)

3. Tension= poor function!

On division (And sometimes before, with manual examination or using a retractor), the fibrous composition of a tie can be commented upon. Some are tighter than others, and this isn’t new science.. but the tight ones seem to get an immediate result when it comes to maternal discomfort.

Having a more accurate terminology is far more useful in identifying the babies that will need extra support, providing better information to assess outcome, help to manage expectations, and most importantly help us to further understand and improve our service to these babies and their mums.

Confused or clarified?

Siun x

Tongue-Tie

Blackrock Aesthetics Blog

Welcome to our blog from Blackrock Aesthetics!

We will rotate topics to cover all treatments offered by us –

From skincare to surgical procedures, whats hot in aesthetic and plastic surgery, topics of interest, and tongue ties of course!

Watch this space…

Siún x

 

Choosing your surgeon in Ireland

Patients seeking plastic, cosmetic (aesthetic) or reconstructive surgery should always check to see if their doctor is qualified to perform plastic surgery.

In Ireland, just about anyone with a basic medical degree is allowed to perform cosmetic surgery. Hard to believe, but currently there is no legislation in place that prevents any doctor, even your local GP, without having undergone formal surgical training to call themselves a ‘surgeon’.

Your only safeguard is to look for the letters FRCS (Plast) with a doctors name and check that they are affiliated with the Irish Association of Plastic Surgeons (IAPS), as only fully qualified plastic surgeons have these titles and memberships. Only after surgeons have completed extensive higher surgical training (six years) in Plastic Reconstructive and Aesthetic Surgery, specialist examination (FRCS Plast) and in-service assessments by the Royal College of Surgeons are they eligible to be entered onto the Irish Medical Council’s specialist register.

In other European countries, such as France and Denmark, there are clear legal guidelines that state what type of surgery can be performed and which practitioners can offer what type of services. These were developed, in the interest of patient safety, after years of misleading advertising, inaccurate website claims and unsubstantiated claims of success by non-specialist doctors and commercial clinics in those countries.

Check www.plasticsurgery.ie for a comprehensive list of all accredited plastic surgeons. Choose wisely. Protect yourself.