Category Archives: Head and Neck

Ear Plugs for musicians and hearing protection

I posted this on my personal FaceBook

“I suffer from hyperacusis (sound distortion) in mainly one ear. I’m wondering if there are ear plugs out there that would work with piano or music playing. About 15 years ago, I had an ENT in Springfield Illinois make me a custom ear plug which cut down the sound partially, but I only had it made for one ear. I’m thinking that I might need it for both ears, and I’m not sure if anything is now off the shelf. I could probably just use those foam buds. If anything I could try Botox around the ear for this – it hasn’t been tried yet, I could be a pioneer here. It seems that Botox works for so many other things.”

And I got the response from another fellow doctor who suggested:

“Try etymotic , they reduce DB in a flat style, appropriate for musicians.”

I’ll have to try these ear buds for hearing protection, and I hope to report back.  This would be great in an operating room environment too.  There is a lot of suction and other noises going on in the operating room.  I’ll have to see if these will work.  I have heard that dentists use ear plugs like these, so I think it would work well for surgeons in the operating room as well.

custom ear plugs

My previous ear plugs (hearing protectors) were made by Westone Laboratories, Inc.   – westone style # 49.  These were custom made and I had them made by an Ear Nose Throat Surgeon who made a mold of my ear canal and sent it to the company.  But this was back around the year 2001.  I just visited their webpage and it seems to have Etymotic ear plugs for sale at their webpage as well.

Google search “westone style 49.” for more info.



When to restart Tretinoin after an Obagi Blue Peel Radiance Peel

I got this question today, and it’s a question we address constantly.  I thought I’d write about restarting facial topical Tretinoin after a Blue Peel Radiance (Obagi) Peel treatment on the face.

Obagi Blue Peel Radiance in Modesto, CA

When should I re-start Tretinoin again after I receive a Blue Peel Radiance Peel (Obagi)?

The quick answer is about 6 days to restart your tretinoin, also known as Retin-A (among other names).  The range for most patients would be 4-8 days.  Some can restart sooner if there wasn’t too much irritation from the Obagi Blue Peel Radiance.

The problem of starting Tretioin too soon after a Blue Peel Radiance is that your skin may become too irritated and uncomfortable.

The same goes for restarting all the other Obagi Nu-Derm skin care products which may have been stopped – such as Exfoderm, Exfoderm Forte.

Everyone’s skin is a little different and every esthetician, doctor, dermatologist, surgeon, nurse has a different plan.  My guideline of about 6 days works for us at Surgical Artistry, Modesto.  But please consult your own practitioner for their own preferences.  Our plastic surgery office is directed by Dr. Tammy Wu, Plastic Surgeon and we are located in Modesto, California.  Different locations and different climates on the skin affect these recommendations on returning back to tretinoin use.

Other important aftercare instructions for Obagi Blue Peel Radiance Chemical Peel:

Download the Blue Peel RADIANCE After-care Card here or with the below link.


The pdf file above will talk about the importance of applying Sunscreen.

When to consider another Blue Peel Radiance Chemical Peel.

One can consider another Blue Peel Radiance chemical peel about 1 month later.  Theoretically, one can consider a repeat Blue Peel Radiance as close as 2 weeks apart.  The purpose of “stacking” the peels closer together is to continue to get better results.  After about a series of 5 peels, the improvement is at it’s maximum, and then the goal is maintenance which may be achieved with continued peels every 2-3 months.

Facial Plastic Surgery – Head, Neck, Facial Cancer Notes


Triangles of the neck – anatomy

Most of this is probably of interest to folks that work with facial anatomy: such as ENT’s – Ear Nose Throat surgeons, facial plastic surgeons, cosmetic surgeons, and those who work around the face all the time such as dermatologists, and cosmetic injectors who perform Botox and dermal fillers.  These are notes that I took for myself while reviewing some head and neck cancer issues.  Keeping up to date and reviewing medical knowledge is important for my – Calvin Lee, MD – surgical practice in Modesto, CA.

Sistrunk Procedure for Thyroid Glossal Duct Cysts with papillary carcinoma

Surgical Review: Sistrunk Procedure (of which I’ve done a few in my career) and some with assistance from my expert Modesto surgeon friend Dr. Suntra (ENT/facial plastic surgeon) is used for the removal of thyroid glossal duct cysts and involves the cyst removal in continuity with the tract, central portion of the hyoid bone, and tissue above the hyoid bone to the base of the tongue. This procedure is usually considered adequate for a finding of a well differentiated papillary carcinoma of the thyroid.

Fine Needle Aspiration for diagnosing neck lymph nodes

Surgical Review: FNA (fine needle aspiration) is considered first line for tissue diagnosis for a solitary neck mass suspicious for metastatic squamous cell carcinoma.

Tonsils – the great sequester of cancer in the head and neck

Surgical Review: Consider tonsils when finding a non-obvious source of metastatic squamous cell carcinoma in the upper neck.

Metachronous and Synchronous – definition

Surgical Review head and neck cancers: Metachronous means occurring at different times, as opposed to synchronous (at the same time).

Lateral Aberrant Thyroid = papillary thyroid carcinoma

My personal Surgical Review: Lateral Aberrant Thyroid is a lymph node metastasis from papillary thyroid carcinoma. Consider the surgery of: total thyroidectomy with a neck dissection ie. central compartment.


Wartin’s Tumor – treat with parotidectomy superficial or total

My personal Surgery Review: Papillary Cystadenoma Lymphomatosum (Warthin’s Tumor) is a benign salivary tumor (like pleomorphic adenoma), which is usually in the Partoid gland. Treatment is excision with superficial (lateral) parotidectomy or total parotidectomy (which preserves the facial nerve) depending on location of the benign tumor. Enucleation is contraindicated due to recurrence.


Facial nerve, parotid gland



Just some personal notes for Calvin Lee, MD Modesto, CA.  No medical advice here.