jawsurgeryforums.com
Surgeon Information => Surgeon Reviews and Leads => Topic started by: UKMaxfac on June 06, 2017, 11:28:38 AM
-
Hello everyone,
I just wondered whether anyone here had surgery with him and their experience?
If I'm not wrong there was an older lady on here who had bimaxillary surgery with him at some point and was pleased with his work.
-
Hello everyone,
I just wondered whether anyone here had surgery with him and their experience?
If I'm not wrong there was an older lady on here who had bimaxillary surgery with him at some point and was pleased with his work.
Yes I forget her username but she had a good result, he did counter clockwise rotation and a genioplasty in something like 4 hours? I can't quite remember but it was in short time which might sound alarming because you would want the surgeon to take care but really the less time you are subjected to general anesthesia the better, it causes brain damage amongst other health problems and the shorter the surgery, the quicker the recovery.
Personally, I would be very interested in having a consultation with him.
-
No, it was under 2 hours. I thought her result was very good and basically made her look 20 years younger as she said. He does jaw surgery as it should be done: big jaw movements with counterclockwise rotation when needed and a small genio.
http://jawsurgeryforums.com/index.php?topic=4156.0
http://www.institutomaxilofacial.com/en/ortonatic-surgery/minimally-invasive-surgery/
-
No, it was under 2 hours. I thought her result was very good and basically made her look 20 years younger as she said. He does jaw surgery as it should be done: big jaw movements with counterclockwise rotation when needed and a small genio.
http://jawsurgeryforums.com/index.php?topic=4156.0
http://www.institutomaxilofacial.com/en/ortonatic-surgery/minimally-invasive-surgery/
Wow under 2 hours, yep he looks like a class A surgeon and his prices aren't ridiculous.
-
I think I emailed Dr Alfaro and I spoke with the lady from England who went to Barcelona to have surgery with him. Her DJS was just under 2 hours, she healed up really fast and was walking around the next day or two in minimal discomfort. She also only has minimal numbing on her chin which is fantastic for us who are older. If I remember correctly Dr Alfaro has an adjoining building for recovering patients next to the hospital that can accommodate the patient and one other person. Its sort of like a recovery hotel with nurses on call. Sounds pretty awesome to me except that its in another country.
-
Damn I hope Alfaro doesn't jack up the prices by the time i'm ready to have surgery, which will be 3 years from now. he seems to me like the best choice so far for ccw rotation
-
Damn I hope Alfaro doesn't jack up the prices by the time i'm ready to have surgery, which will be 3 years from now. he seems to me like the best choice so far for ccw rotation
'
I doubt it, how many people will come from this website? Don't forget he is in Spain.
-
Damn I hope Alfaro doesn't jack up the prices by the time i'm ready to have surgery, which will be 3 years from now. he seems to me like the best choice so far for ccw rotation
Did you have an initial consult with Alfaro or an email or anything? Im curious if you learned any details about the recovery building they have next to the hospital. Im almost positive either someone from Alfaro's office or a patient told me its like a hotel except nurses come check on you, they provide meals, and you can have a guest stay with you as well. That sounds amazing and super comforting to anyone who is anxious about recover (Meeeee!)
-
there must be a catch somewhere... seems almost too good to be true imho
-
there must be a catch somewhere... seems almost too good to be true imho
Many high volume surgeons with a lot of fly in patients have some kind of a deal with a nearby hotel.
-
there must be a catch somewhere... seems almost too good to be true imho
the catch is Alfaro's clinic is like a production line factory.
Some people especially I'm The Most Important Person In Your Life type patients are disturbed by the volume of patients he sees, thinking they won't get optimal treatment or something.
-
Did you have an initial consult with Alfaro or an email or anything? Im curious if you learned any details about the recovery building they have next to the hospital. Im almost positive either someone from Alfaro's office or a patient told me its like a hotel except nurses come check on you, they provide meals, and you can have a guest stay with you as well. That sounds amazing and super comforting to anyone who is anxious about recover (Meeeee!)
I haven't contacted him in any way yet still gathering info and opinions but my intuition points to him. and i am a fan of this minimally invasive s**t. i also dunno exact details about the hospital stay, was hoping to get some juicy info here about it toothere must be a catch somewhere... seems almost too good to be true imho
but rhen i have these exact same thoughts
-
the catch is Alfaro's clinic is like a production line factory.
Some people especially I'm The Most Important Person In Your Life type patients are disturbed by the volume of patients he sees, thinking they won't get optimal treatment or something.
Yet your local "best guy in the state", who's lucky to do 20 orthognathic surgeries per year will not think about you even once outside of your appointment/surgery.
People should stop thinking of surgeons as some sort of friend. Nobody selling you something is your friend. All that fake chumminess flies out the window the moment something goes wrong. Probably the most psychopathic occupation in existence.
-
Heard mixed things from his patients.
Marianetti cited him as the best in Europe.
I think he is super skilled but he wants autonomy in his plans and does not care much for the patient's input if it contradicts his designs.
Mixed bag.
-
Many high volume surgeons with a lot of fly in patients have some kind of a deal with a nearby hotel.
i couldnt care less about the hotel, im talking about his so called 'minimally invasive' surgical approach.
-
I heard a pretty horrid testimonial about this surgeon which I did not know what to make of.
Marianetti cited him as the best in Europe.
I think he is super skilled but he wants autonomy in his plans and does not care much for the patient's input if it contradicts his designs.
Mixed bag.
From who? What did it say? You cant just say 'I heard something really bad' and then not explain yourself...
-
From who? What did it say? You cant just say 'I heard something really bad' and then not explain yourself...
Quite, here we go again lol.
-
From who? What did it say? You cant just say 'I heard something really bad' and then not explain yourself...
I will Pm you.
-
I will Pm you.
thanks
-
The biggest worry with high volume providers is that some intern ends up operating on you instead of the big name.
-
You got it.Yep , that was part of what I was told in the less than 5 star review.
That part really creeps me out. We do all this research ,go to a surgeon like we are going to a new religion and then some intern comes to lose his max fac virginity on you!!!
I mean even if it was a good job , I would be haunted if I learnt that.
-
Christ yes that's a good point, people thought that was the case with Mommaerts.
-
The biggest worry with high volume providers is that some intern ends up operating on you instead of the big name.
this seems like the boogey-man tale of jaw surgery
i.e i do not think it has ever actually been found to be true, nor do I think it is plausible. For starters, the depth of legal hot water is mind boggling, no surgeon in 2017 in any first world country would try that s**t on with a 10 foot pole. Doctors are paranoid about lawsuits stemming from just giving commentary to patients, let alone the amount of CRIMINAL charges that could be brought against them in a case where they let an intern operate on you against your consent.
People should be aware that in any field of medicine there are not just problem doctors.... there are problem patients, and these people are not above making complete bulls**t up to "fortify" their stories for lack of a better term. There was a guy on here who wrote a rather compelling but ultimately nonsensical hollywood like fiction about a surgeon bringing him out of anaethesia mid-surgery "on purpose" to "teach me a lesson" ::) - it may well be the case he has legitimate grievances with the work of his surgeon, but the compulsive need to lie to bolster their perspective against what they have now decided is their enemy in life is probably pathological.
-
this seems like the boogey-man tale of jaw surgery
i.e i do not think it has ever actually been found to be true, nor do I think it is plausible. For starters, the depth of legal hot water is mind boggling, no surgeon in 2017 in any first world country would try that s**t on with a 10 foot pole. Doctors are paranoid about lawsuits stemming from just giving commentary to patients, let alone the amount of CRIMINAL charges that could be brought against them in a case where they let an intern operate on you against your consent.
People should be aware that in any field of medicine there are not just problem doctors.... there are problem patients, and these people are not above making complete bulls**t up to "fortify" their stories for lack of a better term. There was a guy on here who wrote a rather compelling but ultimately nonsensical hollywood like fiction about a surgeon bringing him out of anaethesia mid-surgery "on purpose" to "teach me a lesson" ::) - it may well be the case he has legitimate grievances with the work of his surgeon, but the compulsive need to lie to bolster their perspective against what they have now decided is their enemy in life is probably pathological.
Yeah very true about problem patients making s**t up too.
There was a woman who had a facelift by a well known plastic surgeon in London, I saw photos he actually left folds/ creases on her face like bunched up leather, she was adamant that he had an intern do some of the surgery so was in a battle to get the surgery record, don't know what happened with that.
Well mostly in America doctors are terrified of lawsuits in some parts of Europe it is practically impossible to sue a surgeon.
-
You got it.Yep , that was part of what I was told in the less than 5 star review.
That part really creeps me out. We do all this research ,go to a surgeon like we are going to a new religion and then some intern comes to lose his max fac virginity on you!!!
I mean even if it was a good job , I would be haunted if I learnt that.
Surely if you specify and make absolutely clear u want the main guy doing it, then he will do it...
-
Surely if you specify and make absolutely clear u want the main guy doing it, then he will do it...
Idk. I am not talking about this surgeon specifically I am talking about the possibility of this going on. I think you spoke with the source. He says it happens in Spain. His experience in Spain is limited to this surgeon.
Ofcourse we need to take everything with a grain of salt but that person has no incentive to lie privately.
-
this seems like the boogey-man tale of jaw surgery
i.e i do not think it has ever actually been found to be true, nor do I think it is plausible. For starters, the depth of legal hot water is mind boggling, no surgeon in 2017 in any first world country would try that s**t on with a 10 foot pole.
Doctors are paranoid about lawsuits stemming from just giving commentary to patients, let alone the amount of CRIMINAL charges that could be brought against them in a case where they let an intern operate on you against your consent.
Good luck suing the surgeon. Look at all the botched MM surgeries - I can think of 5 on this forum alone. Results so bad that it could not have possibly been him.
Look at the massive volume of surgeries that these big name clinics do. Even your local bum surgeon typically operates like it's an assembly line: one after the other on the same day. It's mostly wisdom teeth and implants, but hey, even he has to take a piss, have a break. What do you think the interns are there for? Merely to hand him instruments?
A dental nurse who works for max facs told me that once the patient is under, all the pleasantries fly out the window - your head is a football. Not out of malice - it's a business and time is money. You really have no idea what goes on once you're under.
-
I had my Alfaro consult. He wants to do rhinoplasty in the same operation as Bimax AND genioplasty. It's a revision rhino case so I'm worried.
He wants to do all of this without braces before or after surgery.
Not sure what to think!
He also says he does some 'trimming' of the paranasal area during surgery to 'accommodate' the nose and the lips.
-
I had my Alfaro consult. He wants to do rhinoplasty in the same operation as Bimax AND genioplasty. It's a revision rhino case so I'm worried.
He wants to do all of this without braces before or after surgery.
Not sure what to think!
What does he propose for fixation? Imf screws? Arch bars? Didn't know he does rhinos. What does he want to do? What do you need done?
-
What does he propose for fixation? Imf screws? Arch bars? Didn't know he does rhinos. What does he want to do? What do you need done?
I've just emailed that question to him amongst some others. I didn't know either.
In terms of the bimax he says - CW rotation, 6mm+ downgraft (ATLEAST 6mm he said, so that I show 2-3mm of gum postop which is the 'normal' situation for a man of my age)
Not much advancement.. he doesn't see the need for it. It's more of a vertical movement.
I believe I sent you the X-rays I got from another surgeon with the 3d view of my face / skull - its basically the same plan with some changes. I just need to pick between defrancq and alfaro now....
-
Good luck suing the surgeon. Look at all the botched MM surgeries - I can think of 5 on this forum alone. Results so bad that it could not have possibly been him.
Look at the massive volume of surgeries that these big name clinics do. Even your local bum surgeon typically operates like it's an assembly line: one after the other on the same day. It's mostly wisdom teeth and implants, but hey, even he has to take a piss, have a break. What do you think the interns are there for? Merely to hand him instruments?
A dental nurse who works for max facs told me that once the patient is under, all the pleasantries fly out the window - your head is a football. Not out of malice - it's a business and time is money. You really have no idea what goes on once you're under.
This is very scary.
To prevent actions like this happening and to protect each party I think there should be cameras set to the OR and where ever the patient is while they are under anestesia and passed out.
I have friends who have a camera at their home that are attached to wifi. Through that they can observe things through their phone that go around in their house while they are gone. They can also talk with the person who are there. It quite cheap system even the camera quality is quite good. Less than 50€.
Now when something has gone terribly wrong the doctors never take responsibility of their doings and blame many times that the patient is crazy. I think any good facility should set up a video surveillance like this, thus they show they have nothing to hide and they show that if something wrong happens they can always double check that who did what around the patient while they were drugged out. I can not think any reason why would someone argue against this sort of surveillance. Then there would be no need for blaming eg. the malpractice victim who has all ready hard time coping that they are troll and crazy when they only try to tell online the truth about the horrors they went through in some place.
I think 50€ is not a big investment for the safety that should be the number 1 priority at any facility.
-
I've just emailed that question to him amongst some others. I didn't know either.
In terms of the bimax he says - CW rotation, 6mm+ downgraft (ATLEAST 6mm he said, so that I show 2-3mm of gum postop which is the 'normal' situation for a man of my age)
Not much advancement.. he doesn't see the need for it. It's more of a vertical movement.
I believe I sent you the X-rays I got from another surgeon with the 3d view of my face / skull - its basically the same plan with some changes. I just need to pick between defrancq and alfaro now....
I'm guessing Alfaro wants to do a lot more rotation than DF?
-
I'm guessing Alfaro wants to do a lot more rotation than DF?
he wants to do basically the same as defrancq. Extrusion (downgrafting) and advancement.
My choice is basically either go with DF and have a slightly more subtle result, or go with Alfaro which is way more expensive with less downtime but likely a less natural result (I've seen alot of his results and alot of them look very obviously like they have had jaw surgery - i hate that look).
-
whole maxilla , anterior and posterior will be downgrafted in both plans?
-
whole maxilla , anterior and posterior will be downgrafted in both plans?
I'm still waiting on responses from Alfaro - but neither of them mentioned posterior. A UK surgeon did. but I'm not going with him for many reasons.
Basically my face is just entirely too short, and has been since age 13-14, so it's the anterior that needs to come down alot.
-
How much is Alfro roughly for bimax?
-
Hey Maxfac,
Did you have to pay Alfaro for the workup like you had to pay Defrancq?
Cheers.
Well since I already had DF's workup I just showed all the stuff to him (images) with the plan etc. I have only skype consulted with Alfaro, whereas DF i saw in person.
-
Thanks! I'm having a skype consultation with him soon, too. Did you mail him the Defrancq stuff prior to the consultation?
It's interesting that he wants to do rhino at the same time, everything I have heard regarding that has been that it's not a good idea. Then again, Alfaro seems quite progressive. When you say he's more expensive than JDF, are we talking more than 5k euros extra?
It's significantly more expensive yes. Over 5k more.
-
he wants to do basically the same as defrancq. Extrusion (downgrafting) and advancement.
My choice is basically either go with DF and have a slightly more subtle result, or go with Alfaro which is way more expensive with less downtime but likely a less natural result (I've seen alot of his results and alot of them look very obviously like they have had jaw surgery - i hate that look).
What are the tells of bimax surgery w/Alfaro and just in general, other than an overtly protruding/full upper lip to nose region? I don't really notice what you're saying in the b/a's on his site. Except some people have funky lower lips post op. Also some of the shots are kind of awkward in the pose and not proper comparison photos. One guy has obvious divots in his jawline where the cut were made and looks significantly older with overall fat loss to the face, but maybe he just lost a lot of weight from the surgery. Not like he was overweight in the least before.
-
Ya from what I hear/see Alfaro's B n As are not dramatic. Maybe havent seen enough.
-
What are the tells of bimax surgery w/Alfaro and just in general, other than an overtly protruding/full upper lip to nose region? I don't really notice what you're saying in the b/a's on his site. Except some people have funky lower lips post op. Also some of the shots are kind of awkward in the pose and not proper comparison photos. One guy has obvious divots in his jawline where the cut were made and looks significantly older with overall fat loss to the face, but maybe he just lost a lot of weight from the surgery. Not like he was overweight in the least before.
http://www.institutomaxilofacial.com/en/caso-clinico/david/
http://www.institutomaxilofacial.com/en/caso-clinico/leticia/
https://vimeo.com/41901371
They all look 'done' to me..
-
Only overdone one I think is this girl:
(https://i.gyazo.com/6b077d3912ee28896ae79359b84b96a4.png)
What do you guys think?
I like it yeah that is the only one in his gallery that looks somewhat extreme but still natural imo, thrte is nothing unusual about his other results, that's just how soft tissue can react to jaw surgery and there is still some swelling in some of the photos.
-
not good age or even century to undergo any not mandatory surgery. Most surgeons are not responsible for what they are doing
-
not good age or even century to undergo any not mandatory surgery. Most surgeons are not responsible for what they are doing
You've had a bad experience, so you would say that.
I've met many people IRL who had jaw surgery for aesthetic purposes and they told me its the best decision they ever made.
I've only ever heard nightmare stories on this forum
-
Actually I find some of his work UNDERDONE so it's interesting to see different opinions on here, overall from what I see, he looks like a top class surgeon.
-
You've had a bad experience, so you would say that.
I've met many people IRL who had jaw surgery for aesthetic purposes and they told me its the best decision they ever made.
I've only ever heard nightmare stories on this forum
Yes. Same. There are definitely bad outcomes but they end up being vocal while most people who improve just move on with their lives and only recount their experience privately generally.
Sad what Rico has had to go through. But quite a different case from standard bimax.
-
I didn't have surgery on jaw , but on zygoma
anyway If you like having damaged nerves permanently (50% cases) go for it :)
-
I didn't have surgery on jaw , but on zygoma
anyway If you like having damaged nerves permanently (50% cases) go for it :)
So you never had any form of jaw surgery....
???
I'm not going to say anything bad here but seriously you are just trying to provoke a reaction because you are upset about your surgical experience.
No one is saying bimax doesnt have a ton of risks involved but lets keep things in perspective.
-
What does he propose for fixation? Imf screws? Arch bars? Didn't know he does rhinos. What does he want to do? What do you need done?
(http://i.imgur.com/PTGreKC.png)
-
If he's as fast as he claims to be, the swelling will not have set in yet by the time he starts on the nose. Anyway I would favour him for the following reasons:
* piezoelectric tools may lead to less nerve damage
* his age
* surgeons who can do CCW with posterior down grafting (which apparently Alfaro does regularly) can do any kind of plan. Even if you don't need CCW (and you don't) - it's a mark of a skilled surgeon.
What I find questionable:
* I'm not a fan of surgery-first. Some of his before and afters have obviously misaligned mid-lines.
* Clinics with massive volumes like his and a few big name American ones - you may just be buying the brand and not the surgeon. (If you have a friend in dental school, coax him/her to come with you and observe the surgery "for educational reasons". I'm sure he will be allowed to. This way you'll be certain that the big name surgeon will be the one operating on you.)
-
* Clinics with massive volumes like his and a few big name American ones - you may just be buying the brand and not the surgeon. (If you have a friend in dental school, coax him/her to come with you and observe the surgery "for educational reasons". I'm sure he will be allowed to. This way you'll be certain that the big name surgeon will be the one operating on you.)
What are you basing this on? You've heard about this happening alot?
-
i asked:
(http://i.imgur.com/TiAeegv.png)
lol
-
Their website lists four other maxillofacial surgeons, so there is the potential for someone other than Dr Alfaro - unless they are all in the Valencia office. Perhaps making a specific request is enough?
http://www.institutomaxilofacial.com/en/about-the-institute/team/
-
How does he compare to some one like Defranq??
-
i asked:
(http://i.imgur.com/TiAeegv.png)
lol
"This image does not exist"
Does anyone know of other forums or sites going over Alfaro as a max fac?
-
How does he compare to some one like Defranq??
Alfaro is younger, more skilled, cutting edge, has better eye for aesthetics, etc. I would choose Alfaro over Defrancq.
-
"This image does not exist"
Does anyone know of other forums or sites going over Alfaro as a max fac?
The image was a response from his staff. I just asked if it would definitely be HIM doing the surgery as this was extremely important to me, they responded: "ABSOLUTELY"
-
Alfaro is younger, more skilled, cutting edge, has better eye for aesthetics, etc. I would choose Alfaro over Defrancq.
Comparison of Alfaro to Raffaini and Marianetti? Those are the three docs I've been contemplating for EU bimax
-
Comparison of Alfaro to Raffaini and Marianetti? Those are the three docs I've been contemplating for EU bimax
From the pictures I have seen, Raffaini has the best results of any surgeon, hands down. Blows the rest of them out of the water.
I've seen pics from:
Defrancq
Haers
Johnson
Sailer
Mommaerts
Zarrinbal
Alfaro
plus a few more..
Raffainis results (atleast the ones on his website) look to be the most lifechanging and dramatic by far. The kind of results that would make a persons life do a 180. The only comparable results I saw were from Woolford, but many people here keep saying he replaces jaw joints etc, sounds scary and weird.
-
You have seen Dr Zarrinball's results? They are only available in clinic.
-
I too think Raffaini's pictures are great, but I've also spoken to people who've actually consulted with him and have pointed out that he cherry-picks the absolute best cases. Its not a good metric to rely on, IMO its a much better indication of a surgeon when you are seeing not only the good cases with people who are basically good looking aside from their deformity and then having the deformity fixed, but you are also seeing people who are frankly ugly and still ugly but better looking after the surgery.
That said, Raffaini is absolutely competent and experienced I'm sure, but it is worth remembering we're seeing the cream of the crop only.
-
These two Alfaro results don't look good at all:
http://www.institutomaxilofacial.com/en/caso-clinico/ana-4/ - no impaction of the upper jaw
http://www.institutomaxilofacial.com/en/caso-clinico/eva-maria/ - over advancement of the lower with a too long chin (now looks like an underbite)
-
Yes I forget her username but she had a good result, he did counter clockwise rotation and a genioplasty in something like 4 hours? I can't quite remember but it was in short time which might sound alarming because you would want the surgeon to take care but really the less time you are subjected to general anesthesia the better, it causes brain damage amongst other health problems and the shorter the surgery, the quicker the recovery.
Personally, I would be very interested in having a consultation with him.
I am that " older lady" and had the surgery 31 months ago. Delighted with the whole process!
The operation took less than two hours. Great surgeon, excellent treatment. I stayed in a nearby hotel
for six days afterwards. I only looked on the site today as someone contacted me from this site.
-
I am that " older lady" and had the surgery 31 months ago. Delighted with the whole process!
The operation took less than two hours. Great surgeon, excellent treatment. I stayed in a nearby hotel
for six days afterwards. I only looked on the site today as someone contacted me from this site.
Hi Langpam,
Did you have any nasty long term side effects from the surgery? Any significant nerve issues? Funny sensations?
Just curious, thanks.
-
These two Alfaro results don't look good at all:
http://www.institutomaxilofacial.com/en/caso-clinico/ana-4/ - no impaction of the upper jaw
http://www.institutomaxilofacial.com/en/caso-clinico/eva-maria/ - over advancement of the lower with a too long chin (now looks like an underbite)
Yeah those are poor.
Damnit, I wish choosing surgeons was easier.
-
You have seen Dr Zarrinball's results? They are only available in clinic.
Ive seen his results in office. He is very honest about them, showing me extremely good results, more subtle results, and difficult cases which would potentially turn off the uninformed layman. He is very competent aesthetically, and can deliver excellent results. His honesty and transparency put him near the top of my list for europe. Results were all considerable improvements, mostly conservative, but correctly diagnosed. He does decent jaw surgery, and should certainly be considered.
-
Ive seen his results in office. He is very honest about them, showing me extremely good results, more subtle results, and difficult cases which would potentially turn off the uninformed layman. He is very competent aesthetically, and can deliver excellent results. His honesty and transparency put him near the top of my list for europe. Results were all considerable improvements, mostly conservative, but correctly diagnosed. He does decent jaw surgery, and should certainly be considered.
Thanks!
-
These two Alfaro results don't look good at all:
http://www.institutomaxilofacial.com/en/caso-clinico/ana-4/ - no impaction of the upper jaw
http://www.institutomaxilofacial.com/en/caso-clinico/eva-maria/ - over advancement of the lower with a too long chin (now looks like an underbite)
Ana would've benefitted from an upper lip lift followed by impaction... But how many oral surgeons are comfortable suggesting this? Lip lifts are a gamble even with the best plastic surgeons.
Eve would've probably benefitted from vertical chin reduction and I'm not sure if her midlines are perfectly aligned (I could've sworn there used to be close ups of her bite on that page before).
Having said this, these were pretty hard cases. I don't think any surgeon would've done better where I live.
-
Ana would've benefitted from an upper lip lift followed by impaction... But how many oral surgeons are comfortable suggesting this? Lip lifts are a gamble even with the best plastic surgeons.
Eve would've probably benefitted from vertical chin reduction and I'm not sure if her midlines are perfectly aligned (I could've sworn there used to be close ups of her bite on that page before).
Having said this, these were pretty hard cases. I don't think any surgeon would've done better where I live.
Ana's nose is her biggest flaw. It sort of throws everything off.
You can see pictures of Eva's bite in the video. The midlines were way off before. After, the bite looked solid, but the midlines were still a little off.
-
How are these poor? What makes you think the first girl needs impaction? The second girl was rotated drastically and is a huge success considering her base state.
Second girl: went from recessed chin to a masculine chin and an almost class 3 appearance.
First girl: theres no more harmony in the midface, her philtrum is still way too long and she is still a mouth breather with lip incompetence. You can see she still shows way too much tooth at rest.
There are other bad results on there too. I'm not impressed with many of his cases at all. They look 'overdone' in many cases. He assured me this won't happen with me but I'll never trust the words of a surgeon again after my experience with Haers.
-
Plosko - you make an interesting point about lip lifts. The orthodoxy of looking at whether the patient has a short upper lip as a marker of vertical maxillary excess is about as helpful as looking at the colour of one's hair or eyes in the same context. In such cases, what should happen is that the impaction should be done as per the orthognathic problem, THEN a lip lift should be done in order to adapt the soft tissue to the corrected structure. Yet many doctors don't actually think along these lines, which is ridiculous. To me, it's obvious that within a certain growth pattern there will be a number of variations from person to person due to genetics or concurrent/separate facial development issues. Most surgeons have a very orthodox approach to these problems and people just submit to their plans because they aren't aesthetically astute and are "happy" regardless.
As a woman, I would not be comfortable going to Alfaro but if I was male, I might consider him if I desired a very strong jaw.
-
Plosko - you make an interesting point about lip lifts. The orthodoxy of looking at whether the patient has a short upper lip as a marker of vertical maxillary excess is about as helpful as looking at the colour of one's hair or eyes in the same context. In such cases, what should happen is that the impaction should be done as per the orthognathic problem, THEN a lip lift should be done in order to adapt the soft tissue to the corrected structure. Yet many doctors don't actually think along these lines, which is ridiculous. To me, it's obvious that within a certain growth pattern there will be a number of variations from person to person due to genetics or concurrent/separate facial development issues. Most surgeons have a very orthodox approach to these problems and people just submit to their plans because they aren't aesthetically astute and are "happy" regardless.
As a woman, I would not be comfortable going to Alfaro but if I was male, I might consider him if I desired a very strong jaw.
That's what I thought before, but no, the lip lift must happen before and Gunson was the one who suggested it. It makes perfect sense actually. Lip lifts are pretty unpredictable. If you do one afterwards you may end up with lip incompetence. If you do one before, the impaction (and possibly genioplasty) will be tailored to match your new lip length perfectly, so you won't have lip incompetence afterwards.
-
Ideally that would happen, but then you have the challenge of finding a lip lift doctor prepared to do this and expose your 'gummy smile'. I guess you'd have to make a case for the fact you intend on getting bimax afterwards and maybe even ask for the maxillofacial surgeon's input on the amount to remove.
Plosko - you make an interesting point about lip lifts. The orthodoxy of looking at whether the patient has a short upper lip as a marker of vertical maxillary excess is about as helpful as looking at the colour of one's hair or eyes in the same context. In such cases, what should happen is that the impaction should be done as per the orthognathic problem, THEN a lip lift should be done in order to adapt the soft tissue to the corrected structure. Yet many doctors don't actually think along these lines, which is ridiculous. To me, it's obvious that within a certain growth pattern there will be a number of variations from person to person due to genetics or concurrent/separate facial development issues. Most surgeons have a very orthodox approach to these problems and people just submit to their plans because they aren't aesthetically astute and are "happy" regardless.
As a woman, I would not be comfortable going to Alfaro but if I was male, I might consider him if I desired a very strong jaw.
-
Ideally that would happen, but then you have the challenge of finding a lip lift doctor prepared to do this and expose your 'gummy smile'. I guess you'd have to make a case for the fact you intend on getting bimax afterwards and maybe even ask for the maxillofacial surgeon's input on the amount to remove.
In the case of Gunson, he would refer the patient to his favored plastic surgeon with a specific shortening request in mms. So this definitely should be done with the max facs input. Fwiw, he told me that cases requiring lip shortening are rare.
-
These two Alfaro results don't look good at all:
http://www.institutomaxilofacial.com/en/caso-clinico/ana-4/ - no impaction of the upper jaw
This woman's after pic is pretty much the female equivalent of myself. Long midface, philtrum, upturned nose and mouth breathing.
How much of a difference would impaction make to this case? Would it require more forward projection to avoid loose skin? It looks to me like impaction would reduce the upturned nose by raising the ala part of the nose, but I've never seen any examples of that.
-
I have no idea who to go with. I'm stumped.
-
I have no idea who to go with. I'm stumped.
How long is your upper lip?
-
How long is your upper lip?
is that how long my philtrum is?
-
is that how long my philtrum is?
Yes.
-
He is confused regarding which max fac to choose , not lip lift, I think.
-
I dk if it is Gunson's general stance to have lip lift first.Maybe in some cases. In my instance I will need a downgraft and every lip lift surgeon I talked to told me to wait till I was done with the bimax. I'd actually love it if I could just go get the lip lift because otherwise I am living with a long philtrum and suffering for atleast 1.5 years or so.
-
He is confused regarding which max fac to choose , not lip lift, I think.
Im not gonna get a lip lift. No surgeon out of the 6 or 7 ive met has ever mentioned me needing one
-
Anyone else got any feedback on him? I'm very soon picking someone and it's either him or DeFrancq at the time being.
-
wow I really enjoyed reading this thread, people disagreeing but keeping things factual.
i had only seen one albeit amazing result from him on the facebook group. i am in the market for an aggressive ccw. this guy also got jaw implants afterwards, i wonder if he had with with dr alvaro also.
the point was made that the genio should be minimal, for me this depends on the shape of your chin to begin with. mine has no projection, so i think i can get away with more, but in general i agree that as much as possible of the pog movement should be achieved via maximal movement and rotation of max and mandible, in order for the cheek projection to not be left behind.
i believe that this is a more difficult approach compared to an aggressive gneio and a more conservative double jaw.
there is a german surgeon that has a reputation for also being quite agressive with his ccw, I think he is the professor in Leipzig, doe anyone have any infor on this?
-
wow I really enjoyed reading this thread, people disagreeing but keeping things factual.
i had only seen one albeit amazing result from him on the facebook group. i am in the market for an aggressive ccw. this guy also got jaw implants afterwards, i wonder if he had with with dr alvaro also.
the point was made that the genio should be minimal, for me this depends on the shape of your chin to begin with. mine has no projection, so i think i can get away with more, but in general i agree that as much as possible of the pog movement should be achieved via maximal movement and rotation of max and mandible, in order for the cheek projection to not be left behind.
i believe that this is a more difficult approach compared to an aggressive gneio and a more conservative double jaw.
there is a german surgeon that has a reputation for also being quite agressive with his ccw, I think he is the professor in Leipzig, doe anyone have any infor on this?
There is a Facebook group for his results?
If so would you mind sharing? Would help me a lot.
Are you referring to Zarrinbal?
-
I've been refused treatment because I questioned whether it was sensible to also do a revision rhinoplasty at the same time as bimax.
How dare I question a surgeons abilities, my mistake ;D
-
What exactly was the basis of their declining treatment?
Don't forget to type Instituto Maxilofacial into Google and give them a review. 8)
-
I've been refused treatment because I questioned whether it was sensible to also do a revision rhinoplasty at the same time as bimax.
How dare I question a surgeons abilities, my mistake ;D
No offence but the doctor might expect you to know the relationship surgery to the maxilla has to a nose that has been prior altered directly THROUGH the maxilla, especially so if there was anything in your questioning him that came off as your assuming you were knowledgeable enough to 'question' this.
From his perspective, he knows that the prior 'septo rhino' you got (that you think is more 'sensible' to revise at a later time) was a direct surgery to and through the roof of the maxilla because the act of lowering the 'floor' of the nose (to alter the septum) is basically the SAME thing as lowering the roof of the maxilla. Look at a ceph diagram where there is an outline of the part of the maxilla that's displaced during bi max. ANS-PNS is anterior to posterior nasal spine as in 'floor' of the nose. The curve below it is the roof of the maxilla at the palate. So the act of lowering the floor of the nose through prior cutting through the maxilla to do it is basically the same thing as lowering the roof of the maxilla.
So, your question probably came off as you thinking it was more sensible to cut through the maxilla a 3rd time in a different operation to revise your prior septo rhino than revising it during the same surgery where they would be making a cut to the maxilla to do the bi max.
Seriously. If someone got the 'floor' of their nose lowered via direct access through the maxilla and then later wants bi max where the maxilla needs to be cut through again and a rev rhino is contingent on having similar acess to the maxilla as was the case with the septo rhino wanting to be revised, what kind of patient would think it was more 'sensible' to go through the maxilla again, a 3rd time to revise at a later time after bi-max.
He probably doesn't want a patient who thinks that's more sensible. It isn't.
-
Welp here I'm left wondering why the heck did your rhino guy lower the "floor" of your nose. Never heard of rhinoplasty incisions going through the mouth before.
-
Welp here I'm left wondering why the heck did your rhino guy lower the "floor" of your nose. Never heard of rhinoplasty incisions going through the mouth before.
Also see my post on: http://jawsurgeryforums.com/index.php?topic=6882.msg58899#msg58899
It's a way of straightening out the septum.
-
But it's obvious that UKMaxfac didn't want a revision rhino which entailed doing that weird and experimental manoeuvre all over again.
Upper jaw surgery causes massive swelling in the mid face. How can he get anyone's nose to reliably "match" their new facial proportions if their face (and nose) are clouded by massive swelling from upper jaw surgery? How can a surgeon plan a revision rhinoplasty in advance of all this when the nose will change in an unpredictable way when the upper jaw is moved only 1-2 hours before?
Unlike a normal rev rhino, he'll be operating on a swollen nose and face and "guessing" whether the end result will look good on the new face. Plus the recovery will be very traumatic. This is probably what UKmaxfac was questioning, and I'd do the same.
I think it's better to separate these surgeries but Alfaro capitalises on how quick he is, and with that comes the desire to cram everything in at once, I suppose.
Seriously. If someone got the 'floor' of their nose lowered via direct access through the maxilla and then later wants bi max where the maxilla needs to be cut through again and a rev rhino is contingent on having similar acess to the maxilla as was the case with the septo rhino wanting to be revised, what kind of patient would think it was more 'sensible' to go through the maxilla again, a 3rd time to revise at a later time after bi-max.
He probably doesn't want a patient who thinks that's more sensible. It isn't.
-
But it's obvious that UKMaxfac didn't want a revision rhino which entailed doing that weird and experimental manoeuvre all over again.
Upper jaw surgery causes massive swelling in the mid face. How can he get anyone's nose to reliably "match" their new facial proportions if their face (and nose) are clouded by massive swelling from upper jaw surgery? How can a surgeon plan a revision rhinoplasty in advance of all this when the nose will change in an unpredictable way when the upper jaw is moved only 1-2 hours before?
Unlike a normal rev rhino, he'll be operating on a swollen nose and face and "guessing" whether the end result will look good on the new face. Plus the recovery will be very traumatic. This is probably what UKmaxfac was questioning, and I'd do the same.
I think it's better to separate these surgeries but Alfaro capitalises on how quick he is, and with that comes the desire to cram everything in at once, I suppose.
Didn't seem too obvious to me that he even knew what he got in the first place. Best time to rev the rhino is when they are working with the bony nose base at the maxilla via the bi max. Sorry you don't get it. By the way, the swelling is kept down during the surgery with a cocktail of meds. The massive swelling comes in later.
-
If it wasn't obvious to him, then how could he object to his questioning of whether it was a "good idea" to do it or not?
Even if they do keep the swelling down with meds, the nose will still look different after the jaw surgery has been completed. Therefore, a surgeon can't reliably plan a revision rhinoplasty with the patient's input when the status of the nose after the jaw will change, and the patient won't ever get to see that change or appreciate how it changes their starting point.
Whether it's technically better to do it during jaw surgery is another question. I heard that this dual assault can compromise blood supply to the area.
Personally, I think revision rhino needs its own "space" unless a minor adjustment is proposed.
Didn't seem too obvious to me that he even knew what he got in the first place. Best time to rev the rhino is when they are working with the bony nose base at the maxilla via the bi max. Sorry you don't get it. By the way, the swelling is kept down during the surgery with a cocktail of meds. The massive swelling comes in later.
-
If it wasn't obvious to him, then how could he object to his questioning of whether it was a "good idea" to do it or not?
Even if they do keep the swelling down with meds, the nose will still look different after the jaw surgery has been completed. Therefore, a surgeon can't reliably plan a revision rhinoplasty with the patient's input when the status of the nose after the jaw will change, and the patient won't ever get to see that change or appreciate how it changes their starting point.
Whether it's technically better to do it during jaw surgery is another question. I heard that this dual assault can compromise blood supply to the area.
Personally, I think revision rhino needs its own "space" unless a minor adjustment is proposed.
When I said it was not obvious to 'him', I was referring to the patient. Not the doctor. His prior 'rhino' was actually surgery to and through the maxilla. So the rev of it would best be done during surgery to and through the maxilla which allows the doctor to address the 'floor' of the nose and also the spine of the nose at the same time when both are moved anyway during the max surgery. It's one of those things that's just so obvious to me, it becomes tedious to explain further than I have. Also a given that it's obvious to the doctor. If he doesn't want the rev rhino with the max surgery, he most surely will need one after it and it. However with no access through the maxilla to address the altered 'floor' of the nose, there will be more limits to revising than there would be if he got it revised during the max surgery.
There is no 'dual assault' to address the parts of the nose that are going to be displaced ANYWAY during a max surgery. The dual assault comes in when you have to get another surgery to do what you could have done in the first place.
-
The more you do to that area at once, then surely more risk will be incurred in terms of blood supply, or lack thereof.
So you're assuming that a revision rhino would involve another internal approach to the nasal floor?
Another doctor's approach to a revision rhino would likely not involve the same nasal floor access, simply because it's not the norm and can probably be revised externally. So there would be no argument for doing it at the same time on that account IF the same approach was not going to be utilised anyway.
You say that after jaw surgery he'd need a revision rhino anyway - which, from my perspective, is best assessed when the look of the face is stable and you can see what you'd like to do to your nose to "match" your (new) face??
Maybe it's easier for the DOCTOR to do it "at the same time" but is it best for the patient's safety and their goals, well, that is the question I was asking.
-
Well the swelling does not set immediately and Alfaro does operate very fast.
-
The more you do to that area at once, then surely more risk will be incurred in terms of blood supply, or lack thereof.
So you're assuming that a revision rhino would involve another internal approach to the nasal floor?
Another doctor's approach to a revision rhino would likely not involve the same nasal floor access, simply because it's not the norm and can probably be revised externally. So there would be no argument for doing it at the same time on that account IF the same approach was not going to be utilised anyway.
You say that after jaw surgery he'd need a revision rhino anyway - which, from my perspective, is best assessed when the look of the face is stable and you can see what you'd like to do to your nose to "match" your (new) face??
Maybe it's easier for the DOCTOR to do it "at the same time" but is it best for the patient's safety and their goals, well, that is the question I was asking.
I'm assuming that the roof of the maxilla which is basically the access path to the 'floor' of the nose is going to be cut into during the max surgery. Actually, it's OBVIOUS the maxilla along with the spine of the nose will be involved in the max surgery. Due to that the doc will be braced to make alterations to the nose while doing the max surgery. So, yes, I'm assuming that since his problem to the nose arises from lowering the floor of it, he's better off having it revised during max surgery when they have access to the floor of it if that needs to be changed/reversed.
Of COURSE, another doctors way of revising the nose after bimax will not be including direct access through the roof of maxilla to do it or UNDO what was prior done to it through there, which is exactly what I meant by LIMITATION if access via the maxilla is needed to fix it.
If rhinos were 'too risky' to do DURING a max fax surgery due to 'blood supply' then it would not be common practice to perform them DURING a maxfax surgery now would it. But I guess your personal opinion that they are 'unsafe' to do during max surgery trumps the standard practice of doing them during a max surgery.
Rhinos can be and are done after a max surgery but not the kind to UNDO a poor result from lowering the floor of nose if that needs to be undone.
Water under the bridge at this point because he's not going to have the doctor who could revise his nose during the max surgery.
-
True, the doctor will not be operating on him. Which IMO is for the best if he is always in such a rush to get things finished as if he wants to make a world record attempt. TBH that speed factor "brag" serves a dual purpose. Firstly, it's transparent marketing directed towards his ideal customer base: people who aren't surgery vets and more likely to be "scared" of anesthesia/death vs. living with their natural face, which is what scares surgery vets more. And secondly, it's basically him trying to squeeze as much as possible into one day, i.e. he's money orientated or rates his skills very highly and thinks that speed is a measure of this.
This provides some insight into this doctor's disdain for those who dare to "ask questions" because he is targeting the uninformed and the complaint, which is what he usually gets I'd bet, given the Spanish aren't remotely as pedantic about aesthetics as the Americans/Northern Europeans are.
But about common practices and risks... those two are not mutually exclusive in the world of surgery, whereas time and money are intrinsically related.
-
True, the doctor will not be operating on him. Which IMO is for the best if he is always in such a rush to get things finished as if he wants to make a world record attempt. TBH that speed factor "brag" serves a dual purpose. Firstly, it's transparent marketing directed towards his ideal customer base: people who aren't surgery vets and more likely to be "scared" of anesthesia/death vs. living with their natural face, which is what scares surgery vets more. And secondly, it's basically him trying to squeeze as much as possible into one day, i.e. he's money orientated or rates his skills very highly and thinks that speed is a measure of this.
This provides some insight into this doctor's disdain for those who dare to "ask questions" because he is targeting the uninformed and the complaint, which is what he usually gets I'd bet, given the Spanish aren't remotely as pedantic about aesthetics as the Americans/Northern Europeans are.
But about common practices and risks... those two are not mutually exclusive in the world of surgery, whereas time and money are intrinsically related.
The doctor probably doesn't want or need 'know it all know nothing' patients who question things in the absence of knowing the basics. Not saying the OP is that but if he adapts your way of thinking, he probably will be on his way of being rejected by other doctors or maybe will find one who won't alter his nose during the max surgery and will wind up with however it would look via displacements of just the max surgery and no displacements aimed at countering some unfavorable displacements of the nose that CAN occur during a max surgery. But be my guest if you wish to support his decision not to get it reved during his max surgery.
Hell, be my guest in also contending that that SWELLING is so bad DURING a surgery, that the doctor could not possibly perform a rhino during it. Add your 'personal opinion' that it's 'unsafe' to perform a rhino during a max surgery 'because' it compromises blood supply.
Your insights don't reflect much about the doctor at all. Let's see, the ability to perform something FAST and perform it well, reflects SKILL. But you don't differentiate skill from 'rushing'. These surgery 'vets' you speak of, would those be people who do it wrong the first time and have a pattern of doing wrong multiple times who want to use the same thinking process they used to do it wrong to be a back seat driver to tell the doctor what to do? Doctors who know how to do things right don't like patients like that and why should they.Good doctors deserve good patients and have every right to pick and choose which ones are the most appropriate candidates for what they do. Your insights reflect more of a SOUR GRAPES stance more than much about the doctor.
-
You're right, they don't "reflect much about the doctor" because I am not approaching this from a doctor's perspective; rather, from a patient's. Is that so radical on a forum like this?
You are basically saying the OP, who is not a doctor, has asked a question about a topic he doesn't know the ins and outs of because he is not a doctor, and that got him blacklisted. You seem to think that is a reasonable way of dealing with non-medical laypeople when you are a doctor who operates on and derives all of his income from... non-medical laypeople.
From my perspective, the doctor lacked the emotional intelligence to make sense of the sentiments behind his question (conflicting information heard from other doctors and on forums) without taking it as a personal affront. By extension, other conclusions could be drawn about his character, supplemented by a recent Google review from an actual patient that describes him ignoring a patient when things went wrong.
As for "sour grapes". Let me say that I got myself into bad situations purely because I didn't refuse the things that pushy doctors forcefully made it a requirement for me to get along with other surgeries, using similarly "logical" arguments that you espouse here with about as much vigour. I felt like I had no choice, due to that line of thinking that I no longer adopt. And so my subsequent criticism of a pickly doctor is "sour grapes", in your opinion.
Also, a few weeks ago, I posted 2 results that I personally find to be poor from Alfaro. I attributed these to a lack of finesse and skill (assembly line approach to surgery), so my criticism is a lot more material than you state. Moreover, it was in fact based on the statements and pictorial evidence HE put out there on his own site.
For everything you've said, you neglect the human (you might say "irrational") feelings that accompany making such decisions, along with the trepidation people have when they've had a bad experience. These aspects trump diagrams and logic when someone decides to make that final bank transfer. People are not perfect and they do not mind read accurately, and that is also the case with you as much as it is with me.
The doctor probably doesn't want or need 'know it all know nothing' patients who question things in the absence of knowing the basics. Not saying the OP is that but if he adapts your way of thinking, he probably will be on his way of being rejected by other doctors or maybe will find one who won't alter his nose during the max surgery and will wind up with however it would look via displacements of just the max surgery and no displacements aimed at countering some unfavorable displacements of the nose that CAN occur during a max surgery. But be my guest if you wish to support his decision not to get it reved during his max surgery.
Hell, be my guest in also contending that that SWELLING is so bad DURING a surgery, that the doctor could not possibly perform a rhino during it. Add your 'personal opinion' that it's 'unsafe' to perform a rhino during a max surgery 'because' it compromises blood supply.
Your insights don't reflect much about the doctor at all. Let's see, the ability to perform something FAST and perform it well, reflects SKILL. But you don't differentiate skill from 'rushing'. These surgery 'vets' you speak of, would those be people who do it wrong the first time and have a pattern of doing wrong multiple times who want to use the same thinking process they used to do it wrong to be a back seat driver to tell the doctor what to do? Doctors who know how to do things right don't like patients like that and why should they.Good doctors deserve good patients and have every right to pick and choose which ones are the most appropriate candidates for what they do. Your insights reflect more of a SOUR GRAPES stance more than much about the doctor.
-
You're right, they don't "reflect much about the doctor" because I am not approaching this from a doctor's perspective; rather, from a patient's. Is that so radical on a forum like this?
You are basically saying the OP, who is not a doctor, has asked a question about a topic he doesn't know the ins and outs of because he is not a doctor, and that got him blacklisted. You seem to think that is a reasonable way of dealing with non-medical laypeople when you are a doctor who operates on and derives all of his income from... non-medical laypeople.
From my perspective, the doctor lacked the emotional intelligence to make sense of the sentiments behind his question (conflicting information heard from other doctors and on forums) without taking it as a personal affront. By extension, other conclusions could be drawn about his character, supplemented by a recent Google review from an actual patient that describes him ignoring a patient when things went wrong.
As for "sour grapes". Let me say that I got myself into bad situations purely because I didn't refuse the things that pushy doctors forcefully made it a requirement for me to get along with other surgeries, using similarly "logical" arguments that you espouse here with about as much vigour. I felt like I had no choice, due to that line of thinking that I no longer adopt. And so my subsequent criticism of a pickly doctor is "sour grapes", in your opinion.
Also, a few weeks ago, I posted 2 results that I personally find to be poor from Alfaro. I attributed these to a lack of finesse and skill (assembly line approach to surgery), so my criticism is a lot more material than you state. Moreover, it was in fact based on the statements and pictorial evidence HE put out there on his own site.
For everything you've said, you neglect the human (you might say "irrational") feelings that accompany making such decisions, along with the trepidation people have when they've had a bad experience. These aspects trump diagrams and logic when someone decides to make that final bank transfer. People are not perfect and they do not mind read accurately, and that is also the case with you as much as it is with me.
On this string (back pages) the OP showed an e mail where he asked about the rhino and got a response/answer to his question. So, who knows if he kept on expressing circumspection later down the line to the doc. He also expressed that he thought some of the doctors work looked 'done'. His ground point was that he wasn't too sure about Alfaro anyway and may have needed the doctors time to resolve all the uncertainties he had about the doctor.
For a busy and skillful doc who needs to use his time to DO, his approach was to resolve circumspection and uncertainty by declining treatment.
As far as emotional intelligence goes the doc is not going to spend his time coddling or persuading the patient to have surgery as the time to DO surgery on those who are sure they want it trumps the time needing to be spent resolving the uncertainties of a circumspect patient.
In that way, the OP has all the time in the world to find a doc to do his bi max who will accommodate his request not to have rev rhino during it if his 'emotions' are telling him not to get that done during same time.
-
OK, I agree with that, in that if this was part of a series of questions that expressed trepidation about the surgery, then that could make one come off as a "time waster" rather than a possible patient.
I've always thought that the tone of emails, esp if the recipient's first language isn't English, can be misread somewhat. Paying for another consult or a Skype consult could be an alternate strategy.
-
OK, I agree with that, in that if this was part of a series of questions that expressed trepidation about the surgery, then that could make one come off as a "time waster" rather than a possible patient.
I've always thought that the tone of emails, esp if the recipient's first language isn't English, can be misread somewhat. Paying for another consult or a Skype consult could be an alternate strategy.
Yes. I think for the most part, this doctor wants to use his time doing the surgeries and uses the consult time to to TELL a patient what he can do and not SELL a patient on it.
The back threads show the e mail where the OP's question about rhino in same surgery was answered to the effect of; 'We do it and always do it with the bimax'. It didn't say; 'You asked the wrong question and now your out.' So, if he asked similar again as to call into question the safety of that, the doc elected to resolve his circumspection to not getting the surgery.
Like in the e mail he showed, there was nothing wrong with his question and he got an answer. So, if he later he came off as; 'Well, I'm not convinced of the safety of what you're proposing, the doc is probably thinking that in the same time he'd need to convince or pursuade the OP, the doc could be doing a surgery. So, he's prioritizing time to those who are sure they want his surgery.
Personally, I'm not a big fan of docs who spend a lot of time essentially selling a patient on a surgery. Ironically, those are the types who know how to indulge the circumspect patient as to make them more 'sure' he/she is the right doctor for them where that might not be the case at all.
-
It seems like quite a few people have consulted with him. I'm curious what your experience was like, and what you thought of him.
I did see in this thread (http://jawsurgeryforums.com/index.php?&topic=3715.0)
- Spanish surgeon (Alfaro). Had online consult and he agreed to send through his recommendations in writing based on what he'd seen, along with morphs etc. Never came through. Never responded to my e-mails. Again, my money was taken and nothing was gained.
Those who have consulted with him:
- In person or by videoconference?
- What did you receive as far as information, analysis, and planning, and how did this compare to other surgeons' consultations? Did you receive a treatment plan?
- If interested were you given the option to pay for and receive a surgical workup prior to/without committing to surgery?
- Did he ask you for/seem receptive to your opinions? Did you discuss aesthetics?
- If applicable to your case, were you recommended downgrafting (including counterclockwise rotation with posterior downgrafting)?
Also does anyone have links to Spanish forums or other reviews (besides the testimonials on their site and social media)?
alright so I have been snooping this Spanish orthognathic forum and this is what I learned (regarding Instituto Maxilofacial)
a) for the Spaniard lurkers. I.M. does not accept insurance
b) surgery costs around 12K (euros) per jaw
c) you will be treated like cattle, apparently there are dozens of dental students (soon to be surgeons) that do all the consulting (x-ray, ct scan, dental impression, pictures, etc..) Alfaro eventually pops in, talks to the patient for 10 minutes and bolts. you won't see him again til surgery day
d) his rhinoplasty sucks
::) at these (some of their social media/linked reviews are like this too):
Hernandez Alfaro is a great professional, but very busy though. I had an appointment with him (at his office in Barcelona) and he had an outstanding comprehension of my problems and really attentive.
However this is just my first impression with him, I hope it doesn't change quite when I have done my surgery in mid 2015.
I recommend you to come over and see him at his office, by the way you can visit Barcelona.
they have no prices on the website, but you can ask here: http://institutomaxilofacial.com/en/appointment (http://jawsurgeryforums.com/en/appointment)
I've heard Dr.Alfaro is top 1 in Spain and they have pretty good medical services and an international services department too....the place looks great btw...
-
I saw him in person last month. Travelled from London and returned ln the same day.
The hospital itelf is big and very impressive. Its in a very exclusive part of Barcelona.
The office of Dr Alfaro seems on the compact side,. I could be wrong because I only saw tbe reception and a couple of offices. Everything looks nice and very modern.
Dr Alfaro speaks very good English and is charming and honest. Based on my interaction he doesn't do a sales pitch or anythkng like that.
My consultation pretty much lasted 2 minutes - He said there was nothing to be done and when I told him my concerns he did give me a look of surprise so I didn't push him on it.
-
ITALIA, thank you for sharing.
I was wondering how other people's experiences compared with mine.
My consultation pretty much lasted 2 minutes - He said there was nothing to be done and when I told him my concerns he did give me a look of surprise so I didn't push him on it.
I didn't feel he spent much time with me either, but did he examine you? Take pictures or dental molds?
- Spanish surgeon (Alfaro). Had online consult and he agreed to send through his recommendations in writing based on what he'd seen, along with morphs etc. Never came through. Never responded to my e-mails. Again, my money was taken and nothing was gained.
I didn't get any of these things either, but he didn't offer, and I was too clueless to ask.
He examined me briefly (no measurements), dictating notes to a nurse in Spanish. Didn't volunteer much. I did get an itemized quote, and they sent me a set of pictures.
-
Did anyone who consulted with him get a detailed treatment plan?
I'd be interested to hear if anyone has had a different experience, but I do think
True, the doctor will not be operating on him. Which IMO is for the best if he is always in such a rush to get things finished as if he wants to make a world record attempt. TBH that speed factor "brag" serves a dual purpose. Firstly, it's transparent marketing directed towards his ideal customer base: people who aren't surgery vets and more likely to be "scared" of anesthesia/death vs. living with their natural face, which is what scares surgery vets more. And secondly, it's basically him trying to squeeze as much as possible into one day, i.e. he's money orientated or rates his skills very highly and thinks that speed is a measure of this.
This provides some insight into this doctor's disdain for those who dare to "ask questions" because he is targeting the uninformed and the complaint, which is what he usually gets I'd bet, given the Spanish aren't remotely as pedantic about aesthetics as the Americans/Northern Europeans are.
But about common practices and risks... those two are not mutually exclusive in the world of surgery, whereas time and money are intrinsically related.
One user (http://jawsurgeryforums.com/index.php?topic=6744.msg58893) was "refused treatment because [he] questioned whether it was sensible to also do a revision rhinoplasty at the same time as bimax."
It sounds like another (http://jawsurgeryforums.com/index.php?topic=7179.msg63499) didn't get a plan before or her records after, so even now, 3 years later, she doesn't know exactly what he did. Luckily for her, she had a positive experience.
Probably, unless you ask, they just won't offer. And even if you do ask, they might
- Claim your records aren't ready yet,
- Claim they've sent them to you already,
- Try to give you just the parts that don't actually tell you anything, or
- Ignore you entirely.
It's easier to lie to or gaslight people if they don't have information. (And you're in a position of authority. And they think you're "charming and honest.")
Hence
- Not generating information (taking any measurements, doing any analyses) to begin with, which also happens to be less work
- Volunteering little in the way of specifics
- Not offering records
- If asked, making access difficult
-
One user (http://jawsurgeryforums.com/index.php?topic=6744.msg58893) was "refused treatment because [he] questioned whether it was sensible to also do a revision rhinoplasty at the same time as bimax."
Welp, that kills the deal with Alfaro, in my case. He wants almost as much as Gunson anyway, which is ridiculous considering how I understand he charges closer patients half what I was quoted. Without asking he incorporated the rhinoplasty cost into the surgical quote, which I now won't bother asking to remove and just consider it a total loss w/him. In my video consult, he criticized my nose, but NOT the parts I actually need fixing. Specifically he wants to lower my dorsum even more after a massive reduction was already accomplished in my first rhino. I don't need my nose turning even more feminine to match my recessed eyes, tyvm.
-
Welp, that kills the deal with Alfaro, in my case. He wants almost as much as Gunson anyway, which is ridiculous considering how I understand he charges closer patients half what I was quoted. Without asking he incorporated the rhinoplasty cost into the surgical quote, which I now won't bother asking to remove and just consider it a total loss w/him. In my video consult, he criticized my nose, but NOT the parts I actually need fixing.
ditterbo, did you get a treatment plan or the option to pay for a surgical workup?
Does he charge locals more like
I contacted a patient of Raffaini's who lives in Italy and just had the surgery a couple of months ago, he told me it cost around 10k.
which is less than half what Raffaini quoted me?
In my experience,
I think he is super skilled but he wants autonomy in his plans and does not care much for the patient's input if it contradicts his designs.
Mixed bag.
-
My user name is Langpam and I am the lady referred to in these posts.
It is now almost four years since my surgery ( I posted a video of my experience earlier this year and my husband spoke too) and I can only add that it has changed my life. No CPAP machine at night and a younger face. What’s not to like?
I still get questions from people on this site.
My advice to everyone reading this is to look at the facts and NOT to listen to one angry person who has not posted photos and who makes sweeping statements.
-
My user name is Langpam and I am the lady referred to in these posts.
It is now almost four years since my surgery ( I posted a video of my experience earlier this year and my husband spoke too) and I can only add that it has changed my life. No CPAP machine at night and a younger face. What’s not to like?
I still get questions from people on this site.
My advice to everyone reading this is to look at the facts and NOT to listen to one angry person who has not posted photos and who makes sweeping statements.
I think the person should illustrate with photos too as YOU DID to illustrate your experience. Also, not sure how 'fair' it was for you for him/her to ask you a bunch of questions, take your TIME and all and then use your text in quotes when the 'plan' all along was warn about the doctor. When they first got on, it appeared that they were entertaining possibility of consulting with him. Like it was not so clear they had a complaint. I think he/she should have just started with the complaint and not called you into their 'stuff'.
-
Kavan
Thank you so much for your post. You have hit the nail on the head. I was trying to be helpful by answering all the questions, only to find that some of my comments were taken out of context and used for the purpose of condemning the surgeon that to me is brilliant.
I believe that to be so underhanded is a reflection of this individual’s personality. Can anyone trust anything he/she says. ABSOLUTELY NOT!
-
Kavan
Thank you so much for your post. You have hit the nail on the head. I was trying to be helpful by answering all the questions, only to find that some of my comments were taken out of context and used for the purpose of condemning the surgeon that to me is brilliant.
I believe that to be so underhanded is a reflection of this individual’s personality. Can anyone trust anything he/she says. ABSOLUTELY NOT!
I feel for you on this because the poster did not disclose his/her agenda from the get go that they had a complaint. Correct me if I'm wrong but I'm kind of sure that IF you knew AHEAD of time, your efforts would be used in this way, you would not have bothered.
-
Kavan, you are absolutely correct. If I had known this person’s agenda AHEAD of time, that I was being used,I would most certainly NOT have responded.
This calls into question this person’s (uj) criticism of Dr Hernandez Alfaro as not being “ transparent”.
Uj has been far from transparent but rather, I believe, manipulative. It makes me cross that one person can vent so much anger and attempt to destroy such an accomplished surgeon.
I would have more respect if uj made constructive criticism and was more honest from the start.
-
I had wanted to hear from other people without disposing them either way. Looking back, this may not have been the best approach, and I apologize, especially to Langpam.
"Maybe, unless you ask..." These things had happened to me, and I should have stated this clearly.
This was my experience. I should not have mentioned anyone else, and I am very sorry.
I have requested that my thread be deleted. Thank you to everyone who took the time to read and/or respond, and I appreciate the feedback.
-
Why don't you post in the private forum instead with blacked out features, x ray etc?
-
Just wanted to chime in with my experience with Dr. Alfaro as I had surgery with him by the end of last year. I was a lurker on here before that but I feel it's time to give my 2 cents.
Just as Langpam, I had "Surgery First" (actually it was "Surgery Only" as I never had to wear any retainers or bracers, with my bite being perfect today) with him as my bite was fine pre-op. The reasons were a recessed jaw (aesthetics) and sleep apnea, and I am very happy I went ahead with this. Before booking with Dr. Alfaro, I had consulted with a couple other surgeons. I also consulted with Langpam on this forum to ask about her experience (thanks again!).
Altogether my experience with Dr. Alfaro, from the consultation to the months post-op, was very positive and if I had to do it again I wouldn't hesitate. Not only did my sleep improve, but my breathing overall did, which is really a huge plus for me as I train MMA and weightlift. As for aesthetics, my jaw looks a lot sharper from the front but the biggest improvement was in my profile - to the point where I am no longer conscious about my recession. The Dr. was very straightforward and I felt honest too, and he obviously showed me the planned movements the days before the surgery. Everything went according to plan, and I believe I had 11 mm maxillary advancement and around 17-18 mm advancement of the mandible due to CCW rotation (haven't asked for the surgery report as I felt I had no need for it tbh). The surgery took around 2 hours I believe.
I was a bit hesitant to go ahead with the surgery in the months before, but I decided spontaneously to e-mail the clinic while I was on vacation in Barcelona in hopes of perhaps being able to see Dr. Alfaro to ask some questions/discuss some thoughts I had. They replied the same day and were able to arrange for a meeting with the Dr. the next day. We had a sit down, he answered all my questions and we discussed my thoughts and any fears I might've had, feeling no time pressure whatsoever. Seeing that he took his time for me like this, unplanned, on a day's notice sealed the deal for me.
So my experience with Dr. Alfaro, the nurses and the international staff (I am from Scandinavia) was overwhelmlingly positive, and I'd highly recommend him to anyone planning to have jaw surgery.
For privacy reasons however I do not wish to post any pictures of my outcome. If I change my mind later, on I will maybe post some. For now, you'll just have to take my word for it!
-
I have some questions about this paper he wrote.
https://www.semanticscholar.org/paper/U-shaped-osteotomy-in-management-of-paranasal-H%C3%A9rnandez-Alfaro-Garc%C3%ADa/a470963ed660acea1ec721dcbba927dae217ebd4
This surgery seems to be able to solve my facial problems but there is no mention of it at all past this individual paper.
Is there a reason it is not done more?
-
Hello everyone,
I used Dr Hernandez Alfaro and his team in Barcelona nearly a month ago now. (procedure on 5th July) I can assure you that he is one of the best surgeons in Europe and he knows what he is doing, very professional, and has an amazing team of other surgeons, nurses, staff that make the whole team work very efficiently and professionally.
I had first consultation in May 2018 and then went back for the medical procedure for pre op tests 2nd July 2018.
They are very good with the first consultation, scans, tests takes a couple of hours and everything is prepared all in the same day with full detailed document for you to take away, and think about it. I got more done in 2 hours with them than 3 months wasting my time in the UK.
All my life i had a problem breathing and he fixed this problem all at the same time and the jaw surgery by sorting out the septum and its normal that he will correct the nose structure when doing class III operation, and i think in most cases some sort of adjustment is necessery.
Within 2 weeks of the operation i was able to swim in the ocean (salt water only) and this Sat just gone (just after 3 weeks after operation) i was back to rock climbing. i think its important before the procedure that you are fit and healthy (best shape of your life) helps the recovery.
I fully recommend people to go to Barcelona and have a consultation and see what its about, the hospital is clean, nice, and best one i have been to in my life. the staff are very friendly and knowledgable, very professional and helpfull (especially Pertra) and the nurses.
To me and my experience Dr Hernandez Alfaro is the best sureon in Europe ( that's just my experience and opinion) highly recommend. oh and make sure you ask questions and tell him what you think is wrong with your face and what you want, and he will do an exelant job.
Andrew
-
OK, you've got 6 posts up here as of TODAY and 5 of them are recommending Alfaro. Please be mindful not to make almost every post on here a recommendation for Alfaro lest you give yourself the appearance you are promoting/advertising for him.
I'm not saying you are doing that. I'm saying if a new poster comes to the venue and in almost every post they rec. a doctor, it gives the appearance you are promo/advertising for him which incidentally, works against a doctor because people might think you are shilling.