Author Topic: What's the consensus on HA paste?  (Read 13831 times)

PloskoPlus

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What's the consensus on HA paste?
« on: February 22, 2014, 09:18:55 PM »
My surgeon mentioned augmenting my chin to make it less pointy (the length is fine).  He said that in the past it was hard to control (would get mushy and not set properly upon contact with water), but that now days it works a lot better.  I am also considering orbital augmentation.  I hear all sorts of contradictory stuff regarding this stuff (mainly on this forum):

* Waste of time?
* Get reabsorbed?
* Erodes the bones underneath?
* Hard to control?
* Only good for gaps?
* Good as a filler orbital, paranasal augmentation, etc., but not the "edges" - chin, lower, jaw, gonial angles, etc..

So what's the deal?  Can HA paste augmentation be done sometime after the main surgery? Or is it too much of a hassle (cutting gums open again).

Optimistic

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Re: What's the consensus on HA paste?
« Reply #1 on: February 22, 2014, 11:00:44 PM »
Studies show that it does not get reabsorbed, and half those other complaints I really don't know where they come from.

I would love for some members to go through and systematically document the evidence for each of those claims as I've not seen any to date. I'm not taking any side, I just want to see proof for these claims to I can make the best decision possible.
01/10/14 - Last night I spilt spaghetti sauce on my chin for the very first time in my life and cried.

Gregor Samsa

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Re: What's the consensus on HA paste?
« Reply #2 on: February 22, 2014, 11:45:03 PM »
People often confuse temporary fillers like Radiesse with the porous form of hydroxyapatite that surgeons like Arnett and Gunson use. I've tried finding out why so few plastic surgeons use it but I've never really found a good answer.

I assume you're having surgery with Mommaerts despite everything people here have written about him?

sean89

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Re: What's the consensus on HA paste?
« Reply #3 on: February 23, 2014, 08:58:42 AM »
Even when I saw MM, he did not mention using HA even though I told him that I wanted more jaw definition and so am an obvious candidate for it, which seems strange if it so easily brings about good results. Some could say that implies a reluctance to use it. The next time I saw him, I specifically mentioned it to him, and he did say that it could be used, and I asked him whether there's a chance of infection, and he said that it has only ever happened to one person that he has treated with it, who experienced trauma to the jaw while playing soccer and so had to have it removed.

I've spoken to two other surgeons who said it won't give me any definition, although that may be because they don't have the expertise to apply it.

I've spoken to another surgeon who says he does not use it 'from experience' but without elaborating on this remark.

It is also true that not many surgeons use it (which may imply something) but then again, I've never seen a post on a jaw surgery forum saying that they had a bad experience with it so who knows.

It could simply be that its use extends the length of surgery considerably and so many surgeons don't like using it for marginal benefits or it could be that it is unsafe. I think the former is probably closer to the mark since dangers about its use would be recorded in the academic literature but the only way to find out is to actually use it. Reading studies is only going to tell you so much. At some point, you are actually going to have to find out for yourself.   


Tiny

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Re: What's the consensus on HA paste?
« Reply #4 on: February 23, 2014, 11:03:05 AM »
I asked MM about HA paste.  He said it was OK for small augmentations but for anything else, custom titanium implants were the way forward - if you could afford it.

I think HA paste is OK for smoothing any mandible notches and for minor augmentation of malar region in class 3s.  But for those with really weak mandibles or who want defined angles, only custom implants are going to give the desired look.  I've never seen it achieved with HA.

I did find one surgeon who appears to routinely combine implants with jaw surgery.  No idea how good he is as a jaw surgeon, just wanted to share the pictures as examples.  Some of the results look great (e.g. the 5th pair of pics in the malar gallery,  first and second pairs in the ramal gallery) and some look...meh.  I presume the implants are silicone (rare is the surgeon who does titanium implants  :()

Malar implants -
http://www.drwittenberg.com/photo-gallery/checkbone-malars-gallery.html

Mandible Angle implants -
http://www.drwittenberg.com/photo-gallery/ramal-gallery.html

(warning, annoying music on site)

It's a shame it's so difficult to get titanium implants.

Gregor Samsa

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Re: What's the consensus on HA paste?
« Reply #5 on: February 23, 2014, 11:55:46 AM »
Would you get titanium implants for stuff like paranasal or infraorbital rim augmentation? I'm having a hard time imagining how that would work out.

Gregor Samsa

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Re: What's the consensus on HA paste?
« Reply #6 on: February 23, 2014, 12:02:54 PM »
I'm just asking anyone with more knowledge about this than me. I don't like the idea of hardware in the face which is why I prefer HA over silicone implants. It would of course be better not to need any of this to begin with but many of us aren't so lucky and have quite serious deficiencies in the face.

overbiter

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Re: What's the consensus on HA paste?
« Reply #7 on: February 24, 2014, 12:39:22 AM »
Why say this then not offer any proof? Just like everyone else who says this I can not find a single source for it.

In fact studies were done which showed it didn't reabsorb.

So please, I'm not even attacking you here, can you show me some examples of this actually happening?

Why do you give such credence to the idea, that not having studies to show a particular substance causes problems, therefore automatically makes it a safe and useful technique? Is word of mouth information of no value to you? Before you say "no, it is not", remember that people used to believe in extraction orthodontics being the best form of treatment for malocclusions, or that asbestos was a safe and harmless material.

LoveofScotch

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Re: What's the consensus on HA paste?
« Reply #8 on: February 24, 2014, 01:54:10 PM »
Really, we are thinking that it potentially reabsorbs randomly? It's one thing if it just doesn't work, but it's a completely different animal if it reabsorbs randomly all over your face. What if, say, 5 years after surgery, one under eye area is all perky and the other is, um...not?

Anyway, thanks for this post; I was going to ask this same question. 

LoveofScotch

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Re: What's the consensus on HA paste?
« Reply #9 on: February 24, 2014, 02:35:35 PM »
This jaw surgery stuff just keeps getting better and better.

Cmonster

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Re: What's the consensus on HA paste?
« Reply #10 on: February 24, 2014, 08:00:05 PM »
My take on HA paste, is that it is unpredictable and it DOES re-absorb and there is no knowing how much or how little of it will stick around. I've heard of surgeons putting in a bit more than you need as some of it gets re-absorbed, but its tricky. I agree if its something very very minute a little bit of HA paste wont hurt or change too much, its when its utilized solely for major bone deficiencies- than you will probably run into problems down the line.

We have to continually be jumping off cliffs and developing our wings on the way down.

Optimistic

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Re: What's the consensus on HA paste?
« Reply #11 on: February 25, 2014, 12:04:08 AM »
My take on HA paste, is that it is unpredictable and it DOES re-absorb and there is no knowing how much or how little of it will stick around. I've heard of surgeons putting in a bit more than you need as some of it gets re-absorbed, but its tricky. I agree if its something very very minute a little bit of HA paste wont hurt or change too much, its when its utilized solely for major bone deficiencies- than you will probably run into problems down the line.

Ok, that's cool. How about instead of this thread become a six page long echo chamber without proof someone posts photos?

Can nobody provide a single example of verifiable HA reabsorption?

I just want to see photos of this!!!

 >:( >:( >:( >:(
01/10/14 - Last night I spilt spaghetti sauce on my chin for the very first time in my life and cried.

PloskoPlus

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Re: What's the consensus on HA paste?
« Reply #12 on: February 25, 2014, 12:28:17 AM »
Ok, that's cool. How about instead of this thread become a six page long echo chamber without proof someone posts photos?

Can nobody provide a single example of verifiable HA reabsorption?

I just want to see photos of this!!!

 >:( >:( >:( >:(

Maybe reabsorption can only be felt, not seen. i.e.  HA paste effects are minimal to begin with.  So the upside is the reabsorbed part does not look much different from the non-reabsorbed part.  The downside is... the same as the upside.

Tiny

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Re: What's the consensus on HA paste?
« Reply #13 on: February 25, 2014, 07:36:24 AM »
Ok, that's cool. How about instead of this thread become a six page long echo chamber without proof someone posts photos?

Can nobody provide a single example of verifiable HA reabsorption?

I just want to see photos of this!!!

 >:( >:( >:( >:(

Given that there are precious little clear photographic examples of before/after augmentations done with HA paste, I think we are going to be hard pressed to find pictures of absorption.  Most pictures are published by surgeons and no surgeon is going to publicise this kind of picture are they?!

Gregor Samsa

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Re: What's the consensus on HA paste?
« Reply #14 on: February 25, 2014, 08:07:40 AM »
I had paranasal augmentation with HA and two months after the surgery I see no signs of reabsorption. Maybe it's too early?