Author Topic: What's the consensus on HA paste?  (Read 13830 times)

Optimistic

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Re: What's the consensus on HA paste?
« Reply #15 on: February 25, 2014, 06:08:52 PM »
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?!

So we can't talk to people who've had it because they aren't here, and everyone who in recent times got it has had no problems.

There are no photos to demonstrate this.

No studies.

Yet people on here talk about this like it's an undisputed fact.

Where are people getting this information from?
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 #16 on: February 25, 2014, 10:37:03 PM »
IMO, photos can be deceiving.  People could be imagining things.  The best solution would be CT scans for those who suspect reabsorption.  A study like that would be good.

Optimistic

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Re: What's the consensus on HA paste?
« Reply #17 on: February 26, 2014, 04:24:12 AM »
IMO, photos can be deceiving.  People could be imagining things.  The best solution would be CT scans for those who suspect reabsorption.  A study like that would be good.

Scans and studies have been done on reabsorption and have shown it didn't occur, others seem to indicate it was replaced by bone. Here are some I've found:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628530/

http://www.ncbi.nlm.nih.gov/pubmed/11845356

http://boneandjoint.org.uk/highwire/filestream/16123/field_highwire_article_pdf/0/654.full-text.pdf

http://books.google.com/books?id=8yu0OZpAYSgC&pg=PA83&lpg=PA83&dq=hydroxyapatite+resorption&source=bl&ots=UPuKdlxB3P&sig=wBM91uNgFRdRg5pcpS0-cPdZLaY&hl=en&sa=X&ei=9tsNU43cH8fAkgWY3YDYDQ&redir_esc=y#v=onepage&q=hydroxyapatite%20resorption&f=false

http://ispub.com/IJOS/18/2/6058


Interestingly enough MM claims that the outcomes with HA are largely a result of surgeon skill, and not necessarily the material. At least that's the impression I got from a quote out of pastebin.

"2. What is the advantage of using a bone graft? I only ask because another surgeon I consulted with wanted to take a graft from my hip. You said you do this operation without a graft, so I am curious what the difference is.
Experience"
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 #18 on: February 26, 2014, 07:39:05 AM »
I would like to hear what Arnett and Gunson have to say about this since they use HA extensively. If I consult with them then I'll make sure to ask them.

Cmonster

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Re: What's the consensus on HA paste?
« Reply #19 on: February 28, 2014, 07:24:08 PM »
People get their information straight from the horses mouth- people who went through the surgery. HA does get re-absorbed, I myself had HA put on my cheekbones and now have one cheek that is larger than the other, and I know of two other people experiencing the same thing. Not all of us are comfortable sharing pictures (I might once I get it corrected). There is no absolutes in this thing, just because it absorbed for me, doesnt mean it will happen to you (if you end up using HA), its not as predictable as using your own bone or lets say an implant of a specific size and shape.
We have to continually be jumping off cliffs and developing our wings on the way down.

Gregor Samsa

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Re: What's the consensus on HA paste?
« Reply #20 on: March 01, 2014, 02:04:16 AM »
How long did it take before you noticed the reabsorption? What did Gunson say about it?

Marisama

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Re: What's the consensus on HA paste?
« Reply #21 on: March 01, 2014, 07:17:52 AM »
I have HA and have not noticed it reabsorbing at all. 

Gregor Samsa

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Re: What's the consensus on HA paste?
« Reply #22 on: March 01, 2014, 08:22:06 AM »
I have HA and have not noticed it reabsorbing at all.

Me neither but if it affected everyone then they probably wouldn't be using it. The important detail to know is what percentage of patients it affects.

molestrip

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Re: What's the consensus on HA paste?
« Reply #23 on: September 01, 2015, 08:22:55 AM »
I've spoken to a few patients who had it done. In one case, one side ossified and the other completely resorbed. Two other cases said it made no difference. Last case said he liked them but has chronic inflammation around one two years later. Plastic surgeon I spoke to said they don't like it because it doesn't deliver good results and really still is a foreign body.

molestrip

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Re: What's the consensus on HA paste?
« Reply #24 on: September 01, 2015, 06:05:31 PM »
Oh two I spoke to said they solidified asymmetrically but they still recommended the surgeons because overall they saved their lives. You cant see soft tissue until it's too late to change them. It's a cool invention, not sure it can be used anywhere but laterally though. Yes I've heard they use it elsewhere and their patent also mentions drooping.

The nice thing about it is they're using materials that are fillers anyway so have the same safety profile as those. Some bony in growth occurs and hopefully the rest resorbs. That's a good thing! Foreign body reactions and infection still possible but safety profile better than implants since it's vascular but that also means hard to remove. What doesn't respob, well bone is constantly changing, especially after 40. Who knows where it will migrate to, if it'll stay in one piece as the bone underneath changes shape. Would suck to have lose fragments stuck under there, never clean all those up. Might not look good once fat pads thin but I think it's ok in that respect. I'm told best to wait until midlife to think about this stuff so you don't have to live with it too long with the problems, if any.

Bobbit

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Re: What's the consensus on HA paste?
« Reply #25 on: September 01, 2015, 06:29:03 PM »
Scans and studies have been done on reabsorption and have shown it didn't occur, others seem to indicate it was replaced by bone. Here are some I've found:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628530/

http://www.ncbi.nlm.nih.gov/pubmed/11845356

http://boneandjoint.org.uk/highwire/filestream/16123/field_highwire_article_pdf/0/654.full-text.pdf

http://books.google.com/books?id=8yu0OZpAYSgC&pg=PA83&lpg=PA83&dq=hydroxyapatite+resorption&source=bl&ots=UPuKdlxB3P&sig=wBM91uNgFRdRg5pcpS0-cPdZLaY&hl=en&sa=X&ei=9tsNU43cH8fAkgWY3YDYDQ&redir_esc=y#v=onepage&q=hydroxyapatite%20resorption&f=false

http://ispub.com/IJOS/18/2/6058


Interestingly enough MM claims that the outcomes with HA are largely a result of surgeon skill, and not necessarily the material. At least that's the impression I got from a quote out of pastebin.

"2. What is the advantage of using a bone graft? I only ask because another surgeon I consulted with wanted to take a graft from my hip. You said you do this operation without a graft, so I am curious what the difference is.
Experience"


Experience may be a major portion of the issue.   There is a report by Ousterhout of a series of about 200 patients over a period of  25 years for which he  used it in sliding genioplasties.  Zero infections or other significant complications.  Apparently about 9% of those were re-works of earlier surgeries by other surgeons that did not work out well.  Often used to support gaps until natural bone fills in.

 Apparently it quickly gets very hard  and supports the gaps in the bones until nature does her thing.  In that case,  re-absorption over time would not really be a problem.   When used as surface filler to modify the contour,  it also appears to work and last well with very few complications and the noted  very low infection rate. 

I gather that, as noted above, and as is often the case, there is some experience and technique involved in how it is used to get the optimum results.

molestrip

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Re: What's the consensus on HA paste?
« Reply #26 on: September 01, 2015, 10:04:17 PM »
One prominent surgeon told me HA is very weak. Plus, it's not very osteoconductive. That's why A/G mix it with bovine and cadaver bone. I think they also vacuum your bone shards as they cut and add it to the mix. Super sexy technology.

Lazlo

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Re: What's the consensus on HA paste?
« Reply #27 on: September 01, 2015, 10:28:08 PM »
I've heard different things.

Arnett told me it fuses and even turns eventually into bone. That said I don't think it actually produces a hugely augmented effect.

What's his name, the butcher from amsterdam, uses it for jaw angles and all sorts of rim and malar augmentation --many of his patients are assymetrical as a result and it can't be fixed. Horrible situation.

A/G do mix it with you own blood and stem cells and s**t --they really know what they're doing.

Honestly, I don't only use it for minor filling in gaps. I think it's totally safe etc. but I'd wanna se before and afters from a surgeon to actually gauge their skill level. Like Mommaerts no way, I know patients who were lopsided after he used too much HA paste to augment their ramus or whatever.

And I bet he doesn't mix it with stem cells and stuff the way A/G do.

molestrip

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Re: What's the consensus on HA paste?
« Reply #28 on: September 02, 2015, 09:40:52 AM »
Dr G told me the bone grows into it but doesn't replace it. The patent says the same but that sometimes it gets replaced by bone. I didn't see anything about stem cells there, just mixing it with PRP which is just to speed healing along. That why I say, the asymmetry and inability to produce desired results tend to be more of the problem, especially long term. They seem to be round balls in x-rays and that soft tissue masks it well now, later I don't know but the moldability of it probably still makes it better than implants.

My sample size is limited but it seems the odds are about 20% of giving a good result, 40% of giving a neutral result, and 40% of giving a bad result but because it wasn't significant to begin with, didn't matter that much. Despite what people say, it's not too expensive so I don't think it's padding their pockets or anything. It may be a market differentiator. Like I'm not really sure about this facial balance stuff since so many other things need to change too, however in many cases we do have growth deficiencies and it can help there. Many times patients don't go back to surgeon or don't voice their opinions so the surgeons may have less feedback about results than you'd think. Seems that other professionals in the industry have no idea what this product is.

What I like about it is there's no fixation required so it's probably the least foreign augmentation that you can get right now. People I've spoken to have said they're very hardy once cured. There's still is no way to know the long term prognosis for these things. Like, just look at the guy on this forum who had a fracture there and it's compressing a facial nerve causing him lots of pain. I'd say if you really want it, then absolutely these are the guys to deliver and, even if it resorbs, I think you could always augment on top of them later to correct things. It's not like they're doing extra incisions to get there. It seems to me they could be using BMP2 for those now too, I guess they won't want to mess with what works. They could also graft with BioOSS or HA blocks and use this stuff as a binder for more significant results but less moldability post-op. That would give the extra augmentation people may want but again, with unpredictable soft tissue changes might not be a great idea to do too much anyway. Who knows, maybe they're experimenting with it now already. Or maybe Dr G will read this post and it will give him some ideas :P

I would also add that while it's primarily an aesthetic issue, it's not fair to say that's the only reason to fix your cheekbone projection. Flat cheekbones can cause problems down the line. Poorly supported skin pulls on the lower lid more, resulting in extra work for those muscles to support them. In extreme cases, those lids can even flip inside out and a skin lift is needed, which we know doesn't have a great prognosis. The eyelids can also not close properly, a problem I've had before and I can tell you that's one of the most miserable conditions one can suffer. The eyes will tend to dry out poorly supported too I think. These are common problems, since deficiencies here are common even in people with normal jaws. And these are problems we nearly all experience at some point but those who are deficient will experience them sooner. Fixing it or again in your 50s isn't a terrible idea and, hopefully by then we'll have better options on the market for augmentations. As for aesthetic effects, those procedures may be worse and at some point the aesthetic effects can be so demoralizing that the risks of this particular procedure may outweigh the risks of not fixing it. Don't neglect mental health!

ForeverDet

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Re: What's the consensus on HA paste?
« Reply #29 on: September 03, 2015, 04:14:21 AM »
^Am I part of the 20%? lol

I reeeeeally hope it doesn't change for the negative down the line.

yknow I had out of normal range swelling probably due to HA (although Dr. G never admitted that), I wonder if there is a correlation between the stuff giving a prominent "good" result and how much trauma it causes the soft tissue to induce extreme prolonged swelling.

Of course there's nothing to support that and doesn't really make sense but part of me still wants to justify that god awful f**king swelling that tortured me. And it's still some left on my right cheek after 2 years! f**k you HA paste... :D