Concerning news from Dr Triaca regarding HA paste

[Optimistic]

Not sure why I bother doing this when I'm arbitrarily banned from accessing the most important part of the forum. Still I'll share what I learn for now. /rant

So I had a consult with Dr Triaca last night. I'll have another soon once I send more photos and scans - he's very professional might I add. I'll consider doing a write-up once I've had my second consult. All I'll say is 1) he performs a huge number of chin wings and various other osteotomies 2) He has developed and offers a large range of highly specialised osteotomies and DO procedures that nobody else in the world offers. The short end of it is that he has found numerous ways to make the labiomental fold a moot issue with undergoing jaw surgery. I knew this already after looking up a few of his studies, however he took the time to explain a few more.

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So onto the most important part that I wanted to bring up here. I was talking to him about hydroxyapatite and various other things. In his own words he said that he doesn't use any "onlays" as the evidence is that they end up absorbing the bone they're attached to. He said that he sees it a lot, and just recently treated a young girl who came in and literally had a hole in her mandible!

Has anyone heard of this before? It's a scary thought.

Moreover it begs the question then of what he uses instead. What are other alternatives to modestly augmenting various parts of the face and smoothing over contour irregularities from jaw surgery?

I know for a fact that his malar osteotomy is NOT a 'sandwich' osteotomy for this very reason. He doesn't employ the use of foreign objects except for titanium which he said was very good.

[Cmonster]

Dafuq? Do you mind asking him if he has any case studies by himself or his colleagues that demonstrate this ?
- can you ask him how many months post op that he sees this?
- does it depend on where it was used or the amount used ?
- is it reversible ?
I've heard the complete OPPOSITE about HA that it stabilizes bone . s**t.
 ....Will not lie reading this gave me a sinking feeling in my gut. 

[LoveofScotch]

Oh, s**t...really?

I would be super interested, if you come across any more information.

Thanks!

[Optimistic]

Dafuq? Do you mind asking him if he has any case studies by himself or his colleagues that demonstrate this ?
- can you ask him how many months post op that he sees this?
- does it depend on where it was used or the amount used ?
- is it reversible ?
I've heard the complete OPPOSITE about HA that it stabilizes bone . s**t.
 ....Will not lie reading this gave me a sinking feeling in my gut. 

I'll absolutely do that. If people have questions about this put them here and I'll ask as I honestly found his response quite shocking. After all most studies have mentioned reabsorption and stability issues but never actual native bone loss.

The other thing that I'm not sure I emphasised enough in my original post was he kept referring to "onlays" when discussing this. Perhaps there is a nuance I'm missing here? However I never mentioned implants only ever hydroxyapatite so I can't imagine that there was much confusion. I'll be sure to confirm just what he means by 'onlay' and whether he is talking about HA paste or some other kind of similar grafting / filler substance. He also said many surgeons seem to prefer to use "onlays" as it can be done far quicker and simpler than recitfying the problem with an osteotomy or distraction (in reference to me talking about MM and jaw angles). It was also following this thread of conversation that he brought up titanium as an excellent choice. So MAYBE he was referring to implants all along? Although titanium is also used for the screws and brackets in maxfac work. Who knows?

It definitely warrants some digging into. Dr Triaca didn't come across like the kind of guy who would lie about this, nor do I see a reason why he would lie about it.

If you think about it, lying about results of a malar osteotomy in the case of Dr Alfaro makes sense. He claimed that his malar osteotomies were unstable and kept reverting to baseline when every other surgeon's experience is the exact opposite. So there is something in it for him to trash a ZSO / ZO. However in the case of HA paste any surgeon can use it, it clearly has a great deal of utility. Avoiding using it would only be to the surgeons detriment.

Hope you can follow that line of thought. I find it bizarre that HA paste could truly cause such things.

[Gregor Samsa]

How much does he want for a surgery?

[LoveofScotch]

Is HA the exact same regardless of the surgeon using it, or do different clinics utilize different compositions? Besides being curious about the specific composition, I also wonder if all surgeons prepare it the same way? What about how it's cured/set?

I wonder if there's some sort of pattern between the answers to the questions above, and the issues we are potentially seeing with HA. Or...maybe, it comes down to all this being a coin toss.

[Modigliani]

Thanks for sharing this with us, Disillusioned...bet your name feels even more appropriate now!

Regarding HA, could he be dissing it with the intent of selling people the much more costly titanium implants? These guys are businessmen at the end of the day.

I believe A&G mix it with something before slapping it on, could it be your own blood or am I seriously off track here...it's something more organic than just the raw stuff iirc.

[Gregor Samsa]

No one uses the "raw" stuff. Mommaerts mixes it with fibrin and other stuff I can't remember. Arnett and Gunson does do something differently though since they're able to mold the HA for a long time after the surgery.

[Gregor Samsa]

I've also read that. Hydroxiappatite tends to erode to the bone and some surgeon was quoted saying it's useless and the surgeon trying to make more money. He said only calvarial bone grafts don't reabsorb. I have read it somewhere on the jawsurgeryforums I suppose.

The amount of money that Arnett and Gunson charge for HA grafts is shocking.

[Modigliani]

The amount of money that Arnett and Gunson charge for HA grafts is shocking.

Indeed, especially when the results are said to be modest at best...was it CK that was less than impressed?

[PloskoPlus]

Indeed, especially when the results are said to be modest at best...was it CK that was less than impressed?

So how much of antbee's "improvement" was just post operative swelling.

[Modigliani]

So how much of antbee's "improvement" was just post operative swelling.

I wish she'd come back and tell us.

[Gregor Samsa]

Indeed, especially when the results are said to be modest at best...was it CK that was less than impressed?

My HA augmentation is definitely very noticable although I don't like it much due to how it was placed.

[LoveofScotch]

GS,

This is probably a silly question, but you can't feel it, right? Like when you're sleeping on your side with your face pressed into your pillow, it feels normal, correct?

Thanks! 

[Gregor Samsa]

It does feel strange when I touch that area with my fingers. It's a bit harder and much more numb than the rest of my face.