I'm totally confused / stressed / anxious / depressed / dont know what to do

[Rico]

I had more consultations including Dr Z. but MM has got teoretically better sollution for me..... but at the same time there is a few bad opinions

Generally I need 2 procedures during surgery

1) release infraorbtial nerve from compression . MM has got experience with that its not dangerous ...no ther risk (OVERLOOKED CHEEK FRACTURE, INPROPERLY HEALED)
2) osteotomy of whole malar complex: MM told me that no big risk, but other surgeons tells that too high risk of diploplica (double vision) , even loss of sight. Additionally small zygomatic nerve will be damaged...but I'm afraid of any numbness. MM told me that most patients do not fell any distirbuances after destroying this small nerves (supply feeling to the side of the cheek)..However I think they has loss of feeloing, but do not bother about that... and I'm different

I'm thinking about constricting to the first procedure.... but still flattened cheek will by annoying for me...and additionally I don't know if they return me more then half of the money. I have to pay for whole surgery till tuesday, if I wont do that, they will cancel my surgery
What a mess

dont know what to do
stress is killing me.... problem with no good solution, there is no escape and i'm depressed

[Modigliani]

MM destroys more than nerves. That's all I will say, you know my views on him.

[Rico]

I know..but noone can perform such surgery... which surgeon is worth to consider also.... and not to expensive

[Modigliani]

Thing to remember about M is that he talks a good game, like he can do anything with no trouble at all, sadly his ability just doesn't match up to that as many of us have found out to our cost.

What did Z say?

[Optimistic]

Don't let pressure on you! You have doubts that are justified vision loss, dyplopia, permanent numbness.
Don't pay the other half of surgery fees. Search the dialog with Moammerts what are your concerns and explain him that you are not ready for surgery.
They must refund you the money maybe you pay some penalty 200-500 euros.
Don't tell him that you have no confidence in his skills as surgeon  say something else..so you can go to him in the future if he is really the only one who can perform this surgery.  You have good arguments that you are critical to this procedures. I think that other surgeons (Obwegeser, Triaca, Sailer, Sandro Pelo) do this surgery too. 100 percent shure is Dr. Obwegeser in Zürich he is one of the skillest surgeons what concerns reconstructive maxillofacial surgery. Ask for opinions about this specific procedure. And when you have 2-3 more opinions from experts that performs this surgery you can choose without stress. Your situation is not good to perform surgery on you believe me.

Yes I agree with this. You intentionally ignored Switzerland which has arguably some of the best maxfac surgeons in the world. It will cost you more to go there but it's worth it, imo. I'd also see if you can do an online consult with Prof Andrew Heggie.

Sandro Pelo I don't know an awful lot about, though the general opinion is that he's very thorough.

[falcao]

As Modigliani asked  you, what did the other surgeons you saw say? What did Zarrinbal say? Who was the third surgeon you saw?

If you want good advice from people who are knowledgeable on this board (there are several really good ones), you need to learn to write clearly. It' s not about the fact that English is not your first language. It's about the fact that you need to provide more detail, and you are not trying, asking impossible questions that no one can answer based on the little disjointed things you say. This is how you might want to try it:

I went to see Dr X.. He told me XXX, which was different from what Dr Y told me, which was XXX. Dr Z agreed with Dr X on this, but disagreed with Dr Y on this, etc.

Only when you try to write like this, people may be able to give you good advice and critically analyse what you have been told. You should never be told what to do here, that's a personal decision and you are just asking the wrong question over and over again. But people here can help you structure your mind, formulate clear and further questions for your prospective surgeon, suggest what to do next etc.

So, sit down, take your time and provide all the detail you can about your previous consults and your current concerns. Have a good dictionary beside you, re-read what you have written to make sure people can understand it before you post.

As I said, there are good and knowledgeable people here who will try to help when they can.   

[Rico]

FALCAO: I know now, why Dr Z has got only one bad opinion (on german forum) He do not operate very complicated cases or do not do it in more diffiicult way.

Ideal approach for my case is to cut the bone in the place where it broke and make reposition to original place. But its the hardest option, however it give the best results if it is succesful
I had 4 consultations in Poland. 3 of them told me that its impossible to be done. 4th told me that he can...but I couldnt find any opinion on internet. the 5th told me that she can do only decompression of the infraorbital nerve. but what interesting I told her I consider MM for doing that, and she told me that MM is very good option.
So 5 in Poland + MM + Z ...nothing more

DR TRIACA: I sent mail one week ago to his clinic. I wrote what I want and I havent got any response. Because of distance I always try to get some initial information including prices circa about
Do You have actual direct mail to him ?

I know some of you have bad opinions about MM. I take it into mind...however at the same time I;m completely not the same case like You. I will show you how my fractures looks like and where the cuts should take place. Noone of You have  had such procedure. This is why I look with a little distance at bad opinions.... and waht about other thousands people who he operated???

OK: MM told me that line of the fracture is visible and he will cut along them. No diploplia risk, because he will not operate inside orbital. He will cut just the malar and zygomatic arch and pull the bone - lever effect - so the upper part - very thin  part of the bone including orbital floor (less then 1mm of  thickness) will brake resulting in release of the whole bone complex. However I don't know why during this small zygomatic nerves will be destroyed he will cut at least 3cm from them . He also has got an experience with decompression surgery under microscope - what is interesting for me. If he tells the truth

Z.. told me that the line of the fracture is invisible now. He do not use 3D models, He hd a problem with reading my scans - stragne - however as you can se the line is clearly visible... He used to make full osteotomy including orbital to cut whole complex (in oposite to MM during this procedure he also get inside orbital which is dangerous), but now he doesnt, because there is risk of visual loss [of course rare but it can happen] and more likely for example 10% risk o persistent double vision...I told him about other surgeon approach, and he told me, that he is not sure, because it will be a little uncontrolled breaking, He never used to do it in that way. He also claims any movement of the whole bone may results in diploplia. However the bone move about 3mms horizontally and after fracture I diddnt have diploplia. He offered me cut a little bone around infraorbital foramen and then cut falf of the zygomatic bone.

This VR of my CT

You can see 3 points small holes on the side of zygomatic bone. Zygomatic nerves goes out there. So why in MM plan they have to be cut ? Probably during accessing zygomati arch throught the mouth. I can ask MM about other approach - perhaps near from the temple ? in Z plan there is also risk about it

AFTER FRACTURE THE BONE GONE INWARD WITH LITTLE ROTATION

img

img



The plans of MM [red line] and Z [green line]   the black is what is goona to break during pulling, when the main part of the bone [the stronges] will be cut


img



NOW YOU SEE ?

[Rico]

Yes I agree with this. You intentionally ignored Switzerland which has arguably some of the best maxfac surgeons in the world. It will cost you more to go there but it's worth it, imo. I'd also see if you can do an online consult with Prof Andrew Heggie.

Sandro Pelo I don't know an awful lot about, though the general opinion is that he's very thorough.

No I asked in Switzrtland - 60K Euros....its too much.
TRIACA: can't get any information from him. The domain pyramide.ch is banned. Tried to sent from different mails account without results...acutal mail needed on another domain .Do You have ?  Before I go to consultation I need some initial information including prices

 What do you know about costs in Pyramide.ch (dr Triaca) ?

[falcao]

I sent you a PM with some contacts. I hope that helps.

Regarding Mommaerts having bad results because he operates on complex cases and Zarrinbal doesn't - I don't buy it.

I had a straight forward BSSO - how difficult do you think that is? The surgery has been around for decades. He screwed it up completely. Not according to me, according to his colleagues, other surgeons that i have seen since.

Zarrinbal does wing osteotomies which are technically demanding, otherwise there wouldn't be a handful of surgeons in the whole world that do them. I'm not trying to defend him because I have not had experience with him, but he told me he does revision cases which are very difficult and other surgeons do not dare to touch.

Mommaerts may be "cheap" on first glance, but thanks to him I spent 5 times more than I should have and I am broke.

[Rico]

I sent you a PM. I hope that helps.

Regarding Mommaerts having bad results because he operates on complex cases and Zarrinbal doesn't - I don't buy it.

I had a straight forward BSSO - how difficult do you think that is? The surgery has been around for decades. He screwed it up completely. Not according to me, according to his colleagues, other surgeons that i have seen since.

Zarrinbal does wing osteotomies which are technically demanding, otherwise there wouldn't be a handful of surgeons in the whole world that do them. I'm not trying to defend him because I have not had experience with him, but he told me he does revision cases which are very difficult and other surgeons do not dare to touch.

but he do not make full osteotomies which is the best way in my case. I did some medical research / articles. However its the hardest option and more risky...because its close to eye
wing osteotomies is not my case.

[falcao]

Yes, I know, what I am trying to say when you pick up a surgeon you do not judge him based on one isolated procedure, but his competence overall. He told me everything I needed to hear as well before the surgery, and look where I ended.

I am not trying to dissuade you, you are misinterpreting me. I am trying to make you go and see more surgeons, and use my PM as a start. You lived with this condition for a long time, you can live a few months more. Just make sure you are confident in your final decision, and as far as I can tell, you are still not there. There are never guarantees, and there will always be a risk you personally have to carry. It's the same with all of us here.

[Rico]

I know. I'm here because I;m too afraid and still looking for more consultations.

I'm afraid if i cancel my surgery just 2 weeks before then MM put me on black list
BTW You have bad outcome when it comes only to look, or you have some damaged permamently nerve. If it was at least one year ago. You can PM about that.

DO YOU SEE BETTER MY PROBLEM ? I described everything

[falcao]

Well, as i said probably 10 times before, I have seen many surgeons after Mommaerts and they were horrified over both the functional and aesthetical aspect of his result. I told you before it will have taken 3 surgeries by the time I am over to correct the damage he did, and i do not want to repeat myself.

Regarding your problem, yes I understand it better, but my answer is still you are asking a question that only you can answer at the end of the day. Wait for other people to respond and see if they have anything specific to say to you.

We all assume risks in our surgeries. I assume permanent sensation loss in my next surgery as well. It's my responsibility to understand how big that risk is and make a decision.

It's your responsibility to do the same in your case. In order to do so, you have to see many, many more surgeons and make an informed decision around how big the risk is with the different approaches, and then do a risk-benefit analysis.

Those surgeons that you saw in Poland must have told you that they can't help you for a reason. They thought I assume the risk is too high.

There was a guy here who had a specific, risky, procedure and he interviewed more than 20 surgeons.

You are better off spending some of that money you have saved on consults and wait more, even a whole year, than doing something you will regret for the rest of your life. I think I heard you say you are not in a real pain, rather some discomfort, nor your condition is life threatening, so you must do what's right and see many, many more surgeons.

[Rico]

"Well, as i said probably 10 times before, I have seen many surgeons after Mommaerts and they were horrified over both the functional and aesthetical aspect of his result. I told you before it will have taken 3 surgeries by the time I am over to correct the damage he did, and i do not want to repeat myself. "


This is typical. They are competitors.

"It's your responsibility to do the same in your case. In order to do so, you have to see many, many more surgeons and make an informed decision around how big the risk is with the different approaches, and then do a risk-benefit analysis."

Yes. This is exactly what I'm trying to do. But there is another problem. The time... It seems I wont reapair it within 10 years and I'm getting old...and constatly stressed. Strange to feel pain and also a little not my face....its not big deformation, but little visible ..especially for me

I know everything..but every month give me more fixation about this... I mean obsessed thought. due to anxiety about this.
Teoretically I'm half dead .. and no drugs will help for that. terapy also.. I know myself. I just want to have my old face before fracture ...and as I see its impossible

"Those surgeons that you saw in Poland must have told you that they can't help you for a reason. They thought I assume the risk is too high. "  yes and no. In Poand we have national health insurane. its reuired. You cannot quit from that. Any surgery is for free. However they often refuse any surgery if life is not threatened. I cant explain that. Its complicated

"You are better off spending some of that money you have saved on consults and wait more, even a whole year, than doing something you will regret for the rest of your life. I think I heard you say you are not in a real pain, rather some discomfort, nor your condition is life threatening, so you must do what's right and see many, many more surgeons. "

Right, but its very stresful. About the pain ..I can try only decompression. No risk....but leave me with a scar and still flattened side of the face . or  access through the mouth..but in future they have to cut in the same place don;t know if this is good ? double scar ?

[falcao]

This is typical. They are competitors.

100% wrong, but you are not listening so I give up. The surgeons I saw are in America and other continents and are in no way on earth direct competitors (most never even heard the name). Everyone who is established on this forum knows who I saw and when and knows that I am telling the truth.

Last piece of advice (after one hundred I have given you): if I were you, I would pursue the decompression surgery to eliminate the pain and go for a simple small silicone implant option (or even filler) which is much safer and will be probably more gratifying. There are surgeons who specialize in custom implants and who can correct asymmetry to a satisfactory aesthetic level.

Good luck! You will not hear from me again on this, as I understand now your brain is processing all the information you are getting in a very skewed way, and there is nothing else I can do to help apart from urging you to seek more opinions, starting with the contacts I gave you.