Author Topic: make your own bone wider instead of cutting it  (Read 21324 times)

ncharm

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Re: make your own bone wider instead of cutting it
« Reply #15 on: March 19, 2015, 10:41:33 PM »
What about something like Bio Oss? I talked to Norman van der Dussen about this via email, because I have a volume deficiency in my suborbital rim area, and he suggested that as one of the options besides implants. But it seems nobody uses it...

Rico

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Re: make your own bone wider instead of cutting it
« Reply #16 on: March 20, 2015, 03:06:23 AM »
My malar bone (whole) has to be moved about 4mm ...somehow 2-3mm forward and 2-3mm outside to get original cheek prominence before fracture - so is it big augumentation or not ?

Rico

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Re: make your own bone wider instead of cutting it
« Reply #17 on: March 20, 2015, 04:57:39 AM »
just to picture it take a look into link. I have almost the same level (in the same way. small zygomatic displacement are always almost the same) of flattened face after fracture (not treated). Perhaps in my case is little less obvious. This guy perhaps have 5mm bone displacement max 6, for sure no more.
ALL surgeons tell me that 4mm is only minimal displacement (from skeletal point of view), but meybe for augumentation (implants) it's not so minimal. I do not know...

http://www.exploreplasticsurgery.com/wp-content/uploads/2013/07/Zygomatic-Osteotomy-Reconstruction-postop-Dr-Barry-Eppley-Indianapolis.jpg

so I have 2 options:
1) osteotomy - 2 surgeons has identical plan and say the risk is low
2) or as claim other surgeon better to put HA implant which as he belive is much less risky than osteotomy. It's supposed to be less risky for the nerves.

I saw examples only on the computer.  I told the surgeon that I do not want to have fluffy , too softy cheek, I just want to feel hard bone like on the healthy side...and he told me this implant is gonna to change into bone.. that's all




Rico

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Re: make your own bone wider instead of cutting it
« Reply #18 on: March 21, 2015, 06:46:24 AM »
nope, it's only a good example of my problem on the net. I'm not going to do anything outside the Europe.
Most surgeons tell me that osteotomy in my case is quite simple and not very risky.
but there are also the ones who tell me that it's much more less risky to do it not cutting the bone

I wonder who is too optimistic and who has not not enough skills
do you have any experience with comparing / judging osteotomy vs implants surgical plans ?

Lazlo

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Re: make your own bone wider instead of cutting it
« Reply #19 on: March 21, 2015, 02:46:04 PM »
interesting...but why to remove this ?

for example the surgeons I spoke to, told me they perform this in 2 steps
1) put filler (I forgot which type) into skin, to let the body create additional collagen in this region of skin .at the same time patient and surgeon is able to see how all of this will look like. Making first step they are able to predict the outcome of the second step. If something is not enough right, then it is easy to make some corrections at this step.

2) ... then, after 6-12months the filler is no longer in the skin, and they put this HA implant prepared in 3D modelling (based on the data from  CT for 3D modelling and the first step)

and I was told, this is gonna change into bone forever...
so I try to find out how true is this and how it can be useful for me
I always have to keep in mind that every surgeons team wants to push their method, saying that another is worse etc... you know still marketing and cash... new patients = new researh object :D

that's all. On the examples it looks quite OK, like it is very good option for mild corrections. but you know ...no surgeon will show you bad results :)

They claim this procedure is much more safe for the nerves - again true or not.. they always can hit the nerve by nidle

wow that sounds great to me. I mean this could totally improve your orbital rim or cheekbones or even jawline. But is it real? Have they shown you any results?

PloskoPlus

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Re: make your own bone wider instead of cutting it
« Reply #20 on: March 21, 2015, 04:42:00 PM »
What about something like Bio Oss? I talked to Norman van der Dussen about this via email, because I have a volume deficiency in my suborbital rim area, and he suggested that as one of the options besides implants. But it seems nobody uses it...

Unlike HA paste, bio-oss grows into your bone.  It's bovine bone derived bone substitute and this is what it's meant for - building up implant sites when there is not enough bone there.  And by implants I mean teeth.

molestrip

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Re: make your own bone wider instead of cutting it
« Reply #21 on: March 22, 2015, 09:10:26 PM »
I personally don't want implants or pastes for my orbital rims, cheeks, etc. (with the exception of the forhead) because I've read that over time it can naturally wear your actual bone down and when I presented the question to a few surgeons, they hesitantly said that would be the case and quickly directed me to fillers... whomp whomp whomp....

I've got doctors and dentists in the family and they see a lot of the problems that surgery causes down the road and have been warning me against unnecessary work. They're not too thrilled about jaw surgery either but it's gotten to the point that it NEEDS to happen. A lot of solutions on the market look good to me already but I also know that there's limits to what we can test for so I'm on the fence with them. Some day this stuff will all be routine and we'll have procedures with decades of data and thousands of patients behind them but that's not for us, except for jaw surgery (yay!). Most of us have a few decades still to correct our problems but that's only an option if other surgeries don't preclude those solutions later.

I'm leaning toward a philosophy of fix anything which otherwise would cause a functional problem. Jaw surgery is definitely in. Cheek and orbital rim implants could be in for some but maybe not urgently. And if aesthetics are bad enough to affect mental health or cause problems interacting in daily life, I would include it as well. Whole picture matters too. If you've got your hair, good skin, and you're skinny, then a few unaesthetic features could be ok otherwise you gotta fix what you can. /rant

PloskoPlus

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Re: make your own bone wider instead of cutting it
« Reply #22 on: March 22, 2015, 09:47:55 PM »
I've got doctors and dentists in the family and they see a lot of the problems that surgery causes down the road and have been warning me against unnecessary work. They're not too thrilled about jaw surgery either but it's gotten to the point that it NEEDS to happen. A lot of solutions on the market look good to me already but I also know that there's limits to what we can test for so I'm on the fence with them. Some day this stuff will all be routine and we'll have procedures with decades of data and thousands of patients behind them but that's not for us, except for jaw surgery (yay!). Most of us have a few decades still to correct our problems but that's only an option if other surgeries don't preclude those solutions later.

I'm leaning toward a philosophy of fix anything which otherwise would cause a functional problem. Jaw surgery is definitely in. Cheek and orbital rim implants could be in for some but maybe not urgently. And if aesthetics are bad enough to affect mental health or cause problems interacting in daily life, I would include it as well. Whole picture matters too. If you've got your hair, good skin, and you're skinny, then a few unaesthetic features could be ok otherwise you gotta fix what you can. /rant

Can you expand on the kind of problems they've seen?

molestrip

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Re: make your own bone wider instead of cutting it
« Reply #23 on: March 22, 2015, 10:26:14 PM »
The radiologist specifically mentioned chronic osteomyelitis and foreign body reactions from implants slowly breaking down. I know from personal experience about nerve problems. I developed allodynia in my left calf from a varicocele repair, as strange as that sounds, and I'm suspicious about some auto-antibodies that appeared shortly later too (fortunately, they went away). I've heard of a few cases of people losing sense of taste from jaw surgery. Twitching muscles happens sometimes, I have that anyway. Loss of sensation is common as we know but mostly people tolerate that well. We've seen cases of nerve compression here. Migration, relapse, asymmetry, fibrous unions, resorption, scar tissue, necrosis, lip incompetence, joint damage, and infection are other possibilities. "Resorption" sounds like code for "it disappears but who knows where to". That's what we can anticipate. I could come up with another dozen probably but then I'd be catastrophizing :P I'll probably edit this later as it's not good to scare other people with far fetched scenarios (where's my erase button?) but just wanted to answer your question.

FWIW, I think the risks are mostly theoretical as long as you don't make a habit of cosmetic surgeries, just you only get one life so all things being equal, less is better. A surgeon said to me "at your age, we don't really worry about problems" and he's on the ball. The biggest risk in practice is that you get the wrong surgery done and don't like the results, now or at some point later. Odds of disease in general are substantially higher. 20% of people will develop chronic illness at some point in their lives.

In retrospect, I never should have had kids but I'll count my blessings that they're all normal, healthy, and thriving :)
« Last Edit: March 22, 2015, 10:44:00 PM by molestrip »

Lazlo

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Re: make your own bone wider instead of cutting it
« Reply #24 on: March 23, 2015, 03:36:10 PM »
#YOLO

I'd take my chances.  Good looking > Ugly...

Unfortunately moron there's little to suggest jaw surgery will make you good looking. And all the problems molestrip listed --many of those tons of jaw patients deal with, they just don't talk about it on forums too much cause there's nothing they can do. This surgery is still at a highly primitive stage. It only started to be performed really in the 70s with any degree of confidence.

Rico

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Re: make your own bone wider instead of cutting it
« Reply #25 on: March 23, 2015, 03:59:23 PM »
It's true. However, on the other hand, I talked to many patients who has nothing damaged  after such surgery (full recovery)

molestrip

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Re: make your own bone wider instead of cutting it
« Reply #26 on: March 23, 2015, 09:19:31 PM »
@Rico It's true, most patients come out well. The real gamble is over time, no one can predict. Not saying work is problematic but its easier to stomach when you're older because you have more to gain and less risk in time.

The law of diminishing returns applies. Prioritize the items you want to fix and hit the low hanging fruit.

@27F Nevermind Lazlo. That's just the way he is :) He means well. He's right, though, plastic surgery is relatively young. It's a fair risk for you to take, just keep in mind that you may not understand the risk you're taking.

Rico

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Re: make your own bone wider instead of cutting it
« Reply #27 on: March 24, 2015, 03:28:09 AM »
OK I'm gonna to write some questions to the surgeon who offered me HA implant (which as he claims should change into my own bone)

However perhaps You are able to tell me, why he wants to cover more area with this implant . I mean, look at the following picture:
http://i.imgur.com/IrRg2Gf.jpg

The red lines show the lines of old fracture. Between red line and the nose and near the teeth there was no fracture, nothing has changed and I do not see any particular assymetry comparing to healthy side.
The green line shows the area he wants to cover - is much bigger then the recessed area due to old fracture. The whole malar bone moved about 2-3 mm back ( you see this on the second picture) and 2-3mm inward - not clearly at this to examples, but doesnt matter

He told me he wants to cover more area, to avoid strange looking after he put HA, but why not to put HA implant in such way it won't looking strange
Any ideas ?

PloskoPlus

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Re: make your own bone wider instead of cutting it
« Reply #28 on: March 24, 2015, 04:01:41 AM »
OK I'm gonna to write some questions to the surgeon who offered me HA implant (which as he claims should change into my own bone)

However perhaps You are able to tell me, why he wants to cover more area with this implant . I mean, look at the following picture:
http://i.imgur.com/IrRg2Gf.jpg


Rico,

What kind of scan is that?

Rico

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Re: make your own bone wider instead of cutting it
« Reply #29 on: March 24, 2015, 05:12:04 AM »
it is Volume Render of my CT - in quite good program, not as good as Osyrix ( available only on Mac ), but as you see not bad