make your own bone wider instead of cutting it

[PloskoPlus]

So if I've had an i-cat done, they can generate one of those from the data?

[Rico]

Should be dedicated DICOM files for volume render.
The most simple is to try to render in the program. Application can detect if rendering is possible or not

Osyrix or Intage Realia, eventually others

[asphyxia]

Don't forget to keep us updated guy,I'm looking forward to know more about the potential of this procedure 

[Rico]

so, noone knows why the surgeon wants to do this in such way (to cover much more area) ?

[Rico]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906722/figure/Fig6/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906722/

[Rico]

OK now I know it's HA from coral (not paste). Do you know something more about this ?

[terry947]

http://www.biocoral.com/files/Questions%20-%20Answers%20actuel%20VA.pdf

[molestrip]

I met with a plastic surgeon this morning and his comments were the same. He used to use this stuff and it sounds great but is really artificial to your body. He said it's not too bad to remove but it often doesn't look good, either the face looks too full or you can't put it in the desired spots. This is the sad reality of facial implants today. Silicone is really the best way to go I think and it's kind of sucky.

[Rico]

I got response from the surgeon who does these HA based surgeries
His answers are just CAPITALIZED

---------------------------

What I understood , you are going to put some filler into / under my skin to let it to create additionial collagen (to prepare skin to implant) and to let see me how it will look before permament solution will be applied… RIGHT

After 6 months (however at first time you told me that after 1 year ?? ) you are gonna to put kind of hydroxyapatite substance - what it is exactly ? please remind me, is it solid from the beginning ? - I mean solid structutre which is customised for me and then just put through the incision in the mouth ? or it’s kinda paste which change into solid form. ?
MIXTURE OF HYDROXIAPATITE AND MICROFIBRILLAR COLLAGEN  IT IS MOLDABLE FOR AT LEST ONE WEEK

I have also little flattened zygomatic arch - will this solution also help me in this area ? YES


You told me that this implant will change into bone …but I’ve read it may change only partially.  So how it really is ?
Generally, what are disadvantages of such solution ?  none ? there must be something CANNOT GUARANTEE THE VOLUME IS 100% IN EVERY PERSON
Absorbtion issue ?  does a body absorbs this material a little, like 25%, or at all ?… how the outcome is predictible in long term ?SORRY WE DONT HAVE ANY OF THE INFORMATIONS YOU ARE REQUESTING BETTER FOR YOU TO SELECT OTHER CENTERS

My infraorbital nerve issue - high probability of compression due to not enough space into affected canal, or eventually scar
THIS IS VERY IMPORTANT -  When I brush my anterior teeth, I feel itching and kinda pain on the cheek …so the compression is somewhere inside canal before the place where the anterior superior alveovar nerve goes down the ION. Having this in mind, are are you able to reach that area in the canal through the mouth in the second step, if cortisteroid injection will not help . I mean how deep can you get into the canal ?

And please do not understand me wrong, I know that in my case this problem is tricky, but my approach is just to be sure there is no compression, or anything else which may affect the nerve function. causing hypersensitivity.  I will feel more comfortable knowing that there is no compression, despite the procedure will help or not.

Please answer…. Perhaps you can show me some publications  which may answer to some of my questions

DEAR DON  IF YOU READ YOUR LETTER YOU MAY SEE THAT YOUR EXPECTED REQUEST OF RESULTS IS TOO HIGH. I DONT BELIEVE WE ARE THE RIGHT PLACE FOR YOUR PROBLEM SOLVING. PLEASE FEEL FREE TO ASK OTHER HOSPITALS TO ASSIST YOU.

------------------------------

I have to add that he told me I could ask him any question I wanted ...as you see only a few concrete questions...

[Lazlo]

Yup, he straight up doesn't know what the hell he's doing. And he's pissed that you're pressing him on specifics. What a f**ker.

[Rico]

I thought from the beginning that they will not help me too much (I only checkecd another solution). Even nerve issue (very very tricky) did not discourage him, but the question about HA solution

but they have really good opinions
so little strange behavior. I think my questions were very simple.

the other 2 surgeons (Germany, Italy) (osteotomy procedure, similar to  LF3 on one side) whom i'm gonna choose answered me some questions via mail and a lot on  the consultations face to face. I'm gonna have the last one with one of them very soon - that means  I'm gonna decide in the beginning of the May

by the way I put this on another thread ....anyone knows the answer ?

http://jawsurgeryforums.com/index.php/topic,3933.msg34987.html#msg34987

[molestrip]

@27F I heard similar things about HA paste. It doesn't turn into bone and it's just as foreign as any other material. I was told most surgeons don't use it anymore primarily because it doesn't give good results, that some older surgeons still use it because that's what they're comfortable with. A lot of surgeons have done the cheekbone augmentations, via graft or osteotomy, but not in volume, I think also because it's hard to get right. That's a good part of why implants are so popular and why surgeons like to wait until after jaw surgery to do them. The term "market differentiator" came up in conversation a few times. Choices are always imperfect, though, and that imperfection can give a surgeon enough experience just to handle regular cases better so not necessarily a knock against any particular surgeon.

Anyway, it's hard enough as it is to make cheekbones look good (check out Realself reviews), let alone with a big soft tissue change like jaw surgery. I think many surgeons have avoided the non-traditional LeForts b/c of the risks, you need 99 ecstatic patients to outweigh the screams of the 1 who was royally screwed. Change that ratio even to 10/90 and you won't be in business long without a rock solid reputation. That, and, there's still some problems they can't fix, like my laterally weak cheekbones. I'd still fix the negative vector first if I had to choose.

[Rico]

is "MIXTURE OF HYDROXIAPATITE AND MICROFIBRILLAR COLLAGEN "   the same like typical HA paste ? What HA paste exactly means ? what are the components ?

in my case osteotomy to set the bone in original position seems to be only one solution.
Also most surgeons do not perform computer assisted aurgery which perhaps is not superior to non-navigated, but it helps to achieve more predictible results

 

Change that ratio even to 10/90 and you won't be in business long without a rock solid reputation

hmm I found 2 who  perform it from time to time and they are still in business in big hospitals...one of them only in public
perhaps I will be just a guinea pig for them

However only one of them have opinions on internet (good) the second one does not.... but he make a lot of surgeries...so it's little strange

[molestrip]

I think the computer assistance gets old for them very quickly. It's more about communicating to the patient, still I wish they did it more as we all have our personal preferences. You can get away with a 10/90 ratio in cases where the alternative is worse, in syndrome cases for example. The doctor can always say the child was screwed to start with and the parents would believe them. Another example would be trauma. I don't think the cheekbone osteotomies are too bad for someone with experience, just not so great in making them look good. Not all surgeons have a large internet footprint, it just comes down to where they get their referrals from. Call a few orthodontists in every major city and ask for names, you'll find the local guys with good reputations.

[Rico]

unfortunately I do not know German and do not know which orthodontist to ask.  Additionally he is specialised in orbitozygoamtic areas, not jaw ones. Most maxillo-facial surgeons never has touched any bone above teeth in their regular practice (not while studying or in ER practice, where they have easy to reapir fresh fractures....etc)

and in many cases (not all) surgery on jaw has nothing to do with malar bones (from the technical point of view). Surgeries on jaw are much simplier due to:
1) much more references point on the skeleton - not needed navigation -  in the case of malar bone you barely have some reference points...and probably within 30 minutes during surgery you get swelled - so looking at a patient's soft tissue nothing tell a surgeon
2) much more common...and patients who wants jaw surgeries are mostly desperate ones.. they can accept pernament nerve damages...just to get what they wanted for a several years
3) patients can easily find another patients and to talk about specific surgeon - to get first hand opinion


malar osteotomies are mostly performed in patients who has been improperly treated after fracture

So there are completely another issues
jaw patients want to look better than before
most "malar" patients want as it was before
The second option is more tricky - believe me

of course some jaw patients also want to improve their cheekbone (osteotomy not implant) - but it's marginal from what I see

PS NAVIGATION IN MAXILLO FACIAL SURGERY IS KINDA NEW THING transfered from neurosutgery...how it can get old ?