Dr. Cohen of San Diiego

[screwsandplates]

Hi everybody. It's been a while since I posted here.
Has anybody ever heard of Dr. Cohen? http://www.facesplus.com/before-after/facial-procedures/jaw-surgery/
I consulted with him a few weeks ago and he seems pretty amazing. He was so friendly, knowledgeable, and accommodating. He spent over an hour talking to me and answering all of my questions. Like Dr. Arnett, he is a perfectionist and has a fantastic aesthetic eye.

His surgical plan for me looks like this:
4mm impaction
double jaw (plain BSSO)
sliding genioplasty to replace my silicone chin implant

Dr. Arnett is also awesome, as you guys know. His plan was something like this:
BSSO with counter clockwise rotation (CCW)
HA grafting under orbital rims
no genioplasty (he wants to be very conservative with the risk of scar tissue, which I totally understand)

I really don't know who to go with. They both seem like great surgeons! It's not the worst problem you could have haha, but I am conflicted. On one hand, I'm worried that traditional advancement will make my face longer, even with impaction (I have a long face, as noted by both surgeons ... and my mirror ). On the other hand, I thought I heard something about CCW posing the risk of muscle pain. I don't know how true this is though. Cohen was half the price of Arnett and local, so I'm tempted to go with him but I still don't want to completely rule out Arnett.

For good measure, I will be consulting with Dr. Schendel. My mum insists on checking out all of my options, which I agree with. This is pretty big surgery.

Have any of you consulted with Dr. Cohen? What do you think about replacing a silastic chin implant (please don't get one! they suck!) with a sliding genioplasty? Lastly, what do you think would be better for a person with long face syndrome: CCW or traditional advancement? I'm not too concerned about my nose post-op because I plan to get corrective rhinoplasty after.

Thank you!

[Kristen]

Why do silicone chin implants suck?

[screwsandplates]

Kristen: I guess I shouldn't say that they suck. For some people they are a very good option, but for me it was a camouflage surgery (when I really needed jaw surgery). The main reason I don't like them is that they form scar capsules around them and are difficult to remove. Removal and even replacement can lead to 'bunching' and ptosis, even after removing the scar capsule. Having a chin implant has greatly complicated my jaw surgery process. I don't want to act like some authority on implants, but be cautious. They are not as quick and reversible as they might seem. I would like to retract my statement and turn it into a word of caution instead. Just check out all of your options and be 100% sure before getting one

On a personal note: Mine is too wide for me and looks very unnatural. Now I can't remove it. If I do remove it, it will be a very risky procedure. Soft tissue damage could occur 2-6 years down the road, if not immediately after surgery. I kind of rushed into it when I was young and insecure. I didn't even know I had jaw issues at the time.

** EDIT: I was also referring to porous implants like Gore-tex. They are even more difficult to remove.

[Kristen]

Wow ..... Thanks for the info.    That is good to know as I always though it was easily reversible and might be a temporary help if jaw surgery couldn't be done for years to come.   

[pekay]

i've heard of him, he is supposed to be a genioplasty specialist who is very peculiar about which plate he uses (on the chin)

as far as I know he is a plastic surgeon that under-went the whole craniofacial fellowship rather than a oral and maxillofacial surgeon

i think you have the right idea, definitely consult around and hear a 3rd or 4th opinion

there is also Dr Brian Bast (Harvard guy) in San Francisco who is the head/chair at UCSF's Oral and Maxillofacial Surgery Department

small question: did you get a rhino along with your chin implant?

[screwsandplates]

i've heard of him, he is supposed to be a genioplasty specialist who is very peculiar about which plate he uses (on the chin)

as far as I know he is a plastic surgeon that under-went the whole craniofacial fellowship rather than a oral and maxillofacial surgeon

i think you have the right idea, definitely consult around and hear a 3rd or 4th opinion

there is also Dr Brian Bast (Harvard guy) in San Francisco who is the head/chair at UCSF's Oral and Maxillofacial Surgery Department

small question: did you get a rhino along with your chin implant?

He had a bunch of articles about his craniofacial work on his wall. He's corrected deformed newborns and children with craniosyntosis and Crouzon's/Apert syndromes.
Thanks for the recommendation. I will check him out. I did get a rhinoplasty along with the implant. Luckily I'm very pleased with it - it is only a little bit crooked because my little sister sucker punched me right in the face 3 weeks out of surgery. The surgeon is great with noses and revisions. I might go to him after my jaw surgery for a revision in case my nose gets all turned-up looking or abnormally wide.

[pekay]

He had a bunch of articles about his craniofacial work on his wall. He's corrected deformed newborns and children with craniosyntosis and Crouzon's/Apert syndromes.
Thanks for the recommendation. I will check him out. I did get a rhinoplasty along with the implant. Luckily I'm very pleased with it - it is only a little bit crooked because my little sister sucker punched me right in the face 3 weeks out of surgery. The surgeon is great with noses and revisions. I might go to him after my jaw surgery for a revision in case my nose gets all turned-up looking or abnormally wide.

Ideally you want to go to an oral and maxillofacial surgeon (DMD/DDS) for this sort of thing (bi-max + genio)

Craniofacial is a type of apprenticeship that is offered to plastic surgeons, otorhinolaryngologist and maxillofacial surgeons and part of the training covers orthognathic surgery but (imo) it's not nearly the same as going to dental school and specialising solely in oral related procedures.