Cheekbone augmentation (Hydroxyapatite+fat transfer) with Dr. Joel Defrancq

[Lestat]

yeah i know but does this lyophilized cartilage become your own bone or does it just resorb? My fear is that it doesn't integreate with your own bone so there is the possibility of rejection. Also how does he shape and attach this bone? With screws? And does this bone "live" in your face? If you're hit in the face and it breaks does it mend like real bone would? I have to many doubts about lyophilized cartilage I don't understand how it works...

Some of it really transforms into real bone thats true. The risk of an infection is very very low, it is quite impossible. I tell you via pm how he attach it.

[Lazlo]

so he says it turns into the patient's "own bone" and works like a "biological miracle"

but he's the only one who uses it it seems. so what's the problem, why don't others? it's not like it's a new devlopment. Should we use it? Should we go to Sailer?


http://www.sailerclinic.com/en/specialist-fields/aesthetic-surgery/lyophilised-cartilage/

[MrFox]

My understanding is that all cadaver cartilage is lyophilized, perhaps I am wrong? I know which company produces it that Sailer buys from but he is the only surgeon really using it for facial augmentation.

I thought that he sometimes places it on the bone if it is for bone enhancement and other times puts in in soft tissue if it is to replace that. I know that you think he doesn't place the implants on the bone and I have no evidence to refute that but even if that was the case, traditionaly,  cheek implants are placed in pockets not on the bone, so what difference does it make?

[Lazlo]

My understanding is that all cadaver cartilage is lyophilized, perhaps I am wrong? I know which company produces it that Sailer buys from but he is the only surgeon really using it for facial augmentation.

I thought that he sometimes places it on the bone if it is for bone enhancement and other times puts in in soft tissue if it is to replace that. I know that you think he doesn't place the implants on the bone and I have no evidence to refute that but even if that was the case, traditionaly,  cheek implants are placed in pockets not on the bone, so what difference does it make?

okay but then it does not integrate into the patients own bone, it just lies there in the soft tissue pocket or suspended there like a sillicone implant. My question was whether it actually itnegrates and turns into the patient's "own bone" .

[MrFox]

okay but then it does not integrate into the patients own bone, it just lies there in the soft tissue pocket or suspended there like a sillicone implant. My question was whether it actually itnegrates and turns into the patient's "own bone" .

Ok sure that is a point, part of my implants have ossified now but it's not the same as the rest of your living bone. After it calcifies, it will never resorb, but it's not living bone.

[Lestat]

Ok sure that is a point, part of my implants have ossified now but it's not the same as the rest of your living bone. After it calcifies, it will never resorb, but it's not living bone.

Why is it not the same as the rest of your living bone then? You can also clearly see the (calcified) lyocartilage on a ct scan!!

[MrFox]

I think the same way that HA isn't living bone but would appear on a scan, this is what I understood from a doctor that I put this question to.

[Lestat]

I think the same way that HA isn't living bone but would appear on a scan, this is what I understood from a doctor that I put this question to.

Yes, because new bone grows through the HA. You can see it on a ct scan, whereas HA does not appear on a ct scan. It shows new bone where to grow.

[MrFox]

Ok I didn't know that the HA paste doesn't show on a scan, hmmm so why would the ossified cartilage? Maybe this Dr was wrong and it does indeed become living bone,

I know a person who had cheekbone implants with Sailer, after 2 months he decided he didn't want them anymore. Sailer couldn't remove them by pulling them out, the bases had ossified and were connected to his bone. Surely then, he does place them on the bone?

[deputy van halen]

The HA shows on the scans in this article...

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

[Lazlo]

The HA shows on the scans in this article...

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

Yeah this is absolutely true. Okay Lyopholized cartilage might allow blood vessels etc. to grow into it but that doesn't mean it turns into living bone. In fact there is no way it does unless it is actually oseoinductive which it is not since I asked Dr. Sinn if ONLAY cadaver bone turns into your own bone and he said definitively NO.

Also HA paste frankly doesn't do much if anything as far as augmentation goes sorry to say. I think if you're gonna go this route, best to wait for the CT bone if that ever comes out. But I'm also skeptical about how this will 'turn" into the patients own bone if placed as an "ONLAY" augmentation.

[Lestat]

You are welcome!

[Lazlo]

Hello all,
I'm new to the forum but have been researching all of this facial surgery stuff for a while now and felt like it was about time I joined the community. Having recently consulted with both Drs Joel Defranq and Noorman Van Der Dussen, this post seemed like a suitable place to jump in.

I began to write details of my situation but it started getting so long that I figured I had better make a new post for all that. With regards to this thread, I have basically no cheekbone projection (on top of all the other stuff that comes with being a long faced mouth breather who had extractions and braces for 7 years in his developmental stage!).

I also have an untreated ZMC fracture from a fight. This has left one side of my head narrower than the other, with pretty severe cheek depression on that side. Funny enough, the side this happened to used to be my "good side", i.e; more projected, wider, etc. Combine this with a long midface, retruded jaws, weak chin, droopy orbitals, and huge nose that points off in the other direction, and it's safe to say I'm not a good looking guy. Oh yeah, I once fell directly onto concrete, eyebrow bone first, with all my weight. I don't know exactly what damage was done but my face swelled up enormously for a couple weeks. I look weird as f***.

Very recently I consulted with both the Belgian doctors mentioned above (at separate times, not together). Their suggestions seemed quite accurate (to my own analysis), but differed in a couple of ways. Dr  Van Der Dussen suggested septorhinoplasty, cheek augmentation, and genioplasty. Dr Defranq suggested double jaw advancement and re-alignment, genioplasty, cheek augmentation, with rhinoplasty at a later date.

Both doctors wanted to augment the cheeks with paste. Dr Defranq's was definitely bovine sourced HA paste. I can't remember what  Van Der Dussen's was called, but I should have more details once he emails me with the summary. Both doctors felt these substances give a more natural result than synthetic implants, with less complications. Both doctors claim to have decades of experience with the substances. Neither doctor seemed especially phased by the existing fracture and implied that they would just apply more paste to that area to balance out the asymmetry and flatness of the depressed bone. I am concerned that pastes cannot give the anterior or lateral projection that I require, because I have seen no real evidence to the contrary. And, as I'm sure is the case with you guys, I have spent countless hours scouring the internet for information regarding how to fix a messed up noggin, so if there are photos of this stuff that I haven't seen, they are well hidden! Anyway, his post has rambled on too long. If you guys have any questions for me, or want me to ask either surgeon something on your behalf when I next contact them, go right ahead! I have tried to keep this post strictly related to the cheek topic, if you want to know anything about the other aspects of the consultations then feel free to ask. Sorry for the wall of txt

Right so welcome to the forum. Looks like you're deep into this now so I would concur that I don't think just HA paste will give you the results you need unless combined with some sort of osteotomy. Will Dr. De franq do an osteotomy as well? He does list a ZSO type procedure and HA paste together as a solution on his site. Why isn't he offering you the ZSO? And what sort of osteotomy to the cheekbone does the other guy do?

[Lazlo]

Excellent work my friend!

Don't worry, you'll be able to do martial arts and adventure sports after a year no problem. And if you can achieve great results on your cheekbones with paste that will be a major accomplishment for all of us here on the board.

[earl25]

I'm having surgery with him soon, and will be doing the HA + fat transfer for cheek augmentation, along with bimax and genioplasty.  I'll let you know how it goes...I'm pretty freaked out though and think about cancelling like 10 times a day.  Ughhhhh.

Wouldn't the fat injections potentially damage the pocked used to place the HA granules?