Bone Resorption

[Vic]

So I just called Dr Z and spoke to him about Bone Resorption as I know this was a concern from some people who wanted to get the chin/side wing. He said bone resorption can occur with any type of bone surgery. He advised the way to counter bone resorption will be to add more graft of the hip bone and to also watch that the segments aren't too small. He advised that the jaw bone will be stable after one year, so bone resorption only occurs within the first year.
I know when I had lower jaw surgery years ago, that there was a little notch where the cut was after which wasn't visible from the outside and is of no concern now.

[Lestat]

Thank you for this clarification, Vic!

I want to chime in on the discussion!

Bone resorption would be more of a problem if you would get a SEGMENTED chin wing and certainly if you already had prior scar tissue. Certainly with the segmented chin wing surgeons express that absorption of the native bone along the mandible (the wing) is a risk, and apparently that risk increases if the tissues were dissected priorly in the past. Soft tissue is what gives the blood supply to bone - so if the blood flow in the soft tissues is compromised, so is the blood supply to the bone. That is why multiple chin wings or zsos are a bad idea.

I heard that concern less about the zso and I think it should be less of an issue. Now, if you had a previous zso and were to get a second zso I can see that being a different issue since both the quality of the bone and the quality of the soft tissue (which is scarred) would be affected.

I would just do the chin wing without segmenting. I would not want to do a genioplasty + side wing. The side wing would is more prone to bone resorption, because there would be more segmentation.

A SPECIAL THANKS GOES TO "Ilovethemoon"!

[ppsk]

I know Zarrinbal mentioned that the iliac crest graft will decrease the risk of bone resorption and it should thus not really be a problem. From what Z/Triaca/Brusco mentioned, it seemed that Triaca and Brusco were more concerned about bone resorption along the border of the mandible if the wing was segmented: iliac crest graft or not.Scarring after for example a previous chin wing was also mentioned as an extra risk factor for decreased blood supply and thus bone resorption.

Triaca also seemed to use the iliac crest graft (far) less often than Z. since he seemed less convinced of the need of it or improved results when using it. Dunno about Brusco.

It seems to me if the movements Zarrinbal is claiming are indeed what is taking place, then the use of grafts is a necessity. For example, we have a poster here recently stating that he got drop down of the ramus? I can't see that being possible unless Z is sticking some hip bone inbetween to cover the gap.

I think Triaca is largely performing the movement as he originally described it in the literature, i.e all anterior sliding, no drop down or widening. But I wouldn't know, I tried to contact pyramide about the procedure a while ago and got no response, although as I'm learning this seems to be par for the course with many European outfits.

I'm not sure i get what is being mentioned by segmenting, isn't it just the one cut, all along the border of the mandible and then you're doing whatever movement is possible and fixing in place?

[boyo]

It seems to me if the movements Zarrinbal is claiming are indeed what is taking place, then the use of grafts is a necessity. For example, we have a poster here recently stating that he got drop down of the ramus? I can't see that being possible unless Z is sticking some hip bone inbetween to cover the gap.

I think Triaca is largely performing the movement as he originally described it in the literature, i.e all anterior sliding, no drop down or widening. But I wouldn't know, I tried to contact pyramide about the procedure a while ago and got no response, although as I'm learning this seems to be par for the course with many European outfits.

I'm not sure i get what is being mentioned by segmenting, isn't it just the one cut, all along the border of the mandible and then you're doing whatever movement is possible and fixing in place?

this is my ceph post-op in poor quality but you can see the drop down on one side:

[Vic]

What did you have done Boyo? can't see on that X-ray

[ppsk]

this is my ceph post-op in poor quality but you can see the drop down on one side:

I think i can see it yes

This is something most american surgeons would tell you unequivocally is impossible without implants, and I'm willing to bet the result looks 100000% more natural and aesthetic. Silicone is f**king garbage jesus.

[stupidjaws]

I think i can see it yes

This is something most american surgeons would tell you unequivocally is impossible without implants, and I'm willing to bet the result looks 100000% more natural and aesthetic. Silicone is f**king garbage jesus.

i think we came to a consensus:
Osteotomies or medpor. This is is for now. each has it's pros and cons, osteotomies might require 2 surgical times.but these are the ONLY 2 LEGIT options.

[Lestat]

i think we came to a consensus:
Osteotomies or medpor. This is is for now. each has it's pros and cons, osteotomies might require 2 surgical times.but these are the ONLY 2 LEGIT options.

Imo bone substitute materials (HA/Bio Oss) are also legit.