Surgery-first bimax + chin wing + ZSO while saving $$?

[ditterbo]

Am I romanticizing this a bit and not realizing the downside to this hypothetical plan?  What are the things to watch out for if I went to like Alfaro, Marianetti, or Raffaini (assume Z is just too swamped) and got surgery-first bimax, a chin wing, and ZSO all in one operation? I'm a class 1/borderline 2 bite with mild OSA, fyi.  It would cost like 50grand less than it would at a big name US surgeon, and no US surgeon, that I know of, does surgery-first bimax.  I really hated the idea of going abroad for bimax but surgery-first, add-on's, and all for way less than a comparable US surgeon is really starting to add up, in my head. 

[ppsk]

It's a lot of surgery for one session is all.

Also chin wing gets a lot of play on these forums but nobody ever considers the very real possibility that they might not be a candidate for it even if they want it more than anything! (due to the position of the mandibular nerve etc. I'm one of these people, I couldn't have chin wing even if I wanted my nerve runs like 3mm from the border or something I can't remember)

bimax + chin wing shouldn't be a problem but you are operating from the assumption that whatever surgeon you go to will feel comfortable combining them, or even just being familiar with the chin wing at all, or he might not be comfortable doing ZSO, or might just not be comfortable doing all 3 procedures in one surgery .... it IS a lot.

Marianetti will probably suggest medpor jaw angles in preference to chin wing, but he does do chin wing. Not a bad suggestion either, since its obviously much easier to install implants at the same time as bimax than it is to perform chin wing at the same time as bimax and will probably get better results in one surgery as opposed to the very limited lateral augmentation of a chin wing..... also If I'm not mistake the only way to combine bimax and chin wing is to use the bad homburger method instead of a classic bsso.


looks less than ideal to me since its not really fixing the sagittal deficiency.

[Milli_Meters]

Do the Zso later.

[ditterbo]

Ah well considering Gunson would do a ~9mm BSSO, maybe the bad homburger method can't achieve that. It's also apparently unheard of in the US - searching that hardly gets me a single English website. I do want the OSA relief benefit of bimax. Milli, if I can't do a simultaneous chinwing, are you saying postpone ZSO to see where I stand post bimax or just to avoid too much simultaneous surgery?

[Milli_Meters]

Well  a member here got BSSO + CW + zso at once and imo got very good results.But he did not have the added complexity of lf1.It needs to be discussed with the surgeons who do all these procedures , but all 3 at once sounds like too much. I know folks who had the 3 and they generally staged them like -

Bimax + chin wing first and zso later.

or Bimax first and zso + cw later.

From what I know there needs to be a 6 month gap between bimax and CW and 1 year gap between CW  and CW. iDK if its too optimistic , but I would do - bimax first and 7 - 8 months later CW + ZSO.

[Milli_Meters]

It's a lot of surgery for one session is all.

Also chin wing gets a lot of play on these forums but nobody ever considers the very real possibility that they might not be a candidate for it even if they want it more than anything! (due to the position of the mandibular nerve etc. I'm one of these people, I couldn't have chin wing even if I wanted my nerve runs like 3mm from the border or something I can't remember)

bimax + chin wing shouldn't be a problem but you are operating from the assumption that whatever surgeon you go to will feel comfortable combining them, or even just being familiar with the chin wing at all, or he might not be comfortable doing ZSO, or might just not be comfortable doing all 3 procedures in one surgery .... it IS a lot.

Marianetti will probably suggest medpor jaw angles in preference to chin wing, but he does do chin wing. Not a bad suggestion either, since its obviously much easier to install implants at the same time as bimax than it is to perform chin wing at the same time as bimax and will probably get better results in one surgery as opposed to the very limited lateral augmentation of a chin wing..... also If I'm not mistake the only way to combine bimax and chin wing is to use the bad homburger method instead of a classic bsso.


looks less than ideal to me since its not really fixing the sagittal deficiency.

People who "can not have" the CW due to nerve running close are they literally barred from it or just have to accept substantive risk of nerve issue/numbness if they wanna go through with it?

[ppsk]

People who "can not have" the CW due to nerve running close are they literally barred from it or just have to accept substantive risk of nerve issue/numbness if they wanna go through with it?

I would think a conscientious surgeon would refuse to do it due to the risk of damaging the major nerve. In my particular case "not possible"

[Milli_Meters]

Boy , takes a bit of  flight out of my chin wing fantasies.

[skullremodel]

It just amazes me how much money the difference accounts for.

I've been looking into surgery first methods and surgeons abroad as the price is crazy for big name surgeon. For the price of a big surgeon I could get bimax, orbital rim implants, rhinoplasty, and all the traveling.

[Milli_Meters]

It just amazes me how much money the difference accounts for.

I've been looking into surgery first methods and surgeons abroad as the price is crazy for big name surgeon. For the price of a big surgeon I could get bimax, orbital rim implants, rhinoplasty, and all the traveling.

Yeah I guess it requires case specific due diligence to figure out what surgeon is best for u.  I know someone who just had surgery with a big name in US. Result is rather meh.

[skullremodel]

Yeah I guess it requires case specific due diligence to figure out what surgeon is best for u.  I know someone who just had surgery with a big name in US. Result is rather meh.

yeah, i suppose the only thing that gets me is someone like gunson is one of the best in the world and not going to him would be a mistake, but i mean idk.