Chin wing + zygomatic osteotomy with DR Z. in October

[GrendelGegongan]

Do not be a fool. A movement of 7mm forward is not possible. Laterally it is feasible.

In addition, I find it a nonsense to add iliac crest bone at the top of the cheekbones. It is very unpredictable and the risk of resorption is very high. A well-known surgeon from Switzerland once said to me that it is the material that is the first to be resorbed.
Moreover, it also causes bone erosion when used as an onlay. Although it is not foreign material it "grows" into the bone just like each other material, even if it is fixed with titanium screws to prevent it from shifting. (Even if we only speak of a few millimeters, it is precisely these that make the difference).

You could have used Bio Oss or Hydroxyapatite (HA) blocks to fill the gap (Inlay), then you would have spared another scar.

How am I a fool, I'm simply relaying what he told me? Dr. Zarrinbal explained repeatedly that he moved 7mm forward and outwards. I explicitly asked for him to clarify that point seeing as I've seen people say ZSO is only lateral on here. Perhaps this was a modified ZSO, as I understand it the procedure is relatively new and might have evolved quickly and recently.

[Lestat]

And so Dr Z is ignoring these supposed facts?  Somehow I doubt it's that black and white.

You should ask him if the risk of resorption is really high with iliac crest bone, and if it causes bone erosion and then tell us what he said. I think the risk of infection is relatively low.

I did not invent that, on the contrary, these are scientific facts.

Otherwise, many more surgeons would use iliac crest bone instead of medpor or silicone as augmentation material.

[Bowie]

And so Dr Z is ignoring these supposed facts?  Somehow I doubt it's that black and white.

Somehow, I'll take the word of surgeons (Swiss, no less) above that of anonymous dilettantes.

[Lestat]

How am I a fool, I'm simply relaying what he told me? Dr. Zarrinbal explained repeatedly that he moved 7mm forward and outwards. I explicitly asked for him to clarify that point seeing as I've seen people say ZSO is only lateral on here. Perhaps this was a modified ZSO, as I understand it the procedure is relatively new and might have evolved quickly and recently.

I'm just telling you to develop the ability to critically question things.

A forward movement of 7mm would require to completely separate the segment from the mid-face. Another cut would be needed around the zygomatic arch. Although that's quite feasible, I do not think he did that. That would be too dangerous and would be more like a Modified Lefort 3, not a Zygomatic Sandwich Osteotomy.

[kavan]

Do not be a fool. A movement of 7mm forward is not possible. Laterally it is feasible.

In addition, I find it a nonsense to add iliac crest bone at the top of the cheekbones. It is very unpredictable and the risk of resorption is very high. A well-known surgeon from Switzerland once said to me that it is the material that is the first to be resorbed.
Moreover, it also causes bone erosion when used as an onlay and can get infected. Although it is not foreign material it "grows" into the bone just like each other material, even if it is fixed with titanium screws to prevent it from shifting. (Even if we only speak of a few millimeters, it is precisely these that make the difference).

You could have used Bio Oss or Hydroxyapatite (HA) blocks to fill the gap (Inlay), then you would have spared another scar.

Well, the surface of the CUT aspect of the iliac crest bone needs contact with either bone or other material so it does not resorb. You know.. the 'raw' part or part that the knife went through to harvest it can't be left exposed. However, the non 'raw' part eg. the very top of the illiac spine would not tend to resorb.

[GrendelGegongan]

I'm just telling you to develop the ability to critically question things.

A forward movement of 7mm would require to completely separate the segment from the mid-face. Another cut would be needed around the zygomatic arch. Although that's quite feasible, I do not think he did that. That would be too dangerous and would be more like a Modified Lefort 3, not a Zygomatic Sandwich Osteotomy.

Contact him and ask him yourself. I see no reason why he would deceive me. I had already decided on the surgery before I knew of the foward movement so it wasn't like he lured me in with false promises. ZSO doesn't touch the orbitals, only the outermost part of the cheekbone is moved, I fail to see how something that doesn't even touch the orbitals could be compared to Lefort 3 in terms of risk.

[ditterbo]

Somehow, I'll take the word of surgeons (Swiss, no less) above that of anonymous dilettantes.

Yeah all I said was apparently Dr Z doesn't see those risks to be as high or severe as this Swiss doc does, or else he probably wouldn't have performed that surgery. But you can call Dr Z a dilettante I guess, since you're so sure he's wrong.

[kavan]

You should ask him if the risk of resorption is really high with iliac crest bone, and if it causes bone erosion and then tell us what he said. I think the risk of infection is relatively low.

I did not invent that, on the contrary, these are scientific facts.

Otherwise, many more surgeons would use iliac crest bone instead of medpor or silicone as augmentation material.

Science has it that SURFACE CONTACT is needed to the exposed CUT surface of the bone. So, if the slice of iliac crest bone has 2 EXPOSED surface cuts, it needs to make direct contact, usually as a BONE BUTTRESS between the mandible which also has 2 exposed cut surfaces from being cut. Basically, any exposed bone cut, if left exposed will tend to resorb which is why SURFACE CONTACT with something else is needed to reduce chances of resorption.

If the harvest SLICE has only ONE exposed surface cut to it, that's the part which needs to make direct bone contact. The INTACT part of it doesn't.

It's highly unlikely, the doctor left any exposed surface cut on 'top' of the cheek bone (because he too would know the science of this). It's more likely that the part left on 'top' of the cheek bone was the INTACT surface of the iliac spine.

By the way, I'm not deferring to anything a Swiss surgeon told me, NOR any affinity to Dr. Z. I'm deferring to my degree in science from MIT.

[Lazlo]

Well I think its cool that Grendelgog had this surgery and has prominent cheekbones now.

Would you be will to share pics brah? I mean if it was moved 7mm forward then you definitely have a very prominent result so you should be able to measure or tell your self from a before and after selfie and 3/4 view. You'd look VERY different in a good way I think.

[Lestat]

Science has it that SURFACE CONTACT is needed to the exposed CUT surface of the bone. So, if the slice of iliac crest bone has 2 EXPOSED surface cuts, it needs to make direct contact, usually as a BONE BUTTRESS between the mandible which also has 2 exposed cut surfaces from being cut. Basically, any exposed bone cut, if left exposed will tend to resorb which is why SURFACE CONTACT with something else is needed to reduce chances of resorption.

If the harvest SLICE has only ONE exposed surface cut to it, that's the part which needs to make direct bone contact. The INTACT part of it doesn't.

It's highly unlikely, the doctor left any exposed surface cut on 'top' of the cheek bone (because he too would know the science of this). It's more likely that the part left on 'top' of the cheek bone was the INTACT surface of the iliac spine.

By the way, I'm not deferring to anything a Swiss surgeon told me, NOR any affinity to Dr. Z. I'm deferring to my degree in science from MIT.

OK. And that means specifically? How much of the iliac crest bone do you think resorbs then?
The resorption behavior of iliac crest bone is very unpredictable. In addition it resorbs unevenly. Anyway, it erodes the cheekbone on which it is located over the years.

Instead of the iliac crest, I would have opted for lyophilized cartilage. Not only does it not cause bone erosion because it is "sewed" into the soft tissues, it is also less susceptible to resorption. Some of it even calcifies! What a pity that so few surgeons know the power of this material!

[kavan]

OK. And that means specifically? How much of the iliac crest bone do you think resorbs then?
The resorption behavior of iliac crest bone is very unpredictable. In addition it resorbs unevenly. Anyway, it erodes the cheekbone on which it is located over the years.

Instead of the iliac crest, I would have opted for lyophilized cartilage. Not only does it not cause bone erosion because it is "sewed" into the soft tissues, it is also less susceptible to resorption. Some of it even calcifies! What a pity that so few surgeons know the power of this material!

The fact that you are asking me, 'what that means specifically' reflects that you might not understand the GENERAL PRINCIPLE I've explained here.

Clarify to me what you don't understand here:

a: The general principle I've explained

b: The fact that there are people who would elect to go to a surgeon OTHER than Sailer

It's looking more like b to me.

[Lestat]

The fact that you are asking me, 'what that means specifically' reflects that you might not understand the GENERAL PRINCIPLE I've explained here.

Clarify to me what you don't understand here:

a: The general principle I've explained

b: The fact that there are people who would elect to go to a surgeon OTHER than Sailer

It's looking more like b to me.

I only said that I prefer lyophilized cartilage to iliac crest bone for the reasons I have stated.

You should not try to read any other motivation into that - but this is entirely up to you.

Naturally, this is not just only my personal opinion but it is scientifically proven. Of course, it could be controversial a bit, but in any case I hope it will stir up some discussion.

[kavan]

I only said that I prefer lyophilized cartilage to iliac crest bone for the reasons I have stated.

You should not try to read any other motivation into that - but this is entirely up to you.

Naturally, this is just my personal opinion, and it could be controversial a bit, but in any case I hope it will stir up some discussion.

IMO, you are being an insensate opportunist, quite possibly at the emotional expense of this patient (GrendalGong) in an attempt to shake his confidence and call into question whether his doctor did something 'wrong'. I don't have an issue with your liking Sailer. The issue here, as I see it, is you are attempting to undermine the confidence of this patient as to what his doctor did and using that as an opportune time to interject a type of promotion of Sailer.

[Lestat]

IMO, you are being an insensate opportunist, quite possibly at the emotional expense of this patient (GrendalGong) in an attempt to shake his confidence and call into question whether his doctor did something 'wrong'. I don't have an issue with your liking Sailer. The issue here, as I see it, is you are attempting to undermine the confidence of this patient as to what his doctor did and using that as an opportune time to interject a type of promotion of Sailer.

I do not want to promote anyone here. Besides, I never mentioned the name Sailer. I'd just like to discuss whether it might not have been better to use Lyocartilage instead of the iliac crest bone. Myself being an insensate opportunist? There must be room for the truth. But probably I should have been more sensitive.

[kavan]

I do not want to promote anyone here. Besides, I never mentioned the name Sailer. I'd just like to discuss whether it might not have been better to use Lyocartilage instead of the iliac crest bone. Myself being an insensate opportunist? There must be room for the truth. But probably I should have been more sensitive.

Consider the mods here would know which doctor was being referred to here whether or not you mention the name.

 You need to stop using this patient's experience (while he is HEALING) to undermine, challenge, call into question, his doctor's technique or materials, especially so when you are using him as a spring board to interject your preference for what Sailer does. It's not the right time and place to shake his confidence in the surgery he got.

If you want to discuss the pros vs cons of lyocartilage vs ilac crest bone, it is preferable just to start a NEW separate topic on that.