Risk and stability of down-graft to improve tooth-show

[kavan]

Thanks for the clarification Kavan.  Before I go on, I just want to thank your for all the time and effort you dedicate to responding to these questions!  It's extraordinarily generous work that you do here and I am very greatful for it!

After speaking with the professor, I felt reassured in terms of the 'capacity of the doctor doing it'.  It is the risk with multiple surgeries that I am now trying to unpack and examine.
 
Thanks for this question as it prompted me to go back over my shorthand notes. Initially on the phone the Prof said "based on what you've told me I don't like the idea, you've already had a downward fracture of the maxilla and that cut off all the blood supply to the face (except for the greater palatine artery?), then they've gone in again to do the bimax, so they've cut the blood supply off again, that's twice! Then they've gone in a third time!  Every time they do it, you're getting more and more fibrous tissue and less and less chance of healing". 

However after we met in person the following day and talked for a couple of hours, and he had a chance to look at my pre and post surgery photographs, he changed his tune and said "oh yeah ... that is an extremely disappointing result. After meeting you and watching you speak, I think there is good reason to do it and your surgeon really is the best person to do it.  He's given you a good functional result, but it's not at all what you would want ... anyway the new 3D technology will give you a much more predictable result.  I'd say go for it ... you'll never be happy if you don't give it a try, I can tell that just by talking to you!" (verbatim)

So I guess this is why I'm still searching for additional opinions/advice ... my surgeon was strongly  opposed to the idea of this revision for a long time, focusing on the risks ... however, he is now 'on-board'.  Likewise the Prof. began with a conservative view in theory but changed it when he met me.   Because both doctors initially expressed reservations, it's left me with some residual uncertainty I guess.

Well, he gave you a good explanation as to the risk. Sounds like they both know you want it and it might be worth taking the risk and also the doctor is going to try to negotiate the risks to find a way to work around them. (like on a steep ski slope)

[PloskoPlus]

He's had 2 goes at it.  I think that's enough.  Especially considering that he has no experience with virtual surgery planning or downgrafts. It almost sounds like you'll be his first patient on whom he will try these.  Before I had my surgery I got cold feet and consulted with another surgeon, who did nothing but praise my originally chosen surgeon. So I stuck with the "best guy in the state", who then proceeded with the laziest, sloppiest surgery possible.  BTW, he too does not believe in downgrafts and doesn't use 'computers'.  That old semi-retired guy simply had nothing to lose by recommending you to go back to your original surgeon (BTW, was the old guy's name David David?) It's not like he has to live with the consequences.  Professionals like to praise their alumni.  Unfortunately max fac surgery in Australia is bush league.  So it's just one bush league champion praising another.

I think the real reason why he "wants to have another go" is that your bite may be off. When I consulted with my butcher he got more and more weary and irritated by my constant questioning, especially regarding the aesthetic consequences of the surgery and blurted out "at least you'll have a good bite". That pretty much distils the "philosophy" of Australian surgeons - "it's a bite fixing operation".  To them we're just meat bags with dental arches to be matched.  The bite is the only obligation they think they have towards us, nothing else - not tooth show, not symmetry, not facial balance, nothing else. 

[eranthe]

He's had 2 goes at it.  I think that's enough.  Especially considering that he has no experience with virtual surgery planning or downgrafts. It almost sounds like you'll be his first patient on whom he will try these.  Before I had my surgery I got cold feet and consulted with another surgeon, who did nothing but praise my originally chosen surgeon. So I stuck with the "best guy in the state", who then proceeded with the laziest, sloppiest surgery possible.  BTW, he too does not believe in downgrafts and doesn't use 'computers'.  That old semi-retired guy simply had nothing to lose by recommending you to go back to your original surgeon (BTW, was the old guy's name David David?) It's not like he has to live with the consequences.  Professionals like to praise their alumni.  Unfortunately max fac surgery in Australia is bush league.  So it's just one bush league champion praising another.

I think the real reason why he "wants to have another go" is that your bite may be off. When I consulted with my butcher he got more and more weary and irritated by my constant questioning, especially regarding the aesthetic consequences of the surgery and blurted out "at least you'll have a good bite". That pretty much distils the "philosophy" of Australian surgeons - "it's a bite fixing operation".  To them we're just meat bags with dental arches to be matched.  The bite is the only obligation they think they have towards us, nothing else - not tooth show, not symmetry, not facial balance, nothing else.

Hey Plosko, sorry for the delayed reply.  I had my plates and screws removed on Monday and the GA really knocked me around this week (took me 3 hours to wake up in recovery and I've been weak and exhausted all week -  but surgery went well).  Yeah I've had all the same thoughts you have mentioned (and no the guy I spoke to wasn't David David).  Well I guess I have three months up my sleeve now whilst I wait for the old plate holes to heal up ...  lot's of time for thinking ...