Difference between a €80,000 bimax vs a €20,000 bimax?

[61bnc]

I had a phone consultation with the Sailer clinic today. I was leaning towards genioplasty instead of bimax because it has less complications. However, I apparently (probably) have Upper Airways Resistance Syndrome (similar to sleep apnea) so I'll probably get bimax to treat that + vastly superior aesthetic results.

I asked how much bimax would cost approximately, and the assistant told me €80-90k, which sounds insanely expensive. (But that includes bimax and genio)

I've contacted other surgeons in Europe such as Raffini, Moammerts, Joel Defranq, and some guy in Barcelona called Johnny Birbe.
Based on my research these surgeons charge around €20-30k. Johnny Birbe quoted €13k by email.

Why is/does Sailer think his bimax is worth so much more than other prominent European maxfacs?

I'm willing to pay a lot to avoid ruining my face but I won't pay 4x for a surgeon that's the same quality as, say, Raffini or Moammerts.

Or should I just go for a cheap option like Johnny Birbe? He's not as renowned as the other maxfacs mentioned but is bimax really so complicated that it's only safe to do it with 5-10 world-renowned surgeons?

[swisser]

Because kids of rich parents look at the shopped pictures on his site and want him. Thousands of surgeons around the world do normal bimax surgeries and they do them just fine.

[beyondconfusedtbh]

why not contact Dr. Z as well?

[kavan]

Because kids of rich parents look at the shopped pictures on his site and want him. Thousands of surgeons around the world do normal bimax surgeries and they do them just fine.

Correct. It's a type of marketing aimed at APPEALING to the RICH who implicitly associate HIGH price points with quality or luxury or a 'superior' service.

[ExtractionsRuinFaces]

I would imagine that all of these "top tier" surgeons have similar surgical skill, they'll all be efficient with you when you're under and the complication rate will be low with all of them. The main difference is the pre OP planning and how much movement you'll be getting. That's what makes the main difference with these surgeons. Some surgeons are too conservative, some too aggressive (both can work out depending on the case but the best surgeons will be both conservative or aggressive depending on the case) so you have to work out your specific needs and whether or not X surgeon is proposing the right plan for your individual case

I think the only person worth considering that charges significantly more than other top tier names is Gunson, by the looks of things he has the best reputation of a jaw surgeon that i've seen on this board.

[sanddunes]

Not all plastic surgeons have an eye for aesthetics, so what you are paying for is proper planning of the surgery.  I personally like Sailer's focus on ante-face.  I couldn't afford him otherwise I would have gone to him. 

One possibility is getting a consultation with Gunson or Sailer, having them figure out what movements they would do for you, and then bring that plan to the cheaper surgeon and tell him that's what you want. 

[scramfranklin]

Not all plastic surgeons have an eye for aesthetics, so what you are paying for is proper planning of the surgery.  I personally like Sailer's focus on ante-face.  I couldn't afford him otherwise I would have gone to him. 

One possibility is getting a consultation with Gunson or Sailer, having them figure out what movements they would do for you, and then bring that plan to the cheaper surgeon and tell him that's what you want.

This is something I've considered. Going to Arnett/Gunson for a consultation, then taking it to someone cheaper, but not a bad reputation for like a 25k bimax. I just don't have close to six figures to pay Arnett/Gunson, but I want the best face I can get. I hope a surgeon wouldn't be pissed if I brought them some other surgeons plans and told them "this is what I want''.

[sanddunes]

I am pretty sure Gunson will do a full work-up, including cephs, x-rays, movements, before-after imaging etc. for a reasonable consultation fee (obviously don't tell him your plans not to use him)

I don't see why another surgeon would take offense - if anything it makes their job easier.  If they disagree with Gunson's work-up then you move on and find another surgeon. 

[PloskoPlus]

This is something I've considered. Going to Arnett/Gunson for a consultation, then taking it to someone cheaper, but not a bad reputation for like a 25k bimax. I just don't have close to six figures to pay Arnett/Gunson, but I want the best face I can get. I hope a surgeon wouldn't be pissed if I brought them some other surgeons plans and told them "this is what I want''.

The trouble with Gunson is that he's at the sophisticated end of the spectrum.  His plans are complex.  He tries to get it absolutely right both functionally and aesthetically, so may do extra work where other surgeons will say "close enough is good enough" i.e. all is good as long as the bite fits.  It's one thing to take his plan to your "local best guy" and be rejected outright.  It's quite another when he agrees and does something different without telling you. 

For example, CCW rotation can be accomplished by anterior impaction and posterior down grafting or a combination of both.  Gunson is famous for being able to do the latter really well.  Most surgeons don't do it either because they believe it to be unstable or, more likely, because they simply can't and just use the instability claim as an excuse.  Some claim to be able to do it, but don't. You could see such a surgeon, who'll say yeah, yeah, I'll impact you a little at the front and downgraft you at the back just like Gunson's plan says.  Instead they will only impact you, achieving a modicum of CCW and as long as your teeth fit, they are off the hook.  Because a fitting bite is the one and only thing they can be held against. Remember, it's easier to ask for forgiveness than permission, especially if they simply refuse to see you.  At the end of the day it's a business, and they want to "process you", whether their treatment is appropriate or not.

[kavan]

The trouble with Gunson is that he's at the sophisticated end of the spectrum.  His plans are complex.  He tries to get it absolutely right both functionally and aesthetically, so may do extra work where other surgeons will say "close enough is good enough" i.e. all is good as long as the bite fits.  It's one thing to take his plan to your "local best guy" and be rejected outright.  It's quite another when he agrees and does something different without telling you. 

For example, CCW rotation can be accomplished by anterior impaction and posterior down grafting or a combination of both.  Gunson is famous for being able to do the latter really well.  Most surgeons don't do it either because they believe it to be unstable or, more likely, because they simply can't and just use the instability claim as an excuse.  Some claim to be able to do it, but don't. You could see such a surgeon, who'll say yeah, yeah, I'll impact you a little at the front and downgraft you at the back just like Gunson's plan says.  Instead they will only impact you, achieving a modicum of CCW and as long as your teeth fit, they are off the hook.  Because a fitting bite is the one and only thing they can be held against. Remember, it's easier to ask for forgiveness than permission, especially if they simply refuse to see you.  At the end of the day it's a business, and they want to "process you", whether their treatment is appropriate or not.

Great post!

If I may, I would like to add:

If the person has some way of knowing they actually have a STRAIGHT FORWARD case within the capacity of the local maxfax, they would save a lot of $$ by having the local guy do it and not Gunson.

I guess one would be to get a displacement proposal from BOTH Gunson and the local guy. If they are both quite similar/same, then go to the local guy.

My implicit assumption here is STRAIGHT FORWARD case and that Gunson would not overly complicate such a case with the type of complex displacements he does do WHEN they are actually needed.

[Perlkrys]

This is something I've considered. Going to Arnett/Gunson for a consultation, then taking it to someone cheaper, but not a bad reputation for like a 25k bimax. I just don't have close to six figures to pay Arnett/Gunson, but I want the best face I can get. I hope a surgeon wouldn't be pissed if I brought them some other surgeons plans and told them "this is what I want''.

Exactly what I'm planning for a revision surgery (in a more diplomatic discourse perhaps).          Hopefully at that point though they'll realize 'oh, you obviously know what you want..'

[Perlkrys]

The trouble with Gunson is that he's at the sophisticated end of the spectrum.  His plans are complex.  He tries to get it absolutely right both functionally and aesthetically, so may do extra work where other surgeons will say "close enough is good enough" i.e. all is good as long as the bite fits.  It's one thing to take his plan to your "local best guy" and be rejected outright.  It's quite another when he agrees and does something different without telling you. 

For example, CCW rotation can be accomplished by anterior impaction and posterior down grafting or a combination of both.  Gunson is famous for being able to do the latter really well.  Most surgeons don't do it either because they believe it to be unstable or, more likely, because they simply can't and just use the instability claim as an excuse.  Some claim to be able to do it, but don't. You could see such a surgeon, who'll say yeah, yeah, I'll impact you a little at the front and downgraft you at the back just like Gunson's plan says.  Instead they will only impact you, achieving a modicum of CCW and as long as your teeth fit, they are off the hook.  Because a fitting bite is the one and only thing they can be held against. Remember, it's easier to ask for forgiveness than permission, especially if they simply refuse to see you.  At the end of the day it's a business, and they want to "process you", whether their treatment is appropriate or not.

Ugh I think that's true, but so depressing.