Dr Z Bimax+Chin Wing: Stability of Ramus osteotomy

[RedFountain]

I’m looking into bimax + chin wing surgery options. I have noticed Dr Zarrinbal is able to do all procedures in one surgery. He achieves this by making the BSSO cut very high up in the ramus, leaving the inferior border of the mandible free to perform the chin wing. His website speaks of ‘Hohe BSSO’ (translates as high BSSO). See also this x-ray here: http://i.imgur.com/B2E2RMB.jpg

I find this fascinating, since I’ve read pretty much everywhere else that ramus osteotomies are far more likely to relapse than regular BSSOs. Does anyone know if he has found a novel way to stabilize the cut? Or is this simply a trade-off that one should accept?

The few patients he has showcased on his website are absolutely magnificent, and must all have been life changers. I feel his results are superior to anything I have seen so far, including crowd favourites as G&A or Raffaini. It would be a shame if all of the after pics were only temporary, right before the relapse sets in.

https://gesichtschirurgie-berlin.com/patientenbeispiele/

[kavan]

If the goal of the 'chin wing' is to drop down/ LOWER the inferior border of the mandible, the cut would leave a SPACE between the segments. So to stabilize, the SPACE would need to be FILLED in with a BONE BUTTRESS. With regard to the doctor you mentioned, this would be a GRAFT taken from the illiac crest of your PELVIS (hip) and require an operation to HARVEST it.

[ditterbo]

Nice results except the blonde on the right IMO shouldn't have had her maxilla set forward, but rather her jaw set back.  I sure hope this becomes more widely adopted if it's any good. IDK where I've heard it but I thought Dr Z doesn't do terribly experimental / risky maneuvers, ie fairly straight forward bimax movements / smaller rotations.  So I hope he's onto something here.