Dr. David Behrman from New York Presbyterian review

[ArtVandelay]

See the previous discussion with more technical details here: http://jawsurgeryforums.com/index.php?topic=7383.0

In short, there were surgical complications with my double jaw surgery requiring an immediate revision one week later. The revision wouldn't be any issue at all had the planned result been achieved. Yet I was left with a very poor outcome for such an invasive procedure; see for yourself, my x-rays are in the above linked thread. Afterwards, it didn't help matters when I was completely ignored and my surgeon refused to even speak with me; instead he sent out a 1st year resident unfamiliar with my case. Looking back the whole experience from start to finish felt very sloppy.

[ArtVandelay]

An update now that I've almost wrapped up consultations on a revision / read my records. This is written here in case it can help others.

1.) Why I needed an immediate revision?

I feel not unlike an aircraft crash investigator piecing things together. Recall I had a L1 + BSSO done which required a revision one week later. The reason given was "I woke up hard from anesthesia".

Now I have a better sense what went wrong. My molars (#1, #16) are over-erupted and say at a slanted 45 degree angle. They don't fit properly with the rest of my bite but are functional in chewing. After my revision I still had a mild open bite which required the orthodontist to drill down the over-erupted molar as only one corner was hitting early. Since this molar is also on the side which was displaced after my first surgery what I suspect it's the reason why things went wrong. The over-erupted tooth caused my bite to hit on exactly one point and after waking up all the force of my bite was applied there and it manged to overcome the plates and drastically shift my maxilla requiring an revision one week later.

This is personal speculation since Dr. Behrman would not speak with me and instead sent out a 1st year resident who couldn't answer any of this and I doubt was familiar with my case.

2.) Poor planning

This indicates poor planning. This time around surgeons are very mindful of my over-erupted molars while Dr. Behrman never discussed them with me besides saying their fine as is. One top surgeon wants them removed prior to surgery while another wants to salvage them but drill down further.

I don't think my bite had any hope of fitting after my first surgery.

3.) Why the bad result?
The simplest explanation is true in this case: I had a poor plan which was also poorly executed.

While no surgeon will admit it during your consultations, some do not want to be judged on functional/airway/aesthetic issues. They will just care about occlusion even if they make your face severely crooked or shrink your airway or introduce any other problems. 

Compounding the problem, in my second surgery my surgeon most likely abandoned the plan, "the bite guides the surgery" I was told afterwards, without properly considering airway/retrusion. I made the mistake of thinking someone who had done this operation thousands of times and specialized in it was qualified to handle my case.

[PloskoPlus]

3.) Why the bad result?
The simplest explanation is true in this case: I had a poor plan which was also poorly executed.
While no surgeon will admit it during your consultations, some do not want to be judged on functional/airway/aesthetic issues. They will just care about occlusion even if they make your face severely crooked or shrink your airway or introduce any other problems. 

Compounding the problem, in my second surgery my surgeon most likely abandoned the plan, "the bite guides the surgery" I was told afterwards, without properly considering airway/retrusion. I made the mistake of thinking someone who had done this operation thousands of times and specialized in it was qualified to handle my case.

100 times this!

90% of surgeons are butchers who just follow the occlusal splint.

[kavan]

What ever became of the Gunson revision?

[ArtVandelay]

What ever became of the Gunson revision?

I'm still debating between a segmental L1 verus leaving my arches as is and going with no pre-surgery orthodontics and a regular L1.

[ArtVandelay]

Went through my records, here's some stats of my surgery for anyone curious. Overall there really isn't anything surprising there.

Procedure: Lefort I and BSSO, no grafts of any type

Time under anesthesia
First Surgery: 5 hours 15 minutes
Second Surgery: 3 hours 24 minutes

These times seem very long compared to what surgeons quoted during my current consultations.

Weight loss
From official records taken the morning of my first and my second surgery (eight days apart): 18 pounds
Weight loss from first to 3 months later: going from memory it was just under 50 pounds since I was banded completely shut using IMF fixation (no plates in lower jaw after 2nd BSSO)

Did a resident operate on me?
Inconclusive, I'll give them the benefit of the doubt that the head surgeon did in fact perform the key bone breaks. It appears most of his residents focus on the O part of OMFS after graduation so why even bother with practicing the MD  part.

So one of Behrman's surgical assistants, the head resident at the time, has gotten into hot water for allegedly regularly placing young patients under anesthesia for routine extractions where local is sufficient. That type of behavior doesn't happen overnight and you have to wonder if these alleged character flaws were present during my operation, and furthermore where did she learn them from? A valid concern especially considering how my operations turned out.

While the records are over 100 pages long and meticulously detail every shot you received and who administered it; they provide no clues who actually cut your bone and performed the downfracture.

The cynic in me thinks absence of documentation means a resident did in fact perform a big piece of the actual procedure, otherwise why not write it in the operative notes? But I have no way to actually verify it.

[kavan]

Well, if a resident does it, the BLAME or HEAT or bad review--what ever-- still goes to the head surgeon.

[ArtVandelay]

Well, if a resident does it, the BLAME or HEAT or bad review--what ever-- still goes to the head surgeon.

Yes I completely agree!

[ArtVandelay]

My last addition to this thread. For reference, this is a list of lawsuits filed against Dr. David Behrman, I see at least three:

https://www.casemine.com/judgement/us/5c3ef15c342cca4276c84822

https://caselaw.findlaw.com/ny-supreme-court-appellate-division/1857374.html

https://cases.justia.com/new-york/other-courts/2015-2015-ny-slip-op-32205-u.pdf?ts=1448057576

Personally at this point, even without any other information, it makes pursuing a revision a no brainier for me. I don't think what went wrong in my case is randomness inherent in the procedure itself. Rather it was a combination of poor planning and poor execution, both human factors. These hopefully these can be mitigated the second, or third depending on how you're counting, time around.

[ArtVandelay]

Another last comment. Insurance has approved my revision and will cover it (still haven't finalized the specifics, they just submitted it to see). I'm only mentioning this to highlight how untalented and remorseless a surgeon Dr. Behrman is. It's easier to ignore your mistakes, pretend they didn't happen, than try and fix them. The immediate conclusion to draw is that I'm not the only patient who had a botched surgery, surely if I was a rare unsuccessful outcome he would work with me to fix this. Instead it must be the case that he has a huge backlog of unsuccessful surgeries, to the point where fixing them would take time away from performing more mediocre surgeries for more money, this is evidenced by all the lawsuits against him.

[PloskoPlus]

Did he show you a detailed plan before surgery?  Before and afters?

[ArtVandelay]

For the sake of completeness, documented my case here too:

jawsurgeryatnyp.wordpress.com 

[tonebame]

My insurance has this dude as one of my in-network doctors. Thanks for the heads up. Hope your revision goes well.