New here, looking for information

[eglantine]

Goodevening,
I'm new here. My name is Eglantine and I'm from France.
I want to undergo orthodontic surgery with the "surgery first" procedure. (I don't have functional problem and I had renounced to the operation till I discovered "surgery first" existed.) Choosing a surgeon is such an important decision to make and any help will be most appreciated !

The only surgeons I've found are not in my country so before I visit them, I'd like to have a minimum informations.

I'd like to first have confirmation that they can perform "surgery first" procedure on me, and possibly have a simulation of what they would do in my case, to check that we have similar taste aesthetically. But maybe the latter is too much to ask ?

I've read a lot of stuff the last days but I'm very new to the technical aspects of this procedure.

From what I understand:
-some surgeons do "minimal invasive" procedure
-they don't all use the same material, and some are safer
-the Lent of the operation, and thus the Lent of the anesthesia, may vary from one surgeon to another
-some can perform rhinoplasty at the same time (which I could be interested in for a very slight modification of my nose)

Is that correct ?

Also do you know how much time in general you have to wait to get a first appointment and then from the first appointment to get an operation day.

I'm considering Marinetti, Defranck, Zarrinbal. But I'm interested in any other suggestion, and of course, any comments on these surgeons would be much appreciated  !

Thank you to anyone who can help.

[kavan]

No one on here can confirm if you are a surgery first candidate. But maybe you are not asking that. If you are wanting to know if you are a surgery first candidate, you would need to consult with the doctors who do that.The typical candidate for surgery first is CLASS 3.
Surgery first means you get the braces or ortho to align the bite LATER and they want the ortho to work WITH the SF doctor as in being associated with the SF doctor in some way.

The other form of surgery first is when the person gets both the upper and lower jaw advanced equally (linear advancement), in which case they don't need braces afterwards.

Surgery first is not just something you can have just because you want it. You need to be a candidate for it. For any evaluation as to whether or not you are a candidate, you need to consult with the limited number of doctors who offer it.



If you wish to learn more about surgery first, read medical papers about it and look for the names of doctors who write about it, you can Google such terms as; 'Surgery first, orthognathic surgery', 'Surgery first, maxillofacial surgery'

How much wait time for different doctors is a question to ask their SECRETARIES who answer the phone.

[Dogmatix]

What I've been told is that surgery first is an orthodontic term. Meaning if your orthodontist make cast models, and figure that you have a good starting point, he can approve you for surgery. This is what the surgeons have told me, it's not really their decision.

[kavan]

What I've been told is that surgery first is an orthodontic term. Meaning if your orthodontist make cast models, and figure that you have a good starting point, he can approve you for surgery. This is what the surgeons have told me, it's not really their decision.

Sure you're not confusing what you were told or was this something where you asked a doctor who does surgery first and he told you the evaluation for it was with the ortho HE works with OR are you saying that 'any' ortho can make the determination whether or not you can have surgery first which to me sounds kind of strange simply because MOST orthos DON'T work with doctors who do surgery first (limited number of doctors who do surgery first) and doctors who DO surgery first have preferred orthos they work with given it's a team effort just like surgery 'last' and ortho first for it is a team effort.

Which surgeons told you this, the type who still rely on plaster casts. Modern maxfax docs use virtual high tech computer modeling, especially the ones who do surgery first.

[CCW]

Alfaro and Raffaini are the top European surgeons for that. Zarrinbal is a chin wing surgeon (= he'll recommend chin wing for everything), and Defrancq is old and old-fashioned.

[eglantine]

@kavan
Thank you for your reply.
I probably didn't express myself well.
What I meant was "can I ask via mail the surgeon if he thinks I am a good candidate for surgery first and if he could possibly send me a simulation of possible results for me before I travel to his country to meet him ?" (I sure can ask but maybe some are more likely to answer than some others ?)
as the only surgeons I have found are not in my country, I would like toavoid travelling for nothing...

[eglantine]

@ccw
Thank you very much for these informations !

I had thought of Raffaini but I read Sensual_lips testimony of her meeting with: he told her he didn't perform "surgery first" (and wad extremely rude).
Thanks for mentionning Alfaro !


When you say that Defranck is old fashioned do you mean he's using old fashion techniques that are not the most efficiet/safe ?

[kavan]

@kavan
Thank you for your reply.
I probably didn't express myself well.
What I meant was "can I ask via mail the surgeon if he thinks I am a good candidate for surgery first and if he could possibly send me a simulation of possible results for me before I travel to his country to meet him ?" (I sure can ask but maybe some are more likely to answer than some others ?)
as the only surgeons I have found are not in my country, I would like toavoid travelling for nothing...

Well, that's still a 'secretary' question given it would depend on each surgeon's policy which the secretary would have to relay to you. However, if you have a SPECIFIC doctor in mind, you would need to name him here and wait for patients of those doctors to tell you if this or that doctor accommodated how you wish to be accommodated and what the FEES were for what they might term as a 'digital consult'.

What I can tell you is that a digital consult for a maxfax evaluation would most likely require your having CEPH X-RAYS.

[eglantine]

Thank you !
I'm going to contact their secretary as you suggest. If anyone is interested in their answer just let me know.
(I think of contacting Pelo, Alfaro, and the above I mentionned.)

[kavan]

@ccw
Thank you very much for these informations !

I had thought of Raffaini but I read Sensual_lips testimony of her meeting with: he told her he didn't perform "surgery first" (and wad extremely rude).
Thanks for mentionning Alfaro !


When you say that Defranck is old fashioned do you mean he's using old fashion techniques that are not the most efficiet/safe ?

Surgery first is very modern, cutting edge, new frontier type surgery. If you Googled the terms I suggested in my first post to you, you would find Alfaro was an author of papers concerning surgery first. You would not find Defranq or Dr. Z's name.

[eglantine]

Thank you for giving me this idea of how to search !

I read Alfaro's paper from his website (instituto de maxillofacial) but on his after/before pictures, I think men are great but for women, they often have a chin too prominent to my taste.

I also found Sandro Pelo by googling "surgery first". Does anyone have any information about him ?

[Dogmatix]

Sure you're not confusing what you were told or was this something where you asked a doctor who does surgery first and he told you the evaluation for it was with the ortho HE works with OR are you saying that 'any' ortho can make the determination whether or not you can have surgery first which to me sounds kind of strange simply because MOST orthos DON'T work with doctors who do surgery first (limited number of doctors who do surgery first) and doctors who DO surgery first have preferred orthos they work with given it's a team effort just like surgery 'last' and ortho first for it is a team effort.

Which surgeons told you this, the type who still rely on plaster casts. Modern maxfax docs use virtual high tech computer modeling, especially the ones who do surgery first.

I don't wish to disclose the exact communication I've had and with whom. But yes, basically that it's up to any ortho to evaluate if they wish to send their patient for surgery first, since it's they who are going to be left to handle the post op situation. Also correct that not all orthos work with surgery first, which would exclude them from taking such decision.

[PloskoPlus]

IMO, it's a bad idea.  If your bite is "not bad enough to need braces", you'll simply spend less time in braces before and after surgery. 

[CCW]

IMO, it's a bad idea.  If your bite is "not bad enough to need braces", you'll simply spend less time in braces before and after surgery.

Yeah, I'd only recommend it if you're getting surgery to treat severe sleep apnea.

[kavan]

Thank you for giving me this idea of how to search !

I read Alfaro's paper from his website (instituto de maxillofacial) but on his after/before pictures, I think men are great but for women, they often have a chin too prominent to my taste.

I also found Sandro Pelo by googling "surgery first". Does anyone have any information about him ?

Found the following with Pelo as an author. The abstract suggests there are particular med/legal concerns as to the informed consent of sugery first differing from that of the traditional approach.  I've said this before but I shall repeat: Ultimately a surgery first doc wants to have a working relationship with the ortho. So, they are probably at legal risk in the event the patient could be a medical risk in the event the patient does not work with the doctor's selected team of orthos. For example, say a patient travelled from A FAR to have surgery first but that was TOO FAR to travel for the ortho follow ups with an ortho associated with the surgeon and because of that, SF didn't work out well for the patient. So, in order to pre-empt the patient from claiming they were NOT informed of the potential risks of working with an ortho of the patient's own choosing and hence make a malpractice claim on those grounds, docs who do surgery first need to consider drafting out an informed consent that is very SPECIFIC to the risks of SF. I guess, basically one where they DISCLAIM any responsibility in the event the patient elects to use an ortho OUTSIDE of the team of orthos they work with.
----

J Craniofac Surg. 2016 Oct;27(7):1750-1753.
The Medical Legal Aspects of Surgery First and a New Model of Consent Form.
Pelo S1, Saponaro G, Gasparini G, De Angelis P, Spota A, Garagiola U, Foresta E, Moro A.
Author information
Abstract
The introduction of "surgery first" has resulted in a new requirement to compare and resolve medical legal problems which previously did not exist in traditional orthognathic surgery. The first issue relates to the relationship between the doctor and the patient and, in particular, the need to create a new informed consent form for surgery first. The second problem that has arisen with the arrival of surgery first concerns the relationship between health workers, namely the surgeon, and the orthodontist. The authors of this article propose a new template for informed consent specifically created for surgery first and also a model for the new working relationship between surgeons and orthodontists which will facilitate and improve co-operation between them. This will improve results, and guarantee a greater level of protection for the surgeon. It will also enable the identification the individual responsibilities of each person.

PMID: 27741208 DOI: 10.1097/SCS.0000000000003051
[Indexed for MEDLINE]