Okay, I just had a pretty long call with Dr. Sinn. He called me from Texas.
A few highlights:
1) I told him I had also consulted Dr. Y after I found out he (Dr. Sinn) wasn't recommending an osteotomy, because Dr. Y is known for custom implants. He didn't seem to mind. I explained the surgical proposal from Dr. Y, and Dr. S thinks it's overkill. He doesn't think I need jaw angle implants, and he referenced the cuts that are needed to gain access. I didn't ask him in detail what he meant, but he seems to think it's too much.
2) Dr. S thinks my biggest issue is in the orbital area, and the osteotomy he performs he says wouldn't move the rim forward enough to give me the result I want. He recommended a single custom MedPor cheek/orbital implant that address both areas at once. He also recommended taking fat from a small incision in the belly button which would be placed over the orbital area to give "texture" to the implant. Some of this will resorb, but some will stay permanently. He says that it was a mistake for my prior surgeon to take fat from this area in a lower lid blepharoplasty.
3) He thinks my chin is "very slightly deficient" from a lateral view, so he thinks a genioplasty is optional and might give a good result.
4) We had talked about possible PEEK implants when I consulted, but he checked on price and said they are over $7k each. He says since that may be cost prohibitive, he would recommend Medpor implants. They are about $4k each, and he said he wouldn't add an upcharge (a doctor who is actually concerned about cost to the patient is refreshing!) We had a good discussion about bone loss from silicone, and he said this is more of a problem when implants are placed in the chin, because the jaw muscle puts pressure on them and can lead to bone erosion or even migration of the implant. He said this would be less of an issue in a cheek implant. He also said he doesn't do chin implants. He only does genioplasty and doesn't recommend chin implants. He went into detail describing a wing osteotomy, which I wasn't very familiar with, but he said I didn't need this. He recommends a genio.
5) I asked him about Titanium implants, because someone (I believe in this thread) had mentioned it. He said they are custom implants, but he doesn't recommend them. He said the material is too heavy. He uses titanium to secure osteotomy but wouldn't recommend using them as an implant material. He says due to their heaviness, they may migrate, and it is "not something you would want in your face."
6) He says a rhinoplasty/septoplasty would be helpful to me, but he doesn't do them beyond minor issues, so he would recommend a different doctor for my procedure, since I have a deviated septum that would need fixed at the same time. He also said in reference to Dr. Y's surgical plan that he doesn't recommend doing a rhinoplasty along with the other procedures in the same surgery. Swelling sets on quickly, so a rhinoplasty could compromise the result in other areas.
I need to follow up with him to ask him a couple questions I forgot to ask. But it was a good and helpful conversation and MAY present an alternative plan that could work. His office will follow up with me on cost, so I can compare to Dr. Y and make a decision.
