Thoughts on this BiMax?

[valhalar]

I know this surgeon is controversial due to his previous use of this forum and alleged involvement with SJ. I am only interested in the male case for the first 60 seconds of this video:

https://www.youtube.com/watch?v=pdahHJUXeJg

Created an 11% increase in mandible width from BiMax? I didn't know that was even possible. What do you think of Coceancig's work vs. other maxillofacial surgeons as his pricing runs into the tens of thousands... is his work better than others?

[Lefortitude]

I know this surgeon is controversial due to his previous use of this forum and alleged involvement with SJ. I am only interested in the male case for the first 60 seconds of this video:

https://www.youtube.com/watch?v=pdahHJUXeJg

Created an 11% increase in mandible width from BiMax? I didn't know that was even possible. What do you think of Coceancig's work vs. other maxillofacial surgeons as his pricing runs into the tens of thousands... is his work better than others?

Im not sure how hes allowed to say he got an 11% increase in width from a bimax, since its really just an 11% perceived width increase, which results from the BSSO bringing the jaw forward and making it LOOK bigger. Perhaps its because the reference lines are fixed in space around the skull from front view, and so the points on the mandible are 11% wider with respect to those fixed reference points? that appears to be the case, but im sure he did not do any physical widening of the mandible.

I dont like the guy because he acts like a child on social media, talking s**t, advertising his work on discussion groups etc. He got comically defensive when I asked to see some B&As of his IMDO ("I dont need to prove anything to you, youre a nobody!" type response)

That said, the result you're looking at appears to be a pretty good one. SUPER bimax is a stupid juvenile sounding phrase that he appears to be trying to coin. figures.

Ive seen a few really good results from him, IMDO , Bimax etc.  but his arrogance and immaturity made me drop him as an option immediately on contact. 

[kavan]

Im not sure how hes allowed to say he got an 11% increase in width from a bimax, since its really just an 11% perceived width increase, which results from the BSSO bringing the jaw forward and making it LOOK bigger. Perhaps its because the reference lines are fixed in space around the skull from front view, and so the points on the mandible are 11% wider with respect to those fixed reference points? that appears to be the case, but im sure he did not do any physical widening of the mandible.

I dont like the guy because he acts like a child on social media, talking s**t, advertising his work on discussion groups etc. He got comically defensive when I asked to see some B&As of his IMDO ("I dont need to prove anything to you, youre a nobody!" type response)

That said, the result you're looking at appears to be a pretty good one. SUPER bimax is a stupid juvenile sounding phrase that he appears to be trying to coin. figures.

Ive seen a few really good results from him, IMDO , Bimax etc.  but his arrogance and immaturity made me drop him as an option immediately on contact.

Dr. Conceded, Concealing, what ever way he spells his name is another one who uses a lot of SUBTERFUGE where one really has to be really good at the 'forensics of bulls**t' to 'read between the lines' as to his presentation.

Let's take a closer look here. He states the 'SUPER bimax' combines IMDO, SARME and counter clockwise BIMAX surgery (LeFort and BSSO), with GenioPaully... to produce a super advancement of the lower face, in order to overcome severely short jaws.

Well, since the IMDO is something that works when one is STILL in the GROWING stage--as in kid or young adolescent--his examples of final results would be of patients who STARTED a series of procedures with him when they were YOUNG and go through multiple STAGES of other things before they get to the actual bi-max surgery when they are OLDER. Yet, he uses the after photos of patients he started at an EARLY AGE and went through a series of different types of 'expansion' along the way before they got to the final bimax surgery to appeal to an audience (adults) who are WELL PAST the age of when he STARTS his 'series of events'.

[april]

I haven't met or consulted with him, but he probably has a better aesthetic sense than the rest of the surgeons here in Australia. Like 95% of surgeons here don't give a damn about aesthetic outcomes and see no qualms whatsoever giving you the chimp lip or making your face longer, etc. I think he does CCW too. So it's a serious shame about the online persona and attitude.

Im not sure how hes allowed to say he got an 11% increase in width from a bimax, since its really just an 11% perceived width increase, which results from the BSSO bringing the jaw forward and making it LOOK bigger. Perhaps its because the reference lines are fixed in space around the skull from front view, and so the points on the mandible are 11% wider with respect to those fixed reference points? that appears to be the case, but im sure he did not do any physical widening of the mandible

I think they can make the back of your jaw wider by bowing out the posterior segments of the BSSO. I've seen it done in a couple of VSP videos. I don't know if that was done here though.

ETA: Actually yeah, looking at this image the back of the jaw (the ramus section) does look bowed out.

[Dogmatix]

I think they can make the back of your jaw wider by bowing out the posterior segments of the BSSO. I've seen it done in a couple of VSP videos. I don't know if that was done here though.

The ramus bone can be angled outward to some extent while doing a bsso. I was told it's done to balance so the advancement get less pointy, and that it's something they can play around with to make the face slightly more square in this area.

[IconVillage]

Is intermandibular distraction osteogenesis only for overbites?

[valhalar]

Is intermandibular distraction osteogenesis only for overbites?

I would assume so since it has the word mandible in it. According to the Profilo Surgical website IMDO is for fixing a small lower jaw and overbites.

[IconVillage]

I would assume so since it has the word mandible in it. According to the Profilo Surgical website IMDO is for fixing a small lower jaw and overbites.

But what if you just have one of the two (small lower jaw), would be a much less invasive surgery than BSSO if I'm reading correctly.

[valhalar]

But what if you just have one of the two (small lower jaw), would be a much less invasive surgery than BSSO if I'm reading correctly.

Some people on here have argued that if you only need a lower jaw surgery, then BSSO is better because you do the surgery once. IMDO requires a surgery, then turning the intermandibular distraction each day, and then another surgery to take the appliances out. However many adults with small lower jaws will require a jaw extension coupled with a genioplasty. IMDO is suitable because you could potentially do the genioplasty upon removal of the distraction device... I am not quite sure if there is another wait period however.

An example is shown here: https://www.instagram.com/p/66MRpXnEtw/

12mm of advancement with IMDO, followed by 10mm of advancement with a geniopaully (It's a genioplasty - this doctors version of it).

[valhalar]

By the way, here's another picture of the patient 'super' bimax from the video:

https://www.instagram.com/p/BwK5S5PHFMc/

Has his nasal bridge sunk between the first and second image, or would that be from rhinoplasty? I understand upper jaw surgery can pull the bridge down.

[IconVillage]

Some people on here have argued that if you only need a lower jaw surgery, then BSSO is better because you do the surgery once. IMDO requires a surgery, then turning the intermandibular distraction each day, and then another surgery to take the appliances out. However many adults with small lower jaws will require a jaw extension coupled with a genioplasty. IMDO is suitable because you could potentially do the genioplasty upon removal of the distraction device... I am not quite sure if there is another wait period however.

An example is shown here: https://www.instagram.com/p/66MRpXnEtw/

12mm of advancement with IMDO, followed by 10mm of advancement with a geniopaully (It's a genioplasty - this doctors version of it).

I assume the guy in the picture also had bite issues? I don't think this can work for a class 1 bite but mandibular recession right?

[valhalar]

I assume the guy in the picture also had bite issues? I don't think this can work for a class 1 bite but mandibular recession right?

I have a Class I bite and mandibular recession. Dr Coceancig recommended I lengthen my lower mandible but did not say what he would do to achieve it. I am assuming it would be braces, followed by IMDO or BSSO. I only went for a single meeting and he seemed busy, I also had zero understanding of jaw surgery at the time so didn't ask what procedure it would entail. I haven't gone back yet and will seek the opinions of other macfacs to get a proper assessment before I make up my mind because he is apparently rather expensive. One member said their estimated cost was about $30k AUD after medicare. If I find other surgeons are not careful in their aesthetic concerns then I will considering returning to him.

There's no reason to say a Class I bite and a small mandible is not a candidate however. They can move the lower teeth backward with braces to create a large Class II overbite. They'll then perform surgery to extend the lower mandible so that the teeth meet. Other times you might need double jaw surgery to lengthen the maxilla forward so the longer mandible will meet it correctly.

The patient in this photo https://www.instagram.com/p/66MRpXnEtw/ started with a significant Class II bite so the process was likely faster.

[valhalar]

I should also add that often times a Class I bite combined with a small mandible actually means that you have both a small upper and lower jaw. A small mandible but large maxilla often has a much greater overbite and is more often referred immediately to maxfac surgeons. Class I bites with small mandibles are just camouflaged by orthodontists, and they often have larger noses and seek rhinoplasty.

You need a full face analysis to determine if this is the case. If it the case you will probably need a double jaw surgery which will provide you a better result but can have it's downsides too.

[PloskoPlus]

12 mm is well within the realm of bsso.

[Abdulrahman]

They can move the lower teeth backward with braces to create a large Class II overbite. They'll then perform surgery to extend the lower mandible so that the teeth meet.

Are you sure about this part? Moving the lower teeth back, particularly the molars, is next to impossible. The alveolar bone in the lower jaw is less malleable and the lower teeth are constantly pushed forward by the upper teeth through mesial drift.