Author Topic: Consult with Dr. Zarrinbal coming up  (Read 9454 times)

yamahatrophy

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Consult with Dr. Zarrinbal coming up
« on: June 09, 2019, 03:44:29 PM »
Hi all,

I've got an in-person consult scheduled with Dr Z. this week in Berlin.

A brief background to myself: At 19 I got braces to resolve tooth crowding as at the time I didn't understand the true pathology behind why my teeth were crowded. The ortho had to angle the teeth to make enough room for everything to fit, and did a small amount of enamel filing. Despite all this, the lower teeth are still slightly crowded. I'm also unhappy with how much my front teeth stick out due to the expansion. No extractions were performed, which I hear is a good thing. I only had my top left wisdom tooth extracted as it kept causing friction ulcers.

Now at 24 I'm going to see Dr Z. for his opinion on treatment options. Attached is a photo from my head CT scan. I'm trying to determine if I can get away with a camouflage technique like the chin wing or will need a BSSO / bimax.

I'll keep this thread updated after the consult with more details.
« Last Edit: June 10, 2019, 01:22:01 AM by yamahatrophy »

kavan

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Re: Consult with Dr. Zarrinbal coming up
« Reply #1 on: June 09, 2019, 04:31:01 PM »
Very GOOD jaw structure. Lil' bit of class 2 overlap. Z would probably LOVE having you as patient because of the good jaw structure.
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Lestat

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Re: Consult with Dr. Zarrinbal coming up
« Reply #2 on: June 13, 2019, 11:42:08 AM »
I've got an in-person consult scheduled with Dr Z. this week in Berlin.

I'll keep this thread updated after the consult with more details.

Hi :)

Please inform us about your consultation with Dr Z. We are all very excited.

yamahatrophy

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Re: Consult with Dr. Zarrinbal coming up
« Reply #3 on: June 14, 2019, 12:09:49 PM »
This week I had my consultation with Dr. Zarrinbal so thought I'd write a post about the experience after meeting the famous doctor. I've had consultations with five plastic surgeons now (not all for the same issues), but I can say the consultation experience with Dr. Z has by far been the best. I'm not sure how long the actual consultation was supposed to be, but we spent over an hour together discussing in lots of detail the different procedures, observing my CT scan and doing a physical examination. Other consultations I've had felt very impersonal and rushed, over in 10 minutes. His English is also fantastic, completely fluent.

In the end, because of my lack of functional issues, we decided a BSSO would be overkill and settled for chin wing. It seems to be a very good compromise between aesthetics and cost / recovery time / surgical risk. The chin wing can increase chin projection, jaw vertical height and simulate CCW rotation of the mandible. The visor / shield part of the procedure prevents the mentolabial fold from becoming too deep as can happen with sliding genioplasty / chin implant. I brought up a concern about the effect on the jaw angles because if you look at how the bone is moved, it's clear they will become at least somewhat blunted. However, this is the aesthetic tradeoff of the chin wing but IMO it is massively outweighed by the positive aesthetic changes. The gap in the bone is filled with bone harvested from the hip. I asked about using alternative materials to avoid the scar and additional surgery however based on his past experiences Dr Z was not fond of them. Resorption is not an issue.

I saw before and afters of loads of patients who Dr Z has operated on across his spectrum of procedures, including chin wing, rhinoplasty, BSSO / bimax and ZSO. All were very impressive and he has a very good eye for aesthetics. He will give a very natural, harmonious result by default. Some patients have requested more extreme results and he is also happy to comply with that. The ZSO results for men exceeded my expectations after all the flak the procedure has received on various forums (this one included). In one of the before and afters, the eye area of the male was massively improved by the ZSO - his lower eyelid was raised by the additional support and he looked much younger and healthier. I double checked with Z that he didn't have any other procedures done to the eyes, but he apparently only had a ZSO.

As an aside - these procedures will not turn you into a male model. If you have a genuine bony deficiency this can be corrected and you can get a substantial aesthetic improvement. And as long as your expectations are correctly set and the procedure goes as expected, you will be a happy patient.

The Havelklinik itself is quite nice and easily accessible from Berlin Tegel airport. The floor where Dr Z is based could do with a bit of freshening up. For example, a water cooler in the waiting area. But other than that, fairly unremarkable.

So, what next? Unfortunately the CT scan I had done was not the type that Dr Z needed so I'm going to fly back to Berlin in a few months when I'm financially in a position to get the surgery and have it done at Mesantis. The flights, hotel and CT scan actually cost about the same as getting a CT scan done in my country so I figure I may as well ensure it's definitely the right kind of scan and see Dr Z again with any other questions.

Dr Zarrinbal's Notes


Post bimax

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Re: Consult with Dr. Zarrinbal coming up
« Reply #4 on: June 14, 2019, 12:42:52 PM »
Did he quote you a price?

yamahatrophy

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Re: Consult with Dr. Zarrinbal coming up
« Reply #5 on: June 14, 2019, 04:05:46 PM »
Did he quote you a price?

Yes, he mentioned some prices but I can't remember exactly what they were. I'll be emailing him shortly to get a proper quote.

Lestat

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Re: Consult with Dr. Zarrinbal coming up
« Reply #6 on: June 16, 2019, 06:04:50 AM »
Thank you for your report!

So dr. Z did you recommend a chin wing without knowing the exact position of your mandibular nerve?

Lefortitude

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Re: Consult with Dr. Zarrinbal coming up
« Reply #7 on: June 16, 2019, 11:10:09 AM »
Thank you for your report!

So dr. Z did you recommend a chin wing without knowing the exact position of your mandibular nerve?

He typically sends you to mesantis to get a CBCT scan.  I brought the scan to him for our consult and he emailed me later that day to tell me that the mandible nerve was in a good position, my septum was deviated to the left and something else which escapes me.  basically that I was good to go for a chin wing.

yamahatrophy

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Re: Consult with Dr. Zarrinbal coming up
« Reply #8 on: June 16, 2019, 12:29:54 PM »
Thank you for your report!

So dr. Z did you recommend a chin wing without knowing the exact position of your mandibular nerve?

No, he recommended the chin wing on the assumption the nerve is in the right place so he still needs the cone beam CT to be 100% sure. So my fingers are crossed I've got a good nerve position!

yamahatrophy

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Re: Consult with Dr. Zarrinbal coming up
« Reply #9 on: June 16, 2019, 12:32:44 PM »
He typically sends you to mesantis to get a CBCT scan.  I brought the scan to him for our consult and he emailed me later that day to tell me that the mandible nerve was in a good position, my septum was deviated to the left and something else which escapes me.  basically that I was good to go for a chin wing.

Did you decide to have your septum corrected by Dr. Z? I've also got a deviated septum so I'm planning on having that fixed at the same time as the chin wing for hopefully both functional and aesthetic improvement.

swissguy

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Re: Consult with Dr. Zarrinbal coming up
« Reply #10 on: June 16, 2019, 02:46:11 PM »
did any of the chinwing results show significant improvement in the jaw angle area? (= side wing)
also, did he suggest the zso or did you ask?

yamahatrophy

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Re: Consult with Dr. Zarrinbal coming up
« Reply #11 on: June 16, 2019, 02:56:08 PM »
did any of the chinwing results show significant improvement in the jaw angle area? (= side wing)
also, did he suggest the zso or did you ask?

I specifically asked about the ZSO. He didn't mention the side wing or show any results of it, but he may have just been calling it a chin wing to simplify things. I don't specifically remember the general effect on the jaw angles, however overall the procedure had a significantly positive aesthetic benefit on every patient. None of the publicly available results really compare. I remember seeing a compilation someone put together on imgur of patients who really needed jaw surgery rather than CW and the results were average. On the right patient, CW is fantastic. It's a huge improvement over sliding genioplasty, that's for sure. Avoids the step off, allows for widening and vertical height increase, and the chin shield reduces the mentolabial fold, one of the dead giveaways of a class 2 jaw.

kavan

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Re: Consult with Dr. Zarrinbal coming up
« Reply #12 on: June 16, 2019, 03:26:32 PM »
Thank you for your report!

So dr. Z did you recommend a chin wing without knowing the exact position of your mandibular nerve?

A low angle patient with wide ramus and good body of mandible and just a small amount of class 2 like you see in his bone photo is ideal patient for Z which is why i told him Z would love him as patient. Although he would still need scan to show exactly where nerve is, he's low risk for nerve damage. High risk are the ones with flimsy jaw bones and high mandibular plane angles.
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PloskoPlus

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Re: Consult with Dr. Zarrinbal coming up
« Reply #13 on: June 16, 2019, 06:16:17 PM »
A low angle patient with wide ramus and good body of mandible and just a small amount of class 2 like you see in his bone photo is ideal patient for Z which is why i told him Z would love him as patient. Although he would still need scan to show exactly where nerve is, he's low risk for nerve damage. High risk are the ones with flimsy jaw bones and high mandibular plane angles.
So it works the least for those who need it the most.

kavan

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Re: Consult with Dr. Zarrinbal coming up
« Reply #14 on: June 16, 2019, 07:17:22 PM »
So it works the least for those who need it the most.

Well, ya. That's one way of putting it. I just wanted to confirm that the OP was ideal type for it.
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