Opinions on IMDO surgery?

[Mephala’s Razor]

Here is a video showing pictures of the surgery which look quite promising to me and like something that I could benefit from. The only problem is that the people in the video are younger teenagers whereas I am an adult. I know that generally the facial bones become less malleable with age, so I’m not sure if this would still be an effective aesthetic procedure at a later age. Thoughts on this?


(I don’t know how to imbed a video on here  )


https://youtu.be/7_AKD4SlfXA

[kavan]

It won't as in highly unlikely it would since it's meant for use in GROWING STAGE. You can do a search on here as to others asking same/similar hopeful question,

[Dogmatix]

There was some clinic that advertised that they used it and claimed it worked in adults as well. When I researched it a bit and tried to understand what they actually do, it turned out they used it in combination with surgery. So they make a fracture, install the device  and then it can work. Like these SARPE devices you see where they split the palate and turn a screw until it's enough. So if you want to use it as an adult it's still surgery. I think it's an interesting thought though, like braces for the jaws and you can direct and adjust while it heals.

[kavan]

There was some clinic that advertised that they used it and claimed it worked in adults as well. When I researched it a bit and tried to understand what they actually do, it turned out they used it in combination with surgery. So they make a fracture, install the device  and then it can work. Like these SARPE devices you see where they split the palate and turn a screw until it's enough. So if you want to use it as an adult it's still surgery. I think it's an interesting thought though, like braces for the jaws and you can direct and adjust while it heals.

BINGO! Those who market the IMDO never make clear to adults, past the growth stage, that for all intents and purposes the procedure ALONE is unlikely to work for them. Adult CURIOSITY and HOPE that it could is kind of 'bait' to make consult with doc/s who do it. Actual consult being OPPORTUNE time for them to suggest additional surgery in ADDITION.

I'd say better to know ahead of time whether or not one wants to waste time going to a consult to be told and sold additional surgery during the consult inquiry about IMDO 'only' for adults.

[GJ]

Distraction is the new frontier and will one day make jaw surgery look barbaric. I'd have revision if they perfected it. The accuracy was not precise enough last I researched it, and I haven't seen or heard anything to say otherwise.

[Dogmatix]

Distraction is the new frontier and will one day make jaw surgery look barbaric. I'd have revision if they perfected it. The accuracy was not precise enough last I researched it, and I haven't seen or heard anything to say otherwise.

But don't they do similar adjustments with the elastics after surgery and try to pull it while they can?

[Post bimax]

But don't they do similar adjustments with the elastics after surgery and try to pull it while they can?

I don’t think post-surgical elastics are for adjustment purposes. They’re to maintain the bite and prevent movement during the early healing phase.

[Dogmatix]

I don’t think post-surgical elastics are for adjustment purposes. They’re to maintain the bite and prevent movement during the early healing phase.

No, of course not with the purpose of moving. The jaws are put in the exact position they should be in and elastics to stabilise. But preventing movement also imply that they can move, and if they drift a bit and it's caught early enough, I meant that some strong elastics maybe can correct it. I don't know, it was more a question.

[kavan]

No, of course not with the purpose of moving. The jaws are put in the exact position they should be in and elastics to stabilise. But preventing movement also imply that they can move, and if they drift a bit and it's caught early enough, I meant that some strong elastics maybe can correct it. I don't know, it was more a question.

Not totally sure if TADs (temporary anchorage devices) are also called 'elastics' or not. But the TADs use elastics. They are there to anchor things in place and they can also adjust as in move selected teeth if not in place even after a surgery. So, yes, preventing movement can also imply they can move teeth.

Another useful anchorage method is a tiny metal screw called a temporary anchorage device (TAD) that is implanted into the jawbone above the teeth through the gums. Orthodontists then attach elastic bands between implanted TADs and specific braces’ brackets or wires to exert pressure on certain teeth but not others with pinpoint accuracy. After treatment the TADs can be easily removed.  Ref=http://www.blankenaudentist.com/blog/post/anchors-make-all-the-difference-in-successful-orthodontic-treatment.html


eta: 'Adjustments' are in reverence to moving the teeth. Not really to the jaws.

[Sergio-OMS]

Hello everybody,

My name is Sergio González-Otero. I am a maxilofacial surgeon in Madrid, Spain. I have been reading these forums from time to time, but I have increased the frequency of my connections lately as I have found that these forums are useful for me to learn what short of questions and concerns people have so I can address them during my consultations. I have even contacted some users in private to answer some doubts, disclosing from the very beginning who I was. I am not a good marketer though, maybe too honest. I agree with a lot of patients experiences here regarding orthognathic surgery and the overwhelming marketing process they experience. I do not agree with some of the advices done by experienced users here, although I thing a lot of the times they are correct from a theoretical point of view.

This is my first post. I do not like public exposure but I feel I need to participate in this thread as I read some mistakes, that were also repeated in previous posts talking about IMDO.

First of all, I would like to disclose that through my learning process about the IMDO protocol and my close relation with Paul Coceancig I have become friends with him. Paul has never asked me for money and has given me a lot of surgical and diagnostic tips. He has also given me some marketing advices, for instance advised me to register IMDO term as a trademark for Spain, so I did it. He also asked me to teach IMDO following his way, and to share with him my experiences so he could improve the protocol. I must proudly say that as a result of my opinions he has been able to modify it a bit so IMDO is easier for less experienced surgeons.

I have seen him consulting and in the operating theatre and,in my humble opinion, he has a deep understanding of the airway and the aesthetic issues in orthognathic surgery. The only thing he has asked me to do in return is to try to follow his protocol precisely, to keep it updated, and not use "IMDO" term if it is not his protocol what I am doing. No money was asked in return, no "franchise" has been made as stated in other threads. I am in contact with other surgeons of the group and their experience is similar.  It can be inferred from his YouTube videos he is very good at marketing and explaining his point of view about facial skeletal surgery and custom implants. Some prospective patients might not like it, but everybody is free to choose their surgeon and ask for second opinions, aren't they?

Disclosures done, I wanted to say the following:

It is also obvious, from his YouTube videos (the IMDO playlist today has more than 21 videos) and in a free PDF article you can download from Paul's Linkedin profile (and more information available online, it’s stated in my own website, although it's is only in Spanish) that IMDO is a surgical procedure, even for  teenagers. Yes, it is jaw surgery. Yes, we operate from age 12. It is mandibular distraction, it is even in the name of the procedure, Intermolar Mandibular Distraction Osteogenesis. Nobody is saying this is not surgery, nobody is hiding anything. It is quite clear, I suppose. Maybe it is not specified in every video... I don't know... but it is not hidden information.

In my humble opinion, IMDO is THE way to increase the size of a small mandible. It works (and has almost the same limitations) in adults the same way it works in teeenagers, although the procedure is much easier, better tolerated and risks are lower within younger patients. And benefits are more if done at earlier ages, not only from a social point of view but also from a health point of view, as correcting earlier a skeletal class II (better said, mandibular hypoplasia) implies also an earlier correction of the airway, posture and TMJ disfunction risk related to this problem. We do not advise to do IMDO in patients over 40-45. A lot of times genioplasty is done along with IMDO. Sometimes IMDO is combined with surgical procedures in the upped jaw: the older the patient is, the more probability of requiring these done. In younger patients these procedures are not usually necessary, as we can expand the upper jaw without surgery, specially now with MARPE. Personally I advice  to use MSE (Dr. Moon expander) even in kids, I am quite happy with its outcomes.

In my opinion, IMDO is better than BSSO for young adults with small mandibles wanting to get a better result, lower the risk of numbness/paraesthesia of the lower lip, chin and teeth, widen the mandible, have a perfect mandibular contour (no risk of palpable or even visible notches), avoid dental extractions because of having not enough bone for having all the teeth erupted and I never occlusion , widen the UPPER jaw more than with BSSO, but of course, also willing to accept its postops (plural, as we must remove the distractors, that is another procedure), other risks, maybe other procedures and, of course, its costs.

By the way, while searching "IMDO" in these forums I have found a previous message saying that Paul Coceancig wrote in these forums under a fake account. I have spoken with him about it and he swears he has never done that and in fact he is hurt about those apparently false accusations.

Kind regards.

[Lefortitude]

Sergio, Thank you for posting your experience. I appreciate your participation in this, as IMDO is a bit of an enigma to me. 

I would like to start by saying i've personally had a negative experience interacting with Dr. Coceancig on one of the facebook maxillofacial surgery boards.  At the time I was considering having him IMDO me and that experience had him knocked off my list.

MARPE - Microimplant assisted rapid palate expansion, developed by Dr. Won Moon at UCLA has shown excellent results in maxillary expansion and subsequent airway expansion.  Is that what is used in conjunction with IMDO to balance the midface?  Is there no Maxillary or Midface Distraction technique?

In an interview with Arnett and Gunson, Dr. Dipak Chudasama asked: Do you believe skeletal distraction can replace some orthognathic surgeries?

Dr Gunson Responded: Distraction osteogenesis, in our opinion, will not substitute for conventional orthognathic surgery. Well-done orthognathic surgery with rigid fixation produces occlusal, facial, and airway results that are the gold standard. Distraction osteogenesis does not, and will not, treat the bite in three planes of space with the same quality and precision as conventional, well-done orthognathic surgery. When thinking of distraction, we must realize its limitations. Establishment of precise vectors for distraction is exceedingly difficult. Moving a complex object such as the mandible to within 1mm of accuracy is a veritable impossibility with distraction. There are also severe limits on achieving final occlusion compared with traditional orthognathic surgery. What are the valid clinical reasons to avoid the Le Fort I and sagittal osteotomies in favor of distraction? Previously held beliefs that distraction was kinder to nerve and joint tissues have been proved false. We must be careful not to lower our standards for the sake of using new technology. Distraction does have clinical relevance when trying to correct large deformities in skeletally immature patients. Treacher-Collins patients often require early intervention to improve airway patency, and distraction can provide this. Severe hemifacial microsomia patients might also require distraction to increase the skeletal mass and structure in the condyle and ramus areas so that future orthognathic surgery can be successful.

Based on your post, Id imagines you'd hold a somewhat contrary point of view, so I would like to hear your take on this statement.

Thanks.

[kavan]

Well, you certainly do sound like an apologist for him. As the mod of this board, I'll say he participated under the name 'ortho expert' or something to that effect. Account out of his part of Australia with constant links to 'Profilo' videos. A poster called 'ortho expert' posting links to Profilo and posting from his part of Australia was sufficient enough. Unlike you, he didn't disclose his affiliation to himself or to Profilo. But good if you  learned a lesson not to present as he did and disclosing which IMDO maxfax you are.
 
His IMDO videos are full of subterfuge, not making it quite clear that IMDO is best aimed during GROWTH STAGE. Hopes of it working as an isolated procedure is what brings in the consults about it. Fat chance adult consults about it will resolve in option for IMDO 'only' as can be offered to kids, adolescents, teens in growing stages in the absence of additional surgeries to go with it .

You say IMDO is better for 'young adults', less risks than BSSO. Well ya, less risk than needing to get a BSSO in later life for jaw retrusion when the GROWTH STAGE has passed. So, what's a 'young adult' and why not use the term 'during GROWTH STAGE' instead? Term 'young adult' avoids using terms like 'teen' where it's just clearer they are in growth stage.

You admit, younger people as those in the GROWTH STAGE will get more out of this and those past that can have it with OTHER surgeries. But consider, this board's main population is OVER 18, past the growth stage and for the most part curiosity about IMDO is with hope they can have this as SOLE procedure. So, I tell them it's highly unlikely someone in their 20's or so will be offered the IMDO INSTEAD of a BSSO and the consult they go on hoping they can get that only (as a kid could) will resolve to being suggested OTHER surgeries.

So, tell me, how likely is it that say a 20 year old or someone passed the growth stage wanting say, a 5-7 mm advancement will be offered by you and your associates IMDO only?  OK, you could say, it depends. So straight out, what percentage of  ADULTS, those PAST the growth stage are given IMDO only?

Now again the board is aimed at at least over 18. But better if they are over 20. They are not candidates for the max benefits IMDO yields to those in the growth stage. So, my question as the mod (and the one who critiques your associate) is: 'Shouldn't these ADULTS past the GROWTH STAGE be told IMDO as sole procedure to advance jaw is unlikely to be the 'fix' for them as it would be for a kid?' Well I don't see the IMDO promoters telling them straight out. Telling them straight out would cut down the consults about them when those consults could lead to telling them they need other surgeries either instead or with and all because the HOPE of IMDO ONLY is used as kind of a marketing carrot.

Now IF this were a board where PARENTS of CHILDREN were the main population, then IMDO as sole procedure in early growth stages INSTEAD of EXTRACTIONS to push in their faces to get 'bite right' would be fine. They certainly would not be told to have their kids get extractions and their faces pushed backwards instead of IMDO. But again this a  board of population too late to have IMDO only. I just don't think that the lure of imdo 'only' --and they do think it's a possibility when they read marketing material that doesn't tell them straight out it's mostly beneficial for those in growth stages, ie children, adolescents and teens--should be used for consults where the consults are going to suggest other surgeries.

Then we've had posters on here saying they consulted with an Australian doctor and they relay he scared them by telling them they 'needed' this or that and if they didn't have the procedures suggested there could be health consequences. Although they avoided naming the doctor, I guessed it right who it was.

Then the TRADEMARK procedure doesn't sit right with me. I have more respect for doctors who share technique in medical venue than those who TRADEMARK it.  This is something OTHER doctors COULD do but if they use the term; 'IMDO', he's got a TM on it. So, unlike a 'BSSO' or a 'Lefort' or most other procedures in maxfax that are NOT trademarked, this guy has a trademark on his. A trademark is to BRAND.  So inquiries and discussions about 'imdo' resolve to giving exposure to his brand. Posters don't realize this is a TRADEMARK thing because it sounds like a generic procedure. He's certainly entitled to trademark his procedure and pose what ever contingencies he wants to others who agree to his terms in exchange for calling what they do; 'IMDO'. But JFS doesn't want to be positioned to be a defacto 'brand buzzer' when the term 'imdo' is used. Imagine if someone trademarked the term; 'BSSO'. Thankfully, 'BSSO' is not trademarked.  Each time the term is used, it's effectively a 'buzz' for his brand and given the history of his introduction and participation here why should JSF be defacto brand reps for him .

That said, in your opinion, what would be a good GENERIC term for a procedure that does the same thing that a variety of doctors could do WITHOUT using the trademark name?





To bad you never participated on any of the threads that were very informative. Just on this guy's.

Hello everybody,

My name is Sergio González-Otero. I am a maxilofacial surgeon in Madrid, Spain. I have been reading these forums from time to time, but I have increased the frequency of my connections lately as I have found that these forums are useful for me to learn what short of questions and concerns people have so I can address them during my consultations. I have even contacted some users in private to answer some doubts, disclosing from the very beginning who I was. I am not a good marketer though, maybe too honest. I agree with a lot of patients experiences here regarding orthognathic surgery and the overwhelming marketing process they experience. I do not agree with some of the advices done by experienced users here, although I thing a lot of the times they are correct from a theoretical point of view.

This is my first post. I do not like public exposure but I feel I need to participate in this thread as I read some mistakes, that were also repeated in previous posts talking about IMDO.

First of all, I would like to disclose that through my learning process about the IMDO protocol and my close relation with Paul Coceancig I have become friends with him. Paul has never asked me for money and has given me a lot of surgical and diagnostic tips. He has also given me some marketing advices, for instance advised me to register IMDO term as a trademark for Spain, so I did it. He also asked me to teach IMDO following his way, and to share with him my experiences so he could improve the protocol. I must proudly say that as a result of my opinions he has been able to modify it a bit so IMDO is easier for less experienced surgeons.

I have seen him consulting and in the operating theatre and,in my humble opinion, he has a deep understanding of the airway and the aesthetic issues in orthognathic surgery. The only thing he has asked me to do in return is to try to follow his protocol precisely, to keep it updated, and not use "IMDO" term if it is not his protocol what I am doing. No money was asked in return, no "franchise" has been made as stated in other threads. I am in contact with other surgeons of the group and their experience is similar.  It can be inferred from his YouTube videos he is very good at marketing and explaining his point of view about facial skeletal surgery and custom implants. Some prospective patients might not like it, but everybody is free to choose their surgeon and ask for second opinions, aren't they?

Disclosures done, I wanted to say the following:

It is also obvious, from his YouTube videos (the IMDO playlist today has more than 21 videos) and in a free PDF article you can download from Paul's Linkedin profile (and more information available online, it’s stated in my own website, although it's is only in Spanish) that IMDO is a surgical procedure, even for  teenagers. Yes, it is jaw surgery. Yes, we operate from age 12. It is mandibular distraction, it is even in the name of the procedure, Intermolar Mandibular Distraction Osteogenesis. Nobody is saying this is not surgery, nobody is hiding anything. It is quite clear, I suppose. Maybe it is not specified in every video... I don't know... but it is not hidden information.

In my humble opinion, IMDO is THE way to increase the size of a small mandible. It works (and has almost the same limitations) in adults the same way it works in teeenagers, although the procedure is much easier, better tolerated and risks are lower within younger patients. And benefits are more if done at earlier ages, not only from a social point of view but also from a health point of view, as correcting earlier a skeletal class II (better said, mandibular hypoplasia) implies also an earlier correction of the airway, posture and TMJ disfunction risk related to this problem. We do not advise to do IMDO in patients over 40-45. A lot of times genioplasty is done along with IMDO. Sometimes IMDO is combined with surgical procedures in the upped jaw: the older the patient is, the more probability of requiring these done. In younger patients these procedures are not usually necessary, as we can expand the upper jaw without surgery, specially now with MARPE. Personally I advice  to use MSE (Dr. Moon expander) even in kids, I am quite happy with its outcomes.

In my opinion, IMDO is better than BSSO for young adults with small mandibles wanting to get a better result, lower the risk of numbness/paraesthesia of the lower lip, chin and teeth, widen the mandible, have a perfect mandibular contour (no risk of palpable or even visible notches), avoid dental extractions because of having not enough bone for having all the teeth erupted and I never occlusion , widen the UPPER jaw more than with BSSO, but of course, also willing to accept its postops (plural, as we must remove the distractors, that is another procedure), other risks, maybe other procedures and, of course, its costs.

By the way, while searching "IMDO" in these forums I have found a previous message saying that Paul Coceancig wrote in these forums under a fake account. I have spoken with him about it and he swears he has never done that and in fact he is hurt about those apparently false accusations.

Kind regards.

[kavan]

Distraction does have clinical relevance when trying to correct large deformities in skeletally immature patients. Treacher-Collins patients often require early intervention to improve airway patency, and distraction can provide this. Severe hemifacial microsomia patients might also require distraction to increase the skeletal mass and structure in the condyle and ramus areas so that future orthognathic surgery can be successful.

Based on your post, Id imagines you'd hold a somewhat contrary point of view, so I would like to hear your take on this statement.

Thanks.

That's the 'straight out' of it; in skeletally immature patients, ie those still in the GROWTH STAGE. Something to do for those too young to have a maxfax surgery (best done AFTER the growth stage). If  these IMDO guys disagreed with the straight out of it, they would tell you straight out that IMDO can be done instead of bimax (or full orthognathic surgery) in FULL GROWN ADULTS. But they just drop implications of hope where the hopeful end up getting suggested the full orthgnathic surgery when lured by possibility of IMDO only.

[Dogmatix]

Not totally sure if TADs (temporary anchorage devices) are also called 'elastics' or not. But the TADs use elastics. They are there to anchor things in place and they can also adjust as in move selected teeth if not in place even after a surgery. So, yes, preventing movement can also imply they can move teeth.

Another useful anchorage method is a tiny metal screw called a temporary anchorage device (TAD) that is implanted into the jawbone above the teeth through the gums. Orthodontists then attach elastic bands between implanted TADs and specific braces’ brackets or wires to exert pressure on certain teeth but not others with pinpoint accuracy. After treatment the TADs can be easily removed.  Ref=http://www.blankenaudentist.com/blog/post/anchors-make-all-the-difference-in-successful-orthodontic-treatment.html


eta: 'Adjustments' are in reverence to moving the teeth. Not really to the jaws.

My question was regarding movement of the jaws. If there is some elasticity in the fractured spots that can be pulled before it's settling.

[Dogmatix]

Hello everybody,

My name is Sergio González-Otero. I am a maxilofacial surgeon in Madrid, Spain. I have been reading these forums from time to time, but I have increased the frequency of my connections lately as I have found that these forums are useful for me to learn what short of questions and concerns people have so I can address them during my consultations. I have even contacted some users in private to answer some doubts, disclosing from the very beginning who I was. I am not a good marketer though, maybe too honest. I agree with a lot of patients experiences here regarding orthognathic surgery and the overwhelming marketing process they experience. I do not agree with some of the advices done by experienced users here, although I thing a lot of the times they are correct from a theoretical point of view.

This is my first post. I do not like public exposure but I feel I need to participate in this thread as I read some mistakes, that were also repeated in previous posts talking about IMDO.

First of all, I would like to disclose that through my learning process about the IMDO protocol and my close relation with Paul Coceancig I have become friends with him. Paul has never asked me for money and has given me a lot of surgical and diagnostic tips. He has also given me some marketing advices, for instance advised me to register IMDO term as a trademark for Spain, so I did it. He also asked me to teach IMDO following his way, and to share with him my experiences so he could improve the protocol. I must proudly say that as a result of my opinions he has been able to modify it a bit so IMDO is easier for less experienced surgeons.

I have seen him consulting and in the operating theatre and,in my humble opinion, he has a deep understanding of the airway and the aesthetic issues in orthognathic surgery. The only thing he has asked me to do in return is to try to follow his protocol precisely, to keep it updated, and not use "IMDO" term if it is not his protocol what I am doing. No money was asked in return, no "franchise" has been made as stated in other threads. I am in contact with other surgeons of the group and their experience is similar.  It can be inferred from his YouTube videos he is very good at marketing and explaining his point of view about facial skeletal surgery and custom implants. Some prospective patients might not like it, but everybody is free to choose their surgeon and ask for second opinions, aren't they?

Disclosures done, I wanted to say the following:

It is also obvious, from his YouTube videos (the IMDO playlist today has more than 21 videos) and in a free PDF article you can download from Paul's Linkedin profile (and more information available online, it’s stated in my own website, although it's is only in Spanish) that IMDO is a surgical procedure, even for  teenagers. Yes, it is jaw surgery. Yes, we operate from age 12. It is mandibular distraction, it is even in the name of the procedure, Intermolar Mandibular Distraction Osteogenesis. Nobody is saying this is not surgery, nobody is hiding anything. It is quite clear, I suppose. Maybe it is not specified in every video... I don't know... but it is not hidden information.

In my humble opinion, IMDO is THE way to increase the size of a small mandible. It works (and has almost the same limitations) in adults the same way it works in teeenagers, although the procedure is much easier, better tolerated and risks are lower within younger patients. And benefits are more if done at earlier ages, not only from a social point of view but also from a health point of view, as correcting earlier a skeletal class II (better said, mandibular hypoplasia) implies also an earlier correction of the airway, posture and TMJ disfunction risk related to this problem. We do not advise to do IMDO in patients over 40-45. A lot of times genioplasty is done along with IMDO. Sometimes IMDO is combined with surgical procedures in the upped jaw: the older the patient is, the more probability of requiring these done. In younger patients these procedures are not usually necessary, as we can expand the upper jaw without surgery, specially now with MARPE. Personally I advice  to use MSE (Dr. Moon expander) even in kids, I am quite happy with its outcomes.

In my opinion, IMDO is better than BSSO for young adults with small mandibles wanting to get a better result, lower the risk of numbness/paraesthesia of the lower lip, chin and teeth, widen the mandible, have a perfect mandibular contour (no risk of palpable or even visible notches), avoid dental extractions because of having not enough bone for having all the teeth erupted and I never occlusion , widen the UPPER jaw more than with BSSO, but of course, also willing to accept its postops (plural, as we must remove the distractors, that is another procedure), other risks, maybe other procedures and, of course, its costs.

By the way, while searching "IMDO" in these forums I have found a previous message saying that Paul Coceancig wrote in these forums under a fake account. I have spoken with him about it and he swears he has never done that and in fact he is hurt about those apparently false accusations.

Kind regards.

Well, fact is that there is a lot of people confused about IMDO. First time I read about it, it seemed like a non surgical procedure and it was not obvious to find this information, even though it's of course obvious for the one doing the surgery. It's also not obvious what the actual surgery is and how it differs from the fracture you do with BSSO. Can you tell us the technical difference in the cut you make for the IMDO™️?  Because if you want to separate a bone you need to fracture it, and how can we understand the difference in this fracture compared to BSSO and why it's better?

I also agree with Kavan on the nonsense of trade marking a procedure, making it harder to do research on and hindering it to be evaluated by other surgeons.