Disappointed / let down after consult with Australian Maxfac [Story/Pics]

[linoob]

For those who don't know, I only just recently posted explaining my situation which you can read here, if you wish.

Anyway, long story short I had a chin implant done in August 2019 which was poorly executed and is now sitting like this:



I spoke with a legitimate Maxfac in Australia just yesterday who assessed my face and images.

I told him I wanted either A) Genioplasty with reasonable advancement or B) Chin implant revision (With screw fixation)

He told me that fixation is not possible for silicone implants (The second surgeon to tell me this, wtf) and that the only options were PEEK implants with fixation or genioplasty.

He said based on my imaging that only 7mm of advancement was possible, and when I asked about vertical advancement he said he would need a bone graft and would not be willing to do it in my case.

When I asked about the PEEK implant option he said all he would be willing to do in that case would be to give me some names of different surgeons.

I'm genuinely perplexed and extremely disappointed I can't find a single surgeon in Australia willing to help me achieve my goals.

7mm advancement seems pointless. I've seen 10-year-old girls with a better prognosis than this. I also can't make sense of why he refused to offer any vertical advancement, as if this was too difficult or something.

Can anyone recommend a Surgeon/Maxfac in Australia who can achieve what I'm after?

It seems there are handfuls of surgeons in all parts of the world offering reasonable advancement on genioplasty's and implants with screw fixation all the time yet I'm struggling to find a single person here willing to help.

Australian surgeons are f**king pathetic and the least progressive I've ever seen.

[kavan]

what I can tell you is what they are telling you and why. You will be better prepared to get more out of the consults you go on when you understand the basic concepts behind what you are asking for.


Why can't they screw silicone?

Because the silicone used is soft and rubbery. As the screw gets screwed in, the threads of the screw shred off too much of the material such that the screw can't get a good GRIP into the silicone and for that reason won't fixate the implant well. Basically, screws work better with hard material.

What's meant when the term; 'advancement' is used in genioplasty?

Advancement refers to the HORIZONTAL displacement vector. In a sliding genioplasty, a chin segment is displaced over a diagonal cut and displaced diagonally upward. It's a diagonal displacement with 2 displacement vectors; horizontal and vertical. Horizontal is your 'advancement'. The other displacement vector is vertical which is an UPWARD displacement which SHORTENS the chin.

So if they tell you more than 7mm can't be done, it would tend to convey they think your chin would be too SHORT with more advancement than that.

The term 'advancement' is not used for the VERTICAL displacement vector. In a genioplasty that displaces with BOTH horizontal advancement and DOWNWARD vertical ELONGATION, the displacement is diagonally downward. Displacing chin segment diagonally downward leaves a GAP. If the gap is left VACANT with NO bone contact, the bone would resorb. A bone BUTTRESS is needed to fill in the gap. If your own bone is to fill it in, they take from the hip area which requires a separate harvest surgery. If non bone, then either something like a porex/medpore porous block or porous hydroxyappatite block carved to fill in the gap.

By the way, the type of silicone wrap around implant you have is notorious for moving out of place. The surgeon in Australia I know of who uses a porous HARD material for chin augmentation (bone growth happens through the pores of the material) uses CORAL. He's a plastic surgeon. Brian Mendelson (sp?)

[GJ]

Brian Mendelson (sp?)

I thought he used HA? He used to be a big promoter of it back in the day, though I haven't looked at this site in years.

[kavan]

I thought he used HA? He used to be a big promoter of it back in the day, though I haven't looked at this site in years.

Hydroxyapatite he uses is a coral product.

[eastcoastian1]

For those who don't know, I only just recently posted explaining my situation which you can read here, if you wish.

Anyway, long story short I had a chin implant done in August 2019 which was poorly executed and is now sitting like this:



I spoke with a legitimate Maxfac in Australia just yesterday who assessed my face and images.

I told him I wanted either A) Genioplasty with reasonable advancement or B) Chin implant revision (With screw fixation)

He told me that fixation is not possible for silicone implants (The second surgeon to tell me this, wtf) and that the only options were PEEK implants with fixation or genioplasty.

He said based on my imaging that only 7mm of advancement was possible, and when I asked about vertical advancement he said he would need a bone graft and would not be willing to do it in my case.

When I asked about the PEEK implant option he said all he would be willing to do in that case would be to give me some names of different surgeons.

I'm genuinely perplexed and extremely disappointed I can't find a single surgeon in Australia willing to help me achieve my goals.

7mm advancement seems pointless. I've seen 10-year-old girls with a better prognosis than this. I also can't make sense of why he refused to offer any vertical advancement, as if this was too difficult or something.

Can anyone recommend a Surgeon/Maxfac in Australia who can achieve what I'm after?

It seems there are handfuls of surgeons in all parts of the world offering reasonable advancement on genioplasty's and implants with screw fixation all the time yet I'm struggling to find a single person here willing to help.

Australian surgeons are f**king pathetic and the least progressive I've ever seen.

I mean, I have a full custom jaw/chin implant made from silicone and I have screws too (the implant actually comes with small holes where to fix the screws in I think). My implant though aren't going anywhere, as they are covered in bony overgrowth.

[linoob]

what I can tell you is what they are telling you and why. You will be better prepared to get more out of the consults you go on when you understand the basic concepts behind what you are asking for.


Why can't they screw silicone?

Because the silicone used is soft and rubbery. As the screw gets screwed in, the threads of the screw shred off too much of the material such that the screw can't get a good GRIP into the silicone and for that reason won't fixate the implant well. Basically, screws work better with hard material.

What's meant when the term; 'advancement' is used in genioplasty?

Advancement refers to the HORIZONTAL displacement vector. In a sliding genioplasty, a chin segment is displaced over a diagonal cut and displaced diagonally upward. It's a diagonal displacement with 2 displacement vectors; horizontal and vertical. Horizontal is your 'advancement'. The other displacement vector is vertical which is an UPWARD displacement which SHORTENS the chin.

So if they tell you more than 7mm can't be done, it would tend to convey they think your chin would be too SHORT with more advancement than that.

The term 'advancement' is not used for the VERTICAL displacement vector. In a genioplasty that displaces with BOTH horizontal advancement and DOWNWARD vertical ELONGATION, the displacement is diagonally downward. Displacing chin segment diagonally downward leaves a GAP. If the gap is left VACANT with NO bone contact, the bone would resorb. A bone BUTTRESS is needed to fill in the gap. If your own bone is to fill it in, they take from the hip area which requires a separate harvest surgery. If non bone, then either something like a porex/medpore porous block or porous hydroxyappatite block carved to fill in the gap.

By the way, the type of silicone wrap around implant you have is notorious for moving out of place. The surgeon in Australia I know of who uses a porous HARD material for chin augmentation (bone growth happens through the pores of the material) uses CORAL. He's a plastic surgeon. Brian Mendelson (sp?)

Sure bro, I understand this.

I won't argue with the point about fixating silicone, even though loads of world renowned surgeons are saying it's quite possible (Yaremchuck, Eppley, Niamtu).

And as for the genioplasty, I don't understand why they couldn't simple perform horizontal and vertical increases. He implied it was not viable / too much effort for the vertical increase.

Lastly, it shouldn't be this difficult to find a surgeon willing to take this thing out of my face and revise with a PEEK / Medpor implant with proper fixation. Everyday it remains in me it's causing more and more erosion.

I would simply have it removed, but why risk even more trauma / scar tissue when I'm only going to have it revised anyway. It's better off being done at the same time.

Australia is f**ked.

[eastcoastian1]

Sure bro, I understand this.

I won't argue with the point about fixating silicone, even though loads of world renowned surgeons are saying it's quite possible (Yaremchuck, Eppley, Niamtu).

And as for the genioplasty, I don't understand why they couldn't simple perform horizontal and vertical increases. He implied it was not viable / too much effort for the vertical increase.

Lastly, it shouldn't be this difficult to find a surgeon willing to take this thing out of my face and revise with a PEEK / Medpor implant with proper fixation. Everyday it remains in me it's causing more and more erosion.

I would simply have it removed, but why risk even more trauma / scar tissue when I'm only going to have it revised anyway. It's better off being done at the same time.

Australia is f**ked.

If you ever need to get the medpor removed though, you’re screwed.

[linoob]

If you ever need to get the medpor removed though, you’re screwed.

I've read that it's actually quote possible but it just needs a different approach.

Who knows though.

I don't know what to believe anymore though bro.

Every surgeon seems to have a different opinion.

You'd think the field of science would be more congruent with one another

[kavan]

Sure bro, I understand this.

I won't argue with the point about fixating silicone, even though loads of world renowned surgeons are saying it's quite possible (Yaremchuck, Eppley, Niamtu).

And as for the genioplasty, I don't understand why they couldn't simple perform horizontal and vertical increases. He implied it was not viable / too much effort for the vertical increase.

Lastly, it shouldn't be this difficult to find a surgeon willing to take this thing out of my face and revise with a PEEK / Medpor implant with proper fixation. Everyday it remains in me it's causing more and more erosion.

I would simply have it removed, but why risk even more trauma / scar tissue when I'm only going to have it revised anyway. It's better off being done at the same time.

Australia is f**ked.

The type of silicone implant you have, does not appear to be a custom one designed from a CT scan. It looks exactly like the off the shelf one that Dr. Y used to show as the type that does not stay put. Although silicone implants are used in custom implants, they usually come with screw holes in them where the threads of the screws don't tear through the material. Screw is made for them.. So most of the screw action is through the bone and the head of the screw hold them down. There are many grades and consistencies of silicone. The implant guys you mentioned all do the CUSTOM implants. Correct me if I'm wrong and if your implant is not an off the shelf one and is a custom implant.

If you don't understand the explanation I gave you about the directional displacements, then I can't explain further. The explanation I gave assumes some basic elementary concepts in science principles.

The ONLY difficulty in having it removed and replaced at the same time during a surgery is TRAVEL given the coronavirus and you would have to travel outside of Australia to the doctors you name here who do the custom implants if you wanted another silicone implant that was adapted for screwing it down.

[linoob]

The type of silicone implant you have, does not appear to be a custom one designed from a CT scan. It looks exactly like the off the shelf one that Dr. Y used to show as the type that does not stay put. Although silicone implants are used in custom implants, they usually come with screw holes in them where the threads of the screws don't tear through the material. Screw is made for them.. So most of the screw action is through the bone and the head of the screw hold them down. There are many grades and consistencies of silicone. The implant guys you mentioned all do the CUSTOM implants. Correct me if I'm wrong and if your implant is not an off the shelf one and is a custom implant.

Sounds reasonable. Disappointed the surgeons I asked couldn't make this simple distinction for me. I would've stopped asking then.

If you don't understand the explanation I gave you about the directional displacements, then I can't explain further. The explanation I gave assumes some basic elementary concepts in science principles.

My issue is that the surgeon said vertical increase along with horizontal advancement was possible, but he basically couldn't be f**ked in my case as it was not needed.  I'm not trying to understand the intricacies of genioplasty.

The ONLY difficulty in having it removed and replaced at the same time during a surgery is TRAVEL given the coronavirus and you would have to travel outside of Australia to the doctors you name here who do the custom implants if you wanted another silicone implant that was adapted for screwing it down.

Fair. Everything is uncertain right now.