Gunson or Raffaini

[seekingdjs]

Hi all,

I've had a consult with Dr. Gunson to carry out my bimax + genio.

Here are the things I like about him:

• He is world-renowned and universally acknowledged as one of the top jaw surgeons in the world. (Probably in most people's top three? Correct me if I am wrong here please).
  
• I like that he is in the United States (where I'm from), so the logistics of recovery will be quite easy.
• I am mostly in this for aesthetics, and his results are some of the best I've seen in this regard. Also, the cephalometric outline he sent me looks like a big change, which is what I am after.

However, I have a few concerns:

• First, the pending lawsuits against him are troubling. I understand that he performs a lot of surgeries, and with something of this nature there are bound to be some mistakes, but from what I understand of the cases it is his cavalier response to them that is worrying.
  
• Second, some people have shared the opinion that the practice is not as good as it used to be since Arnett left.
  
• Third, his costs are exorbitant, and from what I can tell it may be unlikely that insurance will cover much of it. (Even if they do accept the case, they typically will only pay a very small part of the surgery because he is out of network. Somebody please correct me if I am wrong here). So I have to go into this with the mindset that I am willing to cover the full price tag.
  
• As far as I'm aware, Gunson does not perform rhinoplasty, which means I would have to find another surgeon and pay additional fees + recovery time to address my nose. (But then again, maybe I won't need rhinoplasty after my jaw surgery?)

My other option is Raffaini. I have a consult scheduled with him in June, but I would have to spend ~3k just on the travel and consult fees (plus a few days off work) if I follow through with it.

Here is what I like about Raffaini:

• Also world-renowned and universally acknowledged as one of the top jaw surgeons in the world. (Likewise, most people would have him in the top three along with Gunson? Please correct me if I am wrong here).
• While Gunson has very good results, the best results I have ever seen come from Raffaini. There are a couple of cases he advertises on his website that are absolutely gobsmackingly unbelievable.
• Part of the reason Raffaini gets these unmatched results is because he also performs simultaneous rhinoplasty. It sounds so much more convenient to get both procedures at once if Raffaini decides it would improve my appearance.
• Cost. Even factoring in the additional cost of travel and recovery in Italy, from what I can gather he charges around half of what Gunson charges.

Here are my concerns with Raffaini:

• The logistics of having a major procedure of this magnitude in a different country with a different language.
• English not being Raffaini's or his assistants' native language.
• Age. He is around ten years older than Gunson, and those gobsmackingly amazing results he advertises on his website are all from over a decade ago. Is he past his prime so to speak?
• Raffaini performs rhinoplasty, but is he really a master of it in the same way he is with jaw surgery? His results seem to speak for themselves, but I've never seen him talked about as such an expert. Perhaps I could get a better result by going to Gunson for jaw surgery and then a top rhinoplasty surgeon after.

If any experts here could address any of my concerns that they have ideas about, that would be very helpful. Also, my immediate concern is whether I should follow through with my consult with Raffaini, or save the trip and just commit to Gunson. Please keep in mind that my goal is to have the best possible aesthetic result.

Thanks!

[GJ]

Man, that is tough. A lot of moving parts.

Gunson is the best clinician I've ever come across. He can literally diagnose anything with precision. As far as surgery, I didn't have surgery with him, so I can't say, but I've seen some great cases in-person and some not so great cases in-person (he offered this person free revision, as of 2018, which was "owning it" and a good sign). I think he is a bit overworked, and I think he'd admit that to you if you asked. He really needs to find a partner.

I don't know much about Raffaini so I can't speak to him at all. The people here who have used him generally seem happy. I'd say if you can afford the 3k, take the trip. Otherwise, you will always wonder. Go with the guy you feel most comfortable with and who presents the plan that makes the most sense.

Regarding rhino, another tough call. I'd find Raffaini patients and ask their experience. There are some here. Maybe they'll chime in. Ask his credentials in rhino while on your consult, too. If he's not an expert, then maybe you're wise to parse it out to two different specialists. I'm not sure. Rhino terrifies me so I never looked too deeply into it. I can give you a guy I know is good in the States via PM. Agree the idea of traveling to Europe if there are complications sounds awful...that puts a damper on that option for me, so it's really up to you to figure that out and what you're willing to do.

[seekingdjs]

Yeah, if former Raffaini patients could chime in that would be very helpful.

I may try to set up a consult with Alfaro as well, but then that's adding an additional trip overseas.

[eglantine]

For Alfaro, you don't necessarily need to travel for the first consultation. I had it online. I had to send pictures of me and scan and it surely wasn't as optimal as a face to face consultation but he still was able to speak accurately about my case.

[GJ]

For Alfaro, you don't necessarily need to travel for the first consultation. I had it online. I had to send pictures of me and scan and it surely wasn't as optimal as a face to face consultation but he still was able to speak accurately about my case.

This is a good point. We're in the modern age now with Covid pulling forward work at home, zoom, etc. We can now do anything online, so it opens up the option of using surgeons around the world.

[kavan]

Personally, my advice is to devote an ENTIRE surgery to rhino alone (unless it's just rhino and chin augment with nothing else). My advice also is to do the jaw surgery FIRST and then evaluate the nose. Like does it look better with the new jaw balance or is a rhino needed. If the former, then no rhino. If the latter, then rhino. So, my advice resolves to ONE and only one surgery devoted to the maxfax jaw surgery and ANOTHER separate surgery for the nose IF afterwards that is deemed as needed.

To that regard, you could choose EITHER Gunson or Raffaini for ONLY the jaw surgery. If you choose Raffaini and LIMIT him to ONLY the jaw surgery, if he does a 'gobsmack' great job on the jaw surgery, you could go back LATER to have a separate nose surgery with him. If you choose Gunson (again for ONLY the jaw surgery), your options are open to LATER find a rhino expert in the US and also the option is also there to consider Raffaini as a potential doctor to travel to for the nose surgery subsequent to more research on YOUR PART as to whether or not he's a contender to the recognized experts in rhino in the US. Hence, choosing R will take a lot of research on your part to ferret out the the top rhino guys in US in any decision as to whether or not he can 'top' them.

In short, I would not advocate in favor of going to R for both at same time just because he does rhino with the jaw surgery.

[seekingdjs]

Yes, I am having an online consult with Alfaro as well, but I will likely want a follow-up "in situ" consultation to finalize plans.

Thanks for that advice Kavan; I will be sure to do my due diligence on US rhino experts. So far a couple names that stick out are Dr. Davis in Florida and Dr. Rawnsley in California.

Not sure if you have any insight there. I did see a previous post from you suggesting top rhino experts in Europe, all of whom looked quite good.