I need Advice - Complicated Case

[SavingFace]

So, it has been several years since I posted on here. I ended up going for custom implants with Dr Yaremchuck in Boston. That turned out to be one of the biggest mistakes I ever made. The implants were not very aesthetically pleasing, given I needed jaw advancement. But even worse than that, he did the custom orbital rim and malar implant, and they didn't fit together well, which left it deep trough under my eye. I went for a correction of this in late 2021, and I could go into detail as to how he botched it, but botch it he did. Right now I have a hole in my face, because he switched horses in the middle of the stream and did an unauthorized procedure during the surgery that infected the previous implants he had placed, and the wound won't heal. I've spent the last several years trying to figure out how to undo that without removing the implants and going through more surgeries. I'm at a loss. The implants are going to have to come out.  I probably should have had them out a couple years ago. But I wanted it to be the last resort.

Anyway, now I'm a candidate for jaw surgery, and that's something also I should have done years ago. But no surgeon is going to do the jaw surgery until the infection is fixed with the implants. So I'd like to find a surgeon who has some pretty deep qualifications, can address both issues hopefully. I'd like to if possible coordinate the removal of the implants with the jaw surgery, so I don't have to go under the knife twice, and so I don't have to remove just one side of my implants that are infected and leave my face hollow one one side for months until they replace implants.

Who are some outstanding jaw surgeons who may also have experience with implants? In particular, I'm thinking I might want to replace the implants and do a high cut LeFort I. This is what Dr. Schendel recommended for me before he retired.. I have mid-face hypoplasia, which is the reason I placed the implants in the first place.

So I'm looking for surgeons who 1. Are qualified to do a high cut LeFort I, 2. Have experience with implants, 3. Aren't afraid of bigger movements if needed, and 4. Have a good eye to aesthetics.

I have Aetna for my insurance. A lot of doctors accept that, but I don't know where to begin. I suspect some of the best surgeons may not be the ones that get the most hype or do the most advertising. I suspect with my symptoms it may need to be a craniofacial surgeon, who can do the high cut, but a maxillofacial surgeon is fine as long as they can feel comfortable performing that procedure.

Anyone have any advice or no any surgeons who I might look at? Thank you.

[kavan]

OK, first things first. So, I'm only going to focus on ONE THING. When you say you have a 'hole in your face' (along with??) a wound that won't heal are you saying that in the PRESENT TIME you have an OPEN NON-HEALING wound on/in your face and it has been like that since 2021?

If that is the case, than you need to go to a WOUND HEALING center or said department of a HOSPITAL where they debride (clean out the wound) and quite possibly put you in a hyperbaric oxygen chamber.

No one is going to do surgery on you with an open non healing wound on your face--not the kind you are asking about in the part of your post below the mention of an open non healing wound--so focus on getting the wound healed first.

[SavingFace]

Sorry if I was unclear about what I was asking. Of course that has to be treated first. It has been under treatment for over 2 years now, including wound debridement twice. And no, the hole has not been on my face since 2021. I said it's there now. Somewhere in the intervening time, the infection caused a break in the skin that led to it not healing. My question is not whether I need to take care of that. Of course that has to be done. It's much more complicated than that, but I don't want to go into the explanation of everything.  Long story short, there is actually a potential antibiotic that could completely cure the problem, but it's in an experimental phase. So that's kind of what I've been waiting for, but I can't wait any longer. So my question is about surgeons who would be qualified to do both the jaw surgery and take care of the implants by removing them, either in a separate surgery (most likely) or the same surgery (less likely). Since I'm having the implants removed, I need a doctor who is able to handle a very complicated case. That's my point, not whether I should address the infection. One of the main complications is that I currently have implants, so my face appears fuller then it would if the implants were removed, which they will be. So I want a doctor who is trained enough and sophisticated enough to take those things into account when calculating the movements.

And even if the doctor is not someone who can handle both issues, who is the best jaw surgeon to address midface issues with a high cut LeFort I? I'm not going to ask the surgeon for that, but I want the surgeon to be someone who is able to do it if that's what's indicated. I have had at least one prominent surgeon tell me that's what I needed.

Hope that helps clarify what I was getting at.

[GJ]

That's insane. Hopefully you sued.

Relle and his crew are good jaw surgeons and have experience with implants. They probably take that insurance. Schendel doesn't know anything about modern surgery, so you dodged a bullet avoiding him. There's a Dr. Henry on the East Coast who I've been told is good. I forget his first name offhand. Where are you located?

[SavingFace]

Appreciate the reply. I am in the Washington DC area. I wasted all of last year, planning to get it done. But everyone was talking about how easy it was to get approved and the Kaiser system. It sure was, but finding a surgeon to do it was next to impossible. The first doctor I saw was Dr Agarwal, And he told me he never moves more than 8 mm regardless of the patient. Maybe that's all I would need, but I don't want a doctor who limits based on an arbitrary number. After that, I simply ask Kaiser for the name of another doctor I could consult who they had a contract with. It was to be an external referral, because in this region they don't have jaw surgeons and network. For the entire rest of the year, they refuse to give me the name of a single surgeon that could do it. They denied me the benefit under the plan that I was entitled to. So now I'm starting all over with Aetna Insurance. At least that way I can travel outside this region if needed to find a good doctor. The quality of the doctor is more important to me at this point than the location. With that said, I have a consultation planned next week with Dr Brian Farrell in Charlotte North Carolina. I saw some good things about him on a Facebook for him, but he doesn't seem to be one of the more well-known doctors for the surgery.

Appreciate any and all input. I work a very busy job comment it's so hard for me to find time to research all of this. I've felt a bit overwhelmed.

[kavan]

Sorry if I was unclear about what I was asking. Of course that has to be treated first. It has been under treatment for over 2 years now, including wound debridement twice. And no, the hole has not been on my face since 2021. I said it's there now. Somewhere in the intervening time, the infection caused a break in the skin that led to it not healing. My question is not whether I need to take care of that. Of course that has to be done. It's much more complicated than that, but I don't want to go into the explanation of everything.  Long story short, there is actually a potential antibiotic that could completely cure the problem, but it's in an experimental phase. So that's kind of what I've been waiting for, but I can't wait any longer. So my question is about surgeons who would be qualified to do both the jaw surgery and take care of the implants by removing them, either in a separate surgery (most likely) or the same surgery (less likely). Since I'm having the implants removed, I need a doctor who is able to handle a very complicated case. That's my point, not whether I should address the infection. One of the main complications is that I currently have implants, so my face appears fuller then it would if the implants were removed, which they will be. So I want a doctor who is trained enough and sophisticated enough to take those things into account when calculating the movements.

And even if the doctor is not someone who can handle both issues, who is the best jaw surgeon to address midface issues with a high cut LeFort I? I'm not going to ask the surgeon for that, but I want the surgeon to be someone who is able to do it if that's what's indicated. I have had at least one prominent surgeon tell me that's what I needed.

Hope that helps clarify what I was getting at.

I can't tic all of the boxes as to 'high lefort', 'best for midface' and surgery performed with on going infection as to target doctors. There is a good doctor named Pushkar Mehra who is head of maxfax at Boston city hospital. He himself is very skilled but the practice gets bad reviews. A doctor who has been discussed on these board who has done revision surgery is Steven Sullivan in Oklahoma.  Another possibility is consulting with the department heads at MGH hospital in Boston. Yaremchuk used to be head of the cranio-facial dept. Maybe they could give some leads