jawsurgeryforums.com
Surgeon Information => Surgeon Reviews and Leads => Topic started by: SavingFace on March 11, 2019, 02:10:41 PM
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I consulted with Dr. Sinn, because I thought maybe a "box osteotomy" might be the answer for my midface hypoplasia. He instead remmended a custom implant to correct orbital rim deficiency and cheeks. To the best of my knowledge, Dr. Sinn isn't really known for his skill in implants. So I consulted Dr. Michael Yaremchuk in Boston. He recommended a custom implant for cheeks and malar augmentation, an orbital rim implant, paranasal implants, and an angular jaw implant along with a rhinoplasty. That's a lot of surgery, but his rate is in the mid 20s for that, which is way less than an osteotomy.
Does anyone have any knowledge of Yaremchuk? I found a lot of information positive about him before I consulted with him, and these made me think he's a leading expert in implants. After I consulted with him, I found a lot of negative reviews on Vitals. I'm wondering if anyone here has any personal experience or thoughts on him? I'm not really a big fan of implants, but if even Dr. Sinn says I need an implant rather than something more invasive, maybe I do?
Thanks!
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Going to add this here rather than starting a new thread, in case it's helpful to anyone.
Dr. Y's office hasn't given me a final quote on everything, but in case you're thinking of going with him, here are a couple pointers on cost:
1) He recommended a company in Boston to do the CT Scan. The cost would have been right at $900. I decided to call around to hospitals back home (in the DC metro area) and found that Franklin Square Hospital in Baltimore would do the same scan for $65! So right off the bat, I saved over $800. It pays to shop around, because some hospitals will do a CT scan for a fraction of what other places will charge. He requires a CT scan (for me at least) from the chin through the orbital area, without contrast.
2) The cost for all of my procedures that he recommends (orbital rim implant, custom cheek implant, paranasal implant, angular jaw implant, and rhinoplasty) comes to about $20k. That's not including the fee to create the custom implant from the CT scan, which is about $5800, paid in advance.
Hope this information is helpful to someone who may be considering him. I'm still hoping someone will chime in with an opinion about Dr. Y! I've seen some reviews online that are really harsh about him (but I imagine you can find those kind of reviews with any doctor). And a lot of his online before and after examples are honestly less than remarkable. Sometimes I have a problem even seeing any difference, much less a notable aesthetic improvement, in his patients. Of course, not everyone allows their pictures to be posted publicly, so I've reached out to the office for some examples that are similar to my case. I'll see if they respond.
Any advice?? You guys know so much more than I do about this, so I would love to get some feedback, and happy to share photos in private.
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You would have to go in person to see more photos than you see on his website. I think some patients (and this is true for a lot of doctors) allow their photos to be looked at during an office visit but not to be transmitted to another electronically (like via e mail).
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Make sure the CT scan is the right resolution for his needs. $65 is usually what you pay for a basic lateral ceph. The same machine is used, but you don't get the 3D scan.
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Yeah, Dr. Yaremchuk specified on the order that it had to be a 3D scan, and the hospital verified that they followed his order. I was surprised at the price as well! It pays to shop around!
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You would have to go in person to see more photos than you see on his website. I think some patients (and this is true for a lot of doctors) allow their photos to be looked at during an office visit but not to be transmitted to another electronically (like via e mail).
I think you're right. Unfortunately, I forgot to ask this. I am doing a follow up Skype consult, so I think i'll ask if they can at least show me some then.
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Did you also ask him about bone erosion from these implants?
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I didn't ask him, but Dr. Sinn did mention that when I consulted with him. He said that the MedPor implants don't have the same problem with bone erosion, but they are harder to remove in time. Since I'm not 100% sure how these implants are going to look, it's possible I will want to have them removed at some point. I already have a pair of silicone cheek implants, which are the wrong size, shape and location. So that is a concern. I will ask him about it in the follow up.
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I will ask him about it in the follow up.
Many Thanks. and please do not forget to tell us about it! Please also ask in detail for how many mm in how many years, etc.
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Going to add this here rather than starting a new thread, in case it's helpful to anyone.
Dr. Y's office hasn't given me a final quote on everything, but in case you're thinking of going with him, here are a couple pointers on cost:
1) He recommended a company in Boston to do the CT Scan. The cost would have been right at $900. I decided to call around to hospitals back home (in the DC metro area) and found that Franklin Square Hospital in Baltimore would do the same scan for $65! So right off the bat, I saved over $800. It pays to shop around, because some hospitals will do a CT scan for a fraction of what other places will charge. He requires a CT scan (for me at least) from the chin through the orbital area, without contrast.
2) The cost for all of my procedures that he recommends (orbital rim implant, custom cheek implant, paranasal implant, angular jaw implant, and rhinoplasty) comes to about $20k. That's not including the fee to create the custom implant from the CT scan, which is about $5800, paid in advance.
Hope this information is helpful to someone who may be considering him. I'm still hoping someone will chime in with an opinion about Dr. Y! I've seen some reviews online that are really harsh about him (but I imagine you can find those kind of reviews with any doctor). And a lot of his online before and after examples are honestly less than remarkable. Sometimes I have a problem even seeing any difference, much less a notable aesthetic improvement, in his patients. Of course, not everyone allows their pictures to be posted publicly, so I've reached out to the office for some examples that are similar to my case. I'll see if they respond.
Any advice?? You guys know so much more than I do about this, so I would love to get some feedback, and happy to share photos in private.
Almost every surgeon posts his best results online. Revision rate of implants is very high, no matter what surgeon you choose. It's nearly impossible to calculate the right dimensions based on a CT scan. Implants often turn out too big because of facial harmony. For example, you might get broader jaws but they might turn out too big compared to the chin, etc. The best results are when someone really has a big deficiency, for example a very retruded chin. Silicone should be avoided as an implant material imo.
Y. is called conservative, but I don't know if that's true. Nowadays, surgeons get crazy demands from young men to get 'a model look'. If the surgeon says he's not doing that, cause it wont give natural results, these men go to someone like Eppley, who does everything a client wants. Remember, plastic surgeons are businessmen as well.
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Almost every surgeon posts his best results online. Revision rate of implants is very high, no matter what surgeon you choose. It's nearly impossible to calculate the right dimensions based on a CT scan. Implants often turn out too big because of facial harmony. For example, you might get broader jaws but they might turn out too big compared to the chin, etc. The best results are when someone really has a big deficiency, for example a very retruded chin. Silicone should be avoided as an implant material imo.
Y. is called conservative, but I don't know if that's true. Nowadays, surgeons get crazy demands from young men to get 'a model look'. If the surgeon says he's not doing that, cause it wont give natural results, these men go to someone like Eppley, who does everything a client wants. Remember, plastic surgeons are businessmen as well.
Good points. My case is additionally complicated by the fact that I already have implants in, XL implants in the submalar region! So I worry that there won't be enough augmentation, because looking at my face, it isn't as flat as if the previous implants were removed (which they must be to place the new ones). I also worry that the jaw implant could be too wide and give my face an odd triangular or square shape. I was reading some in the past couple days on Silicone vs. MedPor. Apparently Eppley argues that there is no bone loss problem with silicone implants.
I have a re-consult with Dr. Y this Thursday, so I'm hoping to ask some questions about bone loss with silicone vs. Medpor.
p.s. I have personal experience with Dr. Eppley, back before I knew ANYTHING about what I needed. His office basically agreed to do what I suggested, which I later found out no other surgeon would even consider. :) I'm a little too shy to say what that was on the forum, but would be happy to by PM if anyone actually cares!
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I would also add that I asked Dr. Y during the consultation whether he thought I should get a temple augmentation. My left temple is a bit hollow. He looked at it briefly and said no, he would leave it alone. I always feel better when a surgeon talks me out of a procedure. It's kind of like going to a garage to get the car fixed and you ask them if it needs new tires, and they say no. I don't like being upsold, and I felt that Dr. Y was being realistic and honest about what I needed rather than trying to get me to do things that wouldn't really help.
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Good points. My case is additionally complicated by the fact that I already have implants in, XL implants in the submalar region! So I worry that there won't be enough augmentation, because looking at my face, it isn't as flat as if the previous implants were removed (which they must be to place the new ones). I also worry that the jaw implant could be too wide and give my face an odd triangular or square shape. I was reading some in the past couple days on Silicone vs. MedPor. Apparently Eppley argues that there is no bone loss problem with silicone implants.
I have a re-consult with Dr. Y this Thursday, so I'm hoping to ask some questions about bone loss with silicone vs. Medpor.
p.s. I have personal experience with Dr. Eppley, back before I knew ANYTHING about what I needed. His office basically agreed to do what I suggested, which I later found out no other surgeon would even consider. :) I'm a little too shy to say what that was on the forum, but would be happy to by PM if anyone actually cares!
Let me take a GUESS--remember, it's just a guess--Eppley agreed to remove your ribs to make an extra long and hard penis augmentation.
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Let me take a GUESS--remember, it's just a guess--Eppley agreed to remove your ribs to make an extra long and hard penis augmentation.
:D HOW COULD YOU POSSIBLY!!>.....
(kidding! ... or am I!?) :)
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Let me take a GUESS--remember, it's just a guess--Eppley agreed to remove your ribs to make an extra long and hard penis augmentation.
( ಠ ͜ʖ ಠ) ...Kavan! haha
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Good points. My case is additionally complicated by the fact that I already have implants in, XL implants in the submalar region! So I worry that there won't be enough augmentation, because looking at my face, it isn't as flat as if the previous implants were removed (which they must be to place the new ones). I also worry that the jaw implant could be too wide and give my face an odd triangular or square shape. I was reading some in the past couple days on Silicone vs. MedPor. Apparently Eppley argues that there is no bone loss problem with silicone implants.
I have a re-consult with Dr. Y this Thursday, so I'm hoping to ask some questions about bone loss with silicone vs. Medpor.
p.s. I have personal experience with Dr. Eppley, back before I knew ANYTHING about what I needed. His office basically agreed to do what I suggested, which I later found out no other surgeon would even consider. :) I'm a little too shy to say what that was on the forum, but would be happy to by PM if anyone actually cares!
I think bone loss from silicone might happen in some cases but is it really a big problem to lose like 0.5 millimeter, especially if an implant turns out a big too big? Bone loss seems to occur when there is alot of pressure on the bone, so probably with big implants.
He recommended a custom implant for cheeks and malar augmentation, an orbital rim implant, paranasal implants, and an angular jaw implant along with a rhinoplasty
That's alot of procedures. I don't know, maybe you need it, but it seems alot. How is the soft tissue going to react? Will it look natural (silicone), will there be facial harmony? Sounds like the surgeon needs to be a wizard to do so much procedures succesfully. Maybe Y. Is the special one, maybe he's being a smart businessmen, I don't know.
Does anyone have any knowledge of Yaremchuk? I found a lot of information positive about him before I consulted with him, and these made me think he's a leading expert in implants
Online? 90 percent of the information online is false. I don't know if Y. is a good surgeon or not, but he seems to have a better aestethic eye than Eppley (technically a good surgeon, but seems to lack the aestethic eye). I think you also need to take into consideration that surgeons have alot of bad cases. They show their best cases, they hide the bad ones. That's how you sell a product, along with other things like online exposure. The surgeon with the most online exposure isn't necessarely the best one (most of the time, he isn't). It's business. What would you do as a surgeon if someone asked you to give hij a model face and you knew it was impossible, but he offers you 30k?
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Update: re-consulted with Yaremchuk today and he answered a bunch of questions. I was satisfied with his answers. He said the implants would be silicone in my case and that bone erosion is not an issue. He said it sometimes happens but not in a clinically significant amount.
But I am extremely disappointed with the office! They had twice estimated total cost at about
$2580, which is $20k in fees + the $5800 to design the implants. Today after I finished the re-consult, I talked to the same person who a week ago said $20k+5800, and she NOW says $31k+ $$5800! That’s $11k more than I was told! I had already gotten financing and everything. How can an office that does this every day be off by $11000!? I’m not going to pay nearly $40k for implants and a nose job, so I wrote back and told them I can’t pay that much above the estimate.
Has anyone else encountered something like this? How can this happen unintentionally?? I am SO disappointed. After all this travel and the CT scan, I’m back to square one! 😞
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Update: re-consulted with Yaremchuk today and he answered a bunch of questions. I was satisfied with his answers. He said the implants would be silicone in my case and that bone erosion is not an issue. He said it sometimes happens but not in a clinically significant amount.
But I am extremely disappointed with the office! They had twice estimated total cost at about
$2580, which is $20k in fees + the $5800 to design the implants. Today after I finished the re-consult, I talked to the same person who a week ago said $20k+5800, and she NOW says $31k+ $$5800! That’s $11k more than I was told! I had already gotten financing and everything. How can an office that does this every day be off by $11000!? I’m not going to pay nearly $40k for implants and a nose job, so I wrote back and told them I can’t pay that much above the estimate.
Has anyone else encountered something like this? How can this happen unintentionally?? I am SO disappointed. After all this travel and the CT scan, I’m back to square one! 😞
Typo! They had twice estimated $25800, not $2580. I wish!
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Estimate 'mistake' may have been one based on just the implant surgery and design where maybe they forgot to add in the rhino? IDK. So, if 11grand more, request WITHOUT rhino.
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Estimate 'mistake' may have been one based on just the implant surgery and design where maybe they forgot to add in the rhino? IDK. So, if 11grand more, request WITHOUT rhino.
That is definitely a possibility. I had asked him for an estimate that was all inclusive, but it’s certainly possible they left out the procedure. In any event, they emailed me back and agreed to honor the prior estimate, or close to it. I offered $29,000 to do all of it, since I had already attained the financing. They agreed since they had estimated lower.
In other news, I got a email from Dr. Sinn. He said he wants to talk to me on the phone tomorrow. Anyone have a question for him? It’s a good time for me to ask him something.
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Okay, I just had a pretty long call with Dr. Sinn. He called me from Texas.
A few highlights:
1) I told him I had also consulted Dr. Y after I found out he (Dr. Sinn) wasn't recommending an osteotomy, because Dr. Y is known for custom implants. He didn't seem to mind. I explained the surgical proposal from Dr. Y, and Dr. S thinks it's overkill. He doesn't think I need jaw angle implants, and he referenced the cuts that are needed to gain access. I didn't ask him in detail what he meant, but he seems to think it's too much.
2) Dr. S thinks my biggest issue is in the orbital area, and the osteotomy he performs he says wouldn't move the rim forward enough to give me the result I want. He recommended a single custom MedPor cheek/orbital implant that address both areas at once. He also recommended taking fat from a small incision in the belly button which would be placed over the orbital area to give "texture" to the implant. Some of this will resorb, but some will stay permanently. He says that it was a mistake for my prior surgeon to take fat from this area in a lower lid blepharoplasty.
3) He thinks my chin is "very slightly deficient" from a lateral view, so he thinks a genioplasty is optional and might give a good result.
4) We had talked about possible PEEK implants when I consulted, but he checked on price and said they are over $7k each. He says since that may be cost prohibitive, he would recommend Medpor implants. They are about $4k each, and he said he wouldn't add an upcharge (a doctor who is actually concerned about cost to the patient is refreshing!) We had a good discussion about bone loss from silicone, and he said this is more of a problem when implants are placed in the chin, because the jaw muscle puts pressure on them and can lead to bone erosion or even migration of the implant. He said this would be less of an issue in a cheek implant. He also said he doesn't do chin implants. He only does genioplasty and doesn't recommend chin implants. He went into detail describing a wing osteotomy, which I wasn't very familiar with, but he said I didn't need this. He recommends a genio.
5) I asked him about Titanium implants, because someone (I believe in this thread) had mentioned it. He said they are custom implants, but he doesn't recommend them. He said the material is too heavy. He uses titanium to secure osteotomy but wouldn't recommend using them as an implant material. He says due to their heaviness, they may migrate, and it is "not something you would want in your face."
6) He says a rhinoplasty/septoplasty would be helpful to me, but he doesn't do them beyond minor issues, so he would recommend a different doctor for my procedure, since I have a deviated septum that would need fixed at the same time. He also said in reference to Dr. Y's surgical plan that he doesn't recommend doing a rhinoplasty along with the other procedures in the same surgery. Swelling sets on quickly, so a rhinoplasty could compromise the result in other areas.
I need to follow up with him to ask him a couple questions I forgot to ask. But it was a good and helpful conversation and MAY present an alternative plan that could work. His office will follow up with me on cost, so I can compare to Dr. Y and make a decision.
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IN particular, I forgot to ask him about paranasal implants, which I do think could be helpful for me, as well as whether he thinks a bimax might help (Dr. Y noted that my jaw is shifted slightly to the right. Dr. S agreed, but said it is very minor). Ugh, this all is too much. Once you start micro-analyzing the face for imperfections, everyone has them. The real question is which ones need correcting to add significantly to an aesthetic improvement.
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IN particular, I forgot to ask him about paranasal implants, which I do think could be helpful for me, as well as whether he thinks a bimax might help (Dr. Y noted that my jaw is shifted slightly to the right. Dr. S agreed, but said it is very minor). Ugh, this all is too much. Once you start micro-analyzing the face for imperfections, everyone has them. The real question is which ones need correcting to add significantly to an aesthetic improvement.
Can I ask how old you are?
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Also, from what you've said about your discussion with Sinn. Something doesn't make sense here.
I've heard Sinn say he can get 8-11 mm of advancement from his orbital rim advancement technique. That's f**king way more than most implants would give. So either you have a massively HUGE deficiency (which I doubt) cause I have a huge deficiency and Sinn recommneded the mfl3 for me OR Sinn is kind of being a bit shady giving different info to different people and I'm not sure what's the truth or not.
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Also, from what you've said about your discussion with Sinn. Something doesn't make sense here.
I've heard Sinn say he can get 8-11 mm of advancement from his orbital rim advancement technique. That's f**king way more than most implants would give. So either you have a massively HUGE deficiency (which I doubt) cause I have a huge deficiency and Sinn recommneded the mfl3 for me OR Sinn is kind of being a bit shady giving different info to different people and I'm not sure what's the truth or not.
You are correct. Apparently he can. I think he must’ve been describing a different procedure to me a couple months ago than he described to you. Today, he told me on the phone and told me that he could move the infraorbital rim about 7-8 mm using a different procedure developed by an Australian doctor that he has done recently. I’m not really sure why he did not mention this to me when I consulted with him a couple months ago. But it appears that this may be what you heard him say.
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So... Dr. Sinn followed up with an article on the procedure he does for midface and orbital rim deficiency. If anyone wants to see the (brief) article, please let me know. It is a modified Le-Fort IIi, and I am considering it. Kind of scared of how invasive it is. Does anyone have advice on such a procedure versus implants and what difference I may expect beteeen those two options?
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So... Dr. Sinn followed up with an article on the procedure he does for midface and orbital rim deficiency. If anyone wants to see the (brief) article, please let me know. It is a modified Le-Fort IIi, and I am considering it. Kind of scared of how invasive it is. Does anyone have advice on such a procedure versus implants and what difference I may expect beteeen those two options?
Would be interested in seeing the article.
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Would be interested in seeing the article.
I would be happy to show you. He sent it to me as a pdf, so I don’t have a link to it. Would you maybe PM me your email, and I can email it to you if you’d like.
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I would be happy to show you. He sent it to me as a pdf, so I don’t have a link to it. Would you maybe PM me your email, and I can email it to you if you’d like.
Who's the Australian surgeon?
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Who's the Australian surgeon?
Dr. Andrew Heggie
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I had a procedure done with Yaremchuk. My personal opinion, in my case: he's good and precise. The best I've been to. What i noticed was the tight discipline with him and his assistants. I had the feeling Yaremchuk was transfering his knowledge to his Asian American assistant, and I think his assistant is a talent. He was also honest to me when I asked him questions. Most important, the result is very good. Yaremchuk was the only surgeon that knew what to do aestehtically and executed it very well (and I've been to many). I don't know if yaremchuk did the procedure himself or his assistant did the procedure under supervision of yaremchuk. I don't think it matters. His assistant is clearly a talent and they're both perfectionists. My story doesn't have to correspond with other people's experience of course. It's only my experience.
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hes certainly refined practice of using medpor for cosmetic facial surgery.
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I think silicone will be replaced by PEEK or another material. Eppley is already offering PEEK (probably recently approved in the US for facial implants). There's not enough data yet about PEEK, but it will come.
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By the way, i had an exterior approach, which is in my opinion way better than the interior approach.
1) I suppose there's little time before the swelling comes up. A surgeon needs to 'see' the result of an implant on the face. Suppose a surgeon does the interior approach. He puts the implant in, but it happens to be too big or there are parts that aren't suppose to be there and need to be cut off. How much needs to be shaven off? You just don't know precisely. With the exterior approach, it's easier to see what should be done to get it right (it's a matter of millimeters, sometimes 0.5 millimeters).
2) chances of infection are almost zero if not zero.
3) you get two small scars just under the chin on the neck. As ironically as it sounds, these scars slightly add to your attractiveness as a male (this is scientifically proven). They're not visible on the face, just at the right place.
Maybe I'm wrong, but I don't know why surgeons don't use the exterior approach more often.
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By the way, i had an exterior approach, which is in my opinion way better than the interior approach.
1) I suppose there's little time before the swelling comes up. A surgeon needs to 'see' the result of an implant on the face. Suppose a surgeon does the interior approach. He puts the implant in, but it happens to be too big or there are parts that aren't suppose to be there and need to be cut off. How much needs to be shaven off? You just don't know precisely. With the exterior approach, it's easier to see what should be done to get it right (it's a matter of millimeters, sometimes 0.5 millimeters).
2) chances of infection are almost zero if not zero.
3) you get two small scars just under the chin on the neck. As ironically as it sounds, these scars slightly add to your attractiveness as a male (this is scientifically proven). They're not visible on the face, just at the right place.
Maybe I'm wrong, but I don't know why surgeons don't use the exterior approach more often.
Did Y change his technique. He used to do the jaw implants from inside the mouth where as Ramirez would sometimes place them from an outside incision.
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Did Y change his technique. He used to do the jaw implants from inside the mouth where as Ramirez would sometimes place them from an outside incision.
No, it was an exception in my case because I needed the risdon approach.
But I just thought about it in general, it seems more logical to do it from the outside for practical and aestethical reasons.
Imagine putting it from the inside. Implant happens to be too big. Surgeon has to take it out, doesn't know precisely how much he should shave (and he needs to do it twice). As opposed to the exterior approach: put the implant in from the outside at both sides, immediately see if there's symmetry or not, if it's too big or not or if some parts need to be cut off. Then carving until both sides fit the face, immediately seeing the results.
I can immagine there's only so much time before swelling goes up and the surgeon can't 'see' anything anymore. Internal approach might take longer.
Maybe I'm wrong, I just thought about it. Even if an implant is too small, the surgeon might shave it in a way to improve the angularity or shave part of the upper side of jawbone (hypothetically). I immagine it would be easier to achieve the ideal aesthethic shape from the outside. It would be more like sculpturing instead of puzzling.
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No, it was an exception in my case because I needed the risdon approach.
But I just thought about it in general, it seems more logical to do it from the outside for practical and aestethical reasons.
Imagine putting it from the inside. Implant happens to be too big. Surgeon has to take it out, doesn't know precisely how much he should shave (and he needs to do it twice). As opposed to the exterior approach: put the implant in from the outside at both sides, immediately see if there's symmetry or not, if it's too big or not or if some parts need to be cut off. Then carving until both sides fit the face, immediately seeing the results.
I can immagine there's only so much time before swelling goes up and the surgeon can't 'see' anything anymore. Internal approach might take longer.
Maybe I'm wrong, I just thought about it. Even if an implant is too small, the surgeon might shave it in a way to improve the angularity or shave part of the upper side of jawbone (hypothetically). I immagine it would be easier to achieve the ideal aesthethic shape from the outside. It would be more like sculpturing instead of puzzling.
Oh, OK. thanx
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Thanks for the infos Ben! What did Y tell you about bone erosion? And is it common that facial implants get infected?
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I had a procedure done with Yaremchuk. My personal opinion, in my case: he's good and precise. The best I've been to. What i noticed was the tight discipline with him and his assistants. I had the feeling Yaremchuk was transfering his knowledge to his Asian American assistant, and I think his assistant is a talent. He was also honest to me when I asked him questions. Most important, the result is very good. Yaremchuk was the only surgeon that knew what to do aestehtically and executed it very well (and I've been to many). I don't know if yaremchuk did the procedure himself or his assistant did the procedure under supervision of yaremchuk. I don't think it matters. His assistant is clearly a talent and they're both perfectionists. My story doesn't have to correspond with other people's experience of course. It's only my experience.
That all sounds very encouraging, thanks for sharing. I look forward to consulting with him.
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He said the implants would be silicone in my case and that bone erosion is not an issue. He said it sometimes happens but not in a clinically significant amount.
Hmm I was told by a doctor - who will probably take over Sailer's practice when he retires - that when she worked in Zurich University she saw many cases where they removed chin implants and the erosion was *significant*.
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No, it was an exception in my case because I needed the risdon approach.
But I just thought about it in general, it seems more logical to do it from the outside for practical and aestethical reasons.
Imagine putting it from the inside. Implant happens to be too big. Surgeon has to take it out, doesn't know precisely how much he should shave (and he needs to do it twice). As opposed to the exterior approach: put the implant in from the outside at both sides, immediately see if there's symmetry or not, if it's too big or not or if some parts need to be cut off. Then carving until both sides fit the face, immediately seeing the results.
I can immagine there's only so much time before swelling goes up and the surgeon can't 'see' anything anymore. Internal approach might take longer.
Maybe I'm wrong, I just thought about it. Even if an implant is too small, the surgeon might shave it in a way to improve the angularity or shave part of the upper side of jawbone (hypothetically). I immagine it would be easier to achieve the ideal aesthethic shape from the outside. It would be more like sculpturing instead of puzzling.
Doesn't the external approach create a somewhat obvious gap in beard coverage?
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Doesn't the external approach create a somewhat obvious gap in beard coverage?
It creates a scar underneath the face, at the neck area. I personally don't really mind. Some people don't like scars. It's not that bad imo (for a male).
It was only a suggestion from my part. Maybe I was wrong in my analysis and the internal approach is as difficult or easy.