jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Reality on June 08, 2018, 08:41:34 AM
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Cliffs:
-Currently have implants (custom silicone chin & jaw wrap around)
-Love how they look on me (I was modeling and getting acting auditions)
PROBLEM: Implants became infected and all have to be removed (I'm devastated and angry. Removal is happening today by the way).
I can wait 4 months and try again but...
-I no longer trust nor want silicone and/or implants in my face as it's too risky and has already destroyed certain parts of my life (I.e. wasting time, money and opportunities due to necessitation of removal)
*At this point I'm only concerned with my chin: nevermind the jaw angles.
Looking for a viable and life long solution: Sliding Genioplasty seems to be the answer. I need a large advancement (14mm minimum: this was the projection of my chin implant).
Looking to hear from those of you who have had a SG with large advancements (14-15mm).
1. What has your experience been?
2. Who was your surgeon? (I really need some suggestions here)
I know about Gunson but apparently I need a referral from an Orthodontist to see him. Firstly, I've been living out of country so I have no ortho and second, my home in the US is not in California. I really wish I could just make an appointment to see him because on his website it states that he now does SG for cosmetic purposes.
Who are the other top surgeons for Sliding Genioplasties? (surgeons you would place with Gunson)
By the way, I am willing to share my ceph and custom CT scan with those who have already undergone surgery.
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If you need that much advancement, you won't get a similar result from an isolated genio (not even close and it'll leave a noticeable step-off). That kind of severe recession requires bimax surgery with counterclockwise rotation.
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Sorry to hear that. Do you mind saying who your surgeon was.
Regarding implants I don't think any bone cutting surgery will replicate what you had.
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A sliding genio of the extent of a LOT of augmentation you mention will not replace the look the implants gave you to the chin and lateral chin area. You would get STEP OFFS. You would also most likely need a BUTTRESS between the bone cut. Both step offs and bone buttresses are addressed with either carved porex blocks or hydroxyappatite blocks when such a large genio is made when they are done to AVOID step offs.
Just to give you a 'heads up' that implant materials would need to be used in the type of genio you are wanting to replace the custom implants. Not silicone but either porex or hydroxyappatite blocks carved to 'blend in' and buttress the cut.
Both ITALIA and CCW have also told you right on this regard.
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Thank you to everyone who took the time to reply, I appreciate your thoughts and opinions.
@CCW: I completely understand you and agree to an extent but here's the thing... Before I even considered getting implants I thought exactly as you: that I need Bimax with CCW.
However, I did consult with a couple surgeons abroad (in Europe: this was in 2016), one of them being Professor Sailer (I'm very aware that individuals here do not like nor appreciate his aesthetic and that's cool but I did like some of his results, with respect to what I wanted myself). Anyways, I went to see him and after assessing me, he informed me that I do not need Bimax or CCW (I was ecstatic because I didn't have to drop tons of $ and I could opt for something less invasive).
He actually drew my face in great detail and showed me step by step how he would perform a sliding genioplasty! There would be a cut made to the tip of my chin and it would be advanced forward (we didn't get into details of mm's but instead a general outline for the time being). The rest of my face would be built up with Lyophilised cartilage & medpor for the jaw angles.
In the end, why didn't I choose Sailer? At that point in my life, implants were less invasive than an SG and also, Sailer wasn't too expensive for what I needed done to my face but about $12,000 more than what it cost for my custom implants. Plus, my current implant surgeon was in the States so it was a little more convenient (though I love visiting Switzerland, don't get me wrong)
So, my point being that even Professor Sailer (a maxfax specialist who prefers bone cutting to implants, when needed) said I didn't need Bimax with CCW and instead recommended me a SG after a thorough analysis of my physiognomy.
Furthermore, I saw Triaca and he recommended me a chinwing. However his post-op Photoshop projection of me was less than enticing and in terms of looks, we weren't even in the same "book" let alone page, so I passed. Also, after much discussion with people across different boards I came to realize that he recommends almost everyone who consults with him a CW (not very versatile in my opinion).
@ITALIA: I PM'ed you
@Kavan : I hear you and I'm okay with Medpor or HA depending on the specialist who works with him (examle A&G for HA etc...)
Something I do want to mention with respect to SG's are the different types of cuts. As you can imagine, I've been researching (multiple forums, medical journals etc...) to find out the most information I can for my case. For example, a “Jumping genioplasty” is designed to increase the prominence of the chin and reduce its vertical dimension at the same time (look up the cut online) and a Double-step osteotomy maximizes anterior projection of the chin.
There are many more cuts and they are all detailed in the online medical journal dubbed, "Finesse in Genioplasty" (I would drop the link but it's messy, just goggle it) which features a panel of some of the best Maxfacs discussing different solutions for patient cases.
My point in addressing all of the different SG cuts is that if I can find a competent maxfax with an aesthetic eye, then one of those SG cuts might work in my situation. So far, I've sent emails to a few maxfax who I think fit the ideal.
But... I want to hear from you guys who you believe to be exceedingly qualified and aesthetically gifted in performing SG's.
Here is my list so far:
1. Gunson: is he really that exclusive that I can't even book an appointment with him? (I don't care about the $ I just want him to assess me) It's really disappointing to new potentially new clients but I guess they don't care with an 8 month waiting time just to get a consult.
2. Professor Sailer: Expensive but I believe he can help me
3. Van der Dussen: Heard good things but some have said he's mediocre and that they've had two genioplasties with him (I didn't know that was possible?). Plus I remember reading across different forums that hes more in the sphere of FFS
4. Dr. Gerald J. Wittenberg: Has good B/A's but have read some bad press about him with lawsuits regarding cancer patients? Also, most of his reviews on Realself seem fake (the "person" leaving the review only has one post and it is that glowing review of Wittenburg). As well, I believe he uses gortex or some type of material covered in gortex mesh (not 100% here) which doesn't really vibe with me.
5. Dr. Deschamps-Braly: Seems promising but same as Van der Dussen in that he specializes in FFS. Also there's barely any B/A's on the web (mostly FFS).
*Dr. Henry Kawamoto: This guy was the king og maxfaxs & aesthetics ... unfortunately he is no retired.
6. Dr. Mark Urata: Luckily, this individual studied directly under Henry Kawamoto for quite some time and has many accolades to his name.
***There is one surgeon who I found out about on a different board who performed a 14mm advancement SG on a girl using part of her iliac crest (I'm sure there's some slight re-absorption, as with any other bone grafting material less the cranium but its stable!). Anyways she seem really happy with her result so I have emailed him too.
Let me know what you think about the surgeons I mentioned and do feel free to share any other thoughts, opinions and/or information about other surgeons/suggestions.
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Thank you to everyone who took the time to reply, I appreciate your thoughts and opinions.
I got a sliding genioplasty for my severe recession of the chin. It was moved by 11mm and the result is still disappointing. I have a very noticeable step-off where the bone was cut and moved also it doesn't give me much vertical projection.
I researched a lot, like longer than a year what to do and I don't believe a Chin Wing osteotomy would have been a better choice.
A few months ago I was in touch with a male patient of Dr. Triaca and his results were disappointing as well. He paid about $15k and it was just a very expensive sliding genioplasty, his result doesn't look any better than mine tbh the effect is even smaller.
I am not sure why you consider Medpor now after you already got an infection from implants, Medpor implants can get infected as well. Just googling 'medpor infection' gives you dozens and dozens of results. Take a look at this journal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856534/
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I also had a big’ish genio at 11mm and I am now 12 years post op. I really like it, at the time I was considering full implants with yaremchuk but I was scared of infections and the genio was free on the nhs.
I have steps offs on both sides but they’re really not that noticeable. I can only see them laying on a bench looking at myself upside down in the gym mirror. I can’t notice them in photos.
I like the sound of Sailers approach tbh. Genio and lyophilised Cartlidge. Can they use the Cartlidge material to widen/square off the chin and at the jaw angles? I wouldn’t want medpore
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@tim06: I read your thread: Sliding Genioplasty lost projection after swelling was gone, using filler?. Explicitly referring to your SGP, I think you attained a decent result (just my opinion & I haven't seen your pre-op photos, so I've nothing to compare your post-op result to).
Moreover and again, just stating my opinion: you could have a killer look with work to your mid-face & mandible (undoubtedly you could achieve it with implants as I did but obviously from my experience, I can't personally recommend them).
You're in Germany right... did you have your procedure done on the NHS Gesetzliche Krankenversicherung?
Yes, I agree with you that the CW is useless (at-least for my case)
Regarding Medpor, let me clarify and state unequivocally, that after my experience with silicone implants in the mental region -I strongly believe osteotomies (SGP) to be the gold standard in facial modification of the chin - primarily due to long term stability.
With that said, I am only considering Medpor for the jaw angles (that's my current plan: SG + Medpor JA's). Also, if I were to consider full re-implantation, then I would choose Medpor over Silicone. However, that is highly unlikely as I previously mentioned that I'm currently seeking an aesthetic OMFS for a SGP.
Yes, I've read many medical journals including the one you presented (thank you) and I'm well aware that Medpor can become infected, as well as destroy soft tissue after integration -it comprises it's own risks, just as any other type of implant material. So why Medpor? Medpore is totally different from other alloplastic implants such as silicone.
Compared to Silicone, it's superior in the following:
• Tissue integration (keep in mind that it is not 100% integration & is still considered a foreign body). However, it is treated as less of a FBM and this helps reduce the chance of infection. Silicone lends no way to tissue synthesis and will always have a higher foreign body reaction %
• Porous because Medpor is porous and allows tissue in-growth, it is stable in the long term with a good tensile strength, resistance to stress and fatigue, and a virtual lack of surrounding soft tissue reaction . Silicone has a smooth surface (non-porous) and creates encapsulation. Encapsulation and predisposition to movement are responsible for the majority of late complications reported for smooth surface implants (i.e. silicone)
• No bone resorption Due to good fixation, medpore is quite different from traditional alloplastic implant materials. It does not depress into underlying bone, so results are maintained. Comparatively speaking and specifically in the chin area, with a silicone implant there is extensive resorption of underlying bone.
• Biocompatibility Tissue has shown biocompatibility to medpore biomaterial implants, which remains nonimmunogenic, nonallergic and nontoxic, with no evidence of resorption or alteration. Simply put, the same cannot be said for Silicone.
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@fulcanelli I'm glad that your happy with your results. It's also cool that you got a good result for free on NHS (12 years on an SGP compared to my 3 months of implants really shows the long term stability of a properly performed osteotomy).
Can you PM me your surgeon? Also, if you're OK with it, would you mind including a pic (I'm just curious about the step-off and the overall result -you don't have to include your upper face etc...).
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UPDATED
Surgeons I've axed from my previous list:
Professor Sailer
Dr. Gerald J. Wittenberg
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I've heard stories of plastic surgeons being unable to remove medpor. Although maxillofacial surgeons have told me that it's no big deal.
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@PloskoPlus Cheers for chiming in
I've heard stories of plastic surgeons being unable to remove medpor. Although maxillofacial surgeons have told me that it's no big deal.
Yes, I've heard the same as well - many conflicting statements concerning Medpor (difficult to get solid clarification). I'm just trying to hedge my bets against silicone I guess (I've vacillated between Medpor & Silicone so much it's becoming exasperating). They're both gambles but at this point, I just foresee more long term stability with Medpor regarding jaw angles (that's all I would need it for).
There must be a reason why the vast majority of European surgeons use it for implant material? OTHO the same could be said for why so many American surgeons do not -devils advocate
If anyone on this forum has experience with Medpor -positive or negative, do tell or feel free to PM me -I would greatly appreciate it.
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BTW, what about PEEK implants? They are supposed to have the lowest infection rate of them all.
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UPDATE: Concerning Medpor and Jaw Angles
After coming across new scientific literature and re-reading a phenomenal medical journal, I wish to make a retraction regarding my predisposition towards using Medpor @ the jaw angles.
I knew there was a high rate of infection in the mandibular angle area but couldn't remember if it was ascribed to that area specifically (due to being a tight space which encourage bacterial growth when contamination with saliva occurs etc...) and/or more so due to Medpor being the implant material laced in that area. Thanks to that aforementioned journal, it's the latter and now I have the exact figure of infection attributed to Medpor in the mandibular angle area.
According to the medical journal, Ridwan-Pramana et al. reported a 27.3% infection rate when using porous polyethylene in the mandibular angle area. As porous ethylene is not osseointegrating, it may become infected because fibrovascular ingrowth takes 3 months. The implant can also migrate when not fixed with long enough screws, which may cause it to be exposed and extruded.
Source: Porous polyethylene implants in facial reconstruction: Outcome and complications.
Ridwan-Pramana A, Wolff J, Raziei A, Ashton-James CE, Forouzanfar T
J Craniomaxillofac Surg. 2015 Oct; 43( 8 ):1330-4.
27.3% is colossal for a infection rate. So, for the sake of brevity I will not be using Medpor for my jaw angles.
In light of this and upon further research, I believe that I have found an appropriate alternative (for my case): Titanium implants made by selective laser melting - Titanium alloy (Ti-64). After I address PloskoPlus, I will detail my reasons why I believe Titanium to be exceptional and why I would currently choose this implant material over PEEK as well as osteotomies. Moreover, I will also be including other contemporary implant materials which are newly emerging.
Before I delve into my thoughts on different implant materials, let me preface by saying that the success and longevity of implants depend upon a multitude of various factors like material characteristics, design of the implant and the surgeon's skill.
Each of these materials poses certain complication risks based on their surface contour (smooth vs. porous), pliability, and reactivity with surrounding tissue. In addition, certain implant locations within the head and neck are at risk for different postoperative complications.
@PloskoPlus
BTW, what about PEEK implants? They are supposed to have the lowest infection rate of them all.
Source for lowest infection rate?
Small study but then again, PEEK is limited in scope:
RESULTS:
The overall complication rate of PEEK cranioplasty was 28%. Complications included infection (13 %), postoperative haematoma (10 %), cerebrospinal fluid leak (2.5 %) and wound-related problems (2.5 %). All postoperative infections required removal of the implant. Nonetheless removed implants could be successfully re-used after re-sterilization.
Source: https://www.ncbi.nlm.nih.gov/pubmed/27524384
Outcome in patient-specific PEEK cranioplasty: A two-center cohort study of 40 implants.
PEEK
PEEK custom cranial implants are being used more in the current times. PEEK is a highly strong engineering thermoplastic, which retains its chemical and mechanical properties even at high temperatures. The material has high biocompatibility and biostability maintaining its physical and chemical characteristics on long-term exposure to body fluids. The modulus of elasticity of PEEK is similar to that of cortical bone, preventing any stress shielding making it a better choice over metallic implants that have high modulus of elasticity. PEEK is also radiolucent facilitating postoperative imaging procedures. Implants can be designed to replace exact anatomy even in bulky regions as the material is very light. The material can be repeatedly sterilized by common methods as autoclave, gamma or ethylene oxide. PEEK lends itself to machining of complex organic shapes very well. PEEK implants can be fixated to the adjacent bone with standard screws and plates of surgeons’ choice. All the above mentioned characteristics have made PEEK the sought after material for cranial implants by manufacturers and surgeons in the recent past.
In general, PEEK implants are made from a block of extruded material using a CNC machining. PEEK implants can be used in non-load bearing regions of the craniofacial skeleton. PEEK can also be sintered to produce implants similar to the machined PEEK.[32] CAD designed PEEK custom implants have been used to correct cranial, frontal, malar and mandibular defects.
• My current thoughts on PEEK: At this moment and time, PEEK seems supreme but not superlative in regards to implant material. While I believe PEEK is a good alternative to titanium implants for customized implants; as it may be easier to use and lighter; the following illustrate it's shortcomings & limitations:
-Will not integrate with bone (this increases the chance of long-term complications: infection etc...)
-Currently, mostly only used in cranial reconstruction of the skull and minor areas of the mid-face (not enough is known about the mental and mandibular areas)
-Is as expensive as 3D-printed titanium alloys
-Behavior when transorally implanted is not yet known
-Comparatively short term clinical use to other implant materials (not enough information on long term effects and stability)
-Only a handful of surgeons use PEEK at the moment
*Directly from my implant surgeon when asked why he doesn't offer or use PEEK: "difficult to bend, conform and place due to rigidity" (keep in mind that my surgeon prefers silicone & Medpor. However, he is an implant specialist with extensive knowledge on all alloplastic materials)
Titanium alloy (Ti-64) - Titanium implants made by selective laser melting
This titanium alloy (Ti-64) is a commonly used alloy in load-bearing medical applications because of its strength, low weight and excellent biocompatibility. Using 3D Printing (Selective Laser Melting) to produce patient-specific implants from TI6Al4V creates the possibility of adding porosity throughout the material and allows virtually unlimited shape complexity. It is mainly used for mandible reconstructions and custom osteosynthesis plates. Furthermore, Titanium is the most commonly used material in medical implants because it is highly biocompatible and integrates very well into tissues.
The mechanical properties of SLM titanium products are also within the ranges of the properties of bone . These similarities are particularly important because implant materials that are much stiffer than the bone can generate stress shielding, which can potentially lead to bone resorption or hinder bone regeneration. Bone resorption caused by stress shielding is believed to contribute to the aseptic loosening of implants. In contrast, the porous surfaces of SLM titanium parts have been demonstrated to be favorable for cell adhesion, migration and ingrowth, and these properties result in strong bone-implant contact. When an implant is populated with osteogenic cells, these cells not only migrate on the surface of the implant but also inside the pores of the implant.
Medical Argument for Titanium Over PEEK: The choice of titanium over polyetheretherketone (PEEK) is based on the European belief that it is better to prevent long-term complications caused by nonosseointegrated PEEK implants than to handle those complications associated with osseointegrated titanium (Federal and Drug Administration philosophy).
• My current thoughts on Titanium: Vastly superior to PEEK. The aforementioned states succinctly why. I'll highlight the points below:
-Osseointegrated unlike PEEK
-Porous surfaces are favorable for cell adhesion, migration and ingrowth, and these properties result in strong bone-implant contact.
-Well known and commonly used as a result of strength, low weight and excellent biocompatibility.
-Mainly used for mandible reconstructions and custom osteosynthesis plates
-titanium is resistant to bacterial colonization and causes less inflammation.
-“Satin” finished to prevent contamination from saliva
-Virtually unlimited shape complexity.
Titanium being superior other implant materials and augmenting methods:
• Titanium > polymethylmethacrylate(PMMA), hydroxyapatite(HA) and polyethylene
Materials such as polymethylmethacrylate(PMMA), hydroxyapatite(HA) and polyethylene have proven to be biocompatible but have individual shortcoming. Compared to titanium,PMMA and HA are associated with an increased risk of infection. Polyethylene is not as strong]
• Titanium > general alloplastics
Furthermore, A disadvantage of alloplastic materials is its high susceptibility to infection. However, titanium is resistant to bacterial colonization and causes less inflammation.
Additionally, The bio-compatibility of titanium is well established compared to alloplastics. It is robust enough to resist secondary trauma while providing maximal stability of the cranial vault. As well, titanium implants generally cause less inflammation and conducts well with surrounding mineralized bone.
Source: https://e-acfs.org/upload/pdf/acfs-16-11.pdf
Archives of Craniofacial Surgery
Copyright © 2015
• Titanium > Autologous (calvarial bone) onlays and sandwich osteotomies
In Whitaker’s[1] experience, autologous (calvarial bone) onlays and sandwich osteotomies yielded unpredictable results because of resorption and symmetry issues, and he discontinued their use. Triaca et al.[19] used an extended chin osteotomy using frequent bone grafts and posterior design corrections with the “chin-wing” technique. Results regarding symmetry, fracture, and infection complications are not yet available at the time of writing.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343643
Guidelines for patient-specific jawline definition with titanium implants in esthetic, deformity, and malformation surgery
Ann Maxillofac Surg. 2016 Jul-Dec; 6(2): 287–29
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Newly emerging contemporary implant materials & techniques
CT-Bone®
CT-Bone is a 3D printed calcium phosphate that unifies with the patient’s bone. It can be used for bony augmentations (non-load-bearing) and is converted into real bone in the patient. Because it is 3D printed it can be made into complex shapes with controlled porosity.
Additive manufactured full mandible
The world's first additive manufactured full mandible was implanted in a patient by Dr. Jules Poukens and his team in Belgium.
Source: https://www.xilloc.com/patients/stories/total-mandibular-implant/
To surmise, I think the best we can hope for at this point, is the emergence of patient specific implants that will replicate not only form as it is today but also have mechanical, chemical and physiological properties similar to native tissues they replace and provide an environment for cell differentiation and growth. Currently there is no one material that can provide a complete solution. The future is regenerative medicine that allows for growth of natural tissues similar to the region of implantation.
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Lots of research you have there on MATERIALS. Might be time to take a detour and research PERIODONTAL PATHOGENS.
IMO, the MISSING LINK, as far as infections to ANY material goes, is that infections arise from PERIODONTAL PATHOGENS (found in the mouth, between the teeth or close to gums) that can get released into the BLOOD STREAM when a CUT is made INSIDE the mouth to place the implants. These pathogens just love to find their way to any place in the body where there is an implant.
To cut down on the probability of periodontal pathogens ruining an implant surgery, (or any surgery where cuts are made inside the mouth) get a full CLEANING (deep scaling under gum line if needed) MANY months before implants and another cleaning a few months or so before the surgery and in between be very concious that the teeth and gums are very clean and healthy.
Don't get a cleaning too close to the time of the implant surgery though.
Prep with a lot of mouth baths like salt water rinses, hydrogen peroxide, dilute iodine solutions and any other home remedies you can find that are good for 'periodontitis' or 'gingivitis' since it is those 2 conditions that pretty much have the same/similar pathogens associated with the dental and gum conditions they cause.
You can even search out dental practices that do a periodontal pathogen ASSAY. Doesn't hurt to have prophylactic anti-biotics before hand either.
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A possible downside to titanium is the risk of becoming hypersensitive to it. Wolford patients who get total joint replacement are told to avoid titanium in their diet, even toothpaste.
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for f**k's sake just get a strong 9-10 mm genioplasty.
No one is gonna put titanium implants in you except that quack Coacinceg or whatever his name is.
If you go with him though he might do distraction on you which would be a first on this board for an adult patient. So you know your mileage may vary. But please do keep us abreast of what happens. You're seeking ascension and most of us like icarus fly too close to the sun.
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Good thread here on titanium. http://jawsurgeryforums.com/index.php?topic=6795.0
Seems like Belgium is the place to go. I saw the post op X-ray and there’s a lot of Ti hardware floating around in my chin and it’s never given me any trouble in 12 years.
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Lots of research you have there on MATERIALS. Might be time to take a detour and research PERIODONTAL PATHOGENS.
IMO, the MISSING LINK, as far as infections to ANY material goes, is that infections arise from PERIODONTAL PATHOGENS (found in the mouth, between the teeth or close to gums) that can get released into the BLOOD STREAM when a CUT is made INSIDE the mouth to place the implants. These pathogens just love to find their way to any place in the body where there is an implant.
To cut down on the probability of periodontal pathogens ruining an implant surgery, (or any surgery where cuts are made inside the mouth) get a full CLEANING (deep scaling under gum line if needed) MANY months before implants and another cleaning a few months or so before the surgery and in between be very concious that the teeth and gums are very clean and healthy.
Don't get a cleaning too close to the time of the implant surgery though.
Prep with a lot of mouth baths like salt water rinses, hydrogen peroxide, dilute iodine solutions and any other home remedies you can find that are good for 'periodontitis' or 'gingivitis' since it is those 2 conditions that pretty much have the same/similar pathogens associated with the dental and gum conditions they cause.
You can even search out dental practices that do a periodontal pathogen ASSAY. Doesn't hurt to have prophylactic anti-biotics before hand either.
@Kavan: Excellent point and great information which can only further help others prevent complications when dealing with implantable materials. I dropped an applaud on you for + karma
Extending upon what kavan has said, I did indeed decide to detour and came across some beneficial information/resources relating to periodontal pathogens. The following should help inform individuals in preventative planning as well as treatment/therapy of periodontal pathogens which is paramount when considering implants.
Periodontal Pathogens
Periodontal pathogens are bacteria that have been shown to significantly contribute to periodontitis.
Although approximately 700 bacterial species have been identified in the oral cavity and nearly 300 species have been cultured and found to contribute to the biofilm (once your implant becomes immersed in biofilm it's over i.e. removal) of the periodontal pocket, there is a much smaller number of species that have been shown to be more closely related to the initial incidence and continued persistence of periodontitis, including:
• Aggregatibacter actinomycetemcomitans
• Porphyromonas gingivalis
• Tannerella forsythia (formerly Bacteroides forsythus)
• Treponema denticola
• Fusobacterium nucleatum
• Prevotella intermedia
• Prevotella nigrescens
• Eikenella corrodens
• Eubacterium nodatum
• Parvimonas micra (formerly Peptostreptococcus micros or Micromonas micros)
• Streptococcus intermedius
• Campylobacter rectus
• Capnocytophaga sp.
Periodontal disease is an inflammatory disease of the supporting tissues of the teeth, which is caused by specific microorganisms or groups of microorganisms living in a biofilm, on and around the teeth. Microorganisms initiate an immune response, and in some cases the result is progressive destruction of gingival tissues, the periodontal ligament and alveolar bone (Au revoir to your implants)
ORAL SYSTEMIC LINK (affecting your implants)
One hundred million Americans are infected with periodontal disease. It is recognized to increase risk for diabetes, heart disease, stroke and other systemic diseases.3 One out of every two American adults over age 30 has gum disease, according to the Center for Disease Control and Prevention (CDC). The findings, published in the Journal of Dental Research, estimate that 47.2 percent, or 64.7 million American adults, have some form of periodontal disease.
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Current scientific evidence links periodontal disease to a myriad of health problems, such as pneumonia, chronic respiratory disease, heart disease, pre-term and low-birth weight babies. One study published in Cardiovascular (1999) reported that among Canadians aged 36 to 69, individuals with severe gum disease have a three to seven times higher risk of fatal heart disease. Researchers also found that those with poor oral health may be up to three times more likely to have a stroke.
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Prevention & Risk Assessment
Bacterial DNA is the key to finding out if the patient is at risk from a microbial burden and human DNA is the key to understanding if the patient is genetically predisposed to an exaggerated response to inflammation.
OralDNA® Labs is a specialty diagnostics company that offers saliva screening by three DNA-polymerase chain-reaction (DNA-PCR) tests based on bacteria, genetics and viral load.
• The first is a bacterial test, MyPerioPath®, which is used to detect periodontal disease, specifically pathogenic bacteria. This helps guide therapy based on causative agents and not on subjective observation. Additionally, the results of the test will identify tissue invasive bacteria and suggest adjunct oral and locally applied antibiotic protocols if needed. After therapy is completed, a follow-up sample will help monitor the efficacy of treatment and determine if additional measures are required.
Very comprehensive, check out a test result sample: https://www.oraldna.com/pdf/MyPerioPath_ReportNew.pdf
• The second test is based on the individual’s genetic response to inflammation. MyPerioID® is a genetic susceptibility test which needs to be performed only once in a patient’s lifetime. The Interleukin-6 (IL-6) gene variance in a patient’s DNA is an indication of a predisposition for over-expression of inflammatory mediators. Over-expression of inflammatory mediators can increase the risk for attachment loss or periodontal disease activity. This test result will either be positive or negative. Knowing this information will help determine genetic risk prior to extensive therapy and can help guide therapeutic decisions. Knowing their genetic susceptibility can also help patients understand the severity of their disease and why they might struggle in controlling it. This is additionally helpful for patients with therapy resistant periodontitis or aggressive infections where host modulation therapy is needed.
Test result sample: https://www.oraldna.com/pdf/OralDNALabs-MyPerioID-IL1-report.pdf
In summary, both MyPerioPath® and MyPerioID® enable early identification of risk, and therefore, an opportunity to further personalize care. Without personalized therapy, the patient may continue to experience unresolved infection after therapy and the further spiral of periodontal breakdown.
Here is the link to the kits if anyone is interested: https://www.oraldna.com/periodontal-testing.html
Treatment
An outline of the total mouth disinfection protocol is as follows:
1. Occlusal analysis to identify and remove any fremitus in chewing.
2. Attack the bacteria in the pockets mechanically using scaling and root planing.
3. Attack the bacteria in the pockets chemically by irrigating with CariFree Treatment Rinse (Oral BioTech, www.carifree.com), iodine or chlorhexidine.
4. Deposition of a locally applied time-release antibiotic, Arestin® (OraPharma, Inc., www.orapharma.com) in all pockets equal to or greater than 5mm.
5. Attack the bacteria in the bloodstream with the antibiotic regimen suggested on the OralDNA report.
6. Attack the bacteria in the rest of the oral cavity with CariFree Treatment Rinse, ProFresh (ProFresh International Corp., www.profresh.com) or other chlorine dioxide rinse to control microbial load. The rinse protocol is to swish for one minute, twice daily.
7. Prescribe home care adjuncts such as a mechanical toothbrush, Waterpik® (Water Pik, Inc., www.waterpik.com) or Hydroflosser (Shazzam Tsunami™, Bling Dental Products, www.blingdentalproducts.com) and interproximal aids, etc., for enhanced bacteria load control.
8. Maintain two-month re-evaluation appointments until stability (zero bleeding on periodontal chart) has been achieved.
Here is the specific total mouth disinfection protocol followed:
• Full mouth mechanical debridement with ultrasonic scaling and root planning followed by hand scaling.
• Full mouth in office irrigation with CariFree Treatment Rinse.
• Locally applied Arestin antibiotic placement in all pockets 5mm and above.
• Systemic antibiotic as suggested from the OralDNA report – Amoxicillin 500 mg tid for eight days in combination with Metronidazole 500 mg bid for eight days.
• Oral hygiene instructions were reviewed with specific instructions on the use of an electric toothbrush and an oral irrigator.
• CariFree Treatment Rinse was initiated for one minute twice daily for two months to control biofilm on the tongue, cheeks, and areas not supported by the teeth.
• A tight two-month re-evaluation schedule was planned until zero bleeding was established.
-Ｒｅａｌｉｔｙ
R̼̯̤̗̲̞̥̈ͭ̃ͨ̆e̮̟͈̣̖̰̩̹͈̾ͨ̑͑a̘̫͈̭͌͛͌̇̇̍l͕͖͉̭̰ͬ̍ͤ͆̊ͨi̞̟̫̺ͭ̒ͭͣt̘̟̼̉̈́͐͋͌̊y͉̝͖̻̯ͮ̒̂ͮ͋ͫͨ
R͚e͚a͚l͚i͚t͚y͚ Rͦͯͦͯeͦͯͦͯaͦͯͦͯlͦͯͦͯiͦͯͦͯtͦͯͦͯyͦͯͦͯ
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@ditterbo: Good point and a worthwhile consideration
for f**k's sake just get a strong 9-10 mm genioplasty.
No one is gonna put titanium implants in you except that quack Coacinceg or whatever his name is.
If you go with him though he might do distraction on you which would be a first on this board for an adult patient. So you know your mileage may vary. But please do keep us abreast of what happens. You're seeking ascension and most of us like icarus fly too close to the sun.
@Lazlo: I agree with you about the Sliding Genio and like I mentioned previously, the idea is SG + Jaw Angle implants -thus the autistic amount of information I compiled on implant materials.
I also tend to agree with you when you say that no one is going to put TI in except less then a handful of surgeons. @Fulcanelli mentioned Belgium: Dr Natalie Loomans (however her "website" is quite minimal to put it nicely and there are no photos except for the scientific abstract that @Tim06 procured)
Moreover, when I saw my surgeon today and asked directly about TI he immediately shook his head and said there's no point lol... it was kind of funny if it wasn't so arrogant but he has his own methods & ways that he's accustomed to.
Regarding ascension... I like your sentiment, it's always good to keep in mind for balance and a reality check. For me, patience is the most difficult thing in this game (time always takes a hit: dreams, goals, personal, opportunities etc...) I've already lost a couple in this endeavor but I'll reach them again.
Laz, who would you suggest regarding a Sliding Genio for a moderately large advancement?
Also, has anyone heard of these two surgeons (they're not "big name", at-least on this board or to myself) Found them as I was just browsing photos while waiting for a flight:
• Dr. Alejandro Nogueira Super tacky website but seems to do many SG's with decent results. Plus, I like his technique. However, he's based in Spain: not sure how safe that is.
https://www.lowcostmetic.com/treatments/chin/sliding-genioplasty
• Dr. Ivo Gwanmesia Based in London and seems to produce decent results but not sure how many he's performed.
https://www.ivogwanmesia.com/photo-gallery/genioplasty/
-Ｒｅａｌｉｔｙ
R̼̯̤̗̲̞̥̈ͭ̃ͨ̆e̮̟͈̣̖̰̩̹͈̾ͨ̑͑a̘̫͈̭͌͛͌̇̇̍l͕͖͉̭̰ͬ̍ͤ͆̊ͨi̞̟̫̺ͭ̒ͭͣt̘̟̼̉̈́͐͋͌̊y͉̝͖̻̯ͮ̒̂ͮ͋ͫͨ
R͚e͚a͚l͚i͚t͚y͚ Rͦͯͦͯeͦͯͦͯaͦͯͦͯlͦͯͦͯiͦͯͦͯtͦͯͦͯyͦͯͦͯ
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If all you need is a geniopasty, Gunson doesn't charge that much.
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If all you need is a geniopasty, Gunson doesn't charge that much.
@PloskoPlus
Cool and that would be great but how exactly does one setup a consult with Gunson, without having a referral?! (I have no ortho or dentist either: was living out of country)
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What about the chin wing procedure? Think there was a guy here who got good results in terms of width at the jaw angles with it. Not sure if he had other procedures too
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Reality,
Wow! Great research finding the periodontal pathogen info. I came accross of of same/similar before but did not have links on hand. THANX for the 'karma', I upvoted/applauded you too.
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@PloskoPlus
Cool and that would be great but how exactly does one setup a consult with Gunson, without having a referral?! (I have no ortho or dentist either: was living out of country)
You need a referral to see him. You must have some recession in your jaws to have gotten implants. Get a referral from an Ortho to see him. Another member here told me he doesn't do much isolated genios though.
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@Kavan: Cheers m8 and thank you! ^ _ ^
You need a referral to see him. You must have some recession in your jaws to have gotten implants. Get a referral from an Ortho to see him. Another member here told me he doesn't do much isolated genios though.
@Haven: Thank you for clarifying this. So my next issue is finding an Ortho who will give me a referral but I don't know how any of this works (firstly, getting an Ortho and second, getting an Ortho to refer me).
I think it's going to be difficult for me to find an Ortho in my state, that will refer me outside of my state (I live in the worst state: so many restrictions on where you can get your health/dental care and who you can get it from etc... there's honestly like zero freedom of choice & options, it's terrible). For example, I've already asked a few practices simply about referrals and they all stated that they only refer IN state... like come on, what am I supposed to do now?!
Does anyone know if you can get an Ortho out of state or better yet, does anyone know an Ortho that will be able to refer me to Gunson? (I don't mind paying for the referral, I just need to make it happen)
So many hoops just to get a consult is a turn off for real - healthcare in this country is a joke. (just let me pay to see who I want to see)
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@Kavan: Cheers m8 and thank you! ^ _ ^
@Haven: Thank you for clarifying this. So my next issue is finding an Ortho who will give me a referral but I don't know how any of this works (firstly, getting an Ortho and second, getting an Ortho to refer me).
I think it's going to be difficult for me to find an Ortho in my state, that will refer me outside of my state (I live in the worst state: so many restrictions on where you can get your health/dental care and who you can get it from etc... there's honestly like zero freedom of choice & options, it's terrible). For example, I've already asked a few practices simply about referrals and they all stated that they only refer IN state... like come on, what am I supposed to do now?!
Does anyone know if you can get an Ortho out of state or better yet, does anyone know an Ortho that will be able to refer me to Gunson? (I don't mind paying for the referral, I just need to make it happen)
So many hoops just to get a consult is a turn off for real - healthcare in this country is a joke. (just let me pay to see who I want to see)
Maybe you could try consulting with Mark Urata MD, DDS. Not sure but it's said that he studied with Kawamoto who wrote that book (you cited) on all the types of genios out there. Urata is maxfax, does cranio facial stuff and PS so you would NOT need any referral from an ortho to see him. IF he studied with Kawamoto long ENOUGH, maybe he's got more of a grip on all the esoteric types of genios that maybe Gunson does not do. Now I don't profess to know all the types of genios Gunson does but every ceph displacement diagram I see, he's doing the basic sliding genio and to the best of my knowledge prefers to get the most of the chin point out via the BSSO advancement and likes the more modest genios. Like I've never seen any of the more esoteric genios in his plans BUT then again, I can't say I've seen a very large sampling of his plans. Just that every one I see has the sliding (up) genio that he keeps modest because the folks who get them are also getting pretty much the FULL maxfax.
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You don't need a referral explicitly TO Gunson. Should be just an ortho recommending max facs surgery, and the surgeon in particular doesn't matter. That was my experience in consulting with Gunson and other max facs in the US.
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There's also a fellow in San Francisco who gets mentions here. Deschamps Braley. He does a wide array of oral procedures including isolated genios so maybe consider that. You don't need a referal letter. There more mentions of other surgeons on here. You just have to dig. Kavan is right on Gunsons approach to genios. At least going off the forum. He doesn't seem to do large movements like what you're looking for. At most, I read one patient was suggested 7mm (no jaw surgery).
Maybe see if you can get a general referal letter that outlines your concerns from a doctor (bite, airway, profile).
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You don't need a referral explicitly TO Gunson. Should be just an ortho recommending max facs surgery, and the surgeon in particular doesn't matter. That was my experience in consulting with Gunson and other max facs in the US.
That's correct but 'Reality' does not have an ortho (maybe doesn't need one for teeth). So I suggested a possibility where no ortho middleman is needed.
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Maybe you could try consulting with Mark Urata MD, DDS. Not sure but it's said that he studied with Kawamoto who wrote that book (you cited) on all the types of genios out there. Urata is maxfax, does cranio facial stuff and PS so you would NOT need any referral from an ortho to see him. IF he studied with Kawamoto long ENOUGH, maybe he's got more of a grip on all the esoteric types of genios that maybe Gunson does not do. Now I don't profess to know all the types of genios Gunson does but every ceph displacement diagram I see, he's doing the basic sliding genio and to the best of my knowledge prefers to get the most of the chin point out via the BSSO advancement and likes the more modest genios. Like I've never seen any of the more esoteric genios in his plans BUT then again, I can't say I've seen a very large sampling of his plans. Just that every one I see has the sliding (up) genio that he keeps modest because the folks who get them are also getting pretty much the FULL maxfax.
@Kavan: Prime point relating to Gunson & his scope of Genioplasty technique (honestly makes me think that trouble of a consult isn't worth it). I've just put in an attempt for an Ortho, so waiting to see if anything transpires.
Regarding Urata, yes thank you -I've a consult setup with him in the coming months.
@Haven: Yes, I've been suggested this surgeon numerous times now but I find it slightly odd considering the main focus of his work. Has anyone here actually had surgery or a consult with him - if yes, feel free to PM me with your experience (Also, I'm curious about his price with respect to sliding genioplasty: it's been mentioned that it's in the same league as Gunson but I've not seen/heard anything price related to his isolated SG cases)
Cheers,
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You might want to ask some1afterall & ditterbro. They've both consulted with him. Theres also Bobbit who has told me he's actually seen him work. I live near SF but have never seen him or I'd give you my input.
There was a post by a girl who had a genioplasty with him on realself who said it cost 14k. Take that with a grain of salt though.
If there's a policy on placing prices let me know and I'll remove it.
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Great. Let us hear how it goes.
@Kavan: Prime point relating to Gunson & his scope of Genioplasty technique (honestly makes me think that trouble of a consult isn't worth it). I've just put in an attempt for an Ortho, so waiting to see if anything transpires.
Regarding Urata, yes thank you -I've a consult setup with him in the coming months.
Cheers,
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Frankly, I have 0 thoughts about his interest in FTM/MTF surgery. My revision chin implant guy also did a lot of that stuff, didn't matter to me or the results. Deschamps is a guy that can offer you a 14mm SG with HA paste to hide the deep labiomental sulcas. That's about all there is for me to say. I've seen a few examples in his consult and they looked great.
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Frankly, I have 0 thoughts about his interest in FTM/MTF surgery. My revision chin implant guy also did a lot of that stuff, didn't matter to me or the results. Deschamps is a guy that can offer you a 14mm SG with HA paste to hide the deep labiomental sulcas. That's about all there is for me to say. I've seen a few examples in his consult and they looked great.
Her has no qualms about massive geniopasties, yet considers chin wings extreme.
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Her has no qualms about massive geniopasties, yet considers chin wings extreme.
LOL. Is this a Freudian slip about a doctor who specializes in 'he/she' surgeries? ;D
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LOL. Is this a Freudian slip about a doctor who specializes in 'he/she' surgeries? ;D
Stupid autocorrect. You know what I mean. ;D Anyway, he's on the craniofacial spectrum. He does orthognathic surgeries, but I don't think surgeons like him are the first choice for such surgeries (I know I'm digressing here from OPs concerns, I guess I'm addressing ditterbo).
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@Reality
What work would you recommend to my midface and mandible. As far as my research goes there aren't much options left for me.
Regarding titanium as implant material it is a good choice but it comes with several downsides especially when used for the gonial angle. Since it isn't flexible there need to be much larger incisions then with other materials and it also means a much larger trauma for the muscles and nerves.
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What exactly are the negatives for ti implants? Is it just the larger incision and disruption to muscles? That seems pretty manageable.
Am I right in thinking that ti implants are unlikely to cause infection and do not cause bone erosion? If so it seems like the ideal material I don’t understand why it’s not used more widely. Especially as all the screws and plates used in all jaw surgery is ti anyway.
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What exactly are the negatives for ti implants? Is it just the larger incision and disruption to muscles? That seems pretty manageable.
Am I right in thinking that ti implants are unlikely to cause infection and do not cause bone erosion? If so it seems like the ideal material I don’t understand why it’s not used more widely. Especially as all the screws and plates used in all jaw surgery is ti anyway.
After months of research it indeed appears to be a material with lots of positive features, however you rarely find any reviews of patients who got titan implants during an aesthetic surgery. One reason might be that they are said to be extremely expensive, like $12k for the implants alone. Thats what my doctor in Germany told me when I consulted him for a sliding genioplasty.
But in the example in the thread I posted some time ago I contacted the surgeon and he told me the whole surgery including the custom 3d titan implants would only cost $4k in Belgium.
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What exactly are the negatives for ti implants? Is it just the larger incision and disruption to muscles? That seems pretty manageable.
Am I right in thinking that ti implants are unlikely to cause infection and do not cause bone erosion? If so it seems like the ideal material I don’t understand why it’s not used more widely. Especially as all the screws and plates used in all jaw surgery is ti anyway.
Ti H/W used in jaw surgery does get infected. FWIW, in Europe it's common practice to remove it 12 months after surgery. In the US, Australia, it's left in, unless it causes problems.
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Lots of research you have there on MATERIALS. Might be time to take a detour and research PERIODONTAL PATHOGENS.
IMO, the MISSING LINK, as far as infections to ANY material goes, is that infections arise from PERIODONTAL PATHOGENS (found in the mouth, between the teeth or close to gums) that can get released into the BLOOD STREAM when a CUT is made INSIDE the mouth to place the implants. These pathogens just love to find their way to any place in the body where there is an implant.
To cut down on the probability of periodontal pathogens ruining an implant surgery, (or any surgery where cuts are made inside the mouth) get a full CLEANING (deep scaling under gum line if needed) MANY months before implants and another cleaning a few months or so before the surgery and in between be very concious that the teeth and gums are very clean and healthy.
Don't get a cleaning too close to the time of the implant surgery though.
Prep with a lot of mouth baths like salt water rinses, hydrogen peroxide, dilute iodine solutions and any other home remedies you can find that are good for 'periodontitis' or 'gingivitis' since it is those 2 conditions that pretty much have the same/similar pathogens associated with the dental and gum conditions they cause.
You can even search out dental practices that do a periodontal pathogen ASSAY. Doesn't hurt to have prophylactic anti-biotics before hand either.
Why do you not recommend getting a tooth cleaning a too close to a surgery?
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Why do you not recommend getting a tooth cleaning a too close to a surgery?
Can release bad tooth bacteria into the blood stream which can land on an implant if you're getting implant surgery.
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Can release bad tooth bacteria into the blood stream which can land on an implant if you're getting implant surgery.
Would this be the same case for an osteotomy or no?
Do you think getting a mouth cleaning 1 month before a procedure is too risky.
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Would this be the same case for an osteotomy or no?
Do you think getting a mouth cleaning 1 month before a procedure is too risky.
When they make cuts through the mouth the bad bacteria can escape and get into the blood and then land on an implant. They can still do that for an osteotomy but the anti-biotics would have a better chance of working if one got an infection. One month before is OK. Then a lot of mouth bathing protocols before the surgery which I think Reality listed on this thread.
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When they make cuts through the mouth the bad bacteria can escape and get into the blood and then land on an implant. They can still do that for an osteotomy but the anti-biotics would have a better chance of working if one got an infection. One month before is OK. Then a lot of mouth bathing protocols before the surgery which I think Reality listed on this thread.
Im assuming the cuts are from flossing? If I go to my dentist should I ask for a routine cleaning or the deep cleaning option (didnt know this was a thing). Or just tell them Im going to have surgery and would like by mouth sanitized.
Either way I don't floss regularly so Im assuming if I start flossing and it starts to bleed the same thing will happen so I might as well just start it now.
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Im assuming the cuts are from flossing? If I go to my dentist should I ask for a routine cleaning or the deep cleaning option (didnt know this was a thing). Or just tell them Im going to have surgery and would like by mouth sanitized.
Either way I don't floss regularly so Im assuming if I start flossing and it starts to bleed the same thing will happen so I might as well just start it now.
My reference to 'cuts to the mouth' was about SURGICAL CUTS. Just get a dental check up with cleaning.
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My reference to 'cuts to the mouth' was about SURGICAL CUTS. Just get a dental check up with cleaning.
Why is it better to not have cleaning close to surgery date then?
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Why is it better to not have cleaning close to surgery date then?
END of session.
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for f**k's sake just get a strong 9-10 mm genioplasty.
No one is gonna put titanium implants in you except that quack Coacinceg or whatever his name is.
If you go with him though he might do distraction on you which would be a first on this board for an adult patient. So you know your mileage may vary. But please do keep us abreast of what happens. You're seeking ascension and most of us like icarus fly too close to the sun.
😂 lazlo, reading your stuff always makes me laugh.
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Cliffs:
-Currently have implants (custom silicone chin & jaw wrap around)
-Love how they look on me (I was modeling and getting acting auditions)
PROBLEM: Implants became infected and all have to be removed (I'm devastated and angry. Removal is happening today by the way).
I can wait 4 months and try again but...
-I no longer trust nor want silicone and/or implants in my face as it's too risky and has already destroyed certain parts of my life (I.e. wasting time, money and opportunities due to necessitation of removal)
*At this point I'm only concerned with my chin: nevermind the jaw angles.
Looking for a viable and life long solution: Sliding Genioplasty seems to be the answer. I need a large advancement (14mm minimum: this was the projection of my chin implant).
Looking to hear from those of you who have had a SG with large advancements (14-15mm).
1. What has your experience been?
2. Who was your surgeon? (I really need some suggestions here)
I know about Gunson but apparently I need a referral from an Orthodontist to see him. Firstly, I've been living out of country so I have no ortho and second, my home in the US is not in California. I really wish I could just make an appointment to see him because on his website it states that he now does SG for cosmetic purposes.
Who are the other top surgeons for Sliding Genioplasties? (surgeons you would place with Gunson)
By the way, I am willing to share my ceph and custom CT scan with those who have already undergone surgery.
I also had 10mm genio, with 6 mm lengthening. I also had an implant go bad on me, previous doctor didn’t screw it down, so the implant eventually displaced and endned up high eroding some of the bone. My implant was a joke, never liked it, didn’t really give any noticeable difference. I had planned to have later have bimax after the implant, but had to have it removed-so I figured I might as well do something substantial. Genioplasty was a good decision. 14mm seems like an awful lot. I thought 10mm was a lot. I have a fairly strong jaw/profile, so 10mm doesn’t look overdone. I had a couple small gaps on one side where the bone gap didn’t entirely heal, Dr. just filled with HA paste. Also had a screw protrude thru my gumline nearly 10 months after surgery, Dr. took it out in office; I only mention bc he had never had that happen before, for some reason I felt like it was bc of the big movement and pressure it created, perhaps that’s nonsense. At the end of the day, it was a good decision, and although the aesthetic result is a 1, 000 times better than before, I still feel that genioplasty fails meet the needs of bimax is needed. It’s not like an implant. Implants made me constantly question how I looked, or if it had changed positions, etc....too many factors. It also never felt like, “me”. Genioplasty is obviously your bone, your raw material, so that aspect is great. I have a short mandible with a cant, so although the Genioplasty helped, it still feels like a camouflage. I only tell you this so you can weight your entire aesthetic goal along with any functional needs. 14 mm seems like an awful lot to not need jaw advancement. I called gunson for a Genioplasty, he said no, but maybe you will find a different answer. Dr. Hobar did mine, he’s a great ps. I also consulted with dr. Sinn, he’s also in Dallas, Texas area, he’s gonna do my 3 piece lefort. He does real close to a chin wing. Best of luck.
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I also had 10mm genio, with 6 mm lengthening. I also had an implant go bad on me, previous doctor didn’t screw it down, so the implant eventually displaced and endned up high eroding some of the bone. My implant was a joke, never liked it, didn’t really give any noticeable difference. I had planned to have later have bimax after the implant, but had to have it removed-so I figured I might as well do something substantial. Genioplasty was a good decision. 14mm seems like an awful lot. I thought 10mm was a lot. I have a fairly strong jaw/profile, so 10mm doesn’t look overdone. I had a couple small gaps on one side where the bone gap didn’t entirely heal, Dr. just filled with HA paste. Also had a screw protrude thru my gumline nearly 10 months after surgery, Dr. took it out in office; I only mention bc he had never had that happen before, for some reason I felt like it was bc of the big movement and pressure it created, perhaps that’s nonsense. At the end of the day, it was a good decision, and although the aesthetic result is a 1, 000 times better than before, I still feel that genioplasty fails meet the needs of bimax is needed. It’s not like an implant. Implants made me constantly question how I looked, or if it had changed positions, etc....too many factors. It also never felt like, “me”. Genioplasty is obviously your bone, your raw material, so that aspect is great. I have a short mandible with a cant, so although the Genioplasty helped, it still feels like a camouflage. I only tell you this so you can weight your entire aesthetic goal along with any functional needs. 14 mm seems like an awful lot to not need jaw advancement. I called gunson for a Genioplasty, he said no, but maybe you will find a different answer. Dr. Hobar did mine, he’s a great ps. I also consulted with dr. Sinn, he’s also in Dallas, Texas area, he’s gonna do my 3 piece lefort. He does real close to a chin wing. Best of luck.
You get a 3 piece lefort with Dr. Sinn? Could you elaborate on the reasons and costs?
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You get a 3 piece lefort with Dr. Sinn? Could you elaborate on the reasons and costs?
Correction. I misspoke. I have a short maxilla, not mandible.
Reasons? Well, would be a downgraft to lengthen my maxilla. A 3 Piece because my maxilla is also shorter and back further on one side, so to widen and manipulate it more. As far as cost, I don’t know bc it will change bc I had the genioplasty with another doctor, and the original quote had 3 procedures combined.
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what are the odds of having a narrow chin after a sliding genio?
what about chin ptosis / witche's chin after the procedure ? is it common?