jawsurgeryforums.com
Surgeon Information => Surgeon Reviews and Leads => Topic started by: Langpam on November 29, 2014, 07:57:23 AM
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Remember I am one of the oldest members on this forum. My surgery was on 12th November. I have tried to upload photos and hopefully it has worked!!
My surgery was anticlockwise rotational bimaxillary with genioplasty to cure my sleep apnoea. I have not used my CPAP machine since the day before surgery
Photo 1: 2 hours before surgery http://imgur.com6fz8BM
Photo 2: 6 days post surgery : http://imgur.com/SVJ3yEv
My surgery was to increase my airways. It did that. The improved profile was a bonus. Now my nose has the support from the advanced maxilla and looks smaller
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Thx, but..
typo in first link
How are your nerves / feeling on the face ?
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Photo 1 2hours before surgery http://imgur.com/6fzp8BM
Photo 2 6days after surgery http://imgur.com/SVJ3yEv
Any better?
My God, if Dr Alfaro want to advertise he would choose someone who knew what they were doing, lol
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The profile does indeed look improved and I can see what you said about the nose as well. It's interesting that you had surgery without having any orthodontic work first. I think you might be one of the first on this forum that has done it like that although I knew beforehand that Alfaro is one of the few surgeons that offer a surgery first approach.
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Actually this is partly why I chose him. Sailer said that no orthodontics would be necessary but I had a Class 2 malocclusion, so how does that work??
The surgeon in London wanted me to have 18 months of orthodontics pre op and 6-12 afterwards. Ugh
Now I am using Invisalign and have just started on tray 2. It's a pain, but I have 27 trays and my orthodontist in Malaga (recommended by Dr Hernández Alfaro) said that I'll need to change the trays every five days, because teeth move much faster after surgery. Dr Hdz Alfaro is directing the orthodontic treatment from Barcelona
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Thanks for sharing this. I think we need to dispel the notion that jaw surgery is only for 20 years olds.
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Thank you.
I had lots of concerns due to my age, increased risk of nerve damage being one of them.
It's difficult to explain, but on meeting Dr Hdz Alfaro (albeit via Skype) I believed that with him the risks were reduced. Meeting him in person confirmed everything. You really do need to trust your surgeon.
After all, there is a significant difference between an operation of 5+ hours and one that was to take less than two hours. The recovery time had to be shorter. I am now 18 days post op and feeling wonderful.
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You are lucky, at least he can perfrom such surgery. In my case 2/3 surgeons, can't
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What is your case?
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Malar bone osteotomy and ION decompression. Demanded very low risk of any permament damage, especially to the eye
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Best of luck with your search.
Hope you'll be as lucky as I was to meet Dr Hdz Alfaro
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langpam please do another set of after after photos maybe in another couple of weeks! Very interesting. Congrats on your great result!
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Thank you Lazio, I shall, maybe after my one month post op appointment.
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Bimaxillary plus genioplasty 20 days post op.
Okay, Lazio, I've posted another post op profile, though I haven't quite got the angle right, since it was a Selfie.
However, I'm still pretty happy and most importantly of all I no longer suffer from severe obstructive sleep apnoea.
Thanks go to Dr Hernández Alfaro and his team
http://imgur.com/7C9TpKw
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Received official confirmation (after sleep study) that my sleep apnoea is cured.
Great news. So happy
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Nice to see some MMA before/after pics. May I ask, how much were your advancements? Did you have genio too?
My plan calls for 10mm to lower (13mm to chin), and 7mm to upper. Dr Alfaro was planning on moving me a bit more. My impression is that I'll look like you. I think the aesthetically optimal result is 3-4mm less for both of us.
Aesthetically, I don't like the look of your new jaw line. I think a flat profile is a healthy look that should be attractive but isn't just because post-agricultural revolution it's become less common so you're not seeing it in celebrities. It's not terrible, though, just the aesthetically optimal result is a few mm less forward. That's to be expected with a surgery like this and the tradeoff is you'll get another 10-20 years without CPAP and likely avoid many of the late age health problems many people experience. Your nose looks way better now too, which is uncommon with MMAs. Your cheeks are flat but they were flat before too due to age most likely. They may look better once the swelling is down.
I consulted with Dr Alfaro too btw. I really liked him but wish he wasn't a 15 hour flight away :( I like the minimally invasive technique but I don't think it changes the odds of nerve loss much. The recovery is easier, which is what he advertises about it.
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My advancement was 12mm and yes I did have genioplasty.
I can't be more precise about how much the maxilla was advanced and how much the mandible as I never asked that question. My one big concern was that it would enlarge my airways sufficiently for me not to have to use CPAP ever again.
The result for me was aesthetically pleasing, which was a bonus. I definitely look younger now and my nose has support from the advanced maxilla. So, for me it was a win win.
I think the minimally invasive technique works when it comes to the recovery process.
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are you gonna remove mini-plates in few months ?
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Well, I won't be removing anything, ha.
I'm aware that titanium is the most biocompatible material with very low toxicity and would only need to be removed if there were an infection.
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Check out my new before and after photos (8 weeks post op) in the Overbites section
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I had a consultation last year with Dr Hernandez Alfaro for a corticotomy and he seemed very expensive. I am now considering having surgery first maxillary advancement with him, what prices have people paid for surgery with him?
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I found his prices quite competitive and since the hospital stay is usually very short ( in my case 1 night) this reduces the overall cost. Other quotes were for five nights in hospital ( London and Zürich) and were in fact more expensive.
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He quoted me 7000€ for a corticotomy, I then went to a different clinic and they quoted 2000€. The thing is it's only a 30 minute procedure under local anaesthetic, I have no idea how he could ask for that much for something so quick and simple. What surgery did you have and how much did it cost?
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He quoted me 7000€ for a corticotomy, I then went to a different clinic and they quoted 2000€. The thing is it's only a 30 minute procedure under local anaesthetic, I have no idea how he could ask for that much for something so quick and simple. What surgery did you have and how much did it cost?
His prices are pretty competitive. I paid less than 20,000 euros for bimaxillary and genioplasty. It was worth every penny, or euro in this case!! A fantastic surgeon.
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His prices are pretty competitive. I paid less than 20,000 euros for bimaxillary and genioplasty. It was worth every penny, or euro in this case!! A fantastic surgeon.
You can get it done for less than half of that in Germany but it it could be worth paying that premium if you're comfortable with your surgeon.
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Coming back to this thread, I realize that Dr Alfaro's technique could be very significant. 80% of blood flow is lost in a LeFort, more if segmental. During recovery, the only blood supply remaining is through the oral mucosa, which he is able to spare more of. Less teeth lost, fewer "wood teeth". Dr Alfaro is exactly the kind of doctor I like. Why can't I find anyone in the US like him?
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wow nice find molestrip, do you think a&g do this? also this could explain why langpam had a smooth recovery. also 20e for trimax is a pretty good deal.
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You never know. He published the paper in 2012 and I think they all know each other but I would guess that no they aren't doing it. At least that practice has other reasons it's not viable for them. Other surgeons could potentially do it. I would guess it's not viable for all procedures too.
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You never know. He published the paper in 2012 and I think they all know each other but I would guess that no they aren't doing it. At least that practice has other reasons it's not viable for them. Other surgeons could potentially do it. I would guess it's not viable for all procedures too.
People get used to using certain tools. Look at pro tennis players. Most of them keep using the same racket they grew up with. I heard towards the end of his career Sampras bought hundreds of rackets of the same model he grew up with because they were about to go out of production.
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could someone post a link explaining his technique or explain it to me themselves?
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The paper (http://cdn.institutomaxilofacial.com/uploads/article/file/9/Twist_technique_in_press.pdf) can be found here. Note at the end he notes that for CCW rotations an extra 1-2cm is needed and it sounds like plates are then used, no graft. That doesn't sound very stable to me for an otherwise already unstable procedure but he has enough experience so I'd believe him if he claims it to be. The incision length looks about half the normal incision so the nerves typically most vulnerable have the same risk factor as before. The main benefit I see is that multi-segment surgeries should be less risky with this technique and, to that extent, there should be fewer teeth that die. More of the mucosa is left intact so the drop in blood flow would be less but, at the same time, it's unclear what impact it has on the tear rate from the paper. Less scar tissue is certainly nice. It's certainly not going to impact time needed for bone to heal and soft tissue typically heals well before that point anyway.
It's hard to know if any US surgeons have adopted it or not. I've seen pictures of Dr Alfaro around with other prominent surgeons so I suspect many of the big names here are familiar with it. Some of them may have adopted it but they wouldn't advertise it because it's not their invention and most of their patients wouldn't understand anyway. Probably the biggest reason is that many simply haven't had the training to learn it and don't want to experiment with it on their patients. It takes time for this kind of stuff to percolate. If I lived in Europe, then he'd certainly be at or near the top of a very short list.