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Surgeon Information => Surgeon Reviews and Leads => Topic started by: Rico on November 21, 2014, 12:50:39 AM
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hmmmmmmm
Some of You contacted with Prof. Pelo. How long you had to wait for his answer ?
No answer for a longer time..
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He is extremely busy and I doubt he reads this forum. It took almost a month before I got a reply from him at one point in time.
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He used to answer me after 3 max 4 days :) untill I sent him my doubts, he asked about... so this is why i'm anxious
OK So I'm waiting another 2 weeks. I hope this time he is replaying longer due to longer letter - more questions
I have had several initial consultations via mail and from my experience, I can tell You, that many surgeons can answer at first time and never again if they change their minds not to help You, even If you ask to get confirmation in order to be sure that your message was read - sometimes message can be overlooked.
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Sometimes he answers immediately and sometimes it takes forever for get a reply. It depends on how busy he is.
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Has anyone heard about Prof. Clauser ? also from Italy. He is supposed to be well known on the world
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I found one kinda unhappy patient of P., but this is not typical botched case. It's subjective opinion. So hard to qualify as bad result
http://chirurgiaestetica.forumcommunity.net/?t=52063925&st=15
Please use Google translate - it will become kinda readable
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https://www.youtube.com/watch?v=Ke5tltlAsvM
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I do not know Italian.
Impressive. right...
Unfortunately we do not see the dark side. There is no surgeon without failures. :)
However this movie shows that he / his team has some very good skills. I wonder if MM can do that.
Also wonder who is that person who has posted that on YT. Perhaps student ? I've sent message to him ;)
Don't get me wrong. In Poland we have one famous maxfac "god" and he organises a lot of symposiums where he shows his spectacular results, but he has got a lot of extremely botched cases in real. This is almost like with MM but probably even worse
On wise doctor told me good thing. Be careful when it comes to maxfac surgeons, because many people can't escape from them once they went under knife. - neverending redos, etc. However many people are not careful. At least we try to minimalize the risk by looking for a opinions, etc
I would like to be a guy who will be able to say - I'm happy everything is OK. But I know that there is no guarentee I will have opportunity to say that :(
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ABOUT MALAR BONE OSTEOTOMY - DESIRED TOPIC FOR SOME :)
Hello again
I'm after 2 consultation with Italian surgeons. Comparing to consultations in Poland, to MM, and Zarrinbal, i'm the most impressed with these ones from Italy
For some of You who does not know what I'm gonna do - I'm going to have malar bone osteotomy and infraorbital nerve decompression due to overlooked previous fracture
Some information may be helpful for You.
Prof Pelo and Ianetti generally told me almost the same and they both seem to be very skilled almost at the same level. Why almost? I will outline this...
At the same time I need your little help in choosing one of them
Both of them doesn't speak well in English. Iannetti enough good to communicate, Pelo needs assistant, probably even when someone write e-mail to him. But there is no problem with basic communication. However there is a very little problem with language barrier. My english is also not very good. I better write than speak, because I more use it in that way,
The consultation time was around 45-60 mins in both cases (I didn't check it exactly, but consultation with Pelo was at 4pm and when I was in the waiting room for a longer while I noticed it was about 5:45pm) , but Pelo also gave me extra time about 15-20minut. He had other patients, so after my scheduled consultation, I waited about one hour, when all patients was examined by doctor, and then I was able to ask some more questions.
Pelo performs all LeFort osteotomies from 1 to 4 (didn't know about 4th). Has got experience
I didn't ask Iannetti about this, but for sure the same experience.
Pelo has got international patients (as he says) from time to time.
Both of them don't see this surgery to be risky. just very low of risk. Iannetti even see lower then low ;) Pelo is a little more careful in saying that, but the same comment - this is the one of most simply from the most complicated surgeries they performs. Pelo informed me that there is more simplier method - just using implant, but osteotomy is more professional and only a little more risky.
Iannetti showed me 3 examples of his works, but for me weren't much heplful, because he showed me before / after in more serious cases, which after looks good, but not perfect (for example in one patient case, one of the eyelid was a bit lower and white part of the eye was more visible, but taking how it was before, quite good. However as I said it was not helpful in my case. He just showed that he is able to restore someone face quite good. He had a little troubles with showing me some more samples. He is not familiar with computers well.
Pelo couldn't show me pictures during consultation, but he told me that, he's gonna to send me via mail some of examples - I'm waiting
and now 2 little differences between them and one big..
First Ianetti is able to perform this surgery making only one barely visible incision, but Pelo needs two visible (and of course one inside mouth). In Pelo's approach, one will be on my lower eyelid (to get acces to orbital floor), the second almost invisible on eyebrow.
At first Iannetti also talked about two incisions, but I told him that once I got hypetropric scar, so he told me despite there is still extremely low risk that it will develope on the face, he can do most of the surgery making access from incision inside mouth. He will use endoscope to get to orbital floor
The second difference is Pelo told that during surgery turn out whether I need augumentation floor (by putting special biomaterial - very thin sheet, or piece of animal bone, or just nothing, perhaps it wil be not necessary) . By contrast, Iannetti claims that augumentation won't be necessary for sure in my case. Displacement is not big and he just will move the bone in the same way as it moved after fracture, but just in opposite way.
Additionally, Iannetti showed me on computer how big is my assymetry (only 4mm) and that he can make some calcultations to be sure how much this bone can be moved to be sure if he will not overdo which may cause too much orbital volume. When orbital volume is too big then eye has too much space and it starts to sunken a little. So he just now that it's 4 mm
Pelo didn't show me any calculations, but told me that he see how much this bone can be moved comparing to the other side.
So these are only minor difference - I think minor. One use some calculations on the computer, the other only his "instinct" and experience ;)
The big one is the price. They prices vary much from them.
Druing surgery no nerve will be severly destroyd. I may have only slight loss of feeling after surgery which is good results...even zygomatic small ones, which MM wanted to destroy despite there are far away from the cut line - still wonder what the heck he wanted to do - this was major thing which made me to cancell surgery with him
Genrally You are not in this topic - I mean malar bones and orbitals
but perhaps You can tell me If for example I may ask Pelo about this endoscope solution, but If he could do that, he would have told me about this option. So probably it doesn't have any sense, and at the same I don't want to make him angry asking such qestions.
Scar on lower eyelid is not very visible (if it will not bocome hypotropic) but it's ..so Ianneti perhaps has better solution, but I don't want to wait
Perhaps decision will be more easy for me when Pelo send me his samples
That option with endoscope and one less scar is quite interesting
What You think ?
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Have you asked Pelo about Iannetti's approach? It's not easy picking a surgeon but you should go with the treatment plan that makes the most sense to you. At least you've managed to stay clear of Mommaerts.
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No, because my first appoitment was with Pelo. But Pelo told me that I can ask him some questions on mail after consultation If I remind something. I don't think I should mention Iannetti name in mail to P. ? What You think ?
ah one more thing. The time of waiting for a surgery in Pelo's clinic is very short even 1-2 weeks after decision. hmmmmmmm. Don't know if it sounds good or not ;)
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I'm not sure what the deal with Pelo is. My understanding is that he works in a public hospital, but maybe he has started taking on patients on a private basis now (since he also has a new website). Some plastic surgeons in my own country work for public hospitals on weekdays and then do the surgeries for their own clinic on weekends.
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What I know, both of them I mentioned work in public and private clinics. This is why they told me that this surgery can be covered by my national insurance (unfortunately not in my case - welcome to Poland) or as an private
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No one an choose for me a surgeon it's my part unfortunately the worst :P
When the malar bone is broken it move inward (often) (1/3 of orbital floor belongs to malar bone - its connected - one piece) The cracked pieces of the bones overlaps and heals in that position. When You try to move this bone back , you can restore some of the part which overlapped (including orbital floor) but it's hard to ....hm how to explain..... ok take a picture , then edit it in graphic program. Reduce the size to 75%. Save then open and resize to 100% again. You still have whole picture like before but with some LOSS of bits. Now You understand . When the bone is moved outward and forward then little gap appear. If this gap will be too big then soft tissue under eye may collapse into sinus making eye dropped. However all depends on the movements of this malar bone. If surgeon is very experienced he can move this bone in the way that volume of the orbiall will not increase , then little gap on the floor won;t make any problem . In that way orbital wall heals without problem
This is hard to explain. Needs some lecture ;) to understand.
On the CT orbital floor is not visible in very good way. It is too thin. Barely 1mm. Only during surgery surgeon can see it better.
And Iannetti claims that my displacement is so little that repositioning will not make significant changes in the orbital volume if the bone will set in professional way.
Pelo thinks it's 50% .... than perhaps putting there some thing to keep all tisues over floor will be necessary. Very small pieces of thin bone or biomateriał. Everything turns out during surgery.
Generally for me the less foreign objects the better
Perhaps I shoukd just ask him if he would take special care to avoid putting something there. I mean augumentation there only when it will be necessary for 100%.
Hard thing. Iannetti claims that augumentation may be connecte with some swelling under eye. Pelo didn't say about this anything.
As I see I have to ask some little questions. I ask him about it , and he agreed - I mean I can send to him
But at the same time I don't want to cross the line. I can't demand too much. On the other hand this is one shot. No redo
about MM - I can;t understand it. Because from the beginning I knew it that this kind of surgery has nothing to do with this small nerve. This lighted me red light in his case. This is why I got panic 3 weeks before surgery with him. Because it was so unlogic.
MM generally wanted to cut my lower part of the malar bone, and the rest just break using force. I and P don't do that. They are gonna cut it everywhere to mobilise it (to free it and set in proper way)
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Now I'm at the airport. When I come back to home, I'll show You a part of my face and You will see how this 4mm looks like... this is 4mm in 2-3 directions. Typical fracture of that kind cause then bone moved inward, backward and rotated ;) Generally becasue in this direction face muscles pull the bone when is not fixed. Generally my displacement is minimal but it happend of the cheek which used to be a tiny bit more flat then on the other side (originally). You will see. For sure its not big deformation.. But I think most of us fights with these 4-5mms and by moving this whole bone triggers automatically decompression of infraorbital nerve. Has little Chance it will help, but who knows... this is only slight compression - minimal symptoms. Pelo thinks thath there will be little improvement but rather no 100%....heh but little improvement in my case gives my just 100% of normal function :) I felt that after cortisteroid injection.. Little hope. We will see
PELO WILL PERFORM THIS SURGERY. TOLD ME
PS One girl here - forgot nickname - seen m face. If she notice this post, then he has permission to say something about this ;)
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But if you have bad feeling about Pelo why not consult some alternatives surgeons like Nocini ?
I don't have bad feeling. thet are just neutral. You know this is only talking ;) but I'm kinda impressed
As I wrote in PM to You 2 hours before, Nocini has not responded to my mail which I sent 2 weeks ago. I will wait just one week more.
So what to do if he has not responded . I even asked receptionist a favor to turn his attention into checking spam folder. Sometimes message can go there, but it's rare. I've sent him only 2 messages. One with description of the problem and second request if he received my main message.
No response
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Oh so now You started to see that they may botch my surgery. :) You are telling me now , what I told You before :)
Don't worry I won't call police. You can write whatever You think might be helpful
Decision is only mine.
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When I shave my brows they are visible but not much.
Who do this :) ? I've seen some men with shaved brows only on German gay parade (only on TV) ;)
Yes semi-coronal incision is possible. but jeesuss I prefer to have 2cm mild visible scar than this ;) to be scalped like in indians village ;)
Incision on the eyebrow is necessart to cut the bone there including lateral wall . Whole complex has to bo moblilised. But on the side of eyebrow. He will be able to reach the upper part of the orbital rim...I don't how it is called
(http://2.bp.blogspot.com/-PxQ6pk-EkfA/T4L6tSsneQI/AAAAAAAAAxU/oJ4loqOy2q0/s320/orbitaldermoidinachild3.jpg)
(https://www2.aofoundation.org/AOFileServerSurgery/MyPortalFiles?FilePath=/Surgery/en/_img/surgery/05-RedFix/92/Zygoma/Z30_ORIF-3point_i201_AB_L.gif)
Lobotomy used to be made from the front of the head ;) not of the side
By the way. After incision on the eyebrow i can loose hairs there ?
PS I'm waiting for some pictures pre / post similar to my case. Pelo said that he is gonna send me. We will see. I hope he will do that
How he is skilled we will see after surgery ;) There is no final decision yet. I told him that I'm thinking seriously about surgery with him and I would like to make up my mind within 2 weeks. I asked him about pictures during consultation, but he told me that he couldn't show me - probably he had them on another comp. but he promised to send me. Generally I have only 2 small questions for him and waiting for these pictures. That's all . After that everything will be discussed well
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Now its obvious that Pelo has the best approach from all surgeons that you have consulted. Forget endoscopic approach and others.
Its likely the same approach as in the medical manual that I have posted.
I think You missunderstood their approaches.
The same approach makes I.
All the same, with 2 differences:
P: 50% that augumentation of the orbital floor will be necessary
I: for 100% not necessary
Can't understand why I. told me, that he will just rotate the bone in the opposite way the bone moved after fracture, hence orbital volume won't change, and since the displacement is not big, the existing parts of orbitall wall should be enough to hold all orbital contents in the place. So do not know why P. is a little less sure about this part. Less experience? or Iannetti is too optimistic or P is more safe option. At this point I remind myself about prices differences , hmmm ?????
I had only one consultation for each of them and hard to determine where is the problem - key point. I asked P. again about this issue via mail. As I said I asked him only 2-3 questions ...which developed in my mind after I met I. and also I'm waiting for a few postop photos (examples). I hope he will be my good choice. But I have to wait for last data - information. I will see
P: needs to make incision on the lower eyelid to access orbital floor
I: does not need - he will get access there using endoscope
Both of them are gonna make incision on the side of the eyebrow to get access to upper part of the malar bone
So I think now it's more clear. What do you think ? about these differences
Is it good way to discuss with one surgeon about surgical approaches of the other surgeon ?
I have not acted in this way, but perhaps It is wrong.
Everyone, who reads this, give me some advice please
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thx for info.
I developed numbness of the cheek following a maxilla fracture. Will the sensation return?
Numbness following cheek fractures is relatively common. Cheek fractures often involve the bony channel through which the sensory nerve of the cheek travels. If the nerve is not severed due to trauma, the prognosis for return of sensation is quite good.
This is obvious only for fresh fractures not overlooked - older then 0.5 - 1 year. But generally my nerve is in good condition , and only minor dissfunction, which become better after cortisteroid injections, The chances now are low, but who knows. Only 3-6 months after surgery will show that
so the risk is here that with mobilization the eye can sink in the orbit so Pelo is very cautios to prevent this with bone grafts.
This is the key-point
This is not exactly how you think it is.
Iannetti told me that he will not move the bone horizontically/vertically, he just will only rotate it, without changing orbital volume. He emphasised, that this is crucial thing and needs great experience to not move the bone in wrong way.... I have not got dipoplia after fracture because the displacement of the bone was not big. It mailny only rotated but has not moved vertically / horrizontically.
Generally I think Pello is better option for me. but now I have to wait. I sent him info, that if he does not feel comfortabl with showing me those photos via mail I can meet with him again. OK I will write here again If i'm gonna have surgery / or will be after (I hope)
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You dont mentioned that Ianetti will only rotate not move your zygoma-complex.....
Why you say this not before.....it seems that Ianetti had a lot of experience in this field..
I said.. but You did not read carefully.... but the rest on PM
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Interesting... and in english
http://vimeo.com/101076866
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what is the best italian maxfac for lowering maxilla?? should i go with pelo or raffaini??
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Interesting... and in english
http://vimeo.com/101076866
. . . when this thread was bumped, I noticed this older post. Kind of neat stuff. From that presentation, it appears those surgeons formally trained in craniofacial surgery are pretty much at the top of the pyramid in state of the art surgical skills involving the face and head structure. It looks like most or all of the craniofacial surgeons came out of formal plastic surgery programs (see the slide from the presentation referencing Arnaud and Marchac, for example). A very few of the craniofacial /plastic surgeons also have training in orthognathic surgery. That same distraction technique described in the video for craniofacial skull and face movements is also used for some jaw movements. Would that technique automatically avoid or limit the risk of instability when large moves are needed in the mandible?
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and i didn't choose him. I'm a dork :/ and chose wrong surgeon