jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: FaceDay on September 21, 2014, 03:28:28 PM
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Asking for professional opinions seems worse than random selection, since orthos for example will just recommend the surgeon they have the best business relationship with. Online research will find the worst surgeons with the most tech savvy since most surgeons have terrible online presence to begin with, and the ones that advertise tend to be the ones that need to. Lastly, reviews and forums are a little help, but they are skewed by echo chamber effect and being a very very small and biased subset of people who get surgery.
So, is there actually any intelligent way to select a surgeon? Is it all just down to luck and location?
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If anyone here knew that then we wouldn't be here. ;D
The best option, although much more expensive, is to consult with as many surgeons and possible so you get a good idea of what is possible. I think the surgical ability is pretty similar when it comes to most surgeons so if you can get a surgeon who has a good surgery plan for you then you should be okay. Determining what makes a good or bad surgery plan is not easy though but you definitely decrease the risk of getting a bad one by consulting with as many different surgeons as possible and also by sharing the surgery plan on a forum like this one so that other people can give you their input.
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I was super lucky....talking about requiring jaw surgery at my sons school yard and one if the mums had done journalism work with my surgeon and she thought he was brilliant. I made a cold call to meet with him, thought he was great.
I picked the closest orthodontist to my house and they advised they use two surgeons (one was mine!) quite a fluke that the whole thing fell together!!
Often there are only a selected number who perform certain surgeries and word of mouth travels fast. My orthodontist also had a 'list' of ones they DONT recommend.
If you have a very highly regarded Ortho they will generally use highly regarded surgeons, as they need to work together to make your results work.
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Asking for professional opinions seems worse than random selection, since orthos for example will just recommend the surgeon they have the best business relationship with. Online research will find the worst surgeons with the most tech savvy since most surgeons have terrible online presence to begin with, and the ones that advertise tend to be the ones that need to. Lastly, reviews and forums are a little help, but they are skewed by echo chamber effect and being a very very small and biased subset of people who get surgery.
So, is there actually any intelligent way to select a surgeon? Is it all just down to luck and location?
I would say it's about first of all determining what you are looking to achieve. Different surgeons are better at different things.
Look at their papers, what is published, the quality of said papers, quality of photos.
See what their reputation is amongst other surgeons. So when you consult surgeon X, ask what he thinks about surgeon Y. Most will give a pretty honest opinion.
Find other online testimonials and results if possible.
At the end of the day you're always taking a chance and even the best surgeon doesn't have a 100% satisfaction rate. So with that in mind also find out about their attitude towards revisions. Some will do it for free, for cheaper, and others will become complete assholes.
Edit: I will also say that in a lot of ways things are made complicated by the fact that so few results of any surgeon are online. I guess because maxfac isn't too common a procedure and most are, as the person above says, referred to them by their ortho. They have the work done and never think about it again. On some level I think most surgeons will do a fine just as long as they demonstrate a willingness to achieve a good aesthetic result and aren't just solely focused on functionality.
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It's very simple. When I had my surgery consults I was given a http://www.aaoms.org brochure. It explained underbite, overbite, gummy smile surgery. Every before and after was the world of Richard Joseph.
http://drrichardjoseph.com/jaw-surgery/
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i suppose it’s down to a combination of research, going to at least a few consults and sharing those plans here, as Gregor said.
...Determining what makes a good or bad surgery plan is not easy though but you definitely decrease the risk of getting a bad one by consulting with as many different surgeons as possible and also by sharing the surgery plan on a forum like this one so that other people can give you their input.
Gregor, you were saying to me that Paul Johnson - the guy in Guildford, England - doesn’t do a surgery plan in the consult. :-\ is that common enough or is he an exception? also, with surgeons that do give you a surgery plan how detailed do they tend to be? ???
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See what their reputation is amongst other surgeons. So when you consult surgeon X, ask what he thinks about surgeon Y. Most will give a pretty honest opinion.
I'm not sure how useful that is. There seem to be a rather large discrepancy between what surgeons think of each other and what the patients think. Take Mommaerts for example: He seemed to be highly regarded amongst other surgeons since he does a lot of research, speaks at conferences often and is even the president of various organizations. My orthodontist knew who he was and said that he had a great reputation. Meanwhile he is probably the most criticized surgeon when it comes to what his patients think. Similarly, some of the surgeons who are considered amongst patients or forum communities to be the best in the world are actually heavily criticized by other surgeons (I'm not going to go into detail on that one). Having a surgeon tell you that he has had to redo a lot of botched cases from a certain other surgeon is rather damning though.
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is there a clash between patients and surgeons because we tend to be more aesthetically minded whereas surgeons are more (too) focused on functional problems?
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Gregor, you were saying to me that Paul Johnson - the guy in Guildford, England - doesn’t do a surgery plan in the consult. :-\ is that common enough or is he an exception? also, with surgeons that do give you a surgery plan how detailed do they tend to be? ???
Paul Johnson was supposed to send me a surgery plan but instead I got a letter from him that informed me that he didn't recommend surgery since he didn't believe it was possible to achieve enough improvement. Other people on this forum have consulted with him without receiving a surgery plan but I can't say what his standard praxis is when it comes to this. Ultimately, I don't think the consultation with him was worth it since nothing came out of it and it was pretty expensive. I'd still go with him in a heartbeat if he offered me a surgery that makes sense though.
In general, I'd say most surgeons won't give you a detailed surgery plan after the first visit and they probably need to see study models of your teeth in order to come up with a proper plan. Say what you will about Arnett and Gunson but they will at least listen to you for several hours if needed and they do give you a detailed surgery plan from what I've read. Sandro Pelo is also like that but when you pay 300 euro (500 dollars for Arnett and Gunson) for a consultation I damn well expect something in return. A consultation with Triaca for example is 500 euro and I have no idea what you get for all that money. If he's like Schendel or Mommaerts who will listen to you for 5-15 min without barely giving you any feedback then it would be a complete waste of time and money IMO.
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is there a clash between patients and surgeons because we tend to be more aesthetically minded whereas surgeons are more (too) focused on functional problems?
The vast majority of surgeons only care about the functional aspect. This is probably the most important thing that sets the "top" surgeons apart from the surgeon at your local hospital. Very few surgeons will even consider surgery if your bite is functional even if the aesthetics are off by a large margin. I would even say that some orthdontist and surgeons will go so far that they'll even make you look worse just to improve the bite in the easiest way possible. There have been many stories on this forum about needless extractions at a young age that has led to disastrous results down the road.
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so, Paul Johnson must be one of the very best then. doing the surgery plan a bit further down the road when they've got models and done a bit more research makes sense. however, as you've started the process with them by that stage what happens if you don't like the plan they come up with. i know they can't force you to go any further but financially how much of the cost can you recoup if you back out? or do most surgeons take payments in installments?
what you're saying about Arnett and Gunson sounds ideal. i want time in a consultation to explain my concerns and not be hurried out the door.
it's shocking that surgeons don't give more regard to aesthetics when they're working on something as important as a person's face. :-\
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You usually don't pay anything to the surgeon until you're close to the surgery but it could vary from surgeon to surgeon. The surgeon will instruct your orthodontist how to move the teeth though so if the surgery plan is not adequate then you could just be wasting your time and money on the orthodontic process or even worse, do something that is directly opposite of what you actually needed to have done in order to get the best result. I didn't know what the final surgery plan was until one week before the surgery and in some cases the surgeon will even change his mind once the surgery is underway (that actually happened to someone on this forum with a disastrous outcome).
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Paul Johnson was supposed to send me a surgery plan but instead I got a letter from him that informed me that he didn't recommend surgery since he didn't believe it was possible to achieve enough improvement. Other people on this forum have consulted with him without receiving a surgery plan but I can't say what his standard praxis is when it comes to this. Ultimately, I don't think the consultation with him was worth it since nothing came out of it and it was pretty expensive. I'd still go with him in a heartbeat if he offered me a surgery that makes sense though.
In general, I'd say most surgeons won't give you a detailed surgery plan after the first visit and they probably need to see study models of your teeth in order to come up with a proper plan. Say what you will about Arnett and Gunson but they will at least listen to you for several hours if needed and they do give you a detailed surgery plan from what I've read. Sandro Pelo is also like that but when you pay 300 euro (500 dollars for Arnett and Gunson) for a consultation I damn well expect something in return. A consultation with Triaca for example is 500 euro and I have no idea what you get for all that money. If he's like Schendel or Mommaerts who will listen to you for 5-15 min without barely giving you any feedback then it would be a complete waste of time and money IMO.
I sent this in private but I might as well rehash it here for those who're interested. It's not my intention to be a surgeon shill.
I didn't have to pay for any of my consults with Dr Triaca oddly enough - though I could be the exception and not the rule. Who knows?
During my consult I was given a couple hours to have scans done, photos taken, occlusion looked at, and then discuss everything in great detail. He sat down with me and let me go ask all the questions I wanted, showed me things on models, and discussed some of my options in terms of an aesthetic outcome based on some simulations. He also took lots of notes and asked me to come back again to think everything over and go through a surgical plan one final time. It didn't feel at all rushed.
Truthfully I couldn't have asked for much more.
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^ And he didn't charge you a penny?
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^ And he didn't charge you a penny?
Nope :o
Edit: Granted I had already deposited money for the operation, even if it wasn't 100% locked in. So it wouldn't have made much sense to charge me for the consult and work-up
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Nope :o
Edit: Granted I had already deposited money for the operation, even if it wasn't 100% locked in. So it wouldn't have made much sense to charge me for the consult and work-up
Don't be surprised if you get billed for that after your surgery. That's what happened to me with Mommaerts. I was actually billed around 1700 euro for the pre-op consultation (wtf).
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Don't be surprised if you get billed for that after your surgery. That's what happened to me with Mommaerts. I was actually billed around 1700 euro for the pre-op consultation (wtf).
What crap! Did you dispute it?
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What crap! Did you dispute it?
Yeah but they just kept sending new bills for random crap.
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Yeah but they just kept sending new bills for random crap.
Was this before or after you said the result wasn't good enough?
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Was this before or after you said the result wasn't good enough?
That's just standard praxis over there. They sent Modigliani a bill that was less than what the postage stamp is worth. ;D
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That's just standard praxis over there. They sent Modigliani a bill that was less than what the postage stamp is worth. ;D
LOL
Are there pics of it somewhere?
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You usually don't pay anything to the surgeon until you're close to the surgery but it could vary from surgeon to surgeon. The surgeon will instruct your orthodontist how to move the teeth though so if the surgery plan is not adequate then you could just be wasting your time and money on the orthodontic process or even worse, do something that is directly opposite of what you actually needed to have done in order to get the best result. I didn't know what the final surgery plan was until one week before the surgery and in some cases the surgeon will even change his mind once the surgery is underway (that actually happened to someone on this forum with a disastrous outcome).
i wonder would an orthodontist ever camouflage a jaw misalignment if the patient decided to back out of jaw surgery. sort of reverse what they'd previously done. say if the surgeon had instructed the orthodontist to decompensate the bite prior to surgery but the patient then felt they couldn't go through with the operation. would the ortho put the teeth back into their original alignment, or something close to it?
During my consult I was given a couple hours to have scans done, photos taken, occlusion looked at, and then discuss everything in great detail. He sat down with me and let me go ask all the questions I wanted, showed me things on models, and discussed some of my options in terms of an aesthetic outcome based on some simulations. He also took lots of notes and asked me to come back again to think everything over and go through a surgical plan one final time. It didn't feel at all rushed.
That sounds like a superb approach. I would be quite happy to fork out good money for a consult like that. what is the software/programme they use for doing simulations of potential outcomes?
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Keep in mind that those simulations are far from accurate and many surgeons don't use them for that reason since it just leads to false expectations. I've even seen many cases where the patient ended up looking better than the simulation so it goes both ways.
If you're at the point where you've had full decompensation them you might as well go through with the surgery and I doubt the orthodontist would recommend anything else.
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are simulations often off the mark because, as someone was saying in another thread, the soft tissue response is a bit of a lottery? ??? this is where i find the process quite daunting as what your appearance will turn out like is a bit of an exercise in ‘hit and hope’, if you know what i mean. sure, i’d love to have my bite fixed but i’m somewhat afraid of the effect it will have on how i look. i mean, part of the motivation for doing this is to improve my appearance but i’m terrified things could end up worse. :(
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Most people do end up improved though, even if it's not as much as they hoped.
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I think the biggest difficulty is that you can't really see all of a surgeon's work. At least in the U.S. patient privacy is such that any surgical patient will get a form beforehand asking if they consent for their photos, models, and case info to be viewable by others. I imagine most people sign NO on that form. To even get a patient to sign YES the surgeon usually has to provide a free or reduced price surgery, so any case that the public gets to see was a teaching experiment or was handpicked to showcase something positive.
There are a lot of good, talented surgeons who have no public record of their work because they only do normal, paying patients...that's where word of mouth comes into play...but it's still so hard to make an accurate assessment.
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On a related note I think the patient woman used in the Arnett/Gunson YouTube videos is terribly asymmetrical. I guess her main concern was opening up her airway so maybe they didn't even correct for that, but still. You'd think that isn't the face you want on 5 press videos. But maybe that's the only person they could get to do it.
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I find that there are two types of oral & maxillofacial surgeons in terms of qualifications.
Either they are predominately dentally trained and registered, or, they are predominantly medically trained and registered.
I only work with medically trained oral & maxillofacial surgeons, as they have a wide training base, and are most able and trained in all facets of surgery. "Dental" Oral & Maxillofacial surgeons tend to be very limited in the scope of their work & have a poor wider understanding of medical, radiological and generally of wider surgical care.
I know the dentists say they were trained in medicine as part of their surgery training... But so are hospital nurses. No medical doctor or medical oral & maxillas facial surgeon would claim equivalence with anti e who's basic training is in dentistry alone.
However, I also look for Oral & Maxillofacial Surgeons who have a wide and demonstrable experience of orthognathic (jaw correction) surgery. I look for expertise in basic operations, as well as experience in a wide range of operations... Just so I know that not all patients are offered one operation type because that is the limit of their training or experience.
What I mean to say is that there are many kinds of operations, and real expertise comes with knowing all of them, and maybe even using them all for treating one condition.
For instance a person might have a chin point 3cm short of ideal. A BSSO can only safely advance to 10mm, but some try 12 or 15mm only to have it "come back". A better surgeon would offer jaw distraction, of say 15mm, then later a BSSO advancement (whilst also advancing the upper jaw) of 10mm, then offer a genioplasty (chin) advancement of a stable 5 or so millimeters. That means the patient achieves an ideal overall distance of lower facial advancement, gets a perfect bite, gets a maximally open airway (so they never snore), and they have an ideal jaw line.
These surgeons are rare though.
You should always look for examples of their work... And don't accept cartoons, or maybe case presentations from books to explain process. Look for real proof that the surgeon is capable of excellent results, by using examples of their own real patients.
Remember that surgery is also an art. You wouldn't expect just any painter to have the eye of DaVinci.
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A BSSO can only safely advance to 10mm, but some try 12 or 15mm only to have it "come back".
Can you explain why this is?
What would you consider the maximum safe advancement for a lefort I or high lefort I in an adult patient.
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Can I explain why 10mm is a stable BSSO advancement? It's a predictability thing.
Let's say 20mm (which is impossible to achieve due to tissue stretch) is 100% unstable.
Unstable means it moves more than 1mm... Which is a large distance to a tooth.
5mm is very stable and would have 99% stability...
Between 5mm and 20mm is a scale of chance of instability... Between 1% and 100% chance that there is 1mm of movement.
The distances are even less for a LeFort advancement. And the maximum advancement distance for a maxilla is 12mm. But the risks are quite large. And the instability chance approaches 50% after 5mm.
Move the TV away from the wall too far... And you pull the socket out
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What about other complications of BSSO? like condylar resorption? TMJ problems?
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Yeah there are those complications... But they are likely pressure induced... Or induced by too much IMF... The there is the legitimate chance of rheumatoid arthritis
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Sorry, if I'm misunderstanding, but how could jaw surgery cause rheumatoid arthritis? Did you mean osteoarthritis?
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Osteoarthritis does not cause condylar resorption.
Active destructive joint disease causes active reduction of condylar cartilage and bone.
Rheumatoid arthritis is just one disease from a range of destructive arthropathies.
Osteoarthritis is a long term, slowly adaptive loss of joint surface from the wear and tear of livings long life.
Again... Dentists are not doctors. Rheumatologists do medicine, physician training and then sub specialist in rheumatology and immunology, and pharmacology.
Getting insight from a dentist on orthodontist on joint disease is like asking a chiropractor to tell you how doctors think.
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Osteoarthritis does not cause condylar resorption.
Active destructive joint disease causes active reduction of condylar cartilage and bone.
Rheumatoid arthritis is just one disease from a range of destructive arthropathies.
Osteoarthritis is a long term, slowly adaptive loss of joint surface from the wear and tear of livings long life.
Again... Dentists are not doctors. Rheumatologists do medicine, physician training and then sub specialist in rheumatology and immunology, and pharmacology.
Getting insight from a dentist on orthodontist on joint disease is like asking a chiropractor to tell you how doctors think.
I'm unclear on this. RA is a systemic autoimmune disorder, often with a genetic predisposition. Am I missing something?
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I sent this in private but I might as well rehash it here for those who're interested. It's not my intention to be a surgeon shill.
I didn't have to pay for any of my consults with Dr Triaca oddly enough - though I could be the exception and not the rule. Who knows?
During my consult I was given a couple hours to have scans done, photos taken, occlusion looked at, and then discuss everything in great detail. He sat down with me and let me go ask all the questions I wanted, showed me things on models, and discussed some of my options in terms of an aesthetic outcome based on some simulations. He also took lots of notes and asked me to come back again to think everything over and go through a surgical plan one final time. It didn't feel at all rushed.
Truthfully I couldn't have asked for much more.
Mommaerts listened me for 1h 15m for 80 Euros, However there was a big problem when I realised 3 weeks before surgery that we had little missunderstanding in surgical plan and I asked about rebooking surgery because I needed one more consultation. I even propose his department to move another patient on my surgery date/time. For sure the could have found someone from the queue who wanted to have surgery earlier. But not. He told me that I have to pay whole amonut of money and we will talk about my doubt just before surgery. I got high anxiety because of that . You know one doubt about surgery and also what will happen with my money If I cancel my surgery. They put me in the stressful situation and I did not know what to do... they just canceled my surgery and they "banned me" - no surgery in future for me in his Clinic. I wanted good, but they acted strange. Patient should have some support in that situations. You have doubts too late, pay now, we will see... it doesnt work in that way.
However one thing, I was driving to him 10 hours by a car. and to his private Clinic. Generally everything looked great. I had very good conversation with him. He understood me. But there was problem when I started to have only one small doubt and asked him about preparing another surgical approach/plan. (the plan wasn't nothing special - only how to cut my malar bone, in which place, thats all. His surgical approach could destroyed my small zygomatic nerve at high probability, which i wanted to avoid) Then everything has changed.
Something inside me told "You can't go there having doubts, and do not pay, before everything will be discussed well"
I wanted to stay with him..I just wanted him to give me more time and talk about another solution. But his department didn't give me a choice.
I think Mommaerts is good surgeon. He operate a lot of people, so he may has more botched cases..some even very. However he could be more patient for the patients :) There is no surgeon without fails. The question is, that, is he very good . Some say, not.
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xdon82, I am in contact with yet another Mommaerts victim, he will tell his story here soon when he feels a little stronger. You must put all thoughts of M out of your mind now and move on, his clinic has 'banned' you, be grateful.
I realise that none of that helps you find another surgeon though :D
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xdon82, I am in contact with yet another Mommaerts victim, he will tell his story here soon when he feels a little stronger. You must put all thoughts of M out of your mind now and move on, his clinic has 'banned' you, be grateful.
I realise that none of that helps you find another surgeon though :D
Hmm I wonder what MM done wrong in his case....
You are so wrong Modigliani ;D why you talks such rubbish..
about what exactly?
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That strikes me as a strange statement as well. I visited a few world class surgeons and heard 13mm-15mm several times without DO. They all seem to be using grafts now, though, so perhaps that's why. In any case, this topic is particularly relevant for me now. I did a tour and got opinions from a few top surgeons. People in town are giving me a lot of flack about it. One orthodontist refused to work with me even. I brought it up on Reddit and all the dentists there said I was nuts. I wouldn't say local recommendations are random but random within a small group.
I was going to use the world class guy who's only a few hours driving time away. His plan looks very similar to what a well regarded local guy suggests so after my last ortho visit, I thought maybe I'd stay local and save a lot of money. I'm so confused. What should I do? At least this ortho said he'll work with anyone I pick.
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molestrip: You are from the USA ?
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My surgeon has a good rep from other high-profile medical professionals, even those not in the dental and max fac field. One other max fac told me that he's one of the few not in it for the money. He does a massive amount of craniofacial operations on kids as well. Travels to 3rd world countries to do them for charity. Charges less than others. The downside of this could be that his aesthetic sense maybe somewhat skewed from treating the horribly deformed. Oh well.