jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Rico on March 16, 2015, 11:25:14 AM
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In Italy one clinic use kinda hydroxyapatite based substance which changes into your own bone with the time.
They just make for example malar graft and cover it with this substance,, and you have "wider bone" (your own) in this place after some time.
What you think about it ? Have you heard about it ?
in Europe only this clinic use it, perhaps one other more. it's rare solution (as I suppossed)
I saw examples and was impressed. and this procedure is much less risky than osteotomy
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hmm I'm little confused now. because some say that this is common solution, but I first time hear that such implant from hydroxyapatite is going to change into bone
there is no link... I just had consultation ... find Prof Nocini (and his team) researches , etc ..
now I wonder if hydroxyapatite can be used in many ways ...
those who has HA paste or something like that.. is that changed into your bone ?
anyone know what is going here in this topic ?
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I started to see the difference
http://www.dermnetnz.org/procedures/hydroxyapatite.html
"Over time they are partially resorbed and replaced by natural bone." I wonder what does it mean "partially" ..
so in summary, HA paste and HA solid implant are not the same things. Did you know that ?
any surgeon has given you such option
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This is actually "invented " by a doc in Australia, I believe. He uses this mainly for the orbital rim, cheek and chin areas. I know two females that got this done by him and the results are alright. To remove this stuff will be hassle because no one in the states likes to or wants to remove it but the Aussie doc states it's fairly easy to scoop out- so I guess that's what it means by "partially"?
As far as reabsorption goes, I think it gives subtle changes. I suppose if that's the change that you want- give it a try.
If he's the person I think he is, then he's full of s**t, and just reinvented the HA paste wheel. (No need to mention his name, this site does not need lawsuits). HA paste is a bad idea. It's been around for a long long time. There is a reason why nobody uses it.
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Plosko we do not talk about HA paste, but HA SOLID implants. The link I gave is just random text...has nothing to do with the surgeon I talked.
what I understand this implant become integrated with bone...and Hydroxiapatite is natural component of the bone..so after some time many molecues become typical bone molecules.. Don't forget that in bones there are kinda vessels - the blood must reach bone particulars
We have to find some better information about this. because paste is like filler - no changing into bone accour even partially
the solid structure of HA is little different thing
27F can you show some interesting informatino about this. I need any text where all issues with HA solid implants (not paste) is well explained inluding adventages and disadvantages
The Doctor told me that there is not absorption in the meaning the implant is getting removed from the body, but it's just gonna change into bone... do not how how much true is this...probably he did not tell me all adventages and disadvantages
Plosko: which guy you meant ?
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show me some frigging pictures. What are you saying RICO? That they have hard HA paste implants? Which ones does this place use? Okay let us know! find pics.
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it;s not a paste. it's implant made from hydroxyapatite - you have it in bones... your bone is paste :) ? paste is also made from HA but it's not the same...
like cement with water or without - different thing.
i do not also know enough much.
I put the topic and lets try find out what is going on
forget about paste
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interesting...but why to remove this ?
for example the surgeons I spoke to, told me they perform this in 2 steps
1) put filler (I forgot which type) into skin, to let the body create additional collagen in this region of skin .at the same time patient and surgeon is able to see how all of this will look like. Making first step they are able to predict the outcome of the second step. If something is not enough right, then it is easy to make some corrections at this step.
2) ... then, after 6-12months the filler is no longer in the skin, and they put this HA implant prepared in 3D modelling (based on the data from CT for 3D modelling and the first step)
and I was told, this is gonna change into bone forever...
so I try to find out how true is this and how it can be useful for me
I always have to keep in mind that every surgeons team wants to push their method, saying that another is worse etc... you know still marketing and cash... new patients = new researh object :D
that's all. On the examples it looks quite OK, like it is very good option for mild corrections. but you know ...no surgeon will show you bad results :)
They claim this procedure is much more safe for the nerves - again true or not.. they always can hit the nerve by nidle
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This is not rather the solution i;m gonna choose. but I want to be sure if I should forget about t
since the consultation was short.. and I got permission to ask questions via mails after face-to-face consultation I will ask again what kind of material exactly it is
I need malar bone reposition -whole (osteotomy) or to put big implant there - on the whole zygomatic bone....whole malar bone - almost from the nose to zygomatic arch and from orbital rim down almost to the teeth. i's really relatively huge area I would say 1/5 of the face
Well, I'm gonna to ask the surgeon some questions about this "s**t" :) please write me what to ask him. That would be helpful. Please tell me about all issues you know - generally You mentioned some, but all of you can help me little with this. The good thing is I will get feedback which I can share with you
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27F you said that previous augumentation made it worse, so you want another one ?
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HA paste doesn't turn into bone. Bone grows into it to keep it in place. Sometimes it can replace it, if the augmentation is small. Since it's porous it becomes vascular, both a good and a bad thing. That means infection is less likely but, on the flip side, it's difficult to impossible to remove. I'd imagine very bloody and what if a nerve grew through it? They'll migrate with the bone underneath and who knows how they resorb. earl25 had some from A/G, one resorbed and one calcified. It's not living tissue so if it breaks it won't heal. All in all, I'd say it's a pretty good product for some things but it's not good as new.
One thing I'm wondering is, we have a technology for growing bone already: BMPs. Why aren't they used here? We can also grow bone in vitro now using the same technology (see epibone.com for example). I don't see any reason why we couldn't etch the bone into the right shape using 3d scans to make a perfect implant. There's a company Dr Schendel founded that does 3d simulations so identifying that implant via simulation should be possible. Someone just needs to put all the pieces together and refine them to make a real product out of it. Were someone sufficiently motivated, I'd expect it could be done in 5-10 years.
That being said, most of us don't need implants or augmentations. They're approximations of what we really need, a larger movement. That's harder to see becoming a reality. Less invasive surgical techniques are needed and more practice by more surgeons.
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but surgery means 2 options - solid implant - like HA (not paste)
or osteotomy ?
which option are you gonna to choose ?
Can you describe me, why sometimes putting filler before solid implant is good thing ? I know a little from surgeon as I wrote before, but you are longer in this topic...so perhaps you can tell me little more about the issues connected with that
about examples. I saw several. It was OK. Good work. Mostly some patients who wanted to repair his recessed midface. I did not ask about the worst case. Generally I had only 30 minutes ..including 10 minutes during which they examining my and my scans. it's too less
about this mask looking.. you talked about filler or solid implant? because I won't have filler. the filler is only initial phase of the whole procedure, the main is to put HA which mostly is gonna change into my own bone (I was told that)
in contrast I had already two 1hour consultations with the one surgeon I consider (osteotomy option)
I know from my 1.5year experience ,that one consultation (with the same surgoen) is always not enough, 2 consulattions in most cases is enough
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Purpose of putting filler first is to see if you like it before undergoing something more permanent. I don't like the fillers but then again, I don't like surgery either. The only way I could justify it is to protect the lower eyelid from age related problems and even then, I'd say you could do it with benefit up to late 40s so you probably have some time for technology to improve. Tissue engineering should make great, great strides in the next 1-2 decades.
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The only way I could justify it is to protect the lower eyelid from age related problems
Molestrip, what kind of problems you meant ? Tell me more about this lower eyelid issue
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Skin sags as we age and eyelids aren't immune. How quickly it sags is a function of how much support is underneath. People with deficient cheekbones and orbital rims have less support underneath so the eyelid sags more quickly. At first it's mostly aesthetic, as more white shows but it also causes more dryness. Later the eyelids might stop closing or even prolapse. I hear it's easy to fix with surgery but I suspect prevention is better.
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What about something like Bio Oss? I talked to Norman van der Dussen about this via email, because I have a volume deficiency in my suborbital rim area, and he suggested that as one of the options besides implants. But it seems nobody uses it...
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My malar bone (whole) has to be moved about 4mm ...somehow 2-3mm forward and 2-3mm outside to get original cheek prominence before fracture - so is it big augumentation or not ?
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just to picture it take a look into link. I have almost the same level (in the same way. small zygomatic displacement are always almost the same) of flattened face after fracture (not treated). Perhaps in my case is little less obvious. This guy perhaps have 5mm bone displacement max 6, for sure no more.
ALL surgeons tell me that 4mm is only minimal displacement (from skeletal point of view), but meybe for augumentation (implants) it's not so minimal. I do not know...
http://www.exploreplasticsurgery.com/wp-content/uploads/2013/07/Zygomatic-Osteotomy-Reconstruction-postop-Dr-Barry-Eppley-Indianapolis.jpg
so I have 2 options:
1) osteotomy - 2 surgeons has identical plan and say the risk is low
2) or as claim other surgeon better to put HA implant which as he belive is much less risky than osteotomy. It's supposed to be less risky for the nerves.
I saw examples only on the computer. I told the surgeon that I do not want to have fluffy , too softy cheek, I just want to feel hard bone like on the healthy side...and he told me this implant is gonna to change into bone.. that's all
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nope, it's only a good example of my problem on the net. I'm not going to do anything outside the Europe.
Most surgeons tell me that osteotomy in my case is quite simple and not very risky.
but there are also the ones who tell me that it's much more less risky to do it not cutting the bone
I wonder who is too optimistic and who has not not enough skills
do you have any experience with comparing / judging osteotomy vs implants surgical plans ?
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interesting...but why to remove this ?
for example the surgeons I spoke to, told me they perform this in 2 steps
1) put filler (I forgot which type) into skin, to let the body create additional collagen in this region of skin .at the same time patient and surgeon is able to see how all of this will look like. Making first step they are able to predict the outcome of the second step. If something is not enough right, then it is easy to make some corrections at this step.
2) ... then, after 6-12months the filler is no longer in the skin, and they put this HA implant prepared in 3D modelling (based on the data from CT for 3D modelling and the first step)
and I was told, this is gonna change into bone forever...
so I try to find out how true is this and how it can be useful for me
I always have to keep in mind that every surgeons team wants to push their method, saying that another is worse etc... you know still marketing and cash... new patients = new researh object :D
that's all. On the examples it looks quite OK, like it is very good option for mild corrections. but you know ...no surgeon will show you bad results :)
They claim this procedure is much more safe for the nerves - again true or not.. they always can hit the nerve by nidle
wow that sounds great to me. I mean this could totally improve your orbital rim or cheekbones or even jawline. But is it real? Have they shown you any results?
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What about something like Bio Oss? I talked to Norman van der Dussen about this via email, because I have a volume deficiency in my suborbital rim area, and he suggested that as one of the options besides implants. But it seems nobody uses it...
Unlike HA paste, bio-oss grows into your bone. It's bovine bone derived bone substitute and this is what it's meant for - building up implant sites when there is not enough bone there. And by implants I mean teeth.
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I personally don't want implants or pastes for my orbital rims, cheeks, etc. (with the exception of the forhead) because I've read that over time it can naturally wear your actual bone down and when I presented the question to a few surgeons, they hesitantly said that would be the case and quickly directed me to fillers... whomp whomp whomp....
I've got doctors and dentists in the family and they see a lot of the problems that surgery causes down the road and have been warning me against unnecessary work. They're not too thrilled about jaw surgery either but it's gotten to the point that it NEEDS to happen. A lot of solutions on the market look good to me already but I also know that there's limits to what we can test for so I'm on the fence with them. Some day this stuff will all be routine and we'll have procedures with decades of data and thousands of patients behind them but that's not for us, except for jaw surgery (yay!). Most of us have a few decades still to correct our problems but that's only an option if other surgeries don't preclude those solutions later.
I'm leaning toward a philosophy of fix anything which otherwise would cause a functional problem. Jaw surgery is definitely in. Cheek and orbital rim implants could be in for some but maybe not urgently. And if aesthetics are bad enough to affect mental health or cause problems interacting in daily life, I would include it as well. Whole picture matters too. If you've got your hair, good skin, and you're skinny, then a few unaesthetic features could be ok otherwise you gotta fix what you can. /rant
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I've got doctors and dentists in the family and they see a lot of the problems that surgery causes down the road and have been warning me against unnecessary work. They're not too thrilled about jaw surgery either but it's gotten to the point that it NEEDS to happen. A lot of solutions on the market look good to me already but I also know that there's limits to what we can test for so I'm on the fence with them. Some day this stuff will all be routine and we'll have procedures with decades of data and thousands of patients behind them but that's not for us, except for jaw surgery (yay!). Most of us have a few decades still to correct our problems but that's only an option if other surgeries don't preclude those solutions later.
I'm leaning toward a philosophy of fix anything which otherwise would cause a functional problem. Jaw surgery is definitely in. Cheek and orbital rim implants could be in for some but maybe not urgently. And if aesthetics are bad enough to affect mental health or cause problems interacting in daily life, I would include it as well. Whole picture matters too. If you've got your hair, good skin, and you're skinny, then a few unaesthetic features could be ok otherwise you gotta fix what you can. /rant
Can you expand on the kind of problems they've seen?
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The radiologist specifically mentioned chronic osteomyelitis and foreign body reactions from implants slowly breaking down. I know from personal experience about nerve problems. I developed allodynia in my left calf from a varicocele repair, as strange as that sounds, and I'm suspicious about some auto-antibodies that appeared shortly later too (fortunately, they went away). I've heard of a few cases of people losing sense of taste from jaw surgery. Twitching muscles happens sometimes, I have that anyway. Loss of sensation is common as we know but mostly people tolerate that well. We've seen cases of nerve compression here. Migration, relapse, asymmetry, fibrous unions, resorption, scar tissue, necrosis, lip incompetence, joint damage, and infection are other possibilities. "Resorption" sounds like code for "it disappears but who knows where to". That's what we can anticipate. I could come up with another dozen probably but then I'd be catastrophizing :P I'll probably edit this later as it's not good to scare other people with far fetched scenarios (where's my erase button?) but just wanted to answer your question.
FWIW, I think the risks are mostly theoretical as long as you don't make a habit of cosmetic surgeries, just you only get one life so all things being equal, less is better. A surgeon said to me "at your age, we don't really worry about problems" and he's on the ball. The biggest risk in practice is that you get the wrong surgery done and don't like the results, now or at some point later. Odds of disease in general are substantially higher. 20% of people will develop chronic illness at some point in their lives.
In retrospect, I never should have had kids but I'll count my blessings that they're all normal, healthy, and thriving :)
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#YOLO
I'd take my chances. Good looking > Ugly...
Unfortunately moron there's little to suggest jaw surgery will make you good looking. And all the problems molestrip listed --many of those tons of jaw patients deal with, they just don't talk about it on forums too much cause there's nothing they can do. This surgery is still at a highly primitive stage. It only started to be performed really in the 70s with any degree of confidence.
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It's true. However, on the other hand, I talked to many patients who has nothing damaged after such surgery (full recovery)
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@Rico It's true, most patients come out well. The real gamble is over time, no one can predict. Not saying work is problematic but its easier to stomach when you're older because you have more to gain and less risk in time.
The law of diminishing returns applies. Prioritize the items you want to fix and hit the low hanging fruit.
@27F Nevermind Lazlo. That's just the way he is :) He means well. He's right, though, plastic surgery is relatively young. It's a fair risk for you to take, just keep in mind that you may not understand the risk you're taking.
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OK I'm gonna to write some questions to the surgeon who offered me HA implant (which as he claims should change into my own bone)
However perhaps You are able to tell me, why he wants to cover more area with this implant . I mean, look at the following picture:
http://i.imgur.com/IrRg2Gf.jpg
The red lines show the lines of old fracture. Between red line and the nose and near the teeth there was no fracture, nothing has changed and I do not see any particular assymetry comparing to healthy side.
The green line shows the area he wants to cover - is much bigger then the recessed area due to old fracture. The whole malar bone moved about 2-3 mm back ( you see this on the second picture) and 2-3mm inward - not clearly at this to examples, but doesnt matter
He told me he wants to cover more area, to avoid strange looking after he put HA, but why not to put HA implant in such way it won't looking strange
Any ideas ?
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OK I'm gonna to write some questions to the surgeon who offered me HA implant (which as he claims should change into my own bone)
However perhaps You are able to tell me, why he wants to cover more area with this implant . I mean, look at the following picture:
http://i.imgur.com/IrRg2Gf.jpg
Rico,
What kind of scan is that?
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it is Volume Render of my CT - in quite good program, not as good as Osyrix ( available only on Mac ), but as you see not bad
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So if I've had an i-cat done, they can generate one of those from the data?
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Should be dedicated DICOM files for volume render.
The most simple is to try to render in the program. Application can detect if rendering is possible or not
Osyrix or Intage Realia, eventually others
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Don't forget to keep us updated guy,I'm looking forward to know more about the potential of this procedure ;)
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so, noone knows why the surgeon wants to do this in such way (to cover much more area) ?
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906722/figure/Fig6/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906722/
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OK now I know it's HA from coral (not paste). Do you know something more about this ?
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http://www.biocoral.com/files/Questions%20-%20Answers%20actuel%20VA.pdf
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I met with a plastic surgeon this morning and his comments were the same. He used to use this stuff and it sounds great but is really artificial to your body. He said it's not too bad to remove but it often doesn't look good, either the face looks too full or you can't put it in the desired spots. This is the sad reality of facial implants today. Silicone is really the best way to go I think and it's kind of sucky.
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I got response from the surgeon who does these HA based surgeries
His answers are just CAPITALIZED
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What I understood , you are going to put some filler into / under my skin to let it to create additionial collagen (to prepare skin to implant) and to let see me how it will look before permament solution will be applied… RIGHT
After 6 months (however at first time you told me that after 1 year ?? ) you are gonna to put kind of hydroxyapatite substance - what it is exactly ? please remind me, is it solid from the beginning ? - I mean solid structutre which is customised for me and then just put through the incision in the mouth ? or it’s kinda paste which change into solid form. ?
MIXTURE OF HYDROXIAPATITE AND MICROFIBRILLAR COLLAGEN IT IS MOLDABLE FOR AT LEST ONE WEEK
I have also little flattened zygomatic arch - will this solution also help me in this area ? YES
You told me that this implant will change into bone …but I’ve read it may change only partially. So how it really is ?
Generally, what are disadvantages of such solution ? none ? there must be something CANNOT GUARANTEE THE VOLUME IS 100% IN EVERY PERSON
Absorbtion issue ? does a body absorbs this material a little, like 25%, or at all ?… how the outcome is predictible in long term ?SORRY WE DONT HAVE ANY OF THE INFORMATIONS YOU ARE REQUESTING BETTER FOR YOU TO SELECT OTHER CENTERS
My infraorbital nerve issue - high probability of compression due to not enough space into affected canal, or eventually scar
THIS IS VERY IMPORTANT - When I brush my anterior teeth, I feel itching and kinda pain on the cheek …so the compression is somewhere inside canal before the place where the anterior superior alveovar nerve goes down the ION. Having this in mind, are are you able to reach that area in the canal through the mouth in the second step, if cortisteroid injection will not help . I mean how deep can you get into the canal ?
And please do not understand me wrong, I know that in my case this problem is tricky, but my approach is just to be sure there is no compression, or anything else which may affect the nerve function. causing hypersensitivity. I will feel more comfortable knowing that there is no compression, despite the procedure will help or not.
Please answer…. Perhaps you can show me some publications which may answer to some of my questions
DEAR DON IF YOU READ YOUR LETTER YOU MAY SEE THAT YOUR EXPECTED REQUEST OF RESULTS IS TOO HIGH. I DONT BELIEVE WE ARE THE RIGHT PLACE FOR YOUR PROBLEM SOLVING. PLEASE FEEL FREE TO ASK OTHER HOSPITALS TO ASSIST YOU.
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I have to add that he told me I could ask him any question I wanted ...as you see only a few concrete questions...
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Yup, he straight up doesn't know what the hell he's doing. And he's pissed that you're pressing him on specifics. What a f**ker.
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I thought from the beginning that they will not help me too much (I only checkecd another solution). Even nerve issue (very very tricky) did not discourage him, but the question about HA solution ;)
but they have really good opinions
so little strange behavior. I think my questions were very simple.
the other 2 surgeons (Germany, Italy) (osteotomy procedure, similar to LF3 on one side) whom i'm gonna choose answered me some questions via mail and a lot on the consultations face to face. I'm gonna have the last one with one of them very soon - that means I'm gonna decide in the beginning of the May
by the way I put this on another thread ....anyone knows the answer ;) ?
http://jawsurgeryforums.com/index.php/topic,3933.msg34987.html#msg34987
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@27F I heard similar things about HA paste. It doesn't turn into bone and it's just as foreign as any other material. I was told most surgeons don't use it anymore primarily because it doesn't give good results, that some older surgeons still use it because that's what they're comfortable with. A lot of surgeons have done the cheekbone augmentations, via graft or osteotomy, but not in volume, I think also because it's hard to get right. That's a good part of why implants are so popular and why surgeons like to wait until after jaw surgery to do them. The term "market differentiator" came up in conversation a few times. Choices are always imperfect, though, and that imperfection can give a surgeon enough experience just to handle regular cases better so not necessarily a knock against any particular surgeon.
Anyway, it's hard enough as it is to make cheekbones look good (check out Realself reviews), let alone with a big soft tissue change like jaw surgery. I think many surgeons have avoided the non-traditional LeForts b/c of the risks, you need 99 ecstatic patients to outweigh the screams of the 1 who was royally screwed. Change that ratio even to 10/90 and you won't be in business long without a rock solid reputation. That, and, there's still some problems they can't fix, like my laterally weak cheekbones. I'd still fix the negative vector first if I had to choose.
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is "MIXTURE OF HYDROXIAPATITE AND MICROFIBRILLAR COLLAGEN " the same like typical HA paste ? What HA paste exactly means ? what are the components ?
in my case osteotomy to set the bone in original position seems to be only one solution.
Also most surgeons do not perform computer assisted aurgery which perhaps is not superior to non-navigated, but it helps to achieve more predictible results
Change that ratio even to 10/90 and you won't be in business long without a rock solid reputation
hmm I found 2 who perform it from time to time and they are still in business ;) in big hospitals...one of them only in public
perhaps I will be just a guinea pig for them ;)
However only one of them have opinions on internet (good) the second one does not.... but he make a lot of surgeries...so it's little strange
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I think the computer assistance gets old for them very quickly. It's more about communicating to the patient, still I wish they did it more as we all have our personal preferences. You can get away with a 10/90 ratio in cases where the alternative is worse, in syndrome cases for example. The doctor can always say the child was screwed to start with and the parents would believe them. Another example would be trauma. I don't think the cheekbone osteotomies are too bad for someone with experience, just not so great in making them look good. Not all surgeons have a large internet footprint, it just comes down to where they get their referrals from. Call a few orthodontists in every major city and ask for names, you'll find the local guys with good reputations.
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unfortunately I do not know German ;) and do not know which orthodontist to ask. Additionally he is specialised in orbitozygoamtic areas, not jaw ones. Most maxillo-facial surgeons never has touched any bone above teeth in their regular practice (not while studying or in ER practice, where they have easy to reapir fresh fractures....etc)
and in many cases (not all) surgery on jaw has nothing to do with malar bones (from the technical point of view). Surgeries on jaw are much simplier due to:
1) much more references point on the skeleton - not needed navigation - in the case of malar bone you barely have some reference points...and probably within 30 minutes during surgery you get swelled - so looking at a patient's soft tissue nothing tell a surgeon
2) much more common...and patients who wants jaw surgeries are mostly desperate ones.. they can accept pernament nerve damages...just to get what they wanted for a several years
3) patients can easily find another patients and to talk about specific surgeon - to get first hand opinion
malar osteotomies are mostly performed in patients who has been improperly treated after fracture
So there are completely another issues
jaw patients want to look better than before
most "malar" patients want as it was before
The second option is more tricky - believe me
of course some jaw patients also want to improve their cheekbone (osteotomy not implant) - but it's marginal from what I see
PS NAVIGATION IN MAXILLO FACIAL SURGERY IS KINDA NEW THING transfered from neurosutgery...how it can get old ?