jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: earl25 on April 17, 2016, 12:34:46 PM
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im considering it for more augmentation under the eye and brow.
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im considering it for more augmentation under the eye and brow.
i'm talking to sinn about doing that as well.
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you're risking motor nerve damage when it comes to brow....
any surgeon is able to avoid that in that place?
again Sinn I so regret I didn't choose him. It sounds like he is really superior
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RICO you have no evidence of that. Okay? Stop chiming in on things that are irrelevant to you.
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dr. Z told me HA paste is garbage because it often don't turn out symmetrically and it's almost impossible to remove after some time. He did mention some kind of material used in dental work which may be used.
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dr. Z told me HA paste is garbage because it often don't turn out symmetrically and it's almost impossible to remove after some time. He did mention some kind of material used in dental work which may be used.
Bio-oss?
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Bio-oss?
that may be it, but i'm not completely sure. He was talking about them coming in large blocks, which he could carve out and fit your face. Would be easy to remove in case of infection, in contrast to HA paste and Medpor implants which were hellish.
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Z talked to me about bio-oss as well. He said basically the product is under patent protection so he couldn't say about how it is improved material compared to HA, but in his experience he would expect less complications with it. I talked to a a Spanish surgeon who uses it as well. He stopped using HA long time ago and feels more comfortable using bio-oss in terms of long-term safety. So, I have feedback about bio-oss from two surgeons.
After having lived a major infection from HA and ending up in hospital, I would avoid it, at least the type the butcher Mommaerts in Brussels uses, especially would avoid it in the orbital area. Z definitely said he's seen many cases with HA infections and it's complicated and expensive to remove. I know from personal experience. It would be good to clarify what type the butcher uses, as many people understand different things when they refer to HA. The type the butcher uses is definitely s**t.
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My surgeon said it's only useful for building up dental arches before placing dental implants.
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My surgeon said it's only useful for building up dental arches before placing dental implants.
Well, that's the label use and that's what's he's read. He doesn't know any better (no disrespect to your surgeon). But then there's off-label: there are surgeons out there who use it for augmentation as I said above and I've spoken to two already. I don't know how successfully it resolves cosmetic issues, but according to Z it's a reasonable option where autologous grafting is not possible.
To make an analogy for you: there is no approved filler for the under-eye area in US or anywhere for that matter. Using fillers like Restylane to treat that area is strictly off-label and you'll find hundreds of injectors who will warn you against it. That doesn't mean it's not used for the under-eye area on a daily basis by hundreds, thousands of injectors world-wide. I've had it injected twice in my under-eye area so far.
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if it can be used to build up dental arches it can be used for orbital rims or anything else. and yeah it can come in big square blocks.
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Z talked to me about bio-oss as well. He said basically the product is under patent protection so he couldn't say about how it is improved material compared to HA, but in his experience he would expect less complications with it. I talked to a a Spanish surgeon who uses it as well. He stopped using HA long time ago and feels more comfortable using bio-oss in terms of long-term safety. So, I have feedback about bio-oss from two surgeons.
After having lived a major infection from HA and ending up in hospital, I would avoid it, at least the type the butcher Mommaerts in Brussels uses, especially would avoid it in the orbital area. Z definitely said he's seen many cases with HA infections and it's complicated and expensive to remove. I know from personal experience. It would be good to clarify what type the butcher uses, as many people understand different things when they refer to HA. The type the butcher uses is definitely s**t.
do you know how the butcher mixed your ha paste? does he use clotting agent and blood?
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Z talked to me about bio-oss as well. He said basically the product is under patent protection so he couldn't say about how it is improved material compared to HA, but in his experience he would expect less complications with it. I talked to a a Spanish surgeon who uses it as well. He stopped using HA long time ago and feels more comfortable using bio-oss in terms of long-term safety. So, I have feedback about bio-oss from two surgeons.
After having lived a major infection from HA and ending up in hospital, I would avoid it, at least the type the butcher Mommaerts in Brussels uses, especially would avoid it in the orbital area. Z definitely said he's seen many cases with HA infections and it's complicated and expensive to remove. I know from personal experience. It would be good to clarify what type the butcher uses, as many people understand different things when they refer to HA. The type the butcher uses is definitely s**t.
Ah... that make no sense at all.
By definition IF IT IS PATENTED - - then everything about it is fully disclosed. One has to disclose the details as to how to actually "make" the invention in order to get the patent!!!
That is why Coca Cola is a TRADE SECRET - - .
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This seems concerning
http://www.ncbi.nlm.nih.gov/pubmed/11374460
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This seems concerning
http://www.ncbi.nlm.nih.gov/pubmed/11374460
why? the conclusion is that it "does NOT" carry a risk of transmitting.
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Demineralized-bone matrix (DBX) would be my material of choice. I haven't looked too closely but I believe it's cadaver bone that's had soft tissue removed to remove risk of rejection and increase osteoconductive potential. Unlike HA, which is bone-like, DBX IS bone. It comes in different formulations, solid, putty, and paste. I posted a while ago about Dr Genecov in Dallas using it for midface augmentation according to the website. The case study was from 2006 where the putty was used to fill voids to avoid palpable defects in a double jaw surgery patient. The surgeons in Houston have been using it for CCW grafts for over a decade now without issue I'm told. I wonder if a resorbable version might be created that could be injectable to add volume non-surgically some day.
My impression is that surgeons tend to use materials and techniques that they're comfortable with. They have a limited budget for trying new things out because their reputation can't afford too many failures. I'd guess HA problems were due to foreign body reactions rather than infection, though it's probably hard to differentiate them in practice. And I was told the same, once added it can't be removed.
One place where grafting doesn't work, btw, is the notch after BSSO. Apparently even vascularized grafts failed when tried on rabbits. The best techniques to solve this problem are the inferior border osteotomy, picking young patients, and limiting advancement. And I think there's a reason the inferior border osteotomy hasn't been widely adopted.
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Demineralized-bone matrix (DBX) would be my material of choice. I haven't looked too closely but I believe it's cadaver bone that's had soft tissue removed to remove risk of rejection and increase osteoconductive potential. Unlike HA, which is bone-like, DBX IS bone. It comes in different formulations, solid, putty, and paste. I posted a while ago about Dr Genecov in Dallas using it for midface augmentation according to the website. The case study was from 2006 where the putty was used to fill voids to avoid palpable defects in a double jaw surgery patient. The surgeons in Houston have been using it for CCW grafts for over a decade now without issue I'm told. I wonder if a resorbable version might be created that could be injectable to add volume non-surgically some day.
My impression is that surgeons tend to use materials and techniques that they're comfortable with. They have a limited budget for trying new things out because their reputation can't afford too many failures. I'd guess HA problems were due to foreign body reactions rather than infection, though it's probably hard to differentiate them in practice. And I was told the same, once added it can't be removed.
One place where grafting doesn't work, btw, is the notch after BSSO. Apparently even vascularized grafts failed when tried on rabbits. The best techniques to solve this problem are the inferior border osteotomy, picking young patients, and limiting advancement. And I think there's a reason the inferior border osteotomy hasn't been widely adopted.
Sounds like it's a pretty niche material, how many surgeons really use it?
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We could email them and ask but I don't see why it'd be any more niche than any of the other bone replacement products out there. It's just another offering available to surgeons. I know the surgeons in Houston like it and have gotten great results with it. Thinking about it, jaw surgery, while common now, is not some highly specialized highly refined product yet. Lots of products with limited studies and lack of consensus among surgeons about the best technique. Even the high volume guys simply don't do enough procedures to get to that point. Most don't publish so a lot of data never gets shared.