jawsurgeryforums.com
General Category => Aesthetics => Topic started by: valhalar on May 20, 2019, 04:36:54 AM
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I know this surgeon is controversial due to his previous use of this forum and alleged involvement with SJ. I am only interested in the male case for the first 60 seconds of this video:
https://www.youtube.com/watch?v=pdahHJUXeJg
Created an 11% increase in mandible width from BiMax? I didn't know that was even possible. What do you think of Coceancig's work vs. other maxillofacial surgeons as his pricing runs into the tens of thousands... is his work better than others?
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I know this surgeon is controversial due to his previous use of this forum and alleged involvement with SJ. I am only interested in the male case for the first 60 seconds of this video:
https://www.youtube.com/watch?v=pdahHJUXeJg
Created an 11% increase in mandible width from BiMax? I didn't know that was even possible. What do you think of Coceancig's work vs. other maxillofacial surgeons as his pricing runs into the tens of thousands... is his work better than others?
Im not sure how hes allowed to say he got an 11% increase in width from a bimax, since its really just an 11% perceived width increase, which results from the BSSO bringing the jaw forward and making it LOOK bigger. Perhaps its because the reference lines are fixed in space around the skull from front view, and so the points on the mandible are 11% wider with respect to those fixed reference points? that appears to be the case, but im sure he did not do any physical widening of the mandible.
I dont like the guy because he acts like a child on social media, talking s**t, advertising his work on discussion groups etc. He got comically defensive when I asked to see some B&As of his IMDO ("I dont need to prove anything to you, youre a nobody!" type response)
That said, the result you're looking at appears to be a pretty good one. SUPER bimax is a stupid juvenile sounding phrase that he appears to be trying to coin. figures.
Ive seen a few really good results from him, IMDO , Bimax etc. but his arrogance and immaturity made me drop him as an option immediately on contact.
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Im not sure how hes allowed to say he got an 11% increase in width from a bimax, since its really just an 11% perceived width increase, which results from the BSSO bringing the jaw forward and making it LOOK bigger. Perhaps its because the reference lines are fixed in space around the skull from front view, and so the points on the mandible are 11% wider with respect to those fixed reference points? that appears to be the case, but im sure he did not do any physical widening of the mandible.
I dont like the guy because he acts like a child on social media, talking s**t, advertising his work on discussion groups etc. He got comically defensive when I asked to see some B&As of his IMDO ("I dont need to prove anything to you, youre a nobody!" type response)
That said, the result you're looking at appears to be a pretty good one. SUPER bimax is a stupid juvenile sounding phrase that he appears to be trying to coin. figures.
Ive seen a few really good results from him, IMDO , Bimax etc. but his arrogance and immaturity made me drop him as an option immediately on contact.
Dr. Conceded, Concealing, what ever way he spells his name is another one who uses a lot of SUBTERFUGE where one really has to be really good at the 'forensics of bulls**t' to 'read between the lines' as to his presentation.
Let's take a closer look here. He states the 'SUPER bimax' combines IMDO, SARME and counter clockwise BIMAX surgery (LeFort and BSSO), with GenioPaully... to produce a super advancement of the lower face, in order to overcome severely short jaws.
Well, since the IMDO is something that works when one is STILL in the GROWING stage--as in kid or young adolescent--his examples of final results would be of patients who STARTED a series of procedures with him when they were YOUNG and go through multiple STAGES of other things before they get to the actual bi-max surgery when they are OLDER. Yet, he uses the after photos of patients he started at an EARLY AGE and went through a series of different types of 'expansion' along the way before they got to the final bimax surgery to appeal to an audience (adults) who are WELL PAST the age of when he STARTS his 'series of events'.
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I haven't met or consulted with him, but he probably has a better aesthetic sense than the rest of the surgeons here in Australia. Like 95% of surgeons here don't give a damn about aesthetic outcomes and see no qualms whatsoever giving you the chimp lip or making your face longer, etc. I think he does CCW too. So it's a serious shame about the online persona and attitude.
Im not sure how hes allowed to say he got an 11% increase in width from a bimax, since its really just an 11% perceived width increase, which results from the BSSO bringing the jaw forward and making it LOOK bigger. Perhaps its because the reference lines are fixed in space around the skull from front view, and so the points on the mandible are 11% wider with respect to those fixed reference points? that appears to be the case, but im sure he did not do any physical widening of the mandible
I think they can make the back of your jaw wider by bowing out the posterior segments of the BSSO. I've seen it done in a couple of VSP videos. I don't know if that was done here though.
ETA: Actually yeah, looking at this image the back of the jaw (the ramus section) does look bowed out.
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I think they can make the back of your jaw wider by bowing out the posterior segments of the BSSO. I've seen it done in a couple of VSP videos. I don't know if that was done here though.
The ramus bone can be angled outward to some extent while doing a bsso. I was told it's done to balance so the advancement get less pointy, and that it's something they can play around with to make the face slightly more square in this area.
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Is intermandibular distraction osteogenesis only for overbites?
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Is intermandibular distraction osteogenesis only for overbites?
I would assume so since it has the word mandible in it. According to the Profilo Surgical website IMDO is for fixing a small lower jaw and overbites.
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I would assume so since it has the word mandible in it. According to the Profilo Surgical website IMDO is for fixing a small lower jaw and overbites.
But what if you just have one of the two (small lower jaw), would be a much less invasive surgery than BSSO if I'm reading correctly.
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But what if you just have one of the two (small lower jaw), would be a much less invasive surgery than BSSO if I'm reading correctly.
Some people on here have argued that if you only need a lower jaw surgery, then BSSO is better because you do the surgery once. IMDO requires a surgery, then turning the intermandibular distraction each day, and then another surgery to take the appliances out. However many adults with small lower jaws will require a jaw extension coupled with a genioplasty. IMDO is suitable because you could potentially do the genioplasty upon removal of the distraction device... I am not quite sure if there is another wait period however.
An example is shown here: https://www.instagram.com/p/66MRpXnEtw/
12mm of advancement with IMDO, followed by 10mm of advancement with a geniopaully (It's a genioplasty - this doctors version of it).
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By the way, here's another picture of the patient 'super' bimax from the video:
https://www.instagram.com/p/BwK5S5PHFMc/
Has his nasal bridge sunk between the first and second image, or would that be from rhinoplasty? I understand upper jaw surgery can pull the bridge down.
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Some people on here have argued that if you only need a lower jaw surgery, then BSSO is better because you do the surgery once. IMDO requires a surgery, then turning the intermandibular distraction each day, and then another surgery to take the appliances out. However many adults with small lower jaws will require a jaw extension coupled with a genioplasty. IMDO is suitable because you could potentially do the genioplasty upon removal of the distraction device... I am not quite sure if there is another wait period however.
An example is shown here: https://www.instagram.com/p/66MRpXnEtw/
12mm of advancement with IMDO, followed by 10mm of advancement with a geniopaully (It's a genioplasty - this doctors version of it).
I assume the guy in the picture also had bite issues? I don't think this can work for a class 1 bite but mandibular recession right?
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I assume the guy in the picture also had bite issues? I don't think this can work for a class 1 bite but mandibular recession right?
I have a Class I bite and mandibular recession. Dr Coceancig recommended I lengthen my lower mandible but did not say what he would do to achieve it. I am assuming it would be braces, followed by IMDO or BSSO. I only went for a single meeting and he seemed busy, I also had zero understanding of jaw surgery at the time so didn't ask what procedure it would entail. I haven't gone back yet and will seek the opinions of other macfacs to get a proper assessment before I make up my mind because he is apparently rather expensive. One member said their estimated cost was about $30k AUD after medicare. If I find other surgeons are not careful in their aesthetic concerns then I will considering returning to him.
There's no reason to say a Class I bite and a small mandible is not a candidate however. They can move the lower teeth backward with braces to create a large Class II overbite. They'll then perform surgery to extend the lower mandible so that the teeth meet. Other times you might need double jaw surgery to lengthen the maxilla forward so the longer mandible will meet it correctly.
The patient in this photo https://www.instagram.com/p/66MRpXnEtw/ started with a significant Class II bite so the process was likely faster.
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I should also add that often times a Class I bite combined with a small mandible actually means that you have both a small upper and lower jaw. A small mandible but large maxilla often has a much greater overbite and is more often referred immediately to maxfac surgeons. Class I bites with small mandibles are just camouflaged by orthodontists, and they often have larger noses and seek rhinoplasty.
You need a full face analysis to determine if this is the case. If it the case you will probably need a double jaw surgery which will provide you a better result but can have it's downsides too.
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12 mm is well within the realm of bsso.
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They can move the lower teeth backward with braces to create a large Class II overbite. They'll then perform surgery to extend the lower mandible so that the teeth meet.
Are you sure about this part? Moving the lower teeth back, particularly the molars, is next to impossible. The alveolar bone in the lower jaw is less malleable and the lower teeth are constantly pushed forward by the upper teeth through mesial drift.
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Are you sure about this part? Moving the lower teeth back, particularly the molars, is next to impossible. The alveolar bone in the lower jaw is less malleable and the lower teeth are constantly pushed forward by the upper teeth through mesial drift.
I may be wrong but I thought lower jaw surgery alone was possible in class I cases where they can buck out the upper teeth and pull back the lowers? Perhaps this is only really possible in a Class II because the overbite needs to be bad enough already. I understand they usually recommend a double jaw surgery if the bite is Class I.
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I may be wrong but I thought lower jaw surgery alone was possible in class I cases where they can buck out the upper teeth and pull back the lowers? Perhaps this is only really possible in a Class II because the overbite needs to be bad enough already. I understand they usually recommend a double jaw surgery if the bite is Class I.
Paul Coceancig did mention a procedure where the lower teeth are pulled backward to make space for the incisors to be torqued back and improve the mentolabial angle.
Another orthodontist also mentioned a similar procedure using a skeletal anchorage system such as mini screws. I think it's called distal movement. Maybe that is the same process you were referring to and maybe it does work. If anchorage points are placed in the skeletal part of the mandible and the teeth moved very slowly maybe it can work.
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Extract 2 lower teeth, close the gaps, advance the mandible. Alternatively, if you have a steep occlusal plane, CCW rotation of the maxilla will create a bigger overjet. The maxilla can also be advanced to allow the mandible to be advanced.
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Slightly old thread but although I've never consulted him I'll post what I know about him that nobody else here knows:
My orthodontist used to work with him closely & even co-developed IMDO with Coceancig (surprise surprise Coceancig wasn't alone despite what it seems, orthos of course usually aren't capable of doing surgery but he had some experience in maxfax so thats that) but stopped working with him due to some kind of disagreement on the surgical results Coceancig produced, eventually the relationship got bad enough that there were accusations of defamation & legal threats. Not sure what happened since I didn't ask for an indepth explanation but the but I was told that Coceancig "travels overseas on conference tours but only 1 in 10 of his results are good" or when I expressed fear about overcorrection by advancing the jaws too much "the only surgeon I know that overcorrects is Coceancig in the hopes that the patients will relapse, I told him no don't do this but the patients didn't end up relapsing & that's why I stopped working with him". Now he doesn't want to work with Coceancig anymore so much that I was almost refused treatment by my ortho since he thought I wanted surgery with Coceancig!
I wont name my ortho directly (I don't want to land him in legal hot water or have you guys annoy him with emails about IMDO) but if you look hard enough on the internet of orthos that have collaborated with Coceancig (HINT: PUBLISHED PAPERS) you will eventually find his name.
BTW for anyone in Australia considering IMDO there are actually surgeons other than Coceancig in NSW who perform it, it's just that Coceancig has an huge presence on the internet compared to these other surgeons & he seems to travel to alot of conferences to promote himself (He even managed to land a seat next to A&G in BSCOSO 2015 conference) that you don't hear about other IMDO surgeons (dunno how good these other surgeons are though). Someone on this forum who consulted Coceancig told me via DM "He does come off as car salesman" but nonethless hes does seem to be still well above average compared to average the Australian surgeon skillwise despite what my ortho warned.
Does anybody know if he does CCW with posterior downgrafting?
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Well he isn't kidding about being serious with the term "super-bimax"
https://www.ijoms.com/article/S0901-5027(19)30614-9/abstract
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Can't believe people are tricked by pictures where they only show profile view. I don't know how many times it has to be repeated that the FRONT is the most important. Same thing with nosejobs and implants. Sometimes they show great profile results and then the front happens to be s**t. Unless your only problem is profile, I would always ask front views as well.
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or when I expressed fear about overcorrection by advancing the jaws too much "the only surgeon I know that overcorrects is Coceancig in the hopes that the patients will relapse, I told him no don't do this but the patients didn't end up relapsing & that's why I stopped working with him".
Well not sure what your ortho is talking about specifically, but as far as regular JS goes some surgeons have told me it's common to slightly overcorrect because a bit of relapse is normal/anticipated.
About the over-advanced look - from watching some of his vsp planning on youtube, I think he advances the maxilla until the upper central incisors line up with the most forward bit of the nose bone (not sure what that points called). I'm not sure how that compares to other surgeons such as Gunson, Alfaro etc.
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He used to post here (I think he was "OrthodonticExpert"). Total asshole who didn't disclose he was a surgeon, told people they needed surgery, then made threats when I banned him/called him out on it.
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Yeah but what I don't understand is whether IMDO can even be done in adults? If not, then f**k this huckster!!!!
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Korvitz can your ortho confirm/deny?
I think it might, cause in one of his vids he suggests it to a really recessed 30 yr old to break up the distance (like 10mm IMDO, 10mm BSSO).
I read regular DO takes longer in adults vs kids cause the bone turnover is slower.
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Korvitz can your ortho confirm/deny?
I think it might, cause in one of his vids he suggests it to a really recessed 30 yr old to break up the distance (like 10mm IMDO, 10mm BSSO).
I read regular DO takes longer in adults vs kids cause the bone turnover is slower.
I'll ask him when I meet him again but that's next year in Febuary so wait till then. There might be an limitation to the maximum distraction length for IMDO due to the physical design of the IMDO distractor devices but I dont know if this is indeed the case for IMDO? I will post an answer in this thread when I get the chance
But if you watch https://youtu.be/zoQi3ao1Osw?t=538 at 8:58 you will see an 17mm mandibular distraction in an adult case & I've seen a young adult girl who I was told had 14mm so large D.O. advancements in adults is possible (with an different distractor device in this case) so why not with IMDO??
Réflechir, rechercher, innover en chirurgie maxillo-faciale. Entretien avec Albino Triaca https://sci-hub.tw/10.1051/orthodfr/2016021
"Chez le jeune, la distraction osseuse sagittale est plutôt bien supportée. Ce n’est pas forcément le cas chez l’adulte mais elle présente de nombreux avantages : avancements importants, reconstruction osseuse, absence de risque d’altération condylienne (Figs. 16 à 18). Lorsqu’un patient a présenté des phénomènes de résorptions condyliennes, mais que les condyles sont corticalisés, il est nettement préférable, selon moi, d’envisager une distraction plutôt qu’une ostéotomie sagittale.."
Kids in general heal better than adults & it even goes for genioplasties
https://www.angle.org/doi/pdf/10.2319/030414-152.1
"Better bone apposition and remodeling is observed in younger patient compared with adults."