jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: emanresu on September 06, 2020, 07:48:19 PM
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Those in need of a CCW rotation with posterior downgraft are significantly limited in the surgeons they can choose from, as not many perform it. As well, most surgeons performing it are in the US, and if you're not from there, it makes it even more difficult financially, both due to the exchange rate of the USD, as well as not being able to have insurance cover it. (As a Canadian, the abysmal value of our dollar makes the already astronomically high cost of surgery in the US nigh impossible to afford, and on top of that, since you can’t get insurance coverage, the entire thing must be 100% paid out of pocket.)
There are several doctors who are often suggested as alternatives to Gunson, namely Relle, Movahed, Alfaro, and Antipov, due to their ability to perform CCW rotations with a posterior downgraft. I know we are not supposed to explicitly state prices here, but in an attempt to make the situation outlined above (a little) less grim, the question I'm hoping to have answered is: for those who have consulted with all four of theses surgeons, who have you found to be the cheapest?
I’ve already consulted with Relle, and, to me, he seems like a very competent surgeon who absolutely deserves his reputation. However, his prices were still very high, so he's still not a viable option for many prospective patients.
Currently, due to these costs, it seems like I’m going to have to just resort to either a BSSO and spend the rest of my life with a poor bite, or camouflage treatment in the form of a genio and jaw implants. I'm still trying to come to terms with having invasive surgery that I know is inferior to proper treatment, but it seems like the only remaining choice at this point.
Maybe one day someone will discover another competent surgeon operating out of Mexico or Asia or something that we can all go to for pennies, but for now, it would be great to know, among the current “Gunson Alternatives”, which is the most economical.
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The planning software (Nemofab or something like that) based on Arnett analysis, some of the top guys use, is out of SPAIN. Track down the software company and ask for a list of doctors using their software. I mean the software is used for planning out a posterior CCW downgraft. So, finding out who uses it, could/would give you some leads.
ETA: https://www.youtube.com/watch?v=hXzqNNWPhrw&ab_channel=SoftwareNemotecS.L.
Here's doctor Arnett, innovator of the software (retired). There are probably a lot of young surgeons out there using this software to plan surgeries.
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The planning software (Nemofab or something like that) based on Arnett analysis, some of the top guys use, is out of SPAIN. Track down the software company and ask for a list of doctors using their software. I mean the software is used for planning out a posterior CCW downgraft. So, finding out who uses it, could/would give you some leads.
Hi kavan, hope all is well. That's very interesting. I've found their website here, and you are correct, the software is called NemoFAB. It's developed by NemoTec, and I've sent them an email requesting a list of doctors. I will update if I receive any information of interest.
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I think there's a guy in New Hampshire, Charles Henry, who I think took seminars with Arnett or Gunson. I can't remember exactly, but I seem to remember them speaking highly of him. I think that was the name...long time ago. So if you contact Dr. Henry you can ask if he trained under them or took their seminars. It might have been Wolford who he did some training with, though. Again, so long ago I can't remember exactly. Just write the office and ask, and ask their prices. I'd guess much cheaper.
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Taylor in Houston.
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I think there's a guy in New Hampshire, Charles Henry, who I think took seminars with Arnett or Gunson. I can't remember exactly, but I seem to remember them speaking highly of him. I think that was the name...long time ago. So if you contact Dr. Henry you can ask if he trained under them or took their seminars. It might have been Wolford who he did some training with, though. Again, so long ago I can't remember exactly. Just write the office and ask, and ask their prices. I'd guess much cheaper.
Taylor in Houston.
Thanks so much for the responses guys. I'll be looking into both of them.
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The planning software (Nemofab or something like that) based on Arnett analysis, some of the top guys use, is out of SPAIN. Track down the software company and ask for a list of doctors using their software. I mean the software is used for planning out a posterior CCW downgraft. So, finding out who uses it, could/would give you some leads.
ETA: https://www.youtube.com/watch?v=hXzqNNWPhrw&ab_channel=SoftwareNemotecS.L.
Here's doctor Arnett, innovator of the software (retired). There are probably a lot of young surgeons out there using this software to plan surgeries.
great advice Kavan! Does Alfaro use this software?
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great advice Kavan! Does Alfaro use this software?
I would assume so since he's out of SPAIN and a key CCW downgraft doc.
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Consider looking at teaching hospitals but be wary. The danger is you run into surgeons who rely on the hospital's reputation to fill their patient pipeline and produce shoddy results (in my opinion Dr. D B from NYP, who you should avoid at all costs, is the canonical example of this). This should be less of a danger now with the internet.
Some surgeons who have publications demonstrating they can perform the complex movements are Dr. Jaime Gateno and Dr. Derek Steinbacher. I'm sure there are more.
Note: I have no problems naming Dr. D B, I just don't want to pollute the search results
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Consider looking at teaching hospitals but be wary. The danger is you run into surgeons who rely on the hospital's reputation to fill their patient pipeline and produce shoddy results (in my opinion Dr. D B from NYP, who you should avoid at all costs, is the canonical example of this). This should be less of a danger now with the internet.
Some surgeons who have publications demonstrating they can perform the complex movements are Dr. Jaime Gateno and Dr. Derek Steinbacher. I'm sure there are more.
Note: I have no problems naming Dr. D B, I just don't want to pollute the search results
Thanks for the leads, I'll be looking into them. The more names we can get out there for CCW rotations w/ posterior downgrafts, the better.
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You would have to do some sleuthing as to SYMPOSIUMS and CONFERENCES the ccw guys or nemo fab might be presenting in or hosting. The FAB part of nemofab stands for Face Airway and Bite. See if you can ask the company how many doctors use that software. It's like if they are using it, most likely it's because they want to do stuff the Arnett way. See if you can track down Arnett to ask how many doctors use his system.
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You would have to do some sleuthing as to SYMPOSIUMS and CONFERENCES the ccw guys or nemo fab might be presenting in or hosting. The FAB part of nemofab stands for Face Airway and Bite. See if you can ask the company how many doctors use that software. It's like if they are using it, most likely it's because they want to do stuff the Arnett way. See if you can track down Arnett to ask how many doctors use his system.
Found something mentioning an Antonio D'Agostino (Italy) and from that a FABknowledge website that has some leads as to names of other doctors. https://fabknowledge.com/antonio-dagostino-md/
another link from same website: https://fabknowledge.com/topic/
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Those in need of a CCW rotation with posterior downgraft are significantly limited in the surgeons they can choose from, as not many perform it. As well, most surgeons performing it are in the US, and if you're not from there, it makes it even more difficult financially, both due to the exchange rate of the USD, as well as not being able to have insurance cover it. (As a Canadian, the abysmal value of our dollar makes the already astronomically high cost of surgery in the US nigh impossible to afford, and on top of that, since you can’t get insurance coverage, the entire thing must be 100% paid out of pocket.)
There are several doctors who are often suggested as alternatives to Gunson, namely Relle, Movahed, Alfaro, and Antipov, due to their ability to perform CCW rotations with a posterior downgraft. I know we are not supposed to explicitly state prices here, but in an attempt to make the situation outlined above (a little) less grim, the question I'm hoping to have answered is: for those who have consulted with all four of theses surgeons, who have you found to be the cheapest?
I’ve already consulted with Relle, and, to me, he seems like a very competent surgeon who absolutely deserves his reputation. However, his prices were still very high, so he's still not a viable option for many prospective patients.
Currently, due to these costs, it seems like I’m going to have to just resort to either a BSSO and spend the rest of my life with a poor bite, or camouflage treatment in the form of a genio and jaw implants. I'm still trying to come to terms with having invasive surgery that I know is inferior to proper treatment, but it seems like the only remaining choice at this point.
Maybe one day someone will discover another competent surgeon operating out of Mexico or Asia or something that we can all go to for pennies, but for now, it would be great to know, among the current “Gunson Alternatives”, which is the most economical.
I have consulted with several of these surgeons. I had my initial surgery with Dr. Gunson. I recently had surgery to repair the damage from my first surgery by Dr. Steven Sullivan in OKC. https://profilesofs.com/steven-sullivan IMO, he is as good or better a surgeon than any on that list. Competitive prices. You should know however that like movahed, he does not follow the Arnett analysis.
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as I was told by Kavan ,I need a CW rotation with posterior downgraft.
Should I choose a surgeon who use NEMOfab system,?
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as I was told by Kavan ,I need a CW rotation with posterior downgraft.
Should I choose a surgeon who use NEMOfab system,?
I know that several surgeons were performing the surgery you describe before Arnett and before the software was invented. Others may differ in point of view, but in my opinion the the depth, the experience and execution ability of the surgeon would be top priority to me. My virtual surgery plan from Gunson was made using different software, from 3m. Maybe there is some magic for specific patients in NemoFab?
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The OP in this thread was looking for cheaper alternatives to Gunson.
It was IMPLICIT he was looking for doctors who had something in COMMON with how Gunson does things. It was also implicit to me that IF he had the FINANCES, he would go to Gunson. So here, my advice targeted the common CONNECTION to Gunson; the teachings of Arnett.
Gunson learned (a lot) from Arnett. Also that he uses software attributable to Arnett. I isolated the software that other doctors learning from Arnett's experience (or receptive to his outlook) would most likely be using and suggested ways he could possibly track down other doctors benefiting from Arnett's teachings (Symposiums, conferences).
When ever I give advice on here, it's meant to be RELATIVE to the OP and takes into consideration the CONTEXT of the OP's presentation. I make no claims that advice I TARGET to any one OP of a thread is meant to apply to everyone reading my advice. The only expectation I have when giving advice on here is that the OP be in the CAPACITY to conclude for him/her self whether of not the advice is applicable to him/her.
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The OP in this thread was looking for cheaper alternatives to Gunson.
It was IMPLICIT he was looking for doctors who had something in COMMON with how Gunson does things. It was also implicit to me that IF he had the FINANCES, he would go to Gunson. So here, my advice targeted the common CONNECTION to Gunson; the teachings of Arnett.
Gunson learned (a lot) from Arnett. Also that he uses software attributable to Arnett. I isolated the software that other doctors learning from Arnett's experience (or receptive to his outlook) would most likely be using and suggested ways he could possibly track down other doctors benefiting from Arnett's teachings (Symposiums, conferences).
When ever I give advice on here, it's meant to be RELATIVE to the OP and takes into consideration the CONTEXT of the OP's presentation. I make no claims that advice I TARGET to any one OP of a thread is meant to apply to everyone reading my advice. The only expectation I have when giving advice on here is that the OP be in the CAPACITY to conclude for him/her self whether of not the advice is applicable to him/her.
Feel free to erase my posts if not relevant to the OP. Since Dr. Movahed, a fellow of Wolford, is not a fan of Arnett and his teachings and its not clear if Relle is a follower either, I did not think the post was so limited in its inquiry. I discovered Dr. Sullivan when he recently spoke at the Arnett Gunson Surgery forum, and i know that Dr. Arnett spoke at a forum with Dr. Sullivan in OKC, so it did not appear to me that i was making off topic response. Like i said, feel free to erase my responses to the OP.
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Feel free to erase my posts if not relevant to the OP. Since Dr. Movahed, a fellow of Wolford, is not a fan of Arnett and his teachings and its not clear if Relle is a follower either, I did not think the post was so limited in its inquiry. I discovered Dr. Sullivan when he recently spoke at the Arnett Gunson Surgery forum, and i know that Dr. Arnett spoke at a forum with Dr. Sullivan in OKC, so it did not appear to me that i was making off topic response. Like i said, feel free to erase my responses to the OP.
Actually, what I'd rather not have to do with your posts is correct them due to your not using the QUOTE FUNCTION correctly. I just had to take your comment out which was WITHIN the quote of what I said. When you are posting and using the quote function, PLEASE post your content after the last bracket after where it says; 'quote' . thank you.
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Found something mentioning an Antonio D'Agostino (Italy) and from that a FABknowledge website that has some leads as to names of other doctors. https://fabknowledge.com/antonio-dagostino-md/
another link from same website: https://fabknowledge.com/topic/
Thank you for the follow-up, kavan. Yes, I also see Dr. Esteban Alvarado from Costa Rica, and Dr. Octavio Cintra from Brazil here. While I don't know anything about the medical systems in these countries (yet), nor how “risky” they may or may not be, I imagine they would be cheaper than the US assuming they're using their local currencies, and are absolutely worth investigating.
I have consulted with several of these surgeons. I had my initial surgery with Dr. Gunson. I recently had surgery to repair the damage from my first surgery by Dr. Steven Sullivan in OKC. https://profilesofs.com/steven-sullivan IMO, he is as good or better a surgeon than any on that list. Competitive prices. You should know however that like movahed, he does not follow the Arnett analysis.
Hi there, does Dr. Sullivan perform counterclockwise rotations with posterior downgrafts? If so, he's definitely relevant to this discussion.
I know that several surgeons were performing the surgery you describe before Arnett and before the software was invented. Others may differ in point of view, but in my opinion the the depth, the experience and execution ability of the surgeon would be top priority to me. My virtual surgery plan from Gunson was made using different software, from 3m. Maybe there is some magic for specific patients in NemoFab?
Apologies for any confusion: I reference Gunson not necessarily because of his “style” or method of analysis, but because of his ability to perform CCW rotations w/ posterior downgrafts, a procedure that many people on this board come to learn they need, but are then left trying to figure out how exactly they can realistically go about getting this treatment.
It’s my understanding that if a surgeon is using NemoFAB, it’s a good indicator that they are doing this type of procedure.
I agree that finding a surgeon who is experienced and capable is a top priority, and one with a good reputation can indicate that. However, when someone is need of a CCW rotation w/ posterior downgraft, while there are several doctors with good reputations that come recommended for that, many people cannot afford their prices. I'm trying to find doctors who have a lower price point, but are still capable of performing this complex procedure, and, while they may not have the reputation of some of these other doctors, one would hope that they're still competent surgeons.
Feel free to erase my posts if not relevant to the OP. Since Dr. Movahed, a fellow of Wolford, is not a fan of Arnett and his teachings and its not clear if Relle is a follower either, I did not think the post was so limited in its inquiry. I discovered Dr. Sullivan when he recently spoke at the Arnett Gunson Surgery forum, and i know that Dr. Arnett spoke at a forum with Dr. Sullivan in OKC, so it did not appear to me that i was making off topic response. Like i said, feel free to erase my responses to the OP.
Regarding Dr. Movahed, I have read that he is capable of doing CCWs w/ posterior downgrafts, so that’s why I mentioned him. Having spoken with Dr. Relle, I can also confirm he does them.
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Movahed studied with Wolford. Wolford invented CCW-r.
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great advice Kavan! Does Alfaro use this software?
Alfaro doesn't give 2 s**ts about the bite, or symmetry for that matter. And he's not cheap either.
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Alfaro doesn't give 2 s**ts about the bite, or symmetry for that matter. And he's not cheap either.
Yes, from what I've read, his prices are on par, if not slightly more than some of the previously mentioned US surgeons. Although he may be a consideration for European patients, if you're located in North America and at any point were considering seeing him hoping to get a better price than you would locally, you won't, and you're better off saving yourself the hassle and staying on your continent.
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Thank you for the follow-up, kavan. Yes, I also see Dr. Esteban Alvarado from Costa Rica, and Dr. Octavio Cintra from Brazil here. While I don't know anything about the medical systems in these countries (yet), nor how “risky” they may or may not be, I imagine they would be cheaper than the US assuming they're using their local currencies, and are absolutely worth investigating.
Hi there, does Dr. Sullivan perform counterclockwise rotations with posterior downgrafts? If so, he's definitely relevant to this discussion.
Yes he does, and i think he has been performing counterclockwise rotation with and/or without posterior downgraft for many years. Good luck with your search and your journey, its very consuming.
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Yes, from what I've read, his prices are on par, if not slightly more than some of the previously mentioned US surgeons. Although he may be a consideration for European patients, if you're located in North America and at any point were considering seeing him hoping to get a better price than you would locally, you won't, and you're better off saving yourself the hassle and staying on your continent.
I'd be more concerned about Alfaro's asymmetrical results, cross bites, edge bites, misaligned midlines, canted maxillas.
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I'd be more concerned about Alfaro's asymmetrical results, cross bites, edge bites, misaligned midlines, canted maxillas.
but what about that woman who posted here and said she had great rates with Alfaro.
Okay, here's what i want to know. Assuming my bite is currently fine. Is there a doc who will do CCW posterior downdraft without requiring orthodontics, or if at the minimum can do so with invisaligh.
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I'd be more concerned about Alfaro's asymmetrical results, cross bites, edge bites, misaligned midlines, canted maxillas.
He's looking for an alternative to the big names doing CCW (whether or not they invented CCW) because they are out of his price range. Moot point to suggest concern about a doctor he's not going to.
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but what about that woman who posted here and said she had great rates with Alfaro.
Okay, here's what i want to know. Assuming my bite is currently fine. Is there a doc who will do CCW posterior downdraft without requiring orthodontics, or if at the minimum can do so with invisaligh.
That woman was a long time ago. Alfaro will operate on you without braces, no drama. Just don't expect a stable bite afterwards. If your bite is indeed good, then 1 month pre-op braces, 4 months post-op is enough.
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That woman was a long time ago. Alfaro will operate on you without braces, no drama. Just don't expect a stable bite afterwards. If your bite is indeed good, then 1 month pre-op braces, 4 months post-op is enough.
thanks for the head's up. appreciate it. I've noticed he's taken down all his before/afters.
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That woman was a long time ago. Alfaro will operate on you without braces, no drama. Just don't expect a stable bite afterwards. If your bite is indeed good, then 1 month pre-op braces, 4 months post-op is enough.
I know we aren't discussing prices here, but just as an indication: yes, that woman was a long time ago and currently Alfaro is one of the most expensive maxillofacial surgeons in the whole of Europe (to my knowledge, only Swiss doctors charge more). From what I hear, many doctors in the USA are cheaper. If I recall correctly, that lady who posted here already had a good bite, it was a sleep apnea case. I do not want to say anything more but if anybody is interested, they can go on Youtube to watch his before-after videos (and bear in mind, those are presumably the very best results and the most satisfied patients).
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thanks for the head's up. appreciate it. I've noticed he's taken down all his before/afters.
They are still there https://www.institutomaxilofacial.com/en/orthognathic-surgery/clinical-cases-orthognatic-surgery/
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Dr. Gunson recommended Julio Cifuentes to me as the only surgeon (he knows of) in South America he'd trust with a revision like mine (for the most part). He's from Chile, and when I called in his secretary estimated the cost of surgery at 22 milion chilean pesos (29k in US dollars). That includes hospital, anesthesia, plates and screws, fees, etc.
For reference, if I were to get the surgery Dr. Gunson suggests, it'd be a 5-6 mm anterior downgraft, 8 mm posterior downgraft, that presents added difficulties because it's a second time intervention, my orthodontic set-up is (very) bad and I have little bone on one side of my maxilla.
Let me clarify though, he can't guarantee anything with a referral and still said it'd be convenient I go to Santa Barbara. Another thing to note, he said many surgeons can execute first time surgeries well but that revisions are sort of another category. So if you're going into it fresh, it'll probably be easier to find someone suitable.
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Seeing some of the other responses here, I want to add I've consulted other professionals in my country that use FAB who did not agree with Dr. Gunson's criteria as far as what types of movements are convenient for my bite.
Explanation:
The reason lies in my orthodontic set-up.
My upper incisors are flared out and need to be straightened (ideally). Which would require bringing back all of my upper teeth.
Dr. Gunson didn't think the extensive dental work was worth it (reducing the effects of the problem to aesthetic matters), while the professionals here didn't see fit moving forward with another procedure when, even if my bone structure was in an ideal position, the bite would remain out of place.
Note, if I had CCW in my current situation the position of my incisors would be further compromised.
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Lastly, I haven't been able to schedule a consultation with Dr. Cifuentes because of the pandemic. Apparently he doesn't offer a virtual alternative; therefore I can't yet speak on what he would do.
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as I was told by Kavan ,I need a CW rotation with posterior downgraft.
Should I choose a surgeon who use NEMOfab system,?
Maybe I’m incorrect, but thought posterior downgrafting would be CCW rotation, not CW. Or did he mean overall downgrafting, but more anterior downgrafting than posterior downgrafting? That would be CW rotation
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Maybe I’m incorrect, but thought posterior downgrafting would be CCW rotation, not CW. Or did he mean overall downgrafting, but more anterior downgrafting than posterior downgrafting? That would be CW rotation
overall
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I’m getting a maxilla Downgraft in Korea soon for more tooth show and to get a longer face. I’m not sure if you would want to get it done there since Asian aesthetics are different but since I’m Korean I actually prefer a doctor familiar with asian faces. It’s extremely affordable and he says I won’t need braces either. Sorry if this isn’t what your talking about I just saw the word down graft. Did you have braces to hide a underbite? That was my situation and I have no idea how he hid it without extractions or an expander or anything.
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I’m getting a maxilla Downgraft in Korea soon for more tooth show and to get a longer face. I’m not sure if you would want to get it done there since Asian aesthetics are different but since I’m Korean I actually prefer a doctor familiar with asian faces. It’s extremely affordable and he says I won’t need braces either. Sorry if this isn’t what your talking about I just saw the word down graft. Did you have braces to hide a underbite? That was my situation and I have no idea how he hid it without extractions or an expander or anything.
do you mind sharing which korean doctor you are doing a downgraft with? If I recall correctly, korean surgeons don't really like to do downgrafts