jawsurgeryforums.com
General Category => Aesthetics => Topic started by: jawsurgeryadvice on May 14, 2017, 03:58:04 AM
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I had a consultation with a dr (dr J.D) in Belgium this week.
I have a little overbite and a steep mandibular plane angle with a strong chin.
This is the plan he made for me:
1. Moving my lower jaw +- 4 mm forward.
2. shaving of a bit of the side parts of my jawline (the parts next to the chin).
3. a little bit sliding genioplasty
Now I also thought my upper jaw should be more advanced and some members here who saw my pictures said I should do a CCW rotation. The doctor didn't say anything about CCW and he didn't want to do an advancement and/or impaction because that could age me.
Instead of that he wanted to:
4. fill in my nasolabial fold area with HA paste. He said I lack bone support there and that's one of the reasons I have a little too much gum showing when I laugh.
5. I have low cheekbones and a negative orbital vector, so he wants to put some HA paste on the higher parts of my cheekbones and orbital rim area.
Could you guys give your opinions about his plan. Especially the HA paste. I read a few stuff about it here, but im still not really sure about it yet.
And I'm also a bit skeptical about the jawline shaving, because what will happen to the soft tissues in that area? Will it hang, because there is a lack of bone support? Or will the advancement compensate the lost of bone support?
I could PM some pictures if anyone wants.
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PM me pics.
I had consultation with Dr. Df too. I liked the consultation, but I didn't like his suggested options, so I won't be choosing him.
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Could you guys give your opinions about his plan. Especially the HA paste. I read a few stuff about it here, but im still not really sure about it yet.
You went all that way and you didn't ask for photos just to see what he could achieve with the methods he in fact used!?
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He has a lot of before and after pics on his website, so I actually did. My next appointment will be in July and I'll ask him some more specific pictures. But of course he is positive about the HA paste, since he uses it so often. Just wanted to know your guys' opinion since some are very knowledgeable in this forum.
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Now I also thought my upper jaw should be more advanced and some members here who saw my pictures said I should do a CCW rotation. The doctor didn't say anything about CCW and he didn't want to do an advancement and/or impaction because that could age me.
Did he say why or how that would age you? I've been wondering about this as well.
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@ditterbo I dont know what he exaclty did, but he did measure how much of my front teeth was showing (in height) when i opened my mouth (and that was good already). And also I dont really have gum showing when I smile only when I have a good laugh. So I think based on these 2 things he thought an upper jaw surgery would age me, especially an impaction since there is less bone support for the soft tissues. Also he was scared that my nose will change in a negative way.
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What did he say exactly about the HA ? How does he want to use it ?
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@ditterbo I dont know what he exaclty did, but he did measure how much of my front teeth was showing (in height) when i opened my mouth (and that was good already). And also I dont really have gum showing when I smile only when I have a good laugh. So I think based on these 2 things he thought an upper jaw surgery would age me, especially an impaction since there is less bone support for the soft tissues. Also he was scared that my nose will change in a negative way.
Interesting. I have no gum show and my orthodontist says upper jaw surgery will give way to some gum show for me too.
That's also a huge worry of mine, the aging, but wouldn't a ccw do the opposite? Tighten the skin/bone support and give a more youthful appearance?
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I have little teeth showing when smiling/talking.I would rather have moderate gum show over no teeth showing any given day.
Some gum show looks youthful. Teeth covered while smiling looks old.
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He offers a 3d mapping of your face and skull with a simulation of what jaw surgery can achieve. This is only after you pay the hefty fee for all the x-rays etc to be taken though. He then detracts some of that payment out of the final cost of the surgery.
I found that actually seeing a proper simulation of the changes extremely helpful - it might help you as well.
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I don't like Defrancq and here are three (http://www.facialsculptureclinic.com/en/case/jaw-surgery/open-bite/46/) examples (http://www.facialsculptureclinic.com/en/case/jaw-surgery/open-bite/172/) why (http://www.facialsculptureclinic.com/en/case/jaw-surgery/-lower-jaw-too-short-overbite-deep-bite/68/). He doesn't do CCW and uses a posterior impaction to close an open bite. This makes the OP steeper, puts more strain on the joints, doesn't fix the airway, or the face. He then does a huge ugly genio to camouflage the recession, which would be unnecessary if he did CCW. If you don't routinely do CCW when it's indicated, you're not a good surgeon in my opinion. I wouldn't have surgery with him.
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I don't like Defrancq and here are three (http://www.facialsculptureclinic.com/en/case/jaw-surgery/open-bite/46/) examples (http://www.facialsculptureclinic.com/en/case/jaw-surgery/open-bite/172/) why (http://www.facialsculptureclinic.com/en/case/jaw-surgery/-lower-jaw-too-short-overbite-deep-bite/68/). He doesn't do CCW and uses a posterior impaction to close an open bite. This makes the OP steeper, puts more strain on the joints, doesn't fix the airway, or the face. He then does a huge ugly genio to camouflage the recession, which would be unnecessary if he did CCW. If you don't routinely do CCW when it's indicated, you're not a good surgeon in my opinion. I wouldn't have surgery with him.
That was a bad result. What do you think he did here - http://www.facialsculptureclinic.com/en/case/all-cases/169/ moved the whole maxilla down?
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I don't like Defrancq and here are three (http://www.facialsculptureclinic.com/en/case/jaw-surgery/open-bite/46/) examples (http://www.facialsculptureclinic.com/en/case/jaw-surgery/open-bite/172/) why (http://www.facialsculptureclinic.com/en/case/jaw-surgery/-lower-jaw-too-short-overbite-deep-bite/68/). He doesn't do CCW and uses a posterior impaction to close an open bite. This makes the OP steeper, puts more strain on the joints, doesn't fix the airway, or the face. He then does a huge ugly genio to camouflage the recession, which would be unnecessary if he did CCW. If you don't routinely do CCW when it's indicated, you're not a good surgeon in my opinion. I wouldn't have surgery with him.
Yeah I also noticed that. Most of the outcomes aren't spectacular. And most of the pictures on his site are from people who had a very noticeable deformity, so its easier to make them look normal. I think I look okay already, but I just want that extra, and idk if he can help me with that :-\
My ortho told me a few days ago that there are actually quite some Dutch surgeons who perform a rotation of the jaws. But they are just not so worldwide famous like these other surgeons mentioned in this forum. So maybe I should see a local surgeon? (Im from the Netherlands).
Or does anyone know any good surgeons from the Netherlands or Belgium who do perform CCW rotation?
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I can't give surgeon recommendations in BENE, but I think you should travel if you want the best result. The prices are similar everywhere in Europe. Schedule a consultation with Alfaro, Raffaini and/or Marianetti.
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I can't give surgeon recommendations in BENE, but I think you should travel if you want the best result. The prices are similar everywhere in Europe. Schedule a consultation with Alfaro, Raffaini and/or Marianetti.
Have you heard of dr De Jonge? I Think he did a really great job in this case: http://cindyskaakoperatie.blogspot.nl/2015/09/re-post-voor-en-na-fotos-kaakosteotomie.html
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No, I haven't. In my opinion she should've been rotated more.
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That was a bad result. What do you think he did here - http://www.facialsculptureclinic.com/en/case/all-cases/169/ moved the whole maxilla down?
Yes and thats a fantastic result
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It sure is. But I am guessing no rotation was involved. He just downgrafted the maxilla while advancing the mandible. Looks like a substantive down graft too.
Anyway good for that kiddo. Transformative.
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Had exact same experience with him in regards to pushing the use of HA paste.
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As prometheus said, he was probably taught to use HA when it was all the rage like some surgeons push medpor if they were learning under the medpor revolution.
Most surgeons don't continue learning they just use what they were taught to and are comfortable with.
In some ways it is better to let them use their chosen material as they will have years of experience with it unlike a newer material.
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I think you're right Bowie. If not for this fracture I think I would let him use HA as he has decades of experience with it. Although you would have thought decades of experience would have provided a few more case studies showing how great it is.......
Yeah personally I don't think HA can do much so wouldn't go to a surgeon who uses it, if you want augmentation with a specific material then you really have to go with whatever surgeon is routinely using that material.
Unfortunately, that kind of blasé attitude you describe, like forgetting previous conversations and doing things "on the fly" is common amongst surgeons.
Although to us, our lives often depend upon these surgeries, the surgeons see god knows how many of our cases on a daily basis.
Not to excuse them as he should have looked at the previous email but this is the reality.
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For the surgeon it's A surgery, for you it's THE surgery. They don't have to live with the consequences, you do.
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Exactly. I just kinda expected more after having paid 1000 euro.
I'm actually being unfair now, I think. His proposal seems good and he hasn't been especially bad at anything, just very blasé about things that are a big deal to me.
I suppose these surgeons get a lot of customers who aren't as thorough as we are, and that do just trust the surgeon to do the best thing. But as we know, egos are dangerous in a game like this. He probably fully believes HA is top dog.
The HA is so cheap and I cant afford a separate operation at a later date, plus I need the jaws moved, so I might have to say f**k it and go ahead.
Keep in mind the HA he uses is not like any other HA. During my consultation with Dr Van Der Dussen we were talking about flat midfaces and he said that one way to augment flat midface is to use a granules via technique him and Joel Defrancq developed while they working together back in the day (I imagine he was taking about HA paste).
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Just look at an x-ray of an ha onlay graft. It looks like rough putty. It's imprecise and it's an irritant.
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Why are these reputable surgeons (DF , Gunson) using it? Df just sent someone I know an email saying HA wont be inflammatory at all and will not absorb.
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Gunson uses it too. People say he uses it "in a different way". Idk . Do not see Gunson's use as an orthodoxy or the retirement scheme you suggested. But yes confusing = s
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Okay Update!!
I had another appointment this week (its my 3d already and I have to come a 4th time before surgery).
The plan now is:
moving upper jaw 3 mm forward, some CCW rotation and down grafting (one side more than the other because of my asymmetry).
Lower jaw forward and 4 mm genioplasty.
some HA paste cheekbones and under the eyes.
http://nl.tinypic.com/m/ju8xtx/1
http://nl.tinypic.com/m/ju8xtd/1
http://nl.tinypic.com/m/ju8xua/1
Sorry that you can't see some parts of the after pics.
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Can I ask how you got your scan?? I've been emailing for months and had no reply.
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Those movements are tiny and won't give you much of an aesthetic change. Get a second and third opinion.
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Can I ask how you got your scan?? I've been emailing for months and had no reply.
I just called the hospital and made an appointment. Then he made these scans.
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Those movements are tiny and won't give you much of an aesthetic change. Get a second and third opinion.
Oh hmm, but what about the scans? That looks really different than how it is now i think?
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I just called the hospital and made an appointment. Then he made these scans.
How did you get a copy. I had scans done but I want a copy for myself.
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How did you get a copy. I had scans done but I want a copy for myself.
His assistent put the prints on his desk and while I was waiting for him i just took pictures of it with my phone
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You look to have a nice well proportioned and symmetric face judging by those scans. You should see mine from DF in comparison (I look awful).
I'm not sure the surgery is worth it judging from those. Post a profile image for more opinions however.
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I had a consult with DeFrancq. The consult was fine, but:
I really don't like his results
I think his suggestions for me was horrible and doesn't make any sense
So there's no way I would choose him as a surgeon. I've also had consults with some doctors frequently mentioned here - Raffaini, Z.
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Oh hmm, but what about the scans? That looks really different than how it is now i think?
To me, it looks as though most of the change would come from the genio. He needs more rotation.
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Update! 3 november I will have the surgery! Bimax + genio + ha paste. If someone has any questions about this doctor, feel free to ask :)
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Great to hear you're happy with your results!
I suspect I might only get small movements like you. Did you end up noticing much of a change?
How many mms did your mandible advance? And how much downgrafting was there?
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So I'm more than one year post op now! Haven't been on this website for a while, but I'm back now:) Im really happy with the results, its not perfect but still a great improvement! After my sarpe surgery 3 years ago I felt that something was off in my face and I didnt really know why, until i had my upper + lower + ha paste on cheekbones surgery. Everything looks more balanced now! Only down part is that im still wearing braces because the surgeon unfortunately made my midlines of my upper and lower teeth (jaw) more off balanced (it was better before). So the orthodontist was trying to correct this for one year and its almost good now (still not perfect because it was quite bad and the ortho cant do more than this). But overall im really happy. If anyone has questions about my procedure feel free to ask, because thats the main reason why i'm back here; to help people because I know how this longggg (stressful) journey can feel :)
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So I'm more than one year post op now! Haven't been on this website for a while, but I'm back now:) Im really happy with the results, its not perfect but still a great improvement! After my sarpe surgery 3 years ago I felt that something was off in my face and I didnt really know why, until i had my upper + lower + ha paste on cheekbones surgery. Everything looks more balanced now! Only down part is that im still wearing braces because the surgeon unfortunately made my midlines of my upper and lower teeth (jaw) more off balanced (it was better before). So the orthodontist was trying to correct this for one year and its almost good now (still not perfect because it was quite bad and the ortho cant do more than this). But overall im really happy. If anyone has questions about my procedure feel free to ask, because thats the main reason why i'm back here; to help people because I know how this longggg (stressful) journey can feel :)
How much did you paid for the surgery? Was the doctor Dr Mommaerts?
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Hi everyone again! So I havent been on this website for more than a year now. Still really happy about my results. I'm 3 years post op now. If anyone has any questions, just contact me. I would love to help other people cuz i know how hard and stressfull this whole journey can be. I'll try to be on this website for the upcoming days/weeks to answer. :D
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How much did you paid for the surgery? Was the doctor Dr Mommaerts?
Honestly I can't exactly remember anymore what the price was. My insurance covered most of it. I think the total was between 7 and 10k euros. My doctor was dr. Defrancq
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hi. thanks for your report:) you said that your cheekbones were built up with ha granules (or paste?). Would you recommend this to someone who wants to have more prominent cheekbones? How is your experience with this material? Are the differences clearly visible?
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hi. thanks for your report:) you said that your cheekbones were built up with ha granules (or paste?). Would you recommend this to someone who wants to have more prominent cheekbones? How is your experience with this material? Are the differences clearly visible?
Yes they were built up a little with HA paste. To be honest, the result is veryyyyy subtle and was mainly to create more symmetry. I think most of my facial changes are due to the jaw surgery in general and not so much the HA paste. However, I think the HA paste was needed tho for the overall look.
I still want a little bit more prominent cheekbones so thats why I will probably get some fillers in the upcoming months.
For someone who wants more prominent cheekbones, this material might be good if there is more product used, but I dont know how much is common to use. I honestly dont think very big changes can be made unlike fillers.
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Yes they were built up a little with HA paste. To be honest, the result is veryyyyy subtle and was mainly to create more symmetry. I think most of my facial changes are due to the jaw surgery in general and not so much the HA paste. However, I think the HA paste was needed tho for the overall look.
I still want a little bit more prominent cheekbones so thats why I will probably get some fillers in the upcoming months.
For someone who wants more prominent cheekbones, this material might be good if there is more product used, but I dont know how much is common to use. I honestly dont think very big changes can be made unlike fillers.
hi. thank you for your answer! Why won't you try fat instead of fillers? I suppose it is more permanent. What do you think?
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Fat transfer has a terrible reputation, there are so many accounts from people saying it is unpredictable and uneven and completely messed up people's faces. Fillers are way more predictable and easy to dissolve if necessary. If someone wants a permanent solution, there are PEEK implants etc.