Author Topic: Side wing, chin wing surgeons + zygo osteotomy  (Read 3075 times)

Jordart19

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Side wing, chin wing surgeons + zygo osteotomy
« on: May 16, 2019, 01:41:51 PM »
Hi all

Am currently considering chin or side wing and potential genio.
Was hoping somebody who has been through on could share their experience of the actual recovery process.

Also was hoping for some recommendations on get side wing and/or chin wing docs in the world. I have seen Dr Brussco, Triaca and Dr Z mentioned. Any feedback on these three and are there any better? I am UK based but travel is not a problem.

As I understand it a bone graft is usually taken from the hip. I am not keen on this, is there an alternative way around this? Also I have heard that there is typically some absorption of the graft and the only way to avoid it to graft from skull which I am obviously no going to do. Is cadaveour skull donor possible or is risk of infection too much?

Also would like zygomatic osteotomy. Who's the best in the world at doing them?

I find it hard to believe there isn't a decent implant material out which doesn't carry risk of infection or erosion. Forgive me if this is a stupid question but why can't an implant just be made from actual bone the same way they use bone grafts? Surely there is the technology to be able to cut it/shape it precisely enough then it could just be screwed on like any other implant and I guess then the only problem would be absorption.

Seriously though there must be some ultra advanced implant out there somewhere that is exactly like bone or just bone which ticks all the boxes???

valhalar

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #1 on: May 17, 2019, 06:29:24 PM »
Dr Triaca is older now and reportedly isn't performing chin wings as much now. Some users gave some feedback on consultation with him: http://jawsurgeryforums.com/index.php?topic=6661.0

Dr. Brusco (same clinic) performs most of the chin wings and it essentially the co-creator of the modern version of the procedure. I have seen some good results from him. He will probably be the one who has done them the longest second only to Triaca. Dr. B reportedly did chin wing for 10k Swiss francs a few years ago, however when you factor in hospital stay in Switzerland thats another 8k francs and then maybe anaesthetic is a separate cost (unsure).

Dr. Z learned off them and has been doing them for years now. From what I have read he is just as good. There aren't many before/after pictures due to German law, however you can see these in his clinic. He also performs the zygo osteotomy and from reading forums he seems to be doing the bulk of them. He can do CW and zygos at the same time. Some people have said his price has increased to about 12k euro however others say it's 8k. The hospital stay is a lot cheaper in Germany, right next to Dr Z's clinic and many people stay the full two weeks after.

There is a company that created implants that turn into your bone over time, however they found the bone remained incredibly brittle. I think in one instance a bone in one woman's face completely shattered after a fall. I think it is far too early days for this.

My personal preference is against implants because they just seem like an artificial and embarrassing option. I'd rather have my bone repositioned and be imperfect than having a custom implant that sinks into my bone and looks like crap, also shows up on x-rays every time you are at the dentist lol. Implants look nice in photos but I have seen so many in videos that look plain wrong.

I am looking to consult with Dr. Z in Berlin this year so my answer may change. This is purely word of mouth based on what people have written on this forum and others.

Keep in mind that some people do opt for two chin wing procedures spaced one year apart to get additional projection.
« Last Edit: May 17, 2019, 06:52:02 PM by valhalar »

Jordart19

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #2 on: May 18, 2019, 11:44:20 AM »
Many thanks for your response.

I've seen a place in London does bone grafts as an alternative to implants.

This sounds good although I have heard the bone reabsorbs over time and I am not particularly keen on  actually having the bone harvested from my hip. Although, still likely to need bone graft for chin wing or side wing anyway.

What's the recovery like for zygo osteotomy and CW? It's not as brutal as bimax or say or fort I is it?

Lestat

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #3 on: May 18, 2019, 12:00:30 PM »
I've seen a place in London does bone grafts as an alternative to implants.

Name please.

This sounds good although I have heard the bone reabsorbs over time

Who told you that?!

Jordart19

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #4 on: May 18, 2019, 12:57:17 PM »
The London place doing bone grafts is...
https://www.thefacesurgeons.co.uk/treatments/jaw-surgery/%ef%bb%bfjaw-augmentation-with-implants-mandibular-angle/
If you scroll down to where it says alternatives it says bone only grafts but says bone can resorb overtime. Can't remember the name but somebody on this forum said the same thing.

Jordart19

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #5 on: May 18, 2019, 01:02:18 PM »
Anybody ever seen or heard of the below???

https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/oral-maxillofacial-dental/bone-grafting.html

Could it work as an alternative to mandible implants or chin wing/side wing???

valhalar

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #6 on: May 18, 2019, 02:50:07 PM »
This sounds good although I have heard the bone reabsorbs over time and I am not particularly keen on  actually having the bone harvested from my hip. Although, still likely to need bone graft for chin wing or side wing anyway.

Some surgeons are now offering a balcony genioplasty which pulls forward the bone where you would otherwise get a chin visor. No graft needed, just a genioplasty with a higher cut in the mandible. Obviously only on people who are viable. I am unsure which surgeons offer this but the guy in this thread said his surgeon did:

http://jawsurgeryforums.com/index.php/topic,7698.msg68950.html#msg68950

Lestat

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #7 on: May 19, 2019, 06:04:17 AM »
-"Bone on-lay grafting, bone is harvested from the hip or the skull bone, shaped and fixed onto the jaw. Over time bone placed this way can gradually resorb."

The question is how much of the bone will resorb. I do not believe that everything will resorb. Maybe 30%? Could someone maybe email them, to solve this mystery, English is not my native language.

Jordart19

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #8 on: May 19, 2019, 09:03:00 AM »
-"Bone on-lay grafting, bone is harvested from the hip or the skull bone, shaped and fixed onto the jaw. Over time bone placed this way can gradually resorb."

The question is how much of the bone will resorb. I do not believe that everything will resorb. Maybe 30%? Could someone maybe email them, to solve this mystery, English is not my native language.

Below link seems it could reduce resorption of a graft...
https://www.geistlich.co.uk/en/dental/therapeutic-area/major-boneaugmentation/scientific-background/

kavan

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #9 on: May 19, 2019, 02:00:52 PM »
Bio-Oss is a made from OX-bone (well, cattle). It's called a 'XENO-graft' because it's FORIEGN to your own species (human). It's main advantage over an 'AUTO-graft' (not only bone from your own species but bone from your SELF) is that it doesn't require a separate operation to harvest it. It's often used for putting in tooth implants so there is a bone matrix for the implant to go into and also so your own bone grows into the matrix. In that way, the bone density of the area they need to screw the implant into, increases.

I have NO IDEA how they can differentiate the rate of resorption of bio-oss vs rate of resorption of your own bone in a situation where your own bone grows into the BO matrix. As long as the net bone density to the area grafted with the stuff increases is all that matters.

A bone GRAFT really isn't exactly an 'onlay' as is a 'stick on' face implant unless it's harvested from 'compact' bone (cortical) bone , outer surface of bone. The other type of bone is the inside bone, (cancellous) or spongy. Compact bones are made of osteons while spongy bones are made of trabeculae. Compact bones are tough and heavy while spongy bones are light. Compact bones fill the outer layer of most of the bones while spongy bones fill the inner layer of the bones.

Bone GRAFTS used in such things as chin wings and zygo osteos are NOT 'onlays' or 'stick ons'. They are 'in betweens' as in in between the bones cut and separated by the osteotomy. They are bone BUTTRESSES to the cut surfaces so that bone cells can grow into the CHANNELS (pores) of the bone buttress. That is what bone GRAFTING refers to when the reference is chin wings and zyg osteos. So the cancellous or 'spongy' bone is used for those. For the graft to take, the cut surface of your face bones must make direct contact with the bone graft, otherwise, your cut face bones with exposed surfaces RESORB if there were no buttress between them.

So, if you want an ONLAY (or even a bone buttress) for face augmentation, it isn't going to happen with 'your own bone' without a bone harvest. If you are AVERSE to materials used for onlays (face implants) that have no chance of resorbing (eg. silicone, PEEK, medpore, titanium, onlay augmentation isn't going to happen either. If you want something like CATTLE BONE (Bio-Oss) to be uses as a face augment ONLAY, I doubt that's going to happen either BECAUSE it's meant to be SURROUNDED by your own bone so it can grow into it. If one side of it didn't have direct bone contact (like the outer surface of an implant onlay used in face implants), it would tend to resorb. (exposed surface).

In short, a bone graft, (usually made from cancellous bone) meant to be SURROUNDED by your own bone so your own bone grows into it's channels, can't be used as an ONLAY because an onlay, by definition, would have an exposed outer surface that would tend to resorb.

The only material I can think of that is actually MADE FROM BONES (animal bones) that would not resorb if used as face implant onlays is porcellian as in 'bone china' made from the inorganic mineral containing ash of burned bones. However, how bio-compatible 'tea cup' face implants  would be, I don't know. But they certainly would be breakable.


Please. No PMs for private advice. Board issues only.

Jordart19

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Re: Side wing, chin wing surgeons + zygo osteotomy
« Reply #10 on: May 20, 2019, 10:52:21 AM »
Seen this from another thread on here...

"So I just called Dr Z and spoke to him about Bone Resorption as I know this was a concern from some people who wanted to get the chin/side wing. He said bone resorption can occur with any type of bone surgery. He advised the way to counter bone resorption will be to add more graft of the hip bone and to also watch that the segments aren't too small. He advised that the jaw bone will be stable after one year, so bone resorption only occurs within the first year. "

So I guess at the end of the day one can never really completely avoid some resorption. Is it correct that it is only for the first year or is that just when it is at its most likely to resorb?

I guess with the case of the onlay bone graft to say the mandible you could make minor cuts like scoring on the native bone graft site, layer with osteoconductive membrane laced/layered with bone morphogenetic proteins and then also score the actual onlay graft too and this should in theory reduce resorption.