Author Topic: Revision zygomatic osteotomy: anyone?  (Read 31479 times)

PloskoPlus

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Re: Revision zygomatic osteotomy: anyone?
« Reply #30 on: September 29, 2015, 10:22:02 PM »
All in all, if high strong cheekbones is what you are aiming for, it might be best to take the limitations of the zygomatic sandwich osteotomy into consideration and decide whether you might need a different type of osteotomy that augments a bigger part of the zygomatic bone.
Triaca says zso will create more lateral projection. THAT'S ALL. No anterior projection, not higher cheekbones.

PloskoPlus

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Re: Revision zygomatic osteotomy: anyone?
« Reply #31 on: September 29, 2015, 10:24:47 PM »
Agree with lazlo. Credentials are just that at the end of the day - credentials. Lots of credentialed nobodies out there, medicine is not immune to title inflation.

Lazlo

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Re: Revision zygomatic osteotomy: anyone?
« Reply #32 on: September 30, 2015, 01:13:37 PM »
OP, thank you for the valuable information and thoughts on the ZSO.  You may have saved some people from making the wrong decision by putting information out there that surgeons might not tell patients that are contemplating a ZSO.

Agreed

PloskoPlus

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Re: Revision zygomatic osteotomy: anyone?
« Reply #33 on: September 30, 2015, 01:43:15 PM »
OP, thank you for the valuable information and thoughts on the ZSO.  You may have saved some people from making the wrong decision by putting information out there that surgeons might not tell patients that are contemplating a ZSO.
Alas, seems like too many doctors will only recommend the stuff they know.  "When all you have is a hammer".

Bobbit

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Re: Revision zygomatic osteotomy: anyone?
« Reply #34 on: September 30, 2015, 04:02:16 PM »

But I know for a fact that Kawamoto who is arguably the most notable craniofacial surgeon in America, would not perform zygomatic or orbital rim or modified leforts on ANY patients for cosmetic purposes. I know this because I talked to his nurses several times and was recommended that Kawamoto would do implants only. So big deal if someone has all this training and a designation but doesn't feel competent or trained enough or whatever the reason may be to perform the operation.

Dr. Mark Urata, Kawamoto's most distinguished pupil both a craniofacial surgeon AND a maxillofacial surgeon also doesn't perform and orbital/cheekbone modified lefort operations for cosmetic purposes.



I understand your desire to obtain a specific surgical procedure.   

Consider the possibility that the highly trained and experienced surgeons  you referenced,  - -  declined to do the specific cosmetic procedure you are seeking - -  not because they cannot do that procedure (obviously they do in fact do those procedures in the right circumstances)  but they elect not to do that procedure electively because in their experience the benefits are  exceeded by the risks.  (That is one way to avoid a malpractice suit.)

In any field of human activity, including surgery,  - -  just because you can do something - -  does not mean you should do something.

It puzzles me that in some of these messages:

A) Posters first claim  that surgeons are  (pick the ugly name to be called) - -  because they are not trained well enough but just start cutting on people to make the money;  but then,

B) In nearby messages,  surgeons who are extremely well trained and capable but who decline to do certain well paid elective procedures are criticized for exercising conscientious surgical judgment and refusing to do certain surgeries.

There is a certain disconnect between those two lines of discussion.




« Last Edit: September 30, 2015, 06:56:48 PM by Bobbit »

PloskoPlus

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Re: Revision zygomatic osteotomy: anyone?
« Reply #35 on: September 30, 2015, 04:08:15 PM »
Because complex osteotomies are HARD and time consuming. Why do them when you can make more money doing quick fillers and fat grafts.

Bobbit

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Re: Revision zygomatic osteotomy: anyone?
« Reply #36 on: September 30, 2015, 04:31:38 PM »
Because complex osteotomies are HARD and time consuming. Why do them when you can make more money doing quick fillers and fat grafts.

I do not think that money / time is the reason.  On the contrary.   

They are hard and they are time consuming procedures - -  But that is what surgeons get paid big dollars for doing - - long operations in the operating room. 

Most surgeons make a lot more money in the OR with elective procedures than they do with fillers.   What ?  A & G  get  $50 + K for a double jaw surgery that takes 5 hours ?   If that is not about the right number,  then what is ?

Not being critical of the amount - -  however it appears that is the  ~ $/hour range they are getting paid for their elective operating work.


 (I think fat grafts end up being an art form.  Harder to get right than most anticipate. )

Bobbit

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Re: Revision zygomatic osteotomy: anyone?
« Reply #37 on: September 30, 2015, 07:04:25 PM »
Again, somebody double check my math:

Filler about $300 wholesale for a 2pack of syringes.
Average two syringes per patient treatment
Docs charge about 500 per syringe = $1K per treatment
Profit = 1,000 – 300 = $700 profit per treatment
Estimate 10minutes injecting time (not sure on this, someone correct me if time is not right)
5 patients per day x 5 days per week = 25 treatments per week
4.25 weeks per month * 25 treatments per week = 106.25 treatments per month
106.25 treatments  per month * $700 = $74,375 profit per month
106.25 * 10 minutes =  1,062.5 minutes = 17.7 hours doctor hours
Average $700 profit per 10 minutes = $4,200 per hour

The problem with all of those injectables is that almost any medical person can do those - - and thus - -  the surgeon doesn't control that market.  In many of the offices that offer those - -  they are done by nurses or nurse practioners with no supervision. 

I do not think that has a lot to do with our discussion of osteotomies.


Bobbit

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Re: Revision zygomatic osteotomy: anyone?
« Reply #38 on: September 30, 2015, 08:06:52 PM »
No, it doesn't and I apologize if I came across as abrasive.  I wondered when I saw the discussion in the thread of why docs are moving from the hard surgeries to fillers and decided to do the math.  I am still double-checking it, it seems unreal.

Botox$ 487.50 (= 3 minutes)  + Filler $700   (= 10 minutes)
= $1187.50 every 13 minutes
60 minutes per hour /13 minutes per treatment = 4.615 treatments per hour
= $5480.76 per hour
Or even if appointments were scheduled every 15 minutes a doc could make $4750 per hour if he/she had a good assistant setting the patients up.  I am sure the risk of malpractice is less with injectables than surgeries.  No nurses or anesthesiologist  or sterile operating room fees.
It explains why all the sleezeballs are pushing injectables.

$4750 per hour x 8 hours = $38,000 profit.

I am sure those surgeries take the surgeon's time planning them, too.  I bet they really do make more on injectables.

If you are right - -  then no surgeon would bother to do any surgery.   They would spend all their time doing injectables. 

But since nurses do injectables in general practitioners' offices - -   the competition for the patients in that market is pretty extreme. 

 

ncharm

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Re: Revision zygomatic osteotomy: anyone?
« Reply #39 on: September 30, 2015, 08:31:18 PM »
Fillers also have less risk of going wrong. If somehow the procedure goes awry, you can just wait for the stuff to get reabsorbed, or make it dissolve with another substance etc, but if the bone is moved, then it's moved, and you'd have to go in there again and try and fix it, or maybe you've damaged a nerve, or there's an infection etc...seems quite clear cut to me

Lazlo

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Re: Revision zygomatic osteotomy: anyone?
« Reply #40 on: September 30, 2015, 08:51:25 PM »
Bobbit, you just assume that surgeons are not doing a particular surgery because they're exercising judicious decision making. That's BS. They just don't want to do them cause they're tough and they can make way more money doing implants and injectibles which take way less time and are quick and easy solutions. Bobbit, it is true. Why do you think not only every surgeon,  but every bloody GP on the earth now offers fillers and botox.

Bobbit

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Re: Revision zygomatic osteotomy: anyone?
« Reply #41 on: October 01, 2015, 04:06:05 PM »
Bobbit, you just assume that surgeons are not doing a particular surgery because they're exercising judicious decision making. That's BS. They just don't want to do them cause they're tough and they can make way more money doing implants and injectibles which take way less time and are quick and easy solutions. Bobbit, it is true. Why do you think not only every surgeon,  but every bloody GP on the earth now offers fillers and botox.

Lazlo:

Do some surgeons do what you claim is the norm ?   Probably. 

I have a working knowledge of the practice of about half a dozen board certified plastic surgeons.  A couple of them share a common hobby and we therefore socialize from time to time.  None of them make a living doing injectables.  A few of them have nurses or P.A.'s on their staff who do injectables for a limited number of patients.  I think that is done because it does bring a population of prospective future facelift patients to their offices.   Occasionally the patient will insist on a doctor to do the injectables.   In those few cases,  if the surgeon is available,  he or she may do that.  But personally doing injectables is relatively rare in the case of every one of the surgeons with whom I have some familiarity about the nature of their practices.     So,  from my perspective,  I am about  zero for six that fit your descriptions of what you claim is the norm.

But ultimately I am with Facenit on this - -   enough about injectables !     






hellohello

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Re: Revision zygomatic osteotomy: anyone?
« Reply #42 on: October 03, 2015, 03:34:29 PM »
Does anyone know which surgeons perform a different type of zygomatic osteotomy that also covers at least part of the upper zygomatic bone towards the inferior orbital rim? (So not the zygomatic sandwich osteotomy that I feel as mentioned does nothing for the upper zygomatic bone).

Rico wrote to seek a surgeon that performs a zygomatic osteotomy that covers (part of the) upper zygomatic bone and in his case the inferior orbital rim: which surgeons did he consult with that perform such an osteotomy?

ncharm

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Re: Revision zygomatic osteotomy: anyone?
« Reply #43 on: October 03, 2015, 11:44:58 PM »
There is a reason most surgeons don't want to mess with your infraorbital bone.

PloskoPlus

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Re: Revision zygomatic osteotomy: anyone?
« Reply #44 on: October 04, 2015, 12:00:44 AM »
Does anyone know which surgeons perform a different type of zygomatic osteotomy that also covers at least part of the upper zygomatic bone towards the inferior orbital rim? (So not the zygomatic sandwich osteotomy that I feel as mentioned does nothing for the upper zygomatic bone).

Rico wrote to seek a surgeon that performs a zygomatic osteotomy that covers (part of the) upper zygomatic bone and in his case the inferior orbital rim: which surgeons did he consult with that perform such an osteotomy?
Sinn, Woford, probably some others in Dallas.  Dallas is a hotbed for aggressive osteotomies.