Dr Hernandez Alfaro

[ppsk]

I too think Raffaini's pictures are great, but I've also spoken to people who've actually consulted with him and have pointed out that he cherry-picks the absolute best cases. Its not a good metric to rely on, IMO its a much better indication of a surgeon when you are seeing not only the good cases with people who are basically good looking aside from their deformity and then having the deformity fixed, but you are also seeing people who are frankly ugly and still ugly but better looking after the surgery.

That said, Raffaini is absolutely competent and experienced I'm sure, but it is worth remembering we're seeing the cream of the crop only.

[girl]

These two Alfaro results don't look good at all:
http://www.institutomaxilofacial.com/en/caso-clinico/ana-4/ - no impaction of the upper jaw
http://www.institutomaxilofacial.com/en/caso-clinico/eva-maria/ - over advancement of the lower with a too long chin (now looks like an underbite)

[Langpam]

Yes I forget her username but she had a good result, he did counter clockwise rotation and a genioplasty in something like 4 hours? I can't quite remember but it was in short time which might sound alarming because you would want the surgeon to take care but really the less time you are subjected to general anesthesia the better, it causes brain damage amongst other health problems and the shorter the surgery, the quicker the recovery.

Personally, I would be very interested in having a consultation with him.

I am that " older lady" and had the surgery 31 months ago. Delighted with the whole process!
The operation took less than two hours. Great surgeon, excellent treatment. I stayed in a nearby hotel
for six days afterwards. I only looked on the site today as someone contacted me from this site.

[UKMaxfac]

I am that " older lady" and had the surgery 31 months ago. Delighted with the whole process!
The operation took less than two hours. Great surgeon, excellent treatment. I stayed in a nearby hotel
for six days afterwards. I only looked on the site today as someone contacted me from this site.

Hi Langpam,

Did you have any nasty long term side effects from the surgery? Any significant nerve issues? Funny sensations?

Just curious, thanks.

[UKMaxfac]

These two Alfaro results don't look good at all:
http://www.institutomaxilofacial.com/en/caso-clinico/ana-4/ - no impaction of the upper jaw
http://www.institutomaxilofacial.com/en/caso-clinico/eva-maria/ - over advancement of the lower with a too long chin (now looks like an underbite)

Yeah those are poor.
Damnit, I wish choosing surgeons was easier.

[Lefortitude]

You have seen Dr Zarrinball's results? They are only available in clinic.

Ive seen his results in office.  He is very honest about them, showing me extremely good results, more subtle results, and difficult cases which would potentially turn off the uninformed layman.  He is very competent aesthetically, and can deliver excellent results.  His honesty and transparency put him near the top of my list for europe.  Results were all considerable improvements, mostly conservative, but correctly diagnosed.  He does decent jaw surgery, and should certainly be considered.

[Milli_Meters]

Ive seen his results in office.  He is very honest about them, showing me extremely good results, more subtle results, and difficult cases which would potentially turn off the uninformed layman.  He is very competent aesthetically, and can deliver excellent results.  His honesty and transparency put him near the top of my list for europe.  Results were all considerable improvements, mostly conservative, but correctly diagnosed.  He does decent jaw surgery, and should certainly be considered.

Thanks!

[PloskoPlus]

These two Alfaro results don't look good at all:
http://www.institutomaxilofacial.com/en/caso-clinico/ana-4/ - no impaction of the upper jaw
http://www.institutomaxilofacial.com/en/caso-clinico/eva-maria/ - over advancement of the lower with a too long chin (now looks like an underbite)

Ana would've benefitted from an upper lip lift followed by impaction... But how many oral surgeons are comfortable suggesting this?  Lip lifts are a gamble even with the best plastic surgeons.

Eve would've probably benefitted from vertical chin reduction and I'm not sure if her midlines are perfectly aligned (I could've sworn there used to be close ups of her bite on that page before).

Having said this, these were pretty hard cases.  I don't think any surgeon would've done better where I live.

[CCW]

Ana would've benefitted from an upper lip lift followed by impaction... But how many oral surgeons are comfortable suggesting this?  Lip lifts are a gamble even with the best plastic surgeons.

Eve would've probably benefitted from vertical chin reduction and I'm not sure if her midlines are perfectly aligned (I could've sworn there used to be close ups of her bite on that page before).

Having said this, these were pretty hard cases.  I don't think any surgeon would've done better where I live.

Ana's nose is her biggest flaw. It sort of throws everything off.

You can see pictures of Eva's bite in the video. The midlines were way off before. After, the bite looked solid, but the midlines were still a little off.

[UKMaxfac]

How are these poor? What makes you think the first girl needs impaction? The second girl was rotated drastically and is a huge success considering her base state.

Second girl: went from recessed chin to a masculine chin and an almost class 3 appearance.

First girl: theres no more harmony in the midface, her philtrum is still way too long and she is still a mouth breather with lip incompetence. You can see she still shows way too much tooth at rest.

There are other bad results on there too. I'm not impressed with many of his cases at all. They look 'overdone' in many cases. He assured me this won't happen with me but I'll never trust the words of a surgeon again after my experience with Haers.

[girl]

Plosko - you make an interesting point about lip lifts. The orthodoxy of looking at whether the patient has a short upper lip as a marker of vertical maxillary excess is about as helpful as looking at the colour of one's hair or eyes in the same context. In such cases, what should happen is that the impaction should be done as per the orthognathic problem, THEN a lip lift should be done in order to adapt the soft tissue to the corrected structure. Yet many doctors don't actually think along these lines, which is ridiculous. To me, it's obvious that within a certain growth pattern there will be a number of variations from person to person due to genetics or concurrent/separate facial development issues. Most surgeons have a very orthodox approach to these problems and people just submit to their plans because they aren't aesthetically astute and are "happy" regardless.

As a woman, I would not be comfortable going to Alfaro but if I was male, I might consider him if I desired a very strong jaw.

[PloskoPlus]

Plosko - you make an interesting point about lip lifts. The orthodoxy of looking at whether the patient has a short upper lip as a marker of vertical maxillary excess is about as helpful as looking at the colour of one's hair or eyes in the same context. In such cases, what should happen is that the impaction should be done as per the orthognathic problem, THEN a lip lift should be done in order to adapt the soft tissue to the corrected structure. Yet many doctors don't actually think along these lines, which is ridiculous. To me, it's obvious that within a certain growth pattern there will be a number of variations from person to person due to genetics or concurrent/separate facial development issues. Most surgeons have a very orthodox approach to these problems and people just submit to their plans because they aren't aesthetically astute and are "happy" regardless.

As a woman, I would not be comfortable going to Alfaro but if I was male, I might consider him if I desired a very strong jaw.

That's what I thought before, but no, the lip lift must happen before and Gunson was the one who suggested it.  It makes perfect sense actually.  Lip lifts are pretty unpredictable.  If you do one afterwards you may end up with lip incompetence.  If you do one before, the impaction (and possibly genioplasty) will be tailored to match your new lip length perfectly, so you won't have lip incompetence afterwards.

[girl]

Ideally that would happen, but then you have the challenge of finding a lip lift doctor prepared to do this and expose your 'gummy smile'. I guess you'd have to make a case for the fact you intend on getting bimax afterwards and maybe even ask for the maxillofacial surgeon's input on the amount to remove.

Plosko - you make an interesting point about lip lifts. The orthodoxy of looking at whether the patient has a short upper lip as a marker of vertical maxillary excess is about as helpful as looking at the colour of one's hair or eyes in the same context. In such cases, what should happen is that the impaction should be done as per the orthognathic problem, THEN a lip lift should be done in order to adapt the soft tissue to the corrected structure. Yet many doctors don't actually think along these lines, which is ridiculous. To me, it's obvious that within a certain growth pattern there will be a number of variations from person to person due to genetics or concurrent/separate facial development issues. Most surgeons have a very orthodox approach to these problems and people just submit to their plans because they aren't aesthetically astute and are "happy" regardless.

As a woman, I would not be comfortable going to Alfaro but if I was male, I might consider him if I desired a very strong jaw.

[PloskoPlus]

Ideally that would happen, but then you have the challenge of finding a lip lift doctor prepared to do this and expose your 'gummy smile'. I guess you'd have to make a case for the fact you intend on getting bimax afterwards and maybe even ask for the maxillofacial surgeon's input on the amount to remove.

In the case of Gunson, he would refer the patient to his favored plastic surgeon with a specific shortening request in mms. So this definitely should be done with the max facs input. Fwiw, he told me that cases requiring lip shortening are rare.

[zygotic]

These two Alfaro results don't look good at all:
http://www.institutomaxilofacial.com/en/caso-clinico/ana-4/ - no impaction of the upper jaw

This woman's after pic is pretty much the female equivalent of myself. Long midface, philtrum, upturned nose and mouth breathing.

How much of a difference would impaction make to this case? Would it require more forward projection to avoid loose skin? It looks to me like impaction would reduce the upturned nose by raising the ala part of the nose, but I've never seen any examples of that.