Chin wing + zygomatic osteotomy with DR Z. in October

[Bowie]

I really hope that GrendelGegongan's graft stays, I thought other surgeons had said hip grafts don't last in the face.

Edit- Actually this Australian Professor also uses hip grafts for cheekbone augmentation! http://www.ddms.com.au/cosmetic-procedures/autogenous-cheek-augmentation/

[tim06]

I really hope that GrendelGegongan's graft stays, I thought other surgeons had said hip grafts don't last in the face.

Edit- Actually this Australian Professor also uses hip grafts for cheekbone augmentation! http://www.ddms.com.au/cosmetic-procedures/autogenous-cheek-augmentation/

He should have got an implant placed which is a lot less pain and bone work and it will not resorb after a few years. It is also cheaper.

[Lazlo]

No I think it would be great to have your own bone. f**k implants and lypholized cartilege

I think Grendelbro is gonna do really well. I'm rooting for him! But Grendel, make sure to give us a full report. Also try and note any resorption at the 3 month mark.

[triot]

Well, the surface of the CUT aspect of the iliac crest bone needs contact with either bone or other material so it does not resorb. You know.. the 'raw' part or part that the knife went through to harvest it can't be left exposed. However, the non 'raw' part eg. the very top of the illiac spine would not tend to resorb.

But how would that look in practice when using it as an onlay? The graft has cuts on three sides with only the top being protected by it's natural form. Shouldn't there still be significant absorption then, since not all sides can be protected from being exposed? (btw. I'm actually just assuming how the graft is harvested here, I don't really know how anybody does it.)

Hm, actually the only method that comes to my mind that could only damage one side of the graft would be if they cut through the highest point of the arch (can't really explain what I mean here 😅)

[kavan]

But how would that look in practice when using it as an onlay? The graft has cuts on three sides with only the top being protected by it's natural form. Shouldn't there still be significant absorption then, since not all sides can be protected from being exposed? (btw. I'm actually just assuming how the graft is harvested here, I don't really know how anybody does it.)

Hm, actually the only method that comes to my mind that could only damage one side of the graft would be if they cut through the highest point of the arch (can't really explain what I mean here 😅)

Your asking me to explain how something would look based on an assumption on how the bone is harvested?

All that is needed to be understood here is that the cut surface of the bone needs to make contact with another surface whether it be the cut surface of another bone (used as a bone buttress) or another bone butress material sandwiched between a bone cut.

If the bone slice from the iliac crest segment has an INTACT part to it, say the very 'top' part of the crest, that part is Cancellous bone. The cut under surface of it can be used as an onlay. But the intact part of it does not need to be covered with other bone or material.

[triot]

Your asking me to explain how something would look based on an assumption on how the bone is harvested?

All that is needed to be understood here is that the cut surface of the bone needs to make contact with another surface whether it be the cut surface of another bone (used as a bone buttress) or another bone butress material sandwiched between a bone cut.

If the bone slice from the iliac crest segment has an INTACT part to it, say the very 'top' part of the crest, that part is Cancellous bone. The cut under surface of it can be used as an onlay. But the intact part of it does not need to be covered with other bone or material.

I understood that. I just wanted to know what you think the theory would look like in practice. How would you cut out a graft from the iliac crest and use it as an onlay with only one "raw" side which can be put on the bone.
If you just cut a piece out, in the easiest way imaginable, you would have three "raw" sides. Since it's an onlay, you can only press one "raw" side on the bone. Two other "raw" sides would be exposed and thus vulnerable to absorption.

[kavan]

I understood that. I just wanted to know what you think the theory would look like in practice. How would you cut out a graft from the iliac crest and use it as an onlay with only one "raw" side which can be put on the bone.
If you just cut a piece out, in the easiest way imaginable, you would have three "raw" sides. Since it's an onlay, you can only press one "raw" side on the bone. Two other "raw" sides would be exposed and thus vulnerable to absorption.

Oh. OK. If there are 3 'raw' surface sides and one intact surface of a bone cut, one would use a thin slice of cancellous bone to 'patch' 2 of the exposed raw surfaces where as the other exposed surface would be used to make contact with the area below it. That or some other 'sealant' type of material to patch up any exposed surface.

[Bowie]

Oh. OK. If there are 3 'raw' surface sides and one intact surface of a bone cut, one would use a thin slice of cancellous bone to 'patch' 2 of the exposed raw surfaces where as the other exposed surface would be used to make contact with the area below it. That or some other 'sealant' type of material to patch up any exposed surface.

So in your opinion, is hip bone a good material for facial implants? It won't resorb too much?

[kavan]

So in your opinion, is hip bone a good material for facial implants? It won't resorb too much?

For the most part, it's used as a bone buttress, graft, sandwiched between a bone cut where separating the bone to either elongate, widen or wedge forward leaves a GAP to be FILLED.

As far as materials for face implants go, it's really the SHAPE of them that matters and docs ability to carve the right shape (or have it designed) if the implant is alloplastic (but bio-compatible) material like medpore or firm silicones.

As to hip bone and also cartilage, there would be resorption over time, just like there is in the aging process. I believe they anticipate some over time and for that reason compensate by some over correction.

As to my 'opinion', I'm not sure that even matters given the new phenomena of patients where the ones who would be better served by implants are the ones who want the bone cuts (and bone grafts) instead. Vice versa with the ones who need bone cuts and insist on implants.
So, there is a factor of 'risk aversion' people who are disproportionately averse to the 'risk' of one material over the other as in HYPER focused on the risks of one and HYPO focused on the risks of the other.

[Lazlo]

For the most part, it's used as a bone buttress, graft, sandwiched between a bone cut where separating the bone to either elongate, widen or wedge forward leaves a GAP to be FILLED.

As far as materials for face implants go, it's really the SHAPE of them that matters and docs ability to carve the right shape (or have it designed) if the implant is alloplastic (but bio-compatible) material like medpore or firm silicones.

As to hip bone and also cartilage, there would be resorption over time, just like there is in the aging process. I believe they anticipate some over time and for that reason compensate by some over correction.

As to my 'opinion', I'm not sure that even matters given the new phenomena of patients where the ones who would be better served by implants are the ones who want the bone cuts (and bone grafts) instead. Vice versa with the ones who need bone cuts and insist on implants.
So, there is a factor of 'risk aversion' people who are disproportionately averse to the 'risk' of one material over the other as in HYPER focused on the risks of one and HYPO focused on the risks of the other.

nah cuz, implants will gradually look awful as you age. that's a fact. i  mean you could have them done, but you'll eventually be looking like a bobble head cause they look really artificial as you lose fat and skin goes to s**t. bone cuts look real brah. Go real or there's no deal.

[Lestat]

You need to stop using this patient's experience (while he is HEALING) to undermine, challenge, call into question, his doctor's technique or materials, especially so when you are using him as a spring board to interject your preference for what Sailer does. It's not the right time and place to shake his confidence in the surgery he got.

Ok, maybe I was a bit too hard and I want to apologize for that too. It was just important to me to prevent his (GrendelGegongans) completely overdrawn commentary from raising false expectations among other users. There is no miracle method to get high cheekbones overnight - everything has certain disadvantages and risks.

[kavan]

nah cuz, implants will gradually look awful as you age. that's a fact. i  mean you could have them done, but you'll eventually be looking like a bobble head cause they look really artificial as you lose fat and skin goes to s**t. bone cuts look real brah. Go real or there's no deal.

Well, the implants aren't going 'age' as in resorb. That's true. But the grafts can resorb over time as to age as does bone and cartilage. Even if they don't or have minimimal resorption, it's STILL a SIMILAR situation when the soft tissue loses mass. Have you never seen a person with very pronounced bone structure kind of look like a gargoyle or very skeletal with aging?

Your argument is implicitly predicated on the assumption that a pronounced bone structure via bone movements to do it (vs. implants) won't be revealing very 'skeletal' look with aging. It will and BOTH will eventually require soft tissue fill to plump out the skeletal look with aging.

[kavan]

Ok, maybe I was a bit too hard and I want to apologize for that too. It was just important to me to prevent his (GrendelGegongans) completely overdrawn commentary from raising false expectations among other users. There is no miracle method to get high cheekbones overnight - everything has certain disadvantages and risks.

OK. All is good. Thanx for the explanation. It's a very good point given the history of raised expectations PRIOR promoted about this procedure. Not by the doctor himself, but from a self appointed proxy promoter of him. Nonetheless, if this Grendel guy (gal?) already had the surgery, it's best to leave them with hopeful healing thoughts.

[Bowie]

Well, the implants aren't going 'age' as in resorb. That's true. But the grafts can resorb over time as to age as does bone and cartilage. Even if they don't or have minimimal resorption, it's STILL a SIMILAR situation when the soft tissue loses mass. Have you never seen a person with very pronounced bone structure kind of look like a gargoyle or very skeletal with aging?

Your argument is implicitly predicated on the assumption that a pronounced bone structure via bone movements to do it (vs. implants) won't be revealing very 'skeletal' look with aging. It will and BOTH will eventually require soft tissue fill to plump out the skeletal look with aging.

Exactly, that's why Angelina Jolie has fillers or fat. Look at Willem Dafoe, his face has extreme concavity and creases directly beneath the cheekbones but they are the ones he was born with.

[kavan]

Exactly, that's why Angelina Jolie has fillers or fat. Look at Willem Dafoe, his face has extreme concavity and creases directly beneath the cheekbones but they are the ones he was born with.

Yup.