Minimally invasive lefort 1 alternative (why is this not more well known?)

[dardok]

https://www.semanticscholar.org/paper/U-shaped-osteotomy-in-management-of-paranasal-H%C3%A9rnandez-Alfaro-Garc%C3%ADa/a470963ed660acea1ec721dcbba927dae217ebd4

I had a recent ceph taken and I have a severe paranasal deficiency that would warrant this case.
I would actually become quite good looking with this sort of advancement.

I showed this to my surgeon and he agreed, although he said I would essentially be a "guinea pig" as he had never heard of this procedure before.

He cited possible complications such as inadequate blood supply to the osteotomized area leading to death/relapse as well as just relapse in general over the long term.



Do you guys think the surgeon who wrote this procedure just made this paper to pad his stats, and it is not actually safe? I have contacted a few surgeons about this procedure but the literature is so scarce I do not know what to do or think.

I would only do it if the complications themselves were not severe and the result was stable.

And if this is not viable my only other alternative is to get extractions, pushing my upper jaw back to cause an underbite and then getting bimax, which would be a long and costly process.

[Lazlo]

I don't think the risks are terribly high. It looks like an awesome procedure.

[kavan]

Alfaro is very WELL KNOWN and very innovative. So, if this is one of his innovations, it might take some time for others to do same.

[dardok]

I don't think the risks are terribly high. It looks like an awesome procedure.

How can I better understand the risks of it and find long term follow up data? There does not seem to be much other sources on this specific surgery.

I'm hoping to contact the original author as well as another surgeon in korea who also did a study on this.

I need to know that the risk of relapse or necrosis are low in order to go through with this or im going to be f**king my body and bank up for nothing.



Also is this paper itself enough for a surgeon to duplicate this procedure. My surgeon is not a hack, he actually wrote some of the first papers on CCW, but he also said he is going to eyeball the exact movement once my face is cut open (lol).

Is there any way I can get alfaro and him to talk to each other. It seems simple enough and otherwise my only option is to go to spain/korea.

[kavan]

I've read through your past posts and for the most part, it appears you are looking for a NO RISK at all procedure*.

*

  I'm looking for no erosion resorption and no infection risk that sits well on the skin and maintains its structure.

 Not only that but, 'ideally', you would like your Canadian doctor/s to perform SPECIALTY procedures that only a small handful of doctors (not in Canada) are conversant/skilled at doing whether they be paranasal implants** or innovative paranasal displacment surgery by Alfaro.

**

Where to get paranasal implants done in canada?

Let's  get REAL. For all intents and purposes, these procedures can be considered ESOTERIC procedures LIMITED to doctors of KNOWN capacity to perform them

a: Your Canadian doctor/s is/are not going to be as conversant as is a doctor KNOWN for putting in paranasal implants. (Name of doctor is listed in the bibliography of the article you cited.)

b: Your Canadian doctor/s is not going to be as conversant in performing Alfaro's isolated paranasal displacement surgery as is the innovator of it.

c: What ever the inherent risks are with paranasal implants or Alfaro's isolated U shaped osteo of the paranasal area, they would tend to be even HIGHER in the hands of doctors who are not PIONEERS or 'movers and shakers' in the particular venue you are seeking.

If I wanted paranasal implants, I would go straight to the doctor listed in the bibliography who is expert in putting them in (Yaremchuck). Alternatively, if I wanted a BONE CUT instead, I would go straight to Alfaro. Although seeking out those 2 experts for EITHER don't make the inherent risks of the surgery go away, you shouldn't even be thinking about having your Canadian doctor perform EITHER. I mean it's intuitively obvious to me that the risks would be HIGHER in the hands of doctors who are not the 'movers and shakers' or 'innovators' of these types of surgeries.

Moral of story: STOP THINKING about any possibility of your Canadian doctor performing this. How on earth someone wanting the LOWEST risk possible for an ESOTERIC surgery would have ANY expectation that their local doctor could carry this out with expectation of a LOWER risk than the experts have, I will never know. Can't fathom the reasoning because to ME, it's irrational expectation/ PIPE DREAM.

Doesn't matter if you did not specifically say you 'expected' your doctor to be able to carry this out with lower risk than the experts in this. Your posts belie you harbor some kind of subconscious expectation that your Canadian docs will be in same capacity of the 'grand wazoos' of the type of esoteric surgeries you are wanting. I also pick up the 'vibe' of that type of thinking when you say your 'only option' (here the phrase is used in the PEJORATIVE sense) is to go to .. (eg. the EXPERTS in this as IF they are the LESSER option). It's a 'Can't have the horse take the donkey.' type of thinking. BUT where your priorities are MIXED UP where the Canadian doctor is the 'horse' and the EXPERT(s) in this is the 'donkey' It's the other way around. The expert(s) in this is/are the HORSE(s) and your Canadian doctor(s) is are the DONKEY/donkeys.

That said, if you want to know MORE about this 'U' type osteo, PRIORITIZE your consult with Alfaro. He's going to know more about whether or not you are a good candidate for it and what the risks are IN HIS HANDS.

Oh, did I forget to mention that the answer is 'NO' regarding your Canadian doc doing this for you?

[dardok]

I've read through your past posts and for the most part, it appears you are looking for a NO RISK at all procedure*.

*
 Not only that but, 'ideally', you would like your Canadian doctor/s to perform SPECIALTY procedures that only a small handful of doctors (not in Canada) are conversant/skilled at doing whether they be paranasal implants** or innovative paranasal displacment surgery by Alfaro.

**
Let's  get REAL. For all intents and purposes, these procedures can be considered ESOTERIC procedures LIMITED to doctors of KNOWN capacity to perform them

a: Your Canadian doctor/s is/are not going to be as conversant as is a doctor KNOWN for putting in paranasal implants. (Name of doctor is listed in the bibliography of the article you cited.)

b: Your Canadian doctor/s is not going to be as conversant in performing Alfaro's isolated paranasal displacement surgery as is the innovator of it.

c: What ever the inherent risks are with paranasal implants or Alfaro's isolated U shaped osteo of the paranasal area, they would tend to be even HIGHER in the hands of doctors who are not PIONEERS or 'movers and shakers' in the particular venue you are seeking.

If I wanted paranasal implants, I would go straight to the doctor listed in the bibliography who is expert in putting them in (Yaremchuck). Alternatively, if I wanted a BONE CUT instead, I would go straight to Alfaro. Although seeking out those 2 experts for EITHER don't make the inherent risks of the surgery go away, you shouldn't even be thinking about having your Canadian doctor perform EITHER. I mean it's intuitively obvious to me that the risks would be HIGHER in the hands of doctors who are not the 'movers and shakers' or 'innovators' of these types of surgeries.

Moral of story: STOP THINKING about any possibility of your Canadian doctor performing this. How on earth someone wanting the LOWEST risk possible for an ESOTERIC surgery would have ANY expectation that their local doctor could carry this out with expectation of a LOWER risk than the experts have, I will never know. Can't fathom the reasoning because to ME, it's irrational expectation/ PIPE DREAM.

Doesn't matter if you did not specifically say you 'expected' your doctor to be able to carry this out with lower risk than the experts in this. Your posts belie you harbor some kind of subconscious expectation that your Canadian docs will be in same capacity of the 'grand wazoos' of the type of esoteric surgeries you are wanting. I also pick up the 'vibe' of that type of thinking when you say your 'only option' (here the phrase is used in the PEJORATIVE sense) is to go to .. (eg. the EXPERTS in this as IF they are the LESSER option). It's a 'Can't have the horse take the donkey.' type of thinking. BUT where your priorities are MIXED UP where the Canadian doctor is the 'horse' and the EXPERT(s) in this is the 'donkey' It's the other way around. The expert(s) in this is/are the HORSE(s) and your Canadian doctor(s) is are the DONKEY/donkeys.

That said, if you want to know MORE about this 'U' type osteo, PRIORITIZE your consult with Alfaro. He's going to know more about whether or not you are a good candidate for it and what the risks are IN HIS HANDS.

Oh, did I forget to mention that the answer is 'NO' regarding your Canadian doc doing this for you?

You are very right. I am going to see Dr Alfaro for a consult. My only concern is that I noticed high volume surgeons tend to be conservative and in the event that he (possibly) says no I will be s**t out of luck.

There is  a korean fellow who also used this technique who would be my only other option, and he doesnt seem to do commercial surgeries:
http://www.koreascience.or.kr/article/ArticleFullRecord.jsp?cn=OOMSBS_2009_v31n6_485

I would be pretty much be forced to see a surgeon who has not done it before.

Would it possibly help if I saw a top class surgeon such as Deschamps or Gunson?

[jawguy123]

Personally, I'd rather just have bimax than have a paranasal osteotemy with a doctor who's never done one -- or anything of the sort -- before, even if the doctor is well respected.

[kavan]

You are very right. I am going to see Dr Alfaro for a consult. My only concern is that I noticed high volume surgeons tend to be conservative and in the event that he (possibly) says no I will be s**t out of luck.

There is  a korean fellow who also used this technique who would be my only other option, and he doesnt seem to do commercial surgeries:
http://www.koreascience.or.kr/article/ArticleFullRecord.jsp?cn=OOMSBS_2009_v31n6_485

I would be pretty much be forced to see a surgeon who has not done it before.

Would it possibly help if I saw a top class surgeon such as Deschamps or Gunson?

The Korean guy seems to be doing the 'U' osteo in combination with Lefort 1 and bimax if i speed read correctly. So, not isolated 'U' osteo as Alfaro seems to do.

Let me put it this way, the RISK PROFILE of your Canadian guy doing it is now '0' BECAUSE he never did it before and if he f**ks up with YOU being the FIRST to do with him, his risk profile will be 100%.

Again, this is an ESOTERIC type surgery. It looks like it's Alfaro's 'baby'. So, I would not extrapolate that Gunson or Deschamps would nurture it either.

...and NO, you are NOT 'forced' to see a surgeon who has not done it before. That is DANGEROUS thinking. Risks get HIGH when you seek out doctors to do something who are LOW on the learning curve of that thing or who would rather just do what they do well already.

If Alfaro says 'no' then assume you are not the ideal candidate for it which could be a recipe for disaster if you got someone else not conversant in it to do it instead.

[dardok]

The Korean guy seems to be doing the 'U' osteo in combination with Lefort 1 and bimax if i speed read correctly. So, not isolated 'U' osteo as Alfaro seems to do.

Let me put it this way, the RISK PROFILE of your Canadian guy doing it is now '0' BECAUSE he never did it before and if he f**ks up with YOU being the FIRST to do with him, his risk profile will be 100%.

Again, this is an ESOTERIC type surgery. It looks like it's Alfaro's 'baby'. So, I would not extrapolate that Gunson or Deschamps would nurture it either.

...and NO, you are NOT 'forced' to see a surgeon who has not done it before. That is DANGEROUS thinking. Risks get HIGH when you seek out doctors to do something who are LOW on the learning curve of that thing or who would rather just do what they do well already.

If Alfaro says 'no' then assume you are not the ideal candidate for it which could be a recipe for disaster if you got someone else not conversant in it to do it instead.

The korean guy has done the surgery though. Even if he does it in conjunction with a lefort it does not mean the surgery is related or required to do in conjunction.

I will just write off my guy in that case then. He is very competent and was one of the first to write papers on CCW but like you said the risk is unknown for him.

Do you recommend I do a video consultation with Alfaro first or make the trip to Spain? If I need to save more money I will do so but I do not want to spend more than is necessary.

[kavan]

The korean guy has done the surgery though. Even if he does it in conjunction with a lefort it does not mean the surgery is related or required to do in conjunction.

I will just write off my guy in that case then. He is very competent and was one of the first to write papers on CCW but like you said the risk is unknown for him.

Do you recommend I do a video consultation with Alfaro first or make the trip to Spain? If I need to save more money I will do so but I do not want to spend more than is necessary.

In person consults where they have measuring tools and diagnostics is always better.

[Bobbit]

That said, if you want to know MORE about this 'U' type osteo, PRIORITIZE your consult with Alfaro. He's going to know more about whether or not you are a good candidate for it and what the risks are IN HIS HANDS.

Oh, did I forget to mention that the answer is 'NO' regarding your Canadian doc doing this for you?

Thank you for posting that.  It  *really* needed to be said. 

[dardok]

I appreciate the input

I am also worried due to the fact that alfaro does very high volume that he may overlook my case or give a bad result.

But I guess alfaro is my best shot and whatever happens my fate would be in his hands.

[kavan]

I appreciate the input

I am also worried due to the fact that alfaro does very high volume that he may overlook my case or give a bad result.

But I guess alfaro is my best shot and whatever happens my fate would be in his hands.

This statement just drives home the point I was making regarding what I picked up as to your thinking/decision making process. Basically, you WORRY WRONG. So, now you are worried about the the EXPERT in the (estoteric) procedure you want giving you a bad result. But NOT worried at all prior about your Canadian doctor with NO experience doing it wrong.

Here again, your statement (which comes from somewhat of an irrational thinking process) reflects you are (still) 'settling' for the EXPERT who can do a/the procedure FAST and you use the term 'HIGH VOLUME' in the pejorative (negative) sense.  Being able to do something FAST reflects SKILL especially when cutting into the maxilla where to the best of my knowledge blood loss is minimized when that's over and done with FAST (as opposed to a LOW VOLUME doctor who's never done it before--like your Canadian doctor--who would need to go SLOW to do it!).

The only reason I can think of for this irrational thinking process is that maybe your INTUITION is telling you not to have it at all and instead get the standard full bimax/maxfax with your Canadian doctor along with possible plucking of the pre-molars to do it OR to just the implants (from an expert in paranasal implants) instead.

[kavan]

Thank you for posting that.  It  *really* needed to be said.

 

[dardok]

This statement just drives home the point I was making regarding what I picked up as to your thinking/decision making process. Basically, you WORRY WRONG. So, now you are worried about the the EXPERT in the (estoteric) procedure you want giving you a bad result. But NOT worried at all prior about your Canadian doctor with NO experience doing it wrong.

Here again, your statement (which comes from somewhat of an irrational thinking process) reflects you are (still) 'settling' for the EXPERT who can do a/the procedure FAST and you use the term 'HIGH VOLUME' in the pejorative (negative) sense.  Being able to do something FAST reflects SKILL especially when cutting into the maxilla where to the best of my knowledge blood loss is minimized when that's over and done with FAST (as opposed to a LOW VOLUME doctor who's never done it before--like your Canadian doctor--who would need to go SLOW to do it!).

The only reason I can think of for this irrational thinking process is that maybe your INTUITION is telling you not to have it at all and instead get the standard full bimax/maxfax with your Canadian doctor along with possible plucking of the pre-molars to do it OR to just the implants (from an expert in paranasal implants) instead.

No, I think from my ceph this is the procedure that was made for me. I would accept your input if you want to take a look at it

I would just appreciate some patient input and coordination when working with the surgeon which I know sometimes doesn't happen with the big wig types.

So your saying pretty much cooperating or not that this should be the only doctor to do that procedure on me. And I am inclined to agree which is why I am going to see him for a consult.