Australia: surgeon

[maksimilijan1]

I was hoping someone can help me, as I'm completely lost who to go to. For those of us that can only dream in this lifetime to see Gunson, do you know of anyone in Australia who does orthognathic surgery on adults on a regular basis (as opposed to 2 or 3 per year, mostly on children) and who understands and cares about aesthetics (as opposed to function only). I feel like most surgeons and definitely most orthodontists are decades behind their American counterparts.

I did get my first consultation in Europe, before I moved down here, so I have a pretty good idea of what needs to be done in my case. Apparently, I only need mandibular advancement and maybe genioplasty, which should all be straightforward and easy. From the imaging I did, the opportunities to improve the way I look are pretty dramatic. I would like to get a second opinion though. Do you know how much Gunson charges for a consultation? Even if I never could afford the surgery with him, getting his professional evaluation would be extremely helpful in my further planning.

By the way, I haven't started my orthodontic treatment yet, as I'm looking for someone experienced in surgical orthodontics, as opposed to someone who only knows fixing bites (mostly on children), and completely ignores the aesthetics of the face overall. The orthodontics should create enough space for the lower jaw to be moved forward. Any suggestion is welcome (Sydney...)

As for a surgeon - all suggestions are welcome. My insurance (public) will cover only about $2,000 of the cost, so I'm even prepared to travel overseas if that is a good option for me. The surgeon I consulted in Europe was way too expensive. Canada maybe? Can that work? Or does the surgeon has to be in the same place as the orthodontist? The surgeon I saw in Europe told me he can communicate by email/phone with the orthodontist I will choose here. Can that work?

Thanks for reading this. I hope you can give me your insight with at least some of my questions.

[Teeth of Cthulhu]

These guys aren't in Australia, but if you want stellar work that is fairly affordable you can consider:

Maurice Mommaerts: http://www.mauricemommaerts.eu/en/pathology.aspx

Hernandez Alfaro: http://en.institutomaxilofacial.com/ort ... /class-ii/

[maksimilijan1]

What a coincidence! The surgeon I've been talking about in Europe is precisely Hernandez Alfaro in Barcelona. His quote was a bit higher than I expected though, to be honest (over $20,000 for a single jaw + genioplasty if I go for it). Altogether, with travel costs and accommodation it would cost me about $30,000.

I trust him and his enormous experience, although I feel like he didn't take too much time with me on our first appointment. He came up with a 5 t o 7 mm mandibular advancement just by looking at the photos his assistant took (digital camera) and looking at me. I suppose it's his experience speaking (he's one of the best in the world), but still...I expected some more precise measurements (digital imaging etc)...His consult was 150 euros - acceptable, since here in Australia below average surgeons can charge about 3 times as much for the first appointment...

I'm going to check up the other link. Thanks a lot for your response.

[Teeth of Cthulhu]

He quoted me the same for a bimax. That's actually a pretty solid price. You'd pay just as much here in the UK for a far less accomplished surgeon

Mommaerts is about 30% or so cheaper, for what it's worth, and he's one of the world's best.

[maksimilijan1]

Mommaerts appears to be surprisingly cheap if you take into account his impressive qualifications posted on the web site. Looks very promising to me. Thanks so much for giving me the link.

[maksimilijan1]

Just a quick update - I made an appointment with an orthodontist from Sydney, who I've heard has some experience in surgical orthodontics. The first appointment, I was told, will be $460, none of this I can claim back through Medicare. The fee will include a 3D imaging, I was told. It will not be deducted from the cost of the orthodontic treatment in future, though.

It looks too expensive to me. I heard Gunson/Arnett charge $550 for the first consult, and although not orthodontists, they also do medical and cosmetic imaging.

Maybe what I should do is save for a trip to Santa Barbara before I do anything, get advise from those two (or one of them), and then with all the insights they can give me find an orthodontist and a good surgeon I can afford elsewhere (e.g. the Belgian doctor).

Any thoughts? I appreciate any suggestion.

Also, do you remember how much did you have to pay for your surgical orthodontist consult? Probably nothing if you come from UK or Canada. You're really lucky you live in normal countries.

[Marisama]

http://www.profilo.com.au

These guys have some impressive YouTube videos and they appear to be in Australia. Just click on procedures to see the videos. The blonde girl with asymmetry had spectacular results.

[maksimilijan1]

Thanks for the link - I've come across their youtube videos. It's very hard to find any feedback at all from that doctor's patients (his name is Coceancig) - even a single review would be helpful. He operates in a smaller city in NSW (Newcastle), and for all I know those 4 patients or so he's showing (2 of them children) may be his only orthognathic patients he's ever done. Probably not, but you get my point...it's really hard to know...Does he operate on 2 or 3 adults per year, or 20-30 or more? For me, that makes all the difference in the world. Getting that information is almost impossible though.

I guess not many people like to share their experiences, although they like to read about other people's experiences. Not very fair if you ask me...

I may may an appointment with him after all, although travelling to Newcastle and back and his consultation fee will turn around to be around $500. Not an easy decision...

Thanks again for your help.

[Marisama]

You're welcome. I agree that it's difficult to connect with people that have undergone orthognathic surgery, especially with the surgeon you ultimately choose. I've decided to document my surgery process with a blog in hopes that it will help somebody else with similar problems.

I definitely did a lot of research when searching for a surgeon. Keep searching and calling around. Save money and come to the US if needs be. I would think there are surgeons in Australia that are well qualified though.

[maksimilijan1]

Thanks. Now that you've made some progress yourself as I can see from your blog, I may contact you from time to time with questions, if I do decide to see Gunson/Arnett. Just to know what to expect from 1st visit etc...I hope that's OK.

Australia is a very small market as you know (about half of the population of California) and there is a lack of medical professionals in all fields. There is an obvious lack of experience and expertise in this field especially. Oral surgeons remove wisdom teeth, do implants and very rarely perform orthognathic surgery (mostly on children and more severe adult cases). Dealing with the aesthetics of the face is not what they know and what they do - it's not what they are trained for. People like Gunson or Arnett, on the other hand, have seen thousands of cases like me throughout the years. Experience is what really matters here.

I saw one older and well-known oral surgeon here and he told me he can't see why I would go through orthognathic surgery. Of course he can't, he was evaluating the function of my jaw and bite. He was not looking at how orhtognathic surgery can change my face and improve the quality of my life. Then I saw this well known and highly experienced orthognathic surgeon in Spain (Hernandez) when I was in Europe, and he made his recommendations as I explained above. Then I asked him - on a scale from 1 to 10, how much do you think I need this surgery? He answered: balancing the risks and benefits: 10, nothing less than that. He said, You can decide to do it in Australia if that is easier for you, but make sure you do it. What am I to think? One surgeon thinks I'm nuts because I want to do this, the other thinks I need it 100%. But then I realized who has been dealing with whom and with what their whole careers. The Australian one, as I explained has not seen many orthognathic patients in his life (he said 2 to 3 per year). Hernandez deals with a high volume of patients from all over Europe, as this is his specialty. The Australian one understands function, Hernandez understands aesthetics.

Sorry for these long posts, I'm just trying to make a point. Choosing your surgeon correctly matters if you care about looking good after your surgery. Plus, I'm already 33, and I don't have much time for mistakes.

[maksimilijan1]

I found this ad for Arnett's courses where they say they (both of them) evaluated a total of over 10,000 patients for orthognathic surgery, and performed it on over 4,000. Can this be true? If they spend an hour on average with each patient on first visit, that's a hell lot of working hours only on evaluation. When do they operate? When do they do second and after surgery appointments? I know these numbers are meant for both and for all their working careers...but still...Those numbers border science fiction.

I honestly would think of any Australian surgeon who's done 2% of half (one half for each of them) of that number (4,000, i.e. 40) as highly, highly experienced. Only 2%, not even 10% or 5%, let alone 20% or 50%. If that claim is true...

[CaliforniaKid]

I asked Gunson on my consult how many times he's performed the surgery. He wasn't sure, but he estimated between 900-1100. That means Arnett has done 3,000 or so. That makes sense he's been practicing since the 70s. I think he said he does 2 operations per week...again, I had a lot of other concerns on my mind so I'm only 90% sure on that.

I was told Gunson does 2 or more surgeries a week in my consult as well. I imagine Arnett does less because of speaking engagements.

I found this ad for Arnett's courses where they say they (both of them) evaluated a total of over 10,000 patients for orthognathic surgery, and performed it on over 4,000. Can this be true? If they spend an hour on average with each patient on first visit, that's a hell lot of working hours only on evaluation. When do they operate? When do they do second and after surgery appointments? I know these numbers are meant for both and for all their working careers...but still...Those numbers border science fiction.

I would say the numbers are probably closer to truth. If you manage to schedule a consult - which is typically a several month wait (maybe three months wait for a consult with arnett) - you should find yourself in a room with 100-200 before/after photos plastered all over the wall. Results are quite impressive. Arnett/Gunson have kind of a legendary status in jaw surgery blogs so it's easy to get caught up in the hype.

i know they operate in the AM at a private hospital in goletta, and first surgery appointment (after operation) is typically 5 days later. You schedule your next surgery appointment on that same day, and so on. I believe there are at least 9 week-to-week check ups, and then every other week and then once a month etc..

it makes sense when you realize all they do is jaw surgeries exclusively.

I honestly would think of any Australian surgeon who's done 2% of half (one half for each of them) of that number (4,000, i.e. 40) as highly, highly experienced. Only 2%, not even 10% or 5%, let alone 20% or 50%. If that claim is true...

i would say this is because for most oral surgeons, jaw surgery is only one part of their services. a majority of their time is likely spent removing wisdom teeth.

[Marisama]

Given that Arnett and Gunson operate 50 facial reconstructions per year, they have developed leading treatment planning and surgical techniques in this field. In fact, about 30 percent of the Arnett-Gunson practice is devoted to “re-do” surgeries for patients who’ve undergone operations elsewhere. Extremely difficult and time-consuming, these surgeries can keep them in the operating room at GVCH for hours on end—4 hours in the case of two recent back-to-back “re-do” procedures.

http://www.sbch.org/portals/1/skins/cot ... 7lores.pdf

[CaliforniaKid]

"*Given that Arnett and Gunson operate 150 facial reconstructions per year"

[Marisama]

Thanks. Not sure why a square appeared. 150, not 50.