Beginning my surgical journey, should I get a CBCT for consults?

[Alwaysevolving34]

Hi All,

I’m about to begin my surgical journey by scheduling consults with multiple maxfacs and plastic surgeons. Is it worth it to get a pre consult CBCT done so I have it ready to present during my consults? If I did get a CBCT done, should I get one of the full maxillofacial area? I would like to limit the amount of times I get a scan so if possible I would like to get full face 3D scan. Does anyone whose gotten the scan done know the insurance billing code for this type of scan? If anyone wants to weigh in, I would seriously appreciate the advice. @Sergio-OMS and @RealSurgerymax , I would also greatly appreciate both your advice.

Thanks in Advance!

 

[RealSurgerymax]

No, depending what country you are in chances are you will need a prescription to have one anyway. So you can’t just get one. He will also write the order for exactly the specifications he wants

 

[MedMaxxing]

That's the only cost I am most worried about. Going to start consulting soon but want to do it outside of NA. You would have to get their specific CT's done in your own country and those are pretty expensive.

 

[Sergio-OMS]

Hi All,

I’m about to begin my surgical journey by scheduling consults with multiple maxfacs and plastic surgeons. Is it worth it to get a pre consult CBCT done so I have it ready to present during my consults? If I did get a CBCT done, should I get one of the full maxillofacial area? I would like to limit the amount of times I get a scan so if possible I would like to get full face 3D scan. Does anyone whose gotten the scan done know the insurance billing code for this type of scan? If anyone wants to weigh in, I would seriously appreciate the advice. @Sergio-OMS and @RealSurgerymax , I would also greatly appreciate both your advice.

Thanks in Advance!

No, you risk getting a very badly done study, apart from the prescriptions issues. There are a lot of radiology centres out there with old machines and technicians that wouldn't really do a good study without the prescription from the surgeon.

I NEVER plan surgery on a CBCT, by the way. I order a high resolution spiral CT done at a radiological centre I trust.

 

[Alwaysevolving34]

Thank you so much both for your invaluable advice seriously appreciate your contributions to this forum! @Sergio-OMS , @RealSurgerymax

 

[Alwaysevolving34]

Just for my curiosity, what's the difference between a cbct and a spiral CT scan? @Sergio-OMS

 

[Sergio-OMS]

Just for my curiosity, what's the difference between a cbct and a spiral CT scan? @Sergio-OMS

Basically, quality and radiation.

A spiral CT delivers more radiation, but latest models from some brands have low radiation filters and the difference is not that big.

A study done with spiral CT allows to do a good segmentation and can be used to plan for custom titanium.

 

[Alwaysevolving34]

I didn’t realize there was an option for custom titanium implants, amazing how far science has come! Is titanium superior to Medpor, silicon, peek, etc? Is there a greater risk of bone resorption down the line? @Sergio-OMS ?

 

[Alwaysevolving34]

Does your clinic offer custom titanium implants @Sergio-OMS?

 

[Alwaysevolving34]

I also want to get @RealSurgerymax opinion on this. Also, I remember reading on one of the forums that you were planning on opening a clinic soon? How’s that going, are you a maxfac or plastic surgeon? Did you complete your residency in the US? Just asking because I remember you said you wanted to open a practice in Cambodia or something and I wasn’t sure how medical licensing works over there, I hope things are going well!

 

[MedMaxxing]

I didn’t realize there was an option for custom titanium implants, amazing how far science has come! Is titanium superior to Medpor, silicon, peek, etc? Is there a greater risk of bone resorption down the line? @Sergio-OMS ?

Custom titanium is far superior. You can leave it in and never have to get it removed. Doesn't even set off metal detectors.

 

[Alwaysevolving34]

@MedMaxxing The problem is that I cannot find any surgeons offering this. The problem with titanium implants is that they cannot be positioned into tight areas without a large incision, whereas materials like silicone can often be placed with a small incision. I may be wrong about this though. Also @Sergio-OMS might have been referring to custom titanium plates for use with the MSE procedure but feel free to correct me if I'm wrong.

 

[MedMaxxing]

@MedMaxxing The problem is that I cannot find any surgeons offering this. The problem with titanium implants is that they cannot be positioned into tight areas without a large incision, whereas materials like silicone can often be placed with a small incision. I may be wrong about this though. Also @Sergio-OMS might have been referring to custom titanium plates for use with the MSE procedure but feel free to correct me if I'm wrong.

Custom titanium is commonly used, just it's a bit more expensive on average. Who have you been consulting with? (If you don't want to say this publicly you can PM me if you would like)

 

[Alwaysevolving34]

I would be happy to, I'll PM you. To be honest , there is a lot of trash on this forum but I find it useful because there's useful information about procedures sprinkled amongst the trash. There is too much negativity on here but it's the only place to discuss procedures in depth.

 

[Alwaysevolving34]

@MedMaxxing Do you know which surgeons are offering custom titanium implants at the moment? I couldn't find any that do it for aesthetic purposes, most of the surgeons using custom titanium implants are using them mainly for skull deformities.

 

[MedMaxxing]

@MedMaxxing Do you know which surgeons are offering custom titanium implants at the moment? I couldn't find any that do it for aesthetic purposes, most of the surgeons using custom titanium implants are using them mainly for skull deformities.

Pretty sure Andreischev uses them.

 

[Alwaysevolving34]

Do you know any others, you also have to understand that many of the surgeons mentioned on this website market themselves very well. This doesn't necessarily mean their bad surgeons but there's a lot of other surgeons out there which are not discussed on this site.

 

[MedMaxxing]

Do you know any others, you also have to understand that many of the surgeons mentioned on this website market themselves very well. This doesn't necessarily mean their bad surgeons but there's a lot of other surgeons out there which are not discussed on this site.

Not personally but Ramieri and Pagnoni potentially as they have good reviews and generally have aesthetic goals in mind.

 

[curryslayerordeath]

Custom titanium is commonly used, just it's a bit more expensive on average. Who have you been consulting with? (If you don't want to say this publicly you can PM me if you would like)

is the price the only reason? or are there other drawbacks to titanium materials? idk anything abt implants

 

[Alwaysevolving34]

Like I stated before, larger incisions are required for titanium implant placement in tight spaces. This is one limiting factor.

 

[Sergio-OMS]

Does your clinic offer custom titanium implants @Sergio-OMS?

Yes of course, why not? I think PEEK is better but I don’t care

 

[Alwaysevolving34]

@Sergio-OMS , ok this is great! Thanks again for your input it's very much appreciated. I just don't understand why the use of PEEK implants are so sparse in the US.

 

[RealSurgerymax]

I also want to get @RealSurgerymax opinion on this. Also, I remember reading on one of the forums that you were planning on opening a clinic soon? How’s that going, are you a maxfac or plastic surgeon? Did you complete your residency in the US? Just asking because I remember you said you wanted to open a practice in Cambodia or something and I wasn’t sure how medical licensing works over there, I hope things are going well!

Opinion on? Titanium implants? It’s an unnecessary expense and metallic implant load for no real advantage. It’s better to limit the amount of metal in your body if possible.

Because of coronavirus that is not going as planned, full-body plastic with special interest in face, no, yes hopefully in Phnom Penh. I do have concerns how Incel plastic surgery could limit some of my first-world ambitions (look bad to a US/Australia program) but that will all work itself out.

 

[Alwaysevolving34]

@RealSurgerymax Yea man, US plastic surgery residencies are still somewhat limited on the scope of what they teach and aren't not too focused on aesthetics. There are plenty of aesthetic fellowships that are available thought. If you don't mind me asking , i'm assuming you did your MD in the US but haven't started your residency yet?