Italian Jaw Journey (GTFIH) - Bimax + CCW + Expansion + Infras | Planning with Ramieri/Pagnoni/Raffaini

kuromilover

kuromilover

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Hi guys, long-time lurker, first-time poster from Italy.

I’m finally starting my hardmaxxing journey to try to fix all of my major flaws and I’m looking for the best surgeon in Italy for a complex case.

PRE-OP

Front + Side Profile

Front 11
Front 2
Side 1
Side 2

CBCT (Front + Side) + OPG (Old Before & New After braces) (need decompensation)

Front 11
Front 2

Untitled 1
Side 1
Side 2


Photo 2026 04 01 12 51 42
Photo 2026 01 22 01 34 14

Septum + Palate

Septum
Palate

Disclaimer: I’ve done some preliminary measurements on my CBCT using RadiAnt and Romexis. I’m not a pro, so if I messed up some calculations, please let me know. These should be roughly accurate though.
My Analysis (Based on CBCT):
  • Gonial Angle: 131.8°
  • Inter-molar Width: ~34.7mm (Narrow palate, teeth in compensation).
  • Face Type: High divergence, nasolabial folds, poor midface & infraorbital support)
I want to make sure I find a surgeon who can handle the aesthetic side of this, not just the occlusion.
  • Bimax (BSSO + Lefort 1) with CCW Rotation: I need to close that 132° angle and get projection.
  • Skeletal Expansion (MARPE/MSE/FME/SARPE): My inter-molar width is ~34.7mm. I’m debating and honestly I don't have much knowledge about this. I want to maximize midface widening and cheekbone support. Given I'm planning Bimax anyway, which one would you guys suggest?
  • Midface support: I’m leaning towards custom PEEK inframalar/infraorbital implants but I want to know if I can avoid paranasal implants by performing a High LeFort I cut and advancing the ANS, or maybe eventually both?
  • Jaw/Angles: I definitely lack bone mass here too. I'm considering custom jaw implants (wraparound or angles), but I’m worried about two things: 1) Is it even possible to do Bimax + Midface + Jaw implants in a single op? 2) The budget might explode.
  • Genioplasty: Undecided. If the CCW rotation provides enough projection, I might skip it, but idk tbh.

The Surgeon Question

I’m planning to visit Ramieri, Pagnoni, and Raffaini.
  • Which of these do you think is the best and open to custom midface implants alongside the Bimax? (keeping in mind how much each surgeon charges)
  • Should I do consultations with all three or is there a clear winner for this specific approach?

I’m open to any HIGH IQ advice or suggestions regarding my skeletal plan, movements, or surgeon choice. Don't hold back.

Brutally honest feedback only. If you guys have any questions or need more info, measurements, or specific CBCT slices to help me out, just ask no problem. Thanks.
 
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Ramieri and pagnoni do implants. Ramieri is a great surgeon.

I havent seen photoshopini doing implants. He does fat grafting and is known to photoshop the results on his insta page to make them looks more impressive than they are. He edits the before photos of the patients to make them look uglier and the after photos as well.
 
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Ramieri and pagnoni do implants. Ramieri is a great surgeon.

I havent seen photoshopini doing implants. He does fat grafting and is known to photoshop the results on his insta page to make them looks more impressive than they are. He edits the before photos of the patients to make them look uglier and the after photos as well.
i guess the rumors are true then :ROFLMAO::ROFLMAO:. Btw I heard pagnoni over advances his patients and is really bold with the movements, but he's really good at implants & design, maybe even better than ramieri. What do you think?
 
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pagnoni botched my genio. It became uneven. Also know several that got botched bimaxes with bad bites from him. Do not go to him - unless its implants.
 
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pagnoni botched my genio. It became uneven. Also know several that got botched bimaxes with bad bites from him. Do not go to him - unless its implants.
Show us face or CT broski
 
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Ramieri has his Implate technique which means his implants are part of the custom BSSO Plate of your bimax if you get implants trough his Implate technique but he only does them in titanium (it's not the same as placing implants normally and he claims the infection risk is less) but Ramieri is less Blackpilled than Pagnoni and is not as good as Pagnoni and Raffaini when it comes to Genioplasty and will try to dodge doing a genioplasty if you don't have a bad Base

Also Pagnoni is very honest, takes you seriously, not judgy and explains as much as you want and tries to tell you the truth about what can ascend you (in his opinion)
Pagnoni is more blackpilled and will do bigger movements than Ramieri but costs a lot more than Ramieri (not gonna mention prices here so they don't hike up even more)
He has an amazing Genio but he recently had some botches last
(and this year I believe but not sure)
He is a better implant placer and mor knowledgeable about implants than Ramieri though which matters less than one thinks cause Ramieri isn't gonna make riksy movements like that and will be playing it safe like you will look better than after but (maybe) not ascended of you need a lot but if you need very minimal improvement and have. (very) good base he is probably one of the better options also price wise he is the cheapest out of them all and also pretty fair since he has empathy for his patients when it comes to revision and would try to fix your problem

Raffaini costs almost double as what Pagnoni is charging for bimax because of his reputation and he also does very good bone grafts which allows your bone to heal better together

That being said all of these surgeons had some botches and the unfortunate reality is there is always a chance you get botched

What many people don't tell people is if you have very thick skin implants have a higher chance of making your face puffy looking and uncanny or fat looking and in this case you would be limited to a very conservative design

Raffaini is probably the best of you can afford him purely when it comes to bimax and tied or slightly better than Pagnoni when it comes to Genioplasty but he will only do what he wants not what you tell him what you want
It will only be what he thinks is best for you
I'm not sure if he does implants BTW but his trimax price alone is double of what Ramieri charges for trimax plus full facial implants so Raffaini is almost as out of reach as sailer for the average normie and could be an option if you are very wealthy
I don't know if he is an option for implants

Ramieri is better at playing it safe and improving your looks or if you have a very good base cause complications would very unlikely arise in his case at least that is more or less a given but it still happens cause no surgeon is perfect

Of you have hyoid fat or a low hyoid bone you will need a Genioplasty and Mandible advancement for Bimax so your skin stretches and advances the bone forward into a better position

Implants are very good for people with thin skin cause then they show better

Look at the good results for Jaw angle implants it's either from people that had thin skin or from people that had a good base and conservative designs which can only help so much

Thats something I havent heard anyone mention her if you have very thick skin and a low hyoid bone you will probably need bimax aesthetically speaking

Hope that helps and also consider some of fferent surgeons if you are low on money
The Italian 3 are good depending on what you need one is better than the other but consult with many surgeons cause what if you need revisions guess what you will have to pay for them too

I would be careful with Pagnoni and Ramieri you should plan what you get with them cause Ramieri can underadvance and pagnoni can overadvance
 
Last edited:
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photoshopini
:lul:

known to photoshop the results on his insta page to make them looks more impressive than they are. He edits the before photos of the patients to make them look uglier and the after photos as well.
What a scumbag move.
Any doctor photoshopping his results or even just frauding with the usual lighting/angles/lens tricks should be automatically discarded.
In case of obvious photoshopping, he should also be reported to local medical authorities (national commission, or whatever the name is) ; with repeated reports over time, he might get his license suspended, depending on the local authorities' code of ethics.
 
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Hi guys, long-time lurker, first-time poster from Italy.

I’m finally starting my hardmaxxing journey to try to fix all of my major flaws and I’m looking for the best surgeon in Italy for a complex case.

PRE-OP




Disclaimer: I’ve done some preliminary measurements on my CBCT using RadiAnt and Romexis. I’m not a pro, so if I messed up some calculations, please let me know. These should be roughly accurate though.
My Analysis (Based on CBCT):
  • Gonial Angle: 131.8°
  • Inter-molar Width: ~34.7mm (Narrow palate, teeth in compensation).
  • Face Type: High divergence, nasolabial folds, poor midface & infraorbital support)
I want to make sure I find a surgeon who can handle the aesthetic side of this, not just the occlusion.
  • Bimax (BSSO + Lefort 1) with CCW Rotation: I need to close that 132° angle and get projection.
  • Skeletal Expansion (MARPE/MSE/FME/SARPE): My inter-molar width is ~34.7mm. I’m debating and honestly I don't have much knowledge about this. I want to maximize midface widening and cheekbone support. Given I'm planning Bimax anyway, which one would you guys suggest?
  • Midface support: I’m leaning towards custom PEEK inframalar/infraorbital implants but I want to know if I can avoid paranasal implants by performing a High LeFort I cut and advancing the ANS, or maybe eventually both?
  • Jaw/Angles: I definitely lack bone mass here too. I'm considering custom jaw implants (wraparound or angles), but I’m worried about two things: 1) Is it even possible to do Bimax + Midface + Jaw implants in a single op? 2) The budget might explode.
  • Genioplasty: Undecided. If the CCW rotation provides enough projection, I might skip it, but idk tbh.

The Surgeon Question

I’m planning to visit Ramieri, Pagnoni, and Raffaini.
  • Which of these do you think is the best and open to custom midface implants alongside the Bimax? (keeping in mind how much each surgeon charges)
  • Should I do consultations with all three or is there a clear winner for this specific approach?

I’m open to any HIGH IQ advice or suggestions regarding my skeletal plan, movements, or surgeon choice. Don't hold back.

Brutally honest feedback only. If you guys have any questions or need more info, measurements, or specific CBCT slices to help me out, just ask no problem. Thanks.
mama mia
 
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Reactions: kuromilover
pagnoni botched my genio. It became uneven. Also know several that got botched bimaxes with bad bites from him. Do not go to him - unless its implants.
Dammn I guess He messes up Genioplasties at times after all

Sorry that happened to you
Can we see the ct or a face
 
Ramieri has his Implate technique which means his implants are part of the custom BSSO Plate of your bimax if you get implants trough his Implate technique but he only does them in titanium (it's not the same as placing implants normally and he claims the infection risk is less) but Ramieri is less Blackpilled than Pagnoni and is not as good as Pagnoni and Raffaini when it comes to Genioplasty and will try to dodge doing a genioplasty if you don't have a bad Base

Also Pagnoni is very honest, takes you seriously, not judgy and explains as much as you want and tries to tell you the truth about what can ascend you (in his opinion)
Pagnoni is more blackpilled and will do bigger movements than Ramieri but costs a lot more than Ramieri (not gonna mention prices here so they don't hike up even more)
He has an amazing Genio but he recently had some botches last
(and this year I believe but not sure)
He is a better implant placer and mor knowledgeable about implants than Ramieri though which matters less than one thinks cause Ramieri isn't gonna make riksy movements like that and will be playing it safe like you will look better than after but (maybe) not ascended of you need a lot but if you need very minimal improvement and have. (very) good base he is probably one of the better options also price wise he is the cheapest out of them all and also pretty fair since he has empathy for his patients when it comes to revision and would try to fix your problem

Raffaini costs almost double as what Pagnoni is charging for bimax because of his reputation and he also does very good bone grafts which allows your bone to heal better together

That being said all of these surgeons had some botches and the unfortunate reality is there is always a chance you get botched

What many people don't tell people is if you have very thick skin implants have a higher chance of making your face puffy looking and uncanny or fat looking and in this case you would be limited to a very conservative design

Raffaini is probably the best of you can afford him purely when it comes to bimax and tied or slightly better than Pagnoni when it comes to Genioplasty but he will only do what he wants not what you tell him what you want
It will only be what he thinks is best for you
I'm not sure if he does implants BTW but his trimax price alone is double of what Ramieri charges for trimax plus full facial implants so Raffaini is almost as out of reach as sailer for the average normie and could be an option if you are very wealthy
I don't know if he is an option for implants

Ramieri is better at playing it safe and improving your looks or if you have a very good base cause complications would very unlikely arise in his case at least that is more or less a given but it still happens cause no surgeon is perfect

Of you have hyoid fat or a low hyoid bone you will need a Genioplasty and Mandible advancement for Bimax so your skin stretches and advances the bone forward into a better position

Implants are very good for people with thin skin cause then they show better

Look at the good results for Jaw angle implants it's either from people that had thin skin or from people that had a good base and conservative designs which can only help so much

Thats something I havent heard anyone mention her if you have very thick skin and a low hyoid bone you will probably need bimax aesthetically speaking

Hope that helps and also consider some of fferent surgeons if you are low on money
The Italian 3 are good depending on what you need one is better than the other but consult with many surgeons cause what if you need revisions guess what you will have to pay for them too

I would be careful with Pagnoni and Ramieri you should plan what you get with them cause Ramieri can underadvance and pagnoni can overadvance
raffaini is 25k for bimax only without genio, fat grafts,...
 
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raffaini is 25k for bimax only without genio, fat grafts,...
Wanted to say Trimax I made a typo

Thats good to know I guess the prices I've been told by users were false then

Have you had a Consult with him?
 
Wanted to say Trimax I made a typo

Thats good to know I guess the prices I've been told by users were false then

Have you had a Consult with him?
nah but someone under his latest instagram posts complained about the price and he or one of his stuff commented the actual price.
 
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Y
nah but someone under his latest instagram posts complained about the price and he or one of his stuff commented the actual price.
Yeah he is the only one of the trio I haven't consulted with so I didn't know

I also heard a consult with him is 500 bucks
Is that also a lie?
 
Ramieri has his Implate technique which means his implants are part of the custom BSSO Plate of your bimax if you get implants trough his Implate technique but he only does them in titanium (it's not the same as placing implants normally and he claims the infection risk is less) but Ramieri is less Blackpilled than Pagnoni and is not as good as Pagnoni and Raffaini when it comes to Genioplasty and will try to dodge doing a genioplasty if you don't have a bad Base
Yeah I knew pagnoni was willing to listen to his patient more than ramieri. About ramieri's genioplasty i saw some and yeah ig he's not the best at them, don't even know if I need one

Pagnoni is more blackpilled and will do bigger movements than Ramieri but costs a lot more than Ramieri (not gonna mention prices here so they don't hike up even more)
I mean as long as long as bimax + eventual genio + inframalar don't cost like 40k it's fine ahahah, I'll see it for myself when I go to the consultation w him

He is a better implant placer and mor knowledgeable about implants than Ramieri though which matters less than one thinks cause Ramieri isn't gonna make riksy movements like that and will be playing it safe like you will look better than after but (maybe) not ascended of you need a lot but if you need very minimal improvement and have. (very) good base he is probably one of the better options also price wise he is the cheapest out of them all and also pretty fair since he has empathy for his patients when it comes to revision and would try to fix your problem
So thing is i don't know if you saw my ct scan and my side profile but I'm pretty cooked at baseline and need to be a little bit bold to try and ascend, idk if being conservative here is the right choice

What many people don't tell people is if you have very thick skin implants have a higher chance of making your face puffy looking and uncanny or fat looking and in this case you would be limited to a very conservative design
I'm pretty set on getting implants, is there a way to understand how thick my skin is lol, the last thing i want is being bloated. I'm like at 10%ish bf and my face makes it seem like 20 JFL

Raffaini is probably the best of you can afford him purely when it comes to bimax and tied or slightly better than Pagnoni when it comes to Genioplasty but he will only do what he wants not what you tell him what you want
It will only be what he thinks is best for you
Yeah I hate that he does this, like I get it the patient might not be as knowledgeable as him but still like his mentality is so fucking old, I don't know if I'll be even booking a consultation with him because of this and the implants thing

Hope that helps and also consider some of fferent surgeons if you are low on money
The Italian 3 are good depending on what you need one is better than the other but consult with many surgeons cause what if you need revisions guess what you will have to pay for them too
I'm set on pagnoni and ramieri for now, don't know about raffaini, maybe someone else can enlighten me with a plan to get bimax with him and implants like 12 months later from pagnoni but yeah idk if that's really worth it when I could get everything /almost everything in 1 op
I would be careful with Pagnoni and Ramieri you should plan what you get with them cause Ramieri can underadvance and pagnoni can overadvance
I knew that much, thanks for the help broski
 
Y

Yeah he is the only one of the trio I haven't consulted with so I didn't know

I also heard a consult with him is 500 bucks
Is that also a lie?
I contacted him and his studio told me that for the consult I had to pay €400 in advance by bank transfer :hnghn:
Screenshot 1
 
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Cant help you but mirin the thread and I hope you make it to the very top bhai
 
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Yeah I knew pagnoni was willing to listen to his patient more than ramieri. About ramieri's genioplasty i saw some and yeah ig he's not the best at them, don't even know if I need one


I mean as long as long as bimax + eventual genio + inframalar don't cost like 40k it's fine ahahah, I'll see it for myself when I go to the consultation w him


So thing is i don't know if you saw my ct scan and my side profile but I'm pretty cooked at baseline and need to be a little bit bold to try and ascend, idk if being conservative here is the right choice


I'm pretty set on getting implants, is there a way to understand how thick my skin is lol, the last thing i want is being bloated. I'm like at 10%ish bf and my face makes it seem like 20 JFL


Yeah I hate that he does this, like I get it the patient might not be as knowledgeable as him but still like his mentality is so fucking old, I don't know if I'll be even booking a consultation with him because of this and the implants thing


I'm set on pagnoni and ramieri for now, don't know about raffaini, maybe someone else can enlighten me with a plan to get bimax with him and implants like 12 months later from pagnoni but yeah idk if that's really worth it when I could get everything /almost everything in 1 op

I knew that much, thanks for the help broski
Haven't looked at your profile yet well a tally I have but don't remember from scratch or when I was typing

You don't understand being bloated and the thickness of your skin are two different things having thick or thin skin is genetic
You can be lean and have thick skin as far as I'm aware (and remember I had a Consult with Pagnoni he absolutely hates jaw angle implants and told me he would never ever place them In the same surgery so you would have 1000% to get the implants with him afterwards If they make sense in your case but Ramieri will suggest seeing if ramus widening will be enough in your case but there is also a limit to ramus widening like there is for implants) but yeah I'm just reading your other part if you want to get implants with Pagnoni after Ramieri that's possible just don't tell him you are going to Ramieri first

Well infection risk is lower if you do it seperated but to costs will be higher of course so yeah

Also Pagnoni will touch your face and look lf your skin is fat

If you pinch it and it's very thick it's thick but ask Pagnoni (obviously he can only tell you in person and I dunno if Ramieri does that)

I just looked at it and your skin look thick to me actually but I'm nit a surgeon and don't know how thick it's not thin imo

DM me for the price and gatekeep it's gonna be expensive for you I can say as much
 
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Hi guys, long-time lurker, first-time poster from Italy.

I’m finally starting my hardmaxxing journey to try to fix all of my major flaws and I’m looking for the best surgeon in Italy for a complex case.

PRE-OP




Disclaimer: I’ve done some preliminary measurements on my CBCT using RadiAnt and Romexis. I’m not a pro, so if I messed up some calculations, please let me know. These should be roughly accurate though.
My Analysis (Based on CBCT):
  • Gonial Angle: 131.8°
  • Inter-molar Width: ~34.7mm (Narrow palate, teeth in compensation).
  • Face Type: High divergence, nasolabial folds, poor midface & infraorbital support)
I want to make sure I find a surgeon who can handle the aesthetic side of this, not just the occlusion.
  • Bimax (BSSO + Lefort 1) with CCW Rotation: I need to close that 132° angle and get projection.
  • Skeletal Expansion (MARPE/MSE/FME/SARPE): My inter-molar width is ~34.7mm. I’m debating and honestly I don't have much knowledge about this. I want to maximize midface widening and cheekbone support. Given I'm planning Bimax anyway, which one would you guys suggest?
  • Midface support: I’m leaning towards custom PEEK inframalar/infraorbital implants but I want to know if I can avoid paranasal implants by performing a High LeFort I cut and advancing the ANS, or maybe eventually both?
  • Jaw/Angles: I definitely lack bone mass here too. I'm considering custom jaw implants (wraparound or angles), but I’m worried about two things: 1) Is it even possible to do Bimax + Midface + Jaw implants in a single op? 2) The budget might explode.
  • Genioplasty: Undecided. If the CCW rotation provides enough projection, I might skip it, but idk tbh.

The Surgeon Question

I’m planning to visit Ramieri, Pagnoni, and Raffaini.
  • Which of these do you think is the best and open to custom midface implants alongside the Bimax? (keeping in mind how much each surgeon charges)
  • Should I do consultations with all three or is there a clear winner for this specific approach?

I’m open to any HIGH IQ advice or suggestions regarding my skeletal plan, movements, or surgeon choice. Don't hold back.

Brutally honest feedback only. If you guys have any questions or need more info, measurements, or specific CBCT slices to help me out, just ask no problem. Thanks.
DM me on Discord @41792, I can answer all of these questions, especially related to expansion. I currently have an FME installed
 
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Haven't looked at your profile yet well a tally I have but don't remember from scratch or when I was typing

You don't understand being bloated and the thickness of your skin are two different things having thick or thin skin is genetic
You can be lean and have thick skin as far as I'm aware (and remember I had a Consult with Pagnoni he absolutely hates jaw angle implants and told me he would never ever place them In the same surgery so you would have 1000% to get the implants with him afterwards If they make sense in your case but Ramieri will suggest seeing if ramus widening will be enough in your case but there is also a limit to ramus widening like there is for implants) but yeah I'm just reading your other part if you want to get implants with Pagnoni after Ramieri that's possible just don't tell him you are going to Ramieri first

Well infection risk is lower if you do it seperated but to costs will be higher of course so yeah

Also Pagnoni will touch your face and look lf your skin is fat

If you pinch it and it's very thick it's thick but ask Pagnoni (obviously he can only tell you in person and I dunno if Ramieri does that)

I just looked at it and your skin look thick to me actually but I'm nit a surgeon and don't know how thick it's not thin imo

DM me for the price and gatekeep it's gonna be expensive for you I can say as much
can u dm me instead bc i can't i guess its bc i don't have enough posts lol
 
@kuromilover have you looked into Italian alternatives to the usual trio ?
Here on this forum, I saw someone mentioning once Drs. Lorenzo Trevisiol and Antonio D'Agostino. It was not an endorsement, rather options to be explored. Maybe through the Italian-speaking Facebook group you're most likely aware of. Although you don't seem to be short on money, pricing would of course be much more reasonable than with the usual trio.


I had a Consult with Pagnoni he absolutely hates jaw angle implants
What's the rationale behind this hate ?
 
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Here on this forum, I saw someone mentioning once Drs. Lorenzo Trevisiol and Antonio D'Agostino. It was not an endorsement, rather options to be explored. Maybe through the Italian-speaking Facebook group you're most likely aware of.
I saw someone mentioning this Lorenzo guy once but honestly forgot, don't know about the other one. I don't even have facebook lol so I'll have to look it up, thanks.

Although you don't seem to be short on money
I'm not short on it but not loaded either ahaha, I'm currently working to get to 30k-ish to try and afford at least custom marpe, bimax (w or w/o genio) and inframalar implants bc i really need that projection
 
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I saw someone mentioning this Lorenzo guy once but honestly forgot, don't know about the other one. I don't even have facebook lol so I'll have to look it up, thanks.

I don't know if this is the main group that has been alluded to several times here : https://www.facebook.com/groups/4234704463245047/
This is a smaller private group, boasting only 500 members : https://www.facebook.com/groups/610955933025105
Try to search other groups with different terms (I typed "chirurgia ortognatica / maxillo-facciale). And don't be surprised if you're suggested numerous Brazilian groups with similar spelling (e.g. cirurgia ortognatica).
Register a throwaway account and subscribe to groups in order to facilitate research.

There may be an italian-speaking Discord server dedicated to this topic, but I don't have a direct link to share.
 
I don't know if this is the main group that has been alluded to several times here : https://www.facebook.com/groups/4234704463245047/
This is a smaller private group, boasting only 500 members : https://www.facebook.com/groups/610955933025105
Try to search other groups with different terms (I typed "chirurgia ortognatica / maxillo-facciale). And don't be surprised if you're suggested numerous Brazilian groups with similar spelling (e.g. cirurgia ortognatica).
Register a throwaway account and subscribe to groups in order to facilitate research.

There may be an italian-speaking Discord server dedicated to this topic, but I don't have a direct link to share.
will def do this later, thx bro
 
Wouldn't go to Pagoni for Bimax. Ramieri and Raffaini would be better
 

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