Midface of Death
Blackpilled since I can remember.
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Most informative post on the future of bone augmentation, I say future, but we ALREADY can get it, and that is 3D-printed bone scaffolds.
BONE GRAFTS That's not what I'm going to talk about, but knowing this concept is key for full understanding. I believe that most of you have heard about bone grafts, that cosists of a material that is used to stimulate the body's natural bone growth. This material can be synthetic or derived from natural sources, such as from the patient's own body or from a donor. Over time, the body replaces this material with its own bone tissue, essentially turning the implant into real bone.
As I said above, there are a few types of grafts, some of them are:
3D-PRINTED BONE SCAFFOLDS Basically we're talking about grafting synthetic bone, just like custom silicone implants and stuff like that, in other words, you'll get bones that match your anatomy perfectly, based on MSI/CT Scans. That's very important, because one of the biggest issues with bone grafts is that the surgeon would have to shape it manually and with big limitations, that means unpredictability.
That also serves as a scaffold, simply put, allowing your own body to turn it into natural bone, YOUR bone. Obviously, there are no procedures free of limitations or possible issues, such as resorption, rejection, among others, but these can be mitigated.
As far as I know, the two main options are hydroxyapatite and tricalcium phosphate. Maybe you've already heard about hydroxyapatite paste, commonly used to treat bone defects, also used cosmetically, for the malar area, for example, but much less common than conventional implants. Essentially, it's hydroxyapatite in a "liquified state". However, it's not ideal for convexities; it's better suited for concavities, such as the paranasal areas. Due to its difficulty in shaping, it often yields unpredictable results. Dr. Eppley talks about it in this article.
There are even some times that he mentions that hydroxyapatite paste doesn't turn into bone.
Since we already can 3D-print hydroxyapatite, we don't have the predictability problem anymore. And from what the companies are saying those scaffolds DO turn into bone.
Here's the links of some of the companies, see for yourself.
So now I'm going to tell you some areas where I think it would be ideal and areas where I think we have better options.
Keywords: 3D-printed scaffolds, 3D-printed bone graft, 3D-printed bone substitutes, bone augmentation.
I AM NOT AN EXPERT.
I LACK COMPREHENSION OF THE INTRICANCIES OF BIOLOGICAL AND CHEMICAL PROCESSES.
I'M LIKELY MISSING MAJOR POINTS ABOUT IT, THINGS I DIDN'T TAKE INTO CONSIDERATION.
I WOULD LIKE TO HEAR YOUR THOUGHTS ON THIS, LET'S DISCUSS IT!
"The knowledge of the circumstances of which we must make use never exists in concentrated or integrated form but solely as the dispersed bits of incomplete and frequently contradictory knowledge which all the separate individuals possess." ― Friedrich von Hayek
BONE GRAFTS
As I said above, there are a few types of grafts, some of them are:
- Autologous bone grafting: Bone tissue harvested from the patient's own body.
- Allografts: Bone tissue obtained from a donor.
- Xenografts: Bone tissue sourced from animal donors.
- Synthetic bone substitutes: Biocompatible materials designed to mimic the properties of bone.
3D-PRINTED BONE SCAFFOLDS
That also serves as a scaffold, simply put, allowing your own body to turn it into natural bone, YOUR bone. Obviously, there are no procedures free of limitations or possible issues, such as resorption, rejection, among others, but these can be mitigated.
As far as I know, the two main options are hydroxyapatite and tricalcium phosphate. Maybe you've already heard about hydroxyapatite paste, commonly used to treat bone defects, also used cosmetically, for the malar area, for example, but much less common than conventional implants. Essentially, it's hydroxyapatite in a "liquified state". However, it's not ideal for convexities; it's better suited for concavities, such as the paranasal areas. Due to its difficulty in shaping, it often yields unpredictable results. Dr. Eppley talks about it in this article.
There are even some times that he mentions that hydroxyapatite paste doesn't turn into bone.
Since we already can 3D-print hydroxyapatite, we don't have the predictability problem anymore. And from what the companies are saying those scaffolds DO turn into bone.
Here's the links of some of the companies, see for yourself.
APPLICATIONS
It's expected that the main uses of this technology are for medical purposes, not cosmetic. However if you can adress more complex concerns, why wouldn't you be able to add 5mm to the infraorbital rim, 3mm to the malar prominence and improve your ogee curve, for example.So now I'm going to tell you some areas where I think it would be ideal and areas where I think we have better options.
- Anterior midface augmentation: Most midface surgeries for anterior advancement are just unrealistic. If you're not a real candidate, you shouldn't consider Le Fort 3, OBO, it's just medieval, and most surgeons will not do that. So I think that scaffolds would be perfect for anterior projection and mitigating the lack of forward growth, specifically targeting the infraorbital rim and the anterior part of the zygomatic bone, that would also be the solution for lack of bone mass. If there is insufficient lateral projection, a Zygomatic Sandwich Osteotomy can be performed to reposition the zygomatic bone, followed by the use of scaffolds to address any anterior deficiency.
- Jaw widening and lower third imperfections: I believe that, when it comes to the lower third, osteotomies are the best options, mainly because it looks natural and also fix not only aesthetics issues, but functional ones. However, scaffolds could be amazing for things that only an implant would be suited to. Take me as an example. I have an above-average jaw—it's wide, has good visibility, good projection, and a long ramus. However, the border of the ramus is slightly inward, so it's not very visible from the side profile. To me, a solution to this "problem" could be grafting synthetic bone to that area, but I'm not sure.
- Any other lack of bone: Asymmetries, brown ridge, dentistry, maybe supraorbitals, you name it, just don't expect you'll be able to get a PSL skull, focus on failos, then think about halos, and don't overdo it, because you can fall deep into the uncanny valley.
- Limb lengthening: That's something that I wouldn't expect to see in the near future, but research is being done on this subject. Check out the video down below.
Keywords: 3D-printed scaffolds, 3D-printed bone graft, 3D-printed bone substitutes, bone augmentation.
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