Wires in forehead reconstruction - what do they look like?

[maquillage]

Hi all,

I've been researching forehead reconstruction and was surprised to find the use of wires being mentioned by many surgeons in some point or another. For example, Dr. O used titanium wires for Lynn Conway's FFS. Originally, I thought only plates and screws were used.

I've been trying to google images of what these wires look like, but don't know which is which. Are they like pins (something like k-wires?) or is it something like a "titanium wire mesh"?

Is it down to personal preference what the doctor chooses to use?

[mmmmm]

It depends on patients case. If someone had previously messed up forehead frontal wall by incompetent surgeon doing shaving technique, there are various ways how to fix the problem. One is bone grafting from some donor location, other is titanium wire mesh which holds bone paste with adhesive material, others smaller holes to fix can be only done with bone paste. It depends . now this is not your problem, unless if you decide to go to one of those low budget surgeons, who either perform type 3 or not, and you end up having bad luck, and then you will have to deal with this issues, how to do revisions properly. Be smart and go to one of the surgeons who is properly trained and has done hundreds of more or less complicated forehead reconstructions, and you will have the best chance to avoid any severe complications.

[Ashley3]

I've been trying to google images of what these wires look like, but don't know which is which. Are they like pins (something like k-wires?) or is it something like a "titanium wire mesh"? ... Is it down to personal preference what the doctor chooses to use?

I believe it's both preference (era of surgeon, how they were trained) in combination with what is acceptable given present day knowledge of approaches to various procedures, and a doctor's assessment of a particular case.

Based on my last read of Ousterhout's book, I vaguely recall that he used wires for re-securing the frontal sinus as part of forehead reconstruction, but he also used titanium screws for other procedures. So I believe even he chose various things based on his era, training and assessment of a situation.

In the edition of his book that I have, one rationale for using wire to secure the frontal sinus was that, in some cases, screws can be "felt and seen" through the skin requiring another surgery to fix things. By contrast, I believe at least some surgeons who use titanium screws for the frontal sinus attest to never having had that particular issue with them.

Frankly, I think context matters so general recollections such as mine above are missing a lot of info. For example, were there once a particular type and size of titanium screw, where now they are better? I don't know.

[ADDED]My understanding is that screws and plates are newer, wires are older (see info at Virtual FFS link below). I believe both work. Is one better than the other? I cannot say. I'd defer to a surgeon I'd interview during a consultation. Since many FFS surgeons use screws/plates, I'm betting they're fine.[/ADDED]

It's likely best to interview your FFS surgeons of choice, asking them what they use, why, and see how you feel, and so forth. Many of these doctors will use differing approaches but they're all talented in their own right.

That said, it's quite excellent you're doing your research.

Some possibly helpful links...

http://www.virtualffs.co.uk/Forehead.html

http://www.barnesandnoble.com/w/facial-feminization-surgery-douglas-k-ousterhout-md/1112966615?ean=9781886039933

Best of luck!

[Paula1]

Interesting thread ... 

The inapproprate PEEK implants that were put in over my overburred orbital rims in 2014 have titanium screws to hold them in place.

I asked the surgeon at the time, are they countersunk? ... 

He laughed, so I suppose they are as I can't feel them.

Of course, they are coming out in April when Facial Team properly reconstruct my forehead for the very first time.

See: https://www.susans.org/forums/index.php/topic,180029.0.html

and:  https://www.susans.org/forums/index.php/topic,199847.0.html

In the edition of his book that I have, one rationale for using wire to secure the frontal sinus was that, in some cases, screws can be "felt and seen" through the skin requiring another surgery to fix things. By contrast, I believe at least some surgeons who use titanium screws for the frontal sinus attest to never having had that particular issue with them.

Frankly, I think context matters so general recollections such as mine above are missing a lot of info. For example, were there once a particular type and size of titanium screw, where now they are better? I don't know.

[Ashley3]

Congrats on your upcoming surgery with FT! Based on what I've seen and heard, you're in great hands.

BTW, their site mentions use of "titanium micro-screws"...

http://facialteam.eu/feminization-of-the-upper-third-of-the-face/ffs-forehead-feminization/#theforehead

...so I'd say FT's success and great reputation are further indicators that use of titanium screws themselves is never an issue in the right hands. It seems most modern/newer FFS surgeons are all using screws (unverified, but seems that way to me).

[Paula1]

A'wwwwwwww thanks honeybun ....  

Big hugs

Paula   

Congrats on your upcoming surgery with FT! Based on what I've seen and heard, you're in great hands.

[maquillage]

It depends on patients case. If someone had previously messed up forehead frontal wall by incompetent surgeon doing shaving technique, there are various ways how to fix the problem. One is bone grafting from some donor location, other is titanium wire mesh which holds bone paste with adhesive material, others smaller holes to fix can be only done with bone paste. It depends . now this is not your problem, unless if you decide to go to one of those low budget surgeons, who either perform type 3 or not, and you end up having bad luck, and then you will have to deal with this issues, how to do revisions properly. Be smart and go to one of the surgeons who is properly trained and has done hundreds of more or less complicated forehead reconstructions, and you will have the best chance to avoid any severe complications.

I'm asking about the materials used in primary cases, not revisions.

[maquillage]

I believe it's both preference (era of surgeon, how they were trained) in combination with what is acceptable given present day knowledge of approaches to various procedures, and a doctor's assessment of a particular case.

Based on my last read of Ousterhout's book, I vaguely recall that he used wires for re-securing the frontal sinus as part of forehead reconstruction, but he also used titanium screws for other procedures. So I believe even he chose various things based on his era, training and assessment of a situation.

In the edition of his book that I have, one rationale for using wire to secure the frontal sinus was that, in some cases, screws can be "felt and seen" through the skin requiring another surgery to fix things. By contrast, I believe at least some surgeons who use titanium screws for the frontal sinus attest to never having had that particular issue with them.

Frankly, I think context matters so general recollections such as mine above are missing a lot of info. For example, were there once a particular type and size of titanium screw, where now they are better? I don't know.

[ADDED]My understanding is that screws and plates are newer, wires are older (see info at Virtual FFS link below). I believe both work. Is one better than the other? I cannot say. I'd defer to a surgeon I'd interview during a consultation. Since many FFS surgeons use screws/plates, I'm betting they're fine.[/ADDED]

It's likely best to interview your FFS surgeons of choice, asking them what they use, why, and see how you feel, and so forth. Many of these doctors will use differing approaches but they're all talented in their own right.

That said, it's quite excellent you're doing your research.

Some possibly helpful links...

http://www.virtualffs.co.uk/Forehead.html

http://www.barnesandnoble.com/w/facial-feminization-surgery-douglas-k-ousterhout-md/1112966615?ean=9781886039933

Best of luck!

Thanks Kao3! That makes a lot of sense. Very interesting to imagine the wires underneath the bone holding everything in place. A major pro for not being able to feel it underneath the skin.

Research is great. I've also been searching medical publications by craniofacial surgeons dealing with prominent sinuses (and setting the bone back). Turns out not only transgender women get this done! I'm the type that wants to know as much as I can, even if it doesn't apply to me. I feel like a student studying for her finals *laughs*

[deeiche]

SNIP
Research is great. I've also been searching medical publications by craniofacial surgeons dealing with prominent sinuses (and setting the bone back). Turns out not only transgender women get this done! I'm the type that wants to know as much as I can, even if it doesn't apply to me. I feel like a student studying for her finals *laughs*

I used to get regular, really bad sinus headaches.  Since my frontal sinus was almost completely removed I've only had a couple headaches, none anywhere near as bad as I once had.