Jaw Surgery Matrix Download with Dr. David Alfi | JawCast #47

David Alfi is a very capable, experienced and innovative jaw surgeon who maintains the airway as the number one priority.
He is on the forefront of jaw surgery innovation with his invention and use of 3D custom plate technology.
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TIMESTAMPS
0:00 Introduction
1:34 Small Airway causes Bad Neck Posture
5:02 Traditional vs Non-Traditional Reasons for Jaw Surgery?
8:20 Insurance paying for Jaw Surgery?
12:39 Jaw Surgery is the Boogeyman
16:54 ln-depth Explanation of Jaw Surgery Planning and Technological advancements
26:32 Under-advancement in Jaw Surgery & Field Goal kicking
29:42 Dr Alfi Seeing Under-Advanced Cases on Social Media
30:54 Dr Alfi's Surgical Movements Described by Colleagues
31:34 Do Jaw Surgeons Have an Inherent Understanding of Aesthetics?
33:57 Dog or Monkey-Face Effect from Advancement & Different Types of Leforts
40:59 Genioplasty Only Necessary in Cases That Are Under-Advanced?
43:46 Brief Discussion on Mouth Breathing & Myofunctional Therapy
44:38 Mandibular Distraction & Flaring Out the TMJs
48:32 SFOT, Expanding Before Surgery with Distraction (MARPE or MSE) vs Doing It Segmentally During Surgery
52:34 IMDO
53:41 Both Jaws Are Usually Recessed
55:58 ENTs Taking Furniture Out Instead of Expanding the House & Does Nasal Surgery Complicate Jaw Surgery?
59:00 High Quality Surgeons Who Dr. Alfi Respects?
1:01:30 Dr. Alfi Takes a Look at Ron's Side Profile & Is Ron a Candidate for Jaw Surgery
1:04:51 Down-Grafting vs Impaction
1:06:26 Surgeons Not Confident in Their Ability to Make Larger Movements
1:09:14 How Did Dr. Alfi Get into Jaw Surgery and Using 3D Custom Plates?
1:12:11 Myers-Briggs Personality Test
1:13:25 Recovery in Jaw Surgery
1:15:56 Dr. Alfi Has Seen Patient Positivity Makes a Huge Difference in Recovery

[@chetana1156]

I am 10 days post op from the surgery with him, can tell what he stated about planning and recovery is absolutely true. Amazing guy

[@marcoturra5086]

hello, how much did you pay?

[@EccentricHuman]

How was your overall experience?

[@user-fn2oy1rq5p]

With how much money would I need to calculate for a standard double jaw surgery?

[@HelianaFranko]

What was the cost and what insurance do you recommend

[@jtbigbear3158]

@@marcoturra5086we have to sign a non disclosure on pricing.

[@astraydhurion7697]

I really like that, Dr. Alfi is straightforward to affirm with no hesitation that he is on the more aggressive side when it comes to moving the entire jaw complex forward. Dr. Alfi has perfectly explained in his very own metaphoric way how being too conservative and not trying to score the touchdown will certainly cause relapses in most cases due to muscles and soft tissue tensions during the healing phase of the patients. As Dr. Mew likes to repeat, "muscles always win over bones.".

[@tjam4229]

Ron, you are the man! Having all of these heavy hitters as guests…thank you!! At 34:29, the big reason he has the appearance that you are trying to describe is caused by “advancement WITHOUT widening”… their faces are corrected on a sagittal plane, but Left/Right expansion is left untouched. This is a huge problem that I see all the time. You get guys doing MSE and WIDENING the jaws, but not advancing them…you get guys ADVANCING the jaws but not widening. Those of us who have restricted airways need doctors that incorporate BOTH WIDENING AND ADVANCEMENT!! Why is it so difficult to find competent surgeons that believe in both?! I need “horizontal jaw expansion” to give room for my tongue, PLUS “anterior jaw advancement” to move the tongue anteriorly to give enough room for air to pass posteriorly thru the nose and thru the pharynx. PS: it would be cool if we could see some “before/after” photos or even a link to website showing before/after photos.

[@gurjotsingh8934]

Did you find answers? This comment needs to be pinned.

[@melvingibson4525]

Dr david alfi is a very good man who cares about his patients. During the busy season he does 10 of these surgeries a week. He is a true expert at this procedure

[@Sunrise-fr9jb]

Holy 🐄 that’s a lot

[@HelianaFranko]

Incredible was thinking of getting Surgery with him.

[@shuikai272]

By the way when Dr. Alfi was talking about high lefort, he was referring to a high lefort 1. So that's not shown in the three pictures, but it'd be kind of in-between a LeFort 1 and LeFort 2. I think it usually starts around the middle of the aperture and then curves down so it is below the cheekbone.

[@lukebruce5234]

Coceancig does bimaxes all the time, even more so than IMDO. He also does IMDO+LE FORT too. He also uses custom titanium. He mostly markets IMDOs for growing teenagers.

[@MeatLogg]

Ron, I think you'd find this very interesting, as it is a lighter form of surgery. Apparently, there now exists a way to expand the upper jaw forward, rather than moving it forward, similar to MSE w/ surgical assist but in the anterior/posterior dimension. It's called "Anterior Maxillary Distraction". It should be much cheaper and less involved (perhaps just a simple office procedure like I did with the surgical assist for MARPE) than a LeFort I. It's just a question now of which providers will offer such. I think it will be tremendously useful. There is a good video involving the young man that had it done in India (you'd have to search for what-is-anterior-maxillary-distraction-or-amd). It appears that the surgical cut is approximately between the premolars and first molar, so everything in front of that would expand forward

[@user-fn2oy1rq5p]

But then you'd still need to bring the lower jaw forward surgically to match it to the teeth. That doesn't sound like saving much effort or surgery time

[@darthnihilus777]

Wow thanks Ron for bringing Dr. Alfi on! Would definitely be cool to see more jaw surgeons in the future if you can bring them on as well!

[@avalex6603]

This was such an incredible chat. I learned so much from Dr. Alfi . Also how cool to see another intp.

[@EM10]

one of the best vids yet

[@JAinHTX]

Amazing interview. So much knowledge on both sides! Great awareness of such common issues!

[@waveypizza]

What an exceptional interview Ron, this is a great benefit to people. I really like this doc.

[@Lukewarmclamchowder]

I just had surgery with him in June! Recovery has been so smooth. I’m about to be at 8 weeks next week which means I get to start chewing soft food! I already feel such a difference. I’m so grateful for Dr. alfi!!

[@christianbacigalupi9427]

Luke, thank you for this. I’m considering the surgery as well. Can you give an idea of your final price for the procedure?

[@Lukewarmclamchowder]

@@christianbacigalupi9427 insurance covered the cost so I paid my out of pocket max which was $2500

[@jimfleece2880]

Price range ?

[@Ineedmag]

none of these guys talking about porice. seems so fishy

[@Lukewarmclamchowder]

@@Ineedmag I don’t have a price range because it was through insurance. I don’t know what an out of network cost would be so I’m not going to give information I am not privy to.

[@kathyprince1608]

I had maxillary advancement three decades ago and it relapsed within a short time to a posterior open bite. Now having it done again for sleep apnea with the 3D printed plates with expectation of no relapse this time.

[@AnchorShip]

One of the best content creators❤

[@Sariine436]

This was very informative and im in houston too

[@JohnDoe-xp3ej]

Ron great interview! Just wanted to point out that IMDO in adults is preceded by widening and moving forward of the maxilla via surgery. So the distraction movement of the mandible is not limited by the maxilla. I think it would be better if you spoke with Paul himself first regarding this procedure. Just my two cents.

[@maxrobert7648]

Thank you Ron.

[@timothyjudson9191]

Instant channel classic! I’m an engineering student at Georgia Tech, and I frequently see science majors come in to play around with the CAD operated machines (printers, mills, water jets, etc.) available at the engineering invention studios. I think that their exposure to these resources is going to pay huge dividends in a decade or so, once they are in the medical field.

[@stephencirving]

It’s cool how we interrelate hey. I’m in software and I rarely think about mechanical engineering, but should. For example, an airbnb style site which was like a virtual surgery studio, where software was used for virtual scans & consultations (software) could be achieved with improvements in the camera or amendments (hardware), then the surgery could be done in person (medicine/surgeon) which is then tracked with an app and the doctor & patient can communicate through there. And have nurses/doctors on staff to triage before annoying the surgeon directly (maths/logic) so they can focus surgery.

[@stephencirving]

And as much as we think about all being nodes and individuals at uni (I.e. entrepreneurs). Something like a massive business or hospital or university (should) be a cool thing as it has this share of resources so people can bounce things off each other and share machines etc. whereas a small business is super restricted and wouldn’t hear new ideas like this.

[@jw619]

Wish I was closer to Houston to have this faster surgery. Having jaw surgery in September in PA.

[@krisinua]

I had a consultation with the surgeon and I liked him alot unfortunately he doesn't take my insurance I lost every career I've had because of my deformed causing severe neck issues and headaches my whole life Including an awesome job I had at the postal I can't understand why no one ever told me I needed to have surgery to fix my deformed face or I would have had it when I was younger my whole life is gone now I'm almost 50 and my life has been one nightmare after another for stunted disability just existing and not living and now my teeth are too bad to get the surgery because no one ever bothered to tell me and I'm going to end up dying before I'm 60 probably because I won't live with no teeth and I can't win the lottery to get my teeth fixed

[@druidactual]

Great interview, gives me hope and has me considering going through the procedure for myself. What is the ballpark estimate of the cost for this surgery?

[@Frenk33]

Hi Ron, massive fan of the channel since I discovered it in November 2022. Didn’t you want to switch career paths at some point to become an orthodontist? I don’t know if you want to read this comment fully, but here I go. I’m struggling with some life advice for my career path as a 19 year old. I’m going to start studying computer science next month for a 4 year bachelor because I find AI so interesting; but I’m beginning to regret it. I find Orthotropics so interesting and part of me wants to 180 my life and start a career in airway dentistry. This field is so novel and so under-utilized in our modern society. It feels like people in the orthotropic profession are going to be invaluable to our future as a civilization. But I feel like the 10 year journey of becoming a dentist and orthodontist is something I might underestimate; or perhaps I’m not going to be good at studying due to the sheer difficulty of dental school. I’m totally at a crossroads here and don’t know what to do.

[@danieladelberg7274]

life is not always about taking the easy route. 10 years goes by pretty fast the older you get. Picture yourself 10 years from now at 29. Where would you want to see yourself?

[@tazfi1866]

You may want to combine computer science and airway health. Maybe you will invent or advance some of the 3D programs surgeons or orthodontists use or something like that. So you could use your craft (computer and Ai stuff) on the topic of airway orthodontics

[@thecontenverse2136]

What are your thoughts on peptides like BPC 157 and TB 500 to recover faster from Jaw surgery?

[@packman3979]

So does anybody know how many months it takes for the mandible to expand after MSDO

[@stephencirving]

Dude, Dr Alfi is cool

[@stefaniebrocker8084]

would love some interviews of folks who´ve had his surgery a year or two out

[@natural_law_nutrition]

hi, sprichst du deutsch?

[@burtnation1357]

What happens to the disk when doing double jaw surgery

[@sambro7796]

this guy is like the elon musk of jaw surgery

[@burtnation1357]

Does surgery ever expand the jaw side by side or just foward

[@ambercook6775]

When ppl say they have shoulder pain, where is it? Back of joint or along the top of the supraspinatus ... looking for everyone's locations. Trying to see if my boyfriends pain matches anyone else's location. Thanks!!!

[@Nutella-gn9uv]

If you do MSE if there another treatment for the lower jaw like a expander to make it wider to match with your upper face without surgery?

[@MeatLogg]

I would consider undegoing another (3rd!) surgery with Dr. Alfi. I was originally a severe class III in both AP and transverse dimensions. After my 1997 djs, I became just a mild-to-moderate class III in both dimensions (now I understand why the 1997 surgery only helped somewhat). My 2nd procedure was a MARPE w/ surgical assist, which basically corrected the transverse issue (my upper jaw imw is over 50mm now) and brought the upper jaw forward about 3mm. I'm still about 4mm deficient in the AP direction, though my lower anterior teeth are severely retroclined so I don't have an anterior crossbite. I would certainly consider a simple LeFort I advancement w/ Dr. Alfi; then I'd be complete!

[@MaxServo]

Hey there , you gained 3mm forward on your upper jaw without face mask, is that it? so MARPE/MSE alone did give you some forward projection? Braces were used after that to caret teeth position and still you kept this advancement? Thanks in advance for the details.

[@MeatLogg]

@@MaxServo I have bollard plates fixed to my lower jaw (below the canines), and there were hooks on the upper jaw connected to the MARPE device (near the first molars), with heavy elastics used for protraction. Since the elastics were almost constantly in place, they probably were even more effective than a facemask alone would have been. I had (and still have) invisalign for the teeth alignment, and yes, I still kept the advancement

[@chrisking6695]

That is insane. IMW is totally irrelevant in the first place. But 50mm is abnormal unless you’re 6’7 or something. The airway is more important. Dr. Kasey Li doesn’t even care about IMW because he only cares about the airway.

[@rockyp32]

Bro I need to get something like this

[@user-ip1oy5qb9x]

Ron I’m 17 and I got 4 premolar extractions with braces and I just finished. My face looks recessed but my palate feels like it’s not closed I can feel a little gap and there’s a visible line. I can’t afford mse do you think I can use a three way shwartz expander to make my mouth bigger

[@nafischowdhury6015]

Anyone know a doc of similar level located in NYC?

[@Nutella-gn9uv]

How can i see if I apply from mse or homeoblock my jaw is really narrow,small mouth,small nose,face asymmetry,hard to breath it’s really depressing to see how my face looks where can I get help?

[@user-xj5iw9lq4b]

Question…… is there a cut off age for having DJS procedure?

[@philippeichert]

What do you mean with "Matrix Download"?

[@jackkellerman310]

Does anyone know what Alfi charges for MMA, DOME, and MSDO?

[@amankkg]

In Charite, Germany they also 3D print the plate

[@natural_law_nutrition]

who's the surgeon?

[@amankkg]

@@natural_law_nutrition Dr Ebker. He has academic paper or some kind of research work on this matter

[@amankkg]

@@natural_law_nutrition Dr Ebker

[@Chris-eo1bp]

how much does he charge ?

[@originalserpent1834]

How much does he charge?

[@rickrobinson8417]

Kobe

[@astraydhurion7697]

The success of his procedure is mostly due to improvement in the planning phase by using 3D software and 3D printers. But what's about using robotic assistants to improve the surgery phase itself? Here, we talk about millimetric precision. Wouldn't it be logical to move towards a robotic assisted surgery?

[@DraculaMachine-zs9bu]

humans can already work at precision of sub millimetre by their hand and eye

[@sandydunn8631]

Should have talked about diet after surgery. I believe it’s 2 months without solid food.

[@Lukewarmclamchowder]

I only did liquid for 1 week and then I went no chew. I barely blend my meals now and just swallow stuff or chew with my tongue. It honestly has been super easy to follow

[@Lukewarmclamchowder]

They also have a nutritionist at the office who gives you some meal ideas

[@user-fn2oy1rq5p]

He is an ISTP, not INTP. It's very similar in that ISTPs also prefer to learn things their own way and built their own interdisciplinary web of learnings and convictions, but less abstract, more hands-on engineering style. See how he likes to apply the 3D modelling. He probably has an easy time visualizing anything in 3D even without the software, but the INTP would rather be the guy inventing the system behind it

[@eliseraskolnikov8075]

What do you think is Ron's type btw?

[@MrJayzisme]

He puts a lot of emphasis on custom made plates. I noticed on his insta that these plates require more screws. I'm wondering if there are any other disadvantages to them. 90 min, piezo surgery sounds too good to be true...

[@jimfleece2880]

Well it's more stable which means more screws

[@grahamstoney169]

46:08 Thanks for this video Ron, it helped me confirm my choice of surgeon. One difference I’ve seen amongst Sydney OMFs surgical technique is Dr Coceancig’s 5-piece mandible, which torques the condyles as shown here: kzbin.infoIiPAwd-jTEI

[@MA-dm4xy]

Hi, who are the sydney omfs you have consulted?

[@MaxServo]

So no other surgeon than him uses custom plates in the whole world ?

[@jimfleece2880]

A few do like Dr Coecincig in Australia

[@brandenpratt8567]

I’ll stick to MSE. Way too invasive for me personally. I don’t like the fact I need to be asleep for anything. Scary for me. Plus very costly.

[@bittteusz9136]

do you know the price for this doc?

[@natural_law_nutrition]

you don't need forward expansion?

[@bloomp7999]

Yeah, but i saw on his website, he's practicing wisdom teeth removal

[@HHindsight]

Unironically though if you're looking for jaw surgery to breathe better you should at least try playing the Didgeridoo for a month, something about it makes the push and pull of breathing feel stronger. I think that any one airway problem like bad forward development, narrow jaw, septum deviation/enlarged turbinates will cause the entire airway to collapse over time due to lack of pressure - so maybe a therapy like the didge is good for improving overall airway health prior to going under the knife so that if one issue is corrected it's not throttled by the rest of the airway being out of shape

[@HHindsight]

damn tho, now I want jaw surgery

[@Thinkagain1234]

This is a brilliant form of essentially natural myo-functional therapy via a musical instrument