Jaw surgery in Costa Rica

[shennalicious]

This is for anyone who is interested in surgery abroad as an alternative. I know the topic has been brought up before, but I don't know if anyone has done it.

I had jaw a Lefort 1 with reduction genioplasty on March 7th in San Jose, Costa Rica with Dr. Jairo Vargas. A private hospital system here is like a U.S. hospital. (The public hospital system is not, however.) Additionally, my orthodontist in NYC has another practice in Costa Rica and could personally vouch for my choice in surgeon.

I was terrified about this crazy idea, but my doctor has a very kind manner and explained everything I could ask before having to ask it. Meeting with him got the nerves out of me. His English is great, so communication was not an issue once here. He also seemed more focused on safety than other doctors I had gotten in contact with, recommending two nights in the hospital and three weeks in the country (I can only stay 15 days because of work and opted for one night in the hospital, though). I had to get pre-op testing that was more thorough than any I've every had in the US. He also only uses one specific anesthesiologist for all of his surgeries, and he had two other doctors with maxillofacial experience assisting with the surgery.

The hospital was beautiful and seemed to have a lot of Americans. As far as recovery, things are going perfectly.

I don't mean for this to be an advertisement, but it was the only way this surgery was possible for me so I want to pass it along for someone else in the same position of no insurance approval. I have heard of people spending similar in the U.S. at teaching hospitals, but I never found an experienced surgeon who quoted this low.

Surgeon: $5,500
O.R. + 1 overnight in hospital: $6,200 (this ended up $900 higher than quoted but completely out of the doc's control)
Lodging: $1,600 (I do not really recommend Chetica Ranch)
+airfare

Please be kind in your comments. This might not be for everyone, but it is an option.

[Nozzelnut]

Around $14k total?

Any idea what your cost would have been here in the states at the cash rate?

[samoorelaw]

That is a lot of money. I paid less than $8,000 for a LeFort I in the states. Granted that is without a hospital visit but this procedure can be done outpatient.

[shennalicious]

The hospital bill went from $3,500 estimated by my doc months prior to $5k official quote the week before surgery to over $6k at checkout. It sucked, but you see how I expected about $9k plus lodging to be not a bad deal for a Lefort and genioplasty. Airfare was free.

In the end, I did end up paying something similar to what the teaching hospital in the USA quoted. However, I had a not great experience as a child with getting braces at the university and opted for a private surgeon if financial considerations were the same. I wish I had found a doctor willing to do it outpatient and close to home, but they all preferred an overnight and I would not have been able to afford a genioplasty with them. The prices were pretty outrageous when US hospital fees came into the mix.

[NCStateGal]

Hi All, I have been fighting UHC for a year to have upper and lower jaw surgery (Le fort). They say they cover it for congenital deformities, but apparently not for mine. I am looking into going outside of the county for the procedure and am willing to travel anywhere. The most important part (well, aside from being able to afford it) is having a doctor that I have confidence in and that is experienced in orthognathic/ jaw surgery. I would like to hear recommendations from anyone who went through surgery. Also, if anyone will share cost, that would be great information to have as well! The best quote I've gotten for surgery is $25,000 so far. That is at a teaching hospital in NC.

[sirwired]

Just curious which surgeon you are seeing at UNC? Mine was w/ Dr. Blakey.

[NCStateGal]

Hi Sirwired, I saw Dr. Turvey at UNC.

[Lala082008]

Hi NCStateGal. I'm going to see Dr Turvey in a few months for a consultation about my underdeveloped lower jaw. I've been told I may be a candidate for BSSO. What was your experience like so far with Dr Turvey and the school there? Other than the cost would you want to have your surgery there?

[sirwired]

Well, I thought my surgery (w/ Dr. Blakey, anyway) went very well.

However, as a large and busy academic practice, you can expect the proverbial wheels to turn slowly, and make sure you bring plenty of reading material on appointment days. For instance, if you need an updated x-ray, most practices you go down the hall, the tech sits you down in the x-ray office, and you get x-rayed. At UNC, they call the dental radiology dept., you sit back in the waiting room, and they eventually summon you to one of the whole bank of x-ray machines.

Drs. Blakey and Turvey both are rather prominent (and high-volume) orthognathic surgeons. Dr. Blakey is in charge of the OMFS residents and does a lot more clinical work; Dr. Turvey does more research.

There will likely be a resident assigned to your case, and they will do a lot of the "scut" work, like paperwork and measurements. but Dr. B/T will verify all their dental work. The resident will be present during your surgery. They will likely do at least part of the operation, but it will range anywhere from "holding the suction hose" if they are junior residents to "cutting your jaw while the attending looks over their shoulder" if senior residents. In either case Dr. B/T will be the surgeon of record and is ultimately responsible for your care. (FWIW, I couldn't stand the resident assigned to my case... terrible bedside manner, but most of my interactions were with Dr. Blakey, and he was clearly the one making all the decisions.) Really, having a resident do much of the work isn't as risky as it sounds. With orthognathic surgery, most of the skill is in the planning, which the attending will certainly have full control over.

One advantage of having it done at an academic center is the ability to participate in clinical trials. I was in a (successful) trial to reduce post-op nausea and vomiting. Had I gone with a private-practice surgeon, this would not have been available.

[Lala082008]

Thanks sirwired, that's super helpful. I figured things would move slowly when I couldn't even make an appointment until my orthodontist had sent a referral and it had been reviewed by the surgeon. I called a private surgeon and they could schedule me the same week, but they also didn't accept my insurance and likely wouldn't work with Invisalign. As I mentioned, my appointment (that I made a while back), is still several months out!

I had my x-ray when I had my consult with my orthodontist, do you think I'll likely need another one when I have a consult with the surgeon or would that be later down the road? I've also been told I'd have to be in treatment (Invisalign in my case) for at least 6-12 before I could do the surgery. Is that the approximate time that other people have experienced?

That's interesting about the role of residents in the treatment. Everyone I talked to seem to think Dr. Turvey is fantastic, but I hadn't really realized that a resident would be doing a lot of the care. Is it always the same resident who you would see or does that change around? I'm not sure how I'd feel about a resident doing the surgery when there's such a risk of nerve damage -- I certainly don't like to feel like a guinea pig! But I guess that's the nature of the thing.

[sirwired]

I met a few residents during the very long process leading up to my surgery (it was years between my initial consult and my actual surgery.) The one I considered "my resident" was the one that did a lot of the boring final pre-surgical work, and the tedious post-surgical work. I hadn't even met him up until the final work-ups. (I had met Dr. Blakey several times.)

You'll want to take whatever x-rays you have with you to your consult. In both paper form and on a thumb drive if you have it. (The orthodontist should send it as part of your referral, but it can''t hurt to have your own copies with you.)

[snapdresser]

Having resident(s) in the OR is very common, even if your surgeon doesn't specifically say it. There are lots of reasons why this is the case, but I wouldn't worry too much about it.

[Ashweh]

[quote="sirwired"]Well, I thought my surgery (w/ Dr. Blakey, anyway) went very well.

However, as a large and busy academic practice, you can expect the proverbial wheels to turn slowly, and make sure you bring plenty of reading material on appointment days. For instance, if you need an updated x-ray, most practices you go down the hall, the tech sits you down in the x-ray office, and you get x-rayed. At UNC, they call the dental radiology dept., you sit back in the waiting room, and they eventually summon you to one of the whole bank of x-ray machines.

Drs. Blakey and Turvey both are rather prominent (and high-volume) orthognathic surgeons. Dr. Blakey is in charge of the OMFS residents and does a lot more clinical work; Dr. Turvey does more research.

There will likely be a resident assigned to your case, and they will do a lot of the "scut" work, like paperwork and measurements. but Dr. B/T will verify all their dental work. The resident will be present during your surgery. They will likely do at least part of the operation, but it will range anywhere from "holding the suction hose" if they are junior residents to "cutting your jaw while the attending looks over their shoulder" if senior residents. In either case Dr. B/T will be the surgeon of record and is ultimately responsible for your care. (FWIW, I couldn't stand the resident assigned to my case... terrible bedside manner, but most of my interactions were with Dr. Blakey, and he was clearly the one making all the decisions.) Really, having a resident do much of the work isn't as risky as it sounds. With orthognathic surgery, most of the skill is in the planning, which the attending will certainly have full control over.

One advantage of having it done at an academic center is the ability to participate in clinical trials. I was in a (successful) trial to reduce post-op nausea and vomiting. Had I gone with a private-practice surgeon, this would not have been available.[/quote]



Hello! I saw that you had surgery with Dr. Blakey. I'm currently scheduling my sliding geniolasty surgery with him right now. If you don't mind, I would love to ask you about his ballpark price. I've yet to get ahold of his assistant to ask as it seems she is almost never in the office. Also, was there a long wait to have the surgery done? I hear they are always very booked. Thanks so much!

[tinymandibleAZ]

I am very interested in hearing more about having surgery in Costa Rica.

Specifically, how did you find an orthodontist to work with the surgeon? Did the surgeon's practice give you a list of names?

I am considering Dr. Gunson in Santa Barbara, but with recent Arizona insurance changes that may prove very expensive. Going to CR for the surgery has always been on the list of options. Not only would it be less expensive, but an incredible opportunity to visit CR!