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Non-obvious way to get a mask to seal
Non-obvious way to get a mask to seal
I was unable to find a mask that would fit my face, so I had my face modified to fit my mask.
Short story:
I recently had a medical procedure called a “facial fat graft”.  This is accomplished by removing fat from my belly and injecting it into my facial cheeks.
Long story and other details:
I have been using a CPAP machine for more than seven years.  Although I have benefited by getting a better quality sleep, one common problem I have had from the very beginning was to get my CPAP mask to seal.  I have tried every kind of mask imaginable, including a custom-made mask that was remade twice and never did work.  The main reason is my pressure requirements are way higher than typical.
My optimal setup became a ResMed Quattro FX full face mask, combined with a CPAP liner and lanolin.  This continued to work pretty much okay until last year after losing about 50 pounds.  Although there were many health benefits to losing weight, one unexpected consequence was that my face became thinner and it was way more challenging than ever to get my mask to seal.  I had the tighten the straps to such an extreme level that my nose became so sore I was unable to use my CPAP machine at all for days at a time.  Using a Respironics LiquiCell Nasal CPAP Cushion helped a little, but not enough to prevent my nose from eventually getting too sore to use the mask.
Unlike the experiences of many others, I saw absolutely no improvement whatsoever to my sleep apnea after losing weight.  The main reason is probably because I have Complex Apnea (i.e. Central Sleep Apnea in addition to Obstructive Sleep Apnea). 
I went to my local DME provider and tried every new mask that had come on the market since my last “go around”.  Finally, the technician admitted, you have no other options.
Out of desperation, I made an appointment with a plastic surgeon to see if I could be helped in some other, unorthodox manner.  I placed the mask on my face and he could clearly see large gaps on each side of the mask next to my nose.  These were the exact spots that I had been having leakage problems.
The cost of the procedure was $1200.  No, that is not exactly “pocket-change”, but compared to the cost of the custom-made mask I tried five years ago ($4800), it was an economic bargain.  My PCP suggested I file a medical claim since, in my case, the motivation was not an appearance change but a virtual medical necessity.  Considering that I have been fighting with Medicare since last August to pay for my new CPAP machine, I decided that the effort would not be worth it.
So, you may be wondering, did it work?  Well, to a certain extent, yes it did.  Last night was the first time I tried using my CPAP machine since having the procedure done exactly one week ago.  It took that long for the sensitivity in my cheeks to calm down enough to allow the mask to be used.  Before putting on my mask, I intentionally released the headgear straps’ tension more that I believed would be needed.  After hooking up my machine, there was no leakage, so I loosened them even more.  I was awakened in the middle of the night with severe mask leakage.  I tightened the straps until the leak was gone.  When I got up this morning, I noted that the straps were not as tight as the previous time the mask was used (I made careful observation of exactly where the strap ends were prior to loosening it the first time).  In addition to that, I did not experience the severe soreness in my nose that had been on-going for the previous six months.
Bottom line:  it is significantly improved compared to just before the procedure, but not quite as good as it was before I lost the weight.
The surgeon did warn me that this procedure typically needs to be repeated after about three months.  The main reason is that the body will tend to absorb about 30 to 40% of the fat that was added.  In my case, I think I will need some additional “tweaking” anyway.  He also said that if a second procedure is needed, it will be significantly discounted.
Regarding my appearance, I am most pleased that the difference is subtle rather than dramatic.  In fact, even my wife agrees that if someone were not aware of this procedure being done, most people would not even notice a difference.
I will update this thread if and when I get a second procedure or if anyone has questions.
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RE: Non-obvious way to get a mask to seal
the new under nose masks like the dreamwear full face and resmed f30 have a different kind of seal, they dont seal around your nose but under it, maybe worth trying either of them, i use the dreamwear one.

dreamwear ffm
airfit f30
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RE: Non-obvious way to get a mask to seal
Thanks anyway, but I've tried that mask along with all the other so-called hybrid masks that are currently available.
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RE: Non-obvious way to get a mask to seal
Have you tried the 3 strikes method?

Strike 1  nasal pillows.
Strike 2  mouth taping
Strike 3  a soft cervical collar

All 3 combined has got to work.
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RE: Non-obvious way to get a mask to seal
This is a much belated update to this post.  The first procedure only lasted about three weeks.  The doctor convinced me to have a second procedure done with the expectation that he would add extra amounts of fat to offset my body's apparent tendency to dissolve it.

The second procedure only lasted a few days.  I was then referred to another plastic surgeon who said he could make a permanent change by implanting gel inserts (similar to breast augmentation).  The procedure description and cost scared me too much.

I have now resorted to using a cpapseal gel liner (cut from a 1/8" thick sheet which is no longer sold) along with a Remzzzz liner combined with lanolin on my face.  Those three have given me a pretty good seal, but only for about three weeks at a time and then I have to cut and use a new gel liner.  However, I use a new Remzzzz liner each night.

Regarding the previous post, I have also tried those three things together and that did not work.  My pressure is way too high.  With my mouth taped shut, my lips are repeatedly moving in and out against my teeth preventing any sleep at all.
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RE: Non-obvious way to get a mask to seal
I have learned to use pillows (P30I)and keep my mouth shut. Pressures are WAY down leakage is way down, no face lines. I am a happy sleeper now.
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