Earl's guide to Facial Implants

[geijutsu]

Yes her bone structure is phenomenal and especially for her age but she has admitted to having cosmetic procedures to maintain her looks, I'm not sure what those entail.
To me it looks like something has been done to her cheeks now, perhaps just carefully, sparsely applied filler?

There's no doubt in my mind that she did have a facelift at some point, watching her videos; there's a very slight pulled look going on, very sublte, and her neck looks ridiculously sculpted, I know that she has a jaw that goes on forever, but it's simply impossible to have such a tight neck at her age, it looks even tighter than the picture I posted of her in her youth, I think filler is probable, maybe just to give her smooth lid/cheek transitions but nothing too drastic, carefully put filler can really be deceiving so I can see that as an option.

Dear lord I can't stand Madonnas cheek implants, they're far to big and round for her face but I'm sure most surgeons would say she looks "healthy" now phfft...

Her cheek implants are awful, very large and not placed correctly:

I've said it before but the cheekbones Sailer gave to the red haired lady shown on his website are the closest I have seen to achieving modelesque cheek bones by artificial means. Aparently the lyophilized cartilage he uses transforms partly into the patients own bone which I find hard to believe.

Yeah but aren't they too sculpted? not a good look, really harsh.

Interestingly, it seems Mommaerts and two other surgeons used lyophilized cartilage to transform someones face into Micheal Jackson at his request. http://www.ncbi.nlm.nih.gov/pubmed/11534446

Oh I didn't know it was momaerts who did that MJ lookalike guy, saw the pictures long time ago but never knew where they came from.

RE using bone for augmentation, someone asked this on realsef and the doctors said it could be done but questioned why when there are implants made of silicone, (I would have thought the obvious answer to this is because they look like implants made of silicone!) I think they also said that a large amount of the bone graft would be absorbed.

I'm familiar with some kind of a highly porous material that tend to resorb quickly and replaced by bone in a matter of months, I think they do involve HA but there was something else mixed in there to make it resorbable and highly porous, can't seem to remember what its called, maybe one of you guys can ask one of the doctors your frequently consult with?

[earl25]

so so true, it really is all about bone structure, but of course the shape of the soft tissue as well. why can't one's own bone be grafted and shaped? I didn't know who Carmen Dell'orefice was but wow, incredible bone structure on that woman, incredible. But even how her soft tissue drapes is really remarkable.

She has that S curve bigtime. But why is it that whenever they use fillers/implants etc. like Madonna who has had the works they can never
ever approximate a natural appearance. it always look messed up. This photograph of Carmen dell'orrofice is clearly airbrushed makeup, but
the bone structure is real, this is not an implant and while there maybe some topical stuff no filler really either. She has the greatest bone
structure I've ever seen and she's 82!!!!

There's an old saying "beauty is in the bones". age and beauty are 2 different things. My dad's the perfect example.  Albeit he has a better  overall bone structure than me, he's still not good looking at all with one of the worst noses ever (it was so bad that when he dropped me off for my rhino, my doc literally just stared and went omg). He's in his 60's now and spends tons(thousands to date) of money on botox,fillers,peels etc to "look younger". Does he look a bit younger and "fuller" yes, does it do anything for him absolutely not. He's still not good looking. Even at his age had he put that money towards a nose job and jaw surgery (needs lower jaw bsso anda reverse genio to fix his natural witches chin) he would not only look younger but better looking. I look better now at 30 than I did at 18

[falcao]

I have posted here before to comment on that guy's result (in the original post). I said that I liked how he looked before much, much more than after - the reasons being the unfortunate reduction of his nose (wtf was the surgeon thinking?) and the unfavorable change of his mid-face. So, as far as aesthetic preferences I'm on the same page as geijutsu, 100%. Then I exchanged pms and emails with some members here trying to explain why I think so, using pics of models to illustrate my point - look up Jon Kortajarena - he's a good, radical example of the S curve.

I'd like to debunk some myths though. First of all, we do not know what that guy had done exactly. The site where these pictures are taken from is brazilian, and all it says is that he had some sort of zygomatic osteotomy. Not sandwich. Assuming that he had a sandwich zygomatic osteotomy is wrong.

It is NOT a fact that the sandwich osteotomy (ZSO) advances and augments the lower part of the cheekbone. For all of you who haven't done so, go to Mommaerts's web site, register to access the articles - it's free, and download the ones on zygomatic sandwich osteotomy. There are MANY VARIABLES to this procedure. The underlying idea is to RAISE and move the cheekbone both laterally and forward (anterior and lateral projection). By controlling the variables, you can tweak the procedure to augment more towards the zygomatic arch (laterally). It doesn't even have to be "sandwich". It can simply be zygomatic arch osteotomy (Mommaerts explains the difference with pictures in his articles between arch and sandwich zygomatic osteotomy). The arch one will augment almost exclusively only laterally.

I find it hard to believe that a zygomatic osteotomy gave that guy that look in the after pictures (arch or sandwich, for that matter). If you know this for a fact, please tell me so because this procedure is part of my surgical plan and I sure as hell don't want to end up looking like that. For me, it looks like that guy had SUBMALAR implants, or some other form of submalar augmentation. Certainly not malar.

Yes, it's true that it can exacerbate the deficiency in the orbital rim. This happens.

I took pictures of myself and drew on them - the parts that I want augmented (in one color) and the parts that I absolutely do not want to see augmented (in another). The surgeon assured me that the zygomatic osteotomy augments only the parts I want to see augmented.

this is how Mommaerts explains it in his article "the ZSO is indicated when an anteriolateral deficiency of the malar area is present, inferior and lateral to the lateral canthus. I repeat, inferior and lateral to the lateral canthus. So, it is really a safe and effective replacement for MALAR implants, not submalar. That's why I'm confounded by claims that the patient posted here had a zygomatic osteotomy. Again, sure as f**k he did not get any augmentation lateral to the lateral canthus, as a matter of fact he lost the one he had. His before picture is what I would like to look after, cheekbone and cheek-wise.

Also, geijutsu or whoever said something about a patient being unhappy with Mommaerts' malar osteotomy - could you please give more details? Where did you learn about the case, was the patient male, and what was he unhappy with?

I know for a fact that I'm having a mandibular advancement with HA augmentation of the jaw angles (again think laterally) and very likely paranasal augmentation. This is because my submalar area is already convex, and this is not the look I want. I will only choose the zygomatic ostoetomy if I'm certain 100% that my surgeon understands my aesthetic goals. Fortunately, he's open to the idea of looking at male models pictures which I have used to illustrate my points. I'm using the pictures for illustration - it is an absolute must that you and your surgeon are on the same page, and that you don't end up looking like that guy posted here. I want to make my face more masculine and definitely more concave. I have even been thinking of some subcutaneous liposuction with micro canulas in that area to help create that look - flatten my cheeks, while augmenting my cheekbones high and laterally towards the zygomatic arch. I want to make it clear that I'm by no means overweight and I'm very fit. I simply can observe some access fat in my submalar area which is genetic. I know there are women who want that look for themselves and even have fat transfers there to achieve it. However, I'm not a woman. I know exactly what I want.


I know many of you will not understand what I'm saying - some of you asked me before what is the difference between a cheek and a cheekbone. However, I did my best to explain. And I'm sure some of you do understand. Again, look at Jon Kortajarena - he doesn't have prominent cheeks - his cheeks are hollow even. He has prominent cheekbones. Think malar - submalar. Look at malar and submalar implants at the med-por catalogue to understand the difference.  It's interesting that some people here with hundreds and plus posts don't understand the difference between bone and soft tissue distribution on the cheeks, and between malar and submalar. I've heard the term mid-face used too many times to refer to anything at all. Mid-face is a very wide term and can be anything from paranasal, submalar, malar, zygomatic arch, zygomatic process etc. As long as you treat all this as it is one and the same thing, you'll never understand what you need exactly and how you can improve your face. I'm  not saying submalar augmentation is wrong for everyone. But for most men, YES, it is. And for me, it is 100% not indicated. So, I will make sure the zygomatic osteotomy does not augment this area even a mm, or I will not have it. And it shouldn't. The way it works, it should augment the bordering malar area, and flatten this one. How will it flatten? Again, think soft tissue distribution. You move the cheekbone laterally (and significantly, Mommaerts moves it at least 5 mm, often more), you expect it to balance and pick up some of the excess soft tissue in the submalar area, i.e. more evenly distributed soft tissue with strong high cheekbones in the end. Wishful thinking? I don't know. We'll see. I'll keep you updated after my surgery.

[pekay]

I have posted here before to comment on that guy's result (in the original post). I said that I liked how he looked before much, much more than after - the reasons being the unfortunate reduction of his nose (wtf was the surgeon thinking?) and the unfavorable change of his mid-face. So, as far as aesthetic preferences I'm on the same page as geijutsu, 100%. Then I exchanged pms and emails with some members here trying to explain why I think so, using pics of models to illustrate my point - look up Jon Kortajarena - he's a good, radical example of the S curve.

I'd like to debunk some myths though. First of all, we do not know what that guy had done exactly. The site where these pictures are taken from is brazilian, and all it says is that he had some sort of zygomatic osteotomy. Not sandwich. Assuming that he had a sandwich zygomatic osteotomy is wrong.

I was the one that originally made that assumption but yeah you're right it's very unlikely that he had an actual zygomatic osteotomy because AFAIK no one in the country does that sort of thing, like you so said yourself he most likely had one of those shell implants put in rather than actual bone work.

I do think that overall he looks better but the nose-job was a terrible mistake, his new girly nose throws everything off

[ExtractionsRuinFaces]

One thing to note is maybe that guy didnt like the contour from 3/4, not all people understand facial proportions and stuff. Maybe he thought "I dont see it on other people so I dont want it either" probably why his nose is messed up in the after, he had no idea what to get done.

Anyone know if you had similar cheekbones in the before as that guy would the same thing happen if you had a maxilla advancement? or would the skin become more taut around that area

[Optimistic]

Yes geijutsu will you please shed more light on the Mommaerts patient who was unhappy with the malar osteotomy?
There are so few testimonials on this procedure.

falcao I'm very pleased to see that you want the same kind of look that I'm after, I will also be consulting with Mommaerts to see if he can help me achieve this goal.

Within the last week, there have been two posters on lookyourbest.co.uk who are unhappy jaw surgery patients of Mommaerts but refuse to show pictures...

And what are there really some people who don't know where the cheekbones are located or the difference between them and the soft tissue beneath!?? I'm speechless, flick through Vogue or GQ, there should be no doubt left in your mind.

I tried PM'ing one of the people off lookyourbest but he won't respond. No pics, no response makes me very skeptical. His posts were very inconsistent too.

I'm thinking he may he issues adjusting to his new jaw. Maybe he does have real problems, but so long as he won't post pics I can't take them seriously. Too many shills out there.

[Lazlo]

I have posted here before to comment on that guy's result (in the original post). I said that I liked how he looked before much, much more than after - the reasons being the unfortunate reduction of his nose (wtf was the surgeon thinking?) and the unfavorable change of his mid-face. So, as far as aesthetic preferences I'm on the same page as geijutsu, 100%. Then I exchanged pms and emails with some members here trying to explain why I think so, using pics of models to illustrate my point - look up Jon Kortajarena - he's a good, radical example of the S curve.

I'd like to debunk some myths though. First of all, we do not know what that guy had done exactly. The site where these pictures are taken from is brazilian, and all it says is that he had some sort of zygomatic osteotomy. Not sandwich. Assuming that he had a sandwich zygomatic osteotomy is wrong.

It is NOT a fact that the sandwich osteotomy (ZSO) advances and augments the lower part of the cheekbone. For all of you who haven't done so, go to Mommaerts's web site, register to access the articles - it's free, and download the ones on zygomatic sandwich osteotomy. There are MANY VARIABLES to this procedure. The underlying idea is to RAISE and move the cheekbone both laterally and forward (anterior and lateral projection). By controlling the variables, you can tweak the procedure to augment more towards the zygomatic arch (laterally). It doesn't even have to be "sandwich". It can simply be zygomatic arch osteotomy (Mommaerts explains the difference with pictures in his articles between arch and sandwich zygomatic osteotomy). The arch one will augment almost exclusively only laterally.

I find it hard to believe that a zygomatic osteotomy gave that guy that look in the after pictures (arch or sandwich, for that matter). If you know this for a fact, please tell me so because this procedure is part of my surgical plan and I sure as hell don't want to end up looking like that. For me, it looks like that guy had SUBMALAR implants, or some other form of submalar augmentation. Certainly not malar.

Yes, it's true that it can exacerbate the deficiency in the orbital rim. This happens.

I took pictures of myself and drew on them - the parts that I want augmented (in one color) and the parts that I absolutely do not want to see augmented (in another). The surgeon assured me that the zygomatic osteotomy augments only the parts I want to see augmented.

this is how Mommaerts explains it in his article "the ZSO is indicated when an anteriolateral deficiency of the malar area is present, inferior and lateral to the lateral canthus. I repeat, inferior and lateral to the lateral canthus. So, it is really a safe and effective replacement for MALAR implants, not submalar. That's why I'm confounded by claims that the patient posted here had a zygomatic osteotomy. Again, sure as f**k he did not get any augmentation lateral to the lateral canthus, as a matter of fact he lost the one he had. His before picture is what I would like to look after, cheekbone and cheek-wise.

Also, geijutsu or whoever said something about a patient being unhappy with Mommaerts' malar osteotomy - could you please give more details? Where did you learn about the case, was the patient male, and what was he unhappy with?

I know for a fact that I'm having a mandibular advancement with HA augmentation of the jaw angles (again think laterally) and very likely paranasal augmentation. This is because my submalar area is already convex, and this is not the look I want. I will only choose the zygomatic ostoetomy if I'm certain 100% that my surgeon understands my aesthetic goals. Fortunately, he's open to the idea of looking at male models pictures which I have used to illustrate my points. I'm using the pictures for illustration - it is an absolute must that you and your surgeon are on the same page, and that you don't end up looking like that guy posted here. I want to make my face more masculine and definitely more concave. I have even been thinking of some subcutaneous liposuction with micro canulas in that area to help create that look - flatten my cheeks, while augmenting my cheekbones high and laterally towards the zygomatic arch. I want to make it clear that I'm by no means overweight and I'm very fit. I simply can observe some access fat in my submalar area which is genetic. I know there are women who want that look for themselves and even have fat transfers there to achieve it. However, I'm not a woman. I know exactly what I want.


I know many of you will not understand what I'm saying - some of you asked me before what is the difference between a cheek and a cheekbone. However, I did my best to explain. And I'm sure some of you do understand. Again, look at Jon Kortajarena - he doesn't have prominent cheeks - his cheeks are hollow even. He has prominent cheekbones. Think malar - submalar. Look at malar and submalar implants at the med-por catalogue to understand the difference.  It's interesting that some people here with hundreds and plus posts don't understand the difference between bone and soft tissue distribution on the cheeks, and between malar and submalar. I've heard the term mid-face used too many times to refer to anything at all. Mid-face is a very wide term and can be anything from paranasal, submalar, malar, zygomatic arch, zygomatic process etc. As long as you treat all this as it is one and the same thing, you'll never understand what you need exactly and how you can improve your face. I'm  not saying submalar augmentation is wrong for everyone. But for most men, YES, it is. And for me, it is 100% not indicated. So, I will make sure the zygomatic osteotomy does not augment this area even a mm, or I will not have it. And it shouldn't. The way it works, it should augment the bordering malar area, and flatten this one. How will it flatten? Again, think soft tissue distribution. You move the cheekbone laterally (and significantly, Mommaerts moves it at least 5 mm, often more), you expect it to balance and pick up some of the excess soft tissue in the submalar area, i.e. more evenly distributed soft tissue with strong high cheekbones in the end. Wishful thinking? I don't know. We'll see. I'll keep you updated after my surgery.

I'm willing to exchange information with you falcao if you stay on this site and also continue to provide information as well.

1) First, who is your surgeon, Mommaerts?

By all accounts Mommaerts is a very good surgeon, highly regarded.

What you have provided about the M's zygomatic osteotomy is great information, very interesting and important so thank you for making these clarifications and reinforcing them.

2) Second, if the lefort 1 or even high lefort moves the maxilla and upper part of maxilla forward then that by it's very nature will enhance the submalar region correct? If the S (jon kortajarena) effect is indeed desired then we need to enhance the malar region even further, correct?

3) Okay, now here's the controversial parts. Mommaerts examples on his site are fine. The red headed lady, she apparently is the recipient of the zygomatic osteotomy. I'm a bit skeptical that's what she's had, but if so, the results are amazing. That said, I've seen some of his bi-max and bsso patients and they have not looked great --like minimal improvement.

There was a patient from this site, he posted (search mommaerts and you'll find him) who had the HA paste for gonal/jaw angle augmentation. He said his two sides came out asymmetric(noticeably) --they said maybe he needed time to heal, etc. Apparently M did not offer that the HA paste can be molded for up to 6 weeks after surgery --either it's not true as A/G claim and routinely do to HA paste for the malar region (which does not produce any noticeable results) --I don't know. He was quite disturbed by it. Didn't show me pics but I trust him. He stopped corresponding and posting. I have heard of this problem on another site from someone else --the result was not symmetric.

4) I asked Dr. Schendel about zygomatic osteotomy. He smirked and without prompting said, "oh have you been looking at dr. mommaerts work?" Schendel is a very nice guy so he didn't say it with any anatagonism, but he said he didn't do it or like to do it because he said "well the results are very unpredictable."

5) Now, Schendel's comments were somewhat confirmed to me when I visited Miss J's site --another plastic surgery site you may be aware of. On that site a few months back a male patient, mid 30s posted pics. He had had a few procedures from Mommaerts including the malar osteotomy. He had a few concerns --said the recovery psychologically very rough because how different he looked (not a bad thing for many of us true!). Specifically, though there was a sort of splintering or a slight shatter that produced an indent or asymmetry, I wasn't sure what it was on one side. He actually was quite adamant about wanting the procedure reversed. While I thought he looked overall good and the procedure did give him that quite dramatic cheekbone, you could see there was a bit of a slight indent or something wrong on one side. This at least confirmed that the procedure is not all that predictable. Also, for many of us our cheekbones are not equally developed and bringing them out may exacerbate the difference. I don't know what the reason was, or there was indeed a slight shattering or something during the procedure.

I have corresponded with Mommaerts about the procedure briefly, he suggested it for me, and said that he would use HA paste to augment the orbital rim. I in fact showed him a picture of J Kortajarena to illustrate the result I wanted so we're both on the same page there.
I think the procedure sounds great produces good results but I don't know why it's not used more. Again, how many before/after pics have you seen of the procedure, can you share them on this site?

[Lazlo]

I want to chime in on this issue one more time because here's another illustration of the problem similar to the surfer dude from above. Specifically I was looking at this site from the "good surgeon's in florida" thread. Scroll down to young hispanic looking patient Jorge who was diagnosed with "maxillary hypoplasia" --in the before his cheekbone is more forward in the 3/4 view but he loses it in the after picture once he's had the lefort procedure. Now his submalar area is more forward and puffed out. This, to my view, and several of us is a very unfavorable and disfiguring outcome. The upper malar/zygoma needed to be augmented even further. So barring implants, is the zygomatic osteotomy the only way to do that? What about the quadrangular lefort 1 or the quadrangular lefort 2? Are you familiar with those procedures?

http://floridacranio.com/before-and-after/

[Lazlo]

That patient's Jorge's results are really scaring me frankly, i think it might be because he has a short face that his results were so skewed in the after, but while it may have improved his maxilla it totally ruined his face. He was very handsome before and looks messed up the unfortunate strange monkey face after. How on earth can this be avoided or offset? Is the zygomatic osteotomy the only solution?

[x]

I want to chime in on this issue one more time because here's another illustration of the problem similar to the surfer dude from above. Specifically I was looking at this site from the "good surgeon's in florida" thread. Scroll down to young hispanic looking patient Jorge who was diagnosed with "maxillary hypoplasia" --in the before his cheekbone is more forward in the 3/4 view but he loses it in the after picture once he's had the lefort procedure. Now his submalar area is more forward and puffed out. This, to my view, and several of us is a very unfavorable and disfiguring outcome. The upper malar/zygoma needed to be augmented even further. So barring implants, is the zygomatic osteotomy the only way to do that? What about the quadrangular lefort 1 or the quadrangular lefort 2? Are you familiar with those procedures?

The quad lefort ii brings the cheekbones forward, what you need for that cheek hollowness is lateral protrusion of the cheekbones

I think there's two different kind of looks, the cheek 'apple':


this is more commonly considered ideal in women

and the high, prominent cheekbones:


with the first guy they not only protrude out laterally, but also have a lot of forward projection relative to the rest of the face. with the second guy, I'd bet his upper face would be seen as pretty flat from profile view because he has a lot of lateral projection but not much forward

that's the issue with implants as falcao touched on, they stick them on the front of the face which has a negiligible effect on appearances, the true purpose of cheekbones imo is to add width to the upper face and that is only seen via lateral projection

[Lazlo]

regardless, the point we're asking here is what procedure can do this? it's not from the front that we're concerned about so much as from the 3/4 --i think if the 3/4 is taken care of so will the front. i also disagree that with the lefort II quad the only gain is from the front, by necessity it would seen in the 3/4 as well assuming it's brought more forward than the submalar.

What's disappointing is that this is so obviously a desired aesthetic, why don't the max facs know or aim for this more consistently? The just plump out the "midface"

[x]

the quad lefort ii will only bring the cheekbones forward, it adds no width to them is my point. forward projection is irrelevant to the s-curve. I can guarantee you it's not the miracle procedure

again lateral projection, but not much forward:

[Lazlo]

the quad lefort ii will only bring the cheekbones forward, it adds no width to them is my point. forward projection is irrelevant to the s-curve. I can guarantee you it's not the miracle procedure

again lateral projection, but not much forward:

stop posting these stupid pictures of models. they don't demonstrate anything since these people have a 100 other things going on contributing to the overall effect. if you want to demonstrate the look just keep it simple. too much lateral projection will introduce the problem of making your appears too close set if your face didn't achieve that lateral projection naturally or you already have eyes on the closer set. I'm not saying the lefort II quad is the solution to everything. I do think it will help the s-taper on a 3/4 angle. But I don't know. Let's just keep the discussion on whether Mommaerts technique indeed achieves the look and whether it's viable, predictable etc..

[x]

stop posting these stupid pictures of models. they don't demonstrate anything since these people have a 100 other things going on contributing to the overall effect. if you want to demonstrate the look just keep it simple. too much lateral projection will introduce the problem of making your appears too close set if your face didn't achieve that lateral projection naturally or you already have eyes on the closer set. I'm not saying the lefort II quad is the solution to everything. I do think it will help the s-taper on a 3/4 angle. But I don't know. Let's just keep the discussion on whether Mommaerts technique indeed achieves the look and whether it's viable, predictable etc..

they represent the cheekbone look you're going for do they not? I'll stop posting their pics when you stop living under the delusion that any current procedure will ever give you anything close to that look. unless you want to make a trip to Sailer

[pekay]

If US surgeon (who imo are way ahead in every imaginable field) aren't doing/offering these procedures you can bet your ass that there is a good reason behind it.

also if your "starting point" isn't compatible with these supposedly ideal angles/facial contours that you want it's better to leave it alone.

A&G were able to achieve the look that you guys are talking about with this female patient by using HA paste but is it going to last forever? no one knows...