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General Category => Functional Surgery Questions => Topic started by: Schrödingers Jaw on December 06, 2015, 09:05:58 AM

Title: Zygomatic ARCH augment?
Post by: Schrödingers Jaw on December 06, 2015, 09:05:58 AM
This is the zygomatic arch and it is absolutely vital  for men that want to look good:

(http://www.dentistry.unc.edu/resources/NRA/PanAnatomy/skull_images/-zygomatic-arch.jpg)

It's already been established that the ZSO is more suited towards women as it makes the cheeks take on a more round and feminine appearance rather than the high "chiseled" look that men require. The Z-arch is what makes male cheeks look good and masculine so how would one augment this area to make it wider and more prominent?

This is the bony area we want mobilized and augmented.

(http://i.imgur.com/GzegRSK.jpg)

There are three way to add projection:

Fillers are obviously temporary, soft and hard to shape naturally. The pros are non-invasive, temporary and relatively cheap if only done once. It's very possible to use fillers to preview what an implant would look like.

Implants are an option but would have to be custom made as it is an uncommon placement. Of course it carries with it all the usual risks such as migration, infection etc.

Osteotomy is what peaks my interest, a successful operation would yield natural and stable results with little to no long term risk. Only two questions remain: who does it and is it as easy as it seems?

Well there turns out the Z-arch is target for osteotomies even cosmetic ones. Usually done to shrink the area in women it might as well be moved laterally when mobilized in men.

(http://www.intechopen.com/source/html/48013/media/image15.png)

So it seems very possible. This could very well be the ZSO "for men" that I know several forum members have been looking for the only thing that remains is finding a trustworthy surgeon that has experience working with the zygomatic bone and ask him about it. This clinic comes to mind: http://www.pyramide.ch/en/Centre-for-Maxillo-facial-Surgery/range-of-treatments/facial-surgery/cheekbones

What do you guys think, do you anything about this procedure and who might be a suitable surgeon?
Title: Re: Zygomatic ARCH augment?
Post by: Rico on December 06, 2015, 10:47:00 AM
more in zygomatic arch give a face more in width. Please check first if your eyes won't be look to narrow after that. Check the distances

Keep in mind that in many cases some deficiences may fit to the rest of your face
"fixing" it may give you even opposite effect
Title: Re: Zygomatic ARCH augment?
Post by: swansatcoole on December 06, 2015, 11:49:26 AM
As a female I'm not at all happy with the zygomatic osteotomy either. But I had cheek implants before I had the osteotomy. The implants gave me those high chiseled cheekbones you are talking about. And surgery and recovery were a breeze. I was out days after surgery looking a bit puffy still, but nothing weird. Whereas I was looking like a car crash victim for a good 4 weeks after the zygomatic osteotomy and very swollen long thereafter. If I look back at pictures I can see my face was still a lot bigger months after the osteotomy than it currently is. And I was thinking it was the end result back then (eeuh: not).

The implants gave projection over the malar prominence, laterally too, and part of the orbital rim. Whatever suits your needs however, since they can be placed wherever you need projection. And I often got complimented about my cheekbones. Now, on the other hand, I get the opposite (a friend kind of in awe with his own bone structure and unaware of my surgery, joked I could get some of his cheekbones. After such costly surgery to get cheekbones that sucks).

I had the implants removed because of worries about erosion and infection. People that write on this forum say they worry about that. The surgeon that only performed osteotomies (and didn't use implants) told me the same: that it could be a concern. Yet surgeons that perform both osteotomies and implants said they did not experience it, recommended implants since the outcome would be better, and were willing to give me the contact information of patients that had had implants for many years. Add that I never found anyone with an infection of the cheek implants or erosion of the cheeks on the internet. Frankly I feel I've let doom thinking influence my decision.
I've seen several male patients of Dr. Yaremchuk with the model type high chiseled cheekbones. But he doesn't have those pictures on his website. I've seen a girl that had surgery to her cheeks with him that got into modelling thereafter. She also had the high cheekbones.

Also: a new era in medicine has started. You can get implants now and if you are really that worried, 5-8 years from now there will be enough possibilities to get them replaced with bone implants. It won't be a big deal, you can just get the implants out and the bone implants in if you are so worried. Without going through the looooooooooong recovery of the osteotomy now.

Not to mention that with the kind of osteotomy you want to try to convince any surgeon to do now, you will be at more risk for nerve damage. There is a reason the zygomatic osteotomy is performed as it is often performed, away from the orbit. As my surgeon put it: he found there was way too much risk of nerve damage to cut closer to the orbit. You will be convincing a surgeon to do something he out of practice and knowledge about the risks does not commonly do that way now. You can make any cut in that picture in whatever direction you wish, but that doesn't mean it can be executed in surgery without major risks, if at all possible. And it also doesn't mean that the results will look as you imagine: you might have to rotate the bone, or break it in smaller parts and augment it a bit more here than there, to get those high cheeks you want. It ain't gonna happen exactly as you wish simply by putting the bone outwards.

I'm seeing if I can still get implants over the high part of the zygomatic arch again to get back those high cheekbones. But all in all this pretty much sucks and it must be difficult to get it right now, with the projection I got low on the cheek.
Title: Re: Zygomatic ARCH augment?
Post by: triot on December 06, 2015, 12:08:42 PM
But the problem in men is that even implants wont create the chiseld look most of them are seeking for, because they are still placed to low on the cheek since it's difficult to place an implant on the area most men want projection of. Also they need projection on the zygomatic process of the temporal bone (and that's a thin, slim bone to put an implant on) to create the male model look.

The only results of zygo implants that I saw on men, looked like utter shit (most of these men had underdeveloped midfaces/zygos or were naturally flat faced) and the docs on realself that claim can make it happen on men (because they did it 1000 times before supposedly) don't even have example pictures on their sites (I wonder why, lol.)

PS. I don't think the Swiss surgeons are capable of augmenting the zygomatic bone like you wish, since that one doc in Germany can't do either and he worked in that hospital before moving and got all his skills from there.
Title: Re: Zygomatic ARCH augment?
Post by: swansatcoole on December 06, 2015, 12:12:04 PM
But the problem in men is that even implants wont create the chiseld look most of them are seeking for, because they are still placed to low on the cheek since it's difficult to place an implant on the area most men want projection of. Also they need projection on the zygomatic process of the temporal bone to create the male model look.

The only results of zygo implants that I saw on men, looked like utter shit (most of these men had underdeveloped midfaces/zygos or were naturally flat faced) and the docs on realself that claim can make it happen on men (because they did it 1000 times before supposedly) don't even have example pictures on their sites (I wonder why, lol.)

I've seen several men with those high chiseled cheekbones (male model type) after implant surgery. But it also depends on the surgeon you will choose. And there are implants that also cover part of the orbital rim and give lateral projection.

Surgeons also don't have example pictures on their site since many (younger) patients don't want to give their permission for that. If you visit a surgeon such as Dr. Yaremchuk he has lots of pictures of male patients you can look at that do not at all have a weird stuffed implant look you sometimes see, but the high chiseled cheekbones.
Title: Re: Zygomatic ARCH augment?
Post by: triot on December 06, 2015, 12:17:55 PM
I've seen several men with those high chiseled cheekbones (male model type) after implant surgery. But it also depends on the surgeon you will choose. And there are implants that also cover part of the orbital rim and give lateral projection.

Surgeons also don't have example pictures on their site since many (younger) patients don't want to give their permission for that. If you visit a surgeon such as Dr. Yaremchuk he has lots of pictures of male patients you can look at that do not have a weird stuffed implant look you sometimes see at all, but the high chiseled cheekbones.

Mh, okay than it's just an unfortunate thing that we don't get to see that. But it's just dumb to put the other shitty outcomes. They scare me away, and I guess many others too.
Anyway it's not that I will ever get implants. European surgeons seem to not like doing that and I really can't afford flying to the US either.
Title: Re: Zygomatic ARCH augment?
Post by: swansatcoole on December 06, 2015, 12:23:47 PM
Mh, okay than it's just an unfortunate thing that we don't get to see that. But it's just dumb to put the other shitty outcomes. They scare me away, and I guess many others too.
Anyway it's not that I will ever get implants. European surgeons seem to not like doing that and I really can't afford flying to the US either.

Yes, that is unfortunate. It is an issue a surgeon pointed out to me too. Sometimes you read about cherry picking results, but as he said too: he can't even put the best results on his website since most patients don't give him permission to do so. So he can only put up a handful of results sometimes with an outcome the patient specifically asked for (for example: submalar implants) whereas that is not the look he preferred himself for that patient.
Title: Re: Zygomatic ARCH augment?
Post by: triot on December 06, 2015, 12:37:57 PM
Yes, that is unfortunate. It is an issue a surgeon pointed out to me too. Sometimes you read about cherry picking results, but as he said too: he can't even put the best results on his website since most patients don't give him permission to do so. So he can only put up a handful of results sometimes with an outcome the patient specifically asked for (for example: submalar implants) whereas that is not the look he preferred himself for that patient.

Where did you get your implants and the osteotomy, if you don't mind me asking? (you can also pm me if you don't want to post it here)
Title: Re: Zygomatic ARCH augment?
Post by: Schrödingers Jaw on December 06, 2015, 10:15:53 PM
more in zygomatic arch give a face more in width. Please check first if your eyes won't be look to narrow after that. Check the distances

Keep in mind that in many cases some deficiences may fit to the rest of your face
"fixing" it may give you even opposite effect

I am aware, it's not an issue for me.

But the problem in men is that even implants wont create the chiseld look most of them are seeking for, because they are still placed to low on the cheek since it's difficult to place an implant on the area most men want projection of. Also they need projection on the zygomatic process of the temporal bone (and that's a thin, slim bone to put an implant on) to create the male model look.

The only results of zygo implants that I saw on men, looked like utter shit (most of these men had underdeveloped midfaces/zygos or were naturally flat faced) and the docs on realself that claim can make it happen on men (because they did it 1000 times before supposedly) don't even have example pictures on their sites (I wonder why, lol.)

PS. I don't think the Swiss surgeons are capable of augmenting the zygomatic bone like you wish, since that one doc in Germany can't do either and he worked in that hospital before moving and got all his skills from there.

Yes I have my doubts about malar implants for men, never seen a good result. I know a certain Dr. Eppley in the US deals with cranium shape and the like usually via implants but operating on the Z-arch seems quite rare which is strange.

For now I just want to talk to someone knowledgeable about it.
Title: Re: Zygomatic ARCH augment?
Post by: mike888miller on December 07, 2015, 02:59:44 PM
have had this done with filler before, its a game changer no doubt, especially if you have a longish narrowish face. have discussed this with a couple doctors, you need to be careful not to go overboard as you might end up looking like someone that has abuse hgh.

sub malar and malar is very common have seen tons of great implant results, not sure what reservations you have there.
Title: Re: Zygomatic ARCH augment?
Post by: Schrödingers Jaw on December 07, 2015, 10:37:42 PM
have had this done with filler before, its a game changer no doubt, especially if you have a longish narrowish face. have discussed this with a couple doctors, you need to be careful not to go overboard as you might end up looking like someone that has abuse hgh.

sub malar and malar is very common have seen tons of great implant results, not sure what reservations you have there.

Could you tell us a bit more?
Title: Re: Zygomatic ARCH augment?
Post by: Optimistic on December 09, 2015, 03:59:03 AM
have had this done with filler before, its a game changer no doubt, especially if you have a longish narrowish face. have discussed this with a couple doctors, you need to be careful not to go overboard as you might end up looking like someone that has abuse hgh.

sub malar and malar is very common have seen tons of great implant results, not sure what reservations you have there.

I spoke to Sinn about this and an osteotomy here just isn'T feasible due to the muscle there and fragility of the bone. Plus there'd be a step off at the skull. Filler really is the best option.

Use something like Radiesse that will turn permanent eventually. That'd have to be the best solution.
Title: Re: Zygomatic ARCH augment?
Post by: Schrödingers Jaw on December 09, 2015, 07:35:04 AM
I spoke to Sinn about this and an osteotomy here just isn'T feasible due to the muscle there and fragility of the bone. Plus there'd be a step off at the skull. Filler really is the best option.

Use something like Radiesse that will turn permanent eventually. That'd have to be the best solution.

If Sinn said so I am inclined to believe and I can see his argument about bone delicacy, which muscle is he talking about though?

Will Radiesse be "sharp" enough, won't it create a "full" appearance rather than the preffered angular?
Title: Re: Zygomatic ARCH augment?
Post by: triot on December 09, 2015, 08:19:24 AM
If Sinn said so I am inclined to believe and I can see his argument about bone delicacy, which muscle is he talking about though?

Will Radiesse be "sharp" enough, won't it create a "full" appearance rather than the preffered angular?

Radiesse is injected either in the deepest layer of the skin OR right above the bone. It's thicker and "harder" than any other filler. It's more or less an injectable implant and It's much more controllable.
You may need more syringes though, if you really want "high" cheekbones. One syringe wont give you model cheeks if you were flat before.

All patient reviwes I read were extremly positive. I will for sure try this.
Title: Re: Zygomatic ARCH augment?
Post by: Optimistic on December 09, 2015, 02:21:09 PM
If Sinn said so I am inclined to believe and I can see his argument about bone delicacy, which muscle is he talking about though?

Will Radiesse be "sharp" enough, won't it create a "full" appearance rather than the preffered angular?

The masseter literally wraps about the arch I believe, that is what he told me. Not that it can't be done ever, as there is an osteotomy for it, but you're going to have all kinds of step off issues if you do it since doing it simultaneously with another midface osteotomy is nigh impossible.

There's also the point others have made that only a small amount is required to achieve extra width.

Radiesse is hydroxylapatite, basically a derrivative of HA paste that is injectable and semi-permanent. With repeated use it appears to become permanent as a bit of it is left over each time. Additionally, the arch is a place that moves very little so filler life span is going to be significant (1-3 years). Thats why I think it's ideal. Just a bit of filler onto the bone, easily controlled to avoid creating narrow eye appearance and just enough definition, and sooner or later will be permanently augmented.
Title: Re: Zygomatic ARCH augment?
Post by: Optimistic on December 09, 2015, 02:22:23 PM
Radiesse is injected either in the deepest layer of the skin OR right above the bone. It's thicker and "harder" than any other filler. It's more or less an injectable implant and It's much more controllable.
You may need more syringes though, if you really want "high" cheekbones. One syringe wont give you model cheeks if you were flat before.

All patient reviwes I read were extremly positive. I will for sure try this.

Not sure I'd use this for cheekbones as getting the contours of that might be extremely difficult. Then again I'm not an expert.

My plan would be to have a modified le fort III to widen and advance midface and then use HA paste to widen the arch post-op to suit.
Title: Re: Zygomatic ARCH augment?
Post by: triot on December 09, 2015, 03:00:37 PM
Not sure I'd use this for cheekbones as getting the contours of that might be extremely difficult. Then again I'm not an expert.

My plan would be to have a modified le fort III to widen and advance midface and then use HA paste to widen the arch post-op to suit.

Ok, I think we need to clarify what we all mean when we talk about the zygomatic arch/cheekbones :D

Zygomatic arch = zygomatic process of the temproal bone + temproal process of the zygomatic bone

This is what I thought zygomatic arch is, which translates into cheekbone. Or do you guy really mean only the zygomatic process?
Title: Re: Zygomatic ARCH augment?
Post by: Schrödingers Jaw on December 09, 2015, 05:44:04 PM
Ok, I think we need to clarify what we all mean when we talk about the zygomatic arch/cheekbones :D

Zygomatic arch = zygomatic process of the temproal bone + temproal process of the zygomatic bone

This is what I thought zygomatic arch is, which translates into cheekbone. Or do you guy really mean only the zygomatic process?

This is what we're talking about:

(http://www.i-ball.com.au/medicvision/images/zygo_arch.jpg)
Title: Re: Zygomatic ARCH augment?
Post by: Optimistic on December 10, 2015, 08:37:50 AM
This is what we're talking about:

(http://www.i-ball.com.au/medicvision/images/zygo_arch.jpg)

Anyone been able to find before/after shots of filler being used there?
Title: Re: Zygomatic ARCH augment?
Post by: Lazlo on December 10, 2015, 02:49:57 PM
or HA paste? which is basically radiesse.

Here's the thing, you need a surgeon who knows how to deliver that shit right to the bone, not just superficial skin crap.
Title: Re: Zygomatic ARCH augment?
Post by: Optimistic on December 10, 2015, 04:46:42 PM
or HA paste? which is basically radiesse.

Here's the thing, you need a surgeon who knows how to deliver that shit right to the bone, not just superficial skin crap.

Radiesse is always applied to the bone I believe. I didn't know it could be applied skin deep.. would be weird no?
Title: Re: Zygomatic ARCH augment?
Post by: Lazlo on December 10, 2015, 11:25:10 PM
Radiesse is always applied to the bone I believe. I didn't know it could be applied skin deep.. would be weird no?

yeah it can, which is why you need a guy who knows what he/she is doing.
Title: Re: Zygomatic ARCH augment?
Post by: Lazlo on December 10, 2015, 11:37:55 PM
see even these yahoos have no concrete idea how to do it. so you gotta find a good doc for this too!

http://www.realself.com/question/radiesse-actual-cheekbone
Title: Re: Zygomatic ARCH augment?
Post by: Lazlo on December 10, 2015, 11:42:19 PM
these after photos look hella fake but it would be nice if these results were possible. for me this would be to augment my modified lefort 3 and smooth out any parts i wanted enhanced. not instead of it. http://beautywithouttheblade.com/2011/11/21/cheekbone-enhancement-by-new-york-plastic-surgeon-dr-nicholas-vendemia-of-mas-manhattan-aesthetic-surgery-cheekbone-augmentation-fillers-for-cheeks-juvederm-restylane-radiesse-sculptra/
Title: Re: Zygomatic ARCH augment?
Post by: Schrödingers Jaw on December 11, 2015, 06:13:54 AM
I am still concerned that fillers will create a much too "round" shape and not the angular one we men are looking for.
Title: Re: Zygomatic ARCH augment?
Post by: Schrödingers Jaw on December 13, 2015, 02:58:29 AM
All in all, I'm not convinced any chin wing/malar osteotomy will give a decent type of projection. I was looking at some pics, and it is disappointing really to see people got all the works (bsso's, ching wings, zygomatic osteotomies) and if I compared with a picture of the regular goodlooking dude in the street, the latter still has far better bone structure. Something is not right about that. I have to see the first chin wing/malar osteotomy result still that makes someone very goodlooking with those model features. Thus far I have seen none, not one, of them: not here, not in consult. Just lowset cheeks and a bit of extra projection of the mandible with some rotation, with asymmetry as a trade-off. Yet it seems common to be chasing that look with exactly these procedures.

No one completely understands what makes a person good looking, the most you can hope for with these procedures is that they do what they're supposed to. Could you link the pictures you were looking at?

Title: Re: Zygomatic ARCH augment?
Post by: triot on December 13, 2015, 10:10:10 AM
All in all, I'm not convinced any chin wing/malar osteotomy will give a decent type of projection. I was looking at some pics, and it is disappointing really to see people got all the works (bsso's, ching wings, zygomatic osteotomies) and if I compared with a picture of the regular goodlooking dude in the street, the latter still has far better bone structure. Something is not right about that. I have to see the first chin wing/malar osteotomy result still that makes someone very goodlooking with those model features. Thus far I have seen none, not one, of them: not here, not in consult. Just lowset cheeks and a bit of extra projection of the mandible with some rotation, with asymmetry as a trade-off. Yet it seems common to be chasing that look with exactly these procedures.

Well what exactly are you expecting?! Ofc the dude on the street will look better, his face grew naturally that way and surgery can't mimick nature. Thesw procedures work best on people who grew as nature intended and want to change their features a bit and even then it will never look like the naturally good-looking guys, let alone on people who have generalized facial bone deficiency.

There will never be a surgery that will turn you from a sub avarage dude to a model. Not a chinwing, not a malar osteotomy, not a Lefort III. You take what you can get and hope they will make your situation a bit less bad or you leave it all together.
Title: Re: Zygomatic ARCH augment?
Post by: Optimistic on December 14, 2015, 03:57:04 PM
I did not expect that a sub average dude can end up looking like a model after surgery. But if a guy with some deficiencies gets the complete works, chin wing, zygo's, and some even bsso or max fax in addition, imo you should be able to expect to look like you have good bone structure. And to me the surgery result would be a failure if any regular goodlooking dude in the street still has far better bone structure than you after such an amount of surgery.  The complaints from patients after surgery suggest they feel the same way about that.

As to posting pictures of those people I'm talking about. Search for any pictures on the internet that patients have posted after the procedures named above, and it will show what I mean. I still have to see the first  astonishing result of these type of surgeries not published in a paper by a surgeon but published by an actual patient, more than a year after surgery. (That's how long it takes for the final result to become visible). Up until now I've seen asymmetry, crooked chins, a bit extra rotation and projection with asymmetry, lowset cheeks. How would those patients feel if I would repost their pics here, saying the regular goodlooking dude in the street still has far better bone structure than them. To me it would be devastating to be in that position. Although, as mentioned, most patients that do post pics, are not that satisfied themselves with the result either and seem to be looking for revision or additional surgery to augment. I did see implant results that took the average joe with deficiencies to a dude with good bone structure, which was mentioned by other forum members too. Isn't that what all this surgery is supposed to do in the first place?

Bone structure has little to do with attractiveness, I don't even know what to tell you...
Title: Re: Zygomatic ARCH augment?
Post by: Lestat on February 10, 2018, 10:43:27 AM
My plan would be to have a modified le fort III to widen and advance midface and then use HA paste to widen the arch post-op to suit.

Hi Optimistic! Have you implemented your plan in the meantime?