I had modified lefort iii

[Lazlo]

just wow.

I'm only now catching up. I'm assuming that was a massive joke.

[geijutsu]

I saw earls photo after the modified lefort 3. His lower orbital problems have been resolved. What he need now is to do something about his supraorbital rims. I don't know why he's overlooking it and chasing procedures that are unnecessary after his modified lefort 3.

[earl25]

I saw earls photo after the modified lefort 3. His lower orbital problems have been resolved. What he need now is to do something about his supraorbital rims. I don't know why he's overlooking it and chasing procedures that are unnecessary after his modified lefort 3.

very fes options for supraorbital rims. it needs a coronal. i spoke with ousterhout on this

[Lazlo]

very fes options for supraorbital rims. it needs a coronal. i spoke with ousterhout on this

Interesting. I asked Sinn why my eyes look so buggy when I become expressive and he said it was the shape of the sockets. I didn't ask him what could be done for that, but I will when I see him again for surgery.

[PloskoPlus]

Interesting. I asked Sinn why my eyes look so buggy when I become expressive and he said it was the shape of the sockets. I didn't ask him what could be done for that, but I will when I see him again for surgery.

Same here, but only the bottom of they eyes.  Yet I have small eyes.  The skin around they eyes has always crinkled heavily when I smile.

[Optimistic]

very fes options for supraorbital rims. it needs a coronal. i spoke with ousterhout on this

Did Sinn indicate he could do supraorbital rims at the same time if you were to get a coronal?

[earl25]

Did Sinn indicate he could do supraorbital rims at the same time if you were to get a coronal?

i never asked him. i will tbough. i will be consulting with dr ousterhout.

[meepmeepmeep]

I am brand new to the forum and this is my 1st post! I am female and 27 years old but I have been lurking on any and all forums that talk about aesthetics, midface def, orthodontics, etc. for close to 6 months. So far I have consulted in person with Dr. Hang DDS and Dr. Wolfe (student of Dr. Tessier) the later concerning a seperate craniofacial procedure as well as jaw advancement, and via Skype w/Dr. Movahed (fellow of Dr. Larry Wolford), Dr. Gunson and Dr. Mike Mew. Also, prior to knowing much about any of this I had some cosmetic procedures with Dr. Michael Salzhauer that all left something to be desired and require some tweaking. Anyway, I just keep digging and digging, and thanks to my obsessive nature and you lovely people, I am driving up to consult with Dr. Sinn on June 5th!

My first question about Dr. Sinn is does he work with implants at all? In addition to double jaw surgery including a modified lefort ii or iii I would really like to have mandibular angle implants and even a forehead implant. I am driving up to see him in about two weeks but I'd love to have a somewhat clear understanding of what he does vs. what I would like to have done before I show up to meet him!

My second, I really would like to open up my extraction spaces (top premolars only) with a functional appliance and have a modified multi segmented lefort ii or iii. I know this is very possible with a lefort i with certain orthos who are familiar with these types of appliances and certain maxfac surgeons... do you think Dr. Sinn would be willing to work with me if I opened my extractions first, then braces to prep for surgery? And is a multi segmented modified lefort ii or iii even possible?

Some of you people are so tenacious and brave to pursue and possibly even undergo these procedures, I commend you and am thankful to have you as kindred spirits! This is my first post so if this isn't proper etiquette please let me know! Thanks!

[earl25]

welcome meepmeepmeep Im not sure. I don't think Dr. sinn likes implants. Most maxillofacial surgeons don't. Ask him if he can do some type of  jaw angle osteotomy or supraorbital rim/brow.

[meepmeepmeep]

Well, I want to expand my palate that is very, very narrow (28mm). I was narrow to begin with but as a third grade child my premolars were removed and my teeth pulled back. In order to have a multi segmented lefort opening the extractions isn't necessary but I guess I feel like those teeth were stolen from me. Anyway, It is all kind of a chicken and egg situation. I have a long face, extremely close set eyes (52mm ipd), negative orbital vector, no cheekbone projection (anterior or lateral), and deep nasolabial folds.

[molestrip]

@meepmeepmeep Wow, sounds like you have some serious issues and amazing research you've done already. Yeah I would want those teeth replaced too and expand that palate for sure. Do you have an anterior open bite too? Otherwise, SARPE followed by LeFort I is considered safer I think. It sounds like you met Dr Alfaro already. He's a trek away but he can do the SARPE outpatient I believe with minimal incisions, pretty amazing. Those eyes do indeed sound very close but that's really hard to fix in an adult. What kind of risks and results can you expect? Negative vector, well that's common even among normal people. Maybe 1/3 of the population? What's your age? The funny thing about cheekbones is that when the fat pads thin in your 30s the underlying skeletal structure becomes apparent. That's not so great under the eyes as you know but cheekbones start to become more prominent. I have a picture from nearly 10 years ago, cheeks completely flat. Now they project. I may have gotten a little growth but mostly I think it's just from my face thinning out. Anyway, prominent cheekbones aren't considered to be critical to attractiveness of men. Nasolabial folds should be addressed by a standard double jaw surgery.

So in summary, I think you're doing good stuff but you're looking at a lot of surgeries. Start with SARPE then double jaw surgery. Then something with Sinn for the eyes and may as well hit the cheekbones while you're at it. I don't know about implants, you need to draw the line somewhere. I don't know if it's wise to rotate the maxilla at the same time that you're moving the cheeks around. That's a lot of stuff being held together by fragile little plates where even a tiny mm of movement could throw it all off. You'd also be in no man's land, doing stuff that very, very few people (or adults at least) have done.

[Lazlo]

I am brand new to the forum and this is my 1st post! I am female and 27 years old but I have been lurking on any and all forums that talk about aesthetics, midface def, orthodontics, etc. for close to 6 months. So far I have consulted in person with Dr. Hang DDS and Dr. Wolfe (student of Dr. Tessier) the later concerning a seperate craniofacial procedure as well as jaw advancement, and via Skype w/Dr. Movahed (fellow of Dr. Larry Wolford), Dr. Gunson and Dr. Mike Mew. Also, prior to knowing much about any of this I had some cosmetic procedures with Dr. Michael Salzhauer that all left something to be desired and require some tweaking. Anyway, I just keep digging and digging, and thanks to my obsessive nature and you lovely people, I am driving up to consult with Dr. Sinn on June 5th!

My first question about Dr. Sinn is does he work with implants at all? In addition to double jaw surgery including a modified lefort ii or iii I would really like to have mandibular angle implants and even a forehead implant. I am driving up to see him in about two weeks but I'd love to have a somewhat clear understanding of what he does vs. what I would like to have done before I show up to meet him!

My second, I really would like to open up my extraction spaces (top premolars only) with a functional appliance and have a modified multi segmented lefort ii or iii. I know this is very possible with a lefort i with certain orthos who are familiar with these types of appliances and certain maxfac surgeons... do you think Dr. Sinn would be willing to work with me if I opened my extractions first, then braces to prep for surgery? And is a multi segmented modified lefort ii or iii even possible?

Some of you people are so tenacious and brave to pursue and possibly even undergo these procedures, I commend you and am thankful to have you as kindred spirits! This is my first post so if this isn't proper etiquette please let me know! Thanks!

I am almost certain he doesn't work with implants. He stated he doesn't like them at all to me in person.

And no, multi-segment lefort ii or iii is not possible way to unstable. Theoretically anything is possible, and I guess no harm in asking.

[molestrip]

I was just re-reading the original post. Wow, 7mm advancement! Able to pull an inch of skin off his face? That's a really big movement, he must have been quite deficient before. I can see why he'd want to have that fixed. Neat that he was able to do it in office and separate from the jaw surgery. I wouldn't want to mix the two. Jaw surgeries by themselves are risky enough, relapse rate on an MMA is 15% as I recall and it only goes up with multi-segment and CCW rotations. All the stuff at the bottom of the hierarchy of stability. Not to mention that a CCW rotation would actually pull the oribtal rim down and change the shape of the socket, which is usually undesirable. I guess it'd be nice if they could move the midface at the same time as the jaw surgery so an extra break isn't required. But the midface is also used to support the maxilla after the downfracture so while a small movement to it might not be a big deal aesthetically it could create a functional problem to the bite. Did he redo the downfracture then? Probably the bigger issue is that so few of these procedures are done. Have the relapse rates even been studied? I'm wondering if the reason this isn't done more often is simply because no one has done enough procedures to have figured out how to do it well and in volume.

Anyway, definitely keeping in mind if my face bothers me enough that I feel the need to augment my midface. What was sensory recovery like? Did you lose any sensation, temporarily and permanently? You have some serious balls to undertake this procedure after all that you heard and having had no trailblazer patients ahead of you, just relying on the surgeon's word. The result is well earned for sure.

[terry947]

IMO high cheekbones for men are the most important feature on the face.

Also CCW rotation pulls the orbital rim down?

molestrip what are you talking about.

I dont have prominent cheekbones and even i disagree with that. I could agree with you to make myself feel better, but id my lying to myself.

[geijutsu]

Molestip, 7mm is not an inch.