LeFort 2 / 3 -> Malar osteotomy

[Lazlo]

Yes, I should revise that I personally would never go with Schendel as his work is considered very shoddy, and this took m a while to discover. So even with so-called well respected surgeons, do your research!

[Rico]

Right now th ONLY people are those I can count on 1 hand Obswegger, Keller, that's it.

anyone else from Europe ? only Obwegeser ? Have you ever heard about Nocini , Sesenna,  Iannetti ? Many from Italy are supposed to be very good.
noone from Sweden ? they have very good health system

and I still can't get the whole talking about orbital rim. I mean you talk about this like it was different surgical approach, when this is a part of malar bone and until you cut orbital rim, the whole malar bone is not mobilized
Please, who can explain me this issue.

For example, I have lack of cheek prominence due to overlooked malar fracture. I'm gonna have malar bone osteotomy on the lines of previous fracture. So only 2-3 maxfac surgeons on the world can do that in safe way ?

PS Obwegeser refused to do malar bone osteotomy in my case, because it happened 3 year ago. However there is one issue which could  discourage him to help me, but it was not so important. So do not overrate this surgeon.

[Lazlo]

anyone else from Europe ? only Obwegeser ? Have you ever heard about Nocini , Sesenna,  Iannetti ? Many from Italy are supposed to be very good.
noone from  Norway ? they have very good health system

and I still can't get the whole talking about orbital rim. I mean you talk about this like it was different surgical approach, when this is a part of malar bone and until you cut orbital rim, the whole malar bone is not mobilized
Please, who can explain me this issue.

For example, I have lack of cheek prominence due to overlooked malar fracture. I'm gonna have malar bone osteotomy on the lines of previous fracture. So only 2-3 maxfac surgeons on the world can do that in safe way ?

PS Obwegeser refused to do malar bone osteotomy in my case, because it happened 3 year ago. However there is one issue which could  discourage him to help me, but it was not so important. So do not overrate this surgeon.

yeah, yeah, so just look at the quadrangular lefort-1 case. The zygoma is part of the whole malar complex, as is the orbital rim (the bone just beneath the eye that is scallop shaped). Most surgeons cut BELOW the orbital rim because that's where the f**king nerve that supplies feeling to the eye and upper face is located. If you sever this nerve you could have blindness etc. etc. This is why most surgeons don't f**k with moving the whole orbital rim. Some surgeons it seems SINN did this, cut around the nerve and leave that portion unmoved. I don't know how common it is for surgeons to move the orbital rim. Jesus why don't you just go to some surgeons and get a consultation and ask them!?

[Lazlo]

(Sandwhich) zygomatic osteotomy = always bone resorption, Lazlo? I've seen some absolutely stunning results from zygomatic sandwhich osteotomy. And most of the results I saw were almost without exception amazing. It would be a deception if bone resorption would 'undo' those results.
I have to see the first malar implant result that looks anything close to that (implants to the cheeks imo often look fake. They don't give projection in the good areas and over the lateral portion of the zygomatic arch as can be achieved with a zygomatic osteotomy).

Okay, I am willing to email someone who has seen Zaarrinibal the exact papers with diagrams of the quadrilangular lefort -1 and quad II operations. Someone who knows also how to shrink files so that they can b attacked here on the site. I tried but the files are too large. Maybe put them on a website and attach the links here or something, but I don't know how to do all that s**t. So just PM me and I'll email them to you. But you better ensure total privacy cause I'm not going to create a fake account or something to email you. I want to know in fact how good Zarrinibal is and what sorts of osteotomies he is doing. The stuff I'll send you includes actual papers with diagrams.

[Rico]

yeah, yeah, so just look at the quadrangular lefort-1 case. The zygoma is part of the whole malar complex, as is the orbital rim (the bone just beneath the eye that is scallop shaped). Most surgeons cut BELOW the orbital rim because that's where the f**king nerve that supplies feeling to the eye and upper face is located. If you sever this nerve you could have blindness etc. etc. This is why most surgeons don't f**k with moving the whole orbital rim. Some surgeons it seems SINN did this, cut around the nerve and leave that portion unmoved. I don't know how common it is for surgeons to move the orbital rim. Jesus why don't you just go to some surgeons and get a consultation and ask them!?

Hmmm. There is infraorbital nerve and this nerve supply feeling to the cheek area and part of lips.  NO TO THE EYE. WHO TOLD YOU THIS ? For example, In my case they have to release my nerve so they have to cut there. But I first time hear it is very hard to cut orbital rim near inraorbital foramen without damaging infraorbital nerve too much. 3 surgeons told me it not hard to do that. Many times this nerve must be realeased due to orbital floor damage, due to blow out fracture. I'm not first patient who need ION decompression. Blindness is possibl when you damage optic nerve, but this nerve is behind the eye....deep in eyesocket. During malar bone osteotomy no surgeon goes there. This is almost impossible when surgeon knows what he is doing. BUT YOU MAY have double vision if any eye muscle will be jammed in the orbital floor or orbital volume increases too much

[Rico]

Lazlo: what were you talking about ?

[Lazlo]

Wow, not a single person PM'd me to get the papers. You guys are a bunch of total posers. Keep talking nonsense on the board and wasting everyone's time. Most of you are never gonna get surgery anyway.

[Modigliani]

Wow, not a single person PM'd me to get the papers. You guys are a bunch of total posers. Keep talking nonsense on the board and wasting everyone's time. Most of you are never gonna get surgery anyway.

Stop f**king biting people. You've been on this board since the beginning and still haven't had surgery, or even settled on a surgeon so don't dare accuse others of time wasting, it's obnoxious in the extreme.

[Balanced]

Well said

[Rico]

I will have surgery for 99% within several  weeks. I'm in situation I HAVE to do it - no other option - and I'm very afraid. I'm just finishing my last consultations...then I will have to choose.

[Lazlo]

I have a question. So on the internet there are several programs that allow you to measure the symmetry of your face. I'm assuming that if a catskan of your 3-D skull were to be transferred to a computer there could be a facial analysis that could measure the three-dimensional symmetry of your face bilaterally but also in terms of the forward or backwardness of you cheekbones, etc. And this info could be given to the surgeon to ensure both sides become more symmetrical after surgery. Do such programs exist? Surely they must. I know different surgeons more or less embrace new technologies. I had an average surgeon that used computers for everything whom I consultedd with and he was actually developing the software with some company in scandanavia.

For example, he told me that in a few years a computer program will be used to simulate how braces will move and shift your teeth and will provide you with an exact image of how your teeth will look and this will give the orthodontist EXACT measurements for how to apply your braces! My f**king bad luck I never had that cause I had 4 perfect teeth taken out and my whole lip and midface is now terribly deficient. Anyway, any of you know if Zarrinibal or any of these guys use tech in this way?

[Lazlo]

Stop f**king biting people. You've been on this board since the beginning and still haven't had surgery, or even settled on a surgeon so don't dare accuse others of time wasting, it's obnoxious in the extreme.

Oh yeah? I've given this board more concrete information than ANYONE. So don't f**king tell me how to behave. I get frustrated sometimes and mouth off a bit, I know. But there's a lot of stupidity on this board and I like to keep it in check. Mind your own business!

[Lazlo]

Okay, fine Rico, Modigliani, etc. guys I'm sorry. I just get very frustrated sometimes and I apologize for getting nasty with you and those I've offended. This is hard on all of us mentally, and I've gonee through some really tough times, so it comes out in bad ways and I shouldn't be mean. Also, part of the time I'm just joking and trying to keep things a bit lively and moving on the boards. But you're right. Can we all kiss and make up?

[Alue]

Lazlo are those the same papers you sent me last year?  Or do you have new ones? 

[Lazlo]

ask plosko plus I sent him everything and he has it in a dropbox which I'm sure he can share. They are kellers papers so you probably already have them. Alue, which direction are you headed? Are you going with Sinn?