LeFort 2 / 3 -> Malar osteotomy

[Lazlo]

No idea.  My surgeon did say that under-eye flatness often comes with great facial width like mine.  Maybe he's right:

http://www.listal.com/viewimage/1018849h

This chick has eye bags in almost every photo... and she's a model.

yeah but all her other features are as close to perfection as you can get. beauty is a "gestalt" i.e. the relations amongst forms, you can't cherry pick individual features like that, it's how it all comes together. Also bags under the eyes aren't necessarily a result of poor orbital rim support, though her's aren't great.  Often its a soft tissue problem. Anyway, can we stay on topic please, i.e. papers on this surgery, news from Dr. Obesgesggser or whateber the f**k his name is.

[terry947]

Btw my friend is a university student and he said he'll try and get the papers for me. So if I get them I'll report back!

Also I'm going to email Dr. Obwegesser, is there anything specific you guys want me to ask?

[Lazlo]

Rico, you don't need jaw surgery. You just need a repositioning of your orbital rim/malar right? Okay, got it.

[Rico]

Lazlo...Jesus..of course not problem with the jaw If I needed jaw surgery , then it wouldn't be a problem to do it in my country

You cannot separate orbital rim from the malar whole malar bone, at least in this case it is nonsense

so since you exactly know what is my problem ,what you think ?

[PloskoPlus]

You mean a Le Fort I? If that's what you meant then the answer is unfortunately no; a Le Fort I does nothing to address deficiences under the eye. I'm hoping the zygomatic osteotomy is enough to correct it if you just have a negative vector cheek and no orbital rim deficiency though.

IMO, I think mid face recession is rarely confined to the maxilla only and I'm certain most surgeons are very well aware of the fact.  It's just that Le Fort I is fairly straightforward and "good enough".  That's why so many Le Fort I results still look "off" after the operation - the damn curve is too low.  Those rare "wow" Le Fort I cases are the ones where only the maxilla is recessed and everything else is fine.

[Lazlo]

Again, you hit the nail on the head Ploskoplus, you are ABSOLUTELY right.

Now I would say that probably in 50 percent of cases the lefort 1 is enough, and in another 20 percent it's borderline but in 30 percent of the cases the lefort 1 is not enough as you rightly point out and what is needed is something like the quadrangular lefort II (Keller) or what demon girl had done.

@Rico, okay I thought you had some accident and also needed jaw surgery, don't get your panties in a bunch. Stay cool dude.

So my dream team would be able to do the following: demon girl operation PLUS the chin wing osteotomy.  Does Obeswegger do chin wing?

[Rico]

Lazlo: I had an accident.. malar bone fracture. under the line you can see fracture line. Whole bone moved about 4mm
Look at the orbital rim above ION foramen ..There is about 2mms [in normal scale] fault

typical fracture like this:



My malar bone must be cut on the old line fractures.  All fractures with mild  displacement like this are the same, like in picture above

so what kind of Lefort I need ?

[Rico]

Since now you know exactly what the problem I have, I need little advice..

Some surgeons I have consulted told me that malar bone reposition (in my case) is the one of the easiest procedure from the hardest ones, but at the same time they claim no surgery is easy Nicely said, but....  They tell me they can do that at very low risk of any permanent damage, but when I ask them to show me some photos of some patients who underwent such surgeries they show me the cases just a little similar to mine, for example where one patient had whole his face moved little forward...  so even more complicated [I suppose] but my problem is not very rare and at the same time not frequent.
This type of fracture (even overlooked) is typical. Bone break almost in the same way...So no photos = no patient like me before ?
From time to time some patients after cheek trauma has overlooked fracture or sometimes the fracture is improperly set during first treatment and need redo. All of this come to one thing -> malar bone osteotomy in old line of fracture, like I showed it in my previous posts here.

My question is: Should I trust a surgoen (all I met are cranio-maxillo-facial) who has great experience (opinion) with whole skull , that he can do that at low risk, without giving me examples of the same problem in his previous patients ....
or I should go where a surgeon show me at least 2 examples of such identical treatment ? I do not know If I ever gonna meet such one...
Is it good to have surgery where they have experience with more compliated cases, but not with more simple ? when a surgeon has not had identical case like me (having in mind that my fracture was typical)

What you think ?

[PloskoPlus]

You mean a Le Fort I? If that's what you meant then the answer is unfortunately no; a Le Fort I does nothing to address deficiences under the eye. I'm hoping the zygomatic osteotomy is enough to correct it if you just have a negative vector cheek and no orbital rim deficiency though.

Out of the mouths of babes... I asked a friend who I see about once a month what he thinks.  He said I no longer look as flat as pre-op, but I need "more fat at the top of my face" to balance the protruding middle of the face.  He knows nothing about jaw surgery or aesthetics.

[Lazlo]

Interesting. Can you have a chin wing and bsso done at the same time? Yes I am class II. Man this sometimes feels so impossible.

Plosko did your upper lip protrude? I mean the space between your nose and upper lip? Can you post some pics? I thought you looked amazing after your surgery.

[PloskoPlus]

Interesting. Can you have a chin wing and bsso done at the same time? Yes I am class II. Man this sometimes feels so impossible.

Yes.  But the BSSO cut must be made further up.  I think Zarrinbal definitely does do both at the same time.

Plosko did your upper lip protrude? I mean the space between your nose and upper lip? Can you post some pics? I thought you looked amazing after your surgery.

Yes - it was swollen and thick.  I looked almost class II.   I think it's the VY-plasty that made my lip so thick and numb.  But my friend made the comment yesterday and my lip is thinner (but not there yet).  I think he's right.  The middle of the face is heavy and convex, courtesy of the Le Fort I and recessed upper mid face.  IDK, maybe it's still the swelling.  I was told that the final look is obtained 12 months after surgery.  My ortho said that he even sees difference in the upper lip in 12 and 24 month photos. 

Modified LFIII, here I come.

[Rico]

and of course..no advice ehhh what a pity..

[terry947]

For the lefort 2/3's how much actual projection do you need to have a noticeable improvement?

Is it minor like 1-2 mm or huge about like 8-10mm?

Just wondering because my brother has huge cheekbones but when I compare mine with his it only seems like its maybe 2-3 mm bigger also it feels like the orbital rim under his eye ball is closer to his eye then mine.

[Rico]

the bone has to be moved about 4mms outwards but it is not easy to explain. After the fracture the bone backed a little, gone inward and rotated  
but in more simple words...its about 4mms. There is not big problem if you have less or more of cheek prominence on both sides , the problem is when you have on the one side clarly visible cheek and on the other completely flat Generally I had mild/medium deformation or just not big  but its strange for me..and also pain due to nerve compression. 2 connected problems

and now I found some surgeons that have good reputation and do some really complicated surgeries. They told my surgery is relatively easy for them.
but when I ask them to show me patient with very similar problem, the can't do that. and what I should do in that case ?
My fracture was typical. so called 3pod - typical zygomatic fracture, but overlooked.
But I'm not the first person who had overlooked fracture also sometimes some people needs redo after the bone was set improperly during first treatment.
Only in Poland every surgeon told me that they report 2-3 cases a year who need that surgery, but they refuse to perform that.
So If a surgeon who claims he can do that at low risk, then why he can't show me at least one patient with that problem ?

[Rico]

What you think about such INTERNATIONAL clinics ?

http://www.ukaachen.de/fileadmin/files/global/user_upload/MKG_Englisch_final.pdf

there works one of the main German maxfac surgeon.

Interesting article (download PDF link) : https://www.google.pl/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&uact=8&ved=0CFsQFjAH&url=http%3A%2F%2Frepub.eur.nl%2Fpub%2F21397%2F101119_Nout%2C%2520Erik.pdf&ei=gHezVLTwDNHaaq2XgcAI&usg=AFQjCNHixN1meUHiFIRlJ9uXuNBE9iRbMA&sig2=-tnVEemCH0IshYzErcWEbA&bvm=bv.83339334,d.d2s