Surgeon toleration level

[Rico]

What you think about surgeon who question a patiet motivation to have surgery with him, after he shows his anxiety about surgery ?
Recently, I little insisted by asking about more photos before / after of similar cases like mine (zygomatic bone osteotomy). After that the surgeon told me, that I was too nervous about surgery and I should seriously think about it. I just want to have surgery, but he's like I should trust him in 100%. 
Please keep in your mind I'm not talking here about jaw surgeries, but about something like modified LeFort 3 / zygomatic bone reposition. No other patients on forums I can ask about it, almost no examples.... How to be very calm is such situation..and I wonder if this is typical for the surgeons... or if very skilled / the best ones should be more forbearing. What you think about similar situations ?

[Lazlo]

I would think the surgeon is an asshole and not go with him. And he should definitely admit that he isn't infallible.

[yxcvb]

lol @ all this buzz around LF3. I wonder who will be next after Earl25.

I think a lot of people talk about LF3 because they wanna improve their appearance. But most of them dont really need it from a medical point of view. Most of them wanna have a shorter and wider face but their natural face often is in limits of the normal facial ratios. Its really a vanity thing for most since technically there is nothing wrong with their faces.

Not like vanity is a bad thing, I had a genio because of the same reason.

its just that an LF3 is much much more dangerous and people dont understand that doctors wont take a risk like that just because you think you'd look better with surgery. If I was a doctor I'd think the same. Medically there are a lot of things "possible" that doesnt mean you can find a doctor who is willing to risk complications and even his whole career over vanity.

[Rico]

I found surgeons who can do malar reposition. i need this surgery. They say, they can do that at very low risk and what you think ?

[PloskoPlus]

I think a lot of people talk about LF3 because they wanna improve their appearance. But most of them dont really need it from a medical point of view. Most of them wanna have a shorter and wider face but their natural face often is in limits of the normal facial ratios. Its really a vanity thing for most since technically there is nothing wrong with their faces.

Not like vanity is a bad thing, I had a genio because of the same reason.

its just that an LF3 is much much more dangerous and people dont understand that doctors wont take a risk like that just because you think you'd look better with surgery. If I was a doctor I'd think the same. Medically there are a lot of things "possible" that doesnt mean you can find a doctor who is willing to risk complications and even his whole career over vanity.

If you want a wider face, then a ZO is all that's needed.  My face is already very wide as is.  I need anterior (forward) projection of the upper mid face.

[Skillsaw]

I think a lot of people talk about LF3 because they wanna improve their appearance. But most of them dont really need it from a medical point of view. Most of them wanna have a shorter and wider face but their natural face often is in limits of the normal facial ratios. Its really a vanity thing for most since technically there is nothing wrong with their faces.

Not like vanity is a bad thing, I had a genio because of the same reason.

its just that an LF3 is much much more dangerous and people dont understand that doctors wont take a risk like that just because you think you'd look better with surgery. If I was a doctor I'd think the same. Medically there are a lot of things "possible" that doesnt mean you can find a doctor who is willing to risk complications and even his whole career over vanity.

Legit. I don't think people understand the risks involved with a lefort 3. It is ridiculously invasive and will break their skull into pieces lol. Not a good idea at all unless your skull is crouzon's tier. I mean, personally I am not interested in the risk of losing/damaging my sight

That being said I'm looking into cosmetic lefort 1+bsso since it is a lot less risky but can still improve a lot of retruded maxilla and flat face problems. My occlusion is ok since I had orthodontics but my teeth are well over a whole cm behind my brow. Just like 5mm of advancement will fix my nasolabial folds, weird shaped nose and make my smile look more engaging

[Skillsaw]

If you want a wider face, then a ZO is all that's needed.  My face is already very wide as is.  I need anterior (forward) projection of the upper mid face.

Maybe orbital rim implants or filler can help in that case? I need projection everywhere. I have almost literally zero zygomatic curve, they are baby sized

[PloskoPlus]

Maybe orbital rim implants or filler can help in that case? I need projection everywhere. I have almost literally zero zygomatic curve, they are baby sized

I had a Le Fort I 3.5 months ago.  I'm sort of desensitised to the risks of maxillofacial surgery now (even as I have altered sensation in my palate and partial numbness in my lip).  Implants often look "off".  Then there is the problem of bone erosion, infection.  Medpor implants are also difficult, if not impossible to remove if things go wrong. 

http://jawsurgeryforums.com/index.php/topic,2626.msg22122.html#msg22122

(Earl eventually went through with a modified LFIII and is happy with the result).

[Skillsaw]

I had a Le Fort I 3.5 months ago.  I'm sort of desensitised to the risks of maxillofacial surgery now (even as I have altered sensation in my palate and partial numbness in my lip).  Implants often look "off".  Then there is the problem of bone erosion, infection.  Medpor implants are also difficult, if not impossible to remove if things go wrong. 

http://jawsurgeryforums.com/index.php/topic,2626.msg22122.html#msg22122

(Earl eventually went through with a modified LFIII and is happy with the result).

You are definitely right. Everything other than actual bone being advanced is a compromise and won't look as good as it could otherwise... But I guess that is why it is called a compromise. There aren't really any other options for the midface and a modified lefort 3 probably costs and arm and a leg and is risky.

How was the pain for Lefort 1? Cost? BSSO as well? Cosmetic? How many cm advancement? Are you happy with the result? Any other changes in the nasolabial folds, orbital vector, eyes or nose?

[Rico]

I see here talking about osteotomy vs implant if you do not have significant face deformation

Here is answer from one of the surgeons in my case:

looking at your face for me the problem is only a flatness in
the right cheek area (due to the zygoma dislocation) but I don't appreciate an
enophtalmos.For this reason I am not sure that iswise to osteotomize  and
reposition the zygoma. Probably I would prefer an alloplastic silastic implant
in order to correct the zygomatic prominence

what all of you think now ? every second surgeon tell me this ?

[Lazlo]

Though you have to realize how the soft tissue will react is another question. If you're older you may need fat over the bone or even mid facelifts or cheeklifts to lift the flesh. hopefully though the result with be  a "tautening" facial tissue. Rico, what are you always asking questions about. If you've found a surgeon who has a good track record and can do the surgery and says there's minimal risk go get it done.

[Rico]

All surgeons I contacted have very good track record.
However I found 2 surgeons who can do this safely as they claim, but one of them can't show me examples of such procedures . You know before / after
The second do not know.... I mean malar bone reposition, not any surgery on midface. Repositioning of malar bone is specific and it is easy to recognize

Would you choose a surgeon which can't give you examples of such procedure, but it has very good track record and he says he can do that at very low risk ?
malar bone delayed reposition especially in milder cases is rare...

I'm young 30y and I would be more comfortable with my hard cheekbone

MM also told many people "I can do it. I can fix it" and what ?