Well guys…I don’t know what to say, travelling and having these consultations, if you’ve been at this as long as I have it starts to get to you and it’s withering on your sense of self. It’s not easy on your mind. I mean sitting at home and imagining the outcome in an ideal world is far more comforting than the nitty gritty of actually seeing real results and figuring out what can be done…
I’ll say a few things, I’m feeling a bit skeptical now about surgery making that major a positive different in a person’s appearance. I mean yeah I see the before and afters but now I see them with a much more critical eye, even the so-called miraculous cases where a class 3’s face has been made to “POP!!” due to some movements doesn’t seem as impressive to me.
I’ll say something, the only person’s whose appearance I have been TRULY impressed by has been stupid jaws who had what 2!!! chin-wings and a ZSO etc. by Zarrinabal. But Stupidjaw is very young and was very good looking to begin with. I’m thinking Dr. Z’s procedures may really be what is needed cause he can in fact create a contoured angular jaw line through his chin-wing procedure. regardless I’m not going that route.
I any case as you all know I”m just getting jaw surgery right now “just” hahahaha what a joke. It’s a major thing —Dr. Sinn said he’s going to widen and drop the maxilla, also he said he’ll try and widen the mandible, he’s going to widen, lengthen and project the chin and try and make the gonial angles more angular and prominent. He’s going to do a V-Y plasty on both the upper and lower lips to make them a bit more prominent and he’s going to reduce, not remove the turbinates. He’ll be doing a CCW rotation.
HE said that’s a lot of surgery for one go so just leave it at that for now.
Note on what Sinn calls the “chin-wing” —he has a vague understanding of this procedure I think. I showed him the model of what Dr. Z does and he said he doesn’t make the cut like that because there is a very big risk to the nerve. Not sure what to say to that other than a couple of Dr. Z’s patients have lost total feeling to their lower lip right? So maybe he’s correct. Those of you who have seen Dr. Z will know more and would kindly share it with us here.
Now let me tell you he showed me one patient —not Earl, but someone more recent who had the “modified lefort-3” yes there was a difference but it just resembled a weak ZSO to me. In fact, when I studied the before and after profiles there was no significant augmentation to the area directly beneath the eye and this was not as augmented as when I see Dr. Yaremchuck’s examples of orbital rim implants with “canthopexy” no Sir, not even close. Honestly from the example of the modified lefort 3 I saw this procedure is not the holy grail to your looks as many of you have been assuming I’m very sorry to report and I don’t think it can do a lot at all. You’re like to get a much more dramatic result from a genioplasty to your appearance. The problem I think rests in the facts that the movement isn’t that much AND you’re limited by your own anatomy. If you don’t have large bones they’re not gonna show very well. Also, even though this is supposedly moving the orbital rim, what is needed is more augmentation to the rim height and width itself I think.
Now, I pressed Sinn on augmentation materials. As I have quite a fine chin and would like a more robust one and he said he uses Hydroxyapatite Coral block. Now, he said when you put a material between a joint it stays and any onlay slowly disappears regardless of what material. This is good for people who had hip graft on the chin wing cause it means the bone stays as it is sandwiched between a joint. HA onlay Sinn said will stay like Medpor or Sillicone and it has the same structure as natural bone so blood and tissue will grow into it. It doesn’t “turn” into real bone nor does any other material Sinn said so there are your answers to that. Does it lead to bone erosion underneath? No, that is all nonsense and BS was Sinn’s response. I should tell you Dr. Sinn does some pretty hard craniofacial cases to patients with severe Syndromes so he must be quite experienced with various types of facial surgery. But then so do all the other top docs we’ve all consulted with.
So how do I feel about all this? Well I feel “reasonably” okay about the first surgery. Of course I think the modified lefort might still be necessary but only if combined with significant HA grafting as well to shape the cheekbones. Now, Sinn suggested that using the block and actually carving it to shape the cheekbone was something he had done and could do. And of course this is a bit controversial. I’m not going to worry about it today as these consultation days are so physically and emotionally exhausting. I really don’t know what to say. I thought Mommaerts pictures of grafting done with HA look really good in their afters. Maybe Sinn uses HA differently. I’ve heard there are serious problems with achieving a predictable result and achieving symmetry. Seems that would all depend then on the skill of the doctor. So I don’t know what to think. That Arnett and Gunson also use HA paste significantly is heartening to me and that a few other docs like “Dr. Lefrenq” and Mendelssohn use it and feel it’s positive is heartening. The stories of it leading to erosion etc. are anecdotal not laboratory results.
One thing also that I’m a bit on the fence about. Dr. Sinn suggested buccal fat removal. The one person I know who had it done, didn’t seem to make much of a difference and then he was quite upset that it was asymmetric and went and had a revision with fat that didn’t stay. I’ve heard some surgeons say it’s a bad idea cause we lose fat as we age and it won’t look good down the road. I don’t know, thoughts?
Huh…I’m exhausted and feel like crying I dunno how some of you have the mental fortitude for all of this.
