Infraorbital rim implant result

[Lestat]

is that picture above a ZSO? I have seen a modified lefort three, it just made the cheeks more full the apple of the cheeks become fuller.

"Figure 29. A 32 years woman with malar deficiency, No orthognathic surgery was performed in this case. The patient desired definition of the cheekbones with zygomatic sandwich osteotomy (ZSO) (left) preoperative view, note the triangular shape of she’s face; (right) 18 month postoperative view."

So this is more or less the result we would get from a mod. LefortIII (midface advancement between 5-7mm)?
(I like the result).
Or what is the difference between a ZSO and a mod. LefortIII? Anyone knows? Thanks.

[Lestat]

nope this looks way better than what i saw the modified lefort III to look like.

isn't the ZSO just the thing zarinnbal does?

Yes Zarrinbal / Triaca / Brusco / Cesar Guerrero and maybe a lot of other docs.

A ZSO gives without any doubt forward and lateral projection. I do not understand why some users on this Forum claim it gives only lateral projection.

Dr. T. did not show me before and after pictures, because of patient privacy. What a pity.

But he told me that you can clearly see a difference from a zso also WITHOUT any bone substitute material.
Normally he uses an iliac crest graft (sandwich tecnique-not as an ONLAY!).  Then you have a big difference he told me. Similar to the picture above I think (or even more).

[PloskoPlus]

Yes Zarrinbal / Triaca / Brusco / Cesar Guerrero and maybe a lot of other docs.

A ZSO gives without any doubt forward and lateral projection. I do not understand why some users on this Forum claim it gives only lateral projection.

Dr. T. did not show me before and after pictures, because of patient privacy. What a pity.

But he told me that you can clearly see a difference from a zso also WITHOUT any bone substitute material.
Normally he uses an iliac crest graft (sandwich tecnique-not as an ONLAY!).  Then you have a big difference he told me. Similar to the picture above I think (or even more).

We have to ask Earl if he has achieved a similar result from his mod. lf3? PLEASE NOTICE THE CAMERA ANGLE.
If not then maybe a ZSO is the answer. Sorry for my bad enlish it is not my first language.

Triaca told me zso gives minimal anterior projection, only lateral.

[Bleak]

Must see how long the girl is out of her surgery. ZSO gives long swelling. I had a ZSO asked for maximum projection, have almost no extra anterior projection and when someone says laterally it gives shadows, that is about it. Definitely not worth the surgery.

[Bleak]

I do not understand why some users on this Forum claim it gives only lateral projection.

LOL perhaps because they actually experienced it first hand. I saw another guy Bald88 that said here he had to have extra surgery to get anterior projection after ZSO. It is not different for me. Except that I do not know yet if I want to undergo surgery again. But I have the same thing: just hardly any forward projection, still flatness after ZSO. You can not force a procedure to do what it can not do.

[Lestat]

Must see how long the girl is out of her surgery. ZSO gives long swelling. I had a ZSO asked for maximum projection, have almost no extra anterior projection and when someone says laterally it gives shadows, that is about it. Definitely not worth the surgery.

The girl is 18 month out of her surgery. Which surgeon did your ZSO? I am sorry that you are not happy with your result, but what would you suggest then (if not a ZSO)?

[Lestat]

This paper describes 3 surgical tecniques for "malar augmentation."

According to this paper, a ZSO gives also anterior projection!

http://images.google.de/imgres?imgurl=http%3A%2F%2Fwww.intechopen.com%2Fsource%2Fhtml%2F48013%2Fmedia%2Fimage16.jpeg&imgrefurl=http%3A%2F%2Fwww.intechopen.com%2Fbooks%2Fa-textbook-of-advanced-oral-and-maxillofacial-surgery-volume-2%2Fadvanced-adjunct-orthosurgical-esthetic-procedures&h=468&w=473&tbnid=v0PCJ3fBbmRlwM%3A&docid=mut3qcrEzHLq9M&ei=Ka2wV63aFYfzUKOzm5AL&tbm=isch&iact=rc&uact=3&dur=474&page=1&start=0&ndsp=19&ved=0ahUKEwjtkvHxucHOAhWHORQKHaPZBrIQMwg8KBAwEA&bih=673&biw=1366

Surgical tecniques

Zygomatic  arch  osteotomy:
A  subperiosteal  flap  is  raised  to  expose  the  ascending  malar buttress and the zygomaticomaxillary suture. The position of an oblique sagittal cut is selected by deciding whether augmentation should include any of the anterior buttress or whether it
should be totally lateral to zygomaticomaxillary suture line. The cut is then made with a sagittal
reciprocating saw starting from the inferior portion of the zygomaticomaxilary suture to the
notch of both lateral orbital rim and malar zygomatic process. A previously selected graft may
now be placed between the two segments. The result is an increase in interarch width (zygionzygion).

Zygomatic sandwich osteotomy (ZSO):
To solve some problems, modifications of zygomatic
arch  osteotomy  technique  have  been  presented.  Mommaerts  et  al  [81]modified  Powell’s
technique by connecting a vertical with a semihorizontal osteotomy which both transect the
maxillary sinus, thereby maximizing anterior as well as lateral augmentation.

Zygomatic Sagittal Split Osteotomy (ZSSO):in this technique the zygomatic arch is isolated
from its temporal origin to its zygomatic insertion both on its lateral and medial surfaces Using
a waver sewer, a sagittal full thickness osteotomy of the zygomatic arch is performed (Fig.
26).Later, 2 separate partial thickness osteotomies: one on the arch’s osteotomies are connected
with  the  previously  released  sagittal  osteotomy.  After  correction  of  the  zygomatic  arch
according to presurgical programs. Stabilization is achieved using bicortical titanium screws.

[Schrödingers Jaw]

I heard the masseter muscle would interfere with Z-arch osteotomies, looking at the anatomy I don't quite see how but what do I know?



Anyway, I am getting work done to my eye area but how will a ZSO interfere, should I focus on one area before the other or is it no matter?

[JimmyTheGent]

Was combined with a canthoplasty.

what you guys think of the result? I'm trying the figure out if i should get this or just go suicidal mode and do a mod LF3.

Why dont I notice any difference except his eyes look a little more almond shaped afterwards?  IMO his eyes looked fine to begin with, he doesn't even have bags under his eyes (like I do    )

[Bobbit]

You do not notice any appreciable difference because whatever difference is there - - is so subtle - -  that it would almost be dishonest to say you do!!!

[Bobbit]

i mean this difference could almost be achieved through him squinting every so slightly. so yeah that looks better. if he's not squinting at all (which i doubt) then yeah good result.

Lazlo - -  good result for the canthoplasty ?      or  good result for the orbital rim implant ?

The rim implant "result" is almost non-detectable.     The change in the eyes is likely 100% due to the canthoplasty. 

[PloskoPlus]

He had horrendous scleral show befor.

[JimmyTheGent]

He had horrendous scleral show befor.

lol "horrendous" that's a little harsh wouldn't you say??  That's a term I would reserve for something so disfiguring that it is life altering.    It most certainly didnt hurt this guy, hes doing just fine, scleral show and all.

[David_D]

I think that, for this person, this is a very nice result.  I have some scleral show that I don't think works for me.  I don't want to eyes to get much smaller - there are tradeoffs with everything.  I think that on some people scleral show conveys a certain tiredness.

[Lestat]

Another question: an user told me that the under eye hollows become more prominent because of a zso. Is this usually the case when you do a zso? Anyone knows? Thanks.