How many millimeters can a ZSO widen the cheekbones?

[disabledmaxilla]

Is there a limitation of lateral projection that the particular osteotomy can give?

[Lestat]

7 mm max.

[disabledmaxilla]

I'm getting it done and i've been told we will be aiming around 8mm

7 mm max.

Is this total width from both sides you're talking about or just from each cheekbone?

[Lestat]

7 mm for each cheekbone. If it is not enough for you you could also do a 2nd or 3rd or ten zso. It gives you more lateral but also anterior projection. The cheekbone is getting moved diagonally.

[ascolta]

14 mm of added lateral projection is huge. A narrow face goes along with a narrow forehead and a narrow skull and since there's no way to widen those I'd be really careful to see if the new features will contribute to the gestalt of the face or just look grotesque

[ExtractionsRuinFaces]

14 mm of added lateral projection is huge. A narrow face goes along with a narrow forehead and a narrow skull and since there's no way to widen those I'd be really careful to see if the new features will contribute to the gestalt of the face or just look grotesque

The forehead, jaw and cranium can all be augmented with implants (jaw can also be widened with CW). The issue with having a narrow face is usually the most lateral part of your zygomatic arch is narrow and as far as I know that cannot be augmented.

The ZSO changes this part of the zygomatic complex



Blue here



You'd need tto augment the most lateral part as well for it to remain proportionate.



This is all I could find for augmentation of the entire arch http://pdronline.co.uk/Portfolio/digital-zygomatic-osteotomy

[Lestat]

Listen. This is a ZSO (see my attachment):

Dr. T and Dr. Z. cut very similar to Mommaerts.

The ZSO changes this part of the zygomatic complex

That is a modified lefort 3 / true zygomatic osteotomy not a ZSO!!
With a zso you cannot advance the part under your eyes. The cut is made under the orbital rim nerve.
It is a completely different thing. Take a look at my attachment.

14 mm of added lateral projection is huge. A narrow face goes along with a narrow forehead and a narrow skull and since there's no way to widen those I'd be really careful to see if the new features will contribute to the gestalt of the face or just look grotesque

14 mm is not that huge. Soft tissue distribution is very important. If you have a lot of soft tissue than you will notice only a small difference to before. As less soft tissue as you have as more spectacular is the result.
You will not look grotesque. The result of a zso looks very natural. 100% more natural than f.e. medpor implants. It is your own bone.



[attachment deleted by admin]

[Rico]

Listen. This is a ZSO (see my attachment):

Dr. T and Dr. Z. cut very similar to Mommaerts.


That is a modified lefort 3 / true zygomatic osteotomy not a ZSO!!
With a zso you cannot advance the part under your eyes. The cut is made under the orbital rim nerve.
It is a completely different thing. Take a look at my attachment.


14 mm is not that huge. Soft tissue distribution is very important. If you have a lot of soft tissue than you will notice only a small difference to before. As less soft tissue as you have as more spectacular is the result.
You will not look grotesque. The result of a zso looks very natural. 100% more natural than f.e. medpor implants. It is your own bone.

ALL OF YOU ARE NOT RIGHT
THIS IS ZMC REPOSITION. THE SURGERY I HAD
ONLY I HAD THIS SURGERY ON THE FORUM AFTER OVERLOOKED FRACTURE -  REPOSITIONING WITH OSTEOTOMY TO RESTORE ORIGINAL CHEEK PROMINENCIE, HOWEVER SURGERY FAILED DUE TO ERROR IN PLANNING.The surgeon overlooked specific type of asymmetry

THIS IS NOT ZSO OR MODIFIED LF3

ZMC - ZYGOMATICO MAXILLARY COMPLEX - this is the complex which is often fractured. The fracture line cross the infraorbital canal - the hole near the nose


I answered in different thread about lateral movement. 3mm leterally is safe max when it comes to ZMC repositions.  and probably no more than 7mm forward
You can combine LF3 with ZMC reposition. Some common parts. Therefore you can get kinda modified LF3.

If you want I can show you my scans (3D) PREOP POSTOP

[ExtractionsRuinFaces]

Listen. This is a ZSO (see my attachment):

Dr. T and Dr. Z. cut very similar to Mommaerts.


That is a modified lefort 3 / true zygomatic osteotomy not a ZSO!!
With a zso you cannot advance the part under your eyes. The cut is made under the orbital rim nerve.
It is a completely different thing. Take a look at my attachment.


14 mm is not that huge. Soft tissue distribution is very important. If you have a lot of soft tissue than you will notice only a small difference to before. As less soft tissue as you have as more spectacular is the result.
You will not look grotesque. The result of a zso looks very natural. 100% more natural than f.e. medpor implants. It is your own bone.

Ah yes my mistake sorry, I was just taking pictures from google "zygomatic sandwich osteotomy" assuming the images were correct, it has been a while since I've looked into this kind of stuff. Still, it shows how limited we are in regards to widening the face. ZSO looks quite promising for at least slightly widening the frontal part of the face and improving angularity. Doesnt seem like theres a fix for narrow zygomatic arches though.

[Lestat]

ALL OF YOU ARE NOT RIGHT
THIS IS ZMC REPOSITION. THE SURGERY I HAD


If you want I can show you my scans (3D) PREOP POSTOP

Rico. I have seen Earls X-Rays. It is exactly where Sinn makes the cuts. It is a movement of the zygoma+orbits without moving the upper jaw and nasal bone. So dont tell me this is not a mod. Lefort 3. Or what is the difference between a zmc and a mod. Lefort 3?

The masseter muscle is not a problem. If you advance your midface the masseter gets adapted to the bone and soft tissue. That is why you can also do 10 zso if you want. You would look like a freak afterwards but it is possible without any tmj issue.

Yes Rico please show us your 3d Scans.

[Lestat]

Doesnt seem like theres a fix for narrow zygomatic arches though.

Maybe a lamellar split osteotomy could help in this case:
https://www.ncbi.nlm.nih.gov/pubmed/7918854

Or b. eppleys zygomatic arch implants:
http://exploreplasticsurgery.com/extended-cheek-implants-high-cheekbone-look/

Or a zygomatic arch osteotomy:
http://images.google.de/imgres?imgurl=http%3A%2F%2Fwww.intechopen.com%2Fsource%2Fhtml%2F48013%2Fmedia%2Fimage7.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=422&w=660&tbnid=Hr6K-xUU6CVodM%3A&docid=mut3qcrEzHLq9M&ei=hnoBWNRUx5yABr6Yt5gH&tbm=isch&iact=rc&uact=3&dur=1028&page=0&start=0&ndsp=19&ved=0ahUKEwjUr73-yNvPAhVHDsAKHT7MDXMQMwgtKA8wDw&bih=685&biw=1438

Or a ZSSO:
http://images.google.de/imgres?imgurl=http%3A%2F%2Fwww.intechopen.com%2Fsource%2Fhtml%2F48013%2Fmedia%2Fimage7.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=422&w=660&tbnid=Hr6K-xUU6CVodM%3A&docid=mut3qcrEzHLq9M&ei=hnoBWNRUx5yABr6Yt5gH&tbm=isch&iact=rc&uact=3&dur=1028&page=0&start=0&ndsp=19&ved=0ahUKEwjUr73-yNvPAhVHDsAKHT7MDXMQMwgtKA8wDw&bih=685&biw=1438

[Rico]

Rico. I have seen Earls X-Rays. It is exactly where Sinn makes the cuts. It is a movement of the zygoma+orbits without moving the upper jaw and nasal bone. So dont tell me this is not a mod. Lefort 3. Or what is the difference between a zmc and a mod. Lefort 3?

The masseter muscle is not a problem. If you advance your midface the masseter gets adapted to the bone and soft tissue. That is why you can also do 10 zso if you want. You would look like a freak afterwards but it is possible without any tmj issue.

Yes Rico please show us your 3d Scans.

Earl had mod LF3,  but I had ZMC reposit.  different things in summary- my nose was not touch, just zygoma + a bit of maxilla, zyg. arch and laterall part of the orbit

the masseter is not a problem when you move both masseters not one

I had surgeey only on one side..completely different thing

when you move 5mm the right one and the left one  5mm no problem for sure
when you do not move right, but left 5mm  problem

Yes my muscles have already adjusted and they want to put my jaw a bit to the right, but the jaw is fixed at joints level, hence they are overloaded
causing a lot of problems there.

When you move the muscles in the same way on both sides there is compensation

the issues needs a bit imagnation

the surgeon has the same opinion..but we need to proove it before I undergo next surgery
The problem is no doctor wants to help me with prooving

I need botox injection (very unpredictible in my case) in the right muscle but noone wants to do it in my case.. because of unique case
the surgeon does not do it. he just gave me the idea

[triot]

The forehead, jaw and cranium can all be augmented with implants (jaw can also be widened with CW). The issue with having a narrow face is usually the most lateral part of your zygomatic arch is narrow and as far as I know that cannot be augmented.

The ZSO changes this part of the zygomatic complex



Blue here



You'd need tto augment the most lateral part as well for it to remain proportionate.



This is all I could find for augmentation of the entire arch http://pdronline.co.uk/Portfolio/digital-zygomatic-osteotomy

I asked Zarrinbal exactly this last year, he told me that the zygomatic process of the temporal bone is flexible and bends when you move the zygomatic bone so that that part is augmented automatically. He said that he doesn't break the bone there because of that, only when patients seek zygomatic reduction is the bone there cut. But he said that he could break that part and move it out too.