Newbie: Should I get Fillers before Zygomatic sandwich Osteotomy?

[Kb55]

Fillers can provide augmentation in the right places i.e. Higher up which is what we want. I have dark circles and flat but prominent cheekbones.. Ideally I want the arch to be advanced more anterior than lateral. How come there are no before and afters of ZSO on the web? I hear all this talk but no pics or results..                                                                                                                                                I met with Dr Z and he showed me 1 result of a guy. (Not great) Im thinking hard about if getting a ZSO with Z is the right decision. Fillers can provide a better result with no down time and it's not only cheaper and easier but can provide a better result.

[Lazlo]

nah just go with the ZSO

fillers won't approximate the look of real bone and ZSO isn't a big deal operation.

[Kb55]

I'm Confused. I have quite wide cheekbones already which kinda defeats the purpose of a ZSO. I  don't want to add any width to my cheekbones at all it would make my face look too round. I only want lateral projection and to add some volume under the eye area.                                                                                                  Z said that he can get the high cheekbone look but from what others have said on this forum it does the opposite and makes the cheekbones low and feminine which unfortunately is not the look I want. Saying that, would you say I'd be better off with fillers or should I get the ZSO? I thought fillers could augment higher up and also help with the eye area. People here are obsessed with bone only and osteotomies only but surely Fillers are just as safe and effective arent they?

[CCW]

I don't think it works for that. You'll need a modified LeFort III.

[Kb55]

I don't think it works for that. You'll need a LFIII.

.    You mad? I have no functional problems only a minor cosmetic flaw. Fillers under the eyes do the same thing. You would rather pay to endure the pain and suffering of a lefort with its brutal complications? Ridiculous.

[johnnyg12]

Don't get ZSO if you have this issue. I am going to get fillers for this myself. Have the same issue, I have high and wide cheekbones but they don't protrude that much anteriorly. Fillers done by the right surgeon for this problem will make a difference. Stay away from fat. Zso adds no significant amount of anterior projection and will make your cheeks appear more low set.

Keep in mind that the position of your maxilla can also affect this. I'm pretty sure if your maxilla is advanced it will help with your cheekbones. So stay away from fat, fillers produce better results anyway. Eppley offers implants for this issue specifically, but I don't want to go the implant route myself since I'm already getting jaw implants.

Every result for ZSO I have seen is unimpressive. The surgeons might have better ones in their office. But the ones who have gotten it done complain about anterior projection. Eppley can preform ZSO and has done it before but has said it's not worth it if your cheekbones are laterally wide.

Lefort 3 has 4% blindness risk. That's too much of a high risk for me to take. No point going through all of that when fillers will add better results and is less invasive.

[tjarrr]

I agree with the above ^ I have trouble seeing what ZSO is even good for if you're not trying to add width, based on recent threads I've read through here.

Fillers give the illusion that your cheekbones are higher by adding more anterior projection below the eyes and on top of the malar eminence. I had them done and before I had sufficient width and my cheekbones were relatively high (not low anyway). Before and after are below. The only obvious downside is that fillers don't last and can pretty easily become an expensive habit.

I'm looking into my options but basically my cheekbones I'd say are high enough and ok laterally, I just have significant midfacial hypoplasia due to a maxilla that's recessed by about 2-3 degrees. So I'd be good with a total LeFort III (which brings the whole midface forward, including the nose and maxilla -- perfect in my case) or just infraorbital rim implants + paranasal implants.

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[tjarrr]

In general, there is also a limit to how much aesthetic gain you can expect to get from adding width - the top third of your face (your head) should be widest and any lower width that significantly exceeds head width will not look good. So I would not recommend ZSO in your case.

[Kb55]

Really good input guys. Solid advice. It seems like fillers is the right way to go. I just can't See any benefit to Getting a ZSO especially as a male it just won't look right.

[Kb55]

I agree with the above ^ I have trouble seeing what ZSO is even good for if you're not trying to add width, based on recent threads I've read through here.

Fillers give the illusion that your cheekbones are higher by adding more anterior projection below the eyes and on top of the malar eminence. I had them done and before I had sufficient width and my cheekbones were relatively high (not low anyway). Before and after are below. The only obvious downside is that fillers don't last and can pretty easily become an expensive habit.

I'm looking into my options but basically my cheekbones I'd say are high enough and ok laterally, I just have significant midfacial hypoplasia due to a maxilla that's recessed by about 2-3 degrees. So I'd be good with a total LeFort III (which brings the whole midface forward, including the nose and maxilla -- perfect in my case) or just infraorbital rim implants + paranasal implants.

That's a great change. A lot More volume under the eyes it looks like you've got a good developed midface. What type of fillers did you have? Can't you get longer lasting ones?

[Lazlo]

I agree with the above ^ I have trouble seeing what ZSO is even good for if you're not trying to add width, based on recent threads I've read through here.

Fillers give the illusion that your cheekbones are higher by adding more anterior projection below the eyes and on top of the malar eminence. I had them done and before I had sufficient width and my cheekbones were relatively high (not low anyway). Before and after are below. The only obvious downside is that fillers don't last and can pretty easily become an expensive habit.

I'm looking into my options but basically my cheekbones I'd say are high enough and ok laterally, I just have significant midfacial hypoplasia due to a maxilla that's recessed by about 2-3 degrees. So I'd be good with a total LeFort III (which brings the whole midface forward, including the nose and maxilla -- perfect in my case) or just infraorbital rim implants + paranasal implants.
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What filler and how much did you get? Also can you give us some details on how it was applied (to the bone? etc. etc. )

[The Quest for Aesthetics]

Custom made medpor midface implants. Problem solved.

[johnnyg12]

I agree with the above ^ I have trouble seeing what ZSO is even good for if you're not trying to add width, based on recent threads I've read through here.

Fillers give the illusion that your cheekbones are higher by adding more anterior projection below the eyes and on top of the malar eminence. I had them done and before I had sufficient width and my cheekbones were relatively high (not low anyway). Before and after are below. The only obvious downside is that fillers don't last and can pretty easily become an expensive habit.

I'm looking into my options but basically my cheekbones I'd say are high enough and ok laterally, I just have significant midfacial hypoplasia due to a maxilla that's recessed by about 2-3 degrees. So I'd be good with a total LeFort III (which brings the whole midface forward, including the nose and maxilla -- perfect in my case) or just infraorbital rim implants + paranasal implants.

Hey what do paranasal implants achieve exactly? To me it looks like it makes the maxilla look a little more advanced by a little bit. Also orbital rim implants don't seem to do that much, not even sure what they accomplish either.

[tjarrr]

You're right about the maxilla --  to some doctors, paranasal implants are the cosmetic equivalent of a LeFort I. It adds convexity to all the same areas and can lift the upper midface as well in the same way a LeFort I can by providing greater soft tissue support.

Infraorbital rim implants are for people who have a negative orbital vector -- their eyeballs protrude out more than the malar eminence which in more significant cases is unpleasant aesthetically. Skeletal deficiencies in this area also can cause a negative canthal tilt or downturned eyes and scleral show which are both due to insufficient skeletal/soft tissue support around the eye area.

As for me, I simply got a standard hyaluronic acid filler (juvederm voluma) that was injected into the soft tissue under my eyes and around my nose. Ideally I would've gotten HA paste or something.  The results won't last but like the original poster, I wanted to see how I would look with a fuller midface and see if that really was the key to my aesthetic issues as I thought it was. All of my cephalometric angles are normal except for the ones involving my maxilla -- I'm a skeletal Class III. It gave me a better midface, added dimension to my face in general, and made my cheekbones look sharper. My dysmorphia was very severe before I had the fillers and now I feel incredibly liberated and no longer obsess about being ugly 24/7 like I used to; for me there was a great psychological benefit and I do not regret it at all. My advice is to consider trying them even though they won't perfectly mimic having a LeFort III or I done, they give you some idea of the changes you can expect and can maybe help you breathe easier for a while.

PS- no filler was added under the nose. The fuller facial hair is masking how recessed the region under the nose is -- I think that's called the nasal spine? Anyway, you can literally mimic the effect of bringing the nasal spine forward by putting chewing gum in your upper lip. Makes a big difference for some people depending on their area of deficiency.

[Vic]

Tjarr have you got before and after pics straight on at all without the beard?