Lets talk about cheekbones

[Schrödingers Jaw]

update: i had been basing my misgivings about the ZSO on what seems to be a case of forum chinese whispers

there is B/A that was circulated here that was claimed to have been the result of a ZSO, it wasnt very good. However, apparently it was NOT a ZSO and the b/a was a man who had malar implants and a rhinoplasty.

here are what actual ZSO results can look like: http://www.academia.edu/6713021/1995_The_sandwich_zygomatic_osteotomy_-_technique_indications_and_clinical_results._JCMFS

pay close attention to figure 7. IMO that is a fantastic result.



It has widened his cheekbone to the extent that he now has slight cheek hollows (which would probably be further defined by anything that widens the mandible) but he also seems to have more support under the eye, creating the cushioning effect!

No orthognathic surgery was performed in this case. The patient desired refinement of the nasal tip, definition of the cheekbones and mandibular angle, and volume reduction of the lower lip. (A) preoperative lateral view; (B) preoperative 3/4 profile view; (C) 18 month postoperative lateral view; (D) 18 month postoperative 3/4 profile view

Mommaerts old paper. I can't be bothered to find it but there is an older thread on here which details why he is a questionable choice at best. With that said the ZSO has value -if you lack forward and lateral projection. I've seen the user Stupidjaws results and they were exellent, just as good as the pictures from your link.

If you do not lack forward or lateral projection however you will be underhelmed or even displeased with the results. It is not much bone that is mobilized and the cheekbone will not be "raised". The improvement in the under-eye area is due to soft tissue being supported from below, if you already have support in this area it will not do much at all. Also beware of nasolabials which might appear if you advance your cheeks further than the rest of your midface.

For higher cheekbones, which is a masculine trait, as well as a more prominent ridge I am interested in deep long-term fillers. Implants in this area I object to empirically as I've yet to see even one good result for men.

[ppsk]

Mommaerts old paper. I can't be bothered to find it but there is an older thread on here which details why he is a questionable choice at best. With that said the ZSO has value -if you lack forward and lateral projection. I've seen the user Stupidjaws results and they were exellent, just as good as the pictures from your link.

If you do not lack forward or lateral projection however you will be underhelmed or even displeased with the results. It is not much bone that is mobilized and the cheekbone will not be "raised". The improvement in the under-eye area is due to soft tissue being supported from below, if you already have support in this area it will not do much at all. Also beware of nasolabials which might appear if you advance your cheeks further than the rest of your midface.

For higher cheekbones, which is a masculine trait, as well as a more prominent ridge I am interested in deep long-term fillers. Implants in this area I object to empirically as I've yet to see even one good result for men.

I am pretty confident i could get the exact same results as the guy in that paper.

The only thing i could find about mommaerts on here that is worrisome is a surgical horror story. Well, i hate to break it to people, but this is a risk with every single surgeon in the world. They all have horror story patients, probably a mix of poor bastards who genuinely got f**ked over by statistical anomaly, BDD nutjobs and malicious shills (anyone who has investigated eppley and yaremchuk for example, knows of the huge amount of shills both have attacking eachother)

that said, Zarrinbal is very well spoken of here, so if i were to get it i would probably get it with him since i want a chin wing anyway. Does anyone know if a ZSO and chin wing can be performed in the same operation? I can't see why not.

[PloskoPlus]

I am pretty confident i could get the exact same results as the guy in that paper.

The only thing i could find about mommaerts on here that is worrisome is a surgical horror story. Well, i hate to break it to people, but this is a risk with every single surgeon in the world. They all have horror story patients, probably a mix of poor bastards who genuinely got f**ked over by statistical anomaly, BDD nutjobs and malicious shills (anyone who has investigated eppley and yaremchuk for example, knows of the huge amount of shills both have attacking eachother)

that said, Zarrinbal is very well spoken of here, so if i were to get it i would probably get it with him since i want a chin wing anyway. Does anyone know if a ZSO and chin wing can be performed in the same operation? I can't see why not.

You didn't search hard enough. MM is a butcher.

[The Quest for Aesthetics]

Implants in this area I object to empirically as I've yet to see even one good result for men.

How many custom implant results have you seen exactly? Without that information, and information regarding their placement and the patients' bodyfat levels if you have seen any, you are not qualified to come to that conclusion. If you have seen results of high placed custom zygomatic implants in men with low bodyfat levels, I take that all back and I'm interested to hear more.

[The Quest for Aesthetics]

I am pretty confident i could get the exact same results as the guy in that paper.

The only thing i could find about mommaerts on here that is worrisome is a surgical horror story. Well, i hate to break it to people, but this is a risk with every single surgeon in the world. They all have horror story patients, probably a mix of poor bastards who genuinely got f**ked over by statistical anomaly, BDD nutjobs and malicious shills (anyone who has investigated eppley and yaremchuk for example, knows of the huge amount of shills both have attacking eachother)

that said, Zarrinbal is very well spoken of here, so if i were to get it i would probably get it with him since i want a chin wing anyway. Does anyone know if a ZSO and chin wing can be performed in the same operation? I can't see why not.

Vertical placement is very very important. That particular patient's cheekbones were decently set. But even he would have benefited from higher cheekbones, just in visualising it. I guess if you are opposed to implants and you have high set zygos as is - a ZSO might be the answer. But in my opinion, if you're going to spend money and time on this, I wouldn't settle for a sub-optimal result when there are other alternatives that can raise the position of the cheekbone and augment the (important btw) zygomatic arches.

And yes a chin wing and a ZSO can be done at the same time - I know somebody (virtually) who had both done simultaneously with Zarrinbal. Make sure that you maxillo-mandibular projection and set is optimised as far as is practical first though (i.e. get bimax if you could benefit from it).

[ppsk]

Vertical placement is very very important. That particular patient's cheekbones were decently set. But even he would have benefited from higher cheekbones, just in visualising it. I guess if you are opposed to implants and you have high set zygos as is - a ZSO might be the answer. But in my opinion, if you're going to spend money and time on this, I wouldn't settle for a sub-optimal result when there are other alternatives that can raise the position of the cheekbone and augment the (important btw) zygomatic arches.

And yes a chin wing and a ZSO can be done at the same time - I know somebody (virtually) who had both done simultaneously with Zarrinbal. Make sure that you maxillo-mandibular projection and set is optimised as far as is practical first though (i.e. get bimax if you could benefit from it).

well thats what this thread is for buddy! What are those other options?

ZSO is the only one i know of. I saw ZSSO spoken of here once, but very little details.

[Lazlo]

Could the vertical placement issue be addressed through some sort of HA augmentation when then bone is mobilized?

I've heard lots of docs talk about augmenting orbital rims and malar prominence with HA. Gunson and Arnett slather that s**t on like its nobodies business.

[The Quest for Aesthetics]

well thats what this thread is for buddy! What are those other options?

ZSO is the only one i know of. I saw ZSSO spoken of here once, but very little details.

I don't think that there are any aside from implants. I'm skeptical of implants in this area only because I haven't seen any results but in theory I don't see why they wouldn't work well.

[Schrödingers Jaw]

How many custom implant results have you seen exactly? Without that information, and information regarding their placement and the patients' bodyfat levels if you have seen any, you are not qualified to come to that conclusion. If you have seen results of high placed custom zygomatic implants in men with low bodyfat levels, I take that all back and I'm interested to hear more.

No that's true, I've only seen what is available online. I'm sure there are good implant results that I haven't seen but until I do lay my eyes on them I am cautiously pessimistic.

[The Quest for Aesthetics]

No that's true, I've only seen what is available online. I'm sure there are good implant results that I haven't seen but until I do lay my eyes on them I am cautiously pessimistic.

I share the same general viewpoint except that I'm cautiously optimistic - there aren't results online at all as far as I'm aware. I don't see why they wouldn't work - I've seen excellent and natural looking results in low body fat males for custom brow, forehead and  jaw augmebtation so I don't see why proper zygomatic implant design wouldn't work aesthetically.

[Lefortitude]

Ive been deeply researching implants for the midface because ive seen lots of mediocre results on men.  Malar implants seem to give a strange effect on men with moderate sub cutanous fat, pushing it all forward (an example can be seen on yaremchuks website)
Ive decided that infra obital rim implants will be the most natural looking and give the best results, increasing projection of the infraorbital rim all the way out towards the zygomatic arch or even the lateral orbital rim.   

http://www.stryker.com/en-us/gsdamretirement/index.htmstellent/groups/public/documents/web_prod/141937.pdf

The catalogue includes infra orbital rim implants, extended orbital rim implants, midface contour and midface rim implants.  My surgeon recommended the midface rim, but it only gives 3mm of forward projection. not sure if that will be enough, but i suppose with implants, less is more.

[The Quest for Aesthetics]

Ive been deeply researching implants for the midface because ive seen lots of mediocre results on men.  Malar implants seem to give a strange effect on men with moderate sub cutanous fat, pushing it all forward (an example can be seen on yaremchuks website)
Ive decided that infra obital rim implants will be the most natural looking and give the best results, increasing projection of the infraorbital rim all the way out towards the zygomatic arch or even the lateral orbital rim.   

http://www.stryker.com/en-us/gsdamretirement/index.htmstellent/groups/public/documents/web_prod/141937.pdf

The catalogue includes infra orbital rim implants, extended orbital rim implants, midface contour and midface rim implants.  My surgeon recommended the midface rim, but it only gives 3mm of forward projection. not sure if that will be enough, but i suppose with implants, less is more.

It's strange that you don't mention custom implants.

The reason why most malar implants have that effect is because the implants are placed too low down on the (often times already low set) zygos. The only way to achieve a good result with these implants is to have them custom made, and for the implant prominence to be placed as far up the zygomatic body as possible so that it is basically touching the lower half of the lateral orbital rim. This may require actually raising the orbital rim itself to bring it closer to the lower eyelid margin. And then have it stretching out along the zygomatic arches. This is all speculation however as I've never ever seen this done. Also if the natural zygomatic prominence is low set, bone burring of that prominence in favour of the new one created by the implant may be necessary otherwise it may end up looking odd? I'm not too sure but in theory it makes sense.