What is wrong with my midface?

[dusselgurr]

I got a very flat midface, are my Zygos the problem?
Would a zygomatic osteotomy help?

I am 100% getting a Chin Wing done, already had a consultion and got advised to do both,

but I am not sure if my Maxilla or the Zygos are the problem of the flat face.

Thoughts?

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[diculo]

You probably need bimax (lefort I) if your midface is flat. Do you have a small chin or jaw? If you have no cheekbones projecting, then yes you could benefit from a zygomatic osteotomy.

[CCW]

It'd help if we could see the full ceph and airway, but this looks pretty good. Both upper and lower incisors look proclined and your chin is a little short and maybe vertically long. A genio would help a lot, and if bimax is needed, it'd be a straight advancement. It's hard to say anything about your midface without seeing a picture, but bimax would probably improve it as well.

[dusselgurr]

It'd help if we could see the full ceph and airway, but this looks pretty good. Both upper and lower incisors look proclined and your chin is a little short and maybe vertically long. A genio would help a lot, and if bimax is needed, it'd be a straight advancement. It's hard to say anything about your midface without seeing a picture, but bimax would probably improve it as well.

The surgeon doesn't want to do a bimax on me because my bite is good... do you think a ZSO could help in the upper midface?

[CCW]

The surgeon doesn't want to do a bimax on me because my bite is good... do you think a ZSO could help in the upper midface?

My understanding is ZSO only or mostly increases lateral projection, not anterior. Many people seem to be disappointed after having it done and find it almost pointless. I can't say what you need since I don't know what you look like, but you can do bimax even if the bite is good. A normal Lefort advancement can help with anterior projection since it pulls the tissue forward and gives more bony support. I have even seen an isolated genio do this.

[dusselgurr]

My understanding is ZSO only or mostly increases lateral projection, not anterior. Many people seem to be disappointed after having it done and find it almost pointless. I can't say what you need since I don't know what you look like, but you can do bimax even if the bite is good. A normal Lefort advancement can help with anterior projection since it pulls the tissue forward and gives more bony support. I have even seen an isolated genio do this.

What do you think of chin wing + zso with some grafts around the eyes?

If I want the lefort for midface projection, it needs to be high cut, doesn't it?

[CCW]

What do you think of chin wing + zso with some grafts around the eyes?

If I want the lefort for midface projection, it needs to be high cut, doesn't it?

I think it's always better to correct the jaw relationship rather than have a ton of expensive and maybe pointless camouflage surgery. Then evaluate again if you still think you need something done, but you usually a properly done bimax is enough to balance the features. See another surgeon if possible.

I'd say midface flatness usually tends to be around the base of the nose, and a normal LeFort I is usually enough to correct it even in the worst Class III non-syndrome cases. I don't think many surgeons want to do high a LeFort in non-syndrome cases.

[dusselgurr]

Update: ceph with airways http://i.imgur.com/0oyvQOp.jpg


The surgeon doesn't want to do a bimax because I almost have no functional issues...

Anybody good an idea how to mimic the result of a bimax with other osteotomies?