What went wrong with this result? (Defrancq HA on cheekbones and paranasal area)

[dervyx]

This is the most recent result of Dr Defrancq's. What went wrong? Why did he ended up all chubby?

He had:

Lefort 1 Advancement
Genio
HA on cheekbones
HA on paranasal area

Dick is a young man. Since his childhood dick was suffering from an open bite, and a week chin.The orthodontist proposed to see me as a Maxillofacial surgeon, and so he was prepared with pre surgical orthodontics to the orthognatic surgery. The result shown here is 9 months after the surgery: Le FortI advancement and and genioplasty with vertical reduction advancement. High cheekbone augmentation was proposed with Hydroxyapatite and Tisseel, a human glue (see in the surgery section: cheekbone augmentation).Beautiful result and an extremely happy patient.

Seems interesting to me since I had exact the same surgery proposal with him (+BSSO) and when I see results like this I'm thankful I decided against it.

[The Quest for Aesthetics]

The guy looks way better, what do you mean?

[Bowie]

As the chin was shortened and reshaped it lost the original angular shape which changes the overall look of his face to be rounder and softer. If you block out the chin on the before photo and then compare it with the after, you will see the parts that were augmented just look conservatively more forward, not really fatter or rounder in my opinion.

[boyo]

Looks like the HA got placed too low on the cheekbones.

[GJ]

The guy looks way better, what do you mean?

Exactly.

[boyo]

It's the Lefort I with the filling of the paranasal area that gives that bloated look and fullness in the midface.

And that's exactly why it was important to place the HA high on the cheeks with enough anterior and lateral projection to counter the increased convexity created around the paranasal area with the lf1. You want your zygos to work as the "tent poles" of the face, not the central part around the mouth which will give the face the appearance of being bloated which is unfortune on males.

[GJ]

What are you guys seeing? Before his mouth area is puffy with what looks like highly overworked muscles. After he has a nice, relaxed face without any issues. No clue what you're seeing...are you talking about under his eyes? That's the lighting. On the right the photo is clearly underexposed compared with the left.

[PloskoPlus]

What are you guys seeing? Before his mouth area is puffy with what looks like highly overworked muscles. After he has a nice, relaxed face without any issues. No clue what you're seeing...are you talking about under his eyes? That's the lighting. On the right the photo is clearly underexposed compared with the left.

I remember seeing a before and after where the under eye area looked quite different. I thought the guy had filler.  When I  questioned, the surgeon answered "Nothing was done to his eyes. We changed our photo system from single flash to double flash between his before and after photo." 

IMO his upper lip now looks marginally too long.  And before and after should always come with a photo of the bite, the patient smiling (over impaction looks bad).

[GJ]

Haha, and here I was wondering what you  guys that thought he looked better were seeing, although of course I do agree the position of his lower lip looks more relaxed and much better, and the position of his upper lip looks more relaxed. However the area next to his nose looks more bloated and fuller now, as does the area above the nasolabial folds. It takes emphasis and projection away from the lateral portion of the face shifting it more towards the medial portion of the face. I like it better when the projection is more laterally versus more medially as I feel that way the face has more definition and angles. Just my personal preference.
You see this at moments after a Lefort I. In this situation it seems to be highlighted more by the filling of the paranasal area.

I sort of see what you're saying now, but the muscles around his mouth are so overly developed from straining in the before. They simply relax in the after, and that allows them to settle. Looks way better. Do you guys see how the exposure is so different? It makes a huge difference in the shadows, and shadows are what tend to make faces look harsh (or in this case bloated). The lighting isn't the same in each (under exposure, improper white balance -- i.e. notice the pink in the second photo's upper right), so it's actually impossible to compare accurately. Photos are notoriously inaccurate and one of the worst demonstration of outcomes -- surgeons have told me this.

[GJ]

I wish surgeons would publish more consistent before/after pics in general.

I doubt most understand photography, shadows, and lighting. That is an art unto itself.

You really can't trust photos. I look pretty good in photos, but I'm still recessed after surgery. Head position, lighting, facial hear, and all kinds of other things affect a photo.

The guy in the OP had a great result as far as I can tell, but like I said, I'd have to see him in person, or at least see a ceph along with these photos. What is very positive and obvious is that all the muscular strain around his mouth is now gone. If his bite is good, he should (and probably does) consider himself lucky.

[GJ]

Looks like he's using a camera from the 1970s.

Seriously.

[PloskoPlus]

Seriously.

Defrancq is not a young guy.  So this result may have been done many years ago.  It looks like a typical 90s photo to me.

[Milli_Meters]

Seems like an Ok result. While he looks better in the after , his under eyes seem hollow in the after. Could that be due to HA application raising the lower cheek anteriorly?
Also only maxilla was moved+ paranasal HA ...maybe a tad too much? The lower jaw seems less prominent due to that perhaps.

Defrancq is not a young guy.  So this result may have been done many years ago.  It looks like a typical 90s photo to me.

This. Guy looks like a prototype from late 90s. The before version listens to Eminem and Nofx the after has taken to Backstreetboys. Maybe there are agreements with patients "like blah many years pass by and you can make my b n as public". Idk. If that is the case hope his HA game has stepped UP (no pun intended).

Also just noted this guy's name is DICK. I think people even in non anglophone world stopped naming their kids that in 1970s so yeah probably not contemporary.

[UKMaxfac]

Before his mouth area looked horrendous, now it's normalised and harmonious. I'd say a good result.

And yes that looks like an old result. I went to defrancq and had pics taken - he's got a multitude of high res quality DSLR cameras and the proper lighting in the room etc, its like a studio - so no hes not using old cameras

[Bobbit]

It appears to me that he has also put on significant body fat in the 2nd photo compared to the first photo.