High cheekbones

[Wheatsnax]

The diagrams and photos are an example of a person who legitimately needed the Lefort 3 with the modification of it shown in the diagram. That's demonstrated in the before/after photos and cephs.

The upper part is basically a 'classic' Lf3. The only modification of it is the separate cut used to perform the Lefort 1.

i might be mistakened then, thanks.

[PloskoPlus]

The diagrams and photos are an example of a person who legitimately needed the Lefort 3 with the modification of it shown in the diagram. That's demonstrated in the before/after photos and cephs.

The upper part is basically a 'classic' Lf3. The only modification of it is the separate cut used to perform the Lefort 1.

If the LF3 is a block movement including the nose, it may make any asymmetry at the eye level worse.

[PloskoPlus]

True, and also pre-existing asymmetry of the cheeks that may not be all that noticeable now, but may be when they are brought forward with the LFIII.

These things can be better anticipated with customized implants.

IMO, that's one of the reasons why LFIII (even the modified bilateral kind, where the two sides are moved independently) is not very popular.  It's a general problem with osteotomies - witness how many people complain about asymmetry after jaw surgery.  At least jaw surgery has the side benefit of providing a functional benefit (it's actually the main benefit, but people here tend to forget this).  Also the soft tissue around the jaws is significantly thicker than around the eyes, so any asymmetry, step-offs are less noticeable (unless it's something like a severe cant).  Asymmetry at the eye level is more obvious, because people look into each other's eyes in general.

[kavan]

If the LF3 is a block movement including the nose, it may make any asymmetry at the eye level worse.

Doesn't preclude the person in the photo as being a legitimate candidate for what he got. 

[kavan]

IMO, that's one of the reasons why LFIII (even the modified bilateral kind, where the two sides are moved independently) is not very popular.  It's a general problem with osteotomies - witness how many people complain about asymmetry after jaw surgery.  At least jaw surgery has the side benefit of providing a functional benefit (it's actually the main benefit, but people here tend to forget this).  Also the soft tissue around the jaws is significantly thicker than around the eyes, so any asymmetry, step-offs are less noticeable (unless it's something like a severe cant).  Asymmetry at the eye level is more obvious, because people look into each other's eyes in general.

Nor should it be popular among the 'I want one to look more like a model' crowd. But for someone like the patient in that photo, who might not even have asymmetry, that type of person would be very happy with it. Even if they had some, they'd probably accept the trade-off if they had the start point of the patient in the photo.

[PloskoPlus]

Nor should it be popular among the 'I want one to look more like a model' crowd. But for someone like the patient in that photo, who might not even have asymmetry, that type of person would be very happy with it. Even if they had some, they'd probably accept the trade-off if they had the start point of the patient in the photo.

With any surgery - the worse the starting point, the happier the patient is likely to be. 

[kavan]

With any surgery - the worse the starting point, the happier the patient is likely to be.

So, why were you going on about possible asymmetry re the patient with a really bad starting point. As I said, asymmetry with a L3 would be more of a concern with the 'I'm getting one to look like a model crowd' than people with a legitimate deformity.

[PloskoPlus]

So, why were you going on about possible asymmetry re the patient with a really bad starting point. As I said, asymmetry with a L3 would be more of a concern with the 'I'm getting one to look like a model crowd' than people with a legitimate deformity.

I was actually addressing the "I wanna look like a model" crowd.  But they need psychiatry, not surgery.  IMO (and only IMO, since IANAD), you basically have to have buggy eyes to justify this surgery.

[kavan]

I was actually addressing the "I wanna look like a model" crowd.  But they need psychiatry, not surgery.  IMO (and only IMO, since IANAD), you basically have to have buggy eyes to justify this surgery.

Well, some modifications of the L3 can be for buggy eyes. But that L3 modification was for the dished in upper midface including the nose area. But yes, it's not a surgery for the wanna be model crowd.

[kavan]

I had a 3d x ray thing some time last year, not much had ossified, I will try to find it if you want.

http://jawsurgeryforums.com/index.php?topic=6873.msg60063#msg60063
post #97   is where his 3d x ray thing can be found.

[Adonia]

cheekbones are an overrated feature for males. Even having a visible jawline will make you stand out and results of jaw surgery are somewhat consistent, but I've seen so many bad zso and cheek implant results

[lamb]

bad zso by who?  i've seen a few and they always looked good.

[Adonia]

bad zso by who?  i've seen a few and they always looked good.

can find the ones I was thinking of. Here one just from this forum



can you post the good results you have seen

[ditterbo]

can find the ones I was thinking of. Here one just from this forum



can you post the good results you have seen

If I had to guess I would've assumed he got submalar implants.  IIRC, the zso cut isn't at that apex junction area (not using medical terms) between the orbits and zygoma but somewhat below that. Hell it looks like his malar/zygo apex spot that used to be strongest in his pre-op 3/4 profile shot is now too recessed compared to his submalar region. Now he just needs to do something with the periorbital region I guess. His submalars looked quite deficient in the befores.

[Framboise]

Now he just needs to do something with the periorbital region

When a Lefort 3 impaction/ advancement will be possible and safe as a routine (maybe never), it will be the end of all our problems