Consulting with Sinn - modified lefort 3

[micjawsurgery]

Hi guys. Going to be consulting with Sinn about the modified LF3 he offers soon. From what I understand about the procedure it is a zygoma osteotomy that includes the lower orbital bone. I also plan to ask if he can move the supraorbital, nasal bridge bridge, and lateral orbital rims during the surgery.

My cheeks are pretty flat especially at the lower orbital and upper cheek area, plus my maxilla looks to be relatively forward grown which makes the flat cheeks more apparent. Have a lot of soft tissue in the mid-lower cheeks that I lack in the lower eye area so after this I’ll probably get soft tissue augmentation for that.

From my ceph my SNB looks to be pretty normal but the ANB angle is very high. Don’t think a BSSO would help aesthetics at all since when I jaw jut it just makes my frontal view look more flat. Think moving my maxilla backwards and up would probably help but if someone more informed could analyze the ceph it would be appreciated.

From what I’ve seen Korean surgeons seem pretty used to moving the maxilla back since bimax protrusion is more common in Asians, so I’ll probably do some consultations in Korea eventually about that. But I’m pretty wary about removing bone. Most likely I’ll just get a genio since the aesthetic risk reward for jaw surgery doesn’t seem great in my case.

I’m relatively concerned that Dr Sinn is in his mid 70s, but there are very few other surgeons that would do this procedure for aesthetics that I know of

I’m happy to ask any questions you guys want to Sinn during my consult and I’ll report back next week. Found an old thread about this but no updates from the guy.

Ceph: https://m.imgur.com/a/Y48CfCr

[Lazlo]

I'd be very interested to know if he can move the supraorbital ridge and lateral ridge along with the lower orbital rim and the zygoma.

Try and get a precise picture of what part of the upper/midface he will move. Like a precise diagram and ask how many mm he can move the zygoma forward.

Ask him if there are any ways to get a more dramatic result through a bone graft.

[beyondconfusedtbh]

Hi guys. Going to be consulting with Sinn about the modified LF3 he offers soon. From what I understand about the procedure it is a zygoma osteotomy that includes the lower orbital bone. I also plan to ask if he can move the supraorbital, nasal bridge bridge, and lateral orbital rims during the surgery.

My cheeks are pretty flat especially at the lower orbital and upper cheek area, plus my maxilla looks to be relatively forward grown which makes the flat cheeks more apparent. Have a lot of soft tissue in the mid-lower cheeks that I lack in the lower eye area so after this I’ll probably get soft tissue augmentation for that.

From my ceph my SNB looks to be pretty normal but the ANB angle is very high. Don’t think a BSSO would help aesthetics at all since when I jaw jut it just makes my frontal view look more flat. Think moving my maxilla backwards and up would probably help but if someone more informed could analyze the ceph it would be appreciated.

From what I’ve seen Korean surgeons seem pretty used to moving the maxilla back since bimax protrusion is more common in Asians, so I’ll probably do some consultations in Korea eventually about that. But I’m pretty wary about removing bone. Most likely I’ll just get a genio since the aesthetic risk reward for jaw surgery doesn’t seem great in my case.

I’m relatively concerned that Dr Sinn is in his mid 70s, but there are very few other surgeons that would do this procedure for aesthetics that I know of

I’m happy to ask any questions you guys want to Sinn during my consult and I’ll report back next week. Found an old thread about this but no updates from the guy.

Ceph: https://m.imgur.com/a/Y48CfCr

The lateral orbital rim IS mobilised.

Theres NO way to mobilise the nasal bridge or supra orbital rim with the technique he uses, as far as I'm aware a coronal would be required. The osteotomy stops just short of the nasal bridge on either side and so as to prevent a step off, HA is used.

It isn't a linear anterior advancement by the way.

[Lazlo]

Can someone present a diagram of what parts of the face Sinn's op is moving forward. Like color code them or something. And okay if not just linear, how much lateral?

[kavan]

Can someone present a diagram of what parts of the face Sinn's op is moving forward. Like color code them or something. And okay if not just linear, how much lateral?

I thought you had that op with him. Yes. No. ?

[beyondconfusedtbh]

Can someone present a diagram of what parts of the face Sinn's op is moving forward. Like color code them or something. And okay if not just linear, how much lateral?

Blue area on the diagram: http://jawsurgeryforums.com/index.php?topic=7297.15

Hard to give an exact figure. The highlighted area is rotated outwards and therefore the orbitals come forwards.

[Lazlo]

I thought you had that op with him. Yes. No. ?

No I never had the mfl3 with him. I've asked him about it and seen a result or two. Honestly, the result I saw looked like there was an improvement to the orbital rim, but nothing that significantly changed the appearance of the patient.

I think it would require ANOTHER surgery to actually show significant improvement.

So that's another question to ask Sinn. After the first 7-8mm advancement, Can the operation be done again to give advancement again? So that you could get another 8mm of advancement? I that would be significant to show results.

I know some of you think 7-8 mm advancement is significant. But in this area the soft tissue is quite heavy and prevents the result from really showing.

I would also ask if you could just get a ZSO after the mfl3.

[ODog]

No I never had the mfl3 with him. I've asked him about it and seen a result or two. Honestly, the result I saw looked like there was an improvement to the orbital rim, but nothing that significantly changed the appearance of the patient.

I think it would require ANOTHER surgery to actually show significant improvement.

So that's another question to ask Sinn. After the first 7-8mm advancement, Can the operation be done again to give advancement again? So that you could get another 8mm of advancement? I that would be significant to show results.

I know some of you think 7-8 mm advancement is significant. But in this area the soft tissue is quite heavy and prevents the result from really showing.

I would also ask if you could just get a ZSO after the mfl3.

I find this hard to believe but you wouldn't say it if it isn't true. I've seen decent improvement with orbital rim implants alone so it's surprising the most invasive osteotomy of the face doesn't give a more desirable outcome. It's also possible Lazlo that you're striving for extreme perfection, but the difference in bone structure between a below-average person and a model is very, very substantial and can't be expected to be replicated with cosmetic surgery. I'd be happy with mild-moderate improvement of the orbital rim area because you then cross that threshold where it won't matter/ become noticeable to other people.

[kavan]

No I never had the mfl3 with him. I've asked him about it and seen a result or two. Honestly, the result I saw looked like there was an improvement to the orbital rim, but nothing that significantly changed the appearance of the patient.

I think it would require ANOTHER surgery to actually show significant improvement.

So that's another question to ask Sinn. After the first 7-8mm advancement, Can the operation be done again to give advancement again? So that you could get another 8mm of advancement? I that would be significant to show results.

I know some of you think 7-8 mm advancement is significant. But in this area the soft tissue is quite heavy and prevents the result from really showing.

I would also ask if you could just get a ZSO after the mfl3.

Oh, OK. Thought you went to Sinn after Earl reported he was happy with his results of mfl3. Had posts about the surgeries you were planning to have which included mfl3 and had some kind of accident (mugging) after your Sinn surgery where (i think) the cheekbone and orbital rim area was broken right after your Sinn surgery. Got the impression you too got what Earl got. Wow. New one on me you didn't have what Earl had and thanx for clarifying.

ETA: The norm for projection of the orbital rim is about 5mm ahead of a vertical drop down line from the eyeball. So if someone is -7 (minus 7) behind the line a 7mm advancement would bring them to the norm as to correct 'bug eyed' look. Unlikely a doc would give an extra 8mm in addition over that in another surgery. Whaddaya wanna do, use your lower orbital rim area as a spare book shelf?

[Lazlo]

Oh, OK. Thought you went to Sinn after Earl reported he was happy with his results of mfl3. Had posts about the surgeries you were planning to have which included mfl3 and had some kind of accident (mugging) after your Sinn surgery where (i think) the cheekbone and orbital rim area was broken right after your Sinn surgery. Got the impression you too got what Earl got. Wow. New one on me you didn't have what Earl had and thanx for clarifying.

ETA: The norm for projection of the orbital rim is about 5mm ahead of a vertical drop down line from the eyeball. So if someone is -7 (minus 7) behind the line a 7mm advancement would bring them to the norm as to correct 'bug eyed' look. Unlikely a doc would give an extra 8mm in addition over that in another surgery. Whaddaya wanna do, use your lower orbital rim area as a spare book shelf?

Yeah I would love to have it as far as spare booskshelf! And the whole malar complex would be moving out right? So it's the whole cheekbone. I mean this is what I want:

[Lazlo]

To report: Sinn responded to me that one time procedure is all he'd feel comfortable with.

He said he could add 3-4mm HA on top during the procedure. HA contracts quite a bit so it would only give about 2mm probably. And that's on top of the 7mm movement he could make for a net result of 9mm.

I wish there was a way of predicting soft-tissue movements. But I don't think that's enough to give you the Mads Mikkelsen or most model type cheekbones.

Seems like we're going to have to wait for bone-implants grown in a bioreactor. I say this as an alternative to implants. But I'm not sure implants even get you the results you want. For example, Yaremchuck is well known as the king of implant guys and none of his orbital rim implants or cheekbone work is very impressive at all. Sure some of his jaw stuff looks good, but midface is mostly crap.

Are there any computer programs that can predict before and after results of bone movements? Something you maybe get a CT scan or an MRI for and can move pieces around with some predictability? It seems in this day and age that stuff should be routine!!???

[Lazlo]

So....unfortunately we do not have our Mads Mikkelsen solution yet. To report, here are results of implants from Joe Niamtu a well known implant doc. They just make your face look puffy and stupid. Implants not only suck from an infection point of view, they also suck aesthetically. I mean yeah he looks "better". But no one would ascribe those to be "male model" cheekbones.

In fact the younger guy looks WORSE after the implants. He had good cheekbones and now he has a roundish face that looks like s**t.

https://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/cosmetic-surgery-for-men/facial-implants-for-men/

[Lazlo]

Like for real. We need a computer scientist and a surgeon on this board to work together to build a plastic surgery visualizing tool that could take into account your asymmetries and model your actual face.

Asymmetry by the way is a HUGE problem with both implants and any type of zygomatic movement. Like way over 50 percent. Why the hell can't doctors who have computer tools compensate for the asymmetries by moving one side say 7mm and the other 9mm if there is a discrepancy. Also just look at all the midface implants. They suck deep balls.

What are we missing here in understanding the anatomy of this area? Is it just that Henry Cavill and the male model look is actually caused by something other than strong malar/zygomatic bones? I'm beginning to think it might just be that plus larger forward face growth along all vectors. And I'm also thinking symmetry may be way more important and rare than we think. Henry Cavill has remarkable, indeed preternatural symmetry in his face.

[Lazlo]

Also, can we please just f**king fastforward to the future. The first  lab cell grown bone is already being used though it doesn't seem offered to the public yet. I wonder what's slowing them down. This seems to be based on the same principle as epibone and there must be many labs working on this.

I just don't understand why its going to take to 2030 to see clinical applications of this stuff. This would for legit solve 99 percent of people's problems on this board.

Right now it seems to just be a bone putty, but I'm not sure.

http://nocamels.com/2018/01/shin-bone-implant-procedure/

[Lazlo]

But realistically, f**k waiting for these innovations.

I'm sure a computer visualizing program exists today. So where do we find it?

Then, everyone who I know has downgraded ZSO's as s**t. I always wondered if TWO Zso's would produce a better result, but I've heard Dr. Z said he's never done two zso's on anyone.

So you do Sinn's op. Maybe you do another ZSO, have you gotten closer to the result or are you just spinning wheels? Filler to top it off. But what is the anatomy we're looking for. If your own bones are s**t then no matter how you move them around may not give you a better look.