Female malar osteotomy result - Brusco

[ODog]

https://imgur.com/a/YXefqBf

What’s interesting is the cut seems to be a lot higher than what people here normally say. The cut is just below the orbital rim almost; definitely not on the lower part of the malar.

However even with what seems like a pretty high cut, this still seems like an ideal surgery for females and not males. The oblique view is very improved but the bump out is probably too rounded for males.

Hard to tell how much of those “rounded” central cheeks are due to swelling, though. I’m sure the swelling is massive for like half a year and makes the cheeks look more rounded than they will ultimately be.

That guy StupidJaws certainly did NOT get rounded cheeks...

[Lazlo]

https://imgur.com/a/YXefqBf

What’s interesting is the cut seems to be a lot higher than what people here normally say. The cut is just below the orbital rim almost; definitely not on the lower part of the malar.

However even with what seems like a pretty high cut, this still seems like an ideal surgery for females and not males. The oblique view is very improved but the bump out is probably too rounded for males.

Hard to tell how much of those “rounded” central cheeks are due to swelling, though. I’m sure the swelling is massive for like half a year and makes the cheeks look more rounded than they will ultimately be.

That guy StupidJaws certainly did NOT get rounded cheeks...

i think it's such a great result. even for a man. the chin wing was such an improvement as well!

[ghiggson90]

I think she looked better before.

[PloskoPlus]

Different, but not necessarily better.

[april]

She lost her jawline.
Or is that swelling?

[PloskoPlus]

She lost her jawline.
Or is that swelling?

Her face looks more squared up. 

[Post bimax]

She looks more balanced in the after for sure.  I'd say it was an improvement.

[kavan]

I think this is a very good example of OPTIONS isolated osteos can have.

The photo organization is very good to show it. He's got the the right poses/camera angles to show the outcome. There are lots of doctors who have sloppy photo presentations where they don't show ALL the poses; front, profile and oblique and/or use different camera angles. So, kudos to him for showing all with good organization.

Looks like she had  class 3 skeletal going on as her lower lip is somewhat ahead of her upper lip and of course, mandible ahead of maxilla and soft tissue retrusion to midface areas. Maybe she also had her bite made 'right' with prior ortho.

However IF she had the maxilla moved forward via L1, it would have been one of those things where her cheek area would have looked relatively recessed by comparison. Not to mention all would probably be in venue of bimax with mandible set back and the pre-surgery in braces protocol to do it.

So, what he did to the upper cheek area compensates for soft tissue retrusion and gives good sagittal and oblique cheek curve. The osteo to the mandible corrects both it's protrusion and inclination of mandibular plane (makes less steep).

All in all, I think this is VERY GOOD example of a specific case using these isolated ostetotomies INSTEAD of the bimax route. Good example in the sense that it shows a bone cutting option to improve soft tissue contour of a class 3 skeletal case where the photo shots with cephs are very 'honest' to also show there are still vestiges of the class 3 profile. However, most likely to the trained eye and not average person looking at her whereas frontal soft tissue view is improved as are soft tissue views in oblique and profile. Although there is some loss of soft tissue support under the chin, that would have also happened in the event her  lower jaw had to be setback in a bimax. Other part of bimax L1 forward movement would have made her upper cheek area look MORE relatively recessed. Hence, this is excellent example where someone with similar situation to observe and from there, entertain the option of these isolated osteos being done instead of the full bimax route.

As to all the osteos themselves, such things as where the cuts and displacements were made were well selected for this PARTICULAR case. To that regard, it shows the option for the surgeon to cater the placement and angle of cuts to best adapt to the case at hand. So, the example also shows that the NAMES of things; eg. 'malar osteo' or 'chin wing' does not necessarily PRE-DEFINE where the cuts are to be made and hence clearly shows there are options as to where to ISOLATE the OSTEOS.

[ben from UK]

Slightly too masculine for a woman. There is somehow more balance in the after (probably due to balancing out the long chin), but strangely enough she doesn't look better. So no, it's not a good result if someone doesn't look better in the after. I think cw and genio is just a tricky procedure for females. I don't like it on females (unless there's huge retrusion). I much prefer the inverse, the boneshaving procedures in Asia. I don't know if these boneshaving procedures work out on a caucasian woman, I never saw it on a white woman. But my opinion is: as a woman, you want to have that feminine, soft look, you don't want masculine traits. A soft, more heartshaped face instead of harsh masculine traits.

I would have weakened this woman's chin (making it shorter). She does have a steep golonial angle, but choosing to lower the angle brings the risk of more masculine face when it comes to women, and that's what happened. Now, maybe it was the right procedure but the execution was bad. I'm not impressed by dr. B's results anyway.

I also think, while she had a steep golonial angle, it doesn't show from the front so much (which is the most important). So there's a trade off: less steep from profile but more masculinity from the front. Disastrous result: she had a soft feminine face before.

[ODog]

Slightly too masculine for a woman. There is somehow more balance in the after (probably due to balancing out the long chin), but strangely enough she doesn't look better. So no, it's not a good result if someone doesn't look better in the after. I think cw and genio is just a tricky procedure for females. I don't like it on females (unless there's huge retrusion). I much prefer the inverse, the boneshaving procedures in Asia. I don't know if these boneshaving procedures work out on a caucasian woman, I never saw it on a white woman. But my opinion is: as a woman, you want to have that feminine, soft look, you don't want masculine traits. A soft, more heartshaped face instead of harsh masculine traits.

I would have weakened this woman's chin (making it shorter). She does have a steep golonial angle, but choosing to lower the angle brings the risk of more masculine face when it comes to women, and that's what happened. Now, maybe it was the right procedure but the execution was bad. I'm not impressed by dr. B's results anyway.

I also think, while she had a steep golonial angle, it doesn't show from the front so much (which is the most important). So there's a trade off: less steep from profile but more masculinity from the front. Disastrous result: she had a soft feminine face before.

She didn’t have a soft feminine face before. She had a flat face, long chin, and soft tissue macrogenia.

The malar osteotomy was a big win imo. The chin wing is okay, not really needed but I didn’t think it made her look worse. I don’t think women with squared faces look necessarily masculine. What matters is the CHIN. Some of the most feminine women I know with the softest personalities have squared off faces, but the chin is short and rounded, and maybe narrow.

So, IMO it’s not that the CW makes her look more masculine; it’s that it’s paired with a long bulbous chin which should have been significantly shortened and softened, I.e. IF she was “looking” for a more feminine face - which by the way, we do not know if that was the case. She could be a leader in her career and likes her commanding face.

[InvisalignOnly]

I like the way her cheeks look in the after but quite surprised that someone would be willing to mess with their bones and put screws in to achieve this. Especially on a middle aged woman, fillers would achieve the same or very similar result for a fraction of the cost and the risk. Of course they are temporary, but in that area they last 1-2 years and even if she had many over the next few decades, it would still cost about the same or less than this one surgery and the risk would be so much less, she could change the shape / size any time she wanted etc. I guess it's her decision but I wonder if she considered all options before she decided on this.

[PloskoPlus]

I like the way her cheeks look in the after but quite surprised that someone would be willing to mess with their bones and put screws in to achieve this. Especially on a middle aged woman, fillers would achieve the same or very similar result for a fraction of the cost and the risk. Of course they are temporary, but in that area they last 1-2 years and even if she had many over the next few decades, it would still cost about the same or less than this one surgery and the risk would be so much less, she could change the shape / size any time she wanted etc. I guess it's her decision but I wonder if she considered all options before she decided on this.

Over here filler costs an absolute fortune. And people have gotten significant inflammatory reactions to filler as well.

[Lazlo]

it's a total win. only thing for a man, is you would like that apex of the frontal cheekbone to be in like with the lowerorbital rim. Note the cut is made below the lower orbital rim, but if it could somehow be ifixaded to look flush with the lower orbital rim you would have a TOTAL SLAYER oook on both a ban or a man. I'm sure that can be done, even without added material. Anyone smart enough to morph thta from a fronto;side, 3;4 DO IT!!!!!

[boyo]

So to conclude, is this procedure worth doing on males lacking mild cheek projection or are implants the way to go?
Both options apparently have big drawbacks, zso having bone movement limits and implants having infection risks and bone erosion (especially down the road).
 

[kavan]

So to conclude, is this procedure worth doing on males lacking mild cheek projection or are implants the way to go?
Both options apparently have big drawbacks, zso having bone movement limits and implants having infection risks and bone erosion (especially down the road).

Any conclusion to be drawn about cheek projection from this specific case would be contingent on:

 the person having a SIMILAR situation as does the example and of course the person being at least average intelligence, perceptual, observational abilities to ID either a similar OR a dissimilar (start point) situation in their OWN face.

realizing that in 'isolated osteotomies', there are options as to where to cut and how to displace the bone(s) and a variety of cuts/displacements can be used to accommodate the case.The example shows a type of cut and displacement that is well adapted to the patient's midface retrusion. There could/would be different options for cuts which could accommodate different types of cheek projection requests to different areas for different effects.

No conclusion can be drawn from this example as to whether or not to chose this procedure over implants because it is IMPLICIT that the person had a PREFERENCE for a bone cut procedure RATHER than cheek implants or fillers.