General Category > Aesthetics

Female malar osteotomy result - Brusco

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PloskoPlus:

--- Quote from: april on October 30, 2019, 01:17:16 AM ---She lost her jawline.
Or is that swelling?

--- End quote ---
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:

--- Quote from: ben from UK on October 30, 2019, 03:42:30 PM ---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.

--- End quote ---

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.

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