I have posted here before to comment on that guy's result (in the original post). I said that I liked how he looked before much, much more than after - the reasons being the unfortunate reduction of his nose (wtf was the surgeon thinking?) and the unfavorable change of his mid-face. So, as far as aesthetic preferences I'm on the same page as geijutsu, 100%. Then I exchanged pms and emails with some members here trying to explain why I think so, using pics of models to illustrate my point - look up Jon Kortajarena - he's a good, radical example of the S curve.
I'd like to debunk some myths though. First of all, we do not know what that guy had done exactly. The site where these pictures are taken from is brazilian, and all it says is that he had some sort of zygomatic osteotomy. Not sandwich. Assuming that he had a sandwich zygomatic osteotomy is wrong.
It is NOT a fact that the sandwich osteotomy (ZSO) advances and augments the lower part of the cheekbone. For all of you who haven't done so, go to Mommaerts's web site, register to access the articles - it's free, and download the ones on zygomatic sandwich osteotomy. There are MANY VARIABLES to this procedure. The underlying idea is to RAISE and move the cheekbone both laterally and forward (anterior and lateral projection). By controlling the variables, you can tweak the procedure to augment more towards the zygomatic arch (laterally). It doesn't even have to be "sandwich". It can simply be zygomatic arch osteotomy (Mommaerts explains the difference with pictures in his articles between arch and sandwich zygomatic osteotomy). The arch one will augment almost exclusively only laterally.
I find it hard to believe that a zygomatic osteotomy gave that guy that look in the after pictures (arch or sandwich, for that matter). If you know this for a fact, please tell me so because this procedure is part of my surgical plan and I sure as hell don't want to end up looking like that. For me, it looks like that guy had SUBMALAR implants, or some other form of submalar augmentation. Certainly not malar.
Yes, it's true that it can exacerbate the deficiency in the orbital rim. This happens.
I took pictures of myself and drew on them - the parts that I want augmented (in one color) and the parts that I absolutely do not want to see augmented (in another). The surgeon assured me that the zygomatic osteotomy augments only the parts I want to see augmented.
this is how Mommaerts explains it in his article "the ZSO is indicated when an anteriolateral deficiency of the malar area is present, inferior and lateral to the lateral canthus. I repeat, inferior and lateral to the lateral canthus. So, it is really a safe and effective replacement for MALAR implants, not submalar. That's why I'm confounded by claims that the patient posted here had a zygomatic osteotomy. Again, sure as f**k he did not get any augmentation lateral to the lateral canthus, as a matter of fact he lost the one he had. His before picture is what I would like to look after, cheekbone and cheek-wise.
Also, geijutsu or whoever said something about a patient being unhappy with Mommaerts' malar osteotomy - could you please give more details? Where did you learn about the case, was the patient male, and what was he unhappy with?
I know for a fact that I'm having a mandibular advancement with HA augmentation of the jaw angles (again think laterally) and very likely paranasal augmentation. This is because my submalar area is already convex, and this is not the look I want. I will only choose the zygomatic ostoetomy if I'm certain 100% that my surgeon understands my aesthetic goals. Fortunately, he's open to the idea of looking at male models pictures which I have used to illustrate my points. I'm using the pictures for illustration - it is an absolute must that you and your surgeon are on the same page, and that you don't end up looking like that guy posted here. I want to make my face more masculine and definitely more concave. I have even been thinking of some subcutaneous liposuction with micro canulas in that area to help create that look - flatten my cheeks, while augmenting my cheekbones high and laterally towards the zygomatic arch. I want to make it clear that I'm by no means overweight and I'm very fit. I simply can observe some access fat in my submalar area which is genetic. I know there are women who want that look for themselves and even have fat transfers there to achieve it. However, I'm not a woman. I know exactly what I want.
I know many of you will not understand what I'm saying - some of you asked me before what is the difference between a cheek and a cheekbone. However, I did my best to explain. And I'm sure some of you do understand. Again, look at Jon Kortajarena - he doesn't have prominent cheeks - his cheeks are hollow even. He has prominent cheekbones. Think malar - submalar. Look at malar and submalar implants at the med-por catalogue to understand the difference. It's interesting that some people here with hundreds and plus posts don't understand the difference between bone and soft tissue distribution on the cheeks, and between malar and submalar. I've heard the term mid-face used too many times to refer to anything at all. Mid-face is a very wide term and can be anything from paranasal, submalar, malar, zygomatic arch, zygomatic process etc. As long as you treat all this as it is one and the same thing, you'll never understand what you need exactly and how you can improve your face. I'm not saying submalar augmentation is wrong for everyone. But for most men, YES, it is. And for me, it is 100% not indicated. So, I will make sure the zygomatic osteotomy does not augment this area even a mm, or I will not have it. And it shouldn't. The way it works, it should augment the bordering malar area, and flatten this one. How will it flatten? Again, think soft tissue distribution. You move the cheekbone laterally (and significantly, Mommaerts moves it at least 5 mm, often more), you expect it to balance and pick up some of the excess soft tissue in the submalar area, i.e. more evenly distributed soft tissue with strong high cheekbones in the end. Wishful thinking? I don't know. We'll see. I'll keep you updated after my surgery.