jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: beyondconfusedtbh on June 12, 2018, 12:39:23 PM
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Hi everyone,
I've been lurking a while but this is my first post so go easy on me lol.
So not long after finding this forum I read earl's story about how he got modified lefort iii to advance his orbitals (and cheekbones?)
I though that the orbital area was a no go and that I should just leave it and focus on my jaw (i've been in touch with Dr. Z regarding chin wing and BSSO procedures) but after finding that post I felt like my prayers had been answered.
So now i'm seriously considering having a mlf3 with Dr. S, my only issue is that there is so little information (anecdotal or otherwise) about it.
My main questions are:
1) Is there chance of relapse? (stupid q maybe but im paranoid lmao)
2) Are there long term side effects?
3) Is it actually worth it lol (ie will it improve my orbitals)
If anyone has spoken to Earl or anyone that has had this procedure done, I'd be grateful if you could shed some light on the matter.
This site has helped me tremendously, so kudos to all of you.
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also, in peoples opinions is Dr Ob. superior to Dr S. in this regard?
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Ever since Earl's story, so many people come here wanting to be SPOON FED info about L3s and various permutations of 'modified' L3's.
Earl's real story is that he did research ON HIS OWN (medical journals), knew exactly what he wanted and WHY and had a very strong preference in favor of bone cuts over orbital rim implants and of course had the prominent eyes (bug eyes). I think he took a few years of lots of research into the medical papers and consulting around based on the knowledge he ACQUIRED on HIS OWN to cross reference with a good handful of doctors he traveled far to consult with and subsequently chose the doctor he chose.
So NONE of this stuff was handed to him on a platter (or spoon fed) on here as is the case of most of the people coming to JSF looking to be spoon fed info on L3s and various modifications thereof. In fact, a few people who just blindly fell into Earl's doctor's lap 'because Earl did it' could not have possibly been as well prepared as he was in terms of IDing themselves as ideal candidates for orbital rim area advancements this way because they didn't get the extent of improvement he got.
There is ample info out there on L3s and modifications thereof. But finding requires RESEARCH ABILITIES in addition to having the salient anatomy underbelt and ability to 'digest' medical articles and/or a long time to increase knowledge that way as to 'digest' conceptual material.
In essence Earl had the ability to FIND information on this (appropriate med journals) on HIS OWN and to PROCESS it in ACCORDANCE to his aesthetic situation and had all that UNDERBELT when he consulted with a variety of doctors. Also, he knew enought to pursue that surgery AFTER he got his jaw situation in balance.
Seriously, a LOT of the people flying in here wanting to know about L3s have acquired jacks**t info on their own, need to be spoon fed and demonstrate very little capacity to process information. Any doctor you consult with won't be spoon feeding it either and acquisition of knowledge, ON YOUR OWN (like Earl did) will be needed to increase the level of info you get from any consult you go on. That said, be careful about riding on someone else's coat tails for esoteric surgeries like chin wings and L3s . I find that people who are successful with the more esoteric surgeries are good researchers and good at processing complex information and don't need mother bird to chew up and spit out the worm for them.
That said, my policy on 'spoon feeding' is I will sometimes do it for people having a hard time with some of the JAW BALANCE relationships (Lefort1, BSSO and genio) but NOT for the L3s. This is because people coming to a JAW SURGERY forum demonstrate some to enough understanding of jaw to jaw relationships to fill in some of the blanks they have. But about 90-95% of those coming here wanting to know about L3s (or think they need them) are just TOO FULL of BLANKS to fill in for them.
Hence, my policy is for people wanting what Earl had is to BE LIKE EARL and do their own research as he did. Then come back with some demonstration of knowledge in that regard and only a FEW blanks needed to be filled in. Of course, my policy on this does not preclude others who want to tell you all about L3s in the absence of even seeing what you look like.
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Listen Dr. Sinn does something for the under orbitals. It just is a "meh" like I'd say its an improvement, but not as much as you'd think. I'm more interested in knowing what Dr. Anthony S Wolfe might be able to do with his "malar osteotomy"
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Ever since Earl's story, so many people come here wanting to be SPOON FED info about L3s and various permutations of 'modified' L3's.
Earl's real story is that he did research ON HIS OWN (medical journals), knew exactly what he wanted and WHY and had a very strong preference in favor of bone cuts over orbital rim implants and of course had the prominent eyes (bug eyes). I think he took a few years of lots of research into the medical papers and consulting around based on the knowledge he ACQUIRED on HIS OWN to cross reference with a good handful of doctors he traveled far to consult with and subsequently chose the doctor he chose.
So NONE of this stuff was handed to him on a platter (or spoon fed) on here as is the case of most of the people coming to JSF looking to be spoon fed info on L3s and various modifications thereof. In fact, a few people who just blindly fell into Earl's doctor's lap 'because Earl did it' could not have possibly been as well prepared as he was in terms of IDing themselves as ideal candidates for orbital rim area advancements this way because they didn't get the extent of improvement he got.
There is ample info out there on L3s and modifications thereof. But finding requires RESEARCH ABILITIES in addition to having the salient anatomy underbelt and ability to 'digest' medical articles and/or a long time to increase knowledge that way as to 'digest' conceptual material.
In essence Earl had the ability to FIND information on this (appropriate med journals) on HIS OWN and to PROCESS it in ACCORDANCE to his aesthetic situation and had all that UNDERBELT when he consulted with a variety of doctors. Also, he knew enought to pursue that surgery AFTER he got his jaw situation in balance.
Seriously, a LOT of the people flying in here wanting to know about L3s have acquired jacks**t info on their own, need to be spoon fed and demonstrate very little capacity to process information. Any doctor you consult with won't be spoon feeding it either and acquisition of knowledge, ON YOUR OWN (like Earl did) will be needed to increase the level of info you get from any consult you go on. That said, be careful about riding on someone else's coat tails for esoteric surgeries like chin wings and L3s . I find that people who are successful with the more esoteric surgeries are good researchers and good at processing complex information and don't need mother bird to chew up and spit out the worm for them.
That said, my policy on 'spoon feeding' is I will sometimes do it for people having a hard time with some of the JAW BALANCE relationships (Lefort1, BSSO and genio) but NOT for the L3s. This is because people coming to a JAW SURGERY forum demonstrate some to enough understanding of jaw to jaw relationships to fill in some of the blanks they have. But about 90-95% of those coming here wanting to know about L3s (or think they need them) are just TOO FULL of BLANKS to fill in for them.
Hence, my policy is for people wanting what Earl had is to BE LIKE EARL and do their own research as he did. Then come back with some demonstration of knowledge in that regard and only a FEW blanks needed to be filled in. Of course, my policy on this does not preclude others who want to tell you all about L3s in the absence of even seeing what you look like.
I was reading your replies to some other similar posts and realised that you'd respond with something like this.
To be honest I don't have a smart rebuttal or anything. Earl's story definitely had me excited so perhaps I rushed in. Apologies.
That said, thanks for taking the time to formulate such an apt response.
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Listen Dr. Sinn does something for the under orbitals. It just is a "meh" like I'd say its an improvement, but not as much as you'd think. I'm more interested in knowing what Dr. Anthony S Wolfe might be able to do with his "malar osteotomy"
Interesting, his website gives very little information regarding it though.
edit: yeah a 'meh' result was pretty much my primary concern considering how scary the procedure sounded
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I was reading your replies to some other similar posts and realised that you'd respond with something like this.
To be honest I don't have a smart rebuttal or anything. Earl's story definitely had me excited so perhaps I rushed in. Apologies.
That said, thanks for taking the time to formulate such an apt response.
LOL. Glad to hear you were braced for it.
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Listen Dr. Sinn does something for the under orbitals. It just is a "meh" like I'd say its an improvement, but not as much as you'd think. I'm more interested in knowing what Dr. Anthony S Wolfe might be able to do with his "malar osteotomy"
what are your thoughts on Pelo? He does malar osteotomies too & seems experienced from the videos & B/A i've seen. Theres a thread on here with some i think.
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what are your thoughts on Pelo? He does malar osteotomies too & seems experienced from the videos & B/A i've seen. Theres a thread on here with some i think.
No, he's s**t.
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Why wouldn't you just get implants? I don't know much about the mLF3, but I really don't understand its appeal...
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Why wouldn't you just get implants? I don't know much about the mLF3, but I really don't understand its appeal...
Because a terrible end is better than terror without end. Implants can get infected decades after surgery and medpor can be impossible to remove.
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According to https://www.dryaremchuk.com/blog/complications-and-toxicities-of-implantable-biomaterials-used-in-facial-reconstructive-and-aesthetic-surgery-a-comprehensive-review-of-the-literature/, in a study of 617 patients, malar implant infection rate was around 2.4%.
Because a terrible end is better than terror without end. Implants can get infected decades after surgery
In which case they'll have to be removed? I really don't think the fear of infection (requiring implant removal), which is a pretty low rate anyway, should constitute "terror without end."
On the other hand, mLF3 risks include blindness (or other vision problems), a much higher rate of other major complications, etc. Not to mention it is very difficult (if even possible) to revise. Not to mention that relapse could still be an issue.
Also, it seems hypocritical to criticize implants because of the very low risk of infection decades later when we don't even know the long term risks / complications of mLF3 due to the severe paucity of data (since there are very few non-syndromic patients who would opt for this procedure). I don't even know if there's enough data to study the complication rates of mLF3 short term.
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With an infection, you remove the implant, wait a year or however many months for healing, and then you can go back in with another implant if you so choose. if it happens decades later, then maybe something less risky will be out by then as a better substitute than what you had in before. meh.
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With an infection, you remove the implant, wait a year or however many months for healing, and then you can go back in with another implant if you so choose. if it happens decades later, then maybe something less risky will be out by then as a better substitute than what you had in before. meh.
I've heard horror stories about medpor being impossible to remove. Although maxillofacial surgeons said it was a piece of cake.
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With an infection, you remove the implant, wait a year or however many months for healing, and then you can go back in with another implant if you so choose. if it happens decades later, then maybe something less risky will be out by then as a better substitute than what you had in before. meh.
It is meh, but IMO the complication of having to remove the implant pales in comparison to the complications of mLF3.
I've heard horror stories about medpor being impossible to remove. Although maxillofacial surgeons said it was a piece of cake.
Same here. What's wrong with silicone, especially in the malar/infraorbital area (where bone resorption -- barring extremely rare cases -- shouldn't really cause any issues)?
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No, he's s**t.
Care to elaborate?
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this: https://www.ncbi.nlm.nih.gov/pubmed/24276594 (https://www.ncbi.nlm.nih.gov/pubmed/24276594)
is incredibly interesting.
Now DO is no joke & the patients were fairly young so this won't apply to everyone, but nonetheless this could be the solution some people are after.
I'd love to hear someone else's insight into this
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this: https://www.ncbi.nlm.nih.gov/pubmed/24276594 (https://www.ncbi.nlm.nih.gov/pubmed/24276594)
is incredibly interesting.
Now DO is no joke & the patients were fairly young so this won't apply to everyone, but nonetheless this could be the solution some people are after.
I'd love to hear someone else's insight into this
DO is certainly of interest to the author/s of the article you cited. I've taken a look at other articles authored by Utreja AK where other changes of Distraction Oseteogenesis at L1 level are mentioned and also the DEVICE used for the DO.
It does very much appear that the context of this is in patients with cleft lip deformities who benefit and also that the device used is a rigid external distractor; 'Halo'. Is that the device you are thinking of having to advance orbital rims?
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Some key excerpts pulled from other studies where the context of DO use and device for said is found.
[Customized rigid external distractor was used for distraction.]
[The advancement of maxilla by distraction osteogenesis at Le Fort-I level among subjects with cleft lip and palate deformities increased nasal index significantly.]
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425104/bin/CCD-3-188-g001.jpg)
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DO is certainly of interest to the author/s of the article you cited. I've taken a look at other articles authored by Utreja AK where other changes of Distraction Oseteogenesis at L1 level are mentioned and also the DEVICE used for the DO.
It does very much appear that the context of this is in patients with cleft lip deformities who benefit and also that the device used is a rigid external distractor; 'Halo'. Is that the device you are thinking of having to advance orbital rims?
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Some key excerpts pulled from other studies where the context of DO use and device for said is found.
[Customized rigid external distractor was used for distraction.]
[The advancement of maxilla by distraction osteogenesis at Le Fort-I level among subjects with cleft lip and palate deformities increased nasal index significantly.]
DO Is not the answer for aesthetics. It only can control movement in one direction and is unstable.
The only answers are if Dr. anthony s wolfe can do the malar osteotomy AND/OR HA in addiction to an osteotomy AND/OR
a biological implant made from your own stem cells and grown in a bioreactor.
The latter will be the most impressive. But for now my bets are on Anthony S. Wolfe and someone needs to do an in person consult with him. If i lived in Florida I'd do it now.
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DO Is not the answer for aesthetics. It only can control movement in one direction and is unstable.
The only answers are if Dr. anthony s wolfe can do the malar osteotomy AND/OR HA in addiction to an osteotomy AND/OR
a biological implant made from your own stem cells and grown in a bioreactor.
The latter will be the most impressive. But for now my bets are on Anthony S. Wolfe and someone needs to do an in person consult with him. If i lived in Florida I'd do it now.
And silicone implants are not a good option because...? People seem to have pretty good results with infraorbital rim implants.
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DO Is not the answer for aesthetics. It only can control movement in one direction and is unstable.
The only answers are if Dr. anthony s wolfe can do the malar osteotomy AND/OR HA in addiction to an osteotomy AND/OR
a biological implant made from your own stem cells and grown in a bioreactor.
The latter will be the most impressive. But for now my bets are on Anthony S. Wolfe and someone needs to do an in person consult with him. If i lived in Florida I'd do it now.
Doesn't HA come with the same risks as any other implant? I understand its quite a polarising topic on here.
As for Wolfe, why him over Sinn? Do they do the procedures differently (ie. greater advancement).
Also our goals may be slightly different right? I'm not TOO fussed with the cheekbones, something like (appropriate jared leto pic when i find one) would be just fine in my case, its the orbitals that are my main focus.
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Doesn't HA come with the same risks as any other implant?
No it doesn't.
its the orbitals that are my main focus.
Why don't you try it with fat?
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No it doesn't.
Why don't you try it with fat?
My knowledge of HA is very limited right now, I'll look into it further. Wouldn't consider using fat, wouldn't produce a desirable result in my case.
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Alright I'm back.
I've contacted Sinn & he's responded but all the conflicting information on here is about to give me an aneurysm, so i'm gonna explain my situation in more detail. Hopefully this'll spark some fruitful discussion & others in my position won't have such a hard time with all this.
I don't care about super high model cheekbones, I just want some lateral and anterior projection WHERE MY CHEEKBONES CURRENTLY ARE. '3D' projection if you will.
The problem I have with ZSO is from what I've seen, it only moves the bottom portion of the zygoma forward. Is this correct? Or is this one of the things that differs between surgeons?
I have recessed orbital rims & if possible I'd like them moved forward as well but I don't mind if thats not a possibility, gotta be realistic after all.
Osteotomies & HA are all I'm considering. I know some of you love the other implants, I'd just rather not use them.
The only other information I can give is that currently the left side of my face looks slightly less defined than the right, so I guess I'd have to get less advancement on one side to compensate but again I don't really mind.
Right now I really wish I could speak German so I could look into more surgeons over there.
Btw I'm glad the forums back, thanks everyone I've only been a member on here a short time but I've had a lot of help from all of you :)
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Taken from another thread but [attached] would be fine, even minus the blue bit just under the frontozygomatic suture & the lower orbital.
BTW correspondence with Sinn is slow I assume he's busy but I enquired about a modified ZO, not the whole mlf3 thing. Hence why i've changed the focus a little bit from the orbitals.
The reason is bc i've read a lot of people saying it'd give a sunken look or something to my eyes. I don't buy this 100% but I'll ask him down the line if need be.
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Why have't you also contacted Dr. Anthony S. Wolfe in Florida for his Malar osteotomy procedure? That could be the answer.
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Ever since Earl's story, so many people come here wanting to be SPOON FED info about L3s and various permutations of 'modified' L3's.
Earl's real story is that he did research ON HIS OWN (medical journals), knew exactly what he wanted and WHY and had a very strong preference in favor of bone cuts over orbital rim implants and of course had the prominent eyes (bug eyes). I think he took a few years of lots of research into the medical papers and consulting around based on the knowledge he ACQUIRED on HIS OWN to cross reference with a good handful of doctors he traveled far to consult with and subsequently chose the doctor he chose.
So NONE of this stuff was handed to him on a platter (or spoon fed) on here as is the case of most of the people coming to JSF looking to be spoon fed info on L3s and various modifications thereof. In fact, a few people who just blindly fell into Earl's doctor's lap 'because Earl did it' could not have possibly been as well prepared as he was in terms of IDing themselves as ideal candidates for orbital rim area advancements this way because they didn't get the extent of improvement he got.
There is ample info out there on L3s and modifications thereof. But finding requires RESEARCH ABILITIES in addition to having the salient anatomy underbelt and ability to 'digest' medical articles and/or a long time to increase knowledge that way as to 'digest' conceptual material.
In essence Earl had the ability to FIND information on this (appropriate med journals) on HIS OWN and to PROCESS it in ACCORDANCE to his aesthetic situation and had all that UNDERBELT when he consulted with a variety of doctors. Also, he knew enought to pursue that surgery AFTER he got his jaw situation in balance.
Seriously, a LOT of the people flying in here wanting to know about L3s have acquired jacks**t info on their own, need to be spoon fed and demonstrate very little capacity to process information. Any doctor you consult with won't be spoon feeding it either and acquisition of knowledge, ON YOUR OWN (like Earl did) will be needed to increase the level of info you get from any consult you go on. That said, be careful about riding on someone else's coat tails for esoteric surgeries like chin wings and L3s . I find that people who are successful with the more esoteric surgeries are good researchers and good at processing complex information and don't need mother bird to chew up and spit out the worm for them.
That said, my policy on 'spoon feeding' is I will sometimes do it for people having a hard time with some of the JAW BALANCE relationships (Lefort1, BSSO and genio) but NOT for the L3s. This is because people coming to a JAW SURGERY forum demonstrate some to enough understanding of jaw to jaw relationships to fill in some of the blanks they have. But about 90-95% of those coming here wanting to know about L3s (or think they need them) are just TOO FULL of BLANKS to fill in for them.
Hence, my policy is for people wanting what Earl had is to BE LIKE EARL and do their own research as he did. Then come back with some demonstration of knowledge in that regard and only a FEW blanks needed to be filled in. Of course, my policy on this does not preclude others who want to tell you all about L3s in the absence of even seeing what you look like.
Thanks Kavan, I appreciate the post. It is true a lot of it comes down to just researching then contacting doctors.
As for the medpor questions, I can relate a story of when I consulted with a top medpor doc a few years ago (pre lefort). I feel when it comes to medpor, patients ask the wrong question. They (as I did once) ask can medpor be removed. The answer is DEFINETLEY YES. Anything can be removed. Limbs and stuff get removed all the time. Anything can just be ripped out of you. The real questions is can MEDPOR be removed EASILY, WITH LITTLE TO NO DAMAGE ETC.
I consulted with a top medpor doc about 10 years ago. He wanted to give me medpor jaw angles and orbital rims. I asked if they can be removed if I don't like them or infection. He answered YES they can be removed. Then I asked is it easy to remove, he sort of dodged the question by answering "I have removed medpor before and have experience" So I turned to him and said " so medpor is easy to remove with no issues" he paused , gave off sort of a sigh and said "its very difficult to remove", he said some places more so than others, but its very difficult to remove.
Now I was lucky he gave an honest answer. Many docs would have just lied and said yes very easy to remove.
Silicone orbital rims (tear trough implants ) are easy to remove, but can cause erosion. They also don't give as much projection. I had about 3mm of erosion from silicone cheek implants.
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Thanks Kavan, I appreciate the post. It is true a lot of it comes down to just researching then contacting doctors.
As for the medpor questions, I can relate a story of when I consulted with a top medpor doc a few years ago (pre lefort). I feel when it comes to medpor, patients ask the wrong question. They (as I did once) ask can medpor be removed. The answer is DEFINETLEY YES. Anything can be removed. Limbs and stuff get removed all the time. Anything can just be ripped out of you. The real questions is can MEDPOR be removed EASILY, WITH LITTLE TO NO DAMAGE ETC.
I consulted with a top medpor doc about 10 years ago. He wanted to give me medpor jaw angles and orbital rims. I asked if they can be removed if I don't like them or infection. He answered YES they can be removed. Then I asked is it easy to remove, he sort of dodged the question by answering "I have removed medpor before and have experience" So I turned to him and said " so medpor is easy to remove with no issues" he paused , gave off sort of a sigh and said "its very difficult to remove", he said some places more so than others, but its very difficult to remove.
Now I was lucky he gave an honest answer. Many docs would have just lied and said yes very easy to remove.
Silicone orbital rims (tear trough implants ) are easy to remove, but can cause erosion. They also don't give as much projection. I had about 3mm of erosion from silicone cheek implants.
Well, you are as sharp as tack in terms of knowing the right questions to grill them further and you had good info grounding to start with. Kudos.
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DO is certainly of interest to the author/s of the article you cited. I've taken a look at other articles authored by Utreja AK where other changes of Distraction Oseteogenesis at L1 level are mentioned and also the DEVICE used for the DO.
It does very much appear that the context of this is in patients with cleft lip deformities who benefit and also that the device used is a rigid external distractor; 'Halo'. Is that the device you are thinking of having to advance orbital rims?
--------
Some key excerpts pulled from other studies where the context of DO use and device for said is found.
[Customized rigid external distractor was used for distraction.]
[The advancement of maxilla by distraction osteogenesis at Le Fort-I level among subjects with cleft lip and palate deformities increased nasal index significantly.]
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425104/bin/CCD-3-188-g001.jpg)
They could have at least leveled that girl's eyebrows and eyeballs before taking photos / x-rays. COME ON!
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Hi earl, I've read about your Modified Lefort 3 story, can you provide me with your B/A pics, Lat Ceph and can you tell how many mms of movement were made please? I promise to keep it confidential by not sharing your photos on the internet.
I am definitely not interested in doing one myself (definitely don't need it), however I'm just interested in what a major midface osteotomy looks like on an non-syndromal patient. I've already seen the Obwegeser girl however I want to see more results to satiate my curiousity and I want to show it to my Maxfac surgeon who does Lefort 3s (only on syndromal patients and not for purely aesthetic reasons though, i'm not trying to convince my maxfac to perform an Lefort 3 on me but im curious on what my maxfac's reaction would be upon seeing your results).
Sorry for hijacking the thread but I can't send a PM for some reason
I dont share photos. Advancement was around 8-9 mm from what i remeber.
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They could have at least leveled that girl's eyebrows and eyeballs before taking photos / x-rays. COME ON!
That's not taking xrays - that's the device she has to wear.