jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Lestat on October 18, 2016, 04:28:22 AM
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1 zso = 7mm diagonal movement for each cheekbone.
Just get 2 or 3 zso`s and you would get high cheekbones.
Would not this work?
What are your thoughts?
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1 zso = 7mm diagonal movement for each cheekbone.
Just get 2 or 3 zso`s and you would get high cheekbones.
Would not this work?
What are your thoughts?
What's peoples thoughts on this? I spoke to Dr Z today about my upcoming surgery and he said that he can do the ZSO
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Yes I don't see why not but the problem is that the zygomatic arch would still remain as low as before so I would think that would look very odd. Unless your arch isn't really visible, then it would be ok.
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Yes I don't see why not but the problem is that the zygomatic arch would still remain as low as before so I would think that would look very odd. Unless your arch isn't really visible, then it would be ok.
Are there any risks to your vision with this surgery?
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it can be done, and yields great results. however, continual devascularization via disection of the periostium increases risk of bone resorption.
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it can be done, and yields great results. however, continual devascularization via disection of the periostium increases risk of bone resorption.
Have you seen someone who had multiple ZO's? Only one I saw was photos that Mommaerts showed me, but it was a girl so not high set cheekbones and she had a lot of fat grafting on top.
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I highly doubt it yields great results. You would end up with a cheekbone prominence that is potentially 12+mm out of place with the rest of your zygoma structure. The surrounding bone doesn't grow back in-between ZSO's so in effect literally all you are doing is moving that same tiny piece further and further upwards out of position, which will eventually look both odd and have a visible step-off on your face.
The best path to substantially higher, angular cheekbones seems to be:
- Modified lefort 3
- A zygo osteotomy solely focused on elevating the malar prominence
There's still drawbacks I won't bother rambling about but that to me is the best path I have found so far based on my research.
Lefortitude, what are the drawbacks to your best path?
Have you seen someone who had multiple ZO's? Only one I saw was photos that Mommaerts showed me, but it was a girl so not high set cheekbones and she had a lot of fat grafting on top.
LORC, what was her result like? Did it improve her looks? If so, by how many points in looks scale in your opinion?
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Lefortitude, what are the drawbacks to your best path?
LORC, what was her result like? Did it improve her looks? If so, by how many points in looks scale in your opinion?
It was fake looking but quite attractive in a porn star or reality television sort of way
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The surrounding bone doesn't grow back in-between ZSO's
That's nonsense. They use bone from the iliac crest to fill the gap. Or what do you mean?
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No. Iliac crest resorbs as a facial bone onlay.
Yey of course, but not as an inlay. It gets replaced with new bone. New bone will fill the gap and there will be no step-off.
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The step-offs left by the superior movement aren't inlay gaps Lestat.
I'm sorry, but I do not understand what you mean with "step-offs left by the superior movements." There is a gap (see the picture) that gets filled with bone, bio oss or ha.
http://www.google.it/search?q=zygomatic+sandwich+osteotomy+kim+seul&client=ms-android-samsung&site=webhp&prmd=ivn&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjpktfF4YfSAhVL7RQKHSYfBdkQ_AUIBygB&biw=360&bih=500#imgrc=v0PCJ3fBbmRlwM:
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Between the edges of the mobilised piece and the skull.
If you did it 3 times you would have a banana shaped zygo arch, a noticeable step-off and too much lateral width.
Thanks. Yes of course, 3 times is too much and as you have mentioned before, continual devascularization via disection increases the risk of bone resorption.
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So I just had a call from Dr Z a minute ago, I spoke to him about the ZSO, he said he has his own method of the cut which no one else does, which provides more projection. I tried to get him to send me a diagram of it but he said he doesn't want to give out any details about it yet as he's in the process of getting it published, so he doesn't want any other surgeon stealing his method. He did say that he can get 10mm of projection and advised that 10mm is a lot anyway. He said using his method he can get the projection high up to show the shadow under the cheekbone.
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Thanks for sharing the info Vic!
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He said that the 10mm movement is more than enough to show a big change
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Yes sideways and forwards which provides the biggest impact visually. He said he can move them slightly upwards but not as much as he can from the side and forward, which is the direction you'd want the biggest change anyway
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He said that the 10mm movement is more than enough to show a big change
Does he also have before and after pictures?
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We are talking about gaining high cheekbones. It's common knowledge the ZSO provides decent lateral and anterior projection.
Better than nothing! :-X
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To compensate for the small upwards movement he puts a bone graft on top.
Does the bone graft not resorb, if you use it as an onlay? I am pretty sure it will! :-\
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I had the ZSO. It gave minimal change, and the change it did give was on the lower cheekbone. I did have a great pre-op consult in which we decided I liked high cheekbones with good visibility. The result was very different. Would really not recommend this procedure.
This has been the experience of at least another 2 patients of Dr Z. One even went through the trouble of manufacturing a skull model to show him exactly what she wanted. Didn't help. IMO he clearly oversells the procedure.
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Stupidjaws procedures look good from his ZSO but I think stupidjaws' cheekbones were already on the higher front and it looks good. Also wouldn't at least a good degree of anterior projection push out or "tent" the skin under the eye, at least making it more convex? I don't know, I just hope.
I think probably for best impact you'd want the mf3 and then get the ZSO for good measure. But yeah, we're clearly dealing with the problem of how the f**k do you move the cheekbone up before moving it out. f**k>
They can do face transplants but can't figure this s**t out.
I'll tell you something for truth. Docs who can't do things say it can be done. Docs who know how to do things will oftfer them --but what I don't like is the morons who don't know saying that's its not possible or not a good idea.
They should just say, "I DON"T KNOW OR I DON"T KNOW OF ANY"
I mean almost ANYTHING IS POSSIBLE. I mean if you watch this video you'll see they attached an entirely fully functioning jaw with teeth to this guys face and they had medical engineers working to guide the cuts and how to construct the jaw and attach all the nerves and make it as cosmetically viable as possible --so f**k off when people say s**t can't be done.
http://www.dailymail.co.uk/health/article-4233744/Face-transplant-recipient-hails-staggering-results.html
It's just, can you afford a team of 50 surgeons to work on your case? That would be millions. But I bet most of the things we think aren't possible are still possible given today's technologies even.
We can even make short people tall.
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GB,
These are the ones I was referring to.
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So I just had a call from Dr Z a minute ago, I spoke to him about the ZSO, he said he has his own method of the cut which no one else does, which provides more projection. I tried to get him to send me a diagram of it but he said he doesn't want to give out any details about it yet as he's in the process of getting it published, so he doesn't want any other surgeon stealing his method. He did say that he can get 10mm of projection and advised that 10mm is a lot anyway. He said using his method he can get the projection high up to show the shadow under the cheekbone.
When I saw Z he did indeed mention something about a technique to raise the cheekbone high up. I can't remember much about the consult unfortunately as I didnt take any notes and the consult was a while ago.
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baldguy - can't find relevant quotes as it was probably from missj, but he said similar things. Perhaps he can post if he sees this.
Baldguy83 - via PM (I think it is ok to post it here):
The result was OK, it gave my face more lateral width, which I really needed. I had a narrow face before. The added width was placed lower on the face than I would have liked, though, but that's really limited by the current placement of your cheekbones. Don't expect to get model-tier cheekbones if you don't already have high (but poorly pronounced) cheekbones.
He used bone from the iliac crest yes. You will end up with a 3-4 cm long scar there. Not a really big deal for me.
It did not give any anterior projection, nor did it give the rest of my midface more projection. It made my under-eye hollows more prominent, rather. I have gotten a modified mid-face lift (apparently I did have some fat but it was placed too low) and bone grafts to address that, I am recovering from that now.
I asked him again if a zso makes the under-eye-hollows more prominent. That was his reply to me:
Yes, your under eye hollows become more prominent.
I asked a surgeon who does zso about that. He told me that it is completely nonsense. I believe him.
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About malar augmentation:
"Chubby faces show a preponderance of the posterior over the anterior plane. Lateral soft tissues such as in the temporal and buccal area show increased convexity and dominate the facial appearance. The buccal region should be slightly concave or flat in adults, within the confines of a tangent from the cheekbone to the mandibular angle. Fullness in the buccal region can give the illusion of a poorly developed malar eminence. In these patients, partial excision of the buccal fat pad may be indicated.
Shadowing in the concavity of the buccal area highlights the malar eminence, giving it a sculptured, well-defined look. Caucasian women tend to accentuate this effect by using makeup, whereas Asians prefer much softer contours. But excessive buccal hollowness results in an emaciated, gaunt appearance with exaggerated malar definition.
Excessive width and prominence of the mandibular angle and masseter muscles make the malar eminence look small and give the face a square or triangular shape. Reduction of the mandibular angle and masseter muscles might be more adequate than malar augmentation."
https://www.researchgate.net/publication/8639801_Aesthetic_malar_recontouring_The_zygomatic_sandwich_osteotomy
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I'm still trying to figure out where the line is between having high & low cheekbones?
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Ya I'm looking at my skull scan and can't tell how high or low they are. what are the relative landmarks and proportions we're defining here for low vs high cheekbones?
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Thanks, yeah I did hear about the swelling remaining for a long time. I think that I'll ultimately need fat replaced as well, as I have none in my mid-face area, but I've been told my bones are deficient too. I'm not worried about the lowset cheeks complaint with this surgery, as I feel like that is the part that I need addressed. I know it is regarded as typically feminine but for my face it seems to be the area that needs to be improved the most. Closest example I can find of what I have is this guy
(http://clinicalgate.com/wp-content/uploads/2015/05/B9780702031687000786_f078-010ab-9780702031687.jpg)
My eye isn't quite as bulging but the shape and flatness is the same. I like the look of the area that he has had projected too, despite it being an implant.
Is there anyway to fix bulging eyes?
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Is there anyway to fix bulging eyes?
Orbital decompression
(http://tabanmd-6dce.kxcdn.com/wp-content/uploads/2015/04/OrbitDecompression_11.jpg)
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Thanks, yeah I did hear about the swelling remaining for a long time. I think that I'll ultimately need fat replaced as well, as I have none in my mid-face area, but I've been told my bones are deficient too. I'm not worried about the lowset cheeks complaint with this surgery, as I feel like that is the part that I need addressed. I know it is regarded as typically feminine but for my face it seems to be the area that needs to be improved the most. Closest example I can find of what I have is this guy
(http://clinicalgate.com/wp-content/uploads/2015/05/B9780702031687000786_f078-010ab-9780702031687.jpg)
My eye isn't quite as bulging but the shape and flatness is the same. I like the look of the area that he has had projected too, despite it being an implant.
What surgery did he get?
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Is diagonal movement possible to get higher cheekbones with zso? Theoretically, are there any other osteotomies to get higher cheekbones (not including implants) such as Lefort II or Lefort III?
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Theoretically ,Modified LF3 has been mentioned in the regard, if it is paired with some Zygomatic osteotomy.
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Is it possible to get wider cheekbones? Is there an osteotomy for wider cheekbones? If so, by how many mm (millimeters)?
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ummm yeah , the namesake of this thread :P Zygomatic sandwich osteotomy.
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Can someone upload a pic of someone with high cheekbones and someone with low cheekbones
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http://imgc.allpostersimages.com/images/P-488-488-90/77/7764/C3G5300Z/posters/james-franco.jpg
These are archetypal high cheekbones.
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James Franco doesn't have particularly high cheekbones. He had vertical expanse and a lot of lateral projection. A lot less elegant and aesthetic than these extremely high cheekbones imo :
(https://s-media-cache-ak0.pinimg.com/736x/30/5a/72/305a720964cf59f4cb1719e23ffe81bd.jpg)
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Franco's cheekbones aren't that high at all, but give a better look than Sean O'Pry's in the 2nd pic anyway. I don't think anyone needs to have cheekbones as high as Sean O'Pry. My cheekbones are just as high as Franco's, i've just not got any projection.
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Franco's cheekbones aren't that high at all, but give a better look than Sean O'Pry's in the 2nd pic anyway. I don't think anyone needs to have cheekbones as high as Sean O'Pry. My cheekbones are just as high as Franco's, i've just not got any projection.
O'Pry's look substantially better in my opinion, not even close
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Yeah on more google image searching I agree , Franco's cheekbones are not particularly high set, but very well defined .
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High Cheekbones vs. Low Cheekbones
Someone who has high cheekbones has the widest part of their face just below their eyes. This causes the cheek to dip in slightly below the bone, thus making the cheekbone stand out prominently. The dip might cause a shadow, which can accentuate the face even more. High cheekbones are right under the eye and the upper part of the nose.
Low cheekbones, on the other hand, are toward the bottom part of the nose. For some, they might even be below the nose.
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remember that ZSO (all zygoma related procedures) may not give you aggressive looking cheeks what you probably expect
It depends on the shape of your zygoma and how surgeon will split the zygomatic bone
However if you zygoma are very soft in shape ..you may get cheeks of woman :) just prominent but not good for man :)
A surgeon has limited options here as there are small zygomatic nerves. However if you don't care about them, then of course you give your surgeon more options. Those smal zygomatic nerves give sensation to the side part of the cheek on zygomatic arch area.
If you want to have high prominent cheek , then a surgeon probably will damage them, as they goes out through foramens a few mm from the corner of the orbital rim
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I have frequently encountered this theme that the osteotomy will bring out what "you already have". X rays etc could give a good idea of that.
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Have any of you even seen examples where bigger cheekbones, however they were accomplished (implant or zso) has even made them any more attractive? Faces I've seen with like cheek implants don't really fix the bigger picture skull problem they have, whatever it is, and doesn't really make them look any better.
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Have any of you even seen examples where bigger cheekbones, however they were accomplished (implant or zso) has even made them any more attractive? Faces I've seen with like cheek implants don't really fix the bigger picture skull problem they have, whatever it is, and doesn't really make them look any better.
Yes I've seen 4 impressive ZSO results that definitely increased the subjects attractiveness quite a lot. I've seen hand carved ePTFE orbital rim implants and one medpor implant that also covered the very top part of the cheek that also boosted the subject's attractiveness by a crazy amount. I've yet to see any examples of purely malar implants increasing a male's attractiveness but I'm sure there are some out there.
The issue is of course that 'improving' the zygos by projecting them is only one aspect of the overall facial structure. Most people have too many other aesthetic issues holding them back for movement of the zygomatic prominence to make much tangible difference. Whether that's bodyfat, poor maxillo-mandibular formation (including a narrow central column of the face), poor skin quality, narrow interpupillary distance, excessively long philtrum/midface, unsightly eyes, unsightly mouth area; so on and so forth
The other thing to bear in mind is that zygomatic projection needs to be in harmony with the rest of the face. You can't have protruding zygos and recessed everything else - it will look unnatural. Especially the zygomatic-maxillary relationship
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Yes I've seen 4 impressive ZSO results that definitely increased the subjects attractiveness quite a lot. I've seen hand carved ePTFE orbital rim implants and one medpor implant that also covered the very top part of the cheek that also boosted the subject's attractiveness by a crazy amount. I've yet to see any examples of purely malar implants increasing a male's attractiveness but I'm sure there are some out there.
Can you upload the pics of the 4 ZSO's?
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Can you upload the pics of the 4 ZSO's?
Two are private results so I can't upload those. One is in an old Mommaerts paper, I'll find it later and the other one is the girl that's regularly posted on here. The one that made the most difference attractiveness wise was one of the Zarrinbal private results
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What was special about Zarrinbal's result?
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Yes I've seen 4 impressive ZSO results that definitely increased the subjects attractiveness quite a lot. I've seen hand carved ePTFE orbital rim implants and one medpor implant that also covered the very top part of the cheek that also boosted the subject's attractiveness by a crazy amount. I've yet to see any examples of purely malar implants increasing a male's attractiveness but I'm sure there are some out there.
The issue is of course that 'improving' the zygos by projecting them is only one aspect of the overall facial structure. Most people have too many other aesthetic issues holding them back for movement of the zygomatic prominence to make much tangible difference. Whether that's bodyfat, poor maxillo-mandibular formation (including a narrow central column of the face), poor skin quality, narrow interpupillary distance, excessively long philtrum/midface, unsightly eyes, unsightly mouth area; so on and so forth
The other thing to bear in mind is that zygomatic projection needs to be in harmony with the rest of the face. You can't have protruding zygos and recessed everything else - it will look unnatural. Especially the zygomatic-maxillary relationship
Alright so I presume you've seen my forum threads before, as an example of someone with a hawk face (V shaped). If ZSO's really only help on faces with average to wider, forward rotated maxilla's, then If/when I get bimax, I should be insisting on either SAPRE or a 3 piece lefort to widen my maxilla? I haven't paid attention to the myofunctional device threads but that's another avenue to run down. I know my lower arch is a little narrow per my ortho, so my upper must be the same.
EDIT- Milli Meters & company - y'all need to start taking 'clinical' photos if you want the best guestimate from people on this forum. Straight-on headshot from ~5-feet away (don't quote me on distance), 45 degree angle profile shot, and side profile shots. Consistent light source aimed squarely at your face with no side shadows.. These candid photos would barely even fly on realself Q&A with the doctors pushing PS surgery at the slightest silhouette they see before turning the page.
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Alright so I presume you've seen my forum threads before, as an example of someone with a hawk face (V shaped). If ZSO's really only help on faces with average to wider, forward rotated maxilla's, then If/when I get bimax, I should be insisting on either SAPRE or a 3 piece lefort to widen my maxilla? I haven't paid attention to the myofunctional device threads but that's another avenue to run down. I know my lower arch is a little narrow per my ortho, so my upper must be the same.
It's not to say that they won't help at all in these cases, but the strongest indication for a ZSO would obviously be where the zygomatic projection is the only thing severely deficient. It's pretty indisputable that beautiful faces are broad, namely in the 'central column' of the face (as a general rule, there are many exceptions). So broad IPD, laterally elongated orbital sockets, a broad maxilla from top to bottom and a broad lower palate. SARPE would only deal with the upper palate, and if done alone will probably make little difference. 1) because it's limited by the position of the lower palate, 2) because broadening one portion of the face to the exclusion of others is a recipe for disharmony and looking strange. Ideally you would need to broaden both palates significantly, broaden the central and upper midface (essentially pushing out laterally the point at which the maxilla transitions into the zygomatic bone - including the position of the inferolateral rim), and broaden the supraorbital rim and the eyebrows also. You would then need to modify the border of the mandible, the rest of the zygoma and possibly the temporal region to sit in harmony with the now expanded central column of the face. Ideally you would also broaden the eyes and the IPD but it is practically impossible. You will probably need to broaden the mouth with a lateral commissuroplasty also.
It is even more complicated because beautiful male faces tend to exhibit what I call a lack of exterior sagittal depth to most of their features, in addition to overall breadth. All this means is that the maxilla, the zygoma, the lower palate and the orbits (including the lateral and supraorbital areas) tend to be very 'tabletop' in appearance. All this means is that the the lateral aspects of these features (which if you recall are already broad, since breadth is an independent variable), are not too far behind their central aspects. This is where angularity of features ties in - obviously features like the zygoma have to retreat backwards sagitally where those features end (on the transverse plane). Given that these features a) lack 'exterior sagittal depth', and b) must retreat backwards at some point - those features usually become angular and 'chiseled'.
This is of course also in addition to 'forward projection', 'rotation', 'vertical set' and other issues related to the 'shape' of features; which are obviously important also.
What was special about Zarrinbal's result?
It wasn't the result that was special per se. It was the starting point of the patient. Essentially the individual had bimax advancement and the relationship between the maxilla and the zygoma looked really bad, in fact it looked creepy. The large difference in attractiveness was in correction of that awful disharmony.
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Hi Ditterbo. I agree an opinion based on candid pics may involve a serving of a grain of salt but I would rather get an opinion from some one who has seen results than have no opinions before I meet with the doc myself. I am not looking for a detailed analysis, just a yes no or maybe. Posting clear pics may not be acceptable to everyone's sense of anonymity.
I am just wondering if the disparity in people's opinion of this procedure is based on how the underlying bone looked before. I have spoken to a few folks who are genuinely quite satisfied with it.
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Hi. Those of you that have seen ZSO results , TQFA et al , if this pic represents the starting point - would Zso help get better definition? Thanks.
Photo quality is crap
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IOW, the ideal male face should be like a block of granite (within reason ) - "straight, not rounded bones". This is basically about your cranial development. Chris Carmacks are born, not made.
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Oliver Cheshire must have some of the best cheekbones around which don't seem very high. I don't think high cheekbones are everything but more prominent
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pic
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Oliver Cheshire must have some of the best cheekbones around which don't seem very high. I don't think high cheekbones are everything but more prominent
Again, I disagree.
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Again, I disagree.
Great, response
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I found a way to get Gunson's 3D CT scan into a program that overlays everything into a skull, and it didn't take long to see there's an obvious boney deficiency of some sort, in the whole ZMC. I just don't know yet if there's an individual piece of the ZMC that is deficient, or the whole thing is just small and needs advancement through like a modified lf3. This is the ZMC you don't want, folks. I can just google-image skulls and see a lot more prominent malar and submalars than this on the random ones up there.
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