jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: earl25 on December 09, 2014, 07:01:27 PM
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Whether it be jaw+midface or just malar or just orbital rim whatever, I think members her need to band together and do a "manhatten project" styl coordinated search for doctors who will do this surgery It took me a year and a half to find a doctor willing to do the surgery. Most told me no way, others said yes by email then when I got there they said your deficiency isn't so bad why not try fat or filler. what I did was literally look u maxfax and cranio docs state by state (im in usa, research paper by research paper and either cold emailed or called them asing. If they said yes then I asked to send in photos and a ct scan for review. then I agreed to go in person. I think members here need to stop fighting about what the procedure is called, stop making posts like its a given you will get this surgery and actually take some action in finding doctors. I know how hard it is. Im also the only one I believe who had this surgery on the board (lefort iii with no jaw movement).
these surgeries are rare. most docs don't do them. most prefer filler, fat or implants. The ones who do normally only do it on extreme syndrome cases. Talking like its a given that you will have this surgery is like saying when I become a amous actor, or when I make the nba. its not so easy
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here here.
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I don't understand why it's not more common. People fracture their eye sockets all the time.
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I like this idea. I have spoken with a number of surgeons that suggested a high lefort I, but I'm not sure if that is considered midface surgery. It's kind of half midface surgery.
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there are plenty of korean plasty surgeons in korea who do midface surgery, actually the whole face, every day. they can totally change a face shape, actually a person's look that his/her parents can't even recognize. and almost all people post surgery in korea have a the same face. it just seems like they share the same parents.
you can find some japanese surgeons in japan who do face bone surgeries too. and i think they are better than korean surgeons. at least persons who have their face surgery done in japan don't look like each other.
i think surgeries that change bone structure should be the less the better, because it can fasten face aging process. there are plenty of korean actors and actresses who are experiencing fast aging problem now. they are just in early thirties, but their faces look really weir. chinese and japanese actors and actresses don't have this problem.
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i did email korean surgeries. they said they only do reductions not advancement
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i did email korean surgeries. they said they only do reductions not advancement
Bingo!
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Earl25 please help. Since midface surgery like modified LF3 or typical malar repositioniong are rare, did you surgeon show you before/after photos of previous patients who underwent the same procedure ?
I found surgeons who can do malar bone reposition , but one of them is not able to show me examples and do not know If I should rule him out or not... Should I demand such examples ? What was your approach , when I were looking for a proper surgeon ?
Does modified LF3 has risk of diploplia or enopthatlmos ?
Did you need orbital floor augumentation ?
Please answer. It's very important.
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no , I did not see before and afters from my surgeon.
I cant tell you to rule them out or not, that's up to you, but I will say I don't think you will be able to find a surgeon who can show you several before and after other than what was posted n this board, at best you'll get a few syndrome case examples.
my approach was
1) emails surgeon asking if he did lefort ii or iii
2) if yes, asked if I can send photos and conebeam
3)after review I asked if I can come in person
4)searched pubmed and online to verify the dr. did the surgery before
I don't know what diploplia or enophatlmos is
what do you mean by orbital floor augmentation
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earl25: Did the surgery you have with Sinn fix all the problems you had with the midface and orbital recession? I seem to recall you talking about wanting orbital decompression or something like that.
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Since midface surgery like modified LF3 or typical malar repositioniong are rare, did you surgeon show you before/after photos of previous patients who underwent the same procedure ?
The reason why surgeons can't show you before/after pictures is because there are patient data confidentiality laws in most countries. The surgeons in Germany seem to be allowed to show you before/after pictures while you're in their office, but in some countries like the UK then the surgeons are not allowed to share the pictures no matter what unless the patients have signed a consent form. Most patients do understandingly not want strangers to see their pictures so almost no one signs those.
The pictures of patients you see in research papers are from patients who most likely got the surgery for free on the condition that the surgeons were allowed to use the pictures.
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I don't know what diploplia or enophatlmos is
Double vision and eyeball displacement respectively.
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Earl25: I do the same like you did, + 1 thing I want to see before / after
and one of them invite me to show me that before / after.
If you did not see any of his previous cases, so how were you sure, this surgeon had done some modified LF3 before ? I mean if he were enough skilled to do this ? You just believed what he said ?
If you do not know anything about anopthalmos and diploplia, then it seems like even LF3 is more safe than whole malar reposition. :(
many surgeons show examples of their works on previous patients at least during consultation if they are really have something interesting on their credit.
The pictures of patients you see in research papers are from patients who most likely got the surgery for free on the condition that the surgeons were allowed to use the pictures.
eeee I also would like to have such option instead of paying a lot of Euros ;) No surgeon offered me this
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earl25: Did the surgery you have with Sinn fix all the problems you had with the midface and orbital recession? I seem to recall you talking about wanting orbital decompression or something like that.
it fixed my orbital rim issue. I pretty much look like me just without recessed orbital rims. my eyes still bug out but that's because I have a slew of midface issues including the upper orbits being too small.
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Double vision and eyeball displacement respectively.
double vision was mentioned, eyeball displacement wasnt
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Earl25: I do the same like you did, + 1 thing I want to see before / after
and one of them invite me to show me that before / after.
If you did not see any of his previous cases, so how were you sure, this surgeon had done some modified LF3 before ? I mean if he were enough skilled to do this ? You just believed what he said ?
If you do not know anything about anopthalmos and diploplia, then it seems like even LF3 is more safe than whole malar reposition. :(
many surgeons show examples of their works on previous patients at least during consultation if they are really have something interesting on their credit.
eeee I also would like to have such option instead of paying 20k E ;) No surgeon offered me this
Well I don't know what to tell you then.you need to decide how important this is to you, and what is your line. I also wanted before and afters but realized soon that wasn't gonna happen. heck just getting a dr. in the usa to even DISCUSS lefort iii or ii was a battle. I don't know where ur from but in the USA just mentioning a lefort iii will scare the heck out of a surgeon. they will throw you out. I kew my surgeon did them because
1) I was refered to him by another doc who said while he didn't do lefort iii my doctor does
2)I saw his name on published lefort iii papers
3)found some articles about how he did it on children, even poor ones for free as part of a charity org
40he gave me the most detailed info at the consult.
double ision was mentioned eyeball displacement wasn't. you also need to rmeber diff surgeons say different thing. I have emails and letter from TOP cranio and maxfax surgeries telling me how dangerus this surgery is and begging me to get fat or implants. its all relative. this isn't a nose job.
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so this basically means that your eyes bug on top, but on the bottom they should not since your zygoma and upper maxilla was pushed fowards.
And also, I would like to know where in bones exactly were cuts made.
my socket and structure overall is too small for my eyes
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Do you have that fabled S-curve now?
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so this basically means that your eyes bug on top, but on the bottom they should not since your zygoma and upper maxilla was pushed fowards.
And also, I would like to know where in bones exactly were cuts made.
i dont have the medical report. it was he orbital floor,side of orbit and orbit near th nose i beleive
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So in this surgery orbitals are not involved ? . Can you show me how this surgery looks like, I mean where the bones are cut .... just on a picture from Google images, or perhaps you can draw this on any skull ;) ? I mean draw a lines of cuts
I wonder how it looks like, because I completely do not see this.
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So in this surgery orbitals are not involved ? . Can you show me how this surgery looks like, I mean where the bones are cut .... just on a picture from Google images, or perhaps you can draw this on any skull ;) ? I mean draw a lines of cuts
I wonder how it looks like, because I completely do not see this.
the orbital rims are moved the entire complex is moved
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Earl, was your surgery able to achieve the S-curve in your face? Was the malar complex advanced sufficiently enough to give that protrusive sweep that goes out and comes back in towards the maxilla --you know what I'm talking about, right?
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So in this surgery orbitals are not involved ? . Can you show me how this surgery looks like, I mean where the bones are cut .... just on a picture from Google images, or perhaps you can draw this on any skull ;) ? I mean draw a lines of cuts
I wonder how it looks like, because I completely do not see this.
Rico,
search the aofoundation.org site. For example:
https://www.aofoundation.org/Structure/search-center/Pages/AOSearchResults.aspx?include=Top%2fsources%2fao+surgery+reference&k=le%20fort%20iII
https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=CMF&segment=Midface&Language=en
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Earl, was your surgery able to achieve the S-curve in your face? Was the malar complex advanced sufficiently enough to give that protrusive sweep that goes out and comes back in towards the maxilla --you know what I'm talking about, right?
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i have no idea what your referring to
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Prominent cheekbone and chin give the face a sort of S shape from this angle.
(http://i61.tinypic.com/awowhv.jpg)
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yes earl, sorry here you go, Mr. Fox has posted a good pic of what the S curve looks like from a three quarter angle, you can see how in this older lady above the cheekbone area swells out and then tapers in so that there she has a very strong positive vector under her eyes and then that curve tapers in and comes out again with the chin. I was wondering if you know have that kind of mound under your eyes now after the surgery?
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Earl25: I'm from Europe. And 50% of surgeons I ask can do this. But only one has documented this, and he can (probably) show me some examples.
and he is the most expensive as well.... (not including Swiss surgeons, too expensive for me)
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Earl25: I'm from Europe. And 50% of surgeons I ask can do this. But only one has documented this, and he can (probably) show me some examples.
and he is the most expensive also.... (not including Swiss surgeons, too expensive for me)
who do you like the most rico?
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Prominent cheekbone and chin give the face a sort of S shape from this angle.
(http://i61.tinypic.com/awowhv.jpg)
the picture doesn't come up on my computer
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could someone post the link for that pic so that earl can see it. this is important.
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Earl25: I'm from Europe. And 50% of surgeons I ask can do this. But only one has documented this, and he can (probably) show me some examples.
and he is the most expensive as well.... (not including Swiss surgeons, too expensive for me)
did you ask them in person? I don't know much about Europe dr.'s but I wont be shocked if when you get there majority say it no for you/ too intense. Even in usa I had a lot of initial email responses from dr. saying yes they do them.
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Ok if you google image search "carmen dell'orefice ogee curve" Lol then it's on the first page and the picture where she's on a magazine that says, "Madame".
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did you ask them in person? I don't know much about Europe dr.'s but I wont be shocked if when you get there majority say it no for you/ too intense. Even in usa I had a lot of initial email responses from dr. saying yes they do them.
Probably because Rico wants to fix a fracture that resulted from trauma. You did yours for cosmetic reasons. I just feel that most max facs equate "looks good" with "not obviously deformed".
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I sent the image to earl, and he can respond here if he wants.
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does the S shape come from zygo width or projection? Probably a bit of both I'd think. This picture that Rico posted looks like it'd create the S shape.
(http://i.imgur.com/qye7b2o.jpg)
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IMO, it's both plus tall vertical ramus.
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can you achieve this with surgery with sinn earl?
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i mean look at that guys cheekbones they keep his face from aging even though he's old and there's a real positive vector under his eyes. he has the perfect S-curve.
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Lazlo, answering to your qestions,
at this time, mostly it's Prof. Iannetti but also I consider Prof Pelo. Both seems very professional
but interesting is fact that 50% of surgeons tell me to not do this surgery (enophthalmos, diploplia risk, not easy to set this bone properly)
I have to be careful. Probably I'm gonna choose the one who will show me before / after of such procedures. and initially I know Iannetti is gonna show me, I'm waiting for his answer about last consultation before I make decision
I also bought his article about such surgeries. 77 cases (similar to mine) between 1977 - 1999 year. However it doesn't mean other surgeons do not perform it well, but how can I be sure if they are not able to show me such examples ? It's hard to trust without proof even if specific surgeon can be extremely good
I also think about Prof Goudot (France) and his new techniques of malar bone reposition, of course, if he will be able to show me before/ after photos.
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Lazlo, answering to your qestions,
at this time, mostly it's Prof. Iannetti but also I consider Prof Pelo. Both seems very professional
but interesting is fact that 50% of surgeons tell me to not do this surgery (enophthalmos, diploplia risk, not easy to set this bone properly)
I have to be careful. Probably I'm gonna choose the one who will show me before / after of such procedures. and initially I know Iannetti is gonna show me, I'm waiting for his answer about last consultation before I make decision
I also bought his article about such surgeries. 77 cases (similar to mine) between 1977 - 1999 year. However it doesn't mean other surgeons do not perform it well, but how can I be sure if they are not able to show me such examples ? It's hard to trust without proof even if specific surgeon can be extremely good
I also think about Prof Goudot (France) and his new techniques of malar bone reposition, of course, if he will be able to show me before/ after photos.
Cool if he you can show pics here please post when you get them. If Ianetti has done it 77 times that's A LOT, means he has some real experience.
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Nope . it has done by his team in university , do not know how much he done personally...you know by his hands
keep in mind that 77 cases between 1977 and 1999 , now even more. Overlooked malar fracture, or improperly set.
He cannot send me, he can show me during consultation. But I'm waiting for the answer. Since he is not cheap I was little picky in my last mail, so it is not obvious that invitation is still valid :P we will see. But I will give you very good description if he shows me.
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Terry: I showed example of malar bone reposition. Where the bone must be cut to do this. When you mobilise the whole bone, then you can set it as you need, but having in mind, that enough significant changes in volume orbit will be catastrophic. This is why most surgeon do not do this in mild cases like mine. Anywhay , this is osteotomy surgery typical for similar cases including mine...when malar fracture was overlooked or improperly set during first treatment. In more severe cases may rather be only improperly set. It is almost impossible to overlook , because big malar displacement may block the jaw (you can;t open mouth in full range or at all), you may have double vision, and post truama enopthalmos (sunken of the eye)
I think noone overlook that he can;t open his mouth or got double vision ;)
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Earl25: Did your surgeon use any navigation system to put the zygomatic bone (after osteotomy) in the very right position ? There are plenty of researches which show, that navigation system is very helpful because it decrease the risk of postop and late enopthalmos (sunken eye) and diploplia (double vision) . I wonder if this is really true
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Earl25: Did your surgeon use any navigation system to put the zygomatic bone (after osteotomy) in the very right position ? There are plenty of researches which show, that navigation system is very helpful because it decrease the risk of postop and late enopthalmos (sunken eye) and diploplia (double vision) . I wonder if this is really true
You mean surgical guides?
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Earl25: Did your surgeon use any navigation system to put the zygomatic bone (after osteotomy) in the very right position ? There are plenty of researches which show, that navigation system is very helpful because it decrease the risk of postop and late enopthalmos (sunken eye) and diploplia (double vision) . I wonder if this is really true
to my knowledge he didnt
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PloskoPlus: some surgeons use navigation system ( it's not GPS :P ) to put the bone in right position in order to achieve very good precision, like +/- 0.5mm . Prof Goudot from France additionally do some pre-bore (or something like that) before he install proper miniplate stabilised by screws. He claims it gives him +/- 0.2mm precision
I mean precision related to the model (plan)
Precision is important when it comes to reposition of the zygomatic bone to prevent from enopthlamos and diploplia. Of course such extremely good precision is not required 0.5mm is enough (1mm probably too) ;) unfortunately I do not know any patient after computer assited midface correction. It can be useful also for jaw surgery. Generally it is important for planning. Surgeon first use 3D model to determine how to cut the bone exactly and after that how to move this bone (also by using navigation system). Everything according to the plan. Bad plan = botched surgery.
Something like this
(http://ehealth.eletsonline.com/wp-content/uploads/2012/10/navigation-surgery1.jpg)
Of course there are many surgical navigation systems
BTW I reminded myself about following reserach for midface correction
https://www.researchgate.net/publication/49646858_Zygomatic_sagittal_split_osteotomy_a_novel_and_simple_surgical_technique_for_use_in_midface_corrections
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Earl25: Please tell me, where you had incision on the face (skin incisions) during your modified LF3 surgery ?
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Earl25: Please tell me, where you had incision on the face (skin incisions) during your modified LF3 surgery ?
the only cisible incision is right in the middle of the outer eyelids
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I meant all, not only visible. Only there ? only on the lower eyelids on both sides ? even not on the eyebrow ?
btw how you feel about your visible scars after that ? doesn't it look strange ?
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Found this:
http://www.ncbi.nlm.nih.gov/pubmed/23351774 (ftp://www.ncbi.nlm.nih.gov/pubmed/23351774)
Has anyone else seen it? If this is the case, wouldn't the fear of going blind or having complications be reduced significantly?
I wish there were more info. on this- very aggravating.
Also, about the LF3: wouldn't this advancement leave the supraorbital foramen/browridge and forehead to look or become recessed?
The non-syndrome cases I've seen were all class III. For whatever reason most class IIIs have robust brow ridges. Some (like me) have sloped foreheads however (or maybe the recessed forehead makes the brow ridge look strong).
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you can always end up blind or with enophtlamos, double vision when you touch orbital structure. However blindness it very rare ....and mostly several hours postop due to some hematome in the orbit, other complications also rare but it may happen.
I had fractured orbital floor and laterall wall and even did not feel it :) no problem with eye
but after fracture (especially mild) eventually swelling / hematoma is milder than after surgery
if you would like to feel safe about this, you have to stop thinking about surgery
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what a stupid commercial before / after. Don't look a that. Take another realistic examples