jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: hellohello on September 24, 2015, 09:53:08 PM
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I had a zygomatic osteotomy. The surgical procedure was invasive; the swelling was around for the longest of time and socially isolating, yet the augmentation underwhelming. I'm not sure if I'd want to undergo another zygomatic osteotomy since I would not want to be shut off from friends for such a long time again and the first zygomatic osteotomy was expensive. But the result is really not what was anticipated and I'm unhappy :(.
Did anyone get a zygomatic osteotomy revision? If so, was the revision as invasive as the original surgery? Did it pose additional risks? I'm worried a revision might bring extra risks. Perhaps breaking the bone twice makes it more prone to break/fracture, or might cause additional bone absorption.
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I had a zygomatic osteotomy. The surgical procedure was invasive; the swelling was around for the longest of time and socially isolating, yet the augmentation underwhelming. I'm not sure if I'd want to undergo another zygomatic osteotomy since I would not want to be shut off from friends for such a long time again and the first zygomatic osteotomy was expensive. But the result is really not what was anticipated and I'm unhappy :(.
Did anyone get a zygomatic osteotomy revision? If so, was the revision as invasive as the original surgery? Did it pose additional risks? I'm worried a revision might bring extra risks. Perhaps breaking the bone twice makes it more prone to break/fracture, or might cause additional bone absorption.
Can't answer your question but look into lymphatic drainage. Apparently it helps a lot with swelling.
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lymphatic drainage is just simple massage ? of course made by professionalist ?
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Can't answer your question but look into lymphatic drainage. Apparently it helps a lot with swelling.
Thanks Optimistic, will look into that. Might I opt for revision it might be helpful.
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hellohello: Could you tell me how you chose your surgeon ? Does he has a lot of good opinions ? have you seen examples of his work, or even have you talked to some of his patient ?
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Thanks Facenit. I'm sorry but who is "MM"?
I will look into Triaca too, thanks.
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MM = Maurice Mommaerts. I personally have only seen one of his patients results. That patient is a forum member here that I skyped with that did not get the result he had hoped for.
ZO's seem to be tricky. In other threads, it has been mentioned that how happy you are with your result may depend on the bone structure you start with as they are simply moving that bone to increase lateral projection.
Thanks, FaceNit.
Zygomatic osteotomy does seem to be tricky. However the discrepancy between what was anticipated preoperatively and what I now have, is what surprises me.
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Can you perhaps be a bit more specific about what you were expecting and what you ended up with?
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I had the zygomatic sandwich osteotomy to get decent augmentation of the zygomatic bone.
There is augmentation, however it is low: far away from the orbit at the lower cheek. So ultimately the procedure gave some fullness of the lower cheeks, and that is certainly not what was anticipated.
I do realize the cut through the bone is made away from the orbit and that you can't expect augmentation of the orbit with the sandwich osteotomy (and I did not need augmentation of the orbital rim). However, I did not realize the sandwich osteotomy would give the aesthetic result of having some fullness at the lower cheeks.
I read some posts elsewhere on the forum: in these posts it was said that if you have low cheekbones naturally, this procedure won't miraculously give you high cheekbones. I do comprehend. However scans show I have a small zygomatic bone, so I would expect that not to be the issue.
I feel the culprit is that the cut is made so far away from the orbit, that there is no possible way to get that high projected cheekbone. I asked in anticipation of surgery where the augmentation would be laterally from the canthus. I was told 1 cm away from the canthus. But there is no augmentation 1 cm laterally from the canthus or 1 cm below the canthus: there is no augmention 2 cm laterally from the canthus either, neither 2cm below the canthus. There is augmentation somewhere below that: on the lower cheek. So the procedure gives fullness on the lower cheek, but not what could be considered high cheekbones. As mentioned: this is not what was anticipated.
I emailed a plastic/maxillofacial surgeon with pictures and he said it is the nature of the zygomatic sandwich osteotomy and the cuts made for this procedure. That is what I think too in hindsight. I just wish I had known this before.
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is this the type of cut you got (A)?
(http://oi60.tinypic.com/k02f5v.jpg)
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The cut Dr. Zarrinbal showed me before surgery was certainly not like A. It was in between A and B (the position of the nerve is reason he doesn't get too close to the orbital rim in general).
Judging where the current augmentation is, it appears to me that the cut was made like line B however.
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PSs seem like a scummy (and scammy) lot in general. This isn't slander - they prove this everyday on real self.
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PSs seem like a scummy (and scammy) lot in general. This isn't slander - they prove this everyday on real self.
Plosko,
Some observations about that comment:
1) Unless I am mistaken, this was a max/fac surgery, not done by a plastic surgeon. (Right ?) Most max/facs are not plastic surgeons. Very very few jaw surgeons are also actually board certified plastic surgeons.
2) Almost all doctors, lawyers, accountants, and other professionals are reluctant to directly criticize the earlier work of others- - for the simple reason that such criticism often ends up causing them to be involved as a witness in a malpractice case.
3) The good ones will tell patients (or clients) when they have suffered a legitimate significant adverse outcome as a result of earlier sub-standard care.
I just counted up. I think over the last 10 years, I am personally acquainted with the work and reputation of six different plastic surgeons. All of them are good and good at what they do. Regardless of what you may see on TV reality shows, none of the ones I know deserve the general characterization you put forth.
However, in my experience, it is normally true of almost any profession in any community that if you could eliminate the work of about 10 % of those individuals - - you would eliminate about 90% of the problems in that professional category.
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PloskoPlus is replying to Facenit's comments about plastic surgeons (commenting at www.realself.com) and certainly not referring to the surgeon that performed my surgery (that indeed is a maxillofacial surgeon), it appears, Bobbit.
Thanks Facenit for the comprehensive reply. I will want to reply to it, but not a lot of time currently.
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I was referring to the multitude of PSs advising obviously recessed people on real self to get rhino and chin implants. This makes them either fools or liars. Neither reflects well on the industry.
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I was referring to the multitude of PSs advising obviously recessed people on real self to get rhino and chin implants. This makes them either fools or liars. Neither reflects well on the industry.
Kinda have to agree w/ Plosko and Facenit on this one. It's a shifty profession intrinsically. Surgeons cut whether it's needed or not.
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I was referring to the multitude of PSs advising obviously recessed people on real self to get rhino and chin implants. This makes them either fools or liars. Neither reflects well on the industry.
Plosko ( & Lazlo ) ,
Sorry - - Plosko, my mistake. I took your comment as a general broad side at all plastic surgeons. I have not spent any significant time at the real self location - - but if surgeons are making those kinds of recommendations - - then that does not reflect well on those surgeons.
One thought - - one needs to be careful because there are also "surgeons" who show up on a lot of lists like that and claim to be Plastic Surgeons - - but they are really only something much less in terms of training and skill sets - - when you look carefully at their web sites or they otherwise get pressed on the issue, they then fall back and say they are really "cosmetic surgeons" but they are just as good doing cosmetic surgery as real plastic surgeons because they did not waste a lot of time in training learning to fix hands and jaws and trauma and learning to take care of burn patients, etc.
[ Apparently, there is a racetrack program for people to do a one-year general surgery residence gig and then a one-year "fellowship" in cosmetic surgery at a non accredited program somewhere - - and then claim they are "cosmetic surgeons" and therefore they are instantly as well trained to do cosmetic surgery (noses and chin implants, for example) as board certified plastic surgeons who spent 7 or 8 or 9 years in training. It is possible that is where a lot of those kinds of recommendations come from.]
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Any MD can claim to be a "cosmetic surgeon" or "cosmetic specialist". You have to look for "plastic surgeon," that's a craniofacial surgeon --they can do jaw surgery any time of skull surgery --but that still doesn't mean they're good.
As I said before most surgeons will push ahead with what they can do on you whether it's needed or not. I could go to a cosmetic surgeon who only does maybe nosejobs and facelifts and say "meh meh blah blah my face is saggy and doesn't have good angles." And thy might recommend a facelift to tighten the soft tissue, or little implants that will look like crap, cause they don't know how to change the bones or skull. And they I'll end up looking like a mugwump gism cause I didn't know any better and the surgeon will be like "you look fine, you asked for the procedure!"
This is what I mean by they're intrinsically shifty people.
No surgeon or very few will be like "no you don't need what I know how to do, you need a jaw surgery with a maxillofacial surgeon," or something like that. I've now seen many, many cosmetic and plastic surgeons and they always just say "no it's not possible" if you ask for something they don't know how to do. Even Arnett and Gunson, asked them about cheekbones. They actually told me "no that can't be done it's too unstable, we do HA Paste that will give you the higher cheekbones don't worry," and of course that is bulls**t. So you have to be in control of your own self and your own surgery. research, research, research more, and then finally takee th plunge. Risk is unavoidable.
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Any MD can claim to be a "cosmetic surgeon" or "cosmetic specialist". You have to look for "plastic surgeon," that's a craniofacial surgeon --they can do jaw surgery any time of skull surgery --but that still doesn't mean they're good.
. . . I've now seen many, many cosmetic and plastic surgeons and they always just say "no it's not possible" if you ask for something they don't know how to do. Even Arnett and Gunson, asked them about cheekbones. They actually told me "no that can't be done it's too unstable, we do HA Paste that will give you the higher cheekbones don't worry," and of course that is bulls**t. So you have to be in control of your own self and your own surgery. research, research, research more, and then finally takee th plunge. Risk is unavoidable.
Correct me if I am wrong, but Arnett & Gunson are not plastic surgeons. And, they are not craniofacial surgeons. Neither is Sinn - - right ?
So sure - - their options for doing surgery to meet your specific needs may be limited.
OTOH - - none of them should tell you "something can't be done" merely because they do not do that procedure. They should know better.
Because you have studied the heck out of this subject, this likely does not apply to your situation, but, for many patients, I suspect that sometimes it is a fine line between hearing something like:
" That procedure can't be done but I have an alternative that I do routinely that will fix you right up the way you want."
opposed to something like
"While I do not do that procedure, I am very familiar with that procedure and it is not appropriate for your needs - -"
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Sinn is also a craniofacial surgeon.
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Sinn is also a craniofacial surgeon.
Plosko,
Looked again at his web site, Dr. Sinn is very well qualified and very experienced as a maxillofacial surgeon. And from his list of publications, he has done a lot of work with other craniofacial surgeons that did involve various craniofacial procedures. However, he is trained as a dentist. Without a medical degree and a subsequently completed surgical residency, it is unlikely that he could acquire privileges at a hospital to be lead surgeon on a major craniofacial case - - unless it was a surgery that was clearly limited to only involve work in or about the jaws.
Unless I missed it somewhere, he does not explicitly claim to be or to be trained as a craniofacial surgeon anywhere I could find on his web site.
Apparently very good at what he does.
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I think you're right about Sinns qualifications. But he has published chapters on craniofacial syndromes and regularly treats them. He does box osteotomies. How much more craniofacial does it get? Many so called craniofacial plastic surgeons have never done anything more complicated than a rhinoplasty.
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Since taught Arnett and Schendel. I know about his qualifications. His supreme focus is specifically jaw surgery. He's an exception to the qualification thing cause he's a guy who basically was one of the inventors in the field.
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Since taught Arnett and Schendel. I know about his qualifications. His supreme focus is specifically jaw surgery. He's an exception to the qualification thing cause he's a guy who basically was one of the inventors in the field.
Pretty much this. My surgeon learned orthognathic surgery from his book - one of the first on the subject. Dallas is where they first combined orthognathic surgery with braces.
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I think you're right about Sinns qualifications. But he has published chapters on craniofacial syndromes and regularly treats them. He does box osteotomies. How much more craniofacial does it get? Many so called craniofacial plastic surgeons have never done anything more complicated than a rhinoplasty.
The box osteotomies or the later derivatives of those are part of the big surgeries in the tool box. I did not see anywhere on his web site any suggestion that he did those, but if he is doing that type of work as the lead surgeon on those, then that is certainly part of the tool set of craniofacial surgeons. Other than massive trauma, the big surgeries that the craniofacial surgeons do include surgeries where they re-model the entire skull (not just the orbital areas) to correct deformities and or to increase the skull volume to allow brain growth in infants and small children.
It is my understanding that all plastic surgery training programs give some exposure to the craniofacial procedures - - but the only ones that are actually qualified as craniofacial surgeons and could get hospital privileges to do those surgeries are the ones that (after finishing their full 5 or 6 year surgery-plastic surgery training) then also find a traditional full one year fellowship program devoted to craniofacial surgery that is sanctioned by one of the medical education supervisory groups. (You probably know this, but for others, google up Paul Tessier and maybe Daniel Marchac ) and read Tessier's history to get an idea of how complex those surgeries can be. Pretty sure that it is generally true that very nearly every single surgeon in the world today that legitimately claims to be a craniofacial surgeon was trained by Tessier (or Marchac,) or else trained directly by someone that had previously themselves been trained by either Tessier or Marchac. More of them probably trace back to Tessier.
( read a biography of Tessier a couple of years ago. Fascinating what he had to go through to learn how to do those. )
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When you're dealing with Wolford, Sinn etc. normal rules don't apply. These guys are the pioneers. They could do craniofacial surgery or almost any surgery in their sleep. Like Arnett they are in the category of "supersurgeon". It's the young MD's who have maybe a year of surgery experience that suddenly start providing every cosmetic surgery under the sun who are scumbags.
Yeah Dallas has a huge craniofacial institutte where the most advanced things are done. It's where every ortho and surgeon goes to learn. Also maxillofacial surgeons specialize in jaws but they can do any craniofacial surgery as they are trained in treating and maxillofacial trauma eg. cheebones, cleft palate etc.
So like Sinn can do nosejobs, and he suggested, but I know there are surgeons who only do rhinoplasties --I'm more likely to go with one of those eg. Dr. Guyron, Dr. Gregroyantis, etc. just cause that's all they do and have developed procedures for those areas.
Anyway, Sinn is definitely the boss.
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FaceNit was spot on in one of her previous posts.
I don't have maxillary retrusion. However, most often recession is not just limited to part of the (lower) midface. If the lower part of the zygomatic bone is recessed; often the upper part of the zygomatic bone doesn't have strong projection either. If you have a recessed lower zygomatic bone, then most likely that recession extends upwards towards the inferior orbital rim, and/or it is not unlikely that the medial and lateral inferior orbital rim would be partly recessed to. In my case: the lateral part of the zygoma above the malar prominence is recessed, as is the lateral inferior orbital rim.
In general, to get 'high cheekbones' not just the lower part of the zygomatic bone should be addressed (unless the upper part has strong projection naturally). And the zygomatic sandwich osteotomy augments only the lower part of the zygomatic bone. If you look at the cuts made for the zygomatic sandwich osteotomy, you can see only the lower part of the zygomatic bone is moved. Not the upper part of the zygomatic bone (extending towrds the inferior orbital rim, and/or the inferior orbital rim itself).
Reading a bit up on the forum, sometimes it is suggested to get a zygomatic sandwich osteotomy to get strong, high cheekbones. However the zygomatic sandwich osteotomy will not yield that aesthetic result of high cheekbones, unless you already have strong projection above the malar prominence towards the inferior orbital rim (and strong medial and lateral orbital rims) naturally. (Which is not at all that likely if the lower zygomatic bone is recessed. Since, as written above: if you have recessed lower zygomatic bones, most likely you will have some recession of a bigger part of the zygomatic bone, such as the upper part of the zygomatic bone extending towards the inferior orbital rims, and/or along the orbital rims themselves).
If you are hoping to get some augmentation of the lower part of the zygomatic bone: the zygomatic sandwich osteotomy can give you some extra width and (limited) forward projection at the lower part of the zygomatic bone.
A member here underwent a lefort iii (Earl). He wrote several times the lefort i does not address the inferior orbital rim; and neither does the zygomatic sandwich osteotomy. He was absolutely right. The procedure that does address the lateral and medial inferior orbital rim, as well as the area above the malar prominence exending into the inferior orbital rim, is the (modified) lefort iii he underwent.
Rico wrote the same thing. That the zygomatic sandwich osteotomy does not address the area extending into the inferior orbital rim. You would need a different type of zygomatic osteotomy (or a (modified) lefort iii) to address that area. Some zygomatic osteotomies address the area extending towards the inferior orbital rim. However, as mentioned the zygomatic sandwich osteotomy addresses only the lower part of the zygomatic bone, and the cuts made for this type of osteotomy illustrate exactly that.
In my case 'high cheekbones' were the anticipated results. In general I don't have a deformed result or even a bad looking result. I just have augmentation/fullness of the lower part of the zygomatic bone. The upper part of the zygomatic bone, extending towards the inferior orbital rim is still recessed. (In my case mostly the lateral part, since medially I had good projection naturally/from myself). This looks like lower cheekbones rather than high cheekbones, and it is not what was anticipated. As mentioned I am unhappy.
A revision would be complex, since if I were to somehow address a broader part of the zygomatic bone with a different type of zygomatic osteotomy than the sandwich osteotomy, I now might end up with an overprojected lower zygomatic bone. Which might look awkward. After all the lower part of the zygomatic bone was aready augmented with the sandwich osteotomy and if I were to augment a bigger part of the zygomatic bone (as I would have liked in the first place), that same lower part of the zygomatic bone would be augmented once again. (Unless I would have the zygomatic sandwich osteotomy revised while getting a different zygomatic osteotomy, but that would be very complex revision and probably not worth the risk for me).
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All in all, if high strong cheekbones is what you are aiming for, it might be best to take the limitations of the zygomatic sandwich osteotomy into consideration and decide whether you might need a different type of osteotomy that augments a bigger part of the zygomatic bone.
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When you're dealing with Wolford, Sinn etc. normal rules don't apply. These guys are the pioneers. They could do craniofacial surgery or almost any surgery in their sleep. Like Arnett they are in the category of "supersurgeon".
They are very good maxillofacial surgeons. Top of their fields. Possibly/likely pioneers in some aspects of maxillofacial jaw surgery (although almost all of those jaw surgery procedures discussed here were developed by Hugo Obwegeser in Switzerland well before they finished their training.)
Their specialty involves jaw surgery and related issues. Neither has completed a plastic surgery residency, a common requirement to be a craniofacial surgeon. Ultimately, neither one of those two very well trained and experienced surgical dentists/oral surgeons begin to qualify as “the pioneers” in the broader field of craniofacial surgery.
Pioneers in craniofacial surgery: In the 1970s and 1980s, somewhat before their time, the pioneers in craniofacial surgery were in France. Started by Tessier. He appears to have collaborated to some extent with Hugo Obwegeser. Later, Daniel Marchac started doing similar surgeries independently of Tessier. The first American to figure out that there was a developing new field of surgery and to then go over to Paris (1973) and become trained by Dr. Tessier was Douglas Ousterhout (later UCSF) . Others followed, including Henry Kawamoto, (later UC Los Angeles), Anthony Wolf, (Miami), Arlen Denny, (U Wisconsin, Milwaukee) (total of about 6 US surgeons) (Note: some caution. A number of US surgeons went over to Paris to Tessier’s to be “surgical observers” for brief periods - - but they were not “fellows” doing a full one year training program. Others who observed Tessier operate in the US. Some of those have made claims they were “trained” by Tessier.) [Primary source: Anthony Wolf - Tessier’s biographer. Good read.]
See: www.ascfs.org
“Craniofacial surgery is a sub-specialty of plastic surgery. It traces its beginnings to a group of surgeons who were interested in the treatment of birth defects in children involving the skull and face. In the late 1960's, Dr. Paul Tessier from Paris, France, reported on techniques he had developed to treat children with rare birth defects. Following these initial reports, many surgeons from around the world traveled to Paris to learn these new procedures.”
Neither of the very good maxillofacial surgeons you identified as “pioneers” in the field of craniofacial surgery are eligible for membership in the American Society of Craniofacial Surgery.
Again - - this is not meant to be critical in any way. First class surgeons. Just history.
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I know the entire history of craniofacial surgery and know Tessier and his pioneering work quite well. And everything you're saying is accurate as far as credentials go. But I know for a fact that Kawamoto who is arguably the most notable craniofacial surgeon in America, would not perform zygomatic or orbital rim or modified leforts on ANY patients for cosmetic purposes. I know this because I talked to his nurses several times and was recommended that Kawamoto would do implants only. So big deal if someone has all this training and a designation but doesn't feel competent or trained enough or whatever the reason may be to perform the operation.
Dr. Mark Urata, Kawamoto's most distinguished pupil both a craniofacial surgeon AND a maxillofacial surgeon also doesn't perform and orbital/cheekbone modified lefort operations for cosmetic purposes.
On the other hand, Eugene Keller (NOT A CRANIOFACIAL SURGEON) developed and practiced successful modified leforts that include the zygoma and orbital rim throughout his career.
So while yes a craniofacial designation takes a ton of training and specialization, it doesn't necessarily mean the surgeon is competent enough or willing enough or has experience in the cosmetic or plastic surgery area for most non-syndrome, non-infant (which is the type of surgery most craniofacial surgeons do) population. I too was at first very taken with the whole craniofacial designation and consulted with surgeons who had both this PS designation as well as max fac backgrounds and found some of them to be thoroughly incompetent. Won't mention names.
So I now am more interested in how many cosmetic cases a surgeon has performed, what his or her reputation might be and what professional colleagues and patients think of the surgeon in question. Also, with what regularity does the surgeon in question perform the specific surgery I'm interested in.
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All in all, if high strong cheekbones is what you are aiming for, it might be best to take the limitations of the zygomatic sandwich osteotomy into consideration and decide whether you might need a different type of osteotomy that augments a bigger part of the zygomatic bone.
Triaca says zso will create more lateral projection. THAT'S ALL. No anterior projection, not higher cheekbones.
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Agree with lazlo. Credentials are just that at the end of the day - credentials. Lots of credentialed nobodies out there, medicine is not immune to title inflation.
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OP, thank you for the valuable information and thoughts on the ZSO. You may have saved some people from making the wrong decision by putting information out there that surgeons might not tell patients that are contemplating a ZSO.
Agreed
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OP, thank you for the valuable information and thoughts on the ZSO. You may have saved some people from making the wrong decision by putting information out there that surgeons might not tell patients that are contemplating a ZSO.
Alas, seems like too many doctors will only recommend the stuff they know. "When all you have is a hammer".
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But I know for a fact that Kawamoto who is arguably the most notable craniofacial surgeon in America, would not perform zygomatic or orbital rim or modified leforts on ANY patients for cosmetic purposes. I know this because I talked to his nurses several times and was recommended that Kawamoto would do implants only. So big deal if someone has all this training and a designation but doesn't feel competent or trained enough or whatever the reason may be to perform the operation.
Dr. Mark Urata, Kawamoto's most distinguished pupil both a craniofacial surgeon AND a maxillofacial surgeon also doesn't perform and orbital/cheekbone modified lefort operations for cosmetic purposes.
I understand your desire to obtain a specific surgical procedure.
Consider the possibility that the highly trained and experienced surgeons you referenced, - - declined to do the specific cosmetic procedure you are seeking - - not because they cannot do that procedure (obviously they do in fact do those procedures in the right circumstances) but they elect not to do that procedure electively because in their experience the benefits are exceeded by the risks. (That is one way to avoid a malpractice suit.)
In any field of human activity, including surgery, - - just because you can do something - - does not mean you should do something.
It puzzles me that in some of these messages:
A) Posters first claim that surgeons are (pick the ugly name to be called) - - because they are not trained well enough but just start cutting on people to make the money; but then,
B) In nearby messages, surgeons who are extremely well trained and capable but who decline to do certain well paid elective procedures are criticized for exercising conscientious surgical judgment and refusing to do certain surgeries.
There is a certain disconnect between those two lines of discussion.
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Because complex osteotomies are HARD and time consuming. Why do them when you can make more money doing quick fillers and fat grafts.
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Because complex osteotomies are HARD and time consuming. Why do them when you can make more money doing quick fillers and fat grafts.
I do not think that money / time is the reason. On the contrary.
They are hard and they are time consuming procedures - - But that is what surgeons get paid big dollars for doing - - long operations in the operating room.
Most surgeons make a lot more money in the OR with elective procedures than they do with fillers. What ? A & G get $50 + K for a double jaw surgery that takes 5 hours ? If that is not about the right number, then what is ?
Not being critical of the amount - - however it appears that is the ~ $/hour range they are getting paid for their elective operating work.
(I think fat grafts end up being an art form. Harder to get right than most anticipate. )
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Again, somebody double check my math:
Filler about $300 wholesale for a 2pack of syringes.
Average two syringes per patient treatment
Docs charge about 500 per syringe = $1K per treatment
Profit = 1,000 – 300 = $700 profit per treatment
Estimate 10minutes injecting time (not sure on this, someone correct me if time is not right)
5 patients per day x 5 days per week = 25 treatments per week
4.25 weeks per month * 25 treatments per week = 106.25 treatments per month
106.25 treatments per month * $700 = $74,375 profit per month
106.25 * 10 minutes = 1,062.5 minutes = 17.7 hours doctor hours
Average $700 profit per 10 minutes = $4,200 per hour
The problem with all of those injectables is that almost any medical person can do those - - and thus - - the surgeon doesn't control that market. In many of the offices that offer those - - they are done by nurses or nurse practioners with no supervision.
I do not think that has a lot to do with our discussion of osteotomies.
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No, it doesn't and I apologize if I came across as abrasive. I wondered when I saw the discussion in the thread of why docs are moving from the hard surgeries to fillers and decided to do the math. I am still double-checking it, it seems unreal.
Botox$ 487.50 (= 3 minutes) + Filler $700 (= 10 minutes)
= $1187.50 every 13 minutes
60 minutes per hour /13 minutes per treatment = 4.615 treatments per hour
= $5480.76 per hour
Or even if appointments were scheduled every 15 minutes a doc could make $4750 per hour if he/she had a good assistant setting the patients up. I am sure the risk of malpractice is less with injectables than surgeries. No nurses or anesthesiologist or sterile operating room fees.
It explains why all the sleezeballs are pushing injectables.
$4750 per hour x 8 hours = $38,000 profit.
I am sure those surgeries take the surgeon's time planning them, too. I bet they really do make more on injectables.
If you are right - - then no surgeon would bother to do any surgery. They would spend all their time doing injectables.
But since nurses do injectables in general practitioners' offices - - the competition for the patients in that market is pretty extreme.
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Fillers also have less risk of going wrong. If somehow the procedure goes awry, you can just wait for the stuff to get reabsorbed, or make it dissolve with another substance etc, but if the bone is moved, then it's moved, and you'd have to go in there again and try and fix it, or maybe you've damaged a nerve, or there's an infection etc...seems quite clear cut to me
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Bobbit, you just assume that surgeons are not doing a particular surgery because they're exercising judicious decision making. That's BS. They just don't want to do them cause they're tough and they can make way more money doing implants and injectibles which take way less time and are quick and easy solutions. Bobbit, it is true. Why do you think not only every surgeon, but every bloody GP on the earth now offers fillers and botox.
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Bobbit, you just assume that surgeons are not doing a particular surgery because they're exercising judicious decision making. That's BS. They just don't want to do them cause they're tough and they can make way more money doing implants and injectibles which take way less time and are quick and easy solutions. Bobbit, it is true. Why do you think not only every surgeon, but every bloody GP on the earth now offers fillers and botox.
Lazlo:
Do some surgeons do what you claim is the norm ? Probably.
I have a working knowledge of the practice of about half a dozen board certified plastic surgeons. A couple of them share a common hobby and we therefore socialize from time to time. None of them make a living doing injectables. A few of them have nurses or P.A.'s on their staff who do injectables for a limited number of patients. I think that is done because it does bring a population of prospective future facelift patients to their offices. Occasionally the patient will insist on a doctor to do the injectables. In those few cases, if the surgeon is available, he or she may do that. But personally doing injectables is relatively rare in the case of every one of the surgeons with whom I have some familiarity about the nature of their practices. So, from my perspective, I am about zero for six that fit your descriptions of what you claim is the norm.
But ultimately I am with Facenit on this - - enough about injectables !
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Does anyone know which surgeons perform a different type of zygomatic osteotomy that also covers at least part of the upper zygomatic bone towards the inferior orbital rim? (So not the zygomatic sandwich osteotomy that I feel as mentioned does nothing for the upper zygomatic bone).
Rico wrote to seek a surgeon that performs a zygomatic osteotomy that covers (part of the) upper zygomatic bone and in his case the inferior orbital rim: which surgeons did he consult with that perform such an osteotomy?
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There is a reason most surgeons don't want to mess with your infraorbital bone.
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Does anyone know which surgeons perform a different type of zygomatic osteotomy that also covers at least part of the upper zygomatic bone towards the inferior orbital rim? (So not the zygomatic sandwich osteotomy that I feel as mentioned does nothing for the upper zygomatic bone).
Rico wrote to seek a surgeon that performs a zygomatic osteotomy that covers (part of the) upper zygomatic bone and in his case the inferior orbital rim: which surgeons did he consult with that perform such an osteotomy?
Sinn, Woford, probably some others in Dallas. Dallas is a hotbed for aggressive osteotomies.
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OP, my consultation with Dr. Zarrinbal was kind of interesting. We talked about bimax surgery, chin wing and ZSO. I mentioned your case and that you weren't happy with the result but he couldn't remember you. Are you italian? Anyway, he showed me ZSO and chin wing patients of him, many of them. The male ZSO results did infact look like you described; it seems to augment the lower part of the cheek, giving it a fuller convex type of shape instead of a more high angular look many desire.
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This is not good form.
nah, he was asking me why i suddenly didn't want to get the ZSO so i told him the truth about OP not being happy with the result, making me not wanting it.
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Lets be real here : I had a consult with Zarrinbal before about this surgery, He showed me exactly where the cut was made, and a pictures of results, etc. I did not choose Zarrinbal in the end, and still had the same operation with another surgeon, I think to suggest that OP was somehow scammed into it is really stretching it, but he just confirms the importance of this forum, and that we all need to do our research, and that there is no "turn me into a model" surgery out there.
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Yeah, I think it's a bit uncool to use me and my post here as a tool to communicate your concerns to the surgeon. You could have intensified your own research using the information I gave here if you felt what I am discussing might be a concern for you too; and you could have used that information and your own research to ask the surgeon yourself about the concerns you have (and whether the zyg. sandwich osteotomy could give you the result you desire) instead of referring to me.
Since this post was not about my surgeon and I did not question his competence. (In fact I didn't even remember I mentioned his name and had to search through the topic to see if and where his name was even mentioned). This post was intended to be an informative post about the zygomatic sandwich osteotomy, and how I feel it can not yield the result some members here seem to think. Describing why I feel it can not, and using my own result as an example for that. In the process hoping to find some answers myself too about other osteotomies or options and surgeons that perform different types of osteotomies.
Also since some members seem to think this procedure can give high cheekbones as seen in some male models, whereas the cut for the zygomatic sandwich osteotomy is over the lower part of the zygomatic bone. The upper part of the zygomatic bone is not fractured and thus you will get some fullness of the lower part of the cheekbone, not the higher part/the part above the malar prominence extending into the inferior orbital rim. Not the high or masculine cheekbone most of us seem to aim for.
If you can't make a post without risking the surgeon is informed whereas you didn't even write about him in the first place, that is not so cool. I doubt anyone would feel comfortable to write anything about their surgery result this way. If I would have said anything about the competence of the surgeon, it would be a different story. But my post focuses on the zygomatic sandwich osteotomy.
That being said, I am not happy with the result but I will stay clear from posting about it. Whereas NCharm writes that it was clear for her where the cuts were made and that only the lower cheek would get fullness, that was not nearly so clear-cut for me. And ending up with some fullness at the lower cheek was certainly not what was anticipated as a result of my surgery.
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Send him a PM to get the surgeon's names.
Thanks, I will do so.
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Okay, I've been looking into a surgery called the "lamellar split osteotomy," which apparently tons of models have had and it looks excellent, gives the high cheekbone look. Who can find out more about it? I have some good inside sources that say it delivers.
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Okay, I've been looking into a surgery called the "lamellar split osteotomy," which apparently tons of models have had and it looks excellent, gives the high cheekbone look. Who can find out more about it? I have some good inside sources that say it delivers.
male or female models? both? does this achieve masculine angular cheekbone?
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Okay, I've been looking into a surgery called the "lamellar split osteotomy," which apparently tons of models have had and it looks excellent, gives the high cheekbone look. Who can find out more about it? I have some good inside sources that say it delivers.
Looking at some of the pictures on the net - - I am not sure where the surgical incisions are taking place.
???
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Okay, I've been looking into a surgery called the "lamellar split osteotomy," which apparently tons of models have had and it looks excellent, gives the high cheekbone look. Who can find out more about it? I have some good inside sources that say it delivers.
AFAIK it predates zo and is considered inferior.
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@OP: I think it should be clear that ZSO can not give you high cheek bones, which is associated with masculine look. By googling around you should find that ZSO likely achieves in fact the opposite - feminization of face due to low-set cheek prominence. I suspect this surgery can only look good on females and males with more rounded (feminine) look.
I'm not even sure if there exists a procedure for getting "high cheek bones"?You'd probably have to cut whole zygomatic arch and move it laterally and it's also questionable how moving around that chunk would translate into aesthetic sense. It's about shaping not just linearly moving chunks around. Only way how I see it could be done is fillers or custom implants, maybe.
this is the case malar augmentation using fillers only:
(https://i1.ytimg.com/vi/z4TJzENm8Vo/hqdefault.jpg)
Also, haven't you done simulation of surgery result (3dcone beam+soft tissue imaging) to get idea what are you getting into?If you didn't consider this, that's pretty ignorant, especially due to high unsatisfactory rate in jaw and plastic surgery domain.
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lol that woman above looks so much better in the before. If I were her doc I'd be embarassed to pose those pics.
Yeah, honestly the more I think about this....I'm gonna get some pretty sophisticated imaging done but I think some form of soft tissue augmentation and or other augmentation will be needed. Not sure what this will translate to.... I'm gonna wait till my imaging results are in....
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lol that woman above looks so much better in the before. If I were her doc I'd be embarassed to pose those pics.
That's likely true. She already had good zygos and they got over augmented. Some plastic surgeons still don't know what a subtle result means (the best results are those you can't notice, IMO) and it's questionable how much can these results look natural in first place, as it is commonly the case with plastic surgery. Still this doesn't mean that jaw surgery is better as it should depend on the application.
Yeah, honestly the more I think about this....I'm gonna get some pretty sophisticated imaging done but I think some form of soft tissue augmentation and or other augmentation will be needed. Not sure what this will translate to.... I'm gonna wait till my imaging results are in....
If I was you, I'd check thoroughly inside-out possible solution with many maxfacs and plastic surgeons. If they were unable to show me an accurate simulation model of post-surgery results, I'd run out of office. Even with simulation it's hard to predict final outcome due to soft tissue uncertainty, let alone judging end result by few before-after pics shown by maxfac, possibly on opposite sex.
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That's likely true. She already had good zygos and they got over augmented. Some plastic surgeons still don't know what a subtle result means (the best results are those you can't notice, IMO) and it's questionable how much can these results look natural in first place, as it is commonly the case with plastic surgery. Still this doesn't mean that jaw surgery is better as it should depend on the application.
If I was you, I'd check thoroughly inside-out possible solution with many maxfacs and plastic surgeons. If they were unable to show me an accurate simulation model of post-surgery results, I'd run out of office. Even with simulation it's hard to predict final outcome due to soft tissue uncertainty, let alone judging end result by few before-after pics shown by maxfac, possibly on opposite sex.
yeah good points. i trust sinn quite a bit, but I'll get the imaging done for sure. brother, i've done more research than a max fac by now.
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If I was you, I'd check thoroughly inside-out possible solution with many maxfacs and plastic surgeons. If they were unable to show me an accurate simulation model of post-surgery results, I'd run out of office. Even with simulation it's hard to predict final outcome due to soft tissue uncertainty, let alone judging end result by few before-after pics shown by maxfac, possibly on opposite sex.
I think it comes down to what you want to pay for.
Rational expectations ???
Doing those simulations (doing them carefully) takes a lot of time from the surgeon.
Or you have a surgeon who hires a "service" to do that work - - - in which case you don't really get the expertise you were originally hoping for.
So if a surgeon in Santa Barbara does a double jaw surgery for $50K and it takes 4 or 5 hours - - that is ~ $10K / hour. (yes, that has to cover the patient consult and work up time - - so figure half that . Still a big $/hour number. )
Do you want to pay that surgeon to spend an hour or ? (even with great software) to personally do that "morph" ? When ultimately the morph is just educated artwork ?
If the patients are not willing to pay the surgeon to stop seeing patients in order to take the time to do that work - - how does one rationally expect to get that done ?
Better - - in my view - - is:
To find the right surgeon. One that does digital skeletal modeling (routinely as part of the pre-surgery work up) from the CT scans and to thereby very accurately define the intended new surgical location for the jaws and get the SOTA 3-D printed splints so that the results are as predictable as possible.
It helps if the orthognathic surgeon is also a good plastic surgeon and they can address any other cosmetic issues at the same time. Those plastic surgeons will have a full bag of surgical tools to address any of the other aesthetic issues, which the dental/oral max/fac will not normally have.
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i'm pretty sure sinn does the 3-D simulation.
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Never heard of the lamellar split osteotomy, but you'd expect there must be a reason that it is not used a lot.
All in all there is a lot of discussion about the zygomatic osteotomy on the forum, but having read the forum: very few members seem to actually have gotten a zygomatic (sandwich) osteotomy. And the discussion in general seems to be 'I might get a zso too, to get high cheekbones like male models have', etc. I have written my thoughts about that, but I really feel these type of comments are open to a gross misrepresentation of what a zso can do. The very few members that I did read that got a zygomatic sandwich osteotomy either were posting at 3-6 weeks post-op, when there is still heaps of diffuse swelling that augments the cheekbones. Ncharm is actually one of the only/very few other members I have seen here that is longer out of surgery, and she has written too that she mostly got some projection at a lower level.
As to the result: I estimate there is 2 cm of flatness laterally from the canthus and underneath the canthus, then there is the step off (although not visible given the limited augmentation) and then you have the augmented area. And that is a minor part of the lower zygomatic arch, as mentioned: some fullness at the lower cheek. There is no tapering of course: the area above the fractured bone segment is flat, and then there is the step off to the area that is slightly augmented. And that slight augmentation comes from a small portion of your lower zygomatic bone that is pushed outwards.
I feel these zygomatic osteotomies are massive surgery with unimpressive results. You are not looking at a few weeks of swelling but months and months of diffuse swelling, mostly lingering around the cheeks. A girl that was worried about over-augmentation a few weeks after surgery when getting an osteotomy apparently was told by the surgeon that at 3 months there would only be a subtle change compared to her pre-surgery face. And although 3 months seems a bit optimistic, in general that is what I feel too: you will undergo massive surgery, have swelling for months (which is hard to distinguish from your own tissues once the very visible bulk of swelling is gone), and you end up with a minimal change. (And if you are out of luck and a bit older with less elastic tissues, you risk ending up with some soft tissue changes because of the continuous swelling and minimal change).
I expect this is different when the malars up until the inferior orbital rim are fractured, since obviously you will have a good amount of bone that is fractured and thus more augmentation. Moreover the upper part of the zygo bone gets augmented too this way, so it is expected the procedure might result in that high cheekbone. But I'm still not completely convinced of any zygomatic osteotomy, until I really see a good result first-hand a lot of time after the actual surgery. Concerning the Lefort III: I saw some very small pictures of that member Earl after he got a modified Lefort III and he did seem to have gotten good augmentation, high on the zygo bone, but I don't know how much swelling was still there. Still these surgeries that involve a bigger part of the zygo bone obviously yield more dramatic results.
I do really understand now why it is often de-recommended by surgeons to get a zygomatic (sandwich) osteotomy. I have read the comments that those surgeons that de-recommend to get zygo osteotomies can't perform an osteotomy, and that might be right. However I consulted with both craniofacial and craniofacial plastic surgeons, and I was warned to not get a zygomatic osteotomy. The long downtime was what I was warned for and the unimpressive results. These surgeons could perform both a zygomatic (sandwich) osteotomy and insert an implant, and had done a lot of both, and they picked the implant. The info I got was that they could not let a patient undergo such a massive operation with such a long downtime, swelling for up until a year until the final result is visible, and a mediocre result, when there is a procedure available that gives aesthetically better, more predictable results with far less downtime. Either way: many voices, many visions and I picked differently.
However I have my reservations.
The lefort's, bsso's, etc: these surgeries can bring about dramatic changes that are not comparable to most plastic surgery results. That I can see. The sliding genio can look nice. But some folks seem deadset on augmenting every part of their faces through osteotomies, convinced their own bone can be manipulated in such ways that with a simple 'cut and paste'-surgery involving the mandible or zygo's you can alter your own bone structure dramatically. Whereas in reality the surgeon has to work with your own bone with all its limitations, can only make limited cuts because of nerves and the surgery can give limited augmentation, existing assymetry will become more apparent most of the times, often bone needs to be grafted, there can be some bone resorption etc. And that aside you will be undergoing massive surgery with a long downtime, and it will take a long long time before you will see the results that are often not as dramatic as with implant surgery. I sometimes see suggested here to then get an osteotomy twice to get more augmentation similar to what an implant could give. Twice? :-\ Make that three times if you need a revision of one of those two surgeries. I then read to get the jaw shaved in Asia since the chin wing procedure might give an U-shape to the mandible instead of the often more desirable V-shape. Overall all this just confirms that the results of these osteotomies (lefort's, bsso's etc aside, and I think the sliding genio can also yield nice results) are not as impressive as we'd want them to be, have a lot of limitations (after all: you can not really prevent getting a U-shaped mandible after a chin wing), and require further massive surgery if you'd want to get a more optimal result or a result as drastic as implant surgery might give.
And these are massive/drastic surgeries, with a long downtime (you might as well add all the travel costs/downtime in which you might not be able to work to the costs of surgery, not to mention missing out on socializing for a good while). Getting some cheek fillers gives a much more predictable result, and the downtime is zero.
Either way, if I see someone post pictures from zso's performed by Mommaerts in which the patients are 6 weeks out of surgery, I cringe. This is massive surgery and swelling is lingering all over the face for months and months. What you are looking at at 6 weeks is augmentation caused by swelling.
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Hellohello:
I agree with your sentiments. People want "model cheekbones," "model jawlines," and so on, but things are not that simple in reality. I think if you were to take a 3d scan of the skull of an attractive person with these features, and a 3d scan of an unnatractive, or average person, and put them into a program that would overlay the two scans in order to compare ALL the differences, you'd see there are so many factors. Volume missing here, projection missing there, different curve, different angle, different relationship, and ALL OVER the face. There do seem to be, however, a few basic guidelines and the true game here is finding what procedures fit best to achieving something along those lines.
In regards to the zygomas and orbital rims, neither osteotomies, nor implants are ideal. With implants, shape is customizable, but implants can only be so thick, mostly not more than a few millimetres of projection. With osteotomies, I think the 'modified lefort iii' and other osteotomies which cut a larger section of the zygoma are potential options, but it isn't clear how much projection they can achieve. I actually have a bit of a theory (a very basic and simplistic one) about what makes the difference between improminent and 'model type' cheekbones. Basically, i think it's about forward frojection, lateral projection, and a 3rd thing, which is the squareness of the angle where the lateral and forward 'walls' of the zygoma meet. I'll post a small schematic soon to show what I mean.
One thing I didn't quite get from your post, though, is what you mean about chin-wing giving a U-shaped mandible. Can you elaborate on this?
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When it comes to mid face osteotomies, it's all about volume. An LF1 for example maybe only a 3mm movement, but the volume involved is huge. ZO - even if the movement is big, the bone involved is very small, so the volume involved is small as well. Ditto for implants. To have an effect comparable to LF1 or mod LF2/3, the implants mimicking these movements have to be absolutely huge.
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^well said. Implants give a more obvious outcome. With them it'd be obvious that there is a big difference. But is that really better?
I mean the downsides to implants is that they generally look off, bone recession and possible infection. The bone recession is enough for me to not want to get implants.
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Exactly and say you were to take them out at and older age, your bone loss would probably make everything worse.
Getting implants is tempting though. If the 3D printed bone implants come out in the next 5-10 I'll probably get that.
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Exactly and say you were to take them out at and older age, your bone loss would probably make everything worse.
Getting implants is tempting though. If the 3D printed bone implants come out in the next 5-10 I'll probably get that.
Isn't there a company doing just that? Not 100% bone but "CT Bone" which gets turned into bone eventually? Will be released in Europe next year
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I haven't been keeping names but there's lots of companies in this space. In a decade there's going to be good augmentation options. I mostly don't like midface osteotomies because of the low volume of procedures, sensitivity of the region, limited mobility, extra invasiveness, limited access to underside, etc. If you need revision surgery, then getting access to those locations will be tough. But there are lots of people who have these surgeries done and I've seen some of your pictures, some of you have really flat cheeks. I think it's a health issue too, not just aesthetic. The main reason we don't see it more is that most of the business is for people with minor issues and for those augmentations make a lot more sense. That is, when you only need a few mms an osteotomy seems like gross overkill and it's unclear if it can deliver that kind of resolution. It's also unclear to me how good the contours will be, whether the plates will show eventually, or odds of developing fistulas.
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When it comes to mid face osteotomies, it's all about volume. An LF1 for example maybe only a 3mm movement, but the volume involved is huge. ZO - even if the movement is big, the bone involved is very small, so the volume involved is small as well. Ditto for implants. To have an effect comparable to LF1 or mod LF2/3, the implants mimicking these movements have to be absolutely huge.
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Very smart observation
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Here is an interesting info about why ZSO could not give that masculine look (assuming a properly developed, non-deformed skeleton as staring point). Although it's a quote from plastic surgeons discussing where to place filler for more masculine look, the principle should be the same:
You are exactly right about where men need volume. The apple of the cheek and high lateral cheeks are feminine traits. So in men, I concentrate on widening the width of the cheeks, by placing Voluma on the zygomatic arch (the bone connecting the cheekbone to the skull)). Additionally, this is placed on the lower side of the bone, whereas in women I place the voluma on the upper side of the cheek bones to give a raised cheek appearance in women. This results in a masculine look rather than the treatment I do for women which tries to increase central cheek volume and higher cheek bones.
source: http://www.realself.com/question/voluma-lateral-apex-apple-submalar-cheek
Apparently masculine look is mainly about augmenting zygomatic arch, rather than doing stuff on inappropriate places on zygoma which is what exactly ZSO might be. Thus a feminine appearance, as reported by some male patients and as well from that "modified LeFort3" case.
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I had a ZO done and I'm fairly happy with the results. It gave me quite a bit of really needed width in the midface. I didn't get the chiseled high-cheekboned model look, but that probably would've looked out of place on my thinnish & tallish face anyway.
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Here is an interesting info about why ZSO could not give that masculine look (assuming a properly developed, non-deformed skeleton as staring point). Although it's a quote from plastic surgeons discussing where to place filler for more masculine look, the principle should be the same:
source: http://www.realself.com/question/voluma-lateral-apex-apple-submalar-cheek
Apparently masculine look is mainly about augmenting zygomatic arch, rather than doing stuff on inappropriate places on zygoma which is what exactly ZSO might be. Thus a feminine appearance, as reported by some male patients and as well from that "modified LeFort3" case.
Yeah but is a feminie treatment on a man necessarily a bad thing? I mean look at Johnny Deep's cheekbones or Richard Gere. They have very full cheekbones no? Aren't certain feminine qualities when present in men considered to make men more attractive? Hence the term "pretty boy"??
I'm not talking about facial feminization, but rather that high full cheekbones in a man make the man unique compared to most men and more attractive by comparison. I guess I'd have to see a picture of a man who has had the volumna or whatever surgery done just to the arch and one done to give the apples and higher cheekbones and see which looks better!
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don't these men have the high full apple cheeks your describing? Maybe they have zygomatic arch too, but how is this feminizing??? It looks amazzing!!!!
So please clarify if I'm not understanding or seeing something.
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in the first pic i mean the bearded guy who looks amazing despite his age.
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Men have bigger cheekbones than women. The only reason that it looks otherwise is that women have narrower jaws and use makeup to accentuate the cheekbones. IOW, men have bigger facial bones period.
Another "apple-cheeked" man is Kirk Douglas.
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Men have bigger cheekbones than women. The only reason that it looks otherwise is that women have narrower jaws and use makeup to accentuate the cheekbones. IOW, men have bigger facial bones period.
Another "apple-cheeked" man is Kirk Douglas.
YEAH AND HE LOOKS BOSS!!!! CHEEKBONES ARE WHERE IT"S f**kING AT. SORRY YOU GUYS GOT f**kED WITH YOUR ZSO's BUT THAT"S WHY YOU NEED FULL ORBITAL RIM AND MALAR ADVANCEMENT UPWARD. THEN YOU CAN BE BOSS.
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Can confirm with a real life example. My boyfriend has a heart-shaped face with extremely horizontally wide and prominent (forward) cheekbones, but they are very apple-y and rounded as opposed to being chiseled. He hates that it makes him look young, but he has no idea what he's complaining about, the lucky thing! The actual size of his facial bones is enormous in comparison to mine, particularly since my jaws are as narrow as they are.
Men have bigger cheekbones than women. The only reason that it looks otherwise is that women have narrower jaws and use makeup to accentuate the cheekbones. IOW, men have bigger facial bones period.
Another "apple-cheeked" man is Kirk Douglas.
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"Yeah but is a feminie treatment on a man necessarily a bad thing?..."
Not at all, IMO. Men usually go for more chiseled, sharpened and edgy look, while feminine features tend to more concentrate on curvy and rounded lines. However, this doesn't mean that such approaches should be reserved based on sex. It's pretty much per-case depended, which means dependency on initial face structure. At the end it's about harmony, ratios and balance and if this means acquiring feminine features while being a male, well then be it.
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If it doesn't look bad, why do you want a revision? If you had weak cheekbones before, this might be better (objectively)