jawsurgeryforums.com
General Category => Aesthetics => Topic started by: micjawsurgery on February 25, 2019, 01:18:05 PM
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Hi guys. Going to be consulting with Sinn about the modified LF3 he offers soon. From what I understand about the procedure it is a zygoma osteotomy that includes the lower orbital bone. I also plan to ask if he can move the supraorbital, nasal bridge bridge, and lateral orbital rims during the surgery.
My cheeks are pretty flat especially at the lower orbital and upper cheek area, plus my maxilla looks to be relatively forward grown which makes the flat cheeks more apparent. Have a lot of soft tissue in the mid-lower cheeks that I lack in the lower eye area so after this I’ll probably get soft tissue augmentation for that.
From my ceph my SNB looks to be pretty normal but the ANB angle is very high. Don’t think a BSSO would help aesthetics at all since when I jaw jut it just makes my frontal view look more flat. Think moving my maxilla backwards and up would probably help but if someone more informed could analyze the ceph it would be appreciated.
From what I’ve seen Korean surgeons seem pretty used to moving the maxilla back since bimax protrusion is more common in Asians, so I’ll probably do some consultations in Korea eventually about that. But I’m pretty wary about removing bone. Most likely I’ll just get a genio since the aesthetic risk reward for jaw surgery doesn’t seem great in my case.
I’m relatively concerned that Dr Sinn is in his mid 70s, but there are very few other surgeons that would do this procedure for aesthetics that I know of
I’m happy to ask any questions you guys want to Sinn during my consult and I’ll report back next week. Found an old thread about this but no updates from the guy.
Ceph: https://m.imgur.com/a/Y48CfCr
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I'd be very interested to know if he can move the supraorbital ridge and lateral ridge along with the lower orbital rim and the zygoma.
Try and get a precise picture of what part of the upper/midface he will move. Like a precise diagram and ask how many mm he can move the zygoma forward.
Ask him if there are any ways to get a more dramatic result through a bone graft.
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Hi guys. Going to be consulting with Sinn about the modified LF3 he offers soon. From what I understand about the procedure it is a zygoma osteotomy that includes the lower orbital bone. I also plan to ask if he can move the supraorbital, nasal bridge bridge, and lateral orbital rims during the surgery.
My cheeks are pretty flat especially at the lower orbital and upper cheek area, plus my maxilla looks to be relatively forward grown which makes the flat cheeks more apparent. Have a lot of soft tissue in the mid-lower cheeks that I lack in the lower eye area so after this I’ll probably get soft tissue augmentation for that.
From my ceph my SNB looks to be pretty normal but the ANB angle is very high. Don’t think a BSSO would help aesthetics at all since when I jaw jut it just makes my frontal view look more flat. Think moving my maxilla backwards and up would probably help but if someone more informed could analyze the ceph it would be appreciated.
From what I’ve seen Korean surgeons seem pretty used to moving the maxilla back since bimax protrusion is more common in Asians, so I’ll probably do some consultations in Korea eventually about that. But I’m pretty wary about removing bone. Most likely I’ll just get a genio since the aesthetic risk reward for jaw surgery doesn’t seem great in my case.
I’m relatively concerned that Dr Sinn is in his mid 70s, but there are very few other surgeons that would do this procedure for aesthetics that I know of
I’m happy to ask any questions you guys want to Sinn during my consult and I’ll report back next week. Found an old thread about this but no updates from the guy.
Ceph: https://m.imgur.com/a/Y48CfCr
The lateral orbital rim IS mobilised.
Theres NO way to mobilise the nasal bridge or supra orbital rim with the technique he uses, as far as I'm aware a coronal would be required. The osteotomy stops just short of the nasal bridge on either side and so as to prevent a step off, HA is used.
It isn't a linear anterior advancement by the way.
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Can someone present a diagram of what parts of the face Sinn's op is moving forward. Like color code them or something. And okay if not just linear, how much lateral?
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Can someone present a diagram of what parts of the face Sinn's op is moving forward. Like color code them or something. And okay if not just linear, how much lateral?
I thought you had that op with him. Yes. No. ?
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Can someone present a diagram of what parts of the face Sinn's op is moving forward. Like color code them or something. And okay if not just linear, how much lateral?
Blue area on the diagram: http://jawsurgeryforums.com/index.php?topic=7297.15 (http://jawsurgeryforums.com/index.php?topic=7297.15)
Hard to give an exact figure. The highlighted area is rotated outwards and therefore the orbitals come forwards.
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I thought you had that op with him. Yes. No. ?
No I never had the mfl3 with him. I've asked him about it and seen a result or two. Honestly, the result I saw looked like there was an improvement to the orbital rim, but nothing that significantly changed the appearance of the patient.
I think it would require ANOTHER surgery to actually show significant improvement.
So that's another question to ask Sinn. After the first 7-8mm advancement, Can the operation be done again to give advancement again? So that you could get another 8mm of advancement? I that would be significant to show results.
I know some of you think 7-8 mm advancement is significant. But in this area the soft tissue is quite heavy and prevents the result from really showing.
I would also ask if you could just get a ZSO after the mfl3.
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No I never had the mfl3 with him. I've asked him about it and seen a result or two. Honestly, the result I saw looked like there was an improvement to the orbital rim, but nothing that significantly changed the appearance of the patient.
I think it would require ANOTHER surgery to actually show significant improvement.
So that's another question to ask Sinn. After the first 7-8mm advancement, Can the operation be done again to give advancement again? So that you could get another 8mm of advancement? I that would be significant to show results.
I know some of you think 7-8 mm advancement is significant. But in this area the soft tissue is quite heavy and prevents the result from really showing.
I would also ask if you could just get a ZSO after the mfl3.
I find this hard to believe but you wouldn't say it if it isn't true. I've seen decent improvement with orbital rim implants alone so it's surprising the most invasive osteotomy of the face doesn't give a more desirable outcome. It's also possible Lazlo that you're striving for extreme perfection, but the difference in bone structure between a below-average person and a model is very, very substantial and can't be expected to be replicated with cosmetic surgery. I'd be happy with mild-moderate improvement of the orbital rim area because you then cross that threshold where it won't matter/ become noticeable to other people.
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No I never had the mfl3 with him. I've asked him about it and seen a result or two. Honestly, the result I saw looked like there was an improvement to the orbital rim, but nothing that significantly changed the appearance of the patient.
I think it would require ANOTHER surgery to actually show significant improvement.
So that's another question to ask Sinn. After the first 7-8mm advancement, Can the operation be done again to give advancement again? So that you could get another 8mm of advancement? I that would be significant to show results.
I know some of you think 7-8 mm advancement is significant. But in this area the soft tissue is quite heavy and prevents the result from really showing.
I would also ask if you could just get a ZSO after the mfl3.
Oh, OK. Thought you went to Sinn after Earl reported he was happy with his results of mfl3. Had posts about the surgeries you were planning to have which included mfl3 and had some kind of accident (mugging) after your Sinn surgery where (i think) the cheekbone and orbital rim area was broken right after your Sinn surgery. Got the impression you too got what Earl got. Wow. New one on me you didn't have what Earl had and thanx for clarifying.
ETA: The norm for projection of the orbital rim is about 5mm ahead of a vertical drop down line from the eyeball. So if someone is -7 (minus 7) behind the line a 7mm advancement would bring them to the norm as to correct 'bug eyed' look. Unlikely a doc would give an extra 8mm in addition over that in another surgery. Whaddaya wanna do, use your lower orbital rim area as a spare book shelf?
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Oh, OK. Thought you went to Sinn after Earl reported he was happy with his results of mfl3. Had posts about the surgeries you were planning to have which included mfl3 and had some kind of accident (mugging) after your Sinn surgery where (i think) the cheekbone and orbital rim area was broken right after your Sinn surgery. Got the impression you too got what Earl got. Wow. New one on me you didn't have what Earl had and thanx for clarifying.
ETA: The norm for projection of the orbital rim is about 5mm ahead of a vertical drop down line from the eyeball. So if someone is -7 (minus 7) behind the line a 7mm advancement would bring them to the norm as to correct 'bug eyed' look. Unlikely a doc would give an extra 8mm in addition over that in another surgery. Whaddaya wanna do, use your lower orbital rim area as a spare book shelf?
Yeah I would love to have it as far as spare booskshelf! And the whole malar complex would be moving out right? So it's the whole cheekbone. I mean this is what I want:
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To report: Sinn responded to me that one time procedure is all he'd feel comfortable with.
He said he could add 3-4mm HA on top during the procedure. HA contracts quite a bit so it would only give about 2mm probably. And that's on top of the 7mm movement he could make for a net result of 9mm.
I wish there was a way of predicting soft-tissue movements. But I don't think that's enough to give you the Mads Mikkelsen or most model type cheekbones.
Seems like we're going to have to wait for bone-implants grown in a bioreactor. I say this as an alternative to implants. But I'm not sure implants even get you the results you want. For example, Yaremchuck is well known as the king of implant guys and none of his orbital rim implants or cheekbone work is very impressive at all. Sure some of his jaw stuff looks good, but midface is mostly crap.
Are there any computer programs that can predict before and after results of bone movements? Something you maybe get a CT scan or an MRI for and can move pieces around with some predictability? It seems in this day and age that stuff should be routine!!???
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So....unfortunately we do not have our Mads Mikkelsen solution yet. To report, here are results of implants from Joe Niamtu a well known implant doc. They just make your face look puffy and stupid. Implants not only suck from an infection point of view, they also suck aesthetically. I mean yeah he looks "better". But no one would ascribe those to be "male model" cheekbones.
In fact the younger guy looks WORSE after the implants. He had good cheekbones and now he has a roundish face that looks like s**t.
https://www.lovethatface.com/cosmetic-facial-surgery-richmond-va/cosmetic-surgery-for-men/facial-implants-for-men/
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Like for real. We need a computer scientist and a surgeon on this board to work together to build a plastic surgery visualizing tool that could take into account your asymmetries and model your actual face.
Asymmetry by the way is a HUGE problem with both implants and any type of zygomatic movement. Like way over 50 percent. Why the hell can't doctors who have computer tools compensate for the asymmetries by moving one side say 7mm and the other 9mm if there is a discrepancy. Also just look at all the midface implants. They suck deep balls.
What are we missing here in understanding the anatomy of this area? Is it just that Henry Cavill and the male model look is actually caused by something other than strong malar/zygomatic bones? I'm beginning to think it might just be that plus larger forward face growth along all vectors. And I'm also thinking symmetry may be way more important and rare than we think. Henry Cavill has remarkable, indeed preternatural symmetry in his face.
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Also, can we please just f**king fastforward to the future. The first lab cell grown bone is already being used though it doesn't seem offered to the public yet. I wonder what's slowing them down. This seems to be based on the same principle as epibone and there must be many labs working on this.
I just don't understand why its going to take to 2030 to see clinical applications of this stuff. This would for legit solve 99 percent of people's problems on this board.
Right now it seems to just be a bone putty, but I'm not sure.
http://nocamels.com/2018/01/shin-bone-implant-procedure/
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But realistically, f**k waiting for these innovations.
I'm sure a computer visualizing program exists today. So where do we find it?
Then, everyone who I know has downgraded ZSO's as s**t. I always wondered if TWO Zso's would produce a better result, but I've heard Dr. Z said he's never done two zso's on anyone.
So you do Sinn's op. Maybe you do another ZSO, have you gotten closer to the result or are you just spinning wheels? Filler to top it off. But what is the anatomy we're looking for. If your own bones are s**t then no matter how you move them around may not give you a better look.
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Once more this whole topic seems hopeless.
First, the following pics are crap cause Dr. M. did other bi-max procedures on all patients, so of course they now look more normal. But they all supposedly had ZSO's. And guess what? None of their cheekbone/zygoma areas look any different if isolated in the before and afters. So the ZSO really does seem to be a waste of time.
https://www.academia.edu/6713049/2002_Aesthesic_malar_recontouring_zygomatic_sandwich_osteotomy._FPSCNA
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We're just gonna have to wait to 2025. I thought 2020 would be the golden year of tissue re-engineering. But it looks like that date was optimistic.
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Company like this could take our troubles away, but then we'd have to get the surgeons to use the bloody things.
http://www.bonusbiogroup.com/index.php/products/bonofill
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So he moves the lateral orbital rim, zygoma and the inferior orbital rim. HA paste is used at the inferior orbital rim like beyondconfused said. Can't augment higher, he told me he could inject HA granules to augment the brow bone, but this procedure is only for cheekbone and eye support. He can change the cuts to do some lateral augmentation as well - I'm pretty interested if he can widen the lateral orbital rim by a few mm to widen the eyes.
He does a computer simulation surgery with a CT scan to pre shape the titanium plates that need to get put in as part of the surgery. Unfortunately soft tissue changes can't be modelled so the end result is not totally predictable. He said chance of blindless and vision problems is very low but I may lose some feeling in the sensory nerves in the orbital area.
I was told I'm a good candidate for the surgery. Will get a genio too if I can budget it in
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So he moves the lateral orbital rim, zygoma and the inferior orbital rim. HA paste is used at the inferior orbital rim like beyondconfused said. Can't augment higher, he told me he could inject HA granules to augment the brow bone, but this procedure is only for cheekbone and eye support. He can change the cuts to do some lateral augmentation as well - I'm pretty interested if he can widen the lateral orbital rim by a few mm to widen the eyes.
He does a computer simulation surgery with a CT scan to pre shape the titanium plates that need to get put in as part of the surgery. Unfortunately soft tissue changes can't be modelled so the end result is not totally predictable. He said chance of blindless and vision problems is very low but I may lose some feeling in the sensory nerves in the orbital area.
I was told I'm a good candidate for the surgery. Will get a genio too if I can budget it in
Good luck. When is your surgery? A lot of us are rooting for you.
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Waiting on a price quote and then I’ll probably book it in a couple months if I decide to go through with it. If I do go through I’ll be sure to follow up with some pictures after I heal.
I’ve seen the difference 4mm implants can make in this area so 7-8mm of augmentation sounds pretty good to me
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Waiting on a price quote and then I’ll probably book it in a couple months if I decide to go through with it. If I do go through I’ll be sure to follow up with some pictures after I heal.
I’ve seen the difference 4mm implants can make in this area so 7-8mm of augmentation sounds pretty good to me
That's awesome. I have a couple questions of concern though. I have seen a before and after and I didn't think the changes were significant. But of course your mileage may vary.
Moreover, the operation does not seem to provide the type of augmentation us males (and females) are looking for. Specifically where the upper cheekbone has a chiseled and protrusive look. Instead, the modified lefort III, I have a fear may just provide more bulkiness or fullness in the anterior dimension in a way that isn't particularly aesthetic.
Here are some examples of what I mean:
https://www.semanticscholar.org/paper/%22Modified-Oblique-Le-Fort-III-Osteotomy%22-New-S%C3%A1nchez-Flores/e2a1b75323fa44c44c6f288a8ad7fe0542f1e815
Or I'm afraid you just end up with these sort of pudgy cheeks like this male patient below. I really see no evidence this operation provides you with the high, chiseled cheekbone look. Or even augments the cheekbone in the vectors that will give you the S curve.
http://jawsurgeryforums.com/index.php?topic=548.0
Have you thought about these issues or how to achieve a more aesthetic result?
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I'd like to propose something for us to figure out. If surgeons regularly do CT scans of skulls, can we find the CT scan of a skull that has the features we would find most aesthetic. Like I'm thinking, a CT Scan of a skull that's close to Henry Cavill's proportions. IF we also had a CT scan of our own skull then we could lay one on top of another and figure out which areas need to augmented and in which vectors. Sure the soft tissue wouldn't be perfect, but that can be fixed through other means. It's figuring out the what parts of the skull are prominent in the most idealized types would at least allow us to figure out where and how bone needs to be moved.
Honestly, I think no matter how many times you might show a surgeon pics of what you want to achieve and they agree that they will produce those results --they either wilfully ignore you or dissimulate in their responses to get you to go along with the surgery.
So I think we need to get more scientific about these things.
My buccal fat removal procedure was indicated so that I would achieve my idealized type. But because I had weak cheekbones, and the surgeon should have known this if he already didn't, it was disastrous to my face making it look like I have two indentations from some sort of cancer in my face. I'm going to have to spend thousands to fix this, if it can even be fixed.
So I'm not going forward with any surgery unless I know it will move me in the direction i actually want to go. I can't believe how much this mfl3 is being pushed when most of us have no idea what result it will produce.
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I think the 2nd result is actually very good. First one his orbitals are very setback compared to his lower cheeks, the 7mm movement could never be enough.
I’m not to worried about angularity to be honest. I’m more hoping this procedure reduces my tear trough and dark circles that come from hollowness of the area. I look rather boyish to begin with so I’m ok with just more projection.
Fat storage and soft tissue play a pretty big role too. If I had more fat in the upper cheekbone and under eye region I probably wouldn’t need this procedure, it’s just all my fat is stored in he mid-low cheek region.
Will probably try soft tissue in the upper cheeks and lower eyes after this.
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I think the 2nd result is actually very good. First one his orbitals are very setback compared to his lower cheeks, the 7mm movement could never be enough.
I’m not to worried about angularity to be honest. I’m more hoping this procedure reduces my tear trough and dark circles that come from hollowness of the area. I look rather boyish to begin with so I’m ok with just more projection.
Fat storage and soft tissue play a pretty big role too. If I had more fat in the upper cheekbone and under eye region I probably wouldn’t need this procedure, it’s just all my fat is stored in he mid-low cheek region.
Will probably try soft tissue in the upper cheeks and lower eyes after this.
well, i guess you are okay with having a full midface, without the S curve. The procedure may meet your goals, i really don't know. Regardless it will be helpful for us all to learn about your results so thanks for sharing.
To my mind, however, I think a combination of osteotomy and AGGRESSIVE filler work may be the only options.
I'm convinced only implants can actually solve the problem because the problem is one of shape, not projection necessarily. So....since I don't want synthetic implants I'll wait for bioprinting to take off in teh next several years...
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Sorry I didn’t know you meant the ogee curve when you said S. I do have the S curve already since my face and cheekbones are actually too wide - I look better in selfies compared to photos from 5m away due to how it makes my inner face (eyes, nose, mouth) appear larger relative to my skull. It’s why cheekbones reduction and small skull sizes are very popular in Korea since it provides much better harmony.
I also think the upper part of the S curve isn’t really that important, it’s just most people have their lateral orbital rims setback compared to the cheeks.
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Sinn's procedure will definitely give you MORE of an ogee curve but the final product heavily depends on what you started with.
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Sinn's procedure will definitely give you MORE of an ogee curve but the final product heavily depends on what you started with.
How do you know if it will give you more of an OGEE curve?
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Ogee curves of the result of cheekbone, jawangles and chin. Very few people have the ogee curve, cause you need all three of that to have it.
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Ogee curves of the result of cheekbone, jawangles and chin. Very few people have the ogee curve, cause you need all three of that to have it.
Too general. There's many other factors, the correct combination of these is what creates the ogee curve. I'd say the most important are cheekbones & projection of both jaws.
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wanted to update with some info I didn't consider. the movement involves a cut along the zygomatic maxillary buttress to move the zygoma forward, so the frontal process of the maxilla (near the nose) is not moved at all. Dr. Sinn told me HA paste would be used here to reduce the stepoff but this has me questioning whether implants would be better for this area since I am concerned the stepoff could be an issue aesthetically.
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The cut for the modified LF3 is closer to the nose in this article. I'm asking Sinn if this would be possible but I don't expect it...really need to rethink about implants for this issue I think
https://www.academia.edu/27145374/The_modified_Le_Fort_III_osteotomy_in_the_correction_of_mid-facial_deficiency._Case_reports
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The cut for the modified LF3 is closer to the nose in this article. I'm asking Sinn if this would be possible but I don't expect it...really need to rethink about implants for this issue I think
https://www.academia.edu/27145374/The_modified_Le_Fort_III_osteotomy_in_the_correction_of_mid-facial_deficiency._Case_reports
I think you're right that movie the bone near the nose is important aesthetically. How much HA in mm can be applied really to make an impact I wonder.
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The cut for the modified LF3 is closer to the nose in this article. I'm asking Sinn if this would be possible but I don't expect it...really need to rethink about implants for this issue I think
https://www.academia.edu/27145374/The_modified_Le_Fort_III_osteotomy_in_the_correction_of_mid-facial_deficiency._Case_reports
Man, even those modified lefort results look pretty crappy. They just created more bulk in that area to "normalize" the face but I wouldn't say there was a huge aesthetic improvement. The girl still lacks any undereye support and so does the guy. The negative vector right below the eyeball is not improved at all with this operation? Why? Could it just be this isn't the fix and the need for some kind of implant is still necessary directly under the eye? The guy doesn't have an ogee curve after the operation at all.