jawsurgeryforums.com
General Category => Aesthetics => Topic started by: dervyx on June 09, 2017, 09:53:47 AM
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(http://imgur.com/download/Lz3GIiN)
(http://imgur.com/download/buxupZu)
(http://imgur.com/download/OWNwcFt)
This is the most recent result of Dr Defrancq's. What went wrong? Why did he ended up all chubby?
He had:
Lefort 1 Advancement
Genio
HA on cheekbones
HA on paranasal area
Dick is a young man. Since his childhood dick was suffering from an open bite, and a week chin.The orthodontist proposed to see me as a Maxillofacial surgeon, and so he was prepared with pre surgical orthodontics to the orthognatic surgery. The result shown here is 9 months after the surgery: Le FortI advancement and and genioplasty with vertical reduction advancement. High cheekbone augmentation was proposed with Hydroxyapatite and Tisseel, a human glue (see in the surgery section: cheekbone augmentation).Beautiful result and an extremely happy patient.
Seems interesting to me since I had exact the same surgery proposal with him (+BSSO) and when I see results like this I'm thankful I decided against it.
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The guy looks way better, what do you mean?
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As the chin was shortened and reshaped it lost the original angular shape which changes the overall look of his face to be rounder and softer. If you block out the chin on the before photo and then compare it with the after, you will see the parts that were augmented just look conservatively more forward, not really fatter or rounder in my opinion.
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Looks like the HA got placed too low on the cheekbones.
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The guy looks way better, what do you mean?
Exactly.
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It's the Lefort I with the filling of the paranasal area that gives that bloated look and fullness in the midface.
And that's exactly why it was important to place the HA high on the cheeks with enough anterior and lateral projection to counter the increased convexity created around the paranasal area with the lf1. You want your zygos to work as the "tent poles" of the face, not the central part around the mouth which will give the face the appearance of being bloated which is unfortune on males.
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What are you guys seeing? Before his mouth area is puffy with what looks like highly overworked muscles. After he has a nice, relaxed face without any issues. No clue what you're seeing...are you talking about under his eyes? That's the lighting. On the right the photo is clearly underexposed compared with the left.
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What are you guys seeing? Before his mouth area is puffy with what looks like highly overworked muscles. After he has a nice, relaxed face without any issues. No clue what you're seeing...are you talking about under his eyes? That's the lighting. On the right the photo is clearly underexposed compared with the left.
I remember seeing a before and after where the under eye area looked quite different. I thought the guy had filler. When I questioned, the surgeon answered "Nothing was done to his eyes. We changed our photo system from single flash to double flash between his before and after photo."
IMO his upper lip now looks marginally too long. And before and after should always come with a photo of the bite, the patient smiling (over impaction looks bad).
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Haha, and here I was wondering what you guys that thought he looked better were seeing, although of course I do agree the position of his lower lip looks more relaxed and much better, and the position of his upper lip looks more relaxed. However the area next to his nose looks more bloated and fuller now, as does the area above the nasolabial folds. It takes emphasis and projection away from the lateral portion of the face shifting it more towards the medial portion of the face. I like it better when the projection is more laterally versus more medially as I feel that way the face has more definition and angles. Just my personal preference.
You see this at moments after a Lefort I. In this situation it seems to be highlighted more by the filling of the paranasal area.
I sort of see what you're saying now, but the muscles around his mouth are so overly developed from straining in the before. They simply relax in the after, and that allows them to settle. Looks way better. Do you guys see how the exposure is so different? It makes a huge difference in the shadows, and shadows are what tend to make faces look harsh (or in this case bloated). The lighting isn't the same in each (under exposure, improper white balance -- i.e. notice the pink in the second photo's upper right), so it's actually impossible to compare accurately. Photos are notoriously inaccurate and one of the worst demonstration of outcomes -- surgeons have told me this.
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I wish surgeons would publish more consistent before/after pics in general.
I doubt most understand photography, shadows, and lighting. That is an art unto itself.
You really can't trust photos. I look pretty good in photos, but I'm still recessed after surgery. Head position, lighting, facial hear, and all kinds of other things affect a photo.
The guy in the OP had a great result as far as I can tell, but like I said, I'd have to see him in person, or at least see a ceph along with these photos. What is very positive and obvious is that all the muscular strain around his mouth is now gone. If his bite is good, he should (and probably does) consider himself lucky.
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Looks like he's using a camera from the 1970s.
Seriously.
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Seriously.
Defrancq is not a young guy. So this result may have been done many years ago. It looks like a typical 90s photo to me.
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Seems like an Ok result. While he looks better in the after , his under eyes seem hollow in the after. Could that be due to HA application raising the lower cheek anteriorly?
Also only maxilla was moved+ paranasal HA ...maybe a tad too much? The lower jaw seems less prominent due to that perhaps.
Defrancq is not a young guy. So this result may have been done many years ago. It looks like a typical 90s photo to me.
This. Guy looks like a prototype from late 90s. The before version listens to Eminem and Nofx the after has taken to Backstreetboys. Maybe there are agreements with patients "like blah many years pass by and you can make my b n as public". Idk. If that is the case hope his HA game has stepped UP (no pun intended).
Also just noted this guy's name is DICK. I think people even in non anglophone world stopped naming their kids that in 1970s so yeah probably not contemporary.
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Before his mouth area looked horrendous, now it's normalised and harmonious. I'd say a good result.
And yes that looks like an old result. I went to defrancq and had pics taken - he's got a multitude of high res quality DSLR cameras and the proper lighting in the room etc, its like a studio - so no hes not using old cameras
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It appears to me that he has also put on significant body fat in the 2nd photo compared to the first photo.
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It appears to me that he has also put on significant body fat in the 2nd photo compared to the first photo.
He does look bloated which is making people question the result. Question is , is it due to maxilla advancement +HA ? If the case was that he just gained body fat , yes certainly would not be fair to judge the result.
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He does look bloated which is making people question the result. Question is , is it due to maxilla advancement +HA ? If the case was that he just gained body fat , yes certainly would not be fair to judge the result.
Maybe he's still swollen? I mean he did just have surgery, and it takes up to a year for swelling to drop. But as mentioned, it's mostly the different lighting regarding the orbits. Very clearly it's that. In the first photo that area is all washed out with light. Without the shadows, you're not going to see any hollowing in the area.
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He does look bloated which is making people question the result. Question is , is it due to maxilla advancement +HA ? If the case was that he just gained body fat , yes certainly would not be fair to judge the result.
Looking closely, I think his neck is thicker as well as his face showing an increase in soft tissue volume. So I think his BMI has increased between the before / after pictures.
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Maybe he's still swollen? I mean he did just have surgery, and it takes up to a year for swelling to drop. But as mentioned, it's mostly the different lighting regarding the orbits. Very clearly it's that. In the first photo that area is all washed out with light. Without the shadows, you're not going to see any hollowing in the area.
You are right about lighting. Regarding swelling - Idk how much swelling is contributing to the bloated look but its unlikely as he is 9 months post op. There could be some residual swelling that is not helping but bulk must be either over all fat gain or misadventure in HA.
Still the feller profited over all from the surgery imho.
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I will have my second appointment with dr Defrancq wednesday. He also wants to put HA on my cheekbone, but after seeing this result idk if thats a good idea :s I think he makes people with a real deformity look normal after the surgery. But dont know what he can do if you look okay already.
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He has too much of a centre heavy face in the after, there's too much volume in the black outline and not enough in the red
(https://i.gyazo.com/60e653b741fcf5d494065c19925f51ca.png)
Before his face was equally recessed making the face look more "flat", something almost all good looking people have. He looks much better though, his lower third was quite disproportionate in the before. The mouth bulgyness before looked quite nasty.
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He has too much of a centre heavy face in the after, there's too much volume in the black outline and not enough in the red
That is so nit picky, and it's not even accurate. You really think a surgeon has that much control? Are you picking on his result just to feel better about yourself? It's hard to understand this level of minutia. He looks great after. BUT, photos are unreliable. We'd have to see him in person to truly know.
But again, look at the lighting. In the before, you see no wrinkles under the eye. In the after, you see some. This is a clear indicator (along with the shadows and white balance/pink in the corner) that the after photo is under exposed compared to the other. Under-exposure shows more harsh details. Over-exposure washed out the face. So it's an apples to oranges photographic comparison. You can deduce zero from the images other than his overall bone structure, and especially his muscles around the mouth, look more harmonious after.
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That is so nit picky, and it's not even accurate. You really think a surgeon has that much control? Are you picking on his result just to feel better about yourself? It's hard to understand this level of minutia. He looks great after. BUT, photos are unreliable. We'd have to see him in person to truly know.
But again, look at the lighting. In the before, you see no wrinkles under the eye. In the after, you see some. This is a clear indicator (along with the shadows and white balance/pink in the corner) that the after photo is under exposed compared to the other. Under-exposure shows more harsh details. Over-exposure washed out the face. So it's an apples to oranges photographic comparison. You can deduce zero from the images other than his overall bone structure, and especially his muscles around the mouth, look more harmonious after.
GJ is absolutely correct on all this. Well said.
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(http://imgur.com/download/05p9F48)
Profile picture. It does look like he gained some weight in this angle as he stores a lot of fat in his submental region...
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IMO, not enough CCW rotation.
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Ok he gained quite a bit of fat it seems. Idk if any amount of ccw/advancement can fight facial fat.
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Ok he gained quite a bit of fat it seems. Idk if any amount of ccw/advancement can fight facial fat.
I meant the very vertical upper lip. The best surgeons manage to avoid this (most of the time).
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He only had upper jaw surgery and a genio, no CCW. Defrancq uses posterior impaction to close an open bite because it's so stable. Defrancq is old and his methods are outdated.
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GJ is absolutely correct on all this. Well said.
You can clearly see here he has too much volume in the paranasal area compared to his orbital and cheekbone region, could be attributed to weight gain though (or even swelling), who knows.
(http://imgur.com/download/05p9F48)
And I said he looks much better, he looks quite good now to my eye. Looked a bit below average in the before.
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I once gained 12 kilos due to some medication. It screwed up my whole look.
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Yes he does have proportionately more fullness in the paranasal area compared to other regions of the upper midface. Rather than seeing this is a negative, it is more useful to view the result as a springboard for future augmentation of the rest of the midface. Often bimax acts a 'gateway procedure' in the following way. It unlocks one of the two important aspects of facial development: absolute development of the face. Future procedures (or other procedures performed concomitantly) deal with the second aspect: proportional development.
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What does HA + paranasal alveolar bone augumentstion mean?
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IMHO you guys just have way too high expectations of what jaw surgery can deliver.
I've seen hundreds of results online and his stand out far more than many others. Most jaw surgery results I've seen online are lacklustre anyway
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I mean all of that is true, but we don't know how long his after photos were taken, could have even been years. And yes he looks slightly class 2 in the after, which may just be because of fat. He looks "good". I don't think this result is worth obsessing over. It obvs wasn't a CCW and as above user says, most jaw surgery results aren't amazing from aesthetic point of view. It's just one very small piece in a much larger and very complicated puzzle.
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His after pics are 9 months post op iirc.
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how do you get a double chin AFTER jaw surgery???
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You gain weight.
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So, the weight gain is screwing up the comparison as others have commented.
However, his results do look feminizing. I saw the after first and the before second when I opened this topic, and I thought that was a woman. I don't know exactly why in terms of anatomy, but a fuller submalar area relative to the cheekbone area is definitely a feminine characteristic. The problem with this guy was that his entire midface is recessed, not just the maxilla — the cheekbones are too. The paranasal area is already augmented by LeFort I alone, so getting HA onto that caused even further anterior projection in that area. The cheekbone area by contrast is only raised slightly after a LeFort I, and getting some HA there post-surgery is not enough to make that region equal in anterior projection to the paranasal region. He looked more masculine before because the submalar area was less anreriorly projected relative to the cheekbones.
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So, the weight gain is screwing up the comparison as others have commented.
However, his results do look feminizing. I saw the after first and the before second when I opened this topic, and I thought that was a woman. I don't know exactly why in terms of anatomy, but a fuller submalar area relative to the cheekbone area is definitely a feminine characteristic. The problem with this guy was that his entire midface is recessed, not just the maxilla — the cheekbones are too. The paranasal area is already augmented by LeFort I alone, so getting HA onto that caused even further anterior projection in that area. The cheekbone area by contrast is only raised slightly after a LeFort I, and getting some HA there post-surgery is not enough to make that region equal in anterior projection to the paranasal region. He looked more masculine before because the submalar area was less anreriorly projected relative to the cheekbones.
I agree with the feminizing aspect, but his mouth area is hugely improved
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He looked better before, but the surgery was probably not done for purely aesthetic reasons.