jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: earl25 on August 18, 2013, 05:34:22 PM
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Here's an anecdotal break down of the main facial implant materials. Please note this is totally anecdotal evidence (based on my years on ytf and MISSJ forum) and not the be all and end all. Also I must point out I am biased against MEDPOR. I will explain why below. but in all honesty I hate all implants but there no other alternative in some cases. Many people say were close to growing new bones but Ive spoken to one leading craniofacial doctor who said were decades away from being able to do that safely and effectively and have the ability to control the growth. Its kind of like people saying were so close to cloning hair....were decades away from that.
Silicone:
Solid Silicone is one of the oldest implant material. IMO and most doctor say it has the best long term track record of all the materials in terms of infection rates (although different papers say differently), ease of removal, and doctor familiarity. Its placed in several ways. Mostly its placed in a very tight pocket that the doctor creates. Most do it this way. Some doctors screw it in place (although one doctor claims this can increase the infection rate since it's breaching the bone, but this is just one doctors opinion). Some doctors will use sutures to keep it in place within the tight pocket (my malars were sutured in). Silicone without sutures or screws can slip out of place very easily. There was someone on YTF years ago who was training in jujitsu. Someone took him down face first on the matt and the implant literally ripped out of the pocket and slid out of place. He had a massive facial bruise from it.
BUT at the same time its very very easy to remove. You can go to any good local ps and he can remove them safely. The after effects of removal shouldnt be so bad. ease of removal can't be taken lightly. An implant can get infected ANYTIME. You don't know where you will be 10+ years from now (married with kids, unemployed, career change etc...) so you ned to be able to get help anywhere at anytime,.
After removal You will have the left over capsule/scar tissue and some indentation but for the most part your face should snap back to pre-surgery form. There was one guy who had the works with a top silicone guy on ytf jaw,chin,tear troubh,chin. He got an infection. THe doctor removed it then waited 6 months and put in new ones, he got an infection again . so they had to come out for good. He said his face pretty much went back to presurgical form, but he was in his late 20's so he was young. an older person will have more difficulty. But there was a woman on ytf who had huge silicone jaws put in. She didn't like them and had them removed. She had scar tissue but it worked out positive since it gave her more augmentation then she had prior to implants so she was happy.
It comes in different styles jaw (however the standard silicone jaw implant will only widen a jaw it wont give drop down), malar, sub malar and tear trough(tear troughs give very little projection compared to the medpor counterpart).
Silicone can look fake because of the capsule that forms around it. The bigger the implants the bigger the capsule.
Medpor/Porex
Medpor has been used for many years probably around 25-30. I believe it started out with just reconstruction then doctors started using it for cosmetic. Tissue grows through it making it very very secure(its not moving). It is also screwed in. It has a low long term infection rate (again some papers say it has a lower infection rate than silicone, while others say higher). Some people say the tissue ingrowth helps it keep infections at bay. I don't believe that because the tissue grows through it not "into it". Its not like it has a blood supply. Its not like a bone where the tissue grows and connects to it delivering blood., but again im not a dr. or an expert this is just my opinion. Medpor will not slip out of place. But at the same time removal is very hard. Many dr.s wont even touch you if you have porex especially if you had it for awhile. One story on YTF is someone had jaw implants then 10 years later wanted a bigger set. The doctor said he will remove them and replace. On the table the dr. wasn't able to remove them without breaking the jaw so just stacked them on top of each other. Another story is someone went to a dr. to have them removed only after a few months. the dr. said sure. on the table the doctor couldn't get it out so he just brought the guy out of anesthesia and said he couldn't do it. THeres one woman who was able to have her medpor cheeks removed but the doctor had to cut around the implant to get all that ingrowth out. Now shes left with major aesthetic indents and issues that cant be fixed easily. Now there have been successful cases of people getting there medpor removed. One guy went to korea and had paranasals removed successfully with no issue. Someone had a nose implant removed somewhat easily although the doctor removed a ton of tissue. BUT Dr. ramirez did tell me that hes put them in boxers who continued to box and proffesional football players and wrestler so you never have to worry about them slipping or discontinuing any physical activity which you would have to stop if you got silicone. BUT most local plastic arent that familiar with the stuff if you get an infection (although low chance) you are in trouble. You have to find a doctor willing to remove it and it wil probably cost a lot because its a tough job for the doc. Thats if your still able to move around and have the $$. If your really seriously infected your going to the ER and then the cranio or plastic on staff will have to remove it. His first and only goal will be safe removal .Hes not going to care about aesthetics.
they come in many different types jaw (which can give drop down ,or flare out ,or both), malar, and orbital rims upper and lower and gives far better augmentation than the silicone version. Ive seen peopl vhave theyre face transformed for the better with medpor (havent realy seen such profound changes with people who had all silicone).
Mepor implants resemble bone more then silicone and due to the ingrowth there no huge capsule that forms.
Composite (silicone covered in gore-tex)
While goretex and silicone have been used in the body for year the composite facial implants have only been used for around 15 years. Infection rate for gore-tex and silicone as stand aloine are low but combines imo its unknown. I havent found any papers discussing it. Its either placed in a pocket only or screwed in. Its removal is harder then regular silicone but easier then medpor. The gore-tex coating is only around .3mm so there no ingrowth just "attachement" per the company rep who I spoke with. To date I havent known anyone on any board who has it. A lot of doctors who used to use medpor are switching over to this because medpor no longer makes custom implants. Only the pre-fabricated ones are available.
They come in the same style as the regular silicone but can be made custom. Ive spoken to a few surgeons who said removal isnt a problem BUT i dont know any removal stories so who knows.
PEEK
This is a new material has been used in soine surgery for last 10-11 years. Doctors started using it sine 2007-2008 for custom facial implants. I have heard its expensive to use but the cost is lowering. It doesnt have a long term infection history . The one paper I read tracked people who had it since 2008 and no infection. Its supposedly the future. Its easy to remove because there no ingrowth. Can be screwed down and looks like bone. Can be easily customized.
Again each has pro's and cons. Its up to you to decide. One thing I do recomend is whatever material you do have a "go stick". Get a copy of the surigcal report, how it was placed, style of implant (if custom a design) and a ct or cone beam scan. Keep it on a usb stick that way if you ever do have an issue down the road you have an "intelligence report" to give the dr. helping you so he's not toally blind.
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What sort of implant do you currently have? just malar (silicone) ?
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What sort of implant do you currently have? just malar (silicone) ?
Just malar but I really needed orbital rim. Im in the process of consulting to swap it out
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Just malar but I really needed orbital rim. Im in the process of consulting to swap it out
Did you ever get a reply from Dr S's office regarding the modified LeFort that Lazlo said he offers?
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I guess this is related, so how do you feel about HA paste as a substitute for implants? There's a lot of criticism of it anecdotally on many forums, however I can't find any studies to back up claims of reabsorption and ineffectiveness. Where do you stand on this?
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I guess this is related, so how do you feel about HA paste as a substitute for implants? There's a lot of criticism of it anecdotally on many forums, however I can't find any studies to back up claims of reabsorption and ineffectiveness. Where do you stand on this?
IMO HA is misused. I actually have some. Dr. g put some in my paranasal area and perioalar(I think that's what its called). the ha by my paranals has calcified. one side of my perialar area is completely gone while the other is still there. Ive consulted with dr. byrd who uses it for cheeks. imo its not for people who need a lot of augmentation.
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That's interesting. I don't need much but it's been suggested I get a zygomatic sandwich osteotomy in order to "create more sculpted, higher cheekbones". Mine aren't recessed, just not terribly prominent.
If you had to compare implants to HA to a zygomatic osteotomy for mild to moderate malar augmentation what would you recommend? Based on what I've seen an osteotomy does seem to provide pretty natural results, but can it ever create those "model-like" cheekbones like some implants seem to be able to?
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That's interesting. I don't need much but it's been suggested I get a zygomatic sandwich osteotomy in order to "create more sculpted, higher cheekbones". Mine aren't recessed, just not terribly prominent.
If you had to compare implants to HA to a zygomatic osteotomy for mild to moderate malar augmentation what would you recommend? Based on what I've seen an osteotomy does seem to provide pretty natural results, but can it ever create those "model-like" cheekbones like some implants seem to be able to?
imo always go osteotomy over implants. with an implants you always living with some doubt that an infection could happen.
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imo always go osteotomy over implants. with an implants you always living with some doubt that an infection could happen.
i ABSOLUTELY, ABSOLUTELY agree with this 1000 percent!
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also ive been on the ps boards since 2003. very few people ever get model cheek bones from an implant. regardless of material. I can think of maybe 3-4 ppl who I saw over the years.
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also ive been on the ps boards since 2003. very few people ever get model cheek bones from an implant. regardless of material. I can think of maybe 3-4 ppl who I saw over the years.
I concur with that statement, but isn't that because mainly the majority of the implants are off-the-shelf rather than custom made? I personally would rather not have the surgery at all than having of-the-shelf implants, they are completely different from the aesthetic goal I'm aiming for.
weakjawbrah, I don't recommend the sandwich osteotomy mainy because the advancement is made far too low on the bones making making miniscule positive aesthetic outcomes while exagerating under-eye hollows, also someone had them with a surgeon in brussels and was not pleased with the results aesthetically as well as ended up with some compilaction from asymmetry.
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I concur with that statement, but isn't that because mainly the majority of the implants are off-the-shelf rather than custom made? I personally would rather not have the surgery at all than having of-the-shelf implants, they are completely different from the aesthetic goal I'm aiming for.
weakjawbrah, I don't recommend the sandwich osteotomy mainy because the advancement is made far too low on the bones making making miniscule positive aesthetic outcomes while exagerating under-eye hollows, also someone had them with a surgeon in brussels and was not pleased with the results aesthetically as well as ended up with some compilaction from asymmetry.
Could you please explain what you mean by this a little more? Or do you have videos or photos? The under-eye hollow I thought comes mostly from people getting le forts, not from zygomatic osteotomies so this is new to me.
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Sure, here's the thing, the sandwish osteotomy is basically making a rectangular cut on the lower part of the zygomatic bone and advancing it forward, the advancement will add highlights to the lower part of the cheekbone, but anything above that will look even deeper so to speak, making a not-so-smooth transition from the orbital rims to the malar bone, here is an example:
(http://oi41.tinypic.com/2guhcif.jpg)
The yellow rectangle is where the cut is made and the bone is advanced, the blue area I shaded are the orbital rims, so by increasing the projection of the zygoma and leaving the upper part (orbital rims) you'll be left with even more difference in terms of projection between the oris and the part that was advanced, making it deeper in comparison, not to mention that having over-projected lower cheek bones are not only unaesthetic for men, but tend to be feminizing, atleast that's my opinion.
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Sure, here's the thing, the sandwish osteotomy is basically making a rectangular cut on the lower part of the zygomatic bone and advancing it forward, the advancement will add highlights to the lower part of the cheekbone, but anything above that will look even deeper so to speak, making a not-so-smooth transition from the orbital rims to the malar bone, here is an example:
(http://oi41.tinypic.com/2guhcif.jpg)
The yellow rectangle is where the cut is made and the bone is advanced, the blue area I shaded are the orbital rims, so by increasing the projection of the zygoma and leaving the upper part (orbital rims) you'll be left with even more difference in terms of projection between the oris and the part that was advanced, making it deeper in comparison, not to mention that having over-projected lower cheek bones are not only unaesthetic for men, but tend to be feminizing, atleast that's my opinion.
I totally agree in face that looks to be what happened to this guy
(http://i.imgur.com/lOYuVAX.jpg)
face ends up looking more rounded than angular
I think you'd have laterally widen the prominence of the zygomatic arches and the lateral superior end of the zygomatic bone only to get those ideal cheekbones, with hollowness between cheekbone and maxilla.
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Yikes, he could have looked FAR better had he augmented his laterall upper cheeks, notice in the 3/4 view of the before picture, he used to have that concave dip right around the tip of his nose, that concave is gone in the after, what did he have exactly? just the regular lefor1 or something else?
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Yikes, he could have looked FAR better had he augmented his laterall upper cheeks, notice in the 3/4 view of the before picture, he used to have that concave dip right around the tip of his nose, that concave is gone in the after, what did he have exactly? just the regular lefor1 or something else?
No he also had a cheekbone osteotomy, probably the same one you posted above
we get more into this subject here: http://jawsurgeryforums.com/index.php/topic,833.0.html (http://jawsurgeryforums.com/index.php/topic,833.0.html)
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wow, poor guy, could have ended with far better results.
weakjaebrah, do not do that sandwich osteotomy, if you're looking for a way to enhance your cheeks, focus on the upper laterall portion, this is far more masculine.
edit: look at that, we both practically said the same thing about the lower cheek concavity ;)
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Not not really, obviously he looks far better than the before, but his results are subpar, he could have looked even better if he didn't have the sandwich thing and opted for malar implants.
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I don't know man, I think it's the opposite. With the concavity it's indicative of strong bone structure (unless you're like that patient we keep posting), and the soft tissue basically drapes over it and gets pulled to an ideal tightness. Most guys with that type of bone structure seem to age marvelously, while those of us with too much soft tissue and too little bone projection get screwed
Tell me about it, these are the guys who "get better with age", their angularity accentuates with aging with the loss of baby fat.
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Can you post an example of what you like? I think there's some misscomunication.
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(http://media.tumblr.com/tumblr_lizvclPCwm1qgmygp.jpg)
That's what me and euphoria mean, very projected upper cheeks with an indentation between the highest point of the cheek and the mandible, creating in S curve, if you already had a flat cheek and an S curve then yes that could be an unattractive feature, but with a good amount of highlight in the upper cheeks, whith shadows below them, you;d have the angularity that we're talking about, every good looking guy has that.
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(http://media.tumblr.com/tumblr_lizvclPCwm1qgmygp.jpg)
That's what me and euphoria mean, very projected upper cheeks with an indentation between the highest point of the cheek and the mandible, creating in S curve, if you already had a flat cheek and an S curve then yes that could be an unattractive feature, but with a good amount of highlight in the upper cheeks, whith shadows below them, you;d have the angularity that we're talking about, every good looking guy has that.
for sure, you can look pretty good without any of that but to look really good you have to start having that awesome bone structure. It's pretty uncommon even for class I's though
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(http://media.tumblr.com/tumblr_lizvclPCwm1qgmygp.jpg)
That's what me and euphoria mean, very projected upper cheeks with an indentation between the highest point of the cheek and the mandible, creating in S curve, if you already had a flat cheek and an S curve then yes that could be an unattractive feature, but with a good amount of highlight in the upper cheeks, whith shadows below them, you;d have the angularity that we're talking about, every good looking guy has that.
So frankly I concur with you Geijitsu, this example --the architecture of the S curve you point out is indeed present in almost every good looking guy --I mean other things count too, spacing of the eyes, shape of lips, size of nose, skin hair quality etc. but as far as facial bone structure is concerned I think you're right. Again, not that most of us can aspire to have it, but I think it's on some level the ideal.
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With that one surfer guy everyone has been posting I thought it wasn't even confirmed whether he had a zygomatic osteotomy or not. In the last thread people were discussing how they thought his loss of S-whatever you call it was due to advancing the maxilla from a lefort, and that there weren't any signs of having had any malar osteotomies done.
Regarding the hollowing out underneath the orbital rim, surely that could be smoothed out with either filler or HA paste. It sounds like a stupidly simple solution to this, though I can't see why it wouldn't work.
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I honestly think that she probably did have something done to her cheek, can't say what for sure until I see a video of her with animation, but yes her bone structure is immaculate to begin with, but keep in mind, with age bone resorption starts to take place after mid to late 40s, so she probaby does need some surgical help for maintainance sake.
edit: Soft tissue alteration does exist but it's incredibly tricky and a b*tch to work with, stuff like facial liposuction or lipodissolve exist for leaner face but tend to come with many drawbacks, and the results can be unpredicatble even in the hands of the most skilled plastic surgeon.
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I honestly think that she probably did have something done to her cheek, can't say what for sure until I see a video of her with animation, but yes her bone structure is immaculate to begin with, but keep in mind, with age bone resorption starts to take place after mid to late 40s, so she probaby does need some surgical help for maintainance sake.
but is that the result of fillers or implants? I can't tell. i saw a youtube video of her, seemed pretty normal in animation.
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You know what, now that I saw some videos of her, I don't think she's done anything to her cheeks.
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Here is a picture of her in her youth, even though her cheek are prominant here, they're not as ridiculously projected as her recent pictures, but this could be attributed to the loss of fat eccentuating her already prominant cheekbones, either that or she's in the hand of a really talented surgen:
(http://s3.amazonaws.com/auteurs_production/images/cast_member/105286/original.jpg)
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Yes her bone structure is phenomenal and especially for her age but she has admitted to having cosmetic procedures to maintain her looks, I'm not sure what those entail.
To me it looks like something has been done to her cheeks now, perhaps just carefully, sparsely applied filler?
Dear lord I can't stand Madonnas cheek implants, they're far to big and round for her face but I'm sure most surgeons would say she looks "healthy" now phfft...
Perhaps her main goal was to look younger when she got the cheek implants so angles and contours may not have even been discussed in her consultations. Also being so well known she might not have wanted to do something that could potentially drastically change the shape of her face.
I've said it before but the cheekbones Sailer gave to the red haired lady shown on his website are the closest I have seen to achieving modelesque cheek bones by artificial means. Aparently the lyophilized cartilage he uses transforms partly into the patients own bone which I find hard to believe.
Interestingly, it seems Mommaerts and two other surgeons used lyophilized cartilage to transform someones face into Micheal Jackson at his request. http://www.ncbi.nlm.nih.gov/pubmed/11534446 (http://www.ncbi.nlm.nih.gov/pubmed/11534446)
RE using bone for augmentation, someone asked this on realsef and the doctors said it could be done but questioned why when there are implants made of silicone, (I would have thought the obvious answer to this is because they look like implants made of silicone!) I think they also said that a large amount of the bone graft would be absorbed.
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Here is a picture of her in her youth, even though her cheek are prominant here, they're not as ridiculously projected as her recent pictures, but this could be attributed to the loss of fat eccentuating her already prominant cheekbones, either that or she's in the hand of a really talented surgen:
(http://s3.amazonaws.com/auteurs_production/images/cast_member/105286/original.jpg)
i'm sorry but i'm just in awe of that kind of bone structure on men or women. i must have it! the jaw i can see being done with really good bsso and genioplasty. i just don't know yet how to accomplish the cheekbones(i'm a guy by the way). the quad lefort II seem the only option so far or some kind of orbital rim osteotomy. note that ALL these good looking people right under their eyelid you begin moving outward, not sunken in like i have now.
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Yes her bone structure is phenomenal and especially for her age but she has admitted to having cosmetic procedures to maintain her looks, I'm not sure what those entail.
To me it looks like something has been done to her cheeks now, perhaps just carefully, sparsely applied filler?
There's no doubt in my mind that she did have a facelift at some point, watching her videos; there's a very slight pulled look going on, very sublte, and her neck looks ridiculously sculpted, I know that she has a jaw that goes on forever, but it's simply impossible to have such a tight neck at her age, it looks even tighter than the picture I posted of her in her youth, I think filler is probable, maybe just to give her smooth lid/cheek transitions but nothing too drastic, carefully put filler can really be deceiving so I can see that as an option.
Dear lord I can't stand Madonnas cheek implants, they're far to big and round for her face but I'm sure most surgeons would say she looks "healthy" now phfft...
Her cheek implants are awful, very large and not placed correctly:
(http://i39.tinypic.com/9fs7i9.jpg)
I've said it before but the cheekbones Sailer gave to the red haired lady shown on his website are the closest I have seen to achieving modelesque cheek bones by artificial means. Aparently the lyophilized cartilage he uses transforms partly into the patients own bone which I find hard to believe.
Yeah but aren't they too sculpted? not a good look, really harsh.
Interestingly, it seems Mommaerts and two other surgeons used lyophilized cartilage to transform someones face into Micheal Jackson at his request. http://www.ncbi.nlm.nih.gov/pubmed/11534446 (http://www.ncbi.nlm.nih.gov/pubmed/11534446)
Oh I didn't know it was momaerts who did that MJ lookalike guy, saw the pictures long time ago but never knew where they came from.
RE using bone for augmentation, someone asked this on realsef and the doctors said it could be done but questioned why when there are implants made of silicone, (I would have thought the obvious answer to this is because they look like implants made of silicone!) I think they also said that a large amount of the bone graft would be absorbed.
I'm familiar with some kind of a highly porous material that tend to resorb quickly and replaced by bone in a matter of months, I think they do involve HA but there was something else mixed in there to make it resorbable and highly porous, can't seem to remember what its called, maybe one of you guys can ask one of the doctors your frequently consult with?
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so so true, it really is all about bone structure, but of course the shape of the soft tissue as well. why can't one's own bone be grafted and shaped? I didn't know who Carmen Dell'orefice was but wow, incredible bone structure on that woman, incredible. But even how her soft tissue drapes is really remarkable.
She has that S curve bigtime. But why is it that whenever they use fillers/implants etc. like Madonna who has had the works they can never
ever approximate a natural appearance. it always look messed up. This photograph of Carmen dell'orrofice is clearly airbrushed makeup, but
the bone structure is real, this is not an implant and while there maybe some topical stuff no filler really either. She has the greatest bone
structure I've ever seen and she's 82!!!!
There's an old saying "beauty is in the bones". age and beauty are 2 different things. My dad's the perfect example. Albeit he has a better overall bone structure than me, he's still not good looking at all with one of the worst noses ever (it was so bad that when he dropped me off for my rhino, my doc literally just stared and went omg). He's in his 60's now and spends tons(thousands to date) of money on botox,fillers,peels etc to "look younger". Does he look a bit younger and "fuller" yes, does it do anything for him absolutely not. He's still not good looking. Even at his age had he put that money towards a nose job and jaw surgery (needs lower jaw bsso anda reverse genio to fix his natural witches chin) he would not only look younger but better looking. I look better now at 30 than I did at 18
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I have posted here before to comment on that guy's result (in the original post). I said that I liked how he looked before much, much more than after - the reasons being the unfortunate reduction of his nose (wtf was the surgeon thinking?) and the unfavorable change of his mid-face. So, as far as aesthetic preferences I'm on the same page as geijutsu, 100%. Then I exchanged pms and emails with some members here trying to explain why I think so, using pics of models to illustrate my point - look up Jon Kortajarena - he's a good, radical example of the S curve.
I'd like to debunk some myths though. First of all, we do not know what that guy had done exactly. The site where these pictures are taken from is brazilian, and all it says is that he had some sort of zygomatic osteotomy. Not sandwich. Assuming that he had a sandwich zygomatic osteotomy is wrong.
It is NOT a fact that the sandwich osteotomy (ZSO) advances and augments the lower part of the cheekbone. For all of you who haven't done so, go to Mommaerts's web site, register to access the articles - it's free, and download the ones on zygomatic sandwich osteotomy. There are MANY VARIABLES to this procedure. The underlying idea is to RAISE and move the cheekbone both laterally and forward (anterior and lateral projection). By controlling the variables, you can tweak the procedure to augment more towards the zygomatic arch (laterally). It doesn't even have to be "sandwich". It can simply be zygomatic arch osteotomy (Mommaerts explains the difference with pictures in his articles between arch and sandwich zygomatic osteotomy). The arch one will augment almost exclusively only laterally.
I find it hard to believe that a zygomatic osteotomy gave that guy that look in the after pictures (arch or sandwich, for that matter). If you know this for a fact, please tell me so because this procedure is part of my surgical plan and I sure as hell don't want to end up looking like that. For me, it looks like that guy had SUBMALAR implants, or some other form of submalar augmentation. Certainly not malar.
Yes, it's true that it can exacerbate the deficiency in the orbital rim. This happens.
I took pictures of myself and drew on them - the parts that I want augmented (in one color) and the parts that I absolutely do not want to see augmented (in another). The surgeon assured me that the zygomatic osteotomy augments only the parts I want to see augmented.
this is how Mommaerts explains it in his article "the ZSO is indicated when an anteriolateral deficiency of the malar area is present, inferior and lateral to the lateral canthus. I repeat, inferior and lateral to the lateral canthus. So, it is really a safe and effective replacement for MALAR implants, not submalar. That's why I'm confounded by claims that the patient posted here had a zygomatic osteotomy. Again, sure as f**k he did not get any augmentation lateral to the lateral canthus, as a matter of fact he lost the one he had. His before picture is what I would like to look after, cheekbone and cheek-wise.
Also, geijutsu or whoever said something about a patient being unhappy with Mommaerts' malar osteotomy - could you please give more details? Where did you learn about the case, was the patient male, and what was he unhappy with?
I know for a fact that I'm having a mandibular advancement with HA augmentation of the jaw angles (again think laterally) and very likely paranasal augmentation. This is because my submalar area is already convex, and this is not the look I want. I will only choose the zygomatic ostoetomy if I'm certain 100% that my surgeon understands my aesthetic goals. Fortunately, he's open to the idea of looking at male models pictures which I have used to illustrate my points. I'm using the pictures for illustration - it is an absolute must that you and your surgeon are on the same page, and that you don't end up looking like that guy posted here. I want to make my face more masculine and definitely more concave. I have even been thinking of some subcutaneous liposuction with micro canulas in that area to help create that look - flatten my cheeks, while augmenting my cheekbones high and laterally towards the zygomatic arch. I want to make it clear that I'm by no means overweight and I'm very fit. I simply can observe some access fat in my submalar area which is genetic. I know there are women who want that look for themselves and even have fat transfers there to achieve it. However, I'm not a woman. I know exactly what I want.
I know many of you will not understand what I'm saying - some of you asked me before what is the difference between a cheek and a cheekbone. However, I did my best to explain. And I'm sure some of you do understand. Again, look at Jon Kortajarena - he doesn't have prominent cheeks - his cheeks are hollow even. He has prominent cheekbones. Think malar - submalar. Look at malar and submalar implants at the med-por catalogue to understand the difference. It's interesting that some people here with hundreds and plus posts don't understand the difference between bone and soft tissue distribution on the cheeks, and between malar and submalar. I've heard the term mid-face used too many times to refer to anything at all. Mid-face is a very wide term and can be anything from paranasal, submalar, malar, zygomatic arch, zygomatic process etc. As long as you treat all this as it is one and the same thing, you'll never understand what you need exactly and how you can improve your face. I'm not saying submalar augmentation is wrong for everyone. But for most men, YES, it is. And for me, it is 100% not indicated. So, I will make sure the zygomatic osteotomy does not augment this area even a mm, or I will not have it. And it shouldn't. The way it works, it should augment the bordering malar area, and flatten this one. How will it flatten? Again, think soft tissue distribution. You move the cheekbone laterally (and significantly, Mommaerts moves it at least 5 mm, often more), you expect it to balance and pick up some of the excess soft tissue in the submalar area, i.e. more evenly distributed soft tissue with strong high cheekbones in the end. Wishful thinking? I don't know. We'll see. I'll keep you updated after my surgery.
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I have posted here before to comment on that guy's result (in the original post). I said that I liked how he looked before much, much more than after - the reasons being the unfortunate reduction of his nose (wtf was the surgeon thinking?) and the unfavorable change of his mid-face. So, as far as aesthetic preferences I'm on the same page as geijutsu, 100%. Then I exchanged pms and emails with some members here trying to explain why I think so, using pics of models to illustrate my point - look up Jon Kortajarena - he's a good, radical example of the S curve.
I'd like to debunk some myths though. First of all, we do not know what that guy had done exactly. The site where these pictures are taken from is brazilian, and all it says is that he had some sort of zygomatic osteotomy. Not sandwich. Assuming that he had a sandwich zygomatic osteotomy is wrong.
I was the one that originally made that assumption but yeah you're right it's very unlikely that he had an actual zygomatic osteotomy because AFAIK no one in the country does that sort of thing, like you so said yourself he most likely had one of those shell implants put in rather than actual bone work.
I do think that overall he looks better but the nose-job was a terrible mistake, his new girly nose throws everything off
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One thing to note is maybe that guy didnt like the contour from 3/4, not all people understand facial proportions and stuff. Maybe he thought "I dont see it on other people so I dont want it either" probably why his nose is messed up in the after, he had no idea what to get done.
Anyone know if you had similar cheekbones in the before as that guy would the same thing happen if you had a maxilla advancement? or would the skin become more taut around that area
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Yes geijutsu will you please shed more light on the Mommaerts patient who was unhappy with the malar osteotomy?
There are so few testimonials on this procedure.
falcao I'm very pleased to see that you want the same kind of look that I'm after, I will also be consulting with Mommaerts to see if he can help me achieve this goal.
Within the last week, there have been two posters on lookyourbest.co.uk who are unhappy jaw surgery patients of Mommaerts but refuse to show pictures...
And what are there really some people who don't know where the cheekbones are located or the difference between them and the soft tissue beneath!?? I'm speechless, flick through Vogue or GQ, there should be no doubt left in your mind.
I tried PM'ing one of the people off lookyourbest but he won't respond. No pics, no response makes me very skeptical. His posts were very inconsistent too.
I'm thinking he may he issues adjusting to his new jaw. Maybe he does have real problems, but so long as he won't post pics I can't take them seriously. Too many shills out there.
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I have posted here before to comment on that guy's result (in the original post). I said that I liked how he looked before much, much more than after - the reasons being the unfortunate reduction of his nose (wtf was the surgeon thinking?) and the unfavorable change of his mid-face. So, as far as aesthetic preferences I'm on the same page as geijutsu, 100%. Then I exchanged pms and emails with some members here trying to explain why I think so, using pics of models to illustrate my point - look up Jon Kortajarena - he's a good, radical example of the S curve.
I'd like to debunk some myths though. First of all, we do not know what that guy had done exactly. The site where these pictures are taken from is brazilian, and all it says is that he had some sort of zygomatic osteotomy. Not sandwich. Assuming that he had a sandwich zygomatic osteotomy is wrong.
It is NOT a fact that the sandwich osteotomy (ZSO) advances and augments the lower part of the cheekbone. For all of you who haven't done so, go to Mommaerts's web site, register to access the articles - it's free, and download the ones on zygomatic sandwich osteotomy. There are MANY VARIABLES to this procedure. The underlying idea is to RAISE and move the cheekbone both laterally and forward (anterior and lateral projection). By controlling the variables, you can tweak the procedure to augment more towards the zygomatic arch (laterally). It doesn't even have to be "sandwich". It can simply be zygomatic arch osteotomy (Mommaerts explains the difference with pictures in his articles between arch and sandwich zygomatic osteotomy). The arch one will augment almost exclusively only laterally.
I find it hard to believe that a zygomatic osteotomy gave that guy that look in the after pictures (arch or sandwich, for that matter). If you know this for a fact, please tell me so because this procedure is part of my surgical plan and I sure as hell don't want to end up looking like that. For me, it looks like that guy had SUBMALAR implants, or some other form of submalar augmentation. Certainly not malar.
Yes, it's true that it can exacerbate the deficiency in the orbital rim. This happens.
I took pictures of myself and drew on them - the parts that I want augmented (in one color) and the parts that I absolutely do not want to see augmented (in another). The surgeon assured me that the zygomatic osteotomy augments only the parts I want to see augmented.
this is how Mommaerts explains it in his article "the ZSO is indicated when an anteriolateral deficiency of the malar area is present, inferior and lateral to the lateral canthus. I repeat, inferior and lateral to the lateral canthus. So, it is really a safe and effective replacement for MALAR implants, not submalar. That's why I'm confounded by claims that the patient posted here had a zygomatic osteotomy. Again, sure as f**k he did not get any augmentation lateral to the lateral canthus, as a matter of fact he lost the one he had. His before picture is what I would like to look after, cheekbone and cheek-wise.
Also, geijutsu or whoever said something about a patient being unhappy with Mommaerts' malar osteotomy - could you please give more details? Where did you learn about the case, was the patient male, and what was he unhappy with?
I know for a fact that I'm having a mandibular advancement with HA augmentation of the jaw angles (again think laterally) and very likely paranasal augmentation. This is because my submalar area is already convex, and this is not the look I want. I will only choose the zygomatic ostoetomy if I'm certain 100% that my surgeon understands my aesthetic goals. Fortunately, he's open to the idea of looking at male models pictures which I have used to illustrate my points. I'm using the pictures for illustration - it is an absolute must that you and your surgeon are on the same page, and that you don't end up looking like that guy posted here. I want to make my face more masculine and definitely more concave. I have even been thinking of some subcutaneous liposuction with micro canulas in that area to help create that look - flatten my cheeks, while augmenting my cheekbones high and laterally towards the zygomatic arch. I want to make it clear that I'm by no means overweight and I'm very fit. I simply can observe some access fat in my submalar area which is genetic. I know there are women who want that look for themselves and even have fat transfers there to achieve it. However, I'm not a woman. I know exactly what I want.
I know many of you will not understand what I'm saying - some of you asked me before what is the difference between a cheek and a cheekbone. However, I did my best to explain. And I'm sure some of you do understand. Again, look at Jon Kortajarena - he doesn't have prominent cheeks - his cheeks are hollow even. He has prominent cheekbones. Think malar - submalar. Look at malar and submalar implants at the med-por catalogue to understand the difference. It's interesting that some people here with hundreds and plus posts don't understand the difference between bone and soft tissue distribution on the cheeks, and between malar and submalar. I've heard the term mid-face used too many times to refer to anything at all. Mid-face is a very wide term and can be anything from paranasal, submalar, malar, zygomatic arch, zygomatic process etc. As long as you treat all this as it is one and the same thing, you'll never understand what you need exactly and how you can improve your face. I'm not saying submalar augmentation is wrong for everyone. But for most men, YES, it is. And for me, it is 100% not indicated. So, I will make sure the zygomatic osteotomy does not augment this area even a mm, or I will not have it. And it shouldn't. The way it works, it should augment the bordering malar area, and flatten this one. How will it flatten? Again, think soft tissue distribution. You move the cheekbone laterally (and significantly, Mommaerts moves it at least 5 mm, often more), you expect it to balance and pick up some of the excess soft tissue in the submalar area, i.e. more evenly distributed soft tissue with strong high cheekbones in the end. Wishful thinking? I don't know. We'll see. I'll keep you updated after my surgery.
I'm willing to exchange information with you falcao if you stay on this site and also continue to provide information as well.
1) First, who is your surgeon, Mommaerts?
By all accounts Mommaerts is a very good surgeon, highly regarded.
What you have provided about the M's zygomatic osteotomy is great information, very interesting and important so thank you for making these clarifications and reinforcing them.
2) Second, if the lefort 1 or even high lefort moves the maxilla and upper part of maxilla forward then that by it's very nature will enhance the submalar region correct? If the S (jon kortajarena) effect is indeed desired then we need to enhance the malar region even further, correct?
3) Okay, now here's the controversial parts. Mommaerts examples on his site are fine. The red headed lady, she apparently is the recipient of the zygomatic osteotomy. I'm a bit skeptical that's what she's had, but if so, the results are amazing. That said, I've seen some of his bi-max and bsso patients and they have not looked great --like minimal improvement.
There was a patient from this site, he posted (search mommaerts and you'll find him) who had the HA paste for gonal/jaw angle augmentation. He said his two sides came out asymmetric(noticeably) --they said maybe he needed time to heal, etc. Apparently M did not offer that the HA paste can be molded for up to 6 weeks after surgery --either it's not true as A/G claim and routinely do to HA paste for the malar region (which does not produce any noticeable results) --I don't know. He was quite disturbed by it. Didn't show me pics but I trust him. He stopped corresponding and posting. I have heard of this problem on another site from someone else --the result was not symmetric.
4) I asked Dr. Schendel about zygomatic osteotomy. He smirked and without prompting said, "oh have you been looking at dr. mommaerts work?" Schendel is a very nice guy so he didn't say it with any anatagonism, but he said he didn't do it or like to do it because he said "well the results are very unpredictable."
5) Now, Schendel's comments were somewhat confirmed to me when I visited Miss J's site --another plastic surgery site you may be aware of. On that site a few months back a male patient, mid 30s posted pics. He had had a few procedures from Mommaerts including the malar osteotomy. He had a few concerns --said the recovery psychologically very rough because how different he looked (not a bad thing for many of us true!). Specifically, though there was a sort of splintering or a slight shatter that produced an indent or asymmetry, I wasn't sure what it was on one side. He actually was quite adamant about wanting the procedure reversed. While I thought he looked overall good and the procedure did give him that quite dramatic cheekbone, you could see there was a bit of a slight indent or something wrong on one side. This at least confirmed that the procedure is not all that predictable. Also, for many of us our cheekbones are not equally developed and bringing them out may exacerbate the difference. I don't know what the reason was, or there was indeed a slight shattering or something during the procedure.
I have corresponded with Mommaerts about the procedure briefly, he suggested it for me, and said that he would use HA paste to augment the orbital rim. I in fact showed him a picture of J Kortajarena to illustrate the result I wanted so we're both on the same page there.
I think the procedure sounds great produces good results but I don't know why it's not used more. Again, how many before/after pics have you seen of the procedure, can you share them on this site?
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I want to chime in on this issue one more time because here's another illustration of the problem similar to the surfer dude from above. Specifically I was looking at this site from the "good surgeon's in florida" thread. Scroll down to young hispanic looking patient Jorge who was diagnosed with "maxillary hypoplasia" --in the before his cheekbone is more forward in the 3/4 view but he loses it in the after picture once he's had the lefort procedure. Now his submalar area is more forward and puffed out. This, to my view, and several of us is a very unfavorable and disfiguring outcome. The upper malar/zygoma needed to be augmented even further. So barring implants, is the zygomatic osteotomy the only way to do that? What about the quadrangular lefort 1 or the quadrangular lefort 2? Are you familiar with those procedures?
http://floridacranio.com/before-and-after/ (http://floridacranio.com/before-and-after/)
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That patient's Jorge's results are really scaring me frankly, i think it might be because he has a short face that his results were so skewed in the after, but while it may have improved his maxilla it totally ruined his face. He was very handsome before and looks messed up the unfortunate strange monkey face after. How on earth can this be avoided or offset? Is the zygomatic osteotomy the only solution?
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I want to chime in on this issue one more time because here's another illustration of the problem similar to the surfer dude from above. Specifically I was looking at this site from the "good surgeon's in florida" thread. Scroll down to young hispanic looking patient Jorge who was diagnosed with "maxillary hypoplasia" --in the before his cheekbone is more forward in the 3/4 view but he loses it in the after picture once he's had the lefort procedure. Now his submalar area is more forward and puffed out. This, to my view, and several of us is a very unfavorable and disfiguring outcome. The upper malar/zygoma needed to be augmented even further. So barring implants, is the zygomatic osteotomy the only way to do that? What about the quadrangular lefort 1 or the quadrangular lefort 2? Are you familiar with those procedures?
The quad lefort ii brings the cheekbones forward, what you need for that cheek hollowness is lateral protrusion of the cheekbones
I think there's two different kind of looks, the cheek 'apple':
(http://jawsurgeryforums.com/index.php?action=dlattach;topic=85.0;attach=162;image)
this is more commonly considered ideal in women
and the high, prominent cheekbones:
(http://weirdiary.com/wp-content/uploads/2012/12/diego-miguel-1_2.jpeg)
with the first guy they not only protrude out laterally, but also have a lot of forward projection relative to the rest of the face. with the second guy, I'd bet his upper face would be seen as pretty flat from profile view because he has a lot of lateral projection but not much forward
that's the issue with implants as falcao touched on, they stick them on the front of the face which has a negiligible effect on appearances, the true purpose of cheekbones imo is to add width to the upper face and that is only seen via lateral projection
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regardless, the point we're asking here is what procedure can do this? it's not from the front that we're concerned about so much as from the 3/4 --i think if the 3/4 is taken care of so will the front. i also disagree that with the lefort II quad the only gain is from the front, by necessity it would seen in the 3/4 as well assuming it's brought more forward than the submalar.
What's disappointing is that this is so obviously a desired aesthetic, why don't the max facs know or aim for this more consistently? The just plump out the "midface"
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the quad lefort ii will only bring the cheekbones forward, it adds no width to them is my point. forward projection is irrelevant to the s-curve. I can guarantee you it's not the miracle procedure
again lateral projection, but not much forward:
(http://www.dailymalemodels.com/wp-content/uploads/2012/11/Sean-OPry-Vogue-Mexico-Dailymalemodels-03.jpg)
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the quad lefort ii will only bring the cheekbones forward, it adds no width to them is my point. forward projection is irrelevant to the s-curve. I can guarantee you it's not the miracle procedure
again lateral projection, but not much forward:
(http://www.dailymalemodels.com/wp-content/uploads/2012/11/Sean-OPry-Vogue-Mexico-Dailymalemodels-03.jpg)
stop posting these stupid pictures of models. they don't demonstrate anything since these people have a 100 other things going on contributing to the overall effect. if you want to demonstrate the look just keep it simple. too much lateral projection will introduce the problem of making your appears too close set if your face didn't achieve that lateral projection naturally or you already have eyes on the closer set. I'm not saying the lefort II quad is the solution to everything. I do think it will help the s-taper on a 3/4 angle. But I don't know. Let's just keep the discussion on whether Mommaerts technique indeed achieves the look and whether it's viable, predictable etc..
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stop posting these stupid pictures of models. they don't demonstrate anything since these people have a 100 other things going on contributing to the overall effect. if you want to demonstrate the look just keep it simple. too much lateral projection will introduce the problem of making your appears too close set if your face didn't achieve that lateral projection naturally or you already have eyes on the closer set. I'm not saying the lefort II quad is the solution to everything. I do think it will help the s-taper on a 3/4 angle. But I don't know. Let's just keep the discussion on whether Mommaerts technique indeed achieves the look and whether it's viable, predictable etc..
they represent the cheekbone look you're going for do they not? I'll stop posting their pics when you stop living under the delusion that any current procedure will ever give you anything close to that look. unless you want to make a trip to Sailer
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If US surgeon (who imo are way ahead in every imaginable field) aren't doing/offering these procedures you can bet your ass that there is a good reason behind it.
also if your "starting point" isn't compatible with these supposedly ideal angles/facial contours that you want it's better to leave it alone.
A&G were able to achieve the look that you guys are talking about with this female patient by using HA paste but is it going to last forever? no one knows...
(http://www.arnettgunson.com/images/photos/instrumentsImage1.png) (http://www.arnettgunson.com/images/photos/instrumentsImage2.png)
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If US surgeon (who imo are way ahead in every imaginable field) aren't doing/offering these procedures you can bet your ass that there is a good reason behind it.
also if your "starting point" isn't compatible with these supposedly ideal angles/facial contours that you want it's better to leave it alone.
A&G were able to achieve the look that you guys are talking about with this female patient by using HA paste but is it going to last forever? no one knows...
(http://www.arnettgunson.com/images/photos/instrumentsImage1.png) (http://www.arnettgunson.com/images/photos/instrumentsImage2.png)
It doesn't even look that good, just like every other artificial recreation of an aesthetic ideal...
I just want to maintain my current (mediocre) taper. Lazlo wants a face transplant
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for chrissakes Euphoria it's no wonder you have social anxiety and narcissistic personality disorder. you're unbelievably touchy and take everything so personally. you really just should not participate in this discussion because you just make everything so personal. thanks pekay for actually providing some information.
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THOSE EYES DOE lol
Pekay,
IME the reason why US docs are afraid to try new things is because not enough research on it/ not enough experiences performing said technique/too complicated. Which are not bad reasons.. Anyway idk where you found that case, do you know exactly what she had done?
bracesundcurap you've really, seriously got to read the threads on this forum, her case and others have been discussed extensively already. anyway go to arnett gunson's facial reconstruction website where her procedures are listed: they include bimax, and ha paste as well as hylauronic acid injections (a temp. filler to her orbital rim area) --so she's a unique case. but seriously, you've got to read through these threads some more.
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Now guys, there's no need to argue and attenuate the purpose of this discussion.
Lots of cool stuff mentioned here though, I'm currently lying in my bed and typing this on my iphone (1am over here) and there's no way in hell that I'll be writing a detailed post while I'm on my iphone, so I'll try to reply to you guy tomorrow.
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@ lazlo
Thanks very much for that information, it was useful. Especially about the case that had asymmetry as a result of HA augmentation in the jaw angles. Too bad he didn't post afterwards for us to see if that may have had to do with residual swelling. Or was it long after the surgery? I have to look him up.
I am also a very busy individual and do not find it easy to post often here or even read posts regularly. Most of the time I don't have anything useful to add though.
Yes, I will have the surgery with Mommaerts. I did have several consults in the past year, and explored the options for implants as well. I talked to maxilofacial as well as cosmetic surgeons to understand the pros and cons of different approaches. I have been recommended various options by various surgeons - surgeon will often recommend whatever they know and whatever they are comfortable with - not necessarily what's best for you. It's imperfect world, so we have to do our own research. The hardest decision for me was deciding between bi-max and single jaw surgery, but that's another topic.
I'm aware of some unhappy Mommaerts patients and I have exchanged emails with one of them. He seemed legitimate and it appeared in his case that Mommaerts made some misjudgments. I have not seen any pics though. I have also seen another M's patient's pictures here - he had a bi-max surgery. When I saw the pictures I was very disappointed with his sub-optimal result. What scares me is that there aren't really any posts about him from happy patients (apart from one I found on lyb), and the few that have posted are not happy with the results. Scary s**t!!!
The lesson for me is not to take at face value anything a surgeon says but to use what you know and what your surgeon knows in combination to come up with the best plan. The reason why I decided to go with Mommaerts is because he does tons of cosmetic work apart from the orthognathic surgeries he also performs regularly. I'd rather have an aesthetically great outcome than a perfect bite or whatever, so I need a surgeon who understands aesthetics. That man has written books and writes articles not only on orthognathic and cosmetic work, but also on beauty. In a recent article he analysed faces of the People magazine's most beautiful people, both men and women. He has a scientific interest in what makes people beautiful and he does research to answer this question. He also chaired an international conference on facial makeover with cosmetic surgeons from all over the world only a few months ago. He seems to understand bones but also soft tissue. I want a surgeon who is passionate about people looking beautiful, not a surgeon passionate about occlusion. I'm very careful about promoting him as a great surgeon - I have no idea if he really is, but for me he feels like the right choice. Most obviously because I do not know anyone else who can do all three procedures I mentioned above on me. How many other maxillofacial surgeons in the world you know who do so much cosmetic work and study, publish and read on beauty constantly? None? And he's been doing this for 30 plus years. He even does things like face lifts and lip lifts and s**t. You would assume he would have figured out by now in his 30 years of operating and so many books he's written on cosmetic surgery what works and what makes people beautiful. And the best for me is that he's kept up with orthognathic surgery - he continuously operates on jaw as well as other part of the face. Aside from all his cosmetic work, he still does more jaw surgeries in one year than most surgeons do in 10.
There is always the risk that things will not turn out well for some people. Chance plays a big role in every surgical outcome, even if you have the greatest surgeon and the greatest surgical plan. That's the f**ked up reality. Maybe in the 23rd century things will be different, but now you either take risk and hopefully benefit from it, or you don't. As simple as that. All you can do is communicate clearly with your surgeon. Show him pictures of models if you have to. If he dismisses such approach, walk away. Because otherwise you increase your chances of having a bad outcome if he's not on the same page as you aesthetically. It's a fact that most cosmetic surgeons, let alone maxillofacial surgeons, do not understand male beauty. They don't have a f**king clue about what makes men beautiful. I know people who had cosmetic surgeons suggesting them the most ridiculous and inappropriate for their case things because (1) they want to make easy money with what they know how to do (2) they don't know any better (3) (in the case of maxillofacial surgeons) all they know about is occlusions, TMJs etc. Certainly not beauty. And that's how you end up with a reduced feminine nose, when you already have a great masculine nose and you absolutely do not need rhinoplasty.
About the ZSO - Mommaerts says in his article that the chances for asymmetry are much lower with this procedure, than with implants. He himself has not seen asymetry from this procedure. He cites data for this, it's not only an observation he makes. Implants, especially those that we are discussing here - the high malar type that augments the zygomatic arch, even if you find the ideal for you, can still be and are often misplaced. Another heavy weight surgeon - you may have heard of him - Yaremchuk, explained to me that it's hard or down right impossible to address that area with implants intraorally. He said that if he was going to do implants on me, he would tailor them (custom-made) according to my CT scans and then place them both intraorally and through another incision either in the lower eyelid or the temple (in the hairline). It's really complicated and you guessed right, it costs a fortune to have a custom-made model made of your skull and then implants engineered specifically for you. Most men do not benefit from implants because they are often misled (by ignorant surgeons who know s**t about male beauty) to choose the wrong off-the-shelf type for them, and more often than not, even in the case of the right type (if they find them or custom-made them) they end up placed incorrectly - not high enough, asymmetrically etc. The fact is there are not many types out there (if any at all, I have studied catalogues of implants thoroughly and spoke to surgeons) that cater to men and male aesthetical ideals. Strange, but true. For example, there aren't any acceptable ones for augmenting the zygomatic process of the zygomatic arch (the zygomatic process is the most lateral part that makes all those fashion models attractive). That's why Yaremchuk recommended custom-engineered ones for me.
Mommaerts also mentions in his article one male patient who was not happy with the ZSO outcome (THE ONLY ONE according to the article in his 20+ experience with this procedure) because the patient thought the result is too much, and that he successfully reversed the result. I don't know if that is the same man who posted on MissJ forums - I haven't been following that forum. But the bloody good news is - the procedure is easily reversible ("easily" according to Mommaerts, I'm not adding this myself). Another good news is you can achieve significant results with this procedure if the variables are controlled successfully. My fears as a matter of fact are in the opposite direction - that the result will be so subtle that I may end up wishing I opted for implants. I also liked the fact that at no time Mommaerts was trying to sell this procedure to me - as a matter of fact he did not even mention it on his own, and when I brought it up he was very reserved and cautious about it. I still have to discuss a lot of things with him, and all this will happen in the work up session one week before my surgery. I will not know what exactly I'm having done until one week before the surgery. However, as I posted before, I have a pretty good idea. I know exactly what I want to achieve, and the rest is discussing with Mommaerts what can be achieved in reality and how it will be achieved. He has more than 30 years of experience in both cosmetic and orthognathic work, so I have to rely on his assessment but always within the framework of what I want to achieve and him understanding my goals. He's happy to engage in debating options with you and can appreciate a well informed patient (unlike most asshole surgeons out there). The rest is chance, luck, or whatever. There is no way around it. But I simply can't think of anyone else in the world in this field who is willing and trying hard to listen to you, understand, implement and deliver results. And who is open minded and passionate about beauty, not occlusions. I may be wrong about him, I don't know. I hope not. Time will tell.
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I agree with everything you've written. It's true that we often only hear the negatives from patients as with every kind of surgery when it goes well they move on and never come back. What you've written about ZSO is incredibly interesting, and I can vouche for the results after having seem some patients in his photo book that he has at his office. The results are very natural. I still wonder if it'd ever be possible to achieve those male model type cheekbones. What are your thoughts?
Mommaerts was also very helpful in explaining his opinion about the other surgeries recommended by other surgeons. In fact, I was quite impressed. His responses were as if he was citing a textbook from memory (in a good way). Concise but giving me everything I needed to know to make a fair assessment. I really wish we could see more of these two patients who weren't happy with their outcomes. I wonder why they won't post photos?
By the way, what do you think about Mommaerts' rhinoplasty work? I was considering having him remove my slight dorsal hump and defining the tip a bit more. However, now I'm thinking about leaving the tip of the nose until I can research rhinoplasty more and just sticking with dorsal hump only. I figure my nose is fine as it is, so why risk it? To my rhinoplasties are very hit and miss.
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I don't know. I guess like with everything else it depends what you start with. Also, how much of a risk the surgeon is willing to take. There is a limit to how much laterally you can go. It depends on your own anatomy but also the size of the graft - the sandwich procedure requires grafting, and this is either autologous bone from your own body (preferable), or as Mommaerts practices in 90% of his cases, HA blocks. It also depends on your body fat percentage, i.e. how lean you are - how much fat you have accumulated in your face and how it is distributed (hopefully very, very little). If you have a good starting point, you're lean and the size of the graft is really on the large side (Note it must be at least 5mm to make any difference, so this is the very minimum), then yes, sure you can achieve something very close to that male model look. However, too many variables there so I'm restraining my expectations. I would like to see reasonable, observable, long-lasting improvements, not perfection. I mean, let me correct myself, sure I would like perfection, but how realistic is that is another question.
About the people with negative reviews not wanting to post pictures - I can understand that. I wouldn't post either if I was sad and depressed from my result.
Tell us more about the pictures you saw at his office - I never asked to be shown any pictures. Were they all women, or some men as well? What did you observe? Any good 3/4 views you were able to analyse?
I'll talk to you about his rhinoplasty work later. I have to go now.
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Next time you see him ask if you can have a look through his book. he has a HUGE book full of just photos. After I'd explained the procedures I was looking at and he gave me his own opinion he proceeded to flick through it to find a male patient who had what I was looking at getting. I wish I had more time to look through it. Sadly I didn't get the chance to see too many other patients, which I regret. I was considering asking him to maybe make some scans to send to me of people getting similar procedures to me. If you want I can do that and share them with you. I'm just not sure how this works from a privacy point of view, as they probably agreed just to appearing in the book and wouldn't want their faces posted all over the Internet.
Regarding the ZSO, why do you believe using autologous bone is better than HA paste? And how much give is there to person preference for the ZSO? Would you trust MM's own opinion of facial aesthetics? How easy is it to improve if one wants more? I'd be more inclined to go with something a bit more conservative and go back to have it augmented than go too big straight up.
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Autologous vs coral graft (HA is a type of coral graft if I'm correct):
Because this study says so
http://www.ncbi.nlm.nih.gov/pubmed/15058548 (http://www.ncbi.nlm.nih.gov/pubmed/15058548)
I have talked personally to the French doctor who is the first credited author of the study.
Let's continue the chat about Mommaerts privately. We don't want to highjack this thread, and I'm certainly extremely cautious about promoting his work without having had the surgery myself.
I'll talk to you more tomorrow - pm or email me.
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Ok, I can finally find the time to write, man this is gonna be long...
falcao, thank you so much for mentioning the free publications on Mommaerts site, I have came across some of his papers online only with abstracts and I really wanted to have a glimpse at the detailed information about his sandwich osteotomy without having to fork out $$$ to do that, reading his publications really cleared some of the obscure parts that I had questions about regarding the procedure, example; the way he rotates the bone out after making the cuts.
Having said that, I still stand by my assessment that the cut is made at the inferior part of the zygomatic complex. That does not mean that the advancement takes place at the lower part exclusively, because there will still be a definite lateral movement as well, just not as high as I like them to be, perhaps it's more of a personal assessment rather than a "fact".
I have to say that looking at Jon Kortajarena's cheekbones and comparing it to the sandwich osteotomy's advancement vector, I can tell you that Mommaerts is right on the money that this kind of augmentation will yield the closest results that you're seeking aesthetically, although how much projection can be achieved is hard to say and is probably dependent on your starting point.
Also one have to keep in mind their native facial morphology when electing a procedure to get them closer to the "mental blueprint" they're trying to achieve , Jon K has factors other than simple bone prominence that contribute to his look, everyones bone is different in shape, proportion, and prominence (just like everything else) so your final aesthetic outcome is highly dependent on your starting point or your native facial morphology. For example, I know for a fact that if I had this procedure I would will not magically have Jon K's cheekbones because our morphology is different on many regards, sure, I will be one step closer to what his cheekbones looks like, or I would even look better, but I wouldn't have his cheekbones, not by a long shot. So unless our underlying morphology is similar and the only thing standing between me and his look is more anterior/lateral projection, I'd say electing the ZSO to have his cheekbones is an unrealistic approach.
But please do not be discouraged by that statement, I haven't seen your pictures and I have no idea how close or far is your start point from your mental blueprint, I just gave that example to clear up any unrealistic exceptions some have regarding ZSO and how it compares to how they want their cheekbones to look like.
Regarding the guy in the pictures posted previously, I have to say that I'm sure that whatever he had to his cheekbones is NOT the kind of augmentation that Mommaerts performs, it seems that he had more buccal augmentation to fill in his lower cheeks hollows purposely, which could very well be as you mentioned submalar implants, or some kind of an osteotomy we have not heard of, but it just does not seem that a ZSO is responsible for his outcome, so yes I agree what we're looking here is a different case.
The mommaerts case I mentioned previously is the same one lazlo talks about, he since removed his pictures but I remember that the cheek highlights were set too low for my taste when viewed from the front, which is very similar to the result of the woman mommaerts has in his B/A gallery, but this has more to do with the patients start point than the surgeons skill or technique, and yes the patient was a male late 20s or early 30s I think.
The look you are talking about regarding the cheek vs cheekbone is basically a bone vs. soft tissue relationship, Jon K has very prominent cheek bone while conversely having hollowed lower cheeks, this is attributed to the lack of buccal fat, a facial fat compartment that is in a plane of its own, some surgeons can actually take part of it out by making an incision from inside the cheek, the aesthetic results are immense but it seems that complication rates are high, most of the people who's had it complained that their face dropped few months later due to lack of support, and once you take that fat out there's no going back, your only option is having submalar implants to plump the lower cheek back to where it was, so proceed with caution when manipulating the buccal fat pad.
Lazlo, regarding Schendel's remark about the procedure being unpredictable; I would say that he is on point with that in regards to if the patients has a very clear mental blueprint of what they want their cheeks to look like rather than simply wanting too look improved, the main limiting factor here is your native morphology and its relation to everything else to your own face.
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thanks geijutsu --i think we're having a great discussion about all this. makes this procedures sound good. wonder how it differs from the quad lefort II? Would it be better to have a regular lefort and then the mommaerts procedure separately?
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I think it differs a lot, for the most part occlusion is not altered with the ZSO while the Quad2 does, and the advancement takes place at two different places.
I think Mommaerts did mention that he does perform a lefort1 in conjunction with the ZSO, most of the patients B/A pictures in the paper are a lefort1/ZSO combo.
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Cheekbones and cheeks are two different structures. Cheeks occupy the space between zygomatic bone and maxilla. Unfortunately moving the lower zygomatic bone causes really protruding cheeks in people with already weak bone structure. I mean why do we get this surgery? To have more defined bone structure of course, but moving the cheekbone at the wrong place causes the opposite
the more hollow that area is and taut the skin is, the more angular it looks. the aesthetic difference between a male and female is important in my opinion
with men you want that hollowness directly beneath the zygomatic bone that transitions to the mandible, not a puffy monkey mouth look: http://images.fanpop.com/images/image_uploads/Leonardo-DiCaprio-leonardo-dicaprio-192819_1024_768.jpg (http://images.fanpop.com/images/image_uploads/Leonardo-DiCaprio-leonardo-dicaprio-192819_1024_768.jpg)
women it's more about a general plump cheek apple look because it gives them a youthfulness
If you have decent lateral projection of the zygomatic bone and hollowness beneath that bone what orthognathic surgery procedures increase or decrease that hollowness?
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Regarding ZSO mommaert's said he felt it would allow me to have higher more laterally prominent cheekbones, as opposed to now which are kinda flat. I think I'll talk to him some more and just say that I would only be looking to achieve higher cheekbones with better lateral projection, and nothing further forward.
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Regarding ZSO mommaert's said he felt it would allow me to have higher more laterally prominent cheekbones, as opposed to now which are kinda flat. I think I'll talk to him some more and just say that I would only be looking to achieve higher cheekbones with better lateral projection, and nothing further forward.
could you post some pics of this procedure, either form the articles or other sources.
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right
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Oh, the irony! This post is almost 2 years old. Falcao went with MM, alright... And subsequently spent TENS OF THOUSANDS TO UNDO THE DAMAGE. Ask him yourself.
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Oh, the irony! This post is almost 2 years old. Falcao went with MM, alright... And subsequently spent TENS OF THOUSANDS TO UNDO THE DAMAGE. Ask him yourself.
Yea that post has to be painful for Falcao to read now.
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implants ? look here http://jawsurgeryforums.com/index.php/topic,4378.0.html