jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Lazlo on November 16, 2012, 07:32:54 PM
-
Hi,
now before anyone lays in with the charge that this is irrelevant to most people, I would contend it is in fact NOT irrelevant at all. Most, if not all A/G patients receive some form of
HA augmentation to their suborbital or undereye/cheekbone areas either to compensate for the shifting of the maxilla AND/OR for cosmetic enhancement.
A quadrangular lefort 1 is a lefort 1 (again with all incisions done from the inside) but is modified to include the malr/suborbital/zygoma regions. In other words, the maxilla and part of the cheekbones are moved
forward rendering the need for HA paste or other implants either less or unnecessary.
I'm not sure but it may be this procedure is usually used for patients with more severe midfacial hypoplasia (e.g. crouzen's syndrome etc.), I'm actually not even sure about that, but it does seem to be used
to increase cheekbone/suborbital eminence. I've been researching it and while all reports suggest it is a safe and doable operation, I haven't seen any before/after pics.
Again, this is NOT a lefort II where the incision is made above the nose, the quadrangular lefort 1 is done intraorally and the nose is not affected. Here's a description of the procedure and an abstract, if anyone has
any more info I would appreciate it, especially pics. The main surgeon on this paper, E E Keller is head of maxillofacial surgery at the Mayo clinic. And I will inquire about having a consultation with him.
I haven't seen before and after pics of it yet though, so if anyone could help me out that would be great!
http://www.sciencedirect.com/science/article/pii/027823919090171W (http://www.sciencedirect.com/science/article/pii/027823919090171W)
-
yeah, that's a 4 piece lefort right? i think it is a pretty common technique for AG surgeries if it is double jaw. i would bet - but don't know for sure - that most people who have upper jaw surgery with them require cheeck augmentations because the advancements are so great in terms of pure movement. i believe a 4-piece is necessary to insert the hydroxyapatite. not sure how common it is among other surgeons.
-
yeah, that's a 4 piece lefort right? i think it is a pretty common technique for AG surgeries if it is double jaw. i would bet - but don't know for sure - that most people who have upper jaw surgery with them require cheeck augmentations because the advancements are so great in terms of pure movement. i believe a 4-piece is necessary to insert the hydroxyapatite. not sure how common it is among other surgeons.
actually i don't think that's what a quadrangular lefort 1 is, but i might be wrong, let me try and find a diagram and paste.
-
actually i don't think that's what a quadrangular lefort 1 is, but i might be wrong, let me try and find a diagram and paste.
i dont know how else a surgeon could access the cheekbones through the mouth without a 4 piece.
-
i dont know how else a surgeon could access the cheekbones through the mouth without a 4 piece.
oh that might involve four cuts, but i think that can be done independently of a four piece lefort.
So a quadrangular lefort 1 osteotomy looks like this --scroll down to the third row of dual images entitled (lefort 1 high osteotomies). The third column shows the where the surgical cuts are made --along the line of the traditional lefort 1 --under the nasal base, but around it the cuts are made high, just under the suborbital region --so this whole complex is advanced, i.e. the suborbital and cheekbone area in addition to the maxilla. If you click on the video it will animate to show you the soft tissue movement involved.
Pros of this: can be performed intraorally, no external incisions/scars, does not affect the nose, can address deficient cheekbones and undereye area WITHOUT the use of silicone or medpor implants.
Cons: Is it riskier? I don't know really. There is some talk I've heard that cutting near the orbital rim is dangerous due to the orbital nerve. But the studies I've cited suggest that the orbital nerve remains unaffected. In addition in the 54 patients all had satisfactory outcomes. Can it be performed on anyone with midface hypoplasia? I don't see why not? Especially if you're a candidate for bi-max anyway?
So that's all I have on this now, would love to know more.
http://www.zib.de/vis-long_projects/cas/cas-gallery.html (http://www.zib.de/vis-long_projects/cas/cas-gallery.html)
-
Out of curiosity, have you actually read the papers, or only the abstracts?
-
Out of curiosity, have you actually read the papers, or only the abstracts?
I have read the chapters in two max fac textbooks through google books where they describe both the quadrangular lefort 1 osteotomy in great depth
AND one article has a more extensive abstract, but no I have been unable to find a full article. I will consult with Keller though about this and I'm consulting with Schendel next month.
Schendel's secretary already told me he performs the malar osteotomy.
-
Out of curiosity, have you actually read the papers, or only the abstracts?
ps if you find the full papers, i would love to read them.
-
I have read the chapters in two max fac textbooks through google books where they describe both the quadrangular lefort 1 osteotomy in great depth
AND one article has a more extensive abstract, but no I have been unable to find a full article. I will consult with Keller though about this and I'm consulting with Schendel next month.
Schendel's secretary already told me he performs the malar osteotomy.
You do understand that the "quadrangular lefort 1" is really more of an alternative to the variations of the Lefort 2 or 3, than a normal Lefort 1? It is a very specific operation to correct moderate maxillary hypoplasia with concurrent zygomatic hypoplasia BUT with normal nasal projection. Since the operation keeps the maxillary/zygomatic complex in one piece, mobility and flexibility is limited, and rotation of the occlusal plane--whether for aesthetic or functional reasons--necessitates rotation of the entire fragment.
Feel free to bring it up in the consolation, just make sure you mention it in passing, rather than asking if they'd perform it on you.
What kind of malar osteotomy does Schendel perform? If it's akin to Mommaerts' "sandwich" osteotomy, it may be considerably more applicable to your case.
-
ps if you find the full papers, i would love to read them.
I just use my university's database. If you know anyone who's currently enrolled, they may also have educational access to Elsevier, among other sites.
-
You do understand that the "quadrangular lefort 1" is really more of an alternative to the variations of the Lefort 2 or 3, than a normal Lefort 1? It is a very specific operation to correct moderate maxillary hypoplasia with concurrent zygomatic hypoplasia BUT with normal nasal projection. Since the operation keeps the maxillary/zygomatic complex in one piece, mobility and flexibility is limited, and rotation of the occlusal plane--whether for aesthetic or functional reasons--necessitates rotation of the entire fragment.
Feel free to bring it up in the consolation, just make sure you mention it in passing, rather than asking if they'd perform it on you.
What kind of malar osteotomy does Schendel perform? If it's akin to Mommaerts' "sandwich" osteotomy, it may be considerably more applicable to your case.
That's really interesting! Yes, I assumed there might be concerns with the quad lefort 1 in terms of what other movement could be performed. My nasal projection is fine, i need more malar/zygoma projection. I will ask Schendel specifics when I see him. I know very little about this operation but want to learn as much as I can so I can see if it is indeed an option for me. Thanks Sharptoys!
-
Hello there,
I hope it is okay if I chime in on this conversation. I had a consultation with Dr. Mommaerts today because I wanted cheek augmentation. I did not realize that he did cheek osteotomies. I have read as much as I can and talked to him for a good hour but I am still hesitant to go ahead. My other option is simply getting Hydroxyapatite on the outside of the cheekbone from another surgeon. This seems much less invasive and much safer. I am also concerned about the strength of the cheekbone bone after the osteotomy. He wants to secure the space with a little titanium plate and three screws. Any thoughts or comments on this would be really helpful as I am trying to decide wether or not to go ahead with this or not and from the previous conversation you folks seem fairly knowledgeable.
Thank you :)
-
Hello there,
I hope it is okay if I chime in on this conversation. I had a consultation with Dr. Mommaerts today because I wanted cheek augmentation. I did not realize that he did cheek osteotomies. I have read as much as I can and talked to him for a good hour but I am still hesitant to go ahead. My other option is simply getting Hydroxyapatite on the outside of the cheekbone from another surgeon. This seems much less invasive and much safer. I am also concerned about the strength of the cheekbone bone after the osteotomy. He wants to secure the space with a little titanium plate and three screws. Any thoughts or comments on this would be really helpful as I am trying to decide wether or not to go ahead with this or not and from the previous conversation you folks seem fairly knowledgeable.
Thank you :)
I've been told it achieves unpredictable results, so I really can't advise.
-
Thanks for replying,
What he told me is that you can't say exactly what is going to look like because you are using the natural cheekbone and projecting it anterolateraly (to the side and forward) and since everyone's natural cheekbones are different there is no standard result. The cosmetic result is not really my concern as it seems like the biggest problem would maybe be that it was too small but any improvement or projection I think would be more aesthetically pleasing, my real concern is the strength of the area afterwards as I am 22 years old and have my whole life ahead of me, I live a very active lifestyle. Do you have any knowledge about this or regarding anything related to osteotomies or bone grafts which is another option that would be done in addition to the screws and titanium plate for securing the space made by the osteotomy
Thanks
Daniel
-
Thanks for replying,
What he told me is that you can't say exactly what is going to look like because you are using the natural cheekbone and projecting it anterolateraly (to the side and forward) and since everyone's natural cheekbones are different there is no standard result. The cosmetic result is not really my concern as it seems like the biggest problem would maybe be that it was too small but any improvement or projection I think would be more aesthetically pleasing, my real concern is the strength of the area afterwards as I am 22 years old and have my whole life ahead of me, I live a very active lifestyle. Do you have any knowledge about this or regarding anything related to osteotomies or bone grafts which is another option that would be done in addition to the screws and titanium plate for securing the space made by the osteotomy
Thanks
Daniel
I don't have any knowledge about long term stability. Of course, even if you were 50 years old that would be a concern, you don't want to walk around feeling you have to guard your face once you've healed. What does Dr. M say?
-
Thanks again for the speedy reply, what you said about being fifty is exactly my thought, I don't know what life is gunna throw me and purposely weakening my cheekbone area at my age seems a little crazy. However according to Dr. M who seems to be not just in it for the money and I think was being quite honest with me he has never had anyone that has had this procedure and then had their cheekbone area broken. I think he has been doing them for at least 15 years so I guess that is somewhat comforting although I do a lot of sports and such. He also offered if I wanted to have a small bone graft put in the space created by the osteotomy as well as the titanium plate on the outside. He would harvest the graft from my jaw were he will be accessing anyways to add HA paste. I don't know anything about bone grafts but have been trying to read up on them and it seems like the bone can regenerate to some degree. I think he has done this procedure in the past with bone grafts with success. Let me know your thoughts or any knowledge on bone grafts etc... you might have.
Thanks once again for having a conversation with me. Big decision for me but I do feel quite comfortable with Dr.M I think he is very good at what he does and like I said earlier does't seem to be doing it for the money.
Thanks :)
-
Hey I just pm'd you. This is what I vaguely understand since Dr. Schendel is planning on doing bone grafts for my inferior orbital region (though I don't know yet how they take fragments of your own bone and build up the area under the eye...). It all depends --I think they have substances which they mix with the bone so that instead of resorbing back into your body it stays or integrates etc.. I'm sure there is cutting edge research on this, but I really don't know. It's a topic of interest for me too. Here's one thing I do know. In cases of distraction osteogenesis (where they break the bone and grow it, and this is true of ANY broken bone) the resulting healed bone is actually STRONGER than it was before. I don't know if this is true of bone fractured and then repositioned...
-
Question: is BMP controversial? What does an "extreme" case warrant and why might they not want to use it?
Another question. So if you have dark circles under the eye and they want to build it up because it's a bone deficiency how do they prepare the bone to achieve a uniform texture and molding on your orbital rims? At first I just assumed they take bone from somewhere in your body (like chips of bone or something and kind of glue it to the deficient area) --but how would that be aesthetic and even really form? So obviously they must like powder the bone or do something to it to make into a paste right? Or shape it to the contour of the area you need on your face? And then I suppose they mix it with these substances...
-
Pekay....im very interested to learn what youve found out. I have deprssed regions under my eyes. Dr schendel said he would build up the region with bone grafts. Im assuming this is not the surgery youre talking about. I look forward to hearing your thoughts.
-
Hey just wanted to ask you guys, does anybody know about future complications involving this, I was just reading about people getting jaw surgery that involved screws and then having the body reject the screws years later. Do you know if this is common. From reading over some of the jaw surgery boards it seems like there are lots of people with screws that do not have this problem. It also seems like there are lots of people who have had bones in there face fractured repositioned and then screwed into place. As in most of the bimax surgery. I haven't read anything about refracturing the face from an injury or face trauma which is basically my biggest concern with having a Lefort sandwich done. I feel like I am weakening my face permanently and my cheekbones could break much easier afterwords. Anyone have any thoughts on this.
much appreciated
-
Hey, I think this will be more of interest to Pekay, but perhaps others can chime in. This concerns all of the above, jaw surgery and under-eye hollowness as well as "aging" especially.
So a guy who I think looks ABSOLUTELY amazing and he's 55 years old now is Daniel Day-Lewis. I mean the guy has model good looks, somewhat of a long face actually and also a longer philitrum, but all of that said, his bone structure and soft tissue is preternaturally strong and resistant to what most people look like as they get older. A few words on this.
First, I think people who are generally "good looking," also look better when they're older --that's just us responding to their being good looking.
But the second interesting thing here is that DDL the underlying architecture of DDL's face is such that there is very little soft tissue sagging whatsoever as he's aged, especially around the under-eye area.
Third, there must be something genetic about his facial and bodily soft tissue as well. He's always been extremely slim/ripped/high metabolism type of person clearly. Perhaps some people have genetically gifted soft tissue that is somewhat resistant to sagging. From what I know of him he definitely does not seem like the type of guy who goes to a beauty salon or would ever have cosmetic surgery. He broke his nose while training for the film THE BOXER and never even had it straightened. His nose is big, but due to his broad facial bone structure, it looks balanced. His eyes are also on the much wider apart side of the spectrum.
I don't mean to make this a celebrity thread but it would be interesting to know what the underlying structural and/or soft features of his face are which allow him to look and age so well. He's 55 which is by now means "old" but I would have thought his facial features would show more "sag". I feel in my 30s mine already do quite a bit...and that's why I want my bone structure augmented.
I mean sure there's some slight wrinkling over the years, and grey hair, but otherwise the overall tautness of his features has remained unchanged!
And to clarify on the "dark circles" issue. I don't have dark circles in the sense of skin tissue or color, rather I just have depressed under orbital areas and this is what causes the shadow to hit that area a bit...
-
says the "uploader is full" when I try to attach images, but just google Daniel Day Lewis and you'll see what I'm talking about.
The structural features of his face have remained entirely unchanged from the age of like 35 to 55.
-
http://www.google.ca/imgres?q=daniel+day+lewis&um=1&hl=en&sa=N&tbo=d&biw=1680&bih=868&tbm=isch&tbnid=HxXjCBI_aWWGRM:&imgrefurl=http://blogs.coventrytelegraph.net/passtheremote/2013/01/daniel-day-lewis-may-need-a-bi.html&docid=xdL9q1CaW08yrM&imgurl=http://blogs.coventrytelegraph.net/passtheremote/daniel%252520day-lewis%252520jan%2525202013%252520five.jpg&w=2532&h=3268&ei=VT38UOe6Mo7jqAG84oDIDQ&zoom=1&iact=hc&vpx=602&vpy=291&dur=326&hovh=255&hovw=198&tx=109&ty=120&sig=108372599364285027136&page=1&tbnh=150&tbnw=115&start=0&ndsp=62&ved=1t:429,r:19,s:0,i:211 (http://www.google.ca/imgres?q=daniel+day+lewis&um=1&hl=en&sa=N&tbo=d&biw=1680&bih=868&tbm=isch&tbnid=HxXjCBI_aWWGRM:&imgrefurl=http://blogs.coventrytelegraph.net/passtheremote/2013/01/daniel-day-lewis-may-need-a-bi.html&docid=xdL9q1CaW08yrM&imgurl=http://blogs.coventrytelegraph.net/passtheremote/daniel%252520day-lewis%252520jan%2525202013%252520five.jpg&w=2532&h=3268&ei=VT38UOe6Mo7jqAG84oDIDQ&zoom=1&iact=hc&vpx=602&vpy=291&dur=326&hovh=255&hovw=198&tx=109&ty=120&sig=108372599364285027136&page=1&tbnh=150&tbnw=115&start=0&ndsp=62&ved=1t:429,r:19,s:0,i:211)
-
I was doing a bit of reading about "Bone Morphogenetic Protein," and came across this from 2010. Looks pretty cool. Anyone know what the results finally were on this case?
What's especially interesting is that it sounds we can make a lot of the enhancements we'd like in the near future....
http://www.healio.com/orthopedics/biologics/news/print/orthopedics-today/%7Bfc8a85a2-d695-4780-9b20-13a8020cfabe%7D/novel-procedure-helps-patient-grow-cheek-bones-using-bmp-allograft-andstem-cells (http://www.healio.com/orthopedics/biologics/news/print/orthopedics-today/%7Bfc8a85a2-d695-4780-9b20-13a8020cfabe%7D/novel-procedure-helps-patient-grow-cheek-bones-using-bmp-allograft-andstem-cells)
-
Just thought I'd update all of you with regards to my most recent discussion with Dr. Schendel. He was kind enough to do a follow up phone consult. Unfortunately, I was expecting to see the results of the
much touted "3D MD imaging" which would be an accurate visualization of my post-surgical results (supposedly only off by .3 mm in the past) but they said they only do it right before surgery and they need to take special
pictures etc. with some kind of 3D camera. I actually trust them that this was not an evasion but the truth because Schendel/Jacobson have already published the results of this device in numerous journals and I think
it just takes them a lot more work to do and they usually don't do that till the patient is ready for surgery.
That said, here are a few interesting things. First, Dr. Schendel assured me once again that both the depressed area underneath my eyes (the inferior orbital rim) and my cheekbones could be dramatically augmented through the high-lefort 1 procedure and the bone grafts and that give the pictures I had sent him(of a few people who had the kinds of results I wanted) this would be certainly attainable. This is in stark contrast I should add to a few other surgeons
I have consulted with. Dr. S also indicated again the importance of doing a genioplasty for the results I wanted. Interestingly Dr. Schendel suggested doing a 1cm advancement of my maxilla when doing the "high-left 1" which
is a lot more than what Arnett had recommended (only 2mm!!). I guess the difference has to do with the "high-lefort" versus the CCW proposed by Arnett. I think in Arnett's plan the lower jaw would be augmented somewhere
around 11-16mm, but Schendel wants to do soemthing like 11mm plus 4mm genioplasty.
I'm sure both doctors are equally great, but Dr. Schendel I feel is probably more right for me since he's somewhat more into aesthetic concerns and I just felt like I got along with him more --sometimes I think it
might just be a case of going with someone you feel more comfortable with, like more.
Here is something that is more interesting. I pressed him on distraction osteogenesis. He said that he does it on adults and that indeed he could do it. He did say though that it was a bit more involved because
it would require turning every day and another operation to take out the distractors. Honestly this is not even a problem for me because there are several advantages DO has over traditional jaw surgery.
He said he maxilla, chin, mandible etc. could be advanced linearly and along the transverse axis all through DO, not a problem. He did say though that the technique is usually reserved for patients who need
advancements of 2cm or more and that the amount of advancement I needed was still within the parameters that traditional rigid fixation orthagnathic surgery would do the trick.
That said, I'm going to really investigate whether DO is something that might produce superior results as I'm happy to have learned Dr. Schendel is willing to perform DO, if I'm okay with the longer time i takes to generate results.
I really don't see how the "longer time" is even a problem considering the fact that it's only a matter of a few weeks and the surgery for DO is much less traumatic and leads to a much lower incidence of
neurosensory changes, the soft tissue can be controlled to a much higher degree etc. etc.
And here's another valuable piece of information. I asked Dr. Schendel if DO could still be performed on someone after they've had traditional orthagnathic surgery and he said not only can it,
he's done it several times on patients who were unsatisfied with the results of surgery with other doctors or who have had some kind of relapse etc..
I thought this was important since I truly believe the future of this surgery lies with DO.
Okay, I hope some of this info is helpful to any of you out there who are struggling to make a decision about which doctor to go with or who had questions about distraction osteogenesis.
-
Hey all, I had my surgery yesterday, HA paste to the jaw angles and Lefort sandwhich osteotomy. I am swollen of course but can see already that my jaw is uneven. I have sent my doctor an email asking him what can be done. Since it was with HA paste I don't know how he can correct it exept maybe going through the same incisions and adding more. Do you guys have any ideas suggestions on what I might do/say/etc... Feeling kinda stuck. The augmentation is good but just different on each side.
-
Hey all, I had my surgery yesterday, HA paste to the jaw angles and Lefort sandwhich osteotomy. I am swollen of course but can see already that my jaw is uneven. I have sent my doctor an email asking him what can be done. Since it was with HA paste I don't know how he can correct it exept maybe going through the same incisions and adding more. Do you guys have any ideas suggestions on what I might do/say/etc... Feeling kinda stuck. The augmentation is good but just different on each side.
I'd give it some time. Swelling is often very uneven.
-
I understand this, however on my jaw the Hydroxyapatite is very easy to feel (the contour) and it is most definitely not the same on both sides, I think the sooner the better as your tissue begins to grow into it right away, I am very worried, if this surgeon will not help me maybe I will need to get one side shaved down. Wow this sucks
-
Who was your surgeon? and what did you have done exactly? BSSO + LeFort + genio? and HA augmentation?
-
Yeah it's really inconclusive to me what those models/simulations show. I too doubt the high-lefort looks like that but who knows...
-
It does seem to fill out the midface a bit: http://mcgannfacialdesign.com/before-after/ (http://mcgannfacialdesign.com/before-after/)
-
A girl on JSB who had a high Lefort 1 is really unhappy with her results. I'd stay away with this procedure. IMO, it's much better to experiment with fillers before receiving any permanent implants (let alone an osteotomy!).
http://www.jawsurgeryblog.com/forums/viewtopic.php?f=5&t=11204 (http://www.jawsurgeryblog.com/forums/viewtopic.php?f=5&t=11204)
-
I had a high lefort done only. 4 months post op right now
-
I'd really like to see before/afters of patients who have had this procedure:
http://gradworks.umi.com/14/93/1493972.html (http://gradworks.umi.com/14/93/1493972.html)
-
Again, what's great about this procedure is that it mobilizes the orbital rim --I mean that's really what can make a world of difference on the aesthetics front. If any of you find pics of this procedure, would love to see them.
http://www.ncbi.nlm.nih.gov/pubmed/9289636 (http://www.ncbi.nlm.nih.gov/pubmed/9289636)
-
Dr. Hernández Alfaro performs cheekbones osteotomies according to his website
also it seems that getting a rhino along with orthognathic surgery isn't exactly an issue
regarding my own question on 3D planning (VSP Orthognathics + Dolphin 3d imaging)
any before/after pics of so called malarplasty? does it mobilize the orbital rim?
-
any before/after pics of so called malarplasty? does it mobilize the orbital rim?
I think the malarplasty that Alfaro does may just refer to cheek implants.
If it's an osteotomy, it probably looks like this. It looks like a good option for adding width to the cheekbones, something that implants don't do very well.
(http://ars.els-cdn.com/content/image/1-s2.0-S0094129807000739-gr5.jpg)
-
I think the malarplasty that Alfaro does may just refer to cheek implants.
If it's an osteotomy, it probably looks like this. It looks like a good option for adding width to the cheekbones, something that implants don't do very well.
(http://ars.els-cdn.com/content/image/1-s2.0-S0094129807000739-gr5.jpg)
hmmm, yeah sounds like it. i don't want width, i want frontal projection, i already have width...
Heavyweight, have you seen any before after of quadrangular lefort?
-
I think the malarplasty that Alfaro does may just refer to cheek implants.
If it's an osteotomy, it probably looks like this. It looks like a good option for adding width to the cheekbones, something that implants don't do very well.
How does this procedure adds width to the cheekbones? If it's done like in the pics you posted, then it actually reduces width and makes the cheekbones higher (ie closer the the eye sockets).
-
I think the malarplasty that Alfaro does may just refer to cheek implants.
If it's an osteotomy, it probably looks like this. It looks like a good option for adding width to the cheekbones, something that implants don't do very well.
have you seen or do you happen to have an actual before/after of said procedure?
-
How does this procedure adds width to the cheekbones? If it's done like in the pics you posted, then it actually reduces width and makes the cheekbones higher (ie closer the the eye sockets).
It projects them further from the face I think, adding contour to the face
-
Here's an example of a cone beam scan and the predicted "results" as they affect soft tissue.
http://www.dryaremchuk.com/english/bespoke-example.php (http://www.dryaremchuk.com/english/bespoke-example.php)
-
I'm just starting this, but you definitely want to check it out: http://www.quintpub.com/userhome/aoos/aoos_17_1_Rosenberg4.pdf (http://www.quintpub.com/userhome/aoos/aoos_17_1_Rosenberg4.pdf)
-decreased vermilion show
-increased tip projection of nose (cinch suture that prevented widening actually caused increased tip projection)
-upper lip moved upward (?) 30% of amount of advancement
they can use a v-y plasty and cinch suture depending on the pre-existing shape of your nasolabial angle apparently
unfortunately this is the regular lefort, no idea if the high lefort is different
pics of high lefort cases:
(http://ars.els-cdn.com/content/image/1-s2.0-S0901502706003110-gr9a.jpg)'
(http://ars.els-cdn.com/content/image/1-s2.0-S0901502706003110-gr9d.jpg)
(http://img.medscape.com/pi/emed/ckb/clinical_procedures/1271089-1279039-1279747-1279914.jpg)
-
these are pretty depressing results (i.e. undereye hollowness and especially what happens to the upper lip becoming more convex). the nose is not soooo bad, especially if you have a good doc who knows how to manage this....
-
these are pretty depressing results (i.e. undereye hollowness and especially what happens to the upper lip becoming more convex). the nose is not soooo bad, especially if you have a good doc who knows how to manage this....
Yeah not the breakthrough I was hoping for, but high lefort patients have much worse starting points than you and I too
I'm going to look for some more, will post them if I find em