jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Rico on December 24, 2014, 06:24:48 PM
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Is it true that malar osteotomy should be performed by only surgeons with Lefort 2 and 3 experience?
and at the same time is it true, that Lefort3 can do not many surgeons . I mean not many has got enough good experience to do that ?
What you think ?
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yup, they do.
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yup, they do.
I appreciate you answered. But your message is not clear for me. :)
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We really have to stop this nonsense about LeFort3. 99 percent of maxillofacial surgeons have never done this surgery. The ones that have do it on children with major deformities like alperts etc. Now we've somehow found like the three surgeons who do upper face surgeries for plastic surgery cases. I would never get my malar or zygoma moved from a surgeon who didn't also know how to mobilize the orbital rim. No matter who is doing it it's still in a very experimental stage.
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Interesting, but I met 2 surgeons who do all LeForts (and some similar) even on adults (as they claim)
and I do not understand the part about orbital rim ? orbital rim is a part of whole zygomatic complex, it is always moved a bit during such operation. The crucial thing here is to move the malar bone in such way which will not affect the orbital volume. ..so how can you seperate orbital rim from whole zygoma bone ????
Can you explain in more details your point of view. It's interestng and it seems like you know something about malar bone repositions
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We really have to stop this nonsense about LeFort3. 99 percent of maxillofacial surgeons have never done this surgery. The ones that have do it on children with major deformities like alperts etc. Now we've somehow found like the three surgeons who do upper face surgeries for plastic surgery cases. I would never get my malar or zygoma moved from a surgeon who didn't also know how to mobilize the orbital rim. No matter who is doing it it's still in a very experimental stage.
Well I consulted with 2 such surgeons in my city. Although one said he did "less than 5" which is probably a code word for 1. He did show me the case however (cut under the eye, non-coronal incision). Pretty impressive (given the starting point).
Le Fort IIIs are not the white unicorns you'd think they are. People fracture eye sockets all the time (fights, accidents).
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yes but a fracture means the bone is mobilized already and a surgeon sees exactly or almost exactly how this bone was set originally...it is kinda track /path / hint for a surgeon. In many cases surgoen even can do so called closed reduction - which is not invasive method. but only for simple fractures
to cut the bone and move it is much harder ..much harder to do it in safe way without damaging other things..Crucial thing here is whole eye-socket
I forgot to ask how many such cases they had.. but I think there is no sense, because they may not tell me the truth :) This is kinda silly question
BTW --- Is this interesting ? I got one publication from clinic in Dreseden (Germany)
My question:
First of all (if You can answer) Have the surgeons had such cases before ?. I mean Do they have good experience with malar bone osteotomy (upper maxilla) and infraorbital nerve decompression ?
as an answer I got this:
http://bergemsoft.home.pl/pub/temp/LauerPradel2006.pdf
What you think ?
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Listen Mommaerts moves the malar complex cutting under the orbital rim with his stupid zygomatic sandwich technique. Keller does a "quadrangular lefort 1" which includes part of the zygoma. But neither of these cuts move the crucial orbital rim which is needed to be moved forward. And I've seen TONS of examples on syndrome patients. To throw tact out the window, they still look f**ked. In other words, to perform such an operation that actually improves one's looks aesthetically if you're starting from a regular starting point (i.e. class i or class iii) is very difficult. If anything TWO cuts need to be made, one for the the lefort I to get the dentition and bite correct, and then a separate cut that is basically just a part of the lefort III to move both the orbital rim and the malar. This is basically what the OBswegger girl had done --two maxillary cuts. Now assuming that's the way to go, who has experience actually doing this? Well, almost no one. Surgeons who claim to have don it, usually means they did it on a cadaver with a team in medschool, or assisted on some example case with a senior surgeon. Actually having it as a regular part of your practice is almost nill. Schendel who probably has more experience than ANYONE save for Arnett (who has never done it by the way) --well Schendel told me he has don it three times and this is a guy who has done over 2000 jaw surgeries and countless other craniofacial operations. So listen, when you're dealing with the zygoma, orbital rim or anything above a lefort I, you are going into uncharted territory. Be warned. Even Earl's operation, it was a first time for Sinn doing a cut like that. It was an experiment for him and luckily it turned out okay. If you wanna do it, just know you're in the 99th percentile of "far out" surgeries.
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You know I don't think Schendel is any kind of benchmark of anything at all around here.
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Listen Mommaerts moves the malar complex cutting under the orbital rim with his stupid zygomatic sandwich technique. Keller does a "quadrangular lefort 1" which includes part of the zygoma. But neither of these cuts move the crucial orbital rim which is needed to be moved forward. And I've seen TONS of examples on syndrome patients. To throw tact out the window, they still look f**ked. In other words, to perform such an operation that actually improves one's looks aesthetically if you're starting from a regular starting point (i.e. class i or class iii) is very difficult. If anything TWO cuts need to be made, one for the the lefort I to get the dentition and bite correct, and then a separate cut that is basically just a part of the lefort III to move both the orbital rim and the malar. This is basically what the OBswegger girl had done --two maxillary cuts. Now assuming that's the way to go, who has experience actually doing this? Well, almost no one. Surgeons who claim to have don it, usually means they did it on a cadaver with a team in medschool, or assisted on some example case with a senior surgeon. Actually having it as a regular part of your practice is almost nill. Schendel who probably has more experience than ANYONE save for Arnett (who has never done it by the way) --well Schendel told me he has don it three times and this is a guy who has done over 2000 jaw surgeries and countless other craniofacial operations. So listen, when you're dealing with the zygoma, orbital rim or anything above a lefort I, you are going into uncharted territory. Be warned. Even Earl's operation, it was a first time for Sinn doing a cut like that. It was an experiment for him and luckily it turned out okay. If you wanna do it, just know you're in the 99th percentile of "far out" surgeries.
I'm careful to the point of agony :( However, are you telling me that there is no patients who had overlooked typical malar - tripod fracture with mild displacement or just improperly set during first surgery, who needs revision / redo ? and the best surgeons performed such surgery upon no more than 5 cases ? how it is possible ? Such patients are rather minority , but having milions people it can't be just a several cases for 20 years over the world ??? How can you explain this ?
Update: I've realised, in the malar bone reposition surgery, good experience in both LeFort 2 and 3 is required.
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And I've seen TONS of examples on syndrome patients. To throw tact out the window, they still look f**ked.
What about non-syndrome patients? Is it really necessary to advance the orbital rim in those cases as well? Many people here may have a weak midface, but I haven't seen anyone with bulging eyes.
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What does it means to advance orbital rim.? How can malar bone be mobilized without cutting the orbital rim ?
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What about non-syndrome patients? Is it really necessary to advance the orbital rim in those cases as well? Many people here may have a weak midface, but I haven't seen anyone with bulging eyes.
No it's obviously not NECESSARY. We're talking about aesthetics. How many patients do you think have had just a textbook lefort 1 and are NOT satisfied with the aesthetic outcome.
Oh and I know Schendel's work VERY well. Say what you want but he's considered a giant in the field. Even though we may both know patients who have not liked their outcome with him, he has patents on devices for jaw surgery h invented as well as techniques that bare his name. So don't be silly, the guy has done craniofacial surgery on babies who were born without a nose and reshaping ear cartiledge to reconstruct one. Our friends may not have liked their outcome, but if you're denying the guy is experienced, that's a laugh, he's one of the most experienced surgeons in the world.
And even Arnett, who if you deny his experience I'm gonna really laugh you out the door, told me personally, higher level lefort's and malar advancements are not stable, highly unpredictable and resorb, which is why we don't do them. So there you go from the horse's mouth.
Jesus why are you guys arguing with me on this? Ask the surgeons. How many times have you done an orbital rim advancement or a lefort III or even a II for purely AESTHETIC PURPOSES on a non-syndrome, non-accident case? Right now th ONLY people are those I can count on 1 hand Obswegger, Keller, that's it. These examples of peopel who have fractures don't count. In many cases all that was done was to reposition a bit of broken bone so it would hal and they're calling it a lefort II or whatever. No that was an accident, patient had no choice and the doctor just did the best they could.
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No it's obviously not NECESSARY. We're talking about aesthetics.
Necessary to achieve the best aesthetical result that is.
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Necessary to achieve the best aesthetical result that is.
well not necessarily, does the patient have a negative vector under the eye? Shallow orbital rims? Then NO. But most of the time a shallow orbital rim is part and parcel of a shallow cheekbone, but not always.
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Yes, I should revise that I personally would never go with Schendel as his work is considered very shoddy, and this took m a while to discover. So even with so-called well respected surgeons, do your research!
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Right now th ONLY people are those I can count on 1 hand Obswegger, Keller, that's it.
anyone else from Europe ? only Obwegeser ? Have you ever heard about Nocini , Sesenna, Iannetti ? Many from Italy are supposed to be very good.
noone from Sweden ? they have very good health system
and I still can't get the whole talking about orbital rim. I mean you talk about this like it was different surgical approach, when this is a part of malar bone and until you cut orbital rim, the whole malar bone is not mobilized
Please, who can explain me this issue.
For example, I have lack of cheek prominence due to overlooked malar fracture. I'm gonna have malar bone osteotomy on the lines of previous fracture. So only 2-3 maxfac surgeons on the world can do that in safe way ?
PS Obwegeser refused to do malar bone osteotomy in my case, because it happened 3 year ago. However there is one issue which could discourage him to help me, but it was not so important. So do not overrate this surgeon.
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anyone else from Europe ? only Obwegeser ? Have you ever heard about Nocini , Sesenna, Iannetti ? Many from Italy are supposed to be very good.
noone from Norway ? they have very good health system
and I still can't get the whole talking about orbital rim. I mean you talk about this like it was different surgical approach, when this is a part of malar bone and until you cut orbital rim, the whole malar bone is not mobilized
Please, who can explain me this issue.
For example, I have lack of cheek prominence due to overlooked malar fracture. I'm gonna have malar bone osteotomy on the lines of previous fracture. So only 2-3 maxfac surgeons on the world can do that in safe way ?
PS Obwegeser refused to do malar bone osteotomy in my case, because it happened 3 year ago. However there is one issue which could discourage him to help me, but it was not so important. So do not overrate this surgeon.
yeah, yeah, so just look at the quadrangular lefort-1 case. The zygoma is part of the whole malar complex, as is the orbital rim (the bone just beneath the eye that is scallop shaped). Most surgeons cut BELOW the orbital rim because that's where the f**king nerve that supplies feeling to the eye and upper face is located. If you sever this nerve you could have blindness etc. etc. This is why most surgeons don't f**k with moving the whole orbital rim. Some surgeons it seems SINN did this, cut around the nerve and leave that portion unmoved. I don't know how common it is for surgeons to move the orbital rim. Jesus why don't you just go to some surgeons and get a consultation and ask them!?
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(Sandwhich) zygomatic osteotomy = always bone resorption, Lazlo? I've seen some absolutely stunning results from zygomatic sandwhich osteotomy. And most of the results I saw were almost without exception amazing. It would be a deception if bone resorption would 'undo' those results.
I have to see the first malar implant result that looks anything close to that (implants to the cheeks imo often look fake. They don't give projection in the good areas and over the lateral portion of the zygomatic arch as can be achieved with a zygomatic osteotomy).
Okay, I am willing to email someone who has seen Zaarrinibal the exact papers with diagrams of the quadrilangular lefort -1 and quad II operations. Someone who knows also how to shrink files so that they can b attacked here on the site. I tried but the files are too large. Maybe put them on a website and attach the links here or something, but I don't know how to do all that s**t. So just PM me and I'll email them to you. But you better ensure total privacy cause I'm not going to create a fake account or something to email you. I want to know in fact how good Zarrinibal is and what sorts of osteotomies he is doing. The stuff I'll send you includes actual papers with diagrams.
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yeah, yeah, so just look at the quadrangular lefort-1 case. The zygoma is part of the whole malar complex, as is the orbital rim (the bone just beneath the eye that is scallop shaped). Most surgeons cut BELOW the orbital rim because that's where the f**king nerve that supplies feeling to the eye and upper face is located. If you sever this nerve you could have blindness etc. etc. This is why most surgeons don't f**k with moving the whole orbital rim. Some surgeons it seems SINN did this, cut around the nerve and leave that portion unmoved. I don't know how common it is for surgeons to move the orbital rim. Jesus why don't you just go to some surgeons and get a consultation and ask them!?
Hmmm. There is infraorbital nerve and this nerve supply feeling to the cheek area and part of lips. NO TO THE EYE. WHO TOLD YOU THIS ? For example, In my case they have to release my nerve :) so they have to cut there. But I first time hear it is very hard to cut orbital rim near inraorbital foramen without damaging infraorbital nerve too much. 3 surgeons told me it not hard to do that. Many times this nerve must be realeased due to orbital floor damage, due to blow out fracture. I'm not first patient who need ION decompression. Blindness is possibl when you damage optic nerve, but this nerve is behind the eye....deep in eyesocket. During malar bone osteotomy no surgeon goes there. This is almost impossible when surgeon knows what he is doing. BUT YOU MAY have double vision if any eye muscle will be jammed in the orbital floor or orbital volume increases too much
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Lazlo: what were you talking about ?
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Wow, not a single person PM'd me to get the papers. You guys are a bunch of total posers. Keep talking nonsense on the board and wasting everyone's time. Most of you are never gonna get surgery anyway.
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Wow, not a single person PM'd me to get the papers. You guys are a bunch of total posers. Keep talking nonsense on the board and wasting everyone's time. Most of you are never gonna get surgery anyway.
Stop f**king biting people. You've been on this board since the beginning and still haven't had surgery, or even settled on a surgeon so don't dare accuse others of time wasting, it's obnoxious in the extreme.
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Well said
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I will have surgery for 99% within several weeks. I'm in situation I HAVE to do it - no other option - and I'm very afraid. I'm just finishing my last consultations...then I will have to choose.
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I have a question. So on the internet there are several programs that allow you to measure the symmetry of your face. I'm assuming that if a catskan of your 3-D skull were to be transferred to a computer there could be a facial analysis that could measure the three-dimensional symmetry of your face bilaterally but also in terms of the forward or backwardness of you cheekbones, etc. And this info could be given to the surgeon to ensure both sides become more symmetrical after surgery. Do such programs exist? Surely they must. I know different surgeons more or less embrace new technologies. I had an average surgeon that used computers for everything whom I consultedd with and he was actually developing the software with some company in scandanavia.
For example, he told me that in a few years a computer program will be used to simulate how braces will move and shift your teeth and will provide you with an exact image of how your teeth will look and this will give the orthodontist EXACT measurements for how to apply your braces! My f**king bad luck I never had that cause I had 4 perfect teeth taken out and my whole lip and midface is now terribly deficient. Anyway, any of you know if Zarrinibal or any of these guys use tech in this way?
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Stop f**king biting people. You've been on this board since the beginning and still haven't had surgery, or even settled on a surgeon so don't dare accuse others of time wasting, it's obnoxious in the extreme.
Oh yeah? I've given this board more concrete information than ANYONE. So don't f**king tell me how to behave. I get frustrated sometimes and mouth off a bit, I know. But there's a lot of stupidity on this board and I like to keep it in check. Mind your own business!
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Okay, fine Rico, Modigliani, etc. guys I'm sorry. I just get very frustrated sometimes and I apologize for getting nasty with you and those I've offended. This is hard on all of us mentally, and I've gonee through some really tough times, so it comes out in bad ways and I shouldn't be mean. Also, part of the time I'm just joking and trying to keep things a bit lively and moving on the boards. But you're right. Can we all kiss and make up?
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Lazlo are those the same papers you sent me last year? Or do you have new ones?
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ask plosko plus I sent him everything and he has it in a dropbox which I'm sure he can share. They are kellers papers so you probably already have them. Alue, which direction are you headed? Are you going with Sinn?
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I don't know yet.
I think I did see those papers, the quadrangle lefort looks amazing, just wish more surgeons would adopt this technique.
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I don't know yet.
I think I did see those papers, the quadrangle lefort looks amazing, just wish more surgeons would adopt this technique.
you should show it to sinn and ask him to do it for you.
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http://www.ncbi.nlm.nih.gov/pubmed/2708533
Check this abstract and look at names...
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For example, he told me that in a few years a computer program will be used to simulate how braces will move and shift your teeth and will provide you with an exact image of how your teeth will look and this will give the orthodontist EXACT measurements for how to apply your braces!
SureSmile has been around for quite a while. My ortho uses it, but I think only for very fine final adjustments (hasn't used it on me yet).
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Rico that paper looks good. Is that better than the procedure which Zarrinibal does? If one of you could access the full paper we'd see some visual examples of the procedure.
Come on guys stop being so lazy and let's figure out what the best procedure for this is. You will not the orbital rim remains unchanged, so this is not as good it seems as the procedure Sinn did for Earl!!!!! But I'm not sure how much of the zygoma is advanced by sinn.
Honest'ly I think if you need this procedure and also the lefort 1 (which I do) then you need two fractures since the maxilla needs to be moved for your bite counterclockwise and lowered a bit, but for the cheekbones and orbital rim you probably need the complex raised a bit and projected forward. So I don't see how you can get the upper jaw and the cheekbones fixed with the same procedure. DO you guys agree? Well next week I'm contacting Sinn so I'll figure it out.
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Honest'ly I think if you need this procedure and also the lefort 1 (which I do) then you need two fractures since the maxilla needs to be moved for your bite counterclockwise and lowered a bit, but for the cheekbones and orbital rim you probably need the complex raised a bit and projected forward. So I don't see how you can get the upper jaw and the cheekbones fixed with the same procedure. DO you guys agree? Well next week I'm contacting Sinn so I'll figure it out.
AFAIK, Obwegesser has done a combined Le Fort I + modified Le Fort III in a single operation (the blonde demon->angel girl). His uncle - THE Obwegesser, did it first back in the 60s.
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AFAIK, Obwegesser has done a combined Le Fort I + modified Le Fort III in a single operation (the blonde demon->angel girl). His uncle - THE Obwegesser, did it first back in the 60s.
Yes Plosko, I think this is indeed the best operation. But didn't Rico said he spoke with Obswegesser and he said he wouldn't do it for him? I mean if this is an option it is certainly the perfect solution. I'd prefer not to have to travel to Europe, but if I could get it done with Sinn that would be great. I'll let you guys know. But yes, I agree with you 100 percent Plosko, it's the best solution for the problem. Anyone actually consult with him and know what he has to say?
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How can you tell that your orbital rims are deficient and that you need more than a zygomatic osteotomy?
I sent Obwegeser an e-mail about six months ago by the way but he never replied despite that I made it clear that I'm from Europe (since earl said that Obwegeser doesn't accept patients from North America).
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@ gregor - If your orbital rims are deficient I think you'd have a negative eye tilt or you're eyes would kind of buldge. i think.
@lazlo - why would your maxilla need to be lowered?
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I haven't seen anyone here with bulging eyes but for some reason everyone seems convinced that they need to advance the orbital rims. I don't think my own eyes bulge but I do have a negative vector cheek.
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ya same here I'm pretty sure I also have a negative vector cheek, keeps like my eyes are sort of un-supported (but a left 1 would also fix this no?).
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ya same here I'm pretty sure I also have a negative vector cheek, keeps like my eyes are sort of un-supported (but a left 1 would also fix this no?).
You mean a Le Fort I? If that's what you meant then the answer is unfortunately no; a Le Fort I does nothing to address deficiences under the eye. I'm hoping the zygomatic osteotomy is enough to correct it if you just have a negative vector cheek and no orbital rim deficiency though.
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Yes I meant to say Le Fort I, also I fear I may need a similar procedure as some people here. My nose sticks out a lot but my side cheek bones are super flat, my eye actually protrudes more forward than my cheek bones. As if I have dysgnathia :(. The second guy on google images has a similar eye area as me. I dont want to self-diagnose myself, I guess I'll wait until I get a ceph....
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How can you tell that your orbital rims are deficient and that you need more than a zygomatic osteotomy?
No idea. My surgeon did say that under-eye flatness often comes with great facial width like mine. Maybe he's right:
http://www.listal.com/viewimage/1018849h
This chick has eye bags in almost every photo... and she's a model.
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@ gregor - If your orbital rims are deficient I think you'd have a negative eye tilt or you're eyes would kind of buldge. i think.
@lazlo - why would your maxilla need to be lowered?
for more teeth show.
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No idea. My surgeon did say that under-eye flatness often comes with great facial width like mine. Maybe he's right:
http://www.listal.com/viewimage/1018849h
This chick has eye bags in almost every photo... and she's a model.
yeah but all her other features are as close to perfection as you can get. beauty is a "gestalt" i.e. the relations amongst forms, you can't cherry pick individual features like that, it's how it all comes together. Also bags under the eyes aren't necessarily a result of poor orbital rim support, though her's aren't great. Often its a soft tissue problem. Anyway, can we stay on topic please, i.e. papers on this surgery, news from Dr. Obesgesggser or whateber the f**k his name is.
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Btw my friend is a university student and he said he'll try and get the papers for me. So if I get them I'll report back!
Also I'm going to email Dr. Obwegesser, is there anything specific you guys want me to ask?
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Rico, you don't need jaw surgery. You just need a repositioning of your orbital rim/malar right? Okay, got it.
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Lazlo...Jesus..of course not problem with the jaw ;) If I needed jaw surgery , then it wouldn't be a problem to do it in my country :)
You cannot separate orbital rim from the malar whole malar bone, at least in this case it is nonsense
so since you exactly know what is my problem ,what you think ?
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You mean a Le Fort I? If that's what you meant then the answer is unfortunately no; a Le Fort I does nothing to address deficiences under the eye. I'm hoping the zygomatic osteotomy is enough to correct it if you just have a negative vector cheek and no orbital rim deficiency though.
IMO, I think mid face recession is rarely confined to the maxilla only and I'm certain most surgeons are very well aware of the fact. It's just that Le Fort I is fairly straightforward and "good enough". That's why so many Le Fort I results still look "off" after the operation - the damn curve is too low. Those rare "wow" Le Fort I cases are the ones where only the maxilla is recessed and everything else is fine.
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Again, you hit the nail on the head Ploskoplus, you are ABSOLUTELY right.
Now I would say that probably in 50 percent of cases the lefort 1 is enough, and in another 20 percent it's borderline but in 30 percent of the cases the lefort 1 is not enough as you rightly point out and what is needed is something like the quadrangular lefort II (Keller) or what demon girl had done.
@Rico, okay I thought you had some accident and also needed jaw surgery, don't get your panties in a bunch. Stay cool dude.
So my dream team would be able to do the following: demon girl operation PLUS the chin wing osteotomy. Does Obeswegger do chin wing?
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Lazlo: I had an accident.. malar bone fracture. under the line you can see fracture line. Whole bone moved about 4mm
Look at the orbital rim above ION foramen ..There is about 2mms [in normal scale] fault
typical fracture like this:
(http://www.sonny2.com/articles/OF%20Trauma_files/image027.gif)
My malar bone must be cut on the old line fractures. All fractures with mild displacement like this are the same, like in picture above
so what kind of Lefort I need ;) ?
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Since now you know exactly what the problem I have, I need little advice..
Some surgeons I have consulted told me that malar bone reposition (in my case) is the one of the easiest procedure from the hardest ones, but at the same time they claim no surgery is easy :) Nicely said, but.... They tell me they can do that at very low risk of any permanent damage, but when I ask them to show me some photos of some patients who underwent such surgeries they show me the cases just a little similar to mine, for example where one patient had whole his face moved little forward... so even more complicated [I suppose] but my problem is not very rare and at the same time not frequent.
This type of fracture (even overlooked) is typical. Bone break almost in the same way...So no photos = no patient like me before ?
From time to time some patients after cheek trauma has overlooked fracture or sometimes the fracture is improperly set during first treatment and need redo. All of this come to one thing -> malar bone osteotomy in old line of fracture, like I showed it in my previous posts here.
My question is: Should I trust a surgoen (all I met are cranio-maxillo-facial) who has great experience (opinion) with whole skull , that he can do that at low risk, without giving me examples of the same problem in his previous patients ....
or I should go where a surgeon show me at least 2 examples of such identical treatment ? I do not know If I ever gonna meet such one...
Is it good to have surgery where they have experience with more compliated cases, but not with more simple ? when a surgeon has not had identical case like me (having in mind that my fracture was typical)
What you think ?
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You mean a Le Fort I? If that's what you meant then the answer is unfortunately no; a Le Fort I does nothing to address deficiences under the eye. I'm hoping the zygomatic osteotomy is enough to correct it if you just have a negative vector cheek and no orbital rim deficiency though.
Out of the mouths of babes... I asked a friend who I see about once a month what he thinks. He said I no longer look as flat as pre-op, but I need "more fat at the top of my face" to balance the protruding middle of the face. He knows nothing about jaw surgery or aesthetics.
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Interesting. Can you have a chin wing and bsso done at the same time? Yes I am class II. Man this sometimes feels so impossible.
Plosko did your upper lip protrude? I mean the space between your nose and upper lip? Can you post some pics? I thought you looked amazing after your surgery.
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Interesting. Can you have a chin wing and bsso done at the same time? Yes I am class II. Man this sometimes feels so impossible.
Yes. But the BSSO cut must be made further up. I think Zarrinbal definitely does do both at the same time.
Plosko did your upper lip protrude? I mean the space between your nose and upper lip? Can you post some pics? I thought you looked amazing after your surgery.
Yes - it was swollen and thick. I looked almost class II. I think it's the VY-plasty that made my lip so thick and numb. But my friend made the comment yesterday and my lip is thinner (but not there yet). I think he's right. The middle of the face is heavy and convex, courtesy of the Le Fort I and recessed upper mid face. IDK, maybe it's still the swelling. I was told that the final look is obtained 12 months after surgery. My ortho said that he even sees difference in the upper lip in 12 and 24 month photos.
Modified LFIII, here I come.
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and of course..no advice ehhh what a pity..
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For the lefort 2/3's how much actual projection do you need to have a noticeable improvement?
Is it minor like 1-2 mm or huge about like 8-10mm?
Just wondering because my brother has huge cheekbones but when I compare mine with his it only seems like its maybe 2-3 mm bigger also it feels like the orbital rim under his eye ball is closer to his eye then mine.
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the bone has to be moved about 4mms outwards but it is not easy to explain. After the fracture the bone backed a little, gone inward and rotated ;)
but in more simple words...its about 4mms. There is not big problem if you have less or more of cheek prominence on both sides ;) , the problem is when you have on the one side clarly visible cheek and on the other completely flat :) Generally I had mild/medium deformation or just not big but its strange for me..and also pain due to nerve compression. 2 connected problems
and now I found some surgeons that have good reputation and do some really complicated surgeries. They told my surgery is relatively easy for them.
but when I ask them to show me patient with very similar problem, the can't do that. and what I should do in that case ?
My fracture was typical. so called 3pod - typical zygomatic fracture, but overlooked.
But I'm not the first person who had overlooked fracture also sometimes some people needs redo after the bone was set improperly during first treatment.
Only in Poland every surgeon told me that they report 2-3 cases a year who need that surgery, but they refuse to perform that.
So If a surgeon who claims he can do that at low risk, then why he can't show me at least one patient with that problem ?
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What you think about such INTERNATIONAL clinics ?
http://www.ukaachen.de/fileadmin/files/global/user_upload/MKG_Englisch_final.pdf (http://www.ukaachen.de/fileadmin/files/global/user_upload/MKG_Englisch_final.pdf)
there works one of the main German maxfac surgeon.
Interesting article (download PDF link) : https://www.google.pl/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&uact=8&ved=0CFsQFjAH&url=http%3A%2F%2Frepub.eur.nl%2Fpub%2F21397%2F101119_Nout%2C%2520Erik.pdf&ei=gHezVLTwDNHaaq2XgcAI&usg=AFQjCNHixN1meUHiFIRlJ9uXuNBE9iRbMA&sig2=-tnVEemCH0IshYzErcWEbA&bvm=bv.83339334,d.d2s (https://www.google.pl/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&uact=8&ved=0CFsQFjAH&url=http%3A%2F%2Frepub.eur.nl%2Fpub%2F21397%2F101119_Nout%2C%2520Erik.pdf&ei=gHezVLTwDNHaaq2XgcAI&usg=AFQjCNHixN1meUHiFIRlJ9uXuNBE9iRbMA&sig2=-tnVEemCH0IshYzErcWEbA&bvm=bv.83339334,d.d2s)
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I found interesting abstract. I will try to find full text
http://www.ncbi.nlm.nih.gov/pubmed/12016500
but it correlates with this what I know. it shows that every maxfac clinics have at least 2-3 cases a year like mine.
I had consultation with Prof Iannetti, who is mentioned in the research.
What you think ? I have to choose between some surgeons, but I found only that one of them who made research about delayed or inadeuately treated fractures. Should I put this surgeon on first place ? or it doesn't matter ?
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Say if you were to get a lefort I, would it be possible to still get a lefort III in the future without recutting the lower jaw?
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Say if you were to get a lefort I, would it be possible to still get a lefort III in the future without recutting the lower jaw?
Yes.
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Lazlo: I'm curious why you've ruled out Keller? He has a lot of experience and even offered you the type of surgery you're after.
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Lazlo: I'm curious why you've ruled out Keller? He has a lot of experience and even offered you the type of surgery you're after.
it has to do with the mayo clinic and certain bureaucratic issues.
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it has to do with the mayo clinic and certain bureaucratic issues.
I read your post about them requiring 7000 USD up front for a consultation so I'm guessing bulls**t like that runs through their system? Would you mind sending me a PM if you don't want to post the details here? The Mayo hospital is known for being really good in general and I know that it has world leading surgeons in at least one other field. Considering how hard it is to find a competent surgeon that is willing to do the right procedure then I'm not sure we can afford to dismiss a surgeon for issues like this.
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for more teeth show.
Is lowering the front of the maxilla commonly done in conjunction with CCW? To achieve the rotation you either need to lower the posterior of the maxilla as you move forward, or in the case of gummy smile / long face syndrome, impact the anterior border of the maxilla as you rotate and move forward. If you were to lower the front giving more teeth show and rotating counterclockwise you would need to lower the back of the maxilla even further. I'm just wondering how much this would effect stability, especially with the masseter muscle pulling on it.
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What you think about such INTERNATIONAL clinics ?
http://www.ukaachen.de/fileadmin/files/global/user_upload/MKG_Englisch_final.pdf (http://www.ukaachen.de/fileadmin/files/global/user_upload/MKG_Englisch_final.pdf)
there works one of the main German maxfac surgeon.
Interesting article (download PDF link) : https://www.google.pl/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&uact=8&ved=0CFsQFjAH&url=http%3A%2F%2Frepub.eur.nl%2Fpub%2F21397%2F101119_Nout%2C%2520Erik.pdf&ei=gHezVLTwDNHaaq2XgcAI&usg=AFQjCNHixN1meUHiFIRlJ9uXuNBE9iRbMA&sig2=-tnVEemCH0IshYzErcWEbA&bvm=bv.83339334,d.d2s (https://www.google.pl/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&uact=8&ved=0CFsQFjAH&url=http%3A%2F%2Frepub.eur.nl%2Fpub%2F21397%2F101119_Nout%2C%2520Erik.pdf&ei=gHezVLTwDNHaaq2XgcAI&usg=AFQjCNHixN1meUHiFIRlJ9uXuNBE9iRbMA&sig2=-tnVEemCH0IshYzErcWEbA&bvm=bv.83339334,d.d2s)
This article is very interesting. Thank you Rico for posting it.
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Balanced: Have you ever heard about these surgeons from the article ?
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Nope, but i would not conclude anything from that. Im only learning here too.
In general i think surgeons seem to be better in their articles than in practice!
I am unable to give you any help with those scans, sorry.
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Everyone who is looking for experienced surgeon in malar (zygomatic) osteotomies, should look at this.
http://rd.springer.com/article/10.1007/s00266-002-1484-1#page-1
Here you can see 2 pages in preview. If it does not appear, then click 'Look inside' under the title
it's interesting. Prof. Iannetti (Italy) and his team has performed malar osteotomies at least in many cases, so now even more - I guess 150 at least... Probably, there are no photos but notes, if patients were satisfied or not
I'm thinking about buying this article, but do not know if it's gonna give me something more
I wonder if I should choose him automaticaly when he has malar osteotomies documented....... or perhaps that means nothing
Another surgeon also claims he performs that, but no data
Even many other researches connected with malar fracture etc.. are related to this Iannetti team research .. like this: http://www.curresweb.com/csi/2014/51-64.pdf
Every little advice is very important to me
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I'd say for you to buy it, if this is the procedure that you want to receive then the information within the article could help you, maybe you'll learn something new.
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Buy it, you're about to spend thousands anyway.
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New techniques in midface osteotomy. I bought the article, but do not know If I can share
http://dx.doi.org/10.1016/j.jcms.2014.12.014
or
http://www.jcmfs.com/article/S1010-5182%2814%2900370-9/abstract
Professeur Patrick GOUDOT
Service de Stomatologie et Chirurgie maxillo-faciale
He is probably well known, but not mentioned on the forum before...
PS Here, more info about sandwich osteotomy: http://jawsurgeryforums.com/index.php/topic,3933.msg31978.html#new
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rico, just share the before and after pics from the article, you can attach them.
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no before / after photos. Only info what's going on in this new technique. To be honest I wasted 40E :) Before I bought, I asked Prof Goudot if he can show me full artice. He told me he doesn't have :P yes ..of course....he invented, wrote about this and lost
BTW I started to ask surgeons if they are able to show me some before / after photos during consultation face to face. I ask about this before I book a consultation. And you know what. Every second surgeon answers me that he can't
Should I rule out such surgeon automatically ? (I'm NOT talking about Prof. Goudot here, I have not got answer about this yet, but generally)
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no before / after photos. Only info what's going on in this new technique. To be honest I wasted 40E :) Before I bought, I asked Prof Goudot if he can show me full artice. He told me he doesn't have :P yes ..of course....he invented, wrote about this and lost
BTW I started to ask surgeons if they are able to show me some before / after photos during consultation face to face. I ask about this before I book a consultation. And you know what. Every second surgeon answers me that he can't
Should I rule out such surgeon automatically ? (I'm NOT talking about Prof. Goudot here, I have not got answer about this yet, but generally)
Yeah that sounds like bulls**t. What a bunch of assholes. I mean if they've never done the surgery before then fine, but give me a break, he doesn't have a copy of the f**king article he wrote!!?? I would have told me to go f**k himself right there.
Don't go to that asshole.
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They have done it before.
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Ok so these malar osteotomies, whats the deal? The left side of my face is narrower, and appears slightly more recessed at the undereye area than the right.
I think if the left side was made like the right then that would be enough for me, i think i would be good looking then and would leave it at that.... though I may always be prone to bouts of madness where I dream of lefort 3's and absolute perfection like all them holywood movie stars.
Can you guys help me get some new contacts? I have emailed Zarrinbal, I was hoping to go to him because he does the malar osteotomy and also the mandibular wing for the jaw angle of the left side also and I want both to make the left look like the right does.
Triaca's email always seems to be broken, though its possible his prices are too much.
Anybody else in europe who does both of these or are Triaca and Zarrinbal the only options?
Would going to Mommaerts be a mistake?
Could someone pm me a contact for Obswegger? I couldn't find a website for him.
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Zarrinbal does NOT perform malar osteotomy in full of its meaning - if I'm writing this in english properly
To move the whole malar bone (whole zygomatic) you have to cut orbital rim and zygomatic arch. That may change orbital volume or leave too much gap in the orbital floor (but augumentation orbital-floor possible - so look it's complicated) which leads to the complications with the eye - enophthalmos, diploplia. This is why most maxfac surgeons won't do that on you
Triaca also does not do this - at least in my case. Keep in mind , in my case (overlooked fracture with mild displacement) the surgeons are more prone to do that.
Yes Triaca email...... They have problem with mail server. I sent them fax, rang them, gave them instruction how to remove thier domain from bann list and nothing. Typical problem in Switzerland. Don't send also anything zipped. They can't extract them :) seriously
WRITE FROM THE WEBSITE - http://www.pyramide.ch/en/Contact
Zarrinbal does sandwich osteotomy, like Mommaerts -just minor procedures to give your cheek a bit of more prominence
About this ask also Prof Nadjmi from Belgium
Abut Mommaerts hard question. Keep in mind he has a lot of patients, probably more than anyone else. So the rate of unsuccesful surgeries might be greater. On the other hand some users here say, they have seriously botched surgery with him. However only they know about this enough much .Noone has seen here patient of MM - before / after photos
Make your own research and be careful. THERE IS NO SURGEON WITHOUT FAILURES. ONLY NUMBER OF UNSUCCSEFUL OPERATIONS MATTERS
You can find help for sure in some Swiss clinic. Check Prof Hammer (also Prof. Schramm from Germany), Joachim Obwegeser - but they are very expensive
Also I know that Prof. Giorgio Iannetti (he has documented such procedures at least) and Prof Sandro Pelo from Italy can do that (cheaper).
But I do not know about this enough much. I'm in progress
Read about Prof. Goudot from France
and Dr. M. Koudstaal from Netherland
Consider interesting very good well known hospital in Dresden (Germany), concretely, Prof Lauer
http://www.uniklinikum-dresden.de/international
Those from Switzerland, Germany, France and Netherland do computer assisted malar osteotomy - kinda new helpful technique, It is worth to talk more about with them
The Italian ones may have something in their hands what may have not got others... ..You know Ferrari, Lamborghini, etc ;)
Generally such procedure is rare. And should not be performed untill you really need it.
This is how you check e-mails: Google -> type Obwegesser maxillo e-mail
Sandro Pelo maxillo e-mail
Iannnetti Giorgio maxillo e-mail
Hammer maxillo e-mail
you can put also 'facial' - 'maxillo facial'
Most of them have got at least 2 mails. Just find, write and keep in mind, that sometimes mail message may go into Spam folder. Hence it may be overlooked
example:
https://books.google.pl/books?id=nl58_hwIrY0C&pg=PP15&dq=obwegeser+joachim+maxillo+e-mail&hl=pl&sa=X&ei=ryTVVNb8NMv9UueChJAK&ved=0CCEQ6AEwAA#v=onepage&q=obwegeser%20joachim%20maxillo%20e-mail&f=false
PS check this: (buy article) sounds interesting. http://www.readcube.com/articles/10.1097%2FSCS.0b013e3181f4ab9f
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That article is very interesting to me. Pelo is one of the surgeons on it - Gasparini G1, Saponaro G, Moro A, Boniello R, Cervelli D, Pelo S.
I'd be very interested to talk to some of these guys, if any of them can also perform mandibular wing osteotomy it would even more interest me.
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Just ask Prof. Pelo. (main surgeon in the team you mentioned) Easy to find his mail. and let me know in PM about that article :)
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Ok so these malar osteotomies, whats the deal? The left side of my face is narrower, and appears slightly more recessed at the undereye area than the right.
I think if the left side was made like the right then that would be enough for me, i think i would be good looking then and would leave it at that.... though I may always be prone to bouts of madness where I dream of lefort 3's and absolute perfection like all them holywood movie stars.
Can you guys help me get some new contacts? I have emailed Zarrinbal, I was hoping to go to him because he does the malar osteotomy and also the mandibular wing for the jaw angle of the left side also and I want both to make the left look like the right does.
Triaca's email always seems to be broken, though its possible his prices are too much.
Anybody else in europe who does both of these or are Triaca and Zarrinbal the only options?
Would going to Mommaerts be a mistake?
Could someone pm me a contact for Obswegger? I couldn't find a website for him.
MM is cheap, but people on this board spent 10 times the money undoing the damage he did.
FWIW, I do have asymmetry at the zygomatic level as well. A max fac surgeon ruled out an LFIII for me because advancement at that level would only increase the asymmetry. He suggested custom implants once I fixed my bite with an LF1.
I did have such asymmetry at the maxilla level as well, and it was fixed with an LFI. I think LFIII is simply limited in the kinds of movements possible.
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Would the technique demonstrated here not give the same midface effect as a lefort 3?
-http://www.readcube.com/articles/10.1097%2FSCS.0b013e3181f4ab9f
(Thanks to Rico for the link.)
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there is no full text, so no comparisson. Do you study somewhere? check if you have access to full text of medical aticles.
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New techniques in midface osteotomy. I bought the article, but do not know If I can share
http://dx.doi.org/10.1016/j.jcms.2014.12.014
or
http://www.jcmfs.com/article/S1010-5182%2814%2900370-9/abstract
Professeur Patrick GOUDOT
Service de Stomatologie et Chirurgie maxillo-faciale
He is probably well known, but not mentioned on the forum before...
PS Here, more info about sandwich osteotomy: http://jawsurgeryforums.com/index.php/topic,3933.msg31978.html#new
Go to http://libgen.org/scimag/ and paste the articles DOI code and the search to download it for free.
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The technique used in the article rico posted is the same as one of the pictures that were posted on this thread earlier (could be in another thread). Seems like it could increase the size of the orbital globe from the inside, so it probably could work as a reliever for small orbits.
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http://www.readcube.com/articles/10.1097%2FSCS.0b013e3181f4ab9f
recenlty one user find out , that the photos on that link to publication about ZSSO are available on the left panel - there is one option. Check this out
Who understand by watching all the pictures, what is going there ?
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so much researching to find good surgeon
and I chose wrong - partially due to lack of enough money, and due to my stupi error
I overlooked error in my surgeon's plan. but the error was so stupid that I think he did the surgery first time :/
i mean zygomatic bone reposition (osteotomy)