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General Category => Functional Surgery Questions => Topic started by: Keoro on January 10, 2015, 05:59:56 PM

Title: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Keoro on January 10, 2015, 05:59:56 PM
I seem to have inherited exorbitism ( bulgy eyes ) - exophtalmos which i asked about in Realself hoping to get some answers, apparently the problem is my deficient bony orbital rim and flat hypoplasia face, combined with a flatnose/receding chin makes for a very unmasculine face which frankly is bothersome. I'm thinking about a chin implant to at least fix my receding chin, but the problem from what i've heard from experts seems to be a deficient bony orbital rim and lack of cheek bones which contributes to the severity of my exophtalmos. I'm really looking for a way to accentuate my jaw lines, my face seems to be pretty oval. I'm certain a chin implant would at least help improve projection. Thank you for reading.

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Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Keoro on January 11, 2015, 08:23:46 AM
Bump. Anyone?
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Keoro on January 22, 2015, 12:52:33 AM
Bump again. Le-fort 3? Genioplasty? Le-fort 1? Malar osteotomy? You're the experts guys, would appreciate any answer
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: PloskoPlus on January 22, 2015, 01:00:53 AM
Bump again. Le-fort 3? Genioplasty? Le-fort 1? Malar osteotomy? You're the experts guys, would appreciate any answer

Modified Le Fort 3 + chin wing.
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Rico on January 24, 2015, 02:38:41 AM
http://www.ncbi.nlm.nih.gov/pubmed/7699077

What about this ?

PS Not only Mommaerts performs this kind of surgery
Names are in medical article
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Alue on January 24, 2015, 11:52:16 AM
It's been discussed in length in other threads. 
A lot of people come in here claiming they need it, but you do look like you have a actual case for orbital/malar advancement. 

http://jawsurgeryforums.com/index.php/topic,4198.0.html
http://jawsurgeryforums.com/index.php/topic,3933.0.html
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: PloskoPlus on January 24, 2015, 08:43:02 PM
OP is similar case as me, but I have more severe everything.otherwise,LF3.

No man, I really don't think so.
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Keoro on January 25, 2015, 04:23:09 AM
Realistically, a Sliding genioplasty + Malar osteotomy would do alot of good?
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Rico on January 25, 2015, 05:40:27 AM
I think all of you do not know what is behind term "malar osteotomy"  it is mobilising the whole zygomatic bone. Part of this bone creates orbital floor, hence orbital volume may change what may cause enopthalmos. And at least 50% of  maxillo-facial surgeons (even very experienced, well known) won't do this on you.

The alternative method (not as effcient as full malar osteotomy, but more safe) is zygomatic sandwich osteotomy which can be used (I do not know how, I gave link, you have to buy this article, or find full version) to treat kinda recessed cheekbones probably in 2 directions.

Of course implants are 3rd option

PS If you find such surgeon who has performed a lot of malar osteotomies please let me know.  Now I know only Prof. Iannetti from Rome  (he has at least documented this)
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: PloskoPlus on January 25, 2015, 04:56:04 PM
Realistically, a Sliding genioplasty + Malar osteotomy would do alot of good?

I think Rico is right - malar osteotomy is not zygomatic osteotomy, which is what you probably really mean.  A ZO will widen your face, but not solve your under-eye area at all.  But your lower jaw is narrow, which a ZO will make look even more narrow.  A genio would improve your profile, but that's about it. IMO, you would really benefit from a chin wing - it would improve your whole lower jaw contour.  Alternatively genioplasty + jaw implants.  But aesthetically the eye area is the most important...  Modified LFIII.
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Keoro on January 26, 2015, 01:57:16 AM
Just realized i have an overbite ;(
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: PloskoPlus on January 26, 2015, 03:01:26 AM
Just realized i have an overbite ;(

Post pics of yourself smiling front, side, 3/4.  A few mm of overjet is normal.
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Rico on January 26, 2015, 04:40:55 AM
hmm I suppose modified LFIII is very close to typical malar osteotomy, am I right ?

or in other words. If modified LF3 risk list contains enophtalmos and diploplia, then for sure it is very close.
Who knows anything about the risks of modified LF3 procedure  ?
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: PloskoPlus on January 26, 2015, 01:46:29 PM
hmm I suppose modified LFIII is very close to typical malar osteotomy, am I right ?

or in other words. If modified LF3 risk list contains enophtalmos and diploplia, then for sure it is very close.
Who knows anything about the risks of modified LF3 procedure  ?

Read earl25's modified lefort iii threads.
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Rico on January 31, 2015, 05:46:33 PM
I wonder what is this : https://www.researchgate.net/publication/49646858_Zygomatic_sagittal_split_osteotomy_a_novel_and_simple_surgical_technique_for_use_in_midface_corrections
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Keoro on February 14, 2015, 07:43:34 PM
Update:

Emailed Dr sinn about a modified Lefort iii and what was the issue with my profile.

He said that he performed the Modified LeFort iii numerous times but in my case it would advance my nose forwards which ruled it out. He confirmed my orbital rim deficiency and suggested a orbital rim advancement/malar and asked that i come in for a consult.
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: terry947 on February 14, 2015, 09:48:57 PM
Keoro, good for you for taking action!

Are you gunna go ahead with the consult?

Keep us posted!
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: PloskoPlus on February 15, 2015, 03:54:40 AM
Update:

Emailed Dr sinn about a modified Lefort iii and what was the issue with my profile.

He said that he performed the Modified LeFort iii numerous times but in my case it would advance my nose forwards which ruled it out. He confirmed my orbital rim deficiency and suggested a orbital rim advancement/malar and asked that i come in for a consult.

Hmm, I thought a modified Le Fort III left the nose unaltered...  Anyway, I'm glad you're making headway, because your issue is not a run of the mill jaw surgery.  BTW, what did Sinn say about your bite?
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: terry947 on February 15, 2015, 02:05:55 PM
also did you rule out hypothyroid or graves disease?
Title: Re: Questions about mid-face hypoplasia and fixing it. (Overall profile improvemen )
Post by: Keoro on February 15, 2015, 05:43:49 PM
Never tested for Hyperthyroidism but i'm sure it's inherent exorbitism over exophthalmos caused by thyroid issues due to most of my dad's side of the family having semi/bulgy eyes and deficient cheeks. My case seems to be the worst as far as cheek/orbit deficiency goes i can literally pinch off 1.5 inches off my cheekbones.