jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Macros on February 24, 2015, 09:22:00 PM
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hi all,im new to this forum
im posting some pic of my xray and conebeam for getting some advice of what i need.
i have been talking to some mxillo surgeon and pre all said that i need a lofort 1 and my main problem is the mid face.
Plu i have a narrow maxilla fixable with a palatal expansion.
casue im really sure i will not fix my midface problem only with a lef1,plus i dnt know what to do with my checkbones deficieces ,what do u guys thinks about?
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it looks like everything lines up nicely, a lefort I might give you a chimp look since your pre-maxilla and mandible aren't recessed. The procedures that are talked about on this forum for advancing the midface are, a modified lefort II/III and ZSSO.
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do I say, concerning the images, don't you believe that my lower jaw is grown too much and too much down?and to me it seems that the maxilla is grown too much down, even for the mouth breathing that caused by my deviated septum
what I want to say in short that according to me besides the problem of the mid face, i think also have a problem of vertical growth of my entire face
am i wrong?
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do so u think there is no other option for the midface?
what about implants?
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plus i can post some real life pic
i really appreciate some advice
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Yes you appear to suffer from long face syndrome.
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do so u think there is no other option for the midface?
what about implants?
treating mid-face deficiency with implants is not effective in my opinion. not only it doesn't improve eye area, but it accentuates it and at the end eyes tend to look spooky. I've only seen 1 example of mid-face deficient patient who was treated with implants and that I actually liked.
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so in the end do u think all mid-face deficiency are treated with some like mod lefort like the guy on this forum?
what do u seggest in my case?
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so in the end do u think all mid-face deficiency are treated with some like mod lefort like the guy on this forum?
what do u seggest in my case?
nothing. I'm not thought enough to give you decent opinion. Here are some guys who know cephalometry and they can tell you more, but take all with grain of salt as well. You'll also probably need to upload lateral and 3/4 images color images(you may censure out eye-balls).
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ok im doing this
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here we are
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@Mark505 Nice, I made it into your signature :D I decided later that CCW in that context was ill defined.
@Macros You indeed have significant mid-face deficiency there. I've noticed some of these people have darkening under the eyes as well. Anyone know why that is? Mine just cast shadows right now. In any case, it appears your mid-face needs to come forward and you may need augmentation to form the cheekbones as well. Should you do it? That's been the debate on here. In an ideal world a skeletal movement is certainly preferable. This isn't an ideal world and not all problems should be fixed even if they can be. My brother was just telling me last night about a 22yo in his hospital who had one of the gastric surgeries to lose weight. Simple, routine procedure that they do all the time. Sutures tore and stomach acid ended up over all her internal organs, in her lungs, etc. She's been in the hospital for 4mo, they had to remove the stomach, parts of her intestines (TPN complication), infections, etc. In her position, I'd rather they just let me die. She has a long painful, unhappy life ahead of her.
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i think that the circels under my eyes prob comes from lack of oxygen due to a nasalseptum deviation,but im not sure 100%
i could also say some peopls think is due to think skin.
you are completely rught my freinds since when i understand my midface problems,i have looking for the procedure and every time i see a LF3 OR or something invasive like that,ZSSO etc my heart begins to accelerate.i agree with u on all argument but i continue to dnt stop think about my image.
we live in the social network'era ,appereanceh ahve always had theyr huge importance but right now,in the world of selfie's youtube,facebook etc ìif u have some problems ,if u dnt fit in some standars u are not considerated ,u start 10 point behind,and not only in social contest ,even in ur work carrear.
I dnt know what to do,im really seraching the best way to find my balance.
back to the problem,i was looking for some cepghalometric program\or some 3d analysis face for triyng to do a some simulation u know something?
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I don't really see much midface 'deficiancy' here?
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frontal pic,u can see the mid face problem
u say there is no vertical grow but in fact my appereance seems to suffer form some sort of that.
myabe is coz of my mid face defiance but look at this u see a "tired long unaestethic face"
and in fact im looking to find the best way to enchant my appereance
maybe some sort of "chin wing" can give me better rounded wide lower third ,tryng to fix the long problem?
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Is that a Sailer patient? ::)
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I think it's a pretty good result if his intention was to become a woman. :o
This is exactly the kind of feminizing result that I'm worried that a zygomatic osteotomy or implants can result in.
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In my opinion, just by looking at your cephalometric shot, you have some vertical growth judging by suspiciously increased distance between your eyes and mouth (long midface). Then you have increased gonial angle, which is just a another school sign of increased vertical growth. You also mentioned word "tired" which is TYPICAL sign of mid-face deficiency. You also have under eye pooling which can have many causes, but in your case I'd link it with midface deficiency since it's almost always part of this condition.
As I've probably said it before - this condition is very hard to treat. You can do lefortI advancement, you can augment malar/submalar region...whatever you do, it'll be worthless, if you won't address eye area as well and this is almost impossible using implants, in my opinion. Altough there are infraorbital implants intended for solving eye-area related issues, but they may look unnatural and spooky as you'll be able to hear the same opinion from many maxfac surgeons. Eye area is very sensitive place to mess with with, thus probably hardest to improve effectively. Despite this, infraorbital implants may be viewable option, probably depending of severity of the problem. Maybe submalar implants + fat graft/fillers would be a more suitable option. Again,hing else "fubared" whatever you'll do later, you'll probabably have to solve AT LEAST, otherwise you may end looking like this guy (notice eyes, besides everyt):
(http://www.sailerclinic.com/media/content/bilder_neu/KPS-aesthetische-chirurgie_6c.jpg)
(http://www.sailerclinic.com/media/content/bilder_neu/KPS-aesthetische-chirurgie_7c.jpg)
(http://www.sailerclinic.com/media/content/bilder_neu/KPS-aesthetische-chirurgie_8c.jpg)
(http://www.sailerclinic.com/media/content/bilder_neu/KPS-aesthetische-chirurgie_9c.jpg)
what a horrible result.
as i said in my first post my first consult with a maxillo he suggest me a Sarpe+ Lefort 1+BSSO,but he didnt talk about my mid face and in reality i wasnt satisfied by his plan .
then i went to Raffaini and he said sarpe daouble jaw surgerey he also said my main prob is mid face , he only talks about fat garft . i dnt know whay he said nothing about implants,maybe he thinks they are dangerous?
what the difference between submalar implants and ifraoral implants? do u think is an invasive risky procedure ?
so in the end u think whatever i do unless a mid-face osteotomy like a mod lfort3 or zsso i can end like look that guy?
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plus i would ask u if u know someone who can do a really good 3D ceph analysis with some morph before and after.
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Holy smoking toledos. Sailer really outdid himself on that one!
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so whats ur plan for fix ur problem? lf1 and zygoma bone graft? u know, eevry time i think about some malar osteotomy my blood in the veins become cold.do u rellay would u go for a lefor 3?
im not telling u are arnett and gunson,but i can see u have knowledges much more than me
in the end i know myself and i have not the balls for doing a lefort 3,maybe im worng i dnt know but i wanna look to find some alternatives.
so u are assuming a lefort 1 fracture have more risky than every malar implants,good to know,i really was thinking about the opposite
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so whats ur plan for fix ur problem? lf1 and zygoma bone graft? u know, eevry time i think about some malar osteotomy my blood in the veins become cold.do u rellay would u go for a lefor 3?
bone graft is not osteotomy. bone graft is applaying a bone material on bone. i haven't seen any results of zygo bone graft, so I can't tell you anything.
im not telling u are arnett and gunson,but i can see u have knowledges much more than me
well i know some stuff about midface problems, because I have similar.
in the end i know myself and i have not the balls for doing a lefort 3,maybe im worng i dnt know but i wanna look to find some alternatives.
not only you won't have balls, there might be not many surgeons willing to perform this stuff on you.
so u are assuming a lefort 1 fracture have more risky than every malar implants,good to know,i really was thinking about the opposite
Well puting an implant on a bone and cutting a bone's nerves sound pretty much difference to me. I might be wrong.
now seriously, no more "advices" from me. wait for more knowledgeable guys to come.
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yes yes i know bone grafts isnt an osteotomy,mone was only an emotional though i confuse u due to my bad english
the last question,have u thinked about the future?i mean live with something who arent part of ur face for the rest of ur life?
infection etc?
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look what i have found.
what about ?
https://www.youtube.com/watch?v=U99p9KAF10I#t=210 (https://www.youtube.com/watch?v=U99p9KAF10I#t=210)
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Yes, I'm familiar with this guy in Australia. He charges like $30k for those cheekbone augmentations. He looks young in the video, I thought he was in his 60s.
His point about skeleton pulling back in your 40s is a good one. It could mean a few things. First, that you'll blend in more by that point. Second, that any corrections done while younger need to be redone as you age, as what's appropriate while young will be insufficient when old (to still look young). I spoke to a plastic surgeon who does this work too and he said that HA augmentation was popular in the 80s but that most surgeons abandoned it because the results were terrible. He said only older surgeons still use it because that's what they're comfortable with and it sells well. He mentioned that it's only useful for lateral augmentation but not for projection, which is what we really need. And he said it's just as foreign to the body as other implant materials. They don't solve one of the bigger problems with augmentations - symmetry. Studies are mixed on resorption but I think there's truth to that, just from talking to a few people who had it done. Asymmetric resorption is a real possibility. Heck, it's a problem even when using cavalier bone while still having the problem of how they look as you age. My cheekbones are already asymmetric but only in projection fortunately, not in position (much worse IMO).
To the extent that you need to fix it, earl's approach is probably the way to go. But don't be fooled by his success. He knew it was a big gamble and he was ok with it. It's still a very big gamble IMO. You haven't seen patients 5, 10, 15, etc years out yet. Even earl doesn't know (wish him the best of course :) ). Otherwise, I think the options just suck here. Surgeons are right, implants suck. My position is, I need jaw surgery for health reasons so I'm gonna do that. As for the cheeks and infraorbital rims, yes it's unaesthetic but we're not syndrome patients really. While we lack the advantages more attractive people possess, we pass for normal and can navigate life roughly to the same extent as everyone else. I'll keep an eye out for improvements in this space, we have time on our side and there's a lot of money on the table for anyone who can solve the problem. Sad but it'll probably be solved before Lupus is cured, just because there's that much money on the table. A compromise position might be long term face pulling for a middle ground but once you do surgery that's not gonna be a good option unless you want to repeat surgery to move the maxilla back.
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Yes, I'm familiar with this guy in Australia. He charges like $30k for those cheekbone augmentations. He looks young in the video, I thought he was in his 60s.
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30k for malars only? Daaamn, but still better than Sailer.
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You only think that patient looks feminine because he is wearing makeup in the afters, the face structure isn't feminine.
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He's right, there's volume definitely but it's not a great outcome. I think it's better than before though.
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That sailer patient was actually an incredible success, but it doesn't seem so at first glance because he is still not attractive(Due to his eye are a still being underdeveloped)
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That sailer patient was actually an incredible success, but it doesn't seem so at first glance because he is still not attractive(Due to his eye are a still being underdeveloped)
turning a man into a tranny can't be called success, especially if one didn't want that. any yes, screwed up eye area worsens overall result even more and this is totally expectable if you undergo maxillary-mandibular advancement on weak midface.
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hi guys some news
i went top Sandro Pelo for a consult,he said like other's surgeon i have this narrow maxilla,with this light mandibular deviation.
i told him that i am worried about my skeletal midface and he said he would fix the problem with Medpore implants.im really really sad about that ,what do u guys sugggest i will give u more pics.
even he isnt completely clear, he said i also need double jaw surgey with his "surgery first" method.
im in a dead end guys ,need your advice
here othere's pic
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Medpor can get infected (small chance, but not negligible) and it cannot be removed. Once it's in, it's in for good. A max fac told me that "muscles and bone want to be next to each other". He only uses custom implants when there is absolutely no other way - someone's face really messed up after a car accident, for example. You may find that this is the attitude of most max facs.
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thx for the reply Plosko
so you are sayng that if there is a small chance that they cna het infected,the also Can't be removed?so u have to live with them for the rest of your life?
what do u mean with "custom implants" implants created only for you?
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i think he said "CAN'T" because medpor tend to have small pores in it and if bone grows trough it then it's hard or impossible to remove it.
I don't think none grows into the pores add much as the soft tissue side does. b*tch to remove.
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here are other pic taken by my ortho ,that was the time when i was losing weight too.
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some news and update
i have had another suggestion for an operating plan
Lefot1+ Bsso+CCW+ ZSSO
so,i really dnt know if in a scale 1 to 10 i have to do this bimax.
im sure like all of u guys have seen ,the midface probelm is real and im sure i have to do something about it,but when i talk with surgeons the things that scary me is tehy havent the "same" diagnosis and plan on what to do,and this stuff really make me in a blind alley.
other helps?
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frontal pic,u can see the mid face problem
u say there is no vertical grow but in fact my appereance seems to suffer form some sort of that.
myabe is coz of my mid face defiance but look at this u see a "tired long unaestethic face"
and in fact im looking to find the best way to enchant my appereance
maybe some sort of "chin wing" can give me better rounded wide lower third ,tryng to fix the long problem?
I think this pic is super handsome. My two cents.