jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Lazlo on December 16, 2015, 08:55:40 PM
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lallaa
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How can you afford all this?
I'm going to design my own technique with the help of a periodontist to graft bone between all my teeth in addition to alloderm from cadavers and rebuild my interdental papilla. This is something that definitely can be accomplished.
Also what does this even mean?
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Okay just for fun I'm listing all the surgeries I plan on having. In order I'm gonna have them and just to keep track:
1) Lefort 1 -3 piece/BSSO (with ramus drop)/genioplasty (widening and lengthening) CCW rotation/fat pad removal under lower jaw
(march/april--completion)
What is ramus drop exactly?
2) Modified lefort 3 with bone grafting for height as and 1 cm projection/Canthopexy/Brow bridge augmentation/reshaping
(July 1st/August completion)
Just three months after bi-max you get this? Confirmed? I find it hard to believe. Sinn told me to wait longer before getting such an operation. Why would Sinn do a canthopexy at the same time as a modified le fort III when it's highly possible you'll achieve desired results without an additional operation? Those are his exact words he told me. And brow ridge, didn't you just say you have a decent brow ridge? What do you want to reshape?
3) Rhinoplasty/Otoplasty (probably Dr. Cochran)
(September 1st Completion)
4) Dermabrasion + Co2 laser for acne scars/Sculptra to temples and cheekbones, plus juvederm for volume restoration in face
October 2016
5) Botox to intradermal nasal skin to stop oiliness and shininess of nose
October 2016
6) Stem cell enhanced Hair multiplication to do some grafts to my slightly receded hairline and thicken my crown area
Stem cell hair multiplication does not exist. Perhaps you refer to Dr Gho, but he is a con artist. There is only plain old FUE / FUT for now. If you have hairline recession and crown thinning you should be very certain you've halted all loss before going down the surgery route. Do you take anything for this?
7) I'm going to design my own technique with the help of a periodontist to graft bone between all my teeth in addition to alloderm from cadavers and rebuild my interdental papilla. This is something that definitely can be accomplished.
late 2016/2017
(https://graceonthemoon.files.wordpress.com/2014/02/x-files.jpg)
I truly want to believe this is a surgical plan devised in consultation with your surgeons, however it seems EXTREMELY optimistic to give just a few months between all these operations. Especially when all of them are highly dependent on the proportions of the rest of the face. Modified le fort III you want to widen according to the lower third to a large degree. Likewise, how can a rhinoplasty be done if you have residual swelling from bimax and modified le fort III? Your entire face is going to be swollen as f**k, whether you realise it or not. I think this is an extremely risky decision.
Also bro, that is easily over $100k worth of procedures. That's a lot of pesos.
I hope it works out for you and it'd be great to see the end result.
P.S. please answer my questions, this is relevant to me and I'm curious
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I'm not anti cosmetic surgery, but that sounds like a recipe for disaster. I can't comment on the other procedures but I can give you my two cents regarding rhinoplasty as I've had two.
I had a very minimal dorsal hump, my primary left me with a scooped nose, my tip was rotated up and my nostrils retracted. It destroyed my face, and I had to wait one year before anyone would operate on the nose again. I had to travel half way across the world, pay an awful lot of money and endure a 5 hour procedure to get my nose rebuilt with cartilage grafts. It looks okay now, but not a day goes by that I wish I could have my natural birth nose back.
When the nose is operated on, the tissues in the tip have a tendency to rise and the tip lifts... unless the surgeon uses a cartilage graft to purposely pull it down. This is fine for women but it is not for men, who should have a naso-labial angle around 90-100 degrees. In addition, internal scarring leaves the profile with irregularities and if you have an alar-plasty, the nostrils can scar upwards and inwards leaving them retracted. Regarding the dorsal hump, men look way better with a hump... the scoop is not a good look. Lastly, if you have thick skin, you will swell A LOT, and this swelling takes a full year to resolve. Do not take this decision lightly, rhinoplasty is one of the most complex surgeries out there, horror stories are not uncommon and if things do go wrong, it's a long, slow, painful road to recovery.
Apologies for the rant.
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Lazlo is well researched and I respect him for that. However, I stand with sj549 here. That's a lot of work and lot to go wrong, both short and long term. Wish you best of luck of course! Would love to see the result either way.
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Yeah, rhinoplasty is a bit of a gamble... especially for guys. If you're nose has a slight hump or some minimal imperfection, I say leave it well alone. Slightly big noses are more masculine, and higher bridges are more sophisticated. To give you an idea of what can happen, I've attached an image to show you happened to my nose. Sorry to hijack your thread but I think people should know about this sort of thing.
[attachment deleted by admin]
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your*, sorry about the typos!
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Well if it's not all planned with the clinics it's possible to change surgery dates.
Yeah, rhinoplasty is a bit of a gamble... especially for guys. If you're nose has a slight hump or some minimal imperfection, I say leave it well alone. Slightly big noses are more masculine, and higher bridges are more sophisticated. To give you an idea of what can happen, I've attached an image to show you happened to my nose. Sorry to hijack your thread but I think people should know about this sort of thing.
All 3 look good to me. But I think it looks best on the right so I guess it worked out fine for you.
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Well if it's not all planned with the clinics it's possible to change surgery dates.
All 3 look good to me. But I think it looks best on the right so I guess it worked out fine for you.
If my nose was like that to start with, I would have done nothing.
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If my nose was like that to start with, I would have done nothing.
Same here. Maybe it looked too big because of a bad mandible and/or small chin. My nose used to bother me too untill I realised that my issues were with my jaws.
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[quote author=sj594 link=topic=5056.msg42489#msg42
Yeah, rhinoplasty is a bit of a gamble... especially for guys. If you're nose has a slight hump or some minimal imperfection, I say leave it well alone. Slightly big noses are more masculine, and higher bridges are more sophisticated. To give you an idea of what can happen, I've attached an image to show you happened to my nose. Sorry to hijack your thread but I think people should know about this sort of thing.
[/quote]
wow, and to think I was seriously considering doing something similar before my last operation. Really thankful now I decided to leave my natural nose and look to simply fill in behind the hump with a little filler to make things straight.
Why did they have to touch the tip for the revision? Was that in order to rotate it downwards again?
Same here. Maybe it looked too big because of a bad mandible and/or small chin. My nose used to bother me too untill I realised that my issues were with my jaws.
Apparently people generally have the same size noses and it's only the jaws that affect how big they look. So getting a modified le fort III for example is going to make the nose look much smaller compared to when everything was recessed.
A personal theory of mine which so far I believe holds true is that the actual projection of the nasal tip over the lips is almost the same in every single individual. I believe this is why deprojection is often so risky and leads to unnatural results where something looks off.
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I have a slightly recessed lower jaw, which I'm hoping to fix soon, which did indeed make my nose look a little large. I had tip work to fix the nostrils, the lower lateral cartilages had to be re-positioned as there was far too much columella show. In addition, I had a caudal septal extension graft to add some length back and pull the tip down (though it is still a little high). Plus a whole load of work on the bridge - onlay grafts and spreader grafts to reopen the airway as my mid vault had started to cave in. I personally prefer my birth nose, it was less rotated and had a slight bump, making it more masculine. I'm only 2 months post my revision so I've not finished healing, but the last 12 months have been very difficult, I just looked like a clown. Anyway, if anyone wants to know more then feel free to pm me.
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Yeah, rhinoplasty is a bit of a gamble... especially for guys. If you're nose has a slight hump or some minimal imperfection, I say leave it well alone. Slightly big noses are more masculine, and higher bridges are more sophisticated. To give you an idea of what can happen, I've attached an image to show you happened to my nose. Sorry to hijack your thread but I think people should know about this sort of thing.
Arghhh.... you are absolutely right. Your birth nose was fine. You should never have messed with it. Who did that ? What year ?
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I can't disclose the name of my primary surgeon for legal reasons. Dean Toriumi gets mixed reviews. He has some happy and some very unhappy patients. He does know how to rebuild noses, but he is often times criticized for producing unsightly bulky noses. Many of his patients end up going to Jay Calvert for revisions, but I'm not a fan of his work either. Nevertheless, Toriumi has a lot of experience and will not totally botch you.
To anyone thinking of rhinoplasty, I suggest you select a surgeon who is double board certified - an ENT and a facial plastic surgeon, who performs a minimum of 100 rhinoplasties a year, with at least 15 years experience. There are only two surgeons who I would let anywhere near my nose, Dr Rick Davis in Florida and my revision surgeon, Dr Andrew Frankel in Beverly Hills. Last time I checked, Davis had a one year waiting list for a consultation, and Dr Frankel is quite pricey. Anyway, good luck with your decision!
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Sj594 I know a lot about rhino --you had a terrible result as the alar became retracted and you were left with a saddle deformity. Who was your rhino doc? Definitely not a true pro.
Cochran, Toriumi (who everyone slights but who really knows his s**t. I've talked to tons of really good rhino docs and they are in awe of toriumi but he is super expensive and he actually has revolutionized how we think of rhino).
Anyway, f**kTARDS, Earl had a modified lefort III and told me he was in full recovery a couple weeks after. It's not a big deal. Sinn is great at that surgery and HE TOLD ME I COULD HAVE IT 4-6 months after my BSSO/LEFORT/GENIO So I'm just stating the timeline as he indicated it.
I mean Lazlo how can you be sure it's safe?
I've read earls thread and as far as I remember he had several surgeons urge him not to do it. In the end it worked out but one good outcome doesn't make a trend. I want you to be right because my cheekbones and orbitals are subpar but I also don't want you to get hurt.
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Good luck lazlo! I hope the surgeries go well for you. I'd kill to see an after since a mod Lf3 is sort of a dream procedure I'd wish to have.
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you said in the first surgery that you expect the jaw to be widened and the ramus dropped - how will achieve together with the le fort and genio? are you talking about the chin wing style genio (did not know that sinn did these), or implants? optimist also asked about the ramus, would be interesting for me as i am fighting with my doc, he only wants to do the chin wing but i want the bsso plus genio.
the rest sounds like a good plan. you should look into getting some fat grafting done, as many surgens can do this as an easy add on, and since you will be going under a few times they can fill up and top off as needed. i had this done in korea with stem cell enrichment and it made my skin look 5 to 10 years younger.
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one more - which doc was your 2nd option? why did you decide on sinn?
good luck, and just do it!
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you said in the first surgery that you expect the jaw to be widened and the ramus dropped - how will achieve together with the le fort and genio? are you talking about the chin wing style genio (did not know that sinn did these), or implants? optimist also asked about the ramus, would be interesting for me as i am fighting with my doc, he only wants to do the chin wing but i want the bsso plus genio.
the rest sounds like a good plan. you should look into getting some fat grafting done, as many surgens can do this as an easy add on, and since you will be going under a few times they can fill up and top off as needed. i had this done in korea with stem cell enrichment and it made my skin look 5 to 10 years younger.
Strongly disagree with this approach. You really need to wait and see how everything settles before you go playing with the soft-tissue. Very risky otherwise imo
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Strongly disagree with this approach. You really need to wait and see how everything settles before you go playing with the soft-tissue. Very risky otherwise imo
Exactly soft tissue is more important than one might think and there are bone mass pulling and interacting with it all over the skull. Surgery should be done in steps because your looks will change successively and your needs will change with it.
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yeah i meant i'd have the fat injection done after, but mikemiller did your fat stay?
Everyone I know who had fat injections --they're fat eventually resorbed in like a few weeks/months????? i did hear it improves the skin quite a bit though.
Done properly (note: "properly") - - most (but not all) of the fat grafting will remain and become permanent. Some of the transferred fat cells will not survive and will be re-absorbed. There will be some local swelling and sometimes as that swelling goes down - - there is a perception that a larger portion of the transferred fat has been re-absorbed than is the actual case.
From the results I have seen, and some conversations with some plastic surgeons who do and do not do fat grafting - - the MOST important considerations in obtaining aesthetically pleasing fat grafting are:
1) training;
2) experience - -
AND
3) Bluntly - - an artist on the surgeon side of the long needle being used to transfer the fat tissue.
And if the patient has thin or aged skin, the fat grafting often works an absolute miracle for their skin texture and condition.
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Done properly (note: "properly") - - most (but not all) of the fat grafting will remain and become permanent. Some of the transferred fat cells will not survive and will be re-absorbed. There will be some local swelling and sometimes as that swelling goes down - - there is a perception that a larger portion of the transferred fat has been re-absorbed than is the actual case.
From the results I have seen, and some conversations with some plastic surgeons who do and do not do fat grafting - - the MOST important considerations in obtaining aesthetically pleasing fat grafting are:
1) training;
2) experience - -
AND
3) Bluntly - - an artist on the surgeon side of the long needle being used to transfer the fat tissue.
And if the patient has thin or aged skin, the fat grafting often works an absolute miracle for their skin texture and condition.
The problem is that it's very hard to get a consistent result - multiple injections sites are required and it's a gamble how it will stick. And it can randomly calcify years later.
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The problem is that it's very hard to get a consistent result - multiple injections sites are required and it's a gamble how it will stick. And it can randomly calcify years later.
Plasko,
Re: ". . consistent result". Yes. You are right. It is hard to do well. It appears to be deceptively simple and straight forward. But it is really more involved than it appears.
That is where the training, experience and artistic ability come into outcomes. I hear reports of recent horribly "over done" fat grafting outcomes.
However, it also remains true that a few of the best plastic surgeons do get remarkably good and consistent results.
But you are right, other surgeons do also get inconsistent and mediocre results.
Checking the reports on the internet - - calcifications appears to be pretty rare and more often associated with the donor site in liposuction - - rather than simple fat harvesting for transfer. However, it is reported.
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OP, your plan sounds very hardcore and pretty unrealistic from all views. Still I hope you achieve your goals. Good luck
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is sinn really that good?
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^
Apparently he's not formally trained plastic surgeon, let alone aesthetic-plastic surgeon, but he seem to be very respected craniomaxillofacial surgeon. He's one of few guys who are willing to do high-lefort and custom osteotomies on non-syndrome patients.
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I'm totally with Lazlo here, contemporary rhinoplasty needs grafts! Reduction rhinoplasty clearly does have its uses too, such as a boxy tip or very high dorsal hump, but it's like a house... if you remove all the foundations, it will eventually collapse, causing both aesthetic and functional issues. Grafts are an excellent tool, they add structure and support and can actually make noses look more defined by pushing out against thick skin (African American noses often look puffy due to insufficient cartilage pushing out against the skin).
For those who want to know more, there's a lot of information about rhinoplasty involving grafts (usually revisions) over on Dr Davis' site – http://www.davisrhinoplasty.com/
But to anyone thinking of rhino, I'd say go with a revision specialist – they generally do the best primary rhino too... because they understand grafts!
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And if you just want to check out some awesome work - http://www.rhinoplastyrevisions.com/photo-gallery/rhinoplasty-revision-photos
Although I may be a little biased.
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^
Apparently he's not formally trained plastic surgeon, let alone aesthetic-plastic surgeon, but he seem to be very respected craniomaxillofacial surgeon. He's one of few guys who are willing to do high-lefort and custom osteotomies on non-syndrome patients.
I think this is what makes him so valuable to us really, not that I doubt his skill.
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Any surgeon will tell you too you will look like da bomb a week after sliding genioplasty, two weeks after facelift surgery and whatever-else-is-sold. Doesn't mean it's a matter of fact. You said you wanted to get a Lefort III 3 months after jaw surgery. That, my friend, is insanity. But you'll have to go through that rollercoaster yourself to know why we're saying that since you're not willing to accept what is said by patients that have been there, had the osteotomies, jaw surgeries e t c e t e r a.
For the sake of your plan it might help to now already read and believe that people are not saying that just to be a bully though, but to help you to be more realistic. Of course we all want you to accomplish in what you want but a bit of realism is needed.
As to grafting to your complete alveolar ridge in 2016, resorting to guided bone/tissue regeneration: great, let us know about that. Apparently you know things about bone/soft tissue regeneration nobody knows as of yet including the medical field, so I'm sure all of us would like to hear your secret first-hand info.
lol.
You're forgetting hair multiplication too.
Honestly I'd love for Lazlo to respond to the questions raised in this thread as I'm really curious as to what surgeons have told him. I asked my own but was thoroughly ignored. I'm definitely wanting to know more about this so-called ramus drop.
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I'm definitely wanting to know more about this so-called ramus drop.
im also very curious what is meant by this. lazlo, can you provide any more details?
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I'm sorry but there is no way you can have that many surgeries in one year just by going the need of anasthesia alone. You'd most likely end up dead even if you're young your body cannot take that many surgeries.
Anyway even if you could manage this I doubt they'd really want to operate on someone who had an operation 2 months before on the same area.
My surgery was almost a year ago and the bone hasnt fully consolidated yet and the last bits of sensitivity just went away 1-2 months ago.
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Okay just for fun I'm listing all the surgeries I plan on having. In order I'm gonna have them and just to keep track:
1) Lefort 1 -3 piece/BSSO (with ramus drop)/genioplasty (widening and lengthening) CCW rotation/fat pad removal under lower jaw
(march/april--completion)
2) Modified lefort 3 with bone grafting for height as and 1 cm projection/Canthopexy/Brow bridge augmentation/reshaping
(July 1st/August completion)
3) Rhinoplasty/Otoplasty (probably Dr. Cochran)
(September 1st Completion)
4) Dermabrasion + Co2 laser for acne scars/Sculptra to temples and cheekbones, plus juvederm for volume restoration in face
October 2016
5) Botox to intradermal nasal skin to stop oiliness and shininess of nose
October 2016
6) Stem cell enhanced Hair multiplication to do some grafts to my slightly receded hairline and thicken my crown area
7) I'm going to design my own technique with the help of a periodontist to graft bone between all my teeth in addition to alloderm from cadavers and rebuild my interdental papilla. This is something that definitely can be accomplished.
late 2016/2017
Can you help me understand - - ?
Where will the surgical incisions be for the 1st and 2nd procedures ?
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For the first all inside the mouth.
For the second it will be inside as well. For earl Sinn did some small incisions near the eye but he doesn't need to do that anymore.
This is pretty standard stuff.
Man, yet again you seem to post s**t in direct contradiction to what has been told to me.
I've spoken with him VERY recently and have continued to be informed that incisions near the eye must be made. I know of no surgery on the infraorbital rims that doesn't involve some kind of extraoral incisions.
Are you 110% positive?
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i could spend hours talking about fat injection but don't want to bore people here, so just the cliff notes, most of what people write is accurate, you will have some resorbtion and you will have some lumping, you will have to go back and get it evened out. get the best doctor, make sure he uses the right approach, easy to find out via medscape research how this is done.
if you compare it to normal filler, disadvantage is therefore it much much harder to reverse, you cant be as precise. advantages are it is much cheaper as filler can run into the 10.000s if you use the very doctor and have big areas, it lasts longer i.e. 36 vs 18 months, and best of all it looks more natural, you don't get that housewives of beverly hills looks as the viscosity is lower.
clarification question : you mean he will make the tip of the chin wider, or he will make the jaw wider, i assume it is the former.
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Lazlo how did the MLF3? Was it able to match the forward growth of your lower third after the LF1? thanks
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i dont think he went through with it.