jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: micjawsurgery on April 17, 2019, 08:29:28 AM
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Dr. Sinn sent me the cut he makes for the modified lefort 3. From the looks of it, it should solve a lot of problems with the lower orbits and cheekbones. Goes beyond the infraorbital foramen if im looking at this correctly, so the augmentation reaches close to the nasal structures and includes a good amount of the frontal process of the maxilla. I was worried only the zygoma bone and its respective orbit would be moved.
8mm of augmentation with this cut should be very good. When I was consulting with him he mentioned how the cut can't be too close to the nasal structures due to increased risk of damaging nerves, which is what I was worried about. I will be making the deposit and the payment for the CT model this week.
Any thoughts? Keeping in mind he can also move this area up 2-3mm and to the side by 2-3mm, it seems like a pretty great procedure for the midface. I’ve seen the cuts for the zso and zsso and was not impressed. Implants could provide even more augmentation closer to the nasal base which I was considering as an alternative, but I am pretty commited to this surgery now. He can also add some HA beyond the cut if augmentation is needed closer to the nose
the ZSO cut is on the right here: https://api.intechopen.com/media/chapter/48013/media/image16.jpeg
I plan to provide some visual update in August after my surgery heals up
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He can provide 3mm of anterior movement via HA Granules? Have you looked into MSE+Facemask? Also very effective if you stack these two together you could get good results for frontal maxilla, orbitals, etc
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From my understanding he can add HA onto the bone that is being moved (move the cut forward 8mm, add another 2-3mm of HA), and also near the nose where the bone is not being moved to reduce the visual stepoff that occurs.
I also haven't looked into MSE+facemask and don't plan to. My lower maxilla is very forward so I don't need augmentation there. My upper maxilla and cheeks didnt grow forward as much so this procedure is very close to ideal at augmenting the regions I need. A wider palate would be nice though
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I see..HA applied to nose area meaning close to frontal maxilla? Also have you reach out to Dr. Wolfe in Flordia about his malar osteomony he offers.
I see with MSE+Facemask you can protract and bring upper maxilla forward but a long process
also based off the picture the cut on orbital rim ends not completely at the top of the bone, why is that
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In the picture I provided HA would be added to the left of the cut, beyond the marker line. No I haven't talked to any other surgeons. I am not interested in a malar ostetomy since one of my main aesthetic goals is to move the rims forward and reduce the shadowing and protrusion under my eyes.
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It would be easier to appreciate in entirety with relation to the rest of the skull if the photo were not so cut off. But your description is good.
Does he explain how he gets the eye ball out of the way in order to make the cut WITHIN the ORBIT?
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Yeah I had to run it side by side with a complete picture of the skull to understand the cuts. I think he may be cutting from underneath? I will ask him since I am rather curious too. Didn’t grill him on technical details since hes done the surgery many times before
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Yeah I had to run it side by side with a complete picture of the skull to understand the cuts. I think he may be cutting from underneath? I will ask him since I am rather curious too. Didn’t grill him on technical details since hes done the surgery many times before
I THINK--not sure--the operation he does is after an Andrew Hegge (Australian maxfax) who wrote about modified L3 (like in early 1990s). But each time I try to use Google to read that particular paper, it kicks up sites that want me to sign up using Google account, FB account --basically info I don't feel like sharing just to read that paper because I don't want to risk my edu account being spammed. Anyway, if you can get a hold of the paper of mod L3 by that doctor's name, it might have more details about how they do the op.
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It seems very popular to talk about modified lefort III, compared to regular lefort III. What is it that is modified, is it always same modification, or is it patient specific. Is regular lefort III outdated or not applicable in these cases?
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It seems very popular to talk about modified lefort III, compared to regular lefort III. What is it that is modified, is it always same modification, or is it patient specific. Is regular lefort III outdated or not applicable in these cases?
Lf3 lengthens the nose as well. A coronal incision is used as well. It's a much more invasive surgery.
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I THINK--not sure--the operation he does is after an Andrew Hegge (Australian maxfax) who wrote about modified L3 (like in early 1990s). But each time I try to use Google to read that particular paper, it kicks up sites that want me to sign up using Google account, FB account --basically info I don't feel like sharing just to read that paper because I don't want to risk my edu account being spammed. Anyway, if you can get a hold of the paper of mod L3 by that doctor's name, it might have more details about how they do the op.
No, it's not that paper. Heggies lf3 affects the occlusion as well. I think it's this one https://www.joms.org/article/0278-2391(95)90732-7/pdf
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Lf3 lengthens the nose as well. A coronal incision is used as well. It's a much more invasive surgery.
This is the understanding I have of different lefot cuts.
http://static.wixstatic.com/media/92282f_6749a581803047dbadf34613a49fdb40~mv2.jpg
When I google coronal incision, this is what I get.
https://dp11i9uvzjqmt.cloudfront.net/2/images/upload-flashcards/98/62/68/3986268_m.jpg
You mean that normal lefort III goes this high?
How do you mean that the nose is handled in a modified lefort III? From my first picture it looks like the whole point with lefort II/III is to have the nose included as well. How can the nose be moved any differently with modified cuts?
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It seems very popular to talk about modified lefort III, compared to regular lefort III. What is it that is modified, is it always same modification, or is it patient specific. Is regular lefort III outdated or not applicable in these cases?
Well, if you Google for a diagram Lefort3, you see it takes a large chunk of the frontal face, including the Lefort 1 area and L2 with it. The mod L3 people usually refer to (the one that Earl got) is basically the lower orbital rim area and some cheek bone area. If you can get a hold of the paper I mentioned in this thread, it would probably detail more about it.
Here's a link to Leforts. http://faculty.washington.edu/jeff8rob/wordpress/wp-content/uploads/2017/02/Lefort-1024x576.jpg
In GENERAL--and this is only in general-- a mod L3 is what's left over after you SUBTRACT the 'Type 2' area from the 'Type 3' area. That's the only way I can even attempt to describe it verbally to you. But it's one of those things that requires 'visual' skills to subtract type 2 from the type 3 diagram to 'see' (in your head) what's left over.
Here's a 'fun fact'. The 3 basic Leforts were named after Renee Lefort who SMASHED SKULLS--lots of them--against the wall where he noted the most common fracture lines. So, when he smashed them against the wall, the 3 most common ways they BROKE are described as 'L1', 'L2' and 'L3'. But of course, with some surgical skill--and modern equipment--a doctor doesn't have to perform a surgery along the fracture lines that commonly get kicked up subsequent to smashing a skull against the wall. Instead, he can selectively just cut into the parts he wants to move around. So, say he only wants to move the parts of Type 3 that are LEFT OVER after the Type 2 part is SUBTRACTED from the Type 3. That's an example of a 'modified L3'. If there are still some parts after that that he doesn't want to move, it's still a modified l3.
So, basically, a modified L3 is an L3 that DOES NOT include the L2 area. That's the easiest way to describe it in general. But the ONLY thing that describes SPECIFICALLY what a doc does who calls what he does a 'modified L3' is a diagram or a specific model of WHERE he is making the cuts as to the specific area to be released.
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No, it's not that paper. Heggies lf3 affects the occlusion as well. I think it's this one https://www.joms.org/article/0278-2391(95)90732-7/pdf
OH, OK. Thanks. So, the author must have been the Australian surgeon that Sinn told someone on here he does the mod L3 in that fashion. I just knew Hegge wrote a paper called 'Modified l3' and he's Australian. But I didn't get it because I didn't want to register just to read it.
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Here's a 'fun fact'. The 3 basic Leforts were named after Renee Lefort who SMASHED SKULLS--lots of them--against the wall where he noted the most common fracture lines. So, when he smashed them against the wall, the 3 most common ways they BROKE are described as 'L1', 'L2' and 'L3'. But of course, with some surgical skill--and modern equipment--a doctor doesn't have to perform a surgery along the fracture lines that commonly get kicked up subsequent to smashing a skull against the wall.
It's hard to decide for jaw surgery with today's modern technology. Can imagine how hard it was before it was discovered that you don't have to smash the head against a wall to create the fractures :D
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OH, OK. Thanks. So, the author must have been the Australian surgeon that Sinn told someone on here he does the mod L3 in that fashion. I just knew Hegge wrote a paper called 'Modified l3' and he's Australian. But I didn't get it because I didn't want to register just to read it.
I have the paper if you want it. The result is not impressive. They look quite asymmetric. The infraorbital and occlusal levels can have very different asymmetries. So one in constrained by the other. And if the occlusion is good, this kind of surgery cannot be done.
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I have the paper if you want it. The result is not impressive. They look quite asymmetric. The infraorbital and occlusal levels can have very different asymmetries. So one in constrained by the other. And if the occlusion is good, this kind of surgery cannot be done.
But the mod L3 doesn't move the teeth.
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Kavan, I asked about how the cut is made. From Sinn: the eye is lifted up from the floor to access the inferior orbital fissure to make the bone cut from the superior orbital fissure down to inferior fissure.
I also asked about doing the operation intraorally to hide the scar - I saw some pics of Earl that showed his scarring, which was quite noticeable up close. It has made me rethink the operation. Sinn told me the operation is done differently now compared to when Earl had it, and that the scar should not be a problem. But I am skeptical. The way I see it I will probably need makeup for atleast a year to hide the scar and try to to fade it out with silicone gel and bio-oil early on with laser/fractional/steroid treatment later
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Does seem like they need close access near the eye to lift the eyeball out of the way in order to make the bone cut.
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But the mod L3 doesn't move the teeth.
Hmm ok. When you described it as removing the lefort II area, I thought it maybe was to remove what is extra in the II area compared to I area, ergo keeping the maxilla.
So basically, we're not discussing jaw surgery, it's craniofacial surgery?
If the II area is subtracted from the III area, that would mean this is a 2 piece surgery, because the connecting bone between the eyes is excluded?
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I also asked about doing the operation intraorally to hide the scar.
Is it even possible to anatomically access this area intraorally?
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Is it even possible to anatomically access this area intraorally?
The prospect of a scar from this really scares me. It would be in a very visible area.
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But the mod L3 doesn't move the teeth.
Heggie's does. I think the main difference between mod LF3 and LF3 is whether the nose is involved, and WRT LF2 vs LF3 - LF3 goes further up the lateral rim, LF2 doesn't. Sinn's surgery is mod LF3 minus the alveolar process (teeth), which is basically infraorbital and lateral rims. And that's what he calls it most of the time - "infraorbital rim advancement," because there is not much left of the LF3 once you take away the nose and the maxilla.
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Sinn says he uses a hidden suture technique now and makes a smaller incision. But yeah the scar is a real put off for me
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Sinn says he uses a hidden suture technique now and makes a smaller incision. But yeah the scar is a real put off for me
There've been a few more people who have had it since. They also have scarring?
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Heggie's does. I think the main difference between mod LF3 and LF3 is whether the nose is involved, and WRT LF2 vs LF3 - LF3 goes further up the lateral rim, LF2 doesn't. Sinn's surgery is mod LF3 minus the alveolar process (teeth), which is basically infraorbital and lateral rims. And that's what he calls it most of the time - "infraorbital rim advancement," because there is not much left of the LF3 once you take away the nose and the maxilla.
So, it's kind of like I said on this string where the mod L3 is like what's left over after the Lefort 2 area is subtracted from the Lefort 3 area..
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Hmm ok. When you described it as removing the lefort II area, I thought it maybe was to remove what is extra in the II area compared to I area, ergo keeping the maxilla.
So basically, we're not discussing jaw surgery, it's craniofacial surgery?
If the II area is subtracted from the III area, that would mean this is a 2 piece surgery, because the connecting bone between the eyes is excluded?
I've already given an explanation of the mod L3. Try to visualize it more based on the diagrams.
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Hmm ok. When you described it as removing the lefort II area, I thought it maybe was to remove what is extra in the II area compared to I area, ergo keeping the maxilla.
So basically, we're not discussing jaw surgery, it's craniofacial surgery?
If the II area is subtracted from the III area, that would mean this is a 2 piece surgery, because the connecting bone between the eyes is excluded?
Yes, Sinn's surgery is bilateral - the 2 sides are moved independently. IMO, it's a better approach because often the 2 sides can be quite different and the movements are not constrained by any occlusion considerations.
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Is it even possible to anatomically access this area intraorally?
Wolford does it all through the mouth. Some surgeons say he cannot possibly go far enough laterally with this approach, others just freak out.
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How bad is the scaring , anybody have a picture?
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How bad is the scaring , anybody have a picture?
What a bad canthotomy scar looks like.
https://imgur.com/a/ItUwCCQ
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What a bad canthotomy scar looks like.
https://imgur.com/a/ItUwCCQ
Yeah that's not acceptable.
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Wolford does it all through the mouth. Some surgeons say he cannot possibly go far enough laterally with this approach, others just freak out.
Do you know more how it's done? BSSO is easy to understand because you can stick your finger in and reach where the cut can be made. Lefort I is in my opinion semi intraorally, you detach and reach it under the skin. This modified lefort III area seems unreachable without going through the palate, or maybe doing a face-off, but then the cut is still made from the outside.
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Do you know more how it's done? BSSO is easy to understand because you can stick your finger in and reach where the cut can be made. Lefort I is in my opinion semi intraorally, you detach and reach it under the skin. This modified lefort III area seems unreachable without going through the palate, or maybe doing a face-off, but then the cut is still made from the outside.
"curved osteotome" and skill
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I wish the cut covered more of the LOR the line seems to end at half part of the LOR, hopefully, this diagram is helpful, I think one would need to get MOD Lefort III and then zygoma osteotomy to fully augment the zygomatics.
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I booked a consultation with Yaremchuk next week and by Thursday I’ll decide whether I’ll be going with Sinn’s osteotomy or custom implants. I thought about this osteotomy a lot yesterday and realized it’s insane for me to go through this procedure without consulting with an implant doctor. My orbital and malar recession is not so bad that I need an osteotomy; I emailed Eppley very detailed and accurate photos that confirmed this.
What makes Yaremchuk appealing is that I can have jaw lipo done at the same time, and can probably fit a genioplasty into my budget. In addition to the procedure being reversible and much safer of functional issues.
I shared a few pictures elsewhere. I wouldn’t mind uploading more detailed and accurate photos (these are cherrypicked) if I can make them private somehow.
https://imgur.com/a/XmDpBiT
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You have a good lower third. Be careful with the SG.
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I booked a consultation with Yaremchuk next week and by Thursday I’ll decide whether I’ll be going with Sinn’s osteotomy or custom implants. I thought about this osteotomy a lot yesterday and realized it’s insane for me to go through this procedure without consulting with an implant doctor. My orbital and malar recession is not so bad that I need an osteotomy; I emailed Eppley very detailed and accurate photos that confirmed this.
What makes Yaremchuk appealing is that I can have jaw lipo done at the same time, and can probably fit a genioplasty into my budget. In addition to the procedure being reversible and much safer of functional issues.
I shared a few pictures elsewhere. I wouldn’t mind uploading more detailed and accurate photos (these are cherrypicked) if I can make them private somehow.
https://imgur.com/a/XmDpBiT
Dude you don't need any surgery. Your under eye area is not weak, it's just normal. I don't think mfl3 will make you look much better or different. And you don't need neck lip or nothing dude. You look very handsome.
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You have a great face. I know you said these are cherrypicked but you don't look like you need any work at all.
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I don't think you'll look any better, just different.
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Here is the photo I sent Sinn/Eppley regarding the orbital recession to make it more clear https://imgur.com/a/KYxSeGj
My maxilla projects very far compared to the cheeks which makes the flatness more apparent
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To add some useful info:
Sinn told me custom implants could create similar results but it won’t look as good as bone being moved. Risks are certainly less with implants.
He performed 6 of these last year. Probably will do more this year. So he definitely has a lot of experience at this point with the surgery since he’s probably been doing it for at the least the last decade.
Since 2018 he has changed and improved the technique he told me, so it is not the exact same procedure Earl got.
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Here is the photo I sent Sinn/Eppley regarding the orbital recession to make it more clear https://imgur.com/a/KYxSeGj
My maxilla projects very far compared to the cheeks which makes the flatness more apparent
You don't have prominent eye; 'Bug eyes'. Would not even say you had 'negative vector' but maybe 'zero vector'. Keep in mind that type of surgery whether it be the bone cut mod L3 or orbital rim implants is really for people who have the BUG EYES to make the eye look LESS prominent and your eyes don't look prominent at all. Your eyes could even look too small for you after that type of surgery given that the surgery's aim is making the eyes look more recessed.
NORMAL Asian 'evenness' under the eyes.
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I’ve never though my eye prominence was an issue, more so flat cheeks and under eye tear troughs
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Dr. Sinn sent me the cut he makes for the modified lefort 3.
If he'd do surgery on you, he should fall under the irresponsible/unethical doctors who just want to line their pockets.
You look great. Proceed with surgery at your peril.
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I’ve never though my eye prominence was an issue, more so flat cheeks and under eye tear troughs
EXACTLY. You DON'T have eye prominence which is what that type of surgery is actually aimed at addressing. Earl got it for the right reasons. But a lot of people 'chasing' that surgery cuz Earl got it aren't doing for the right reasons.
There's nothing wrong with some flatness to the area where you have it and even people with prominent orbital rims have tear troughs because the tear trough is in the soft tissue area superior to the orbital rim bone. I guess all you can do is see how it works out for you. But you are really not the typical candidate for that type of surgery.
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I have tried filler in the cheeks and chin before. Not really any noticeable differences. It worked well for raising the nasal bridge temporarily though. I also went about looking for fat grafting in Korea but it’s not done in the under eye area for aesthetic issues, only cheeks. I saw what cheek fillers did so I have decided against it, but maybe I did not inject enough. I was also worried cheek augmentation without infraorbital augmentation would just make my troughs worse.
Not sure I’d even call them troughs - they show up when I’m standing under vertical lighting, so I’m almost sure they’re caused by the shadowing of the recessed area under the eye. I was also told a Blepharoplasty would be pointless when I saw a surgeon in person. So some sort of augmentation is needed to fix this issue.
Sinn told me I’d be ideal for his procedure, same thing with Eppley when I asked about custom infraorbital/malar implants. I have another consultation with Yaremchuk next week where I will ask more about the aesthetic outcome
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You have bdd you need a pschologist not a surgeon
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I have tried filler in the cheeks and chin before. Not really any noticeable differences. It worked well for raising the nasal bridge temporarily though. I also went about looking for fat grafting in Korea but it’s not done in the under eye area for aesthetic issues, only cheeks. I saw what cheek fillers did so I have decided against it, but maybe I did not inject enough. I was also worried cheek augmentation without infraorbital augmentation would just make my troughs worse.
Not sure I’d even call them troughs - they show up when I’m standing under vertical lighting, so I’m almost sure they’re caused by the shadowing of the recessed area under the eye. I was also told a Blepharoplasty would be pointless when I saw a surgeon in person. So some sort of augmentation is needed to fix this issue.
Sinn told me I’d be ideal for his procedure, same thing with Eppley when I asked about custom infraorbital/malar implants. I have another consultation with Yaremchuk next week where I will ask more about the aesthetic outcome
Dude seriously you're more likely to spend a lot of money and f**k up your face than anything. You're already handsome and don't look recessed. Don't do this
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you're more likely to spend a lot of money and f**k up your face
He seems intent on doing that.
Sometimes you just can't stop an irrational mind, and people have to learn the hard way.
That Sinn would operate on him lowers my opinion of Sinn.
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thanks guys. I appreciate the responses telling me to reconsider.
Talked to yaremchuk today who guessed 3-4mm of orbital rim augmentation would be good on me. He agreed with my aesthetic issues. Had a good experience with him, but I’ll probably go with Eppley who is younger and has more experience with silicone.
Sinn was a great guy to talk to during the last 2 weeks. Probably shot him 50 emails in total. He’s never had any blindness with a Lefort 3 or standard jaw surgery, so I felt barring horrible nerve damage I could live with the complications. But not being able to reverse the aesthetic outcome and his increasing age were the 2 factors that got to me.
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Talked to yaremchuk today who guessed 3-4mm of orbital rim augmentation would be good on me.
Is this the maximum augmentation for orbital rim implants?
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Yes I've read that 3-4mm is usually the max. And that the MFL3 moves the bone about 7mm max.
The soft tissue does not move as much as 7mm though, probably can expect 5mm of soft tissue movement.
See https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200589#pone-0200589-t003
For how soft tissue generally responds to bone movements.
Also, the technique seems to be getting better for the MFLF3 procedure. Truth be told I'm not sure how risky it is with the recent advancments that have been made. Reading this paper was very interesting. If anyone else is concerned with Sinn's age, I would try contacting the authors here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4444669/
J. M. García y Sánchez has published many research articles about the modified lefort 3
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These results are amazing IMO. No scars to be seen.
https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=5328863_12663_2016_893_Fig40_HTML.jpg
https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=5328863_12663_2016_893_Fig46_HTML.jpg
Source
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5328863/
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Those are class iii patients with severe midface hypoplasia. That's not the case with you.
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Those are class iii patients with severe midface hypoplasia. That's not the case with you.
Agree and will add that people entertaining L3 modified or otherwise, who DON'T have the extent of deformity shown in articles about L3, should be looking at photos of people who got the surgery just for 'cosmetics' as in people who did not really NEED what it corrects but just WANTED it for better cosmetics. For that, consults are needed with docs who have done it just for COSMETICS on those who just WANTED it but didn't really need it.
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Yes I've read that 3-4mm is usually the max. And that the MFL3 moves the bone about 7mm max.
Thanx!
Have you asked Sinn if there is a possible risk of relapse with this surgery (Mod. Lefort III)?
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Relapse I think is often due to improper orthondotic posture, mouth breathing, posture etc
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Sinn told me relapse is possible but rare. I'll have my decision made tomorrow whether I'll go with Sinn or Eppley.
I'm pretty confident I won't have major functional issues after surgery with Sinn, although there is always a risk. He's done this surgery atleast 50 times now for cosmetic purposes so he understands it very well. He doesn't think its riskier than a standard Lefort 1 (which fair enough is relatively risky for cosmetic surgery)
I think Eppley can deliver a better aesthetic result because Sinn doesn't really have too much control over the movements. With Eppley I'd be consulting him the entire time over the implant design. But the potential minor bone erosion and eventually having to have the implant removed due to infection are not very appealing.
Perhaps I am being illogical in preferring the osteotomy over implants. From my viewpoint as long as the surgery and initial healing goes well I should be "good", whereas I'll always have a fear if I go with implants and how they'll look 10 years later
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Sinn told me relapse is possible but rare. I'll have my decision made tomorrow whether I'll go with Sinn or Eppley.
I'm pretty confident I won't have major functional issues after surgery with Sinn, although there is always a risk. He's done this surgery atleast 50 times now for cosmetic purposes so he understands it very well. He doesn't think its riskier than a standard Lefort 1 (which fair enough is relatively risky for cosmetic surgery)
I think Eppley can deliver a better aesthetic result because Sinn doesn't really have too much control over the movements. With Eppley I'd be consulting him the entire time over the implant design. But the potential minor bone erosion and eventually having to have the implant removed due to infection are not very appealing.
Perhaps I am being illogical in preferring the osteotomy over implants. From my viewpoint as long as the surgery and initial healing goes well I should be "good", whereas I'll always have a fear if I go with implants and how they'll look 10 years later
I think you're making a terrible mistake either way. But I will point out that I have seen multiple horror stories and cases of unethical practice from Eppley. Your money your face though. Knock yourself out
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I think you're making a terrible mistake either way. But I will point out that I have seen multiple horror stories and cases of unethical practice from Eppley. Your money your face though. Knock yourself out
Yeah I really don’t see the indication for wanting this surgery and Im not saying that because I’m overly conservative or downplaying the importance of aesthetics or something. You just literally don’t have recessed orbital rims or midface. Even if you had slightly recessed orbital rims but still within the normal range I would understand your desire for the surgery, even though others might still deem it crazy.
But honestly good luck and let us know how it goes I’m curious to see the change !!!
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Yeah I guess my midface recession isn't so bad. I want midface advancement because my upper jaw is very forward compared to my midface. I attached a lateral ceph to show. I get these tear troughs (not even sure i'd call them that exactly, blepharoplasty would not work though, my eyes are also shallow set since im asian which exaggerates it) under my eyes in some lighting which really bothers me. So I am getting something done for sure.
Part of me is curious about what advancing the midface would do to someone who is average. It's probably best for myself that I let others figure that out but I haven't ruled that out completely. I notice "greyandblue" was scheduled for a lefort 3 but ended up not updating in 2017 - did anyone see his results?
I will be sure to update my result since we are all curious about aesthetics
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I see a straight profile, good symmetry, high hyoid bone. You're aesthetically pretty average or above. If you're really looking for god tier aesthetics i think youre on the right track with this midface thing.
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I see a straight profile, good symmetry, high hyoid bone. You're aesthetically pretty average or above. If you're really looking for god tier aesthetics i think youre on the right track with this midface thing.
Plenty of handsome men with flat midfaces. It's the eyes and spacing of features. Other things only come into it when they are so bad they divert attention from the eyes.
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Plenty of handsome men with flat midfaces. It's the eyes and spacing of features. Other things only come into it when they are so bad they divert attention from the eyes.
This +100. Kavan always makes the point of guys wanting the "parts" of the mm aesthetic without realizing the important of mm eyes (impossible to achieve via surgery) and facial gestalt. Honestly nobody gives a f**k about a couple milimeters of midface flatness unless you are actually deformed. I think the only osteotomy that can reliably make 'normal' range men more attractive (besides a properly done and stable bimax) is a sliding genioplasty in the case of a weak chin.
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This +100. Kavan always makes the point of guys wanting the "parts" of the mm aesthetic without realizing the important of mm eyes (impossible to achieve via surgery) and facial gestalt. Honestly nobody gives a f**k about a couple milimeters of midface flatness unless you are actually deformed. I think the only osteotomy that can reliably make 'normal' range men more attractive (besides a properly done and stable bimax) is a sliding genioplasty in the case of a weak chin.
Indeed. The MM aesthetic, you can see when you block out EVERYTHING ELSE to the face EXCEPT the EYES. It's the EYES. They are the 'art' and the rest of the structure around them, including but not not limited to the orbital rim/cheek complex, jaw and forehead is the FRAME. So, you have all these guys going after the MM aesthetic. Ya, they can get the FRAME. But what are they framing? Their EYES. So, effectively with this they are 'showcasing' something that best NOT be showcased. Very FEW people have the type of EYES MMs have. You can't 'buy' them with PS or bone altering procedures.
Also, Leonardo DaVinci has said (forgot the name of book but I read it years back) that a hollowed out area or concave area--let's relate that to an UNPROJECTED upper midface area--catches MORE light than does a convex area. Basically when the area can be 'bathed' in light there is an aesthetic perk to that., So, artistically/aesthetically, there is really NO NEED for a MALE to turn that area into a CONVEXITY. The aesthetic need for that is only IF the eyes are PROMINENT like as in 'bug eye'.
People get that cuz 'Earl got it'. But Earl was the IDEAL candidate for it because he had the bug eyes and was adverse to implants.
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Plenty of handsome men with flat midfaces. It's the eyes and spacing of features. Other things only come into it when they are so bad they divert attention from the eyes.
Agree. Also, it is common and acceptable for Asian men to have some flatness to the lower orbital rim/cheek area. Since this surgery is really aimed at people with BUG EYES (prominent eye), his eyes could look relatively smaller with it. Docs WONT tell him that though. They will just listen and note THE the patient WANTS more advancement below the eye and also note; 'ya, I can accommodate that request' (whether it be bone cuts or implants). The NEW TREND is to give a patient WHAT they ASK FOR and the docs LOVE IT when they ask for the bone structure of MMs because it allows them to WITHHOLD that what makes an MM an MM is the EYE AREA that NO ps or cranio guy can replicate.
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My eye area isn’t the mm hunter look but I am quite happy with it. Im not really after the model look. Really I’m just looking for under eye support and to fix my hollowing. Here’s a picture that kinda shows that
But I will take your advice. May also consider fillers and just get a bridge rhino which I need. Was considering the lefort first because Sinn’s getting old
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You don't have big eyes. You don't have a narrow face. Your eyes may look really small afterwards with no way of reversing the surgery. If you're hellbent on it, consider Wolford. He does it all through mouth. I don't think he goes as far laterally, but you don't need that anyway.
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Your eyes are not prominent relative to your face and may actually look recessed after a MLF3. You're probably going to end up 'fixing' one problem (which isn't even really a problem) while creating a much worse and irreversible other problem.
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My eye area isn’t the mm hunter look but I am quite happy with it. Im not really after the model look. Really I’m just looking for under eye support and to fix my hollowing. Here’s a picture that kinda shows that
But I will take your advice. May also consider fillers and just get a bridge rhino which I need. Was considering the lefort first because Sinn’s getting old
That's the point. Your EYES are GOOD. Canthal tilt is great. They are not prominent as in you don't have 'BUG EYES'. It looks to be normative Asian bone structure.
With the custom implants, those go with a MIDFACE LIFT and quite often they might need outside access to assist placing the implants for which that access involves an incision next to (your nice UPWARD TILTED) lateral canthal area and that incision is a DOWNWARD DIAGONAL. That type of cut can also be used if no implants but just access to the bone area they wish to pronounce out.
Now IF that scar does not heal perfectly flat and perfectly 'invisible'--and keep in mind that part of how a scar heals has to do with the patient as some have more KELOID issues than others--what you will have beside your nice UPWARD TILTED canthal angle is a DOWNWARD TILTED incision line. From an artistic point of view, a downward tilted diagonal right next to a preferred upward tilted diagonal 'visually INTERFERES' with total appreciation of the nice upward tilted diagonal.
Don't get me wrong. I think it's a great surgery and I recognize that the docs who can pull it off whether it be the custom implant docs who will do it or Sinn who will do with just the bone cuts. But some of the TRADE-OFFS associated with it like that downward tilted diagonal scar right beside an upward tilted lateral canthus! is MORE ACCEPTABLE for someone who NEEDS that kind of surgery to address the aesthetic PROBLEM of 'BUG EYE' than it is for a case like yours.
What the docs are tuning in on, in your case, when they say you are a good candidate for this is that they CAN address your complaint of 'flatness' to the area and on the grounds that you WANT more outward projection. They have NOT confirmed possibility of your eyes looking relatively smaller or more recessed to you, possibility of your NOT liking a downward diagonal scar next to your upward diagonal canthus. Why? Because you didn't present to them with that concern. You presented to them as someone who WANTED the surgery because you WANTED more projection and not as someone who 'needed' it to address what it BEST corrects (prominent eye) where the trade-offs are acceptable when one has the problem it's aimed at addressing.
So, upshot of all this is that you CAN have the surgery on GROUNDS that you WANT it. Whether you will LIKE the outcome or 'look' of it (which WILL change how your eyes--that you LIKE--will look to you) will just be a 'wait and see' deal after it's all done.
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You don't have big eyes. You don't have a narrow face. Your eyes may look really small afterwards with no way of reversing the surgery. If you're hellbent on it, consider Wolford. He does it all through mouth. I don't think he goes as far laterally, but you don't need that anyway.
Wolford does this? Wow that’s good to know.
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Does one need to have a wide jaw in order to maintain harmony with the wider midface that results from this procedure? So it wouldn’t be a good idea to do this if you have high angles/ steep mandible plane? Or is he bulk of the advancement forward and thus would only have a minimal effect on making the lower third seem narrower by comparison? How was Earl’s lower jaw structured?
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Does one need to have a wide jaw in order to maintain harmony with the wider midface that results from this procedure? So it wouldn’t be a good idea to do this if you have high angles/ steep mandible plane? Or is he bulk of the advancement forward and thus would only have a minimal effect on making the lower third seem narrower by comparison? How was Earl’s lower jaw structured?
Earl seemed to have a very good loser jaw from a BSSO procedure, very straight. I don't think you necessarily need a wider jaw for a wider midface, your jaw can taper down with a strong chin and still look good.
Did you send me a message that you had an open bite on one side? Small discrepancies can be fixed with orthodontics afterward. The bite isn't always perfect after jaw surgery hence the need for several months more of orthodontics and elastics etc. My bite is okay, but certainly not perfect. I wouldn't stress about it AT ALL.
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Earl seemed to have a very good loser jaw from a BSSO procedure, very straight. I don't think you necessarily need a wider jaw for a wider midface, your jaw can taper down with a strong chin and still look good.
Did you send me a message that you had an open bite on one side? Small discrepancies can be fixed with orthodontics afterward. The bite isn't always perfect after jaw surgery hence the need for several months more of orthodontics and elastics etc. My bite is okay, but certainly not perfect. I wouldn't stress about it AT ALL.
Ah yeah that makes sense. I think I read somewhere Sinn told McJaw he was an ideal candidate because his jaw was wide, so it might play some role.
Thanks dude you’re the best.
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OH, OK. Thanks. So, the author must have been the Australian surgeon that Sinn told someone on here he does the mod L3 in that fashion. I just knew Hegge wrote a paper called 'Modified l3' and he's Australian. But I didn't get it because I didn't want to register just to read it.
Heggie is in fact the Australian surgeon that Sinn talked to regarding the MLF3 and whose cut Sinn now models his MLF3 cut after. I talked to Sinn regarding this in the past week to confirm. It's a little concerning to me after seeing Heggie's results in his study: https://www.academia.edu/27145374/The_modified_Le_Fort_III_osteotomy_in_the_correction_of_mid-facial_deficiency._Case_reports
especially with the increased sclera show. Sinn didn't show me any before and after's of the MLF3 so I don't know if that is an issue with his procedure. Is increased sclera show a side effect of this procedure?
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Heggie is in fact the Australian surgeon that Sinn talked to regarding the MLF3 and whose cut Sinn now models his MLF3 cut after. I talked to Sinn regarding this in the past week to confirm. It's a little concerning to me after seeing Heggie's results in his study: https://www.academia.edu/27145374/The_modified_Le_Fort_III_osteotomy_in_the_correction_of_mid-facial_deficiency._Case_reports
especially with the increased sclera show. Sinn didn't show me any before and after's of the MLF3 so I don't know if that is an issue with his procedure. Is increased sclera show a side effect of this procedure?
Looks like you found the paper and it was indeed Heggie.
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i still dont get the difference between a modified lefort 3, a real lefort 3 and various zygomatic osteotomies that doctors offer (like zygomatic sandwich osteotomy)
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i still dont get the difference between a modified lefort 3, a real lefort 3 and various zygomatic osteotomies that doctors offer (like zygomatic sandwich osteotomy)
You probably didnt try very hard.
LF3 is the full fracture,
MLF3 has some variations but is basically LF3 minus the nose and jaws
ZSO is just moving the zygomatic body (and maybe the arch? i dont remember) http://www.mauricemommaerts.eu/files/PDF/633277834186613750.pdf