jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: earl25 on August 01, 2014, 09:04:55 AM
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Ok so back in June I had the mother of all max fax surgeries. I had a modified lefort iii where my entire midface (orbital rim, cheeks) WITHOUT THE JAW. My midface was advanced 7mm.
background:
So after my malar implant was a bust (for everyone who says malar augmentation will help the orbital rims I can tell you from experience it doesn't, at best it wont do anything, at worst it will make it worse) . So I flew all around the world consulting with cosmetic surgeons an craniofacial surgeons for orbital rim implants. I was all ready and set to have custom implants and a midface lift when Lazlo pm'ed me about a quadrangular lefort ii or iii and showed me the 2 pics of those girls who had it done. I knew about these surgeries for years but didn't think anyone did it on non syndrome people. A guy I knew on miss j board needed one and tried but no one would do it on him. So I decided to look into it again. I searched like crazy through pumed. sent tons of photos with ds and scans to docs who I saw dos this surgery. most said heck no , other doctors gave me this heartfelt impassioned email to reconsider because this surgery is so dangerous. They all recommended I try fat (don't get me started on fat to the orbital rims, I can write you a novel on why it stinks ).
so a handful of doctors said they would do it and I flew out to meet with them Most said they would only do the surgery with moving the jaw and with a coronal incision with cavalial bone and a bunch of other scary stuff. most docs said price was 50k 20k for surgeon fee 30k for hospital I then found 2 doctors who said they can do it without the jaw and without a coronal. One also said he can do it in his office operating suite. He was going to do 2 incisions on nar the eye ,one inside the mouth to move the midface. He was going to cut at the buttress of the maxilla to separate the jaw and cut the bones near the orbital rim to advance it all out as one piece.
so I went with him. cost was 17k(just about the same cost as custom implants). I was very very nervous and scared. I kept thinking about what all those doctors said and what I read online etc.
surgery was uneventful. It was done in his office operating room. had a 7 mm advancement. I was myself again after a day. I had tons and tons of swelling. didn't really have any pain. no vision issues, no loss or double vision. all the scary things dr.''s said would happen didn't. no step off anywhere. my doctor and his staff gave amazing care before and after surgery. he didn't shy away from any of my questions and answered them with facts ,not just generic stuff. an example is every doctor(except obwegeser) told me this cannot be done without moving the jaw and never has been done and very very technically difficult. when I said this to my doc he responded he has done it before, he explained where he will cut to accomplish it and why etc. they checked up on me daily post surgery. his assistant even came to my hotel to clean my incision sites.
so far I like my result. I feel and see the difference having my midface advanced. no I didn't become the Adonis or have the massive transformation we all hope fore, but in the 10 years ive been in this cosmetic surgery maxfax life I can tell you very very very few ppl go from ugly to hot. most end up a better looking version of themselves 1-2 points more in the attractive scale. one thing I do like is pre malar surgery I could pull off more than an inch of skin from my midface. now I can brely pinch any.
I wish my doctor and obwegeser and dr. z would really push all these surgeries like lfort ii,iii, chin wing etc. they can help a lot of people. the generic cliché routine procedures these cosmetic surgeons offer really don't do much.
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17k sounds really cheap. Who was your surgeon? You mentioned dr Z so I assume that's Zarrinbal? What did he say?
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Glad you're seeing improvement and like the result. Still can't quite believe you went through with it, hats off to you Sir!
Have you got anything else up your sleeve or is that you done and dusted?
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17k sounds really cheap. Who was your surgeon? You mentioned dr Z so I assume that's Zarrinbal? What did he say?
no it was a surgeon in the usa
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no it was a surgeon in the usa
Oh yeah, I know that Zarrinbal didn't do your surgery but you consulted with him right? What did he say during the consultation? Do you think you look "normal" now that you've had the surgery?
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Wow. I'm really glad things are going well!
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Were all the incisions done through the mouth or do you have some external ones?
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Glad to you like your results. Ive seen a lot of your posts around here and I know youve wanted to do something about your midface for a while.
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did Dr Sinn do your surgery?
Glad it worked out for you.
yes
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That's great and really fascinating. How old are you Earl? And also when you say orbital rim was it just the bottom part or the entire orbital rim surrounding the eyes?
Im 30 it was the infraoribtal and lateral orbital not upa orbital rim
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any chance you could upload your post-op X-ray or CT Scan. I'm curious to see what the incisions and screw + plates look like
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Were all the incisions done through the mouth or do you have some external ones?
internal via mouth and externam by the side of the eye
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Great stuff bro, so happy for you. srs.
do you think a zygo osteotomy can give good results?
depends. I don't believe it will move the orbital rim so if you have an orbital rim deficiency I don't believe it will help
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any chance you could upload your post-op X-ray or CT Scan. I'm curious to see what the incisions and screw + plates look like
if I get them I will ty
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Glad you're seeing improvement and like the result. Still can't quite believe you went through with it, hats off to you Sir!
Have you got anything else up your sleeve or is that you done and dusted?
im looking into orbital decompression
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Wow, Earl! Well done for doing all that research and having the balls to go through with the surgery
Hope everything heals fine and you enjoy the results!!
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Congratulations Earl, I'm really glad it went ahead without complication.
How much of an improvement do you feel it has been and was it worth the risk?
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Congratulations Earl, I'm really glad it went ahead without complication.
How much of an improvement do you feel it has been and was it worth the risk?
its still early as you cant tell a final result until all swelling is gone which takes a few months.
in terms of worth the risk. I don't really know how to answer that. All the risks that I read about or was told about didn't happen. doesn't mean those risks aren't real ,but im also proof they aren't a guarantee. I literally have a few emails or letter from TOP TOP cranio and maxfaxs giving me a heartfelt please not o pursue this. so I don't know. I can also tell you it depends on how bad you look.
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Kizarq, at the end of the day I'll have the zygomatic osteotomy too.
I will send you pictures as you've been very helpful.
I have a very bad orbital deficiency.
Are you having surgery today or did you mean that you're getting it eventually? There are a lot of us here on the board who have a similar problem and I for one am really interested in seeing what a zygomatic osteotomy can achieve.
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Oh nice, you are going to have great bone structure well into old age now! That seems to be the case with people who have jaw advancement surgeries, they maintain the new bone structure when they are older as well.
Is this to move the upper portion of the orbital rim?
no,to move my eyes back further into my socket. i hav bug eyes due to sockets being too small
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earl25,
Congrats! Really happy for you man! (Those swollen weeks must have been torture for you.)
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Congratulations Earl!
It's done more often than you think. I've seen before and afters of non-syndromal cases besides the Obwegesser girl. The prerequisites seem to be eyeballs protruding past the rim - strong negative vector.
Do you have links? could you post them?
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Thanks for updating earl. I didn't realize you were going through with it. I'm glad everything turned out well! And a little bit jealous... This is something I could probably benefit from, well a higher level lefort, but I'm not sure I'm willing to risk blindness. I may have to consult with your surgeon just to see what he says. He is in the Southwest right?
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Congratulations Earl!
Do you have links? could you post them?
FWIW, all the cases I've seen were class III pre-op. earl25 is class I (and was class II before his BSSO).
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FWIW, all the cases I've seen were class III pre-op. earl25 is class I (and was class II before his BSSO).
yes I was a class 1 with perfect bite.
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WTF is MM tier? MM on this forum stands for something you definitely don't want anything to do with.
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MM stands for male model in this instance I believe.
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MM stands for male model in this instance I believe.
Just more proof that this forum has a substantial amount of former and current puahate/sluthate posters. It's practically a sleeper cell for them ;D
You pick them every time they come in talking about philtrum length and other reasonably technical terms that someone who's never considered surgery previously and is a first time poster would never know about.
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Just more proof that this forum has a substantial amount of former and current puahate/sluthate posters.
:( :( :( :-[ :-[ :-[ :o :o :o
whyyyyyyy
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I'm really glad for you Earl, and I'm glad some of the info I provided helped you make the decision you came to. You're a real hero in my world. Thank you.
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Awsome , very gutsy! What was the final cost?
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17k usa
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That's really cheap. Did your insurance cover anything? Hell, I believe some guys here paid more than that in hospital costs alone.
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no insurance didnt pay
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You weren't in a hospital though, am I right?
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correct surgery was done in th office operating room
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Were you sent home straight after the surgery or where did you go? Pretty crazy that they can do such a big surgery in the office operating room. I wonder why surgeons like Arnett and Gunson don't do that?
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17k usa
Did you have a lot of lower scleral show, and what does it look like now?
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correct surgery was done in th office operating room
Lefort III in an office operating room. Damn you're balllsey! Glad everything turned out well, that's super cheap.
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Did you have a lot of lower scleral show, and what does it look like now?
i didnt really have scleral show
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Oh here's an important question. Dr. Schendel said that to do the operation he would need to take a hip graft. What did Dr. Z. do? Did he need grafting material of any sort? Hip or cadaver bone etc..?
And also, from 1-10 how different do you look? I don't mean how much better looking are you, I mean would someone who knows you think wow Earl looks really different or not so much. 1 being no change, and I suppose 10 being radically different unrecognizable. 7 is probably what a good rhinoplasty and chin genioplasty might accomplish. So that's the metric I'm curious about.... Thanks again!
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Oh here's an important question. Dr. Schendel said that to do the operation he would need to take a hip graft. What did Dr. Z. do? Did he need grafting material of any sort? Hip or cadaver bone etc..?
And also, from 1-10 how different do you look? I don't mean how much better looking are you, I mean would someone who knows you think wow Earl looks really different or not so much. 1 being no change, and I suppose 10 being radically different unrecognizable. 7 is probably what a good rhinoplasty and chin genioplasty might accomplish. So that's the metric I'm curious about.... Thanks again!
my doctor used bovne bone
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Bovine bone? Wut? :o
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Bovine bone? Wut? :o
Yeah, that was pretty much my reaction ;D
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Yeah, that was pretty much my reaction ;D
yes bovine bone. my options were hip bone,cadaver or bovine.
LAZLO- honesly no one has noticed a difference but I wear glasses and have a small face so my face is mostly covered. I would say I look different, again just an improved version of myself
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yes bovine bone. my options were hip bone,cadaver or bovine.
LAZLO- honesly no one has noticed a difference but I wear glasses and have a small face so my face is mostly covered. I would say I look different, again just an improved version of myself
Why not hip bone?
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I am incredibly surprised that you didnt have to be admitted to a hospital for this procedure and that you were back to yourself after a few days (despite crazy swelling). That's insane. Im incredibly happy for you that this all worked out well it just seems like for such a major surgery there would have been so much more involved??
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I am incredibly surprised that you didnt have to be admitted to a hospital for this procedure and that you were back to yourself after a few days (despite crazy swelling). That's insane. Im incredibly happy for you that this all worked out well it just seems like for such a major surgery there would have been so much more involved??
I doubt it. Maybe this doctor was just an honest guy you know? These "top" surgeons just are mostly greedy f--ks who try and make lots of money. THey just "plan" these operations the night or even morning before and then wing it in surgery. And that includes like all of you who had surgery with A&G, Schendel, etc. etc. etc. I didn't know much about the process but I know a lot more now. Most of them do like 4 surgeries a day. You're not special to them. They're not emotionally involved in your outcome. They just don't want to hear anything went wrong or you're dissatisfied. No sooner do they see you out the door and they're on to the next patient. If you got screwed by one of these doctors SUE THE f**kING HELL OUT OF THEM. [sorry didn't mean to hijack the thread with this, but after two years of studying all this s**t, it's time to get REAL]
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I wouldn't of course ask you earl to share your pics. But I would love to see maybe in a drawing or a morph what your outcome looks like. I don't mean you personally but anyone.
Can you answer this: Did your under-eye area go from a negative vector to a straight or even positive vector? i.e. assuming you had a negative vector (i have a negative vector under my eye for example) right under my eye socket the upper cheek sinks in (and will likely become more pronounced as I age and tissue descends and I lose fat in that area). Surgery could make it more flush with my eye, or alternately as some asian people or richard gere etc. have it could curve outwards and be a positive vector. Do you think this surgery is powerful enough to produce a positive vector from a negative one under the eye area?
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So where did the bovine bone get grafted?
Btw...Did you require a blood transfusion?
no transfusion. bovn bone was placed behing the advanced bone to hold it whil it heals
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I am incredibly surprised that you didnt have to be admitted to a hospital for this procedure and that you were back to yourself after a few days (despite crazy swelling). That's insane. Im incredibly happy for you that this all worked out well it just seems like for such a major surgery there would have been so much more involved??
more and more advanced procedure are being done out of offic operating rooms these days
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i didnt really have scleral show
How does one know if one's orbital rims are retruded?
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Guys guys guys...
I am really really confused here...
I became a member less than 6 months ago and since then Ive been reading all kind of different things regarding jaw surgeries and other related surgeries on here. Many of you guys write with super confidence and sound like you know alot, which some of you actually do because of doing lots of researching and talking to different specialist and ... but... before Earl went for this surgery most of you believed that this is a really dangerous surgery and no way you would let the operation to happen in the office operating room.... So I'm really confused here.. After all those researches and consulting many many different surgeons, Earl accepted to do the simplest thing and just trust this one less known surgeon to operate on him in his office?! I mean you guys are really surprised too, aren't you? Earl asked all those other doctors and they told him that this is a really really risky surgery... I mean how can you guys now trust these surgeons you ask questions from?! Im really not getting how is this even possible?! I myself am one of those people who cant trust doctors and has to do lots of research before letting them do the smallest thing to me... so I'm really confused...
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Most of those surgeons earl25 consulted with probably don't have a lot of experience doing Lefort IIIs. A surgeon can be excellent at doing some procedures and be completely ignorant about other slightly more esoteric ones. Most surgeons don't have any experience with the chin wing for example but that doesn't mean that they're bad surgeons in general. Knowing what your specific needs are and what you want to get out of the surgery is of uttermost importance when selecting the right surgeon for you. Most people just need to have their jaws moved into the right position and that's it, so in those cases you would be fine with almost any surgeon.
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Most of those surgeons earl25 consulted with probably don't have a lot of experience doing Lefort IIIs. A surgeon can be excellent at doing some procedures and be completely ignorant about other slightly more esoteric ones. Most surgeons don't have any experience with the chin wing for example but that doesn't mean that they're bad surgeons in general. Knowing what your specific needs are and what you want to get out of the surgery is of uttermost importance when selecting the right surgeon for you. Most people just need to have their jaws moved into the right position and that's it, so in those cases you would be fine with almost any surgeon.
But you know... they are god damned maxillofacial surgeons FFS! They should know everything related to their field at least in theory right? Telling a patient that he/she is going to get blind from a surgery that another surgeon does easily shows that they don't know enough about their field and havent tried enough to be up to date.
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But you know... they are god damned maxillofacial surgeons FFS! They should know everything related to their field at least in theory right? Telling a patient that he/she is going to get blind from a surgery that another surgeon does easily shows that they don't know enough about their field and havent tried enough to be up to date.
theres 2 sides to his argument. first of all the docs I saw where top top guys. in cranio and maxillo. Now the reasons why other doctors told me scary stuff were due to several reasons imo.
1)just because theyre a top cranio or maxillo doesn't mean they do lefort iii often or even well versed in it. lefort iii in general is a rare procedure. and its only really done for syndrome cases
2)doctors in general are moving towards less invasive procedures/less risk. so any doctor would say "why do you want this invasive procedure when you cann get fat grafts or impants with less risk.
3)all those things they told me could have occurred also.
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Guys guys guys...
I am really really confused here...
I became a member less than 6 months ago and since then Ive been reading all kind of different things regarding jaw surgeries and other related surgeries on here. Many of you guys write with super confidence and sound like you know alot, which some of you actually do because of doing lots of researching and talking to different specialist and ... but... before Earl went for this surgery most of you believed that this is a really dangerous surgery and no way you would let the operation to happen in the office operating room.... So I'm really confused here.. After all those researches and consulting many many different surgeons, Earl accepted to do the simplest thing and just trust this one less known surgeon to operate on him in his office?! I mean you guys are really surprised too, aren't you? Earl asked all those other doctors and they told him that this is a really really risky surgery... I mean how can you guys now trust these surgeons you ask questions from?! Im really not getting how is this even possible?! I myself am one of those people who cant trust doctors and has to do lots of research before letting them do the smallest thing to me... so I'm really confused...
my sugeon is actually a pioneer in the field and a very well known and respected maxillofacial surgeon.
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earl25, did your surgeon share his own statistics of his Lefort III procedures? It's quite possible that the surgeons who are saying that there are X and Y risks with a Lefort III have never actually performed one themselves.
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Could you tell me your doctors name? Somebody said Doctor Sinn? I searched, I'm not sure if I found the right one...
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earl25, did your surgeon share his own statistics of his Lefort III procedures? It's quite possible that the surgeons who are saying that there are X and Y risks with a Lefort III have never actually performed one themselves.
he did but not concrete number stuff he said hes done this many times,is very confident etc.he addressed every fear of mine with info.
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Could you tell me your doctors name? Somebody said Doctor Sinn? I searched, I'm not sure if I found the right one...
its listed in the thread
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its listed in the thread
What do you mean thread!? I am not a 24/7 on forums kind of person...
God damn it, is it so difficult to just answer a question....
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What do you mean thread!? I am not a 24/7 on forums kind of person...
God damn it, is it so difficult to just answer a question....
http://oralfacialsurgerydfw.com/
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http://oralfacialsurgerydfw.com/
Thank you
Wow this guy is old... So from the things you guys say, when doctors like him go retired then there is nobody to replace them? since "doctors in general are moving towards less invasive procedures/less risk."
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Only one review on Health Grades and it wasn't good: http://www.healthgrades.com/physician/dr-douglas-sinn-yn88x
Another review site: http://www.ratemds.com/doctor-ratings/2449260/Dr-DOUGLAS+P.-SINN-Mansfield-TX.html
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Only one review on Health Grades and it wasn't good: http://www.healthgrades.com/physician/dr-douglas-sinn-yn88x
Another review site: http://www.ratemds.com/doctor-ratings/2449260/Dr-DOUGLAS+P.-SINN-Mansfield-TX.html
online reviews arent reliable
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online reviews arent reliable
My former orthodontist that messed up my face during teenage years has a 100% rating on doctoroogle, but I wouldn't rate him much higher than a child molester. I think he just pays to have negative ratings removed / positive ones put in.
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I doubt it. Maybe this doctor was just an honest guy you know? These "top" surgeons just are mostly greedy f--ks who try and make lots of money. THey just "plan" these operations the night or even morning before and then wing it in surgery. And that includes like all of you who had surgery with A&G, Schendel, etc. etc. etc. I didn't know much about the process but I know a lot more now. Most of them do like 4 surgeries a day. You're not special to them. They're not emotionally involved in your outcome. They just don't want to hear anything went wrong or you're dissatisfied. No sooner do they see you out the door and they're on to the next patient. If you got screwed by one of these doctors SUE THE f**kING HELL OUT OF THEM. [sorry didn't mean to hijack the thread with this, but after two years of studying all this s**t, it's time to get REAL]
I know you did a lot of consults and research, did you ever wind up getting surgery?
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I know you did a lot of consults and research, did you ever wind up getting surgery?
my work has prevented me from taking the time off necessary so i won't be having surgery until after mid October. Which is fine since I'm evaluating a few more options.
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Congrats Earl !!! Glad everything worked out. I think you did the right thing by conducting extensive research and such. How many modified lefort III's has your surgeon done?
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Earl please tell me what you think ? http://jawsurgeryforums.com/index.php/topic,4198.msg31928.html#msg31928
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Hey earl, how are you feeling?
Its been a while since your jaw surgery and I'm wondering how everything going?
Any permanent numbness, or any other issues?
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to not open a new topic, I'll just ask here; I was recommended LFIII as an option for my midface defficiency, and the occompaying reply by doc was this:
I wonder why eval of nose is necessary?Is nose a factor when choosing between standard LFIII (aka NoThanks surgery) or modified LFIII?
Maybe he meant a bog standard Le Fort I? Because it does change the nose.
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You can always try zygomatic sandwich osteotomy or something like this. he just cut maxilla a little and eventually the part of orbital rim near lateral wall and the rest he breaks and change a little its position.
all people here talk about classic jaw surgery with him, but do not know if he has botched cases also in that area.
Yesterday first time I was told what is going on in this procedure
Mommaerts "invented" it. I used not to know, despite I consulted with him, and even I would have choosen him, but he wanted he told me he wanted to cut my zygomatic nerves so I canceled surgery
Zarrinbal does not perform these "sanwdiches"
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I think it is performed mainly to increse prominence including increasing anterior projection (moving bone forward and horizontally). When the zygomatic arch and maxilla is cut (inculding orbital rim), little force is used to break upper parts and orbital floor and then the bone is moved a little outside and can be moved forward (that MM told me), giving this projection. This is (I think) limited only for a cases which do not require big reposition, I guess max 5mms (mainly horizontally), to avoid significant orbital volume change which can result in sunkening of the eye (but I can be wrong, or in other words, more advancement requires orbital floor augumentation)
Unfortunately I never seen such case, and when I was on the consultation with MM 6 months ago, I was so enchanted by his popularity, experience, good opinions (before I registered on this forum) so I even did not ask much about examples. I know it's stupid, but that was my first consultation abroad, and he was first surgeon who said that he could help me. Now I know what to ask , etc. I had to learn this during these 6 months ;) but this trip last too long for me :(
But you have to know that, MM during this surgery can damage your zygomatic nerves and you will "suffer" some loss of feeling on the side of the cheek (he told this is very likely). However most people are not sensitive for such disadvantage. It is no problem for them (I've been told that)
I now realised I should also take this "sandwich" into account. However I do not know any surgeon except MM who does this. AND YOU ?
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You can write to them....look below the title
http://www.ncbi.nlm.nih.gov/pubmed/9915389
It seems like, they do not work always together. I mean MM and Nadjmi. Do not know about others.
Anyone knows anything about Prof. Nadjmi (and others mentioned in article except MM) from Belgium ?
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So from what I gather the different between a LF 2 and LF3 would be that, in a LF 2 the sides of the face would be untouched. IMO, that sucks. If you zygos are also recessed then technically youd still look off. They'd have to bring the zygos and upper maxilla forward, without touching the nose.
What I dont understand is that when they advance the lower maxilla in a Le Fort 1, there is still some contant with the upper maxilla. But If they basically move your whole face forward, like in a Le Fort 3, what do they will the space with? Cow bone? or they just leave the space hollow?
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hey Rico tbh, I know nothing about sandwich osteotomy, from what I've read it doesn't really do much (aesthetics wise) and I've never seen any before and afters.
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to not open a new topic, I'll just ask here; I was recommended LFIII as an option for my midface defficiency, and the occompaying reply by doc was this:
I wonder why eval of nose is necessary?Is nose a factor when choosing between standard LFIII (aka NoThanks surgery) or modified LFIII?
Nose change?

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@27F - these drops seem cool, I wonder if there are any side effects...
I've noticed that over the years I've developed bags under my eyes. It also feels like my eyes are slightly starting to buldge out, I feel pressure behind the eyes at times. I'm going to check my thyroid and rule that out first before looking into those eye drops. Maybe its related to not sleeping enough, or a mild form of sleep apnea..
Did bimatopros improve the look to where your eyes are normal again? also did you have any side effects?
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Congrats!
Making an appt. with him late Feb. for consultation- it'd be nice to get an experts opinion about my case.
Also, may be an obvious question but, is he versed in LF2? Another surgeon mentioned that a LF3 may leave my face looking wider since I have high cheekbones.
If I may ask, wtih whom ?
BTW, look here: http://www.ncbi.nlm.nih.gov/pubmed/16770194
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heres a cropped b4 and after
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after
[attachment deleted by admin]
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those pictures are too small and say nothing, i can say before was better
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not smiling in either
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Use your eyes there's a CLEAR difference despite the different lighting, his mid face projects much more in the after photo.
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^
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Cmon earl we won't judge you man
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what if we can get lisa to do a morph of you riding a dragon into battle? give us dem pics bb
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That's really cool, big transformation. You could pull an inch off before? Wow! Are you sure you don't have EDS or something? My current is somewhere between your before and your after. I'm told I'm just a few mm off. Implants are great for cases like mine, no?
Is that Dr Sinn in Dallas? Shame I didn't think to visit him while I was there. I met his colleague I guess, who I also think is very impressive.
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Do you find you get less crap in your eyes when it's windy and (if you did get dry eyes) that your eyes now don't dry out anymore? I have scleral show and functional problems are an issue too, not just esthetic
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The difference is clear. I had no change at that level after a le fort i. The muscles under the eye tilted up a little, and that's it.
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Wow! A full profile would be awesome. You could cover your eyes like Lisa did in the other thread.
My eyes also water when it's windy and I'm walking.
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don't worry I will be next who is gonna have something very close to modified LF3.
If my surgery will be a success - I have less than 1% chance (50% of my surgery is nerve decompression - I can't stand the symptoms , but it's too late) - then I will public here ;).
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You could post the images to Imgur and then delete the album a few days later. That's what I typically do. That way people here get to see it but most of the internet and any lurking surgeons don't.
As to the functional issues, my eyelids stopped closing at one point. I think that was neurological but my eyelids do seem to work a bit harder than most to close and they dry more easily. Allergies is a large factor too I think. That's why I consulted an oculoplastic surgeon, I wanted to know if there was a functional reason to touch my rim/cheeks. He was honest and said no, not in my case my eyes aren't that bad. But he said it would help with the dryness and strain and I'd look better. He agreed for mental health it could be important in 10 years. For me that says, revisit in 10 years lol. I don't think that was what he was hoping for.
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Is there a way to tell if your eyes are too big for the socket or if there isn't enough bone to support the eyes?
Also I wonder info have a thyroid issue because it feels like my eyes have been getting bigger over the years, or maybe my bones have been receding.
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The difference is clear. I had no change at that level after a le fort i. The muscles under the eye tilted up a little, and that's it.
thats y it pisses me off when docs tell ppl a lefort i will fix under eye issue. it wont.
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thats y it pisses me off when docs tell ppl a lefort i will fix under eye issue. it wont.
Earl, I just want to thank you for posting more pictures. It really is a great help. While seeing more of the face in profile would help get a better feel for the changes that occured I can make some observations here that I couldn't previously.
Astonishingly it looks like you've gone from negative to extremely positive orbital vector! That's crazy! Funnily enough my orbital vector and yours pre-op look very similar. s**tty midfaces run in one side of my family and it looks like I ended up inheriting that. A Mod. Le Fort III would put me in good stead for future ageing as I quite literally have no support there at the moment. I'll still look into other options involving full thickness malar osteotomies that include the infraorbital rim, however.
Finally, how has all of this affected your cheekbones themselves? Are the effects as pronounced as say a malar osteotomy on its own?
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heres a 3/4
[attachment deleted by admin]
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So earl25 are you satisfied with the outcome of this surgery?
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Yea, earl25! Very awesome, and I'm so glad this went well for you! For whatever it's worth, I see a substantial difference...in a great way!
Do you have any problems with numbness or discomfort when you sleep on your face, etc.?
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Yea, earl25! Very awesome, and I'm so glad this went well for you! For whatever it's worth, I see a substantial difference...in a great way!
Do you have any problems with numbness or discomfort when you sleep on your face, etc.?
no numbness
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yeah earl i think your results look awesome. I mean you have a full positive vector under your eye after and you also have a very impress S-curve in your 3/4 profile after (by the way my consultation got delayed till next week with same doc). I think these are incredible results. I wish I could see how it plays out in terms of your full face, but thanks a lot for sharing these results. Super positive.
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Ya I agree with everyone, these results are amazing!
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i wish it could be done without that little scar by the eye though.
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i wish it could be done without that little scar by the eye though.
The alternative is coronal incision.
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^^ Nothing a little laser treatment can't smooth and buff out .
And great results! It actually looks better than what I had pictured.
I had a consult today and we mapped out my concerns and was willing to do it, to my surprise. Now it's that decision to actually go through with it. I honestly didn't think he'd do it... anyhow, looking atu these results helps me feel a lot better.
with d. sinn?
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with d. sinn?
yup
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The alternative is coronal incision.
Wouldn't that be preferrable? Who cares about a scar that's covered by hair vs something visible on your face?
Or is there more to this that I'm not understanding?
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Wouldn't that be preferrable? Who cares about a scar that's covered by hair vs something visible on your face?
Or is there more to this that I'm not understanding?
Huge scar potentially (even if it's hidden).
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Huge scar potentially (even if it's hidden).
i dunno, i know doctor sinn does it with a scar by the eye, but keller's examples of quadrangular lefort 2 have no scars and he mobilizes the orbital rim as well. so it clearly can be done without an external scar. but yeah the scar is pretty minimal with sinn. i bet you wouldn't even notice it except when looking at a side picture like earl posted.
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i dunno, i know doctor sinn does it with a scar by the eye, but keller's examples of quadrangular lefort 2 have no scars and he mobilizes the orbital rim as well. so it clearly can be done without an external scar. but yeah the scar is pretty minimal with sinn. i bet you wouldn't even notice it except when looking at a side picture like earl posted.
Agreed. Having spoken with a number of people there does certainly appear to be a number of options when it comes to scarring.
Still, I would opt for a coronal incision over and above anything around the eyes. At least no matter what there's always the option of transplanting hair into the scar, thus making it invisible.
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I feel like the after pic looks a little more feminine because the cheeks are now more convex looking and emphasized at least from the little you can see (unless that is just swelling). I actually think the before looks completely fine too and I recently noticed a lot of guys that people consider very good looking have a quite "deep" or concave midface by this forum's standards. Honestly before the pics I always expected earl to have a completely disfigured midface or something but anyway...the only thing that matters is that earl is happy with the results
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I thought I'd feel better about getting the "ok" for any jaw surgery but now I feel even more confused after going to two consults so far. Both docs have differing views and mine align somewhere between both. I'll go ahead and finish the rest of the consults abroad- I need more opinions...
what did they tell you?
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Agreed. Having spoken with a number of people there does certainly appear to be a number of options when it comes to scarring.
Still, I would opt for a coronal incision over and above anything around the eyes. At least no matter what there's always the option of transplanting hair into the scar, thus making it invisible.
it depends on how bald your potential is. my family are nw6-7 by 50 so a coronal wont work
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dr. sinn is excelent. him and his offic gave m the best after care i ever had.
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I got this from one girl from German forum. Perhaps it will be heplful for all of you:
And if ever somebody should recommend you Dr. Kater in Bad Homburg: I would never ever go there!
Some love him and are very satisfied with the result, others have more problems than before the operation and need several more operations, treatments etc. elsewhere.
She lives in France now and recommend Dr. Deffrennes
She had succeful surgery with him. However 2 years after surgery she still has got slight sensation distirbuances...
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hey earl could you please consider advising me on a surgical plan, thanks (your pms where disabled)
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Hey Earl, this is sort of unrelated but aren't you American? I'm just wondering why it's so hard to communicate with you lol.
I've written this like three times now in an attempt to not come across rude. Ultimately I guess myself and many others feel like we're being trolled. I'm sure your English is good, and yet you constantly ignore questions or respond to but a fraction of what's being asked. And when that does occur it's often with little to no regard for basic grammar. Because of that threads end up spamming out over many pages because it turns into a shouting match where people are posing the same question to you over and over and over, or bickering and speculating amongst themselves.
It's a bit like the photos. You appear to be happy showing some of your results. We're told high quality photos exist which document your results. Yet instead of censoring those high quality pictures we're given drips and drabs of 50x50 pixel photos taken on a potato cam which are of very little use to anyone trying to evaluate the effectiveness of the procedure.
This isn't to say myself and others aren't grateful. Your work in researching Dr Sinn, getting a mod. LF III, telling us about it is all GREATLY appreciated. It just feels like we're so close to getting the answers we need to make an informed decision but it's being hampered for no real reason.
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Hey Earl, this is sort of unrelated but aren't you American? I'm just wondering why it's so hard to communicate with you lol.
I've written this like three times now in an attempt to not come across rude. Ultimately I guess myself and many others feel like we're being trolled. I'm sure your English is good, and yet you constantly ignore questions or respond to but a fraction of what's being asked. And when that does occur it's often with little to no regard for basic grammar. Because of that threads end up spamming out over many pages because it turns into a shouting match where people are posing the same question to you over and over and over, or bickering and speculating amongst themselves.
It's a bit like the photos. You appear to be happy showing some of your results. We're told high quality photos exist which document your results. Yet instead of censoring those high quality pictures we're given drips and drabs of 50x50 pixel photos taken on a potato cam which are of very little use to anyone trying to evaluate the effectiveness of the procedure.
This isn't to say myself and others aren't grateful. Your work in researching Dr Sinn, getting a mod. LF III, telling us about it is all GREATLY appreciated. It just feels like we're so close to getting the answers we need to make an informed decision but it's being hampered for no real reason.
have you contacted me by email before?
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in regards to grammer, i respond from my phone which has a small keyboard. i also have stubby figures.
in regards to questions. i have answered all of them. i keep getting asked the exact same ones over and over again. i dont respond when people ask me weird questions that contain phrases that quite frankly i dont understand because they contain terms im unfamiliar with or beyond th scope of my knwoledge.
also most of these questions regarding other peoples cases, i cant answer. those questions specific to yours or somebody else case have to be answered by a dr. most ppl on this thread arent serious imo. i spend HOURS researching docs and contacting them about lefort iii. if i didnt get a response by email, i called by phone. if ic ouldnt get through by phone i sent a writtn letter. all of you should be doing the same.
as for photos, i dont owe you photos whether partial, full, high quality or low quality. i do not owe u photos. i posted what i wanted to post. if you feel that isnt good enough,then too bad, go see an actual dr and ask him for questions and bother him for photos.
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in regards to grammer, i respond from my phone which has a small keyboard. i also have stubby figures.
in regards to questions. i have answered all of them. i keep getting asked the exact same ones over and over again. i dont respond when people ask me weird questions that contain phrases that quite frankly i dont understand because they contain terms im unfamiliar with or beyond th scope of my knwoledge.
also most of these questions regarding other peoples cases, i cant answer. those questions specific to yours or somebody else case have to be answered by a dr. most ppl on this thread arent serious imo. i spend HOURS researching docs and contacting them about lefort iii. if i didnt get a response by email, i called by phone. if ic ouldnt get through by phone i sent a writtn letter. all of you should be doing the same.
as for photos, i dont owe you photos whether partial, full, high quality or low quality. i do not owe u photos. i posted what i wanted to post. if you feel that isnt good enough,then too bad, go see an actual dr and ask him for questions and bother him for photos.
Thanks, that makes a lot more sense. I hope it didn't come off as overly rude or mean as that wasn't my intention at all.
I agree about contacting doctors like that and I've done it myself a number of times. It seems e-mailing is very unreliable and most have terrible secretaries.
Regarding photos, I think a lot of us are wanting better photos simply because doctors will tend to cherry pick. Whereas you being the first forum member to ever get this done we can see more what a realistic result would be. Of course, I never posted photos of my surgery so it's wrong to be demanding. It's just since you've already posted photos before I was wondering if there's a reason for not just editing some high quality ones (cover eyeballs, nose, eyebrows) to help us see the effect it has on the overall face, and whether or not the results are harmonious with the rest of the face.
I've already messaged Dr Sinn and plan on having a consult with him soon.
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I've already messaged Dr Sinn and plan on having a consult with him soon.
Not happy with the result you had from your surgery with Triaca?
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I agree Earl has been helpful to everyone over and above the call of duty. He's shared decent pics to give us an idea of the surgery and answered questions very well. Most of you are just forum trolls who don't have the cash nor the intention of ever getting surgery and just lurk around here. Tumerican are you even in braces yet? You do realize it could take up to two years in braces to prepare you for surgery. You better get on that, you might be 25 soon and then well life will be over.
Optimistic, where are your before and afters?
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Lazlo told it how it is
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Not happy with the result you had from your surgery with Triaca?
I'm looking into Sinn (and others) for a mod. LF III or a malar osteotomy that runs along the infraorbital rim. I had a chin wing with Triaca, so two completely different things.
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I'm looking into Sinn (and others) for a mod. LF III or a malar osteotomy that runs along the infraorbital rim. I had a chin wing with Triaca, so two completely different things.
Oh I'd love to see the results of that. Do you have before and afters. I'm serious. Did you have with it with a BSSO, or on it's own?
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I agree Earl has been helpful to everyone over and above the call of duty. He's shared decent pics to give us an idea of the surgery and answered questions very well. Most of you are just forum trolls who don't have the cash nor the intention of ever getting surgery and just lurk around here. Tumerican are you even in braces yet? You do realize it could take up to two years in braces to prepare you for surgery. You better get on that, you might be 25 soon and then well life will be over.
Optimistic, where are your before and afters?
Aren't you the one who has never had surgery and comes and goes with autistic fits of rage at random members? You should be the last one to throw stones about "forum trolls" who won't ever have surgery.
As I stated already, I'm greatly appreciative of the information Earl has provided to us and agree completely that he's gone well beyond what one would expect of an ordinary member. My point is more that reading Earl's threads is akin to being in a strip club. We're given so much, yet for no apparent reason we're cock blocked with 50x50 pixel potato cam pictures. If one is willing to post pictures and information I don't understand why we can't just get some decent pictures and put it to rest.
Again, I am hugely thankful to what Earl has provided and if he was to stop posting tomorrow I wouldn't hold anything against him. He's done a lot raise awareness of this type of operation when previously everyone thought implants and fat grafting were the only options.
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Aren't you the one who has never had surgery and comes and goes with autistic fits of rage at random members? You should be the last one to throw stones about "forum trolls" who won't ever have surgery.
As I stated already, I'm greatly appreciative of the information Earl has provided to us and agree completely that he's gone well beyond what one would expect of an ordinary member. My point is more that reading Earl's threads is akin to being in a strip club. We're given so much, yet for no apparent reason we're cock blocked with 50x50 pixel potato cam pictures. If one is willing to post pictures and information I don't understand why we can't just get some decent pictures and put it to rest.
Again, I am hugely thankful to what Earl has provided and if he was to stop posting tomorrow I wouldn't hold anything against him. He's done a lot raise awareness of this type of operation when previously everyone thought implants and fat grafting were the only options.
I was being serious, why won't you show us a pic? You can block out your identity.
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Oh I'd love to see the results of that. Do you have before and afters. I'm serious. Did you have with it with a BSSO, or on it's own?
It was on its own, no BSSO. My jaws weren't recessed for whatever reason I just lacked a lot of chin projection. Don't ask me how that even happens but I ended up getting close to 1cm advancement. It did a LOT to improve jaw angles, drop down, and chin projection. My submental fold is not at all too deep, as I've seen in a lot of other chin wing patients who forewent a BSSO when it was indicated.
As such, my result would not be indicative of what could be expected of anyone who isn't in a similar situation. That said, Triaca is a bit of a wizard with the chin wing. Some of the results I saw were truly, truly impressive.
I plan on posting photos soon once I can get my camera fixed. Everything I've taken on webcam or phone is too low quality, unfortunately.
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It was on its own, no BSSO. My jaws weren't recessed for whatever reason I just lacked a lot of chin projection. Don't ask me how that even happens but I ended up getting close to 1cm advancement. It did a LOT to improve jaw angles, drop down, and chin projection. My submental fold is not at all too deep, as I've seen in a lot of other chin wing patients who forewent a BSSO when it was indicated.
As such, my result would not be indicative of what could be expected of anyone who isn't in a similar situation. That said, Triaca is a bit of a wizard with the chin wing. Some of the results I saw were truly, truly impressive.
I plan on posting photos soon once I can get my camera fixed. Everything I've taken on webcam or phone is too low quality, unfortunately.
cool. look forward to the images.
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Thanks for posting the before and afters. I've been wondering how it looked.
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Look at the map on the second page. Why is that ?
Big difference comparing Italy to the rest of the Europe..and maybe world
http://www.eurofaces.com/fileadmin/user_upload/pdf/EACMFS_newsletter_2013-14_6.pdf
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just zoom it.. it will be blurry but it's still readable, anyway I'm gonna describe this map down here:
there are shown the numbers of responders (maxillo facial surgens) in each country to the inquiry about the research centers in Europe like EACMFS - EUROPEAN ASSOCIATION FOR CRANIO-MAXILLO-FACIAL SURGERY
in Italy 29 ..in the rest countries less than 10
Germany 8
the rest 1-3
my country 1 :D (I could not find help here)
The question is why so much responders from Italy...
The interesting thing is that I relised now that right surgeons (not for sure) I found in Italy and Germany ;)
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just zoom it.. it will be blurry but it's still readable, anyway I'm gonna describe this map down here:
there are shown the numbers of responders (maxillo facial surgens) in each country to the inquiry about the research centers in Europe like EACMFS - EUROPEAN ASSOCIATION FOR CRANIO-MAXILLO-FACIAL SURGERY
in Italy 29 ..in the rest countries less than 10
Germany 8
the rest 1-3
my country 1 :D (I could not find help here)
The question is why so much responders from Italy...
The interesting thing is that I relised now that right surgeons (not for sure) I found in Italy and Germany ;)
probably because Italians are obsessed with beauty and aesthetics.
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probably because Italians humans are obsessed with beauty and aesthetics.
FTFY
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FTFY
true, but italians and italian men take it to another level, trust me.
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true, but italians and italian men take it to another level, trust me.
another level ? what you mean ?
do you think, that some maxfac surgeons there (Italy) may be superior to the others from another countries ?
or it's just not good line of thought ?
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another level ? what you mean ?
do you think, that some maxfac surgeons there (Italy) may be superior to the others from another countries ?
or it's just not good line of thought ?
I think he means aesthetics. Italians are the greatest aesthetes in the world.
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I think he means aesthetics. Italians are the greatest aesthetes in the world.
how you know this ?
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how you know this ?
He doesn't, it's just a stereotype.
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He doesn't, it's just a stereotype.
haha... but how you know that ;) how can you be sure ?
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So of course I just stare at faces wherever I go.
Was at the pharmacy and couldn't stop staring at this guy who was objectively beautiful. Like a James Dean or Brad Pitt type. And I was looking at his face when he couldn't see and he had all of it.
And I'll tell you what it is, but I don't understand how to surgically reproduce it.
Very strong maxilla, like angled at 45 degrees from his nose very protrusive and i noticed the skin around his philtrum was taught, and of course very strong jawwline and chin with great elasticity of skin.
But then his face dipped in above the maxilla so it was a bit gaunt there and then boom really strong bon structure under the eyes and the cheekbones. He had great hear and a nicely proportioned forhead, young, good skin. But man, th bone structure that created that sort of rise then fall then rise and the soft tissue that clung strongly to the face. He was what they call pretty. Thin nose with a strong bridge. He must have been a model (i live in a fashion district).
f**k. If only we could reproduce that.
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Sounds a bit like this guy...hell, I'm a woman but I'd still kill to look like him.
(https://40.media.tumblr.com/e848c9f5a856159ce00bdeecbbafbe8f/tumblr_ngloge6N9Q1rvo6iuo1_500.jpg)
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it's funny, modigliani, i remember reading somewhere a long time ago that the difference between a pretty or even beautiful woman vs. sexy was the sexy woman will have more angular/masculine rather than round features. especially around the eye area. i've always perceived this difference and it was interesting to read that it was a "thing". an example of it would be allesandra ambrosio's face. so when i see guys like in the photo you posted, sometimes i imagine them with longer hair and less facial hair and think daaamn, that'd make a good looking woman.
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it's funny, modigliani, i remember reading somewhere a long time ago that the difference between a pretty or even beautiful woman vs. sexy was the sexy woman will have more angular/masculine rather than round features. especially around the eye area. i've always perceived this difference and it was interesting to read that it was a "thing". an example of it would be allesandra ambrosio's face. so when i see guys like in the photo you posted, sometimes i imagine them with longer hair and less facial hair and think daaamn, that'd make a good looking woman.
Spot on.
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Spot on.
Oh my GOD!!! It's so true. f**k, I'd never make a f**king good looking woman. I would make the most horrible looking woman you could imagine. There's just no hope. I'm ugly, repulsive and a troll.
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it's funny, modigliani, i remember reading somewhere a long time ago that the difference between a pretty or even beautiful woman vs. sexy was the sexy woman will have more angular/masculine rather than round features. especially around the eye area. i've always perceived this difference and it was interesting to read that it was a "thing". an example of it would be allesandra ambrosio's face. so when i see guys like in the photo you posted, sometimes i imagine them with longer hair and less facial hair and think daaamn, that'd make a good looking woman.
That makes sense, I obviously prefer the sexier looking women then cause all the people (male and female) that I rate most highly kind of share his facial structure.
The combination of angular facial structure and feminine full lips tends to produce consistently stunning results, to my eye at least.
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So of course I just stare at faces wherever I go.
Was at the pharmacy and couldn't stop staring at this guy who was objectively beautiful. Like a James Dean or Brad Pitt type. And I was looking at his face when he couldn't see and he had all of it.
And I'll tell you what it is, but I don't understand how to surgically reproduce it.
Very strong maxilla, like angled at 45 degrees from his nose very protrusive and i noticed the skin around his philtrum was taught, and of course very strong jawwline and chin with great elasticity of skin.
But then his face dipped in above the maxilla so it was a bit gaunt there and then boom really strong bon structure under the eyes and the cheekbones. He had great hear and a nicely proportioned forhead, young, good skin. But man, th bone structure that created that sort of rise then fall then rise and the soft tissue that clung strongly to the face. He was what they call pretty. Thin nose with a strong bridge. He must have been a model (i live in a fashion district).
f**k. If only we could reproduce that.
I notice a lot of model types have basically no fat distributed around the nasolabial folds up towards beneath the eyes (basically where the zygomatic major minor muscles run, or whatever they are really called). I don't give a f**k that models have this, but what I do like is how it ensures they'll never ever develop nasolabial folds as there is simply no weight pushing that tissue down. Coupled with good facial support and they're guaranteed to age well.
I wonder how much this is due to the muscles in the area being atrophied vs fat distribution.
Finally, does anyone know if fat can be removed from this area? It seems logical to do I would suppose
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You don't owe us any photos? What a d*ck! For an American, like I am, you give us a bad name. Your postage stamp sized photos stink, you looked normal in the first pic and now look like a female. You are obviously a nut case if you were so unsatisfied with how you looked that you had to get your face chopped in half with a surgery reserved for down syndrome patients and now that it's done and you like the results you are scared to post pictures. You are a lunatic so I don't know why anyone would take advice from you.
that post literally made my day. i was having a stressful day at work and you just cheered me up by reading that. thank you. welcome to the board.
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just wow.
I'm only now catching up. I'm assuming that was a massive joke.
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I saw earls photo after the modified lefort 3. His lower orbital problems have been resolved. What he need now is to do something about his supraorbital rims. I don't know why he's overlooking it and chasing procedures that are unnecessary after his modified lefort 3.
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I saw earls photo after the modified lefort 3. His lower orbital problems have been resolved. What he need now is to do something about his supraorbital rims. I don't know why he's overlooking it and chasing procedures that are unnecessary after his modified lefort 3.
very fes options for supraorbital rims. it needs a coronal. i spoke with ousterhout on this
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very fes options for supraorbital rims. it needs a coronal. i spoke with ousterhout on this
Interesting. I asked Sinn why my eyes look so buggy when I become expressive and he said it was the shape of the sockets. I didn't ask him what could be done for that, but I will when I see him again for surgery.
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Interesting. I asked Sinn why my eyes look so buggy when I become expressive and he said it was the shape of the sockets. I didn't ask him what could be done for that, but I will when I see him again for surgery.
Same here, but only the bottom of they eyes. Yet I have small eyes. The skin around they eyes has always crinkled heavily when I smile.
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very fes options for supraorbital rims. it needs a coronal. i spoke with ousterhout on this
Did Sinn indicate he could do supraorbital rims at the same time if you were to get a coronal?
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Did Sinn indicate he could do supraorbital rims at the same time if you were to get a coronal?
i never asked him. i will tbough. i will be consulting with dr ousterhout.
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I am brand new to the forum and this is my 1st post! I am female and 27 years old but I have been lurking on any and all forums that talk about aesthetics, midface def, orthodontics, etc. for close to 6 months. So far I have consulted in person with Dr. Hang DDS and Dr. Wolfe (student of Dr. Tessier) the later concerning a seperate craniofacial procedure as well as jaw advancement, and via Skype w/Dr. Movahed (fellow of Dr. Larry Wolford), Dr. Gunson and Dr. Mike Mew. Also, prior to knowing much about any of this I had some cosmetic procedures with Dr. Michael Salzhauer that all left something to be desired and require some tweaking. Anyway, I just keep digging and digging, and thanks to my obsessive nature and you lovely people, I am driving up to consult with Dr. Sinn on June 5th!
My first question about Dr. Sinn is does he work with implants at all? In addition to double jaw surgery including a modified lefort ii or iii I would really like to have mandibular angle implants and even a forehead implant. I am driving up to see him in about two weeks but I'd love to have a somewhat clear understanding of what he does vs. what I would like to have done before I show up to meet him!
My second, I really would like to open up my extraction spaces (top premolars only) with a functional appliance and have a modified multi segmented lefort ii or iii. I know this is very possible with a lefort i with certain orthos who are familiar with these types of appliances and certain maxfac surgeons... do you think Dr. Sinn would be willing to work with me if I opened my extractions first, then braces to prep for surgery? And is a multi segmented modified lefort ii or iii even possible?
Some of you people are so tenacious and brave to pursue and possibly even undergo these procedures, I commend you and am thankful to have you as kindred spirits! This is my first post so if this isn't proper etiquette please let me know! Thanks!
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welcome meepmeepmeep Im not sure. I don't think Dr. sinn likes implants. Most maxillofacial surgeons don't. Ask him if he can do some type of jaw angle osteotomy or supraorbital rim/brow.
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Well, I want to expand my palate that is very, very narrow (28mm). I was narrow to begin with but as a third grade child my premolars were removed and my teeth pulled back. In order to have a multi segmented lefort opening the extractions isn't necessary but I guess I feel like those teeth were stolen from me. Anyway, It is all kind of a chicken and egg situation. I have a long face, extremely close set eyes (52mm ipd), negative orbital vector, no cheekbone projection (anterior or lateral), and deep nasolabial folds.
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@meepmeepmeep Wow, sounds like you have some serious issues and amazing research you've done already. Yeah I would want those teeth replaced too and expand that palate for sure. Do you have an anterior open bite too? Otherwise, SARPE followed by LeFort I is considered safer I think. It sounds like you met Dr Alfaro already. He's a trek away but he can do the SARPE outpatient I believe with minimal incisions, pretty amazing. Those eyes do indeed sound very close but that's really hard to fix in an adult. What kind of risks and results can you expect? Negative vector, well that's common even among normal people. Maybe 1/3 of the population? What's your age? The funny thing about cheekbones is that when the fat pads thin in your 30s the underlying skeletal structure becomes apparent. That's not so great under the eyes as you know but cheekbones start to become more prominent. I have a picture from nearly 10 years ago, cheeks completely flat. Now they project. I may have gotten a little growth but mostly I think it's just from my face thinning out. Anyway, prominent cheekbones aren't considered to be critical to attractiveness of men. Nasolabial folds should be addressed by a standard double jaw surgery.
So in summary, I think you're doing good stuff but you're looking at a lot of surgeries. Start with SARPE then double jaw surgery. Then something with Sinn for the eyes and may as well hit the cheekbones while you're at it. I don't know about implants, you need to draw the line somewhere. I don't know if it's wise to rotate the maxilla at the same time that you're moving the cheeks around. That's a lot of stuff being held together by fragile little plates where even a tiny mm of movement could throw it all off. You'd also be in no man's land, doing stuff that very, very few people (or adults at least) have done.
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I am brand new to the forum and this is my 1st post! I am female and 27 years old but I have been lurking on any and all forums that talk about aesthetics, midface def, orthodontics, etc. for close to 6 months. So far I have consulted in person with Dr. Hang DDS and Dr. Wolfe (student of Dr. Tessier) the later concerning a seperate craniofacial procedure as well as jaw advancement, and via Skype w/Dr. Movahed (fellow of Dr. Larry Wolford), Dr. Gunson and Dr. Mike Mew. Also, prior to knowing much about any of this I had some cosmetic procedures with Dr. Michael Salzhauer that all left something to be desired and require some tweaking. Anyway, I just keep digging and digging, and thanks to my obsessive nature and you lovely people, I am driving up to consult with Dr. Sinn on June 5th!
My first question about Dr. Sinn is does he work with implants at all? In addition to double jaw surgery including a modified lefort ii or iii I would really like to have mandibular angle implants and even a forehead implant. I am driving up to see him in about two weeks but I'd love to have a somewhat clear understanding of what he does vs. what I would like to have done before I show up to meet him!
My second, I really would like to open up my extraction spaces (top premolars only) with a functional appliance and have a modified multi segmented lefort ii or iii. I know this is very possible with a lefort i with certain orthos who are familiar with these types of appliances and certain maxfac surgeons... do you think Dr. Sinn would be willing to work with me if I opened my extractions first, then braces to prep for surgery? And is a multi segmented modified lefort ii or iii even possible?
Some of you people are so tenacious and brave to pursue and possibly even undergo these procedures, I commend you and am thankful to have you as kindred spirits! This is my first post so if this isn't proper etiquette please let me know! Thanks!
I am almost certain he doesn't work with implants. He stated he doesn't like them at all to me in person.
And no, multi-segment lefort ii or iii is not possible way to unstable. Theoretically anything is possible, and I guess no harm in asking.
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I was just re-reading the original post. Wow, 7mm advancement! Able to pull an inch of skin off his face? That's a really big movement, he must have been quite deficient before. I can see why he'd want to have that fixed. Neat that he was able to do it in office and separate from the jaw surgery. I wouldn't want to mix the two. Jaw surgeries by themselves are risky enough, relapse rate on an MMA is 15% as I recall and it only goes up with multi-segment and CCW rotations. All the stuff at the bottom of the hierarchy of stability. Not to mention that a CCW rotation would actually pull the oribtal rim down and change the shape of the socket, which is usually undesirable. I guess it'd be nice if they could move the midface at the same time as the jaw surgery so an extra break isn't required. But the midface is also used to support the maxilla after the downfracture so while a small movement to it might not be a big deal aesthetically it could create a functional problem to the bite. Did he redo the downfracture then? Probably the bigger issue is that so few of these procedures are done. Have the relapse rates even been studied? I'm wondering if the reason this isn't done more often is simply because no one has done enough procedures to have figured out how to do it well and in volume.
Anyway, definitely keeping in mind if my face bothers me enough that I feel the need to augment my midface. What was sensory recovery like? Did you lose any sensation, temporarily and permanently? You have some serious balls to undertake this procedure after all that you heard and having had no trailblazer patients ahead of you, just relying on the surgeon's word. The result is well earned for sure.
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IMO high cheekbones for men are the most important feature on the face.
Also CCW rotation pulls the orbital rim down?
molestrip what are you talking about.
I dont have prominent cheekbones and even i disagree with that. I could agree with you to make myself feel better, but id my lying to myself.
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Molestip, 7mm is not an inch.
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cheekbones on their own aren't gonna make or break an attractive face. So many other factors and it's the overall relationship of parts that makes the difference. For example, short upper lip, eye-width, etc. are important on a man, maybe even more important than cheekbones. And yes, many very attractive men have negative orbits.
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Negative vectors are normal in Asians too, no? Sigh.. I lose on the lip front too. Maybe I'll fix that. Come to think of it, any rotation of the maxilla has to have a downfracture.
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cheekbones on their own aren't gonna make or break an attractive face. So many other factors and it's the overall relationship of parts that makes the difference. For example, short upper lip, eye-width, etc. are important on a man, maybe even more important than cheekbones. And yes, many very attractive men have negative orbits.
Probably true. I have lack of cheek prominenece on one side due to overlooked fracture and noone noticed this :)
However to be honest, there is little loss of attractiveness / charackter of the face ..but not very visible - this is the point
I think all taking together is important.. no part is less or more important
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I am almost certain he doesn't work with implants. He stated he doesn't like them at all to me in person.
And no, multi-segment lefort ii or iii is not possible way to unstable. Theoretically anything is possible, and I guess no harm in asking.
not that everyone is addressing my concerns, but i am a woman. so cheek bone projection is important to me.
awesome, lazlo. thanks for the heads up on the implants. of course, i agree they aren't ideal either. did dr. sinn tell you if he does any osteotomies that address forehead, supraorbital def or jaw angles?
i have had a surgeon suggest a multi-segmented high lefort i with ccw rotation. he said he would do the cuts just below the infraorbital foramen. if this is possible, then it seems that a lefort ii or iii could also be possible but possibly a bit riskier. i will ask when i see him.
from what i gather, earl didn't have any ccw rotation of the jaws by dr. sinn. but is it possible to ccw rotate/bsso during a lefort ii or iii the same way as one would with a lefort i/bsso?
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not that everyone is addressing my concerns, but i am a woman. so cheek bone projection is important to me.
awesome, lazlo. thanks for the heads up on the implants. of course, i agree they aren't ideal either. did dr. sinn tell you if he does any osteotomies that address forehead, supraorbital def or jaw angles?
i have had a surgeon suggest a multi-segmented high lefort i with ccw rotation. he said he would do the cuts just below the infraorbital foramen. if this is possible, then it seems that a lefort ii or iii could also be possible but possibly a bit riskier. i will ask when i see him.
from what i gather, earl didn't have any ccw rotation of the jaws by dr. sinn. but is it possible to ccw rotate/bsso during a lefort ii or iii the same way as one would with a lefort i/bsso?
hi, yes Dr. Sinn recommended a high, multi-segment lefort for me as well.
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I saw my eye doc today for a regular checkup and asked him about this. He told me my eyes are very average for my age based on what he sees in his practice. He said he sees some patients with dryness and eyelid closure problems after having plastic surgery to try and reverse the effects of aging though. His advice was that if I wanted I could do implants but that I should wait till I'm older. His thought was that the higher LeForts are very risky. He said they have a lot of trouble treating people with defects around the orbits and he couldn't fathom why someone would intentionally do that to themselves. Nothing new here earl heard the same in his research, just wanted to add the anecdote.
Somehow, despite my issues I still see 20/20. The machine reports small aberrations. I think Dr Park's book claimed that facial deformities alter the eye socket which changes the shape of the eye and causes vision problems. What's the story for the rest of you? Do you need glasses to see well?
Rate of dentofacial deformities is 20% btw. Midface deficiency is considered a variant of normal, that is present in the normal population without deformity. I don't know the rate but I think it's not rare. Between the two, I'd still venture my 33% figure is in the right ballpark. I see many guys around without prominent cheekbones and it looks good. I haven't seen a case yet where it detracts. I've seen some faces without cheekbones at all, as in less than flat, and that looks bad. The assistant at the office today had a narrow arch, said they advised surgery for her too, and deficient cheekbones in her 40s. Somehow she has less sagging than me. Maybe it's possible to control with products? Or she's using makeup. She was still attractive but I wouldn't say hot. Just kind of average.
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im not saying all men need to have prominent cheekbones. They don't have to be huge, just forward enough to support the eyes properly. A buddy of mine who is very good looking has flat cheekbones but they go past the bottom of his eyes, so he has good eye support and his zygos dont curve into his face if that makes sense. They're kind of angles outwards. IMO this is the most important part of male aesthetics. You can have flat frontal cheekbones but side/zygos matter more. Just my opinion though. ID that that over a strong jaw any day.
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you can move the back of the maxilla up in a CW rotation, which is also the preferred way to close an open bite.
You mean for a single jaw surgery? Yeah, one of the local surgeons tried that on me. That's what they said 15 years ago too. They like it because it's less invasive and more stable. That doesn't make it the right procedure. You fix the open bite but create new problems. Isn't that what you had jawbone? I know one other person who had it and she's now on her 2nd revision. Occlusal plane ends up very high, you don't fix the long face, increases load on TMJ, reduces space in nasal cavity contributing to nasal resistance, etc. Double jaw surgery w/CCW rotation is the way to go. It's riskier relapse-wise but you end up in the right spot even if you end up needing revision. Only most people in that position also need a 3-piece LeFort and, combined, that's one of the riskiest procedures they can do (that's considered stable enough to do).
@terry947 I agree with your position. Positive vector is ideal, negative vector is ok but if the eyes are bugging out, that's a problem. My mom and her sister both have bug eyes, fortunately I avoided that fate. Also, people with bug eyes often have deficient orbital rims. I tried pressing under my mom's eye once and there's nothing there!
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Earl: is CAS helpful in LF3 ? CAS -computer assisted surgery.
What you think about that ? What you know ? Have you ever asked a surgeon about that ?
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LOL I have more karma than anyone. I rock.
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Hi Earl, how is your sensation post-op? Have you regained full sensation? Did Sinn mention this much to you?
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LOL I have more karma than anyone. I rock.
And humble too! That's ok, you've earned it. Now that you mention it, you do have a lot of posts.
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Earl just post some f**king decent pictures... jesus christ
where?
i tried to get more info from him. if Dr Sinn uses navigation , etc. What I noticed, he has problem with eyes after surgery..he wrote something about it. he barely answer so I do not know how it really is
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where?
nowhere.
i tried to get more info from him. if Dr Sinn uses navigation , etc. What I noticed, he has problem with eyes after surgery..he wrote something about it. he barely answer so I do not know how it really is
What?!
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nowhere.
What?!
English is not Rico's first language. Earl's "eye problems" are aesthetic and were not caused by surgery. While the surgery helped, he still thinks they are too prominent.
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no problem. I read in english perfectly, only writing and speaking are little worse ;)
I never read all of his posts - too many. I just asked him about it and no answer...that's all. Somewhere I read his post about eyes...and I answered myself for him :) it's not about my english. I would have problem with this also in my primary with one who never can answer on simply questions... :( OK so now I know, but...
I'M ASKING 2ND TIME. EARL: DID YOU TALK TO DR SINN ABOUT NAVIGATION SYSTEM DURING SURGERY ? HOW HE KNEW THE BONE IS SET PROPERLY IF YOU BECAME SWELLED SOON AFTER SURGERY STARTED
Please also answer to Optimistic's question (a few posts above). I'm curious about it too
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English is not Rico's first language.
neither is mine.
Earl's "eye problems" are aesthetic and were not caused by surgery. While the surgery helped, he still thinks they are too prominent.
lol rico, what are you writing man. I thought he's describing post surgery problems like diplopia or other nerve-related issues.
...
I'M ASKING 2ND TIME. EARL: DID YOU TALK TO DR SINN ABOUT NAVIGATION SYSTEM DURING SURGERY ? HOW HE KNEW THE BONE IS SET PROPERLY IF YOU BECAME SWELLED SOON AFTER SURGERY STARTED
...
What has swelling to do with proper bone placement? Also good luck with Earl since it's greater chance that we'll see color images of loch ness monster, rather than seeing his stuff.
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no dipliplia etc, I meant something minor.... sorry for making chaos ;) or perhaps he had temporarly.. dunno... had he ?
What has swelling to do with proper bone placement?
You can't see the result during surgery. It's not surgery on jaw or lefort 1
Midface is much more difficult to set. Less reference points.
This is why some surgeons perform CAS on midface. Very well known surgeons with good opinions in Germany or Switzerland (mostly in these countries) or perhaps the others can do it manually ??.... but I spoke to someone from Germany who had CAS after bad first treatment - malar repositions needed and he told me they corrected it perfectly by using this method. CAS is not superior method, but many surgeons claim it helps. This is why I'm asking Earl about this
2-3 surgeons told me, there is too little movement to perform CAS
on the oher side, others says it's too little movement to do it manually ;)
Well known rule in maxfac specialisation says, better to undercorrect then to overcorrect
heh
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neither is mine.
lol rico, what are you writing man. I thought he's describing post surgery problems like diplopia or other nerve-related issues.
What has swelling to do with proper bone placement? Also good luck with Earl since it's greater chance that we'll see color images of loch ness monster, rather than seeing his stuff.
Because you it's like Rico says, you don't have a fest reference point. Less to work off. Once operation begins so does the swelling, meaning he can't tell how it's going to look without all the swelling. So he would presumably have to rely on exact movements planned out pre-op, and thus, Computer Assisted Surgery.
Earl did mention that Sinn made a practice operation on a cast of his skull before the real thing, so I'm guessing he did have exact movements in mind, and tested those out. Just how CAS might differ to what Sinn did I don't know. Perhaps this was CAS?
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Just how CAS might differ to what Sinn did I don't know. Perhaps this was CAS?
good question so we have to wait for Earl's answer.
I wrote PM asking him to look at this thread...I hope he is gonna answer
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Because you it's like Rico says, you don't have a fest reference point. Less to work off. Once operation begins so does the swelling, meaning he can't tell how it's going to look without all the swelling. So he would presumably have to rely on exact movements planned out pre-op, and thus, Computer Assisted Surgery.
Earl did mention that Sinn made a practice operation on a cast of his skull before the real thing, so I'm guessing he did have exact movements in mind, and tested those out. Just how CAS might differ to what Sinn did I don't know. Perhaps this was CAS?
The swelling does not set in for a couple of hours. I guess with a coronal incision, there are more reference points as well.
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dr. sinn didnt use CAS during thr surgery
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dr. sinn didnt use CAS during thr surgery
any other things connected with planning / measurements ? how he was sure about postop effect ?
Optimistic's question: Hi Earl, how is your sensation post-op? Have you regained full sensation? Did Sinn mention this much to you?
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any other things connectec with planning / measurments ? how he was sure about postop effect ?
A max-fac textbook I have says upper mid face advancement has MORE PREDICTABLE RESULTS than implants or alloplast onlay augmenation, but REQUIRES MORE PLANNING.
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more predictible does not sounds like 100% or even 99%
upper midface ?
tell me the title of that book , please
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any other things connectec with planning / measurments ? how he was sure about postop effect ?
Optimistic's question: Hi Earl, how is your sensation post-op? Have you regained full sensation? Did Sinn mention this much to you?
i have regained full sensation.only planning tools was a wax bite,teeth mold and skull model made
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Thank you ,last questions from my side:
teeth mold and skull model made
Can you write something more how he did it ? what he used during surgery - what kind of measurements tools
How you assess (do you find) the effect ? ok, very good, perfect ?
Changing position of zygoma and maxilla / moving orbital rims have not given you enough for your eye issue - why ? it was not planned ?
Full feeling back - you mean 100% of feeling, not 99.9%...just how it was before surgery? after surgery how much it was dimnished ?
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Hey Earl25,
First of all, thanks for sharing your story. I've really enjoyed reading it and I can see that it has interested a lot of people. My twin and I are in the same boat...perfect bite but flat upper face. My twin sister has it worse than I do, actually. She had teeth extracted when she was younger, maybe that's why. It seems like you've done a lot of research on the subject; do I understand correctly that this modified type of surgery is really the only treatment for people who don't have malocclusion? I've seen pics of people who got cheek implants and I don't think its a good look.
Meesh
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Thank you ,last questions from my side:
Can you write something more how he did it ? what he used during surgery - what kind of measurements tools
How you assess (do you find) the effect ? ok, very good, perfect ?
Changing position of zygoma and maxilla / moving orbital rims have not given you enough for your eye issue - why ? it was not planned ?
Full feeling back - you mean 100% of feeling, not 99.9%...just how it was before surgery? after surgery how much it was dimnished ?
What the f**k Rico, Earl isn't a f**king doctor. Go ask Sinn yourself.
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Hey Earl25,
First of all, thanks for sharing your story. I've really enjoyed reading it and I can see that it has interested a lot of people. My twin and I are in the same boat...perfect bite but flat upper face. My twin sister has it worse than I do, actually. She had teeth extracted when she was younger, maybe that's why. It seems like you've done a lot of research on the subject; do I understand correctly that this modified type of surgery is really the only treatment for people who don't have malocclusion? I've seen pics of people who got cheek implants and I don't think its a good look.
Meesh
I've seen your pics Meeshi you definitely don't need this surgery so don't worry about it. You are a bit deficient in the maxillary area that covers a lefort 1 osteotomy (the maxilla under the nose).
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OK Lazlo ... I'm gonna ask Sinn if Earl's surgery was enough successful ;) good thinking
Generally I'm gonna to talk about Earl case with him..not about mine :D
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OK Lazlo ... I'm gonna ask Sinn if Earl's surgery was enough successful ;) good thinking
Generally I'm gonna to talk about Earl case with him..not about mine :D
I already know it was successful cause Earl told us and Sinn told me he did it on a patient and the patient was very pleased.
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Hi Earl!
I have decided to go through with a Lefort III after years of deliberation. Your story is what gave me the bravery to finally make the decision.
I would just like to ask you how you got in contact with Dr Sinn. I have emailed his office but I haven't gotten a reply.
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If you have time, then I think wait to see how these new osseoconductive implants will pan out. They should be here in 2016? They are attached with resorbable sutures so no hardware required. Customized to each patient from CT scans. Soft tissue modeling is almost there. I'd guess it won't be more than 5 years before this product starts showing very promising results with some patients to back it up.
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Hi Earl!
I have decided to go through with a Lefort III after years of deliberation. Your story is what gave me the bravery to finally make the decision.
I would just like to ask you how you got in contact with Dr Sinn. I have emailed his office but I haven't gotten a reply.
So call them.
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There was some discussion earlier on in this thread about the suraorbital rims, eyebrow ridge area, and possible solutions. Has Earl25 or anyone else found anything out about this?
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The complete supraorbital ridge/glabella area can be fractured/mobilized as a block and moved forward. Even the complete forehead including the supraorbital ridge/glabella can be moved forward. It does require a full coronal incision. (I saw an example of a glabella implant in which a pretrichial incision was used (in front of the hairline). Not sure if this could be used too to mobilize the complete supraorbital ridge and move it forward. Might not be the case. The complete forehead could certainly not be mobilized through such an incision).
Picture to illustrate (not for the faint of heart, so if a little bit of blood freaks you out don't look at this: http://img.medscapestatic.com/pi/meds/ckb/62/8062tn.jpg)
I doubt these procedures will be performed on anyone purely for aesthetic reasons, unless suffering from a syndrome/deformed though.
I stumbled upon an example of a lateral orbitotomy in which the lateral orbital wall had been fractured/mobilized. These type of procedures are mostly used to remove tumors, etc. though. (The osteotomized segment is put back in the original position). Insicions that I saw were over the temple, next to the canthus extending quite far into the temple, or in the eyelid crease and extending next to the canthus (and most were quite visible). Again: I very much doubt anyone would want to perform such a procedure to give you some nice augmentation at the lateral orbit ;D, but please enlighten me if I'm wrong.
This was the incision they used (no bloody mess here: ) http://www.ijournalhs.org/viewimage.asp?img=indianjhealthsci_2014_7_2_125_148817_f3.jpg
Some info about the surgery: http://www.ijournalhs.org/article.asp?issn=2349-5006;year=2014;volume=7;issue=2;spage=125;epage=129;aulast=Balihallimath
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I'm gonna surprise You.
Yes, some surgeons (but minority) do coronal approach in midface surgeries just for aesthetic reasons.
2 surgeons offered me this for zygomatic reposition.
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Wow, thanks for the great info, hellohello. That seems pretty invasive. With that said, I'll bet the biggest thing here is just that these surgeries are largely unknown and fairly stigmatized. If they were more common it probably wouldn't be as big a deal to surgeons.
Still, seems like too much to go through purely for the sake of aesthetics.
I guess the only real options for the brow ridge are then those 3d printed bony implants, or silicon. Are the bony ones really a possibility for this area though?
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What's with this brow ridge hype? Maybe I don't get it because I have a brow ridge but some of my friends who are way better looking than me don't have brow ridges. I think it's too invasive of a surgery fir that.
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i wrote 3-4 page but i want to ask why. U cant get lefort 1 or jaw surgeries for fix jaw. Lefort 2 and lefort 3 for what. Any before after photo. I can only find internet people has very deformities. Why normal people get lefort 2 or 3
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LF3 makes face wider ? hmmm I thought it's just to move the bone forward... maxillary and zygomatic..I even can't understand how it could make you zygomatic arch more prominent
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jesus christ. Whole thing just gets stranger and stranger. 17k usd for a lf3 performed in an OFFICE by a man with no legit medical qualifications. Earl you deserve a medal for having the balls to do that. ;D
Earl looks great. The best midface result I've ever seen.
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If Earl has balls because he underwent LF3, then what about my ones ;) ?
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jesus christ. Whole thing just gets stranger and stranger. 17k usd for a lf3 performed in an OFFICE by a man with no legit medical qualifications. Earl you deserve a medal for having the balls to do that. ;D
Dr Sinn is one of the leading max fac surgeons in the world who has worked on several text books. I've confirmed this with several other surgeons I've spoken with.
The operation is performed in his CLINIC which is setup properly to handle the operations, however certain procedures such as a coronal incision require a hospital stay.
Not sure if you're trolling but to say he has no legit medical qualifications is insane.
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jesus christ. Whole thing just gets stranger and stranger. 17k usd for a lf3 performed in an OFFICE . . . Earl you deserve a medal for having the balls to do that. ;D
And then, today:
Double Jaw ....cardiac arrest
« on: Today at 01:08:30 AM »
Quote
I had my double jaw surgery after a year of braces. I went into cardiac arrest during surgery and a code blue was called. I Woke up in the ICU (REALLY RARE). I I have to go back to basically do what I did the first time around. Has anyone gone through this?!
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crazy people
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Earl looks great. The best midface result I've ever seen.
didn't he complain that his midface looks "too compact" after?
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he mean he get lefort 3 in a office and someone went into cardiac arrest while takingjaw surgery. he mean earl or who get lf3 in office has great big balls.
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lol
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Ilovethemoon,
You are making assumptions that are not accurate. I do not work for any medical professional.
I am pretty sure that I have consistently pointed out that Dr. Sinn is an excellent dental trained surgeon, with an excellent reputation, who has done some innovative jaw surgery work and is well published and very well regarded by his peers.
Leaving that aside, the reality is that some surgeries are inherently low or lower risk and are perfectly appropriate for an office based surgical suite. Other types of surgeries should be done in a fully staffed hospital environment, with all of the supporting services, including blood supply for emergency transfusions, cardiologists available, anesthesiologists on staff, rather than a CRNA, and an available ICU.
I think the patient who coded - - is evidence of the merits of the observations in the previous paragraph.
Thinkingme - - identified the issue.
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I cheerfully plead guilty :) to having an acquaintance with a number of surgeons, including plastic surgeons, living in at least four states and two different countries ! I also know a couple of max-facs and oral surgeons. One of them teaches that stuff to dentists at a University.
But you are casting aspersions at the messenger - - not the message .
The recent portion of the message string was focused on the risks of surgery in an office surgery center verses in a hospital - - depending on the scope of the surgery.
I think it would be more appropriate and productive if we could focus on that subject, since one of the recent posts reported a cardiac arrest during a routine jaw surgery.
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I cheerfully plead guilty :) to having an acquaintance with a number of surgeons, including plastic surgeons, living in at least four states and two different countries ! I also know a couple of max-facs and oral surgeons. One of them teaches that stuff to dentists at a University.
But you are casting aspersions at the messenger - - not the message .
The recent portion of the message string was focused on the risks of surgery in an office surgery center verses in a hospital - - depending on the scope of the surgery.
I think it would be more appropriate and productive if we could focus on that subject, since one of the recent posts reported a cardiac arrest during a routine jaw surgery.
You're such a weasel and oh so full of s**t. First you go around saying "17k usd for a lf3 performed in an OFFICE by a man with no legit medical qualifications."
Then when called out on it you start singing his praises for how you've always said he's great and it's just about "office" vs local hospital in your mind. Yeah, f**k off shill.
Why do you insist on calling it an office? It's a fully featured operating theatre at his own private clinic which is nearby to a hospital. Dr Sinn takes into account the severity of the operation as to whether or not it's necessary to do locally or at the hospital. For example, if I want a coronal incision I can't do that at the clinic. It's performed in a room full of medical professionals including Dr Sinn, an anaesthetist, and nurses who are looking after you. Given we're talking about cutting bone and not open heart surgery I'm pretty confident in their ability to spot if something wrong happens and send me to the hospital.
And no legit medical qualifications? wtf are you even on about? First of all, HE'S A f**kING DOCTOR. Secondly, he's one of the most highly regarded surgeons there is. He's a pioneer in his field. Your statement is as dumb as trying to use a lack of a business degree against the many billionaires out there - only Dr Sinn has actually studied, is fully qualified, has published numerous papers, and contributed several innovations to the field. So I'm not sure if you expect someone of his calibre to go back to uni to study a worthless degree (what degree would you want anyway?) just to satisfy whatever strange desire it is.
Most max fac surgeons are dentists who have specialised in the field with additional work in plastic surgery.
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You're such a weasel and oh so full of s**t. First you go around saying "17k usd for a lf3 performed in an OFFICE by a man with no legit medical qualifications."
Ah... Optimistic - - how about an apology for the name calling ? Check your facts. Tumerican is the member of this forum who wrote the quote that you attributed to me. But that kind of name calling and cursing is not appropriate for this type of forum - - - regardless of who is your intended target.
And no legit medical qualifications?
Again - - if you are going to vigorously curse people on public forums - - then common decency would suggest that you have an obligation to get the right target for your anger and outrage.
You might consider taking your message down ?
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Now... assuming you can get around to engaging in a non-cursing / non name-calling civil conversation, then it would likely be useful to have a discussion about office based surgery centers verses hospital based surgeries.
For example, having a full-up hospital near-by with a pre-negotiated protocol and standing arrangements for urgent patient transfer would mitigate some of the risks for major surgery in the office based surgery center.
If you would like to have THAT discussion in a civil way, then I would be happy to continue that discussion. I would request that the personal attacks and cursing not be repeated.
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Ah... Optimistic - - how about an apology for the name calling ? Check your facts. Tumerican is the member of this forum who wrote the quote that you attributed to me. But that kind of name calling and cursing is not appropriate for this type of forum - - - regardless of who is your intended target.
Again - - if you are going to vigorously curse people on public forums - - then common decency would suggest that you have an obligation to get the right target for your anger and outrage.
You might consider taking your message down ?
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Now... assuming you can get around to engaging in a non-cursing / non name-calling civil conversation, then it would likely be useful to have a discussion about office based surgery centers verses hospital based surgeries.
For example, having a full-up hospital near-by with a pre-negotiated protocol and standing arrangements for urgent patient transfer would mitigate some of the risks for major surgery in the office based surgery center.
If you would like to have THAT discussion in a civil way, then I would be happy to continue that discussion. I would request that the personal attacks and cursing not be repeated.
Epic fail. I apologise then. That sort of undermines the entire premise of my post.
Regardless, I still stand by my points about it not being an "office", nor unsafe, and that he's a top quality surgeon etc etc.
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Epic fail. I apologise then. That sort of undermines the entire premise of my post.
Regardless, I still stand by my points about it not being an "office", nor unsafe, and that he's a top quality surgeon etc etc.
No problem !
It is behind us.
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Listen, first I trust Earl, he's very very smart and vigilant and had Sinn's entire history checked by PI. Second, I visited Dr. Sinn and he was incredibly comprehensive. He was amongst the teaching faculty and trained ARNETT who everyone considers a maverick. Arnett has praised Sinn to more than one forum member as a magician who can do anything.
This business about Sinn not having a medical degree is ridiculous. He is an EXPERT in the medical understanding of the jaw and craniofacial deformities. That's all he does and specializes in. He said himself that a PS is while able to do jaw surgery is in no way specialized as much as a maxillofacial surgeon is who specializes in that area of the face. A medical degree is pointless for such a surgeon. Who would you want to get your car fixed by, some dude who graduated with a two year college degree in automotive repair or an old guy who has been fixing cars his entire life and even designed and built some of the cars you might need repaired even though he never had any degree. Who would you trust with your car. This analogy, while imperfect, broadly describes Sinn.
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Sinn for surge is experienced. But remember, every surgeon gets experience often on failures too. There is no surgeon without failure. Don't be fool
My surgeon made a lot of publications - above 100 and he didn't predict little thing
now I speak with him like Prof to Prof to resolve my problem. I spent many hours to draw some models to help me and him to resolve my problem
conflict in muscles working... surgeries on midface are the most difficult
Of course he is boss here, i only give him my observations. Perhaps some of them will be helpful
I found about 5 functional relationship and I had to draw about 10 models to describe this ;)
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No surgeon can ever make you good as new.
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Can you still get some cheek augment after a mod L3, like say a small custom implant or fillers?
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Can you still get some cheek augment after a mod L3, like say a small custom implant or fillers?
If you can get custom jaw implants after bsso (I've been told by respected surgeons you can) then there should be no reason why not.
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Turvey recently published a paper (http://www.ncbi.nlm.nih.gov/pubmed/26166028) on 13 patients who had modified LeFort 3. That's still not a lot of course but another surgeon to consider if interested.
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If you can get custom jaw implants after bsso (I've been told by respected surgeons you can) then there should be no reason why not.
I was thinking since the zygomatic bone is (partly) mobilized and moved. It might be problematic to insert an implant or perform another osteotomy on that bone a second time.
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I was thinking since the zygomatic bone is (partly) mobilized and moved. It might be problematic to insert an implant or perform another osteotomy on that bone a second time.
i see what you are saying. I'm not sure about a second osteotomy but i think an implant or fillers after a mod lefort 3 is possible for sure. it is really only a small section of the zygomatic arch that is mobilized in a mod lefort 3 as far as i know. the cut is made maybe less than a cm past the malar prominence on the zygomatic area. the whole arch or generally even the majority of the arch isn't mobilized because the amount of muscles (strong muscles at that) that attach to the zygomatic arch. or at least this is what I've been told. so there will be a slight step off between the back of the malar prominence and the zygomatic arch where advancement was made. which i guess means that a custom implant would just have to account for that step off or for however that step off heals. apparently they can smooth themselves out to a degree.
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Are you referring to Dr. Douglas Sinn in Dallas?
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yes
Sorry, forgot to quote what you said. You responded that Dr. Sinn did your surgery, but I'm wondering if you mean Dr. Douglas Sinn in Dallas. If so, I may want to reach out to him for my case. I have a very depressed mid face that cheek implants didn't really help at all. Also very weak orbital area. If you recommend him, I'll give him a call.
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Sorry to revive this topic. Earl I'm not sure if you got my email but I'm just wondering, where were your problem areas for swelling? Did the swelling in your upper eyelids last long? Thanks.
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Sorry to revive this topic. Earl I'm not sure if you got my email but I'm just wondering, where were your problem areas for swelling? Did the swelling in your upper eyelids last long? Thanks.
I know from talking to various patients this is a very mild operation as far as recovery is concerned. Most people look fine and are back to work in two weeks.
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Sorry to revive this topic. Earl I'm not sure if you got my email but I'm just wondering, where were your problem areas for swelling? Did the swelling in your upper eyelids last long? Thanks.
I replied to your email. Check your spam folder
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I replied to your email. Check your spam folder
Nothing, try pming.
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Earl,
I'll be getting jaw surgery in the future. After that, I was planning on doing custom midface implants rather than a modified lefort iii. I don't need it, but it would help my aesthetics. Do you agree that a similar outcome can be gotten from implants? This is what Eppley has to say about it:
"Q: Dr. Eppley, Since you’re a maxillofacial surgeon, you know about the LeFort III Osteotomy that is done in cases of severe midfacial hypoplasia where the patient usually suffers from a syndrome like Crouzon’s.
However, many say that such a procedure,although extremely invasive and dangerous in some cases, could theoretically improve the appearance of a non-deformed patient dramatically.
Since almost no maxillofacial surgeons would perform this osteotomy on patients that have no bite or jaw problems, are there any cosmetic operations that can be done on a non-syndrome patient and replicate the aesthetic outcomes of a Lefort III osteotomy?
A: The effects of a LeFort III osteotomy are to bring forth the lower orbital rim, nose bridge and base and maxilla. This type of change can be replicated by a custom only implant placed over the exact same facial areas. While previously not possible, the use of custom implant design from a 3D CT scan make possible a midface implant that can essentially replicate what a LeFort III osteotomy can do. (minus the occlusal changes) I have made several of these midface implant designs recently and they are inserted through an intraoral incisional approach. Only the augmentation of the nose needs to be done separately through a closed rhinoplasty approach.
Dr. Barry Eppley"
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Earl,
I'll be getting jaw surgery in the future. After that, I was planning on doing custom midface implants rather than a modified lefort iii. I don't need it, but it would help my aesthetics. Do you agree that a similar outcome can be gotten from implants? This is what Eppley has to say about it:
"Q: Dr. Eppley, Since you’re a maxillofacial surgeon, you know about the LeFort III Osteotomy that is done in cases of severe midfacial hypoplasia where the patient usually suffers from a syndrome like Crouzon’s.
However, many say that such a procedure,although extremely invasive and dangerous in some cases, could theoretically improve the appearance of a non-deformed patient dramatically.
Since almost no maxillofacial surgeons would perform this osteotomy on patients that have no bite or jaw problems, are there any cosmetic operations that can be done on a non-syndrome patient and replicate the aesthetic outcomes of a Lefort III osteotomy?
A: The effects of a LeFort III osteotomy are to bring forth the lower orbital rim, nose bridge and base and maxilla. This type of change can be replicated by a custom only implant placed over the exact same facial areas. While previously not possible, the use of custom implant design from a 3D CT scan make possible a midface implant that can essentially replicate what a LeFort III osteotomy can do. (minus the occlusal changes) I have made several of these midface implant designs recently and they are inserted through an intraoral incisional approach. Only the augmentation of the nose needs to be done separately through a closed rhinoplasty approach.
Dr. Barry Eppley"
There's a handful of surgeons that will perform what you're calling a 'modified lefort iii'. It is not as invasive as a traditional Lefort III.
To answer your question though, I guess implants can probably replicate the effect. Weigh up the pros & cons before making your decision.
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Hi Earl
Did you notice any difference in nasolabial folds?
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I imagine this procedure to basically be a guarantee to produce dry eye syndrome. Incision along the eyelid will cause so much inflammation and disrupt tear flow/ oil secretion of the glands. I can’t see how this could not be the case and might lead to severe problems down the road.
There is no cure for dry eye and it is a living hell living with it.
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Hey Earl, any side effects 6 years later? reading your posts it seems like your existing asymmetry became more noticeable?
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I replied to your email. Check your spam folder
Have you blocked PM's?
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I imagine this procedure to basically be a guarantee to produce dry eye syndrome. Incision along the eyelid will cause so much inflammation and disrupt tear flow/ oil secretion of the glands. I can’t see how this could not be the case and might lead to severe problems down the road.
There is no cure for dry eye and it is a living hell living with it.
f**k I wanna know if there's a risk of this as well!?
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I imagine this procedure to basically be a guarantee to produce dry eye syndrome. Incision along the eyelid will cause so much inflammation and disrupt tear flow/ oil secretion of the glands. I can’t see how this could not be the case and might lead to severe problems down the road.
There is no cure for dry eye and it is a living hell living with it.
Could this also happen with zso?
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Could this also happen with zso?
No
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No
but it could with mfl3? I haven't heard of any complaints on that score from the 2-3 people who have had it.
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but it could with mfl3? I haven't heard of any complaints on that score from the 2-3 people who have had it.
Not every surgeon uses cathotomies for lf3.
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Have you blocked PM's?
Yeah he did
Did he post any pics of his lefort 3 in this thread btw?
@earl25 any before and afters u can provide
This is a high risk surgery imho
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FWIW, I woke up from my DJS with aggravated dry eye (I have DES) for about 2 weeks but it has now returned to normal. Turns out in extremely rare cases (only 2 reported cases) a lefort-1 can cause dry eye: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974743/ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974743/)
It’s made me think twice about a ZO. I’d imagine it’s even likelier with a MLF3. This may only be an issue for people who have dry eye already.
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heres a cropped b4 and after
[attachment deleted by admin]
why did admin delete the before after pics?
THIS IS LITERALLY CRUCIAL FOR ALL OF US!
how else are we to know what the results were like if no pics exist, we can't go by word of mouth only... @kavan
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Most likely due to earl's request. I understand your frustration but if someone wants to preserve their anonymity then it's really their choice. They don't owe you anything.
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Most likely due to earl's request.
Yes.
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why did admin delete the before after pics?
THIS IS LITERALLY CRUCIAL FOR ALL OF US!
how else are we to know what the results were like if no pics exist, we can't go by word of mouth only... @kavan
To the best of my understanding Earl does not want to show his pics and the one he once did show was said to be a small postage stamp size. He doesn't want to be bothered with PMs either.
Although I don't mean to be his 'spokes person' here, I will say that Earl did his OWN research about the mod L3. He tracked down academic papers and then he consulted with MANY doctors about this until he found Sinn. He also could have had orbital rim implants but he was very much against implants and wanted a bone cut surgery to advance his lower orbital rim area and his cheek bone area. He relayed (maybe here, maybe elsewhere) that people used to make FUN of him because he had facial problems, one of which was the BUG EYES. Extreme BUG EYES. So he pursued a cranio-facial surgery to advance the area that implants could have advanced BUT he did not want implants. So instead he pursued the modified L3 and to this regard he spent a LONG TIME researching it and CONSULTING around the world (or part of the world) and he took what ever RISKS that came with the surgery. Some docs told him blindness was a risk. So, he kept consulting around until he found one that said blindness was a LOW risk (in the hands of the doc who did the surgery for him).
Earl was SMART enough to do HIS OWN research. But ever since he got that surgery, it just seems to attact people who are NOT as smart as him and who need to be SPOON FED about the surgery he got 'because' they want it. Again, he had EXTREME BUG EYES and who the hell knows if some of the types who want this surgery have the extent of what he had. Another thing about him was he was a 'DIE HARD' against implants whereas there are implants (orbital rims) that can address prominent eye. So, there really is no impending need for people to have this type of surgery UNLESS they have extreme prominent eye and wish to avoid implants at any costs.
Other than that nothing (except low IQ) precludes OTHERS from doing what earl did--which was his OWN RESEARCH and CONSULTING AROUND--if they wish to pursue the type of surgery he got. I'm sure he would AGREE, that it is NOT his 'task' to show you his photos, coach you on this surgery or SPOON FEED people info just because he got this surgery.
As to admin deleting pics, this is done after some time passes and it's done sometimes to cut down on bandwidth and others via request.
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Most likely due to earl's request. I understand your frustration but if someone wants to preserve their anonymity then it's really their choice. They don't owe you anything.
BINGO!
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It is not as invasive as a traditional Lefort III.
On TV a few weeks ago, there was craniofacial maxfac program, and they performed a traditional le fort 3 on a guy with a syndrome and showed the op on tv. It was pretty intense.
https://www.abc.net.au/catalyst/face-surgeons-inside-craniofacial-unit/11564724
(this might be geo-blocked)