jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: boyo on August 07, 2016, 03:48:46 AM
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Was combined with a canthoplasty.
what you guys think of the result? I'm trying the figure out if i should get this or just go suicidal mode and do a mod LF3.
(http://tabanmd.com/wp-content/uploads/2014/08/Eyelid-Cosmetic-Surgery-in-Los-Angeles.jpg)
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So strange, I asked myself the exact same question today.
I was planning to go to Dr Taban for orbital rim implants and whatever soft tissue changes I need but after reading Lazlo say he is going for the lefort 3, part of me feels like I might be missing out if I don't try this.
I have seen a full lefort 3 on one of Sailer's patients but it didn't improve the eyes, the patient still needed canthoplasty and maybe other things. I saw the patient in person, not in photographs.
Hmm actually it could have something to do with the SHAPE of the orbital rims, not just how far back they are, if the rims start too low down then if you advance them the eyes still won't look right.
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So strange, I asked myself the exact same question today.
I was planning to go to Dr Taban for orbital rim implants and whatever soft tissue changes I need but after reading Lazlo say he is going for the lefort 3, part of me feels like I might be missing out if I don't try this.
I have seen a full lefort 3 on one of Sailer's patients but it didn't improve the eyes, the patient still needed canthoplasty and maybe other things. I saw the patient in person, not in photographs.
[Hmm actually it could have something to do with the SHAPE of the orbital rims, not just how far back they are, if the rims start too low down then if you advance them the eyes still won't look right.
Taban told me you'll be needing both a canthoplasty and added vertical/anterior orbital bone support when trying to lift the lower eyelid. If your orbital floor is convex-shaped or low-set i guess you can get them filled with grafts when doing the LF3 to get that necessary vertical support. This explains why earl still isn't happy with his eyes, even after a LF3.
I would almost certainly do a mod LF3 if Lazlo manage to go through the surgery without vision problems or muscle paralysis. I suspect the risks are somewhat exaggerated when executed by experienced surgeons. I wonder if any of Sinns LF3 patients had any problems at all post-op?
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What do you think about that Taban result?
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taban is a good doctor. he did my orbital decompression and ectropion repair
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taban is a good doctor. he did my orbital decompression and ectropion repair
I didn't know you had decompression, I know he does that and wouldn't be surprised if he recommended it to me. Are you happy with your eyes now?
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I didn't know you had decompression, I know he does that and wouldn't be surprised if he recommended it to me. Are you happy with your eyes now?
not really but its not a knock on taban or sin. i just have naturally very messed up eyes/ bone structure . naturally huge eyes and small sockets /small bone structure
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Two major things are concerning me:
Is the result of a modified lefort 3 stable/durable? (5 or 10 years later?)
Bovine, cadaver or hip bone is placed behind the advanced bone to hold it. Could this cause any problems (infection) years after the procedure?
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Two major things are concerning me:
Is the result of a modified lefort 3 stable/durable? (5 or 10 years later?)
Bovine, cadaver or hip bone is placed behind the advanced bone to hold it. Could this cause any problems (infection) years after the procedure?
Plates hold things together in the short and long term. In the long term the graft bone (but not HA) will get replaced with your own bone. It's probably no less stable than le fort 1.
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Plates hold things together in the short and long term. In the long term the graft bone (but not HA) will get replaced with your own bone. It's probably no less stable than le fort 1.
Rate the implant result itt.
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Rate the implant result itt.
Very good, but the outer canthus could be higher. I've been told it can be raised by up to 2mms. I suppose there are limitations. It may warp the eye shape. Who's the surgeon?
Anyway, I am not sure if I'll bother with any of this stuff. My upper midface cheekbones are very flat. But my face is very wide so my eyes look tiny. Building up the upper midface would make them smaller. Is your paresthesia getting any better?
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Can anyone please ask sinn if the result of a modified lefort 3 is permanent or if the advanced midface bones resorb due to the higher pressure of the soft tissue/muscles etc. (It is not the same as a natural forward grown face imo but I am no surgeon).
No surgeon will say that his procedure is anything but the best option possible
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I do not really know if a modified Lefort 3 is a good idea.
Lazlo, you have seen before and after pics. Is the final result of a modified Lefort 3 similar to this result of a ZSO?
http://www.intechopen.com/source/html/48013/media/fig27.png
This is exactly what I am looking for. Is it not a spectacular result?
Is there much difference in the outcome between this zso and a mod. lf3 without moving the jaw?
Is it true that a mod. LF3 makes the face also wider?
Thank you!
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I've probably seen the same photos you have and I think calling them "nasty scars" is a pretty dramatic over exaggeration. Light, fine scars with a bit of discoloration would probably be more appropriate. And they photos you've seen were within the first year of surgery I assume. Lots of people have facial scars from chicken pox or falling as a child that don't even mildly take away from their attractiveness. I would say the scarring from this surgery with Dr. Sinn is less noticeable than something like that.
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Dr. Sinn's LEFORT III leaves huge scars on the side of eyes. You'll always have that and it will look like you're a bit messed up. At least that's what I saw on some examples. So I'm debating if its worthwhile.
you can try scar after care stuff like silicone gel,silicone strips,msm,dmso etc
i didnt
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is that picture above a ZSO? I have seen a modified lefort three, it just made the cheeks more full the apple of the cheeks become fuller.
"Figure 29. A 32 years woman with malar deficiency, No orthognathic surgery was performed in this case. The patient desired definition of the cheekbones with zygomatic sandwich osteotomy (ZSO) (left) preoperative view, note the triangular shape of she’s face; (right) 18 month postoperative view."
So this is more or less the result we would get from a mod. LefortIII (midface advancement between 5-7mm)?
(I like the result).
Or what is the difference between a ZSO and a mod. LefortIII? Anyone knows? Thanks.
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nope this looks way better than what i saw the modified lefort III to look like.
isn't the ZSO just the thing zarinnbal does?
Yes Zarrinbal / Triaca / Brusco / Cesar Guerrero and maybe a lot of other docs.
A ZSO gives without any doubt forward and lateral projection. I do not understand why some users on this Forum claim it gives only lateral projection.
Dr. T. did not show me before and after pictures, because of patient privacy. What a pity.
But he told me that you can clearly see a difference from a zso also WITHOUT any bone substitute material.
Normally he uses an iliac crest graft (sandwich tecnique-not as an ONLAY!). Then you have a big difference he told me. Similar to the picture above I think (or even more).
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Yes Zarrinbal / Triaca / Brusco / Cesar Guerrero and maybe a lot of other docs.
A ZSO gives without any doubt forward and lateral projection. I do not understand why some users on this Forum claim it gives only lateral projection.
Dr. T. did not show me before and after pictures, because of patient privacy. What a pity.
But he told me that you can clearly see a difference from a zso also WITHOUT any bone substitute material.
Normally he uses an iliac crest graft (sandwich tecnique-not as an ONLAY!). Then you have a big difference he told me. Similar to the picture above I think (or even more).
We have to ask Earl if he has achieved a similar result from his mod. lf3? PLEASE NOTICE THE CAMERA ANGLE.
If not then maybe a ZSO is the answer. Sorry for my bad enlish it is not my first language.
Triaca told me zso gives minimal anterior projection, only lateral.
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Must see how long the girl is out of her surgery. ZSO gives long swelling. I had a ZSO asked for maximum projection, have almost no extra anterior projection and when someone says laterally it gives shadows, that is about it. Definitely not worth the surgery.
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I do not understand why some users on this Forum claim it gives only lateral projection.
LOL perhaps because they actually experienced it first hand. I saw another guy Bald88 that said here he had to have extra surgery to get anterior projection after ZSO. It is not different for me. Except that I do not know yet if I want to undergo surgery again. But I have the same thing: just hardly any forward projection, still flatness after ZSO. You can not force a procedure to do what it can not do.
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Must see how long the girl is out of her surgery. ZSO gives long swelling. I had a ZSO asked for maximum projection, have almost no extra anterior projection and when someone says laterally it gives shadows, that is about it. Definitely not worth the surgery.
The girl is 18 month out of her surgery. Which surgeon did your ZSO? I am sorry that you are not happy with your result, but what would you suggest then (if not a ZSO)?
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This paper describes 3 surgical tecniques for "malar augmentation."
According to this paper, a ZSO gives also anterior projection!
http://images.google.de/imgres?imgurl=http%3A%2F%2Fwww.intechopen.com%2Fsource%2Fhtml%2F48013%2Fmedia%2Fimage16.jpeg&imgrefurl=http%3A%2F%2Fwww.intechopen.com%2Fbooks%2Fa-textbook-of-advanced-oral-and-maxillofacial-surgery-volume-2%2Fadvanced-adjunct-orthosurgical-esthetic-procedures&h=468&w=473&tbnid=v0PCJ3fBbmRlwM%3A&docid=mut3qcrEzHLq9M&ei=Ka2wV63aFYfzUKOzm5AL&tbm=isch&iact=rc&uact=3&dur=474&page=1&start=0&ndsp=19&ved=0ahUKEwjtkvHxucHOAhWHORQKHaPZBrIQMwg8KBAwEA&bih=673&biw=1366
Surgical tecniques
Zygomatic arch osteotomy:
A subperiosteal flap is raised to expose the ascending malar buttress and the zygomaticomaxillary suture. The position of an oblique sagittal cut is selected by deciding whether augmentation should include any of the anterior buttress or whether it
should be totally lateral to zygomaticomaxillary suture line. The cut is then made with a sagittal
reciprocating saw starting from the inferior portion of the zygomaticomaxilary suture to the
notch of both lateral orbital rim and malar zygomatic process. A previously selected graft may
now be placed between the two segments. The result is an increase in interarch width (zygionzygion).
Zygomatic sandwich osteotomy (ZSO):
To solve some problems, modifications of zygomatic
arch osteotomy technique have been presented. Mommaerts et al [81]modified Powell’s
technique by connecting a vertical with a semihorizontal osteotomy which both transect the
maxillary sinus, thereby maximizing anterior as well as lateral augmentation.
Zygomatic Sagittal Split Osteotomy (ZSSO):in this technique the zygomatic arch is isolated
from its temporal origin to its zygomatic insertion both on its lateral and medial surfaces Using
a waver sewer, a sagittal full thickness osteotomy of the zygomatic arch is performed (Fig.
26).Later, 2 separate partial thickness osteotomies: one on the arch’s osteotomies are connected
with the previously released sagittal osteotomy. After correction of the zygomatic arch
according to presurgical programs. Stabilization is achieved using bicortical titanium screws.
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I heard the masseter muscle would interfere with Z-arch osteotomies, looking at the anatomy I don't quite see how but what do I know?
(http://familychiropracticstettler.ca/wp-content/uploads/2013/06/TMJ-muscles.jpg)
Anyway, I am getting work done to my eye area but how will a ZSO interfere, should I focus on one area before the other or is it no matter?
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Was combined with a canthoplasty.
what you guys think of the result? I'm trying the figure out if i should get this or just go suicidal mode and do a mod LF3.
(http://tabanmd.com/wp-content/uploads/2014/08/Eyelid-Cosmetic-Surgery-in-Los-Angeles.jpg)
Why dont I notice any difference except his eyes look a little more almond shaped afterwards? IMO his eyes looked fine to begin with, he doesn't even have bags under his eyes (like I do >:( )
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You do not notice any appreciable difference because whatever difference is there - - is so subtle - - that it would almost be dishonest to say you do!!!
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i mean this difference could almost be achieved through him squinting every so slightly. so yeah that looks better. if he's not squinting at all (which i doubt) then yeah good result.
Lazlo - - good result for the canthoplasty ? or good result for the orbital rim implant ?
The rim implant "result" is almost non-detectable. The change in the eyes is likely 100% due to the canthoplasty.
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He had horrendous scleral show befor.
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He had horrendous scleral show befor.
lol "horrendous" that's a little harsh wouldn't you say?? That's a term I would reserve for something so disfiguring that it is life altering. It most certainly didnt hurt this guy, hes doing just fine, scleral show and all.
(http://stupidcelebrities.net/wp-content/2011/11/robert-pattinson.jpg?e83a2c)
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(http://tabanmd.com/wp-content/uploads/2014/08/Eyelid-Cosmetic-Surgery-in-Los-Angeles.jpg)
I think that, for this person, this is a very nice result. I have some scleral show that I don't think works for me. I don't want to eyes to get much smaller - there are tradeoffs with everything. I think that on some people scleral show conveys a certain tiredness.
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Another question: an user told me that the under eye hollows become more prominent because of a zso. Is this usually the case when you do a zso? Anyone knows? Thanks.
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Baldguy posted pics last year and complained exactly about that.
It was also baldguy who told me about that but maybe he is an exception who knows. I mean the orbital rim is not touched during a zso, or?
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-can filler replace the need of infraorbital rim implant?
- is infraorbital rim and malar eminence somewhat the same thing?
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-can filler replace the need of infraorbital rim implant?
- is infraorbital rim and malar eminence somewhat the same thing?
i'm having a "facial analyis" do asess the firt issue. i think i still have a pretty significant orbital rim defciciency that i am treating pretty decently with fillers. i'm also thinking myofunctional treatment helped. i specifically asked before paying the service is opting for fillers long term is a good strategy in my case. i'll see and i'll let you know. the filler i use is "MACROLANE", very heavy.
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i'm having a "facial analyis" do asess the firt issue. i think i still have a pretty significant orbital rim defciciency that i am treating pretty decently with fillers. i'm also thinking myofunctional treatment helped. i specifically asked before paying the service is opting for fillers long term is a good strategy in my case. i'll see and i'll let you know. the filler i use is "MACROLANE", very heavy.
how much of filler do you put under eyes and how long does it last?
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how much of filler do you put under eyes and how long does it last?
tbh it is the part where it lasted less. it lasts ages in my jaw and chin but in that area i put a bit put appearently it vanished soon. this is why i specifically asked this question when ordering an analysis i want to hear their input: is treating my "mild" upper midface deficiency with strong fillers a solid option or is it awaste of time and should i focus on orbital rim implants or other surgical techniques??? i'll let you know as soon as i'll receive it.
From my experience i only injected once there and it didn't last much compared to other areas, but the first time it's always tricky.
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i'm having a "facial analyis" do asess the firt issue. i think i still have a pretty significant orbital rim defciciency that i am treating pretty decently with fillers. i'm also thinking myofunctional treatment helped. i specifically asked before paying the service is opting for fillers long term is a good strategy in my case. i'll see and i'll let you know. the filler i use is "MACROLANE", very heavy.
Who is doing your facial analysis?
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i'm having a "facial analyis" do asess the firt issue. i think i still have a pretty significant orbital rim defciciency that i am treating pretty decently with fillers. i'm also thinking myofunctional treatment helped. i specifically asked before paying the service is opting for fillers long term is a good strategy in my case. i'll see and i'll let you know. the filler i use is "MACROLANE", very heavy.
Which doctor are you going to in order to have the macrolane injections? I've been using hyaluronic acid fillers for 4 months and have never even heard of macrolane--a quick google search shows it's used a lot in breast augmentation procedures though.