jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Lestat on December 08, 2016, 04:02:59 AM
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Cheek bones can be built up permanently using two basic approaches. The two techniques can be combined with no problem.
1.) Onlay material (f.e. HA) applied directly to the bone area, this material is intended to become ‘part of the bone’.
2.) Or tissue filler augmentation (preferably lipofilling) in the cheek’s soft tissues. This fat is intended to become a part of the overlaying tissues.
A combination of the two is possible.
http://www.facialsculptureclinic.com/en/surgery/jaw-surgery/cheek-bones/
What are your thoughts?
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i don't think significant augmentation can be created using even the two methods together. Better to wait for xilloc bone.
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Are you having surgery with him, Lestat?
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Are you having surgery with him, Lestat?
The problem is I am not rich. I need to save money. Maybe after my Zso next summer.
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No homo but Freddie Ljungberg has the most perfect cheekbones I have ever seen on a man. Just Google him and let me know what you think.
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I have found this in an older thread!
I saw him on Saturday and he comes across as friendly and very knowledgeable, he pointed out a number of things with my face which have already bothered me.
He spoke about HA for the cheeks and he's done over 600 of these and says it doesn't move.
OVER 600!!!
I think he is worth a consult.
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I have found this in an older thread!
OVER 600!!!
I think he is worth a consult.
that sounds good joel de franq?
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that sounds good joel de franq?
Yes, Dr. Joel Defrancq.
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Yes, Dr. Joel Defrancq.
are you going to consult with him?
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are you going to consult with him?
Maybe next year. When I have money+time.
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I'm having surgery with him soon, and will be doing the HA + fat transfer for cheek augmentation, along with bimax and genioplasty. I'll let you know how it goes...I'm pretty freaked out though and think about cancelling like 10 times a day. Ughhhhh.
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HA paste will never give sculptured masculine cheekbones that a lot of men want, nor will any paste, filler or soft form of augmentation.
Some men look good with more feminine, rounded nondescript shapes... and that's fine but currently that's pretty much ALL the market caters for, I would argue that is through ignorance and lack of skill.
The top implant surgeons in the US can provide the high and sharp cheekbone shape but the problem is that they use artificial materials which will always lead to resorption of the underlying bone.
For me, at the moment cartilage really is the best tested material on the market due to the fact that it doesn't cause resorption of the bone beneath it, the infection rate is low and it is natural so your body isn't exposed to toxins.
The problem is, of course, that cartilage can resorb and to what degree is unpredictable.
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HA paste will never give sculptured masculine cheekbones that a lot of men want, nor will any paste, filler or soft form of augmentation.
Some men look good with more feminine, rounded nondescript shapes... and that's fine but currently that's pretty much ALL the market caters for, I would argue that is through ignorance and lack of skill.
The top implant surgeons in the US can provide the high and sharp cheekbone shape but the problem is that they use artificial materials which will always lead to resorption of the underlying bone.
For me, at the moment cartilage really is the best tested material on the market due to the fact that it doesn't cause resorption of the bone beneath it, the infection rate is low and it is natural so your body isn't exposed to toxins.
The problem is, of course, that cartilage can resorb and to what degree is unpredictable.
why we need the CT Bone. I agree with you, osteotomy even plus HA paste won't give the results we want. Only implants even for the jawline or genioplasty don't give strong enough results.
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For me, at the moment cartilage really is the best tested material on the market due to the fact that it doesn't cause resorption of the bone beneath it, the infection rate is low and it is natural so your body isn't exposed to toxins.
The problem is, of course, that cartilage can resorb and to what degree is unpredictable.
What Mr. Fox means is not cartilage, it is Lyophilized cartilage and only Prof S. from Z. uses it! Dont confuse them. They are two completely different materials. I bet he does not even know how S. attach it.
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What Mr. Fox means is not cartilage, it is Lyophilized cartilage and only Prof S. from Z. uses it! Dont confuse them. They are two completely different materials. I bet he does not even know how S. attach it.
yeah i know but does this lyophilized cartilage become your own bone or does it just resorb? My fear is that it doesn't integreate with your own bone so there is the possibility of rejection. Also how does he shape and attach this bone? With screws? And does this bone "live" in your face? If you're hit in the face and it breaks does it mend like real bone would? I have to many doubts about lyophilized cartilage I don't understand how it works...
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yeah i know but does this lyophilized cartilage become your own bone or does it just resorb? My fear is that it doesn't integreate with your own bone so there is the possibility of rejection. Also how does he shape and attach this bone? With screws? And does this bone "live" in your face? If you're hit in the face and it breaks does it mend like real bone would? I have to many doubts about lyophilized cartilage I don't understand how it works...
Some of it really transforms into real bone thats true. The risk of an infection is very very low, it is quite impossible. I tell you via pm how he attach it.
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so he says it turns into the patient's "own bone" and works like a "biological miracle"
but he's the only one who uses it it seems. so what's the problem, why don't others? it's not like it's a new devlopment. Should we use it? Should we go to Sailer?
http://www.sailerclinic.com/en/specialist-fields/aesthetic-surgery/lyophilised-cartilage/
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My understanding is that all cadaver cartilage is lyophilized, perhaps I am wrong? I know which company produces it that Sailer buys from but he is the only surgeon really using it for facial augmentation.
I thought that he sometimes places it on the bone if it is for bone enhancement and other times puts in in soft tissue if it is to replace that. I know that you think he doesn't place the implants on the bone and I have no evidence to refute that but even if that was the case, traditionaly, cheek implants are placed in pockets not on the bone, so what difference does it make?
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My understanding is that all cadaver cartilage is lyophilized, perhaps I am wrong? I know which company produces it that Sailer buys from but he is the only surgeon really using it for facial augmentation.
I thought that he sometimes places it on the bone if it is for bone enhancement and other times puts in in soft tissue if it is to replace that. I know that you think he doesn't place the implants on the bone and I have no evidence to refute that but even if that was the case, traditionaly, cheek implants are placed in pockets not on the bone, so what difference does it make?
okay but then it does not integrate into the patients own bone, it just lies there in the soft tissue pocket or suspended there like a sillicone implant. My question was whether it actually itnegrates and turns into the patient's "own bone" .
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okay but then it does not integrate into the patients own bone, it just lies there in the soft tissue pocket or suspended there like a sillicone implant. My question was whether it actually itnegrates and turns into the patient's "own bone" .
Ok sure that is a point, part of my implants have ossified now but it's not the same as the rest of your living bone. After it calcifies, it will never resorb, but it's not living bone.
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Ok sure that is a point, part of my implants have ossified now but it's not the same as the rest of your living bone. After it calcifies, it will never resorb, but it's not living bone.
Why is it not the same as the rest of your living bone then? You can also clearly see the (calcified) lyocartilage on a ct scan!!
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I think the same way that HA isn't living bone but would appear on a scan, this is what I understood from a doctor that I put this question to.
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I think the same way that HA isn't living bone but would appear on a scan, this is what I understood from a doctor that I put this question to.
Yes, because new bone grows through the HA. You can see it on a ct scan, whereas HA does not appear on a ct scan. It shows new bone where to grow.
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Ok I didn't know that the HA paste doesn't show on a scan, hmmm so why would the ossified cartilage? Maybe this Dr was wrong and it does indeed become living bone,
I know a person who had cheekbone implants with Sailer, after 2 months he decided he didn't want them anymore. Sailer couldn't remove them by pulling them out, the bases had ossified and were connected to his bone. Surely then, he does place them on the bone?
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The HA shows on the scans in this article...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906722/ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906722/)
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The HA shows on the scans in this article...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906722/ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906722/)
Yeah this is absolutely true. Okay Lyopholized cartilage might allow blood vessels etc. to grow into it but that doesn't mean it turns into living bone. In fact there is no way it does unless it is actually oseoinductive which it is not since I asked Dr. Sinn if ONLAY cadaver bone turns into your own bone and he said definitively NO.
Also HA paste frankly doesn't do much if anything as far as augmentation goes sorry to say. I think if you're gonna go this route, best to wait for the CT bone if that ever comes out. But I'm also skeptical about how this will 'turn" into the patients own bone if placed as an "ONLAY" augmentation.
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You are welcome! ;)
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Hello all,
I'm new to the forum but have been researching all of this facial surgery stuff for a while now and felt like it was about time I joined the community. Having recently consulted with both Drs Joel Defranq and Noorman Van Der Dussen, this post seemed like a suitable place to jump in.
I began to write details of my situation but it started getting so long that I figured I had better make a new post for all that. With regards to this thread, I have basically no cheekbone projection (on top of all the other stuff that comes with being a long faced mouth breather who had extractions and braces for 7 years in his developmental stage!).
I also have an untreated ZMC fracture from a fight. This has left one side of my head narrower than the other, with pretty severe cheek depression on that side. Funny enough, the side this happened to used to be my "good side", i.e; more projected, wider, etc. Combine this with a long midface, retruded jaws, weak chin, droopy orbitals, and huge nose that points off in the other direction, and it's safe to say I'm not a good looking guy. Oh yeah, I once fell directly onto concrete, eyebrow bone first, with all my weight. I don't know exactly what damage was done but my face swelled up enormously for a couple weeks. I look weird as f***.
Very recently I consulted with both the Belgian doctors mentioned above (at separate times, not together). Their suggestions seemed quite accurate (to my own analysis), but differed in a couple of ways. Dr Van Der Dussen suggested septorhinoplasty, cheek augmentation, and genioplasty. Dr Defranq suggested double jaw advancement and re-alignment, genioplasty, cheek augmentation, with rhinoplasty at a later date.
Both doctors wanted to augment the cheeks with paste. Dr Defranq's was definitely bovine sourced HA paste. I can't remember what Van Der Dussen's was called, but I should have more details once he emails me with the summary. Both doctors felt these substances give a more natural result than synthetic implants, with less complications. Both doctors claim to have decades of experience with the substances. Neither doctor seemed especially phased by the existing fracture and implied that they would just apply more paste to that area to balance out the asymmetry and flatness of the depressed bone. I am concerned that pastes cannot give the anterior or lateral projection that I require, because I have seen no real evidence to the contrary. And, as I'm sure is the case with you guys, I have spent countless hours scouring the internet for information regarding how to fix a messed up noggin, so if there are photos of this stuff that I haven't seen, they are well hidden! Anyway, his post has rambled on too long. If you guys have any questions for me, or want me to ask either surgeon something on your behalf when I next contact them, go right ahead! I have tried to keep this post strictly related to the cheek topic, if you want to know anything about the other aspects of the consultations then feel free to ask. Sorry for the wall of txt :)
Right so welcome to the forum. Looks like you're deep into this now so I would concur that I don't think just HA paste will give you the results you need unless combined with some sort of osteotomy. Will Dr. De franq do an osteotomy as well? He does list a ZSO type procedure and HA paste together as a solution on his site. Why isn't he offering you the ZSO? And what sort of osteotomy to the cheekbone does the other guy do?
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Excellent work my friend!
Don't worry, you'll be able to do martial arts and adventure sports after a year no problem. And if you can achieve great results on your cheekbones with paste that will be a major accomplishment for all of us here on the board.
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I'm having surgery with him soon, and will be doing the HA + fat transfer for cheek augmentation, along with bimax and genioplasty. I'll let you know how it goes...I'm pretty freaked out though and think about cancelling like 10 times a day. Ughhhhh.
Wouldn't the fat injections potentially damage the pocked used to place the HA granules?
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I'm having surgery with him soon, and will be doing the HA + fat transfer for cheek augmentation, along with bimax and genioplasty. I'll let you know how it goes...I'm pretty freaked out though and think about cancelling like 10 times a day. Ughhhhh.
so have you had surgery yet?
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I'm gonna email the doctor my question. for those considering HA granules, I am curious how fat injections would not rip the pocket used to place the HA
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hmm only see a book consult option no contact email
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I think he places the ha on the bone, not in a pocket.
http://www.facialsculptureclinic.com/en/surgery/jaw-surgery/cheek-bones/
Scroll down to see the picture.
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I think he places the ha on the bone, not in a pocket.
http://www.facialsculptureclinic.com/en/surgery/jaw-surgery/cheek-bones/
Scroll down to see the picture.
even wit on the bone theres still some type of pocket over it. I have heard this
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even wit on the bone theres still some type of pocket over it. I have heard this
I think it is no problem. Fat injections are Rice Grain-Size fat implants. Imo they are to little to damage the pocket used to place the HA granules.
Another question: Do you think HA can damage the soft tissue due to the fact that is rough?
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I'm seeing Defrancq in Belgium next month - will ask him about this.
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I think it is no problem. Fat injections are Rice Grain-Size fat implants. Imo they are to little to damage the pocket used to place the HA granules.
Another question: Do you think HA can damage the soft tissue due to the fact that is rough?
the fat itself should be in an in issue but the needle or canula used to inject would penetrate the pocket
Question 2, I have no idea. The literature doesn't support what's said on the board regarding HA, now keep in mind that doesn't mean the people on the board are wrong (especially since some lived through it), and it doesn't mean the literature is wrong (since if this was the case on a wide spread level then it would definitely be reported) .
The best way imo to approach this question would be to first define what's considered damage to the tissue Next see what type of scan r imaging can be done to view the skin in question
to add if it's place sub periosteum then I'm not sure its actually touching the tissue. wouldn't it be wedges between bone and the periosteum
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It doesn't damage soft tissue if placed correctly in a pocket. Bad surgeons shove too much in there so it comes out or don't create good pockets in the first place.
Passed on directly from Sinn who is extraordinary experienced with HA.
Legit.
Thanks for the info.
Do you know if Dr. Sinn would use it also for jaw angle augmentation?
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Legit.
Thanks for the info.
Do you know if Dr. Sinn would use it also for jaw angle augmentation?
Good question.
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Most of us are not just patients or perspective patients on this site, thanks to the members that share vital information, we have become uber informed patients. Although much is still unknown to us, the knowledge that is shared on here goes well above what someone could find on a mainstream site like RealSelf. Of course, RealSelf is a business but I couldn't think of a good comparison.
After seeing everything that has been posted on here about HA and also talking to people who have actually had it on the jaw and cheeks, I think I can say that if you would not be happy with Radiesse for cheek augmentation (not saying that is the same as HA but it will give the same aesthetic result in my opinion) then how could you even contemplate HA for zygomatic arch or any part of the malar area? Fat, filler, HA, pretty much the same nondescript shape sort of results in my opinion.
I think it should be fine for a bit of brow augmentation.
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Most of us are not just patients or perspective patients on this site, thanks to the members that share vital information, we have become uber informed patients. Although much is still unknown to us, the knowledge that is shared on here goes well above what someone could find on a mainstream site like RealSelf. Of course, RealSelf is a business but I couldn't think of a good comparison.
After seeing everything that has been posted on here about HA and also talking to people who have actually had it on the jaw and cheeks, I think I can say that if you would not be happy with Radiesse for cheek augmentation (not saying that is the same as HA but it will give the same aesthetic result in my opinion) then how could you even contemplate HA for zygomatic arch or any part of the malar area? Fat, filler, HA, pretty much the same nondescript shape sort of results in my opinion.
I think it should be fine for a bit of brow augmentation.
well dr aharonov supposedly gets great cheek results with restylane but he uses boat loads
bigger question, can someone et cartilage if they already got HA on their cheeks or brow etc
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well dr aharonov supposedly gets great cheek results with restylane but he uses boat loads
bigger question, can someone et cartilage if they already got HA on their cheeks or brow etc
People can good a good amount of augmentation from restylane, I mean that the result looks like shapeless putty or like fat, in my opinion. You could never get hard, angular, contoured shapes that actually resemble bone.
I don't know about cartilage over HA, I mean technically yes you could but I suppose it might have a higher chance of resorption.
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then I imagine it def would resorb if placed over a metal plate
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If you want cheek implants that turn into real bone and won't be brittle then wait for hyperelastic bone implants.
See this thread http://jawsurgeryforums.com/index.php?topic=6366.0 (http://jawsurgeryforums.com/index.php?topic=6366.0)
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would fat even survive if placed over HA?
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Any kind of secondary op on a HA site massively raises infection risk, even if it's a second application of HA. It's not understood why but it's documented in papers.
is it because it punctures the pocket. is that temporary infection risk that can be controlled by anti biotics or long ter
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I believe A&G mix it with something before slapping it on, could it be your own blood or am I seriously off track here...it's something more organic than just the raw stuff iirc.
No one uses the "raw" stuff. Mommaerts mixes it with fibrin and other stuff I can't remember. Arnett and Gunson does do something differently though since they're able to mold the HA for a long time after the surgery.
Also I had a consultation with Dr. van der Dussen who uses HA direct to permanently mould cheeks and he mentioned he mixes it with something to allow him time to shape it before it sets. I can't remember for certain but maybe it was with Bioalcamid (of which I have read very bad reviews from HIV wasting patients online, another quote found there was: ?Most [permanent] soft tissue fillers have not stood the test of time and thus should still be considered experimental.?
A later consultation with Dr. Daniel Sim?n (maxfac with Facial Team who worked with van der Dussen) said that they reviewed a few patients who had this HA mix and when they investigated the HA area it was still wet (not sure how long after, whether due to complications or not). Just food for thought on the matter, sorry I can't be more certain but maybe someone could clarify some of this
Indeed, especially when the results are said to be modest at best...was it CK that was less than impressed?
My HA augmentation is definitely very noticable although I don't like it much due to how it was placed.
Anyone has further information regarding this (mixing HA with something)?
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Anyone has further information regarding this (mixing HA with something)?
I know sinn mixes it with a blood clotting agent drug.
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Any kind of secondary op on a HA site massively raises infection risk, even if it's a second application of HA. It's not understood why but it's documented in papers.
Ive ever seen or heard of this can you post where its documented
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have you discussed that paper with dr. sinn.
I didn't see where it said what was used in the primary operation
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I've read the full paper, from memory it's HA both times. I haven't discussed it with Sinn because I'm not planning on getting repeated rounds of HA.
I have heard from both sinn and eppley Hydroxyapatite is a generic term with diff types etc. I'm curious if that plays a factor. did you ask sinn about repeated use and infection?
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I have heard from both sinn and eppley Hydroxyapatite is a generic term with diff types etc. I'm curious if that plays a factor. did you ask sinn about repeated use and infection?
but does that mean fat also increases the risk. was the new ha cause of the infection or the old ha?
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I think the area the ha is placed also has an impact
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Hello, did anyone get this procedure done? OP I sent you a PM :)