jawsurgeryforums.com
General Category => Aesthetics => Topic started by: AustralianLabrador on September 10, 2017, 09:49:47 PM
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"Comes with the vertical growth pattern. Sorry but low cheekbones can't be fixed :( Best you could do would be to augment on top of them in a higher location, assuming you have midface hypoplasia to begin with. In that case you'd augment above, which might be ok if you're a girl and if not it'll give you a feminine look. This is not a great problem to have."
This was a quote by molestrip and to be honest it doesn't sound right.
Unless you have cheekbones that start below your mouth (hyperbole) then there is no reason a combination of:
-single or multiple ZSO
- Custom Implants with arch
- Orbital rim augmentation
- MLFIII
won't
give you high cheekbones
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The one mlf3 thats been seen gave low feminine cheekbones. Even when cut as high as possible.
I am leaning towards zso + infraorbital implants.
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Yeah but ZSO + Custom implants for cheekbone/zyg arch + infraorbital REGARDLESS of whether you need MLIII will work incredibly well to almost everyones liking
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modified oblique lefort 3
(https://i.imgur.com/aVU0KhE.jpg)
(https://i.imgur.com/QB1zGcH.jpg)
lefort 3 cut moves both forward and upwards in a diagonal movement. it was created to take into account vertical maxillary excess which includes downward grown cheekbones
if you do a simple horizontal advancement you're just advancing along along the downward growth plane, just like how a straight bimax will produce bad result when rotation is warranted. if the dude above got a simple ll3 (with or without lf1 level seperated), his result would have been worse
if you look at the syndromic patients who do this, their jaws are extremely steep and the cephs for planning aren't at an ideal horizontal plane either. of course aesthetics aren't the priority but the surgeons are adopting this same technique to non-syndromic patients.
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Hard to say what effect it had on the eyes. I wonder if there is a step off at the sides. Looks like the nose was involved as well. I guess the bridge is raised.
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modified oblique lefort 3
(https://i.imgur.com/aVU0KhE.jpg)
(https://i.imgur.com/QB1zGcH.jpg)
lefort 3 cut moves both forward and upwards in a diagonal movement. it was created to take into account vertical maxillary excess which includes downward grown cheekbones
if you do a simple horizontal advancement you're just advancing along along the downward growth plane, just like how a straight bimax will produce bad result when rotation is warranted. if the dude above got a simple ll3 (with or without lf1 level seperated), his result would have been worse
if you look at the syndromic patients who do this, their jaws are extremely steep and the cephs for planning aren't at an ideal horizontal plane either. of course aesthetics aren't the priority but the surgeons are adopting this same technique to non-syndromic patients.
so that diagonal up movement and/or
+ further zso + custom implants
is legit all thats needed
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Just want to note I actually do need a MLFIII
I've been offered it and I'm ecstatic but I won't commit until I learn more
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The diagrams and photos are an example of a person who legitimately needed the Lefort 3 with the modification of it shown in the diagram. That's demonstrated in the before/after photos and cephs.
The upper part is basically a 'classic' Lf3. The only modification of it is the separate cut used to perform the Lefort 1.
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I've seen that advice to get ZSO + implants now several times as the ultimate solution to get high cheekbones, and it is bullocks. Those surgeons I've spoken to said the ZSO will create such a step-off that makes it difficult to maneuver an implant on the orbital rim. Is it possible? Possibly, but you'd need a customized orbial rim implant since it would have to fit above the step off from the ZSO. If you have a verticallly short zygoma that's going to be a lot more challenging to accomplish. And you can forget about getting a not customized orbital rim implant (unless the surgeon can carve it perfectly well to fit that area above the ZSO cut while you're on the operating table, but that is by far not failure proof).
Second point: most of the projection is on the lower part of the cheek with a ZSO, and part of the lataral portion of the cheek will be moved too. Ideally most persons with a recessed midface would get good projection also on the higher, more lateral part of the zygoma (malar prominence). That's just not going to happen with the ZSO. It will move the segment (and that entails mostly the area underneath the malar prominence) 'en block' outwards. Some surgeons say they can rotate the segment a bit, don't expect too much of that until we see that in an actual result. So you can not just choose where you want to get most projection, and it will not be on the malar prominence with the ZSO. Doesn't matter if you put an orbital rim implant above it. Again: the cut of the ZSO is through the lower part of the zygoma, and it can mostly be moved outwards/laterally with if you're lucky a little bit of extra anterior projection. You can not determine where you want the most projection: it is just your own bone that moves outwards. And with the ZSO most projection is not going to be on the malar prominence.
Only if your orbital rim implant would also cover part of the malar prominence you could still get the amount of projection there that you would wish for. But with the step off of the ZSO that is going to be a problem.
And if you're going to get orbital rim implants anyway: why the hell would you still go through the s**t of a ZSO, and not get an implant that covers the malar prominence too? Sounds unlogical as s**t to first get a ZSO and then still implants.
Amen. Just jump over the whole ZSO part and get the custom made extended orbital rim implant and you should get the most optimal result.
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I've seen that advice to get ZSO + implants now several times as the ultimate solution to get high cheekbones, and it is bullocks. Those surgeons I've spoken to said the ZSO will create such a step-off that makes it difficult to maneuver an implant on the orbital rim. Is it possible? Possibly, but you'd need a customized orbial rim implant since it would have to fit above the step off from the ZSO. If you have a verticallly short zygoma that's going to be a lot more challenging to accomplish. And you can forget about getting a not customized orbital rim implant (unless the surgeon can carve it perfectly well to fit that area above the ZSO cut while you're on the operating table, but that is by far not failure proof).
Second point: most of the projection is on the lower part of the cheek with a ZSO, and part of the lataral portion of the cheek will be moved too. Ideally most persons with a recessed midface would get good projection also on the higher, more lateral part of the zygoma (malar prominence). That's just not going to happen with the ZSO. It will move the segment (and that entails mostly the area underneath the malar prominence) 'en block' outwards. Some surgeons say they can rotate the segment a bit, don't expect too much of that until we see that in an actual result. So you can not just choose where you want to get most projection, and it will not be on the malar prominence with the ZSO. Doesn't matter if you put an orbital rim implant above it. Again: the cut of the ZSO is through the lower part of the zygoma, and it can mostly be moved outwards/laterally with if you're lucky a little bit of extra anterior projection. You can not determine where you want the most projection: it is just your own bone that moves outwards. And with the ZSO most projection is not going to be on the malar prominence.
Only if your orbital rim implant would also cover part of the malar prominence you could still get the amount of projection there that you would wish for. But with the step off of the ZSO that is going to be a problem.
And if you're going to get orbital rim implants anyway: why the hell would you still go through the s**t of a ZSO, and not get an implant that covers the malar prominence too? Sounds unlogical as s**t to first get a ZSO and then still implants.
Absolutely, guys want high cheekbones especially prominent on the arch right? Why have a procedure that enhances the very bottom part of the cheekbones?
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I've seen that advice to get ZSO + implants now several times as the ultimate solution to get high cheekbones, and it is bullocks. Those surgeons I've spoken to said the ZSO will create such a step-off that makes it difficult to maneuver an implant on the orbital rim. Is it possible? Possibly, but you'd need a customized orbial rim implant since it would have to fit above the step off from the ZSO. If you have a verticallly short zygoma that's going to be a lot more challenging to accomplish. And you can forget about getting a not customized orbital rim implant (unless the surgeon can carve it perfectly well to fit that area above the ZSO cut while you're on the operating table, but that is by far not failure proof).
Second point: most of the projection is on the lower part of the cheek with a ZSO, and part of the lataral portion of the cheek will be moved too. Ideally most persons with a recessed midface would get good projection also on the higher, more lateral part of the zygoma (malar prominence). That's just not going to happen with the ZSO. It will move the segment (and that entails mostly the area underneath the malar prominence) 'en block' outwards. Some surgeons say they can rotate the segment a bit, don't expect too much of that until we see that in an actual result. So you can not just choose where you want to get most projection, and it will not be on the malar prominence with the ZSO. Doesn't matter if you put an orbital rim implant above it. Again: the cut of the ZSO is through the lower part of the zygoma, and it can mostly be moved outwards/laterally with if you're lucky a little bit of extra anterior projection. You can not determine where you want the most projection: it is just your own bone that moves outwards. And with the ZSO most projection is not going to be on the malar prominence.
Only if your orbital rim implant would also cover part of the malar prominence you could still get the amount of projection there that you would wish for. But with the step off of the ZSO that is going to be a problem.
And if you're going to get orbital rim implants anyway: why the hell would you still go through the s**t of a ZSO, and not get an implant that covers the malar prominence too? Sounds unlogical as s**t to first get a ZSO and then still implants.
Thanks for that perspective.
I want to get a zso because I feel my zygo shape is fine I just want to subtly widen the area. Maybe I am misguided. The infraorbital implants are more to deal with some lack of volume/dark circles under eyes but if they can extend on to the zygos and give some anterior projection in theory that should help my case.
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Absolutely, guys want high cheekbones especially prominent on the arch right? Why have a procedure that enhances the very bottom part of the cheekbones?
What if you got silicone implants placed in the same area instead of cartilage? You reckon you would have had a similar outcome (sans the resorption) ? I have seen many implant results that look "puffy". :-\
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Absolutely, guys want high cheekbones especially prominent on the arch right? Why have a procedure that enhances the very bottom part of the cheekbones?
Idk tbh. I have seen many great looking guys with the much dreaded "lowjection". Jeremy Meeks , Johnny Depp , Brad pitt. I think its about over all harmony .
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I've seen that advice to get ZSO + implants now several times as the ultimate solution to get high cheekbones, and it is bullocks. Those surgeons I've spoken to said the ZSO will create such a step-off that makes it difficult to maneuver an implant on the orbital rim. Is it possible? Possibly, but you'd need a customized orbial rim implant since it would have to fit above the step off from the ZSO. If you have a verticallly short zygoma that's going to be a lot more challenging to accomplish. And you can forget about getting a not customized orbital rim implant (unless the surgeon can carve it perfectly well to fit that area above the ZSO cut while you're on the operating table, but that is by far not failure proof).
Second point: most of the projection is on the lower part of the cheek with a ZSO, and part of the lataral portion of the cheek will be moved too. Ideally most persons with a recessed midface would get good projection also on the higher, more lateral part of the zygoma (malar prominence). That's just not going to happen with the ZSO. It will move the segment (and that entails mostly the area underneath the malar prominence) 'en block' outwards. Some surgeons say they can rotate the segment a bit, don't expect too much of that until we see that in an actual result. So you can not just choose where you want to get most projection, and it will not be on the malar prominence with the ZSO. Doesn't matter if you put an orbital rim implant above it. Again: the cut of the ZSO is through the lower part of the zygoma, and it can mostly be moved outwards/laterally with if you're lucky a little bit of extra anterior projection. You can not determine where you want the most projection: it is just your own bone that moves outwards. And with the ZSO most projection is not going to be on the malar prominence.
Only if your orbital rim implant would also cover part of the malar prominence you could still get the amount of projection there that you would wish for. But with the step off of the ZSO that is going to be a problem.
And if you're going to get orbital rim implants anyway: why the hell would you still go through the s**t of a ZSO, and not get an implant that covers the malar prominence too? Sounds unlogical as s**t to first get a ZSO and then still implants.
Agree with what ILTM is saying.
Will also add that Milli-meters and Australian Lab have either been the recipients of stupid advice or came up with the idea on their own to first have ZSO and then get implants over that when the smart thing to do is to just get the custom implants.
Milli-meters and Australian Lab....which is it..recipients of stupid advice or did you think that up yourself?
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What if you got silicone implants placed in the same area instead of cartilage? You reckon you would have had a similar outcome (sans the resorption) ? I have seen many implant results that look "puffy". :-\
No I don't think it would have looked the same, yeah exactly silicone look puffy, i guess because it isn't as solid as cartilage or medpor or PEEK. I'd never have silicone. I bloody wish cartilage wouldn't resorb, it could have been the perfect material because it doesn't cause resorption of the underlying bone, HA paste doesn't either.
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Agree with what ILTM is saying.
Will also add that Milli-meters and Australian Lab have either been the recipients of stupid advice or came up with the idea on their own to first have ZSO and then get implants over that when the smart thing to do is to just get the custom implants.
Milli-meters and Australian Lab....which is it..recipients of stupid advice or did you think that up yourself?
Thought it up my own pretty self.
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Idk tbh. I have seen many great looking guys with the much dreaded "lowjection". Jeremy Meeks , Johnny Depp , Brad pitt. I think its about over all harmony .
No that is true absolutely, I just think most guys would want the high lateral masculine look. Also the lower the cheekbone prominence comes down, the less concave the cheeks will be, if that is a look you want.
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No I don't think it would have looked the same, yeah exactly silicone look puffy, i guess because it isn't as solid as cartilage or medpor or PEEK. I'd never have silicone. I bloody wish cartilage wouldn't resorb, it could have been the perfect material because it doesn't cause resorption of the underlying bone, HA paste doesn't either.
You want this: http://www.ossdsign.com/introduction
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You want this: http://www.ossdsign.com/introduction
Said. No one. Ever.
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Just want to note I actually do need a MLFIII
I've been offered it and I'm ecstatic but I won't commit until I learn more
who has offered you the modified lefort III?
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That does sound too good to be true.
S used Cadaver cartilage.
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who has offered you the modified lefort III?
who do you think
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Amen. Just jump over the whole ZSO part and get the custom made extended orbital rim implant and you should get the most optimal result.
so skip zso and just get MLFIII w/ custom zygoma implants w/arch extension + custom infraorbital rim implants?
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Well their gist is just skip the zso and get a single (medpor , i guess) implant that covers the infra orbital and extends on to the malar prominence.
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Well their gist is just skip the zso and get a single (medpor , i guess) implant that covers the infra orbital and extends on to the malar prominence.
well if skipping zso is going to yield a better result then I'm all for saving money
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That does sound too good to be true.
S used Cadaver cartilage.
He said it was from German humans, really hoping that wasn't another lie and I don't have rabbit bone in there or something lol.
Ilovethemoon, I asked a doctor that works there, she said under normal conditions most of the cartilage will ossify after 3 years but there will always be a top layer that doesn't, which I assume is susceptible to resorption. She said osteoclasts resorb the cartilage just like they do with bone. When it calcifies it doesn't become living bone it is like HA paste.
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So whats the consensus???
custom zygoma implants with custom infra orbital for high cheekbones?
my boyfriend looks like a saint laurent model and I want to 1up him :(
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Consensus on JSF regarding cheekbones?
bahahahahahhahaha.
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I don't believe there is any osteotomy that will accomplish this.
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LMAO
So part of the graft will ossify and then there is a top layer that doesn't, is what that doctor said. Interesting. Do they have some studies (and not just published or funded by Sailer) that support this? Did you ever get a CAT scan or X-ray of the cheeks done? How much projection would you say you lost after a few years compared to let's say 3 months after surgery?
Oh no S likes to give the impression that cartilage doesn't resorb at all but admits it does under pressure. Dr Jacobsen, who works there, tells the truth about every procedure. Sailer's study said about 20 percent resorbs, I don't believe it.
I had a 3d x ray thing some time last year, not much had ossified, I will try to find it if you want.
my boyfriend looks like a saint laurent model and I want to 1up him :(
Saint Laurent was awesome when Hedi Slimane was there
Consensus on JSF regarding cheekbones?
bahahahahahhahaha.
The surgery train wreck guy had good cheek implants admit it
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The diagrams and photos are an example of a person who legitimately needed the Lefort 3 with the modification of it shown in the diagram. That's demonstrated in the before/after photos and cephs.
The upper part is basically a 'classic' Lf3. The only modification of it is the separate cut used to perform the Lefort 1.
i might be mistakened then, thanks.
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The diagrams and photos are an example of a person who legitimately needed the Lefort 3 with the modification of it shown in the diagram. That's demonstrated in the before/after photos and cephs.
The upper part is basically a 'classic' Lf3. The only modification of it is the separate cut used to perform the Lefort 1.
If the LF3 is a block movement including the nose, it may make any asymmetry at the eye level worse.
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True, and also pre-existing asymmetry of the cheeks that may not be all that noticeable now, but may be when they are brought forward with the LFIII.
These things can be better anticipated with customized implants.
IMO, that's one of the reasons why LFIII (even the modified bilateral kind, where the two sides are moved independently) is not very popular. It's a general problem with osteotomies - witness how many people complain about asymmetry after jaw surgery. At least jaw surgery has the side benefit of providing a functional benefit (it's actually the main benefit, but people here tend to forget this). Also the soft tissue around the jaws is significantly thicker than around the eyes, so any asymmetry, step-offs are less noticeable (unless it's something like a severe cant). Asymmetry at the eye level is more obvious, because people look into each other's eyes in general.
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If the LF3 is a block movement including the nose, it may make any asymmetry at the eye level worse.
Doesn't preclude the person in the photo as being a legitimate candidate for what he got.
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IMO, that's one of the reasons why LFIII (even the modified bilateral kind, where the two sides are moved independently) is not very popular. It's a general problem with osteotomies - witness how many people complain about asymmetry after jaw surgery. At least jaw surgery has the side benefit of providing a functional benefit (it's actually the main benefit, but people here tend to forget this). Also the soft tissue around the jaws is significantly thicker than around the eyes, so any asymmetry, step-offs are less noticeable (unless it's something like a severe cant). Asymmetry at the eye level is more obvious, because people look into each other's eyes in general.
Nor should it be popular among the 'I want one to look more like a model' crowd. But for someone like the patient in that photo, who might not even have asymmetry, that type of person would be very happy with it. Even if they had some, they'd probably accept the trade-off if they had the start point of the patient in the photo.
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Nor should it be popular among the 'I want one to look more like a model' crowd. But for someone like the patient in that photo, who might not even have asymmetry, that type of person would be very happy with it. Even if they had some, they'd probably accept the trade-off if they had the start point of the patient in the photo.
With any surgery - the worse the starting point, the happier the patient is likely to be.
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With any surgery - the worse the starting point, the happier the patient is likely to be.
So, why were you going on about possible asymmetry re the patient with a really bad starting point. As I said, asymmetry with a L3 would be more of a concern with the 'I'm getting one to look like a model crowd' than people with a legitimate deformity.
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So, why were you going on about possible asymmetry re the patient with a really bad starting point. As I said, asymmetry with a L3 would be more of a concern with the 'I'm getting one to look like a model crowd' than people with a legitimate deformity.
I was actually addressing the "I wanna look like a model" crowd. But they need psychiatry, not surgery. IMO (and only IMO, since IANAD), you basically have to have buggy eyes to justify this surgery.
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I was actually addressing the "I wanna look like a model" crowd. But they need psychiatry, not surgery. IMO (and only IMO, since IANAD), you basically have to have buggy eyes to justify this surgery.
Well, some modifications of the L3 can be for buggy eyes. But that L3 modification was for the dished in upper midface including the nose area. But yes, it's not a surgery for the wanna be model crowd.
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I had a 3d x ray thing some time last year, not much had ossified, I will try to find it if you want.
http://jawsurgeryforums.com/index.php?topic=6873.msg60063#msg60063
post #97 is where his 3d x ray thing can be found.
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cheekbones are an overrated feature for males. Even having a visible jawline will make you stand out and results of jaw surgery are somewhat consistent, but I've seen so many bad zso and cheek implant results
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bad zso by who? i've seen a few and they always looked good.
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bad zso by who? i've seen a few and they always looked good.
can find the ones I was thinking of. Here one just from this forum
(http://i.imgur.com/lOYuVAX.jpg)
can you post the good results you have seen
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can find the ones I was thinking of. Here one just from this forum
(http://i.imgur.com/lOYuVAX.jpg)
can you post the good results you have seen
If I had to guess I would've assumed he got submalar implants. IIRC, the zso cut isn't at that apex junction area (not using medical terms) between the orbits and zygoma but somewhat below that. Hell it looks like his malar/zygo apex spot that used to be strongest in his pre-op 3/4 profile shot is now too recessed compared to his submalar region. Now he just needs to do something with the periorbital region I guess. His submalars looked quite deficient in the befores.
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Now he just needs to do something with the periorbital region
When a Lefort 3 impaction/ advancement will be possible and safe as a routine (maybe never), it will be the end of all our problems