Alright so I presume you've seen my forum threads before, as an example of someone with a hawk face (V shaped). If ZSO's really only help on faces with average to wider, forward rotated maxilla's, then If/when I get bimax, I should be insisting on either SAPRE or a 3 piece lefort to widen my maxilla? I haven't paid attention to the myofunctional device threads but that's another avenue to run down. I know my lower arch is a little narrow per my ortho, so my upper must be the same.
It's not to say that they won't help at all in these cases, but the strongest indication for a ZSO would obviously be where the zygomatic projection is the only thing severely deficient. It's pretty indisputable that beautiful faces are broad, namely in the 'central column' of the face (as a general rule, there are many exceptions). So broad IPD, laterally elongated orbital sockets, a broad maxilla from top to bottom and a broad lower palate. SARPE would only deal with the upper palate, and if done alone will probably make little difference. 1) because it's limited by the position of the lower palate, 2) because broadening one portion of the face to the exclusion of others is a recipe for disharmony and looking strange. Ideally you would need to broaden both palates significantly, broaden the central and upper midface (essentially pushing out laterally the point at which the maxilla transitions into the zygomatic bone - including the position of the inferolateral rim), and broaden the supraorbital rim and the eyebrows also. You would then need to modify the border of the mandible, the rest of the zygoma and possibly the temporal region to sit in harmony with the now expanded central column of the face. Ideally you would also broaden the eyes and the IPD but it is practically impossible. You will probably need to broaden the mouth with a lateral commissuroplasty also.
It is even more complicated because beautiful male faces tend to exhibit what I call a lack of exterior sagittal depth to most of their features, in addition to overall breadth. All this means is that the maxilla, the zygoma, the lower palate and the orbits (including the lateral and supraorbital areas) tend to be very 'tabletop' in appearance. All this means is that the the lateral aspects of these features (which if you recall are already broad, since breadth is an independent variable), are not too far behind their central aspects. This is where angularity of features ties in - obviously features like the zygoma have to retreat backwards sagitally where those features end (on the transverse plane). Given that these features a) lack 'exterior sagittal depth', and b) must retreat backwards at some point - those features usually become angular and 'chiseled'.
This is of course also in addition to 'forward projection', 'rotation', 'vertical set' and other issues related to the 'shape' of features; which are obviously important also.
What was special about Zarrinbal's result?
It wasn't the result that was special per se. It was the starting point of the patient. Essentially the individual had bimax advancement and the relationship between the maxilla and the zygoma looked really bad, in fact it looked creepy. The large difference in attractiveness was in correction of that awful disharmony.
