modified lefort 3

[earl25]

i have a 1cm orbital rim deficiency. i have seen just about every ps\maxfax\cranio doc in the usa . i was all ready to get custom orbital rim implants with dr. y when i saw some photos of dr. obwegesers lefort 3 girl aNd dr kellers lefort 2.these were the best orbital rim work i ever seen. so ive been consulting with top maxfaxs. i found 4 who will do it. they claim blindness isnt any higher risk with the lefort than orbital rim implants. other docs say this is the most dangerous surgery ever. what aRe your thoughts?

[LoveofScotch]

Hey earl25,

I think getting Lazlo's opinion is going to be your best bet. I have consulted with Keller, but never discussed what you are asking about. I think Lazlo went to the Mayo, to meet with Keller, awhile back and discussed both the quadrangular Le Fort I and II.

It sounds amazing, my concern would be that so few surgeons are willing to do it.

[pekay]

I wouldn't do it but my opinion is biased since that is the one thing I dread the most (going blind).

if a 10mm upper jaw advancement is already considered invasive I can't even imagine how dreadful a 10mm LeFort III must be

[earl25]

I wouldn't do it but my opinion is biased since that is the one thing I dread the most (going blind).

if a 10mm upper jaw advancement is already considered invasive I can't even imagine how dreadful a 10mm LeFort III must be

well they wouldn't do 10mm they said 5-7mm. its weird ive seen the top of the top docs and they said blindness isn't a major risk or anymore risky than implants. other doctors who ive spoken with say this is the most dangerous and unpredictable surgery ever.

[pekay]

well they wouldn't do 10mm they said 5-7mm. its weird ive seen the top of the top docs and they said blindness isn't a major risk or anymore risky than implants. other doctors who ive spoken with say this is the most dangerous and unpredictable surgery ever.

What did Keller say?

[earl25]

What did Keller say?

never spoke with keller

I spoke with
Dr. schendel- said risk of blindness is no more than implants
Dr. Turvey  tuvey - said it is an intense surgery and more risky than otherv max fax surgeries but said blindness shouldn't occur due to the orbital nerve not being near the cut
Dr.  wolford- said blindness isn't an issue and not a major surgery in terms of blood loss(for a lefort II)
Dr.  sinn- said not a major surgery in terms of blood loss and risk of blindness is no more than implants or any other surgery near the eye (lefort III)
Dr.  obwegeser- said lefort III is not a dangerous surgery more intense than implants yes but not dangerous and fixes the problem unlike implants which mask it
Dr.  heggie- said blindness isn't a major risk

Now for others who said the opposite
dr. Bartlett -said its a high morbidity surgery and told me to go get fat
dr. urata - just sent my letter,picture, ct scan back to me with no!!!!!!!!!! written on the letter in big letters (weird)
Dr. fearon - said it shouldn't be done for non syndrome patients
others maxfax doctors said its a risky surgery.

I don't know who to believe. I do know they all told me I will have double vision for 2-3 weeks

[pekay]

never spoke with keller

you should try Keller and Kaban (online consult or whatever) just to be safe.

Turvey is well regarded in the maxillofacial/craniofacial field. His "opinion" carries a lot of weight.

[earl25]

I'm really wondering as how bad your (supra) orbital rim recession (10mm?) must be, and what it looks like.

Do you have a lot of scleral show in the front? Without this support it must be so right?

I have some midface hypoplasia too - I consider it pretty bad - with scleral show, negative vector orbit, but I have never even thought yet about fixing it with LeFort III. Because I have read that it's a pretty horrible surgery and there is a reason they only like to perform it on Crouzon patients.

Personally, I find it useless to operate on Crouzon patients with LeFort III, because even in the after, they sadly remain inevitably ugly. Would it not be more useful for patients with moderate midfacial recession, because they can achieve a truly stunning result? I have only seen one result, that was not performed on a Crouzon patient:




This girl had LeFort I + LeFort III + BSSO

Absolutely incredible result. She is a beauty afterwards ... I can understand OP and In my case, I'd hate to have double jaw surgery and being left with a flat midface and a recessed orbital rim ...

Greetings.

that's dr obwegeser's work.

[earl25]

you should try Keller and Kaban (online consult or whatever) just to be safe.

Turvey is well regarded in the maxillofacial/craniofacial field. His "opinion" carries a lot of weight.

doug sinn is also, all the surgeons I listed are known names and leaders in the field.

[earl25]

no joachim obwegeser

[sean89]

Try fat with a hard filler first.

If you're still dissatisfied with the way you look after that, then maybe the risk is worth taking. Not wanting to sound harsh but if you are 10mm deficient now, then you do not have much to lose in terms of aesthetics so why not try a largely temporary procedure and if it looks s**t, it's not going to matter because it will dissolve a few months down the line if not topped up.

Over the time it's took you to have all those consultation, you probably could have tried it already since it's such a quick, (relatively) cheap procedure. 

P.S. Good luck with whatever you decide.

[earl25]

How did you contact him for his assessment of your situation? Have you travelled to Zurich? I would appreciate some input of him in my case.

I emailed him. he answered my first 2 e-mails then stopped responding. I wish I could get him to give specifics of that girl. how many mm,where he cut etc

[PloskoPlus]

its difficult when ppl ask if your retarded and star at you and tell you you look weird

Pics, or it didn't happen (I kid!).  Which Dr Heggie did you consult with?  I presume you consulted with all these doctors remotely i.e. not face to face?  Would you have any links to how this surgery is actually done?  Are external incisions used?  Can it be done at the same time as malocclusion surgery i.e. Le Fort 1, BSSO?

Thanks in advance

[PloskoPlus]

I'm really wondering as how bad your (supra) orbital rim recession (10mm?) must be, and what it looks like.

Do you have a lot of scleral show in the front? Without this support it must be so right?

I have some midface hypoplasia too - I consider it pretty bad - with scleral show, negative vector orbit, but I have never even thought yet about fixing it with LeFort III. Because I have read that it's a pretty horrible surgery and there is a reason they only like to perform it on Crouzon patients.

Personally, I find it useless to operate on Crouzon patients with LeFort III, because even in the after, they sadly remain inevitably ugly. Would it not be more useful for patients with moderate midfacial recession, because they can achieve a truly stunning result? I have only seen one result, that was not performed on a Crouzon patient:




This girl had LeFort I + LeFort III + BSSO

Absolutely incredible result. She is a beauty afterwards ... I can understand OP and In my case, I'd hate to have double jaw surgery and being left with a flat midface and a recessed orbital rim ...

Greetings.

Kizarq,

Great find!  OK, I'm sure it's a cherry-picked case.  But everybody cherry-picks.  So we are really comparing the best against the best on the web.  And this is the best Class III surgical case outcome I have ever seen by far.  Better than anything from Arnett and Gunson.  All LeFort I's seem to have this step off.  You can't see it here.  This girl looks like she has always looked that way in the after.  Completely natural.  I too have this pancake midface like she does in the before.  I never thought it is possible to change it.

[earl25]

if any europeN bros want to consult with obwegeser and get more info on the girl case i will contribute 50 usd towards your consult fee