QUADRANGULAR LEFORT 1 OSTEOTOMY? HIGH LEVEL LEFORTS?

[danny44]

Thanks again for the speedy reply, what you said about being fifty is exactly my thought, I don't know what life is gunna throw me and purposely weakening my cheekbone area at my age seems a little crazy. However according to Dr. M who seems to be not just in it for the money and I think was being quite honest with me he has never had anyone that has had this procedure and then had their cheekbone area broken. I think he has been doing them for at least 15 years so I guess that is somewhat comforting although I do a lot of sports and such. He also offered if I wanted to have a small bone graft put in the space created by the osteotomy as well as the titanium plate on the outside. He would harvest the graft from my jaw were he will be accessing anyways to add HA paste. I don't know anything about bone grafts but have been trying to read up on them and it seems like the bone can regenerate to some degree. I think he has done this procedure in the past with bone grafts with success. Let me know your thoughts or any knowledge on bone grafts etc... you might have.
Thanks once again for having a conversation with me. Big decision for me but I do feel quite comfortable with Dr.M I think he is very good at what he does and like I said earlier does't seem to be doing it for the money.
 Thanks

[Lazlo]

Hey I just pm'd you. This is what I vaguely understand since Dr. Schendel is planning on doing bone grafts for my inferior orbital region (though I don't know yet how they take fragments of your own bone and build up the area under the eye...). It all depends --I think they have substances which they mix with the bone so that instead of resorbing back into your body it stays or integrates etc.. I'm sure there is cutting edge research on this, but I really don't know. It's a topic of interest for me too. Here's one thing I do know. In cases of distraction osteogenesis (where they break the bone and grow it, and this is true of ANY broken bone) the resulting healed bone is actually STRONGER than it was before. I don't know if this is true of bone fractured and then repositioned...

[Lazlo]

Question: is BMP controversial? What does an "extreme" case warrant and why might they not want to use it?

Another question. So if you have dark circles under the eye and they want to build it up because it's a bone deficiency how do they prepare the bone to achieve a uniform texture and molding on your orbital rims? At first I just assumed they take bone from somewhere in your body (like chips of bone or something and kind of glue it to the deficient area) --but how would that be aesthetic and even really form? So obviously they must like powder the bone or do something to it to make into a paste right? Or shape it to the contour of the area you need on your face? And then I suppose they mix it with these substances...

[Lazlo]

Pekay....im very interested to learn what youve found out. I have deprssed regions under my eyes. Dr schendel said he would build up the region with bone grafts. Im assuming this is not the surgery youre talking about. I look forward to hearing your thoughts.

[danny44]

Hey just wanted to ask you guys, does anybody know about future complications involving this, I was just reading about people getting jaw surgery that involved screws and then having the body reject the screws years later. Do you know if this is common. From reading over some of the jaw surgery boards it seems like there are lots of people with screws that do not have this problem. It also seems like there are lots of people who have had bones in there face fractured repositioned and then screwed into place. As in most of the bimax surgery. I haven't read anything about refracturing the face from an injury or face trauma which is basically my biggest concern with having a Lefort sandwich done. I feel like I am weakening my face permanently and my cheekbones could break much easier afterwords. Anyone have any thoughts on this.
much appreciated

[Lazlo]

Hey, I think this will be more of interest to Pekay, but perhaps others can chime in. This concerns all of the above, jaw surgery and under-eye hollowness as well as "aging" especially.

So a guy who I think looks ABSOLUTELY amazing and he's 55 years old now is Daniel Day-Lewis. I mean the guy has model good looks, somewhat of a long face actually and also a longer philitrum, but all of that said, his bone structure and soft tissue is preternaturally strong and resistant to what most people look like as they get older. A few words on this.

First, I think people who are generally "good looking," also look better when they're older --that's just us responding to their being good looking.

But the second interesting thing here is that DDL the underlying architecture of DDL's face is such that there is very little soft tissue sagging whatsoever as he's aged, especially around the under-eye area.

Third, there must be something genetic about his facial and bodily soft tissue as well. He's always been extremely slim/ripped/high metabolism type of person clearly. Perhaps some people have genetically gifted soft tissue that is somewhat resistant to sagging. From what I know of him he definitely does not seem like the type of guy who goes to a beauty salon or would ever have cosmetic surgery. He broke his nose while training for the film THE BOXER and never even had it straightened. His nose is big, but due to his broad facial bone structure, it looks balanced. His eyes are also on the much wider apart side of the spectrum.

I don't mean to make this a celebrity thread but it would be interesting to know what the underlying structural and/or soft features of his face are which allow him to look and age so well. He's 55 which is by now means "old" but I would have thought his facial features would show more "sag". I feel in my 30s mine already do quite a bit...and that's why I want my bone structure augmented.
I mean sure there's some slight wrinkling over the years, and grey hair, but otherwise the overall tautness of his features has remained unchanged!

And to clarify on the "dark circles" issue. I don't have dark circles in the sense of skin tissue or color, rather I just have depressed under orbital areas and this is what causes the shadow to hit that area a bit...

[Lazlo]

says the "uploader is full" when I try to attach images, but just google Daniel Day Lewis and you'll see what I'm talking about.
The structural features of his face have remained entirely unchanged from the age of like 35 to 55.

[Lazlo]

http://www.google.ca/imgres?q=daniel+day+lewis&um=1&hl=en&sa=N&tbo=d&biw=1680&bih=868&tbm=isch&tbnid=HxXjCBI_aWWGRM:&imgrefurl=http://blogs.coventrytelegraph.net/passtheremote/2013/01/daniel-day-lewis-may-need-a-bi.html&docid=xdL9q1CaW08yrM&imgurl=http://blogs.coventrytelegraph.net/passtheremote/daniel%252520day-lewis%252520jan%2525202013%252520five.jpg&w=2532&h=3268&ei=VT38UOe6Mo7jqAG84oDIDQ&zoom=1&iact=hc&vpx=602&vpy=291&dur=326&hovh=255&hovw=198&tx=109&ty=120&sig=108372599364285027136&page=1&tbnh=150&tbnw=115&start=0&ndsp=62&ved=1t:429,r:19,s:0,i:211

[Lazlo]

I was doing a bit of reading about "Bone Morphogenetic Protein," and came across this from 2010. Looks pretty cool. Anyone know what the results finally were on this case?

What's especially interesting is that it sounds we can make a lot of the enhancements we'd like in the near future....

http://www.healio.com/orthopedics/biologics/news/print/orthopedics-today/%7Bfc8a85a2-d695-4780-9b20-13a8020cfabe%7D/novel-procedure-helps-patient-grow-cheek-bones-using-bmp-allograft-andstem-cells

[Lazlo]

Just thought I'd update all of you with regards to my most recent discussion with Dr. Schendel. He was kind enough to do a follow up phone consult. Unfortunately, I was expecting to see the results of the
much touted "3D MD imaging" which would be an accurate visualization of my post-surgical results (supposedly only off by .3 mm in the past) but they said they only do it right before surgery and they need to take special
pictures etc. with some kind of 3D camera. I actually trust them that this was not an evasion but the truth because Schendel/Jacobson have already published the results of this device in numerous journals and I think
it just takes them a lot more work to do and they usually don't do that till the patient is ready for surgery.

That said, here are a few interesting things. First, Dr. Schendel assured me once again that both the depressed area underneath my eyes (the inferior orbital rim) and my cheekbones could be dramatically augmented through the high-lefort 1 procedure and the bone grafts and that give the pictures I had sent him(of a few people who had the kinds of results I wanted) this would be certainly attainable. This is in stark contrast I should add to a few other surgeons
I have consulted with. Dr. S also indicated again the importance of doing a genioplasty for the results I wanted. Interestingly Dr. Schendel suggested doing a 1cm advancement of my maxilla when doing the "high-left 1" which
is a lot more than what Arnett had recommended (only 2mm!!). I  guess the difference has to do with the "high-lefort" versus the CCW proposed by Arnett. I think in Arnett's plan the lower jaw would be augmented somewhere
around 11-16mm, but Schendel wants  to do soemthing like 11mm plus 4mm genioplasty.

I'm sure both doctors are equally great, but Dr. Schendel I feel is probably more right for me since he's somewhat more into aesthetic concerns and I just felt like I got along with him more --sometimes I think it
might just be a case of going with someone you feel more comfortable with, like more.

Here is something that is more interesting. I pressed him on distraction osteogenesis. He said that he does it on adults and that indeed he could do it. He did say though that it was a bit more involved because
it would require turning every day and another operation to take out the distractors. Honestly this is not even a problem for me because there are several advantages DO has over traditional jaw surgery.
He said he maxilla, chin, mandible etc. could be advanced linearly and along the transverse axis all through DO, not a problem. He did say though that the technique is usually reserved for patients who need
advancements of 2cm or more and that the amount of advancement I needed was still within the parameters that traditional rigid fixation orthagnathic surgery would do the trick.
That said, I'm going to really investigate whether DO is something that might produce superior results as I'm happy to have learned Dr. Schendel is willing to perform DO, if I'm okay with the longer time i takes to generate results.
I really don't see how the "longer time" is even a problem considering the fact that it's only a matter of a few weeks and the surgery for DO is much less traumatic and leads to a much lower incidence of
neurosensory changes, the soft tissue can be controlled to a much higher degree etc. etc.

And here's another valuable piece of information. I asked Dr. Schendel if DO could still be performed on someone after they've had traditional orthagnathic surgery and he said not only can it,
he's done it several times on patients who were unsatisfied with the results of surgery with other doctors or who have had some kind of relapse etc..
I thought this was important since I truly believe the future of this surgery lies with DO.

Okay, I hope some of this info is helpful to any of you out there who are struggling to make a decision about which doctor to go with or who had questions about distraction osteogenesis.

[danny44]

Hey all, I had my surgery yesterday, HA paste to the jaw angles and Lefort sandwhich osteotomy. I am swollen of course but can see already that my jaw is uneven. I have sent my doctor an email asking him what can be done. Since it was with HA paste I don't know how he can correct it exept maybe going through the same incisions and adding more. Do you guys have any ideas suggestions on what I might do/say/etc... Feeling kinda stuck. The augmentation is good but just different on each side.

[Heavyweight]

Hey all, I had my surgery yesterday, HA paste to the jaw angles and Lefort sandwhich osteotomy. I am swollen of course but can see already that my jaw is uneven. I have sent my doctor an email asking him what can be done. Since it was with HA paste I don't know how he can correct it exept maybe going through the same incisions and adding more. Do you guys have any ideas suggestions on what I might do/say/etc... Feeling kinda stuck. The augmentation is good but just different on each side.

I'd give it some time. Swelling is often very uneven.

[danny44]

I understand this, however on my jaw the Hydroxyapatite is very easy to feel (the contour) and it is most definitely not the same on both sides, I think the sooner the better as your tissue begins to grow into it right away, I am very worried, if this surgeon will not help me maybe I will need to get one side shaved down. Wow this sucks

[pekay]

Who was your surgeon? and what did you have done exactly? BSSO + LeFort + genio? and HA augmentation?

[Lazlo]

Yeah it's really inconclusive to me what those models/simulations show. I too doubt the high-lefort looks like that but who knows...