Listen Mommaerts moves the malar complex cutting under the orbital rim with his stupid zygomatic sandwich technique. Keller does a "quadrangular lefort 1" which includes part of the zygoma. But neither of these cuts move the crucial orbital rim which is needed to be moved forward. And I've seen TONS of examples on syndrome patients. To throw tact out the window, they still look f**ked. In other words, to perform such an operation that actually improves one's looks aesthetically if you're starting from a regular starting point (i.e. class i or class iii) is very difficult. If anything TWO cuts need to be made, one for the the lefort I to get the dentition and bite correct, and then a separate cut that is basically just a part of the lefort III to move both the orbital rim and the malar. This is basically what the OBswegger girl had done --two maxillary cuts. Now assuming that's the way to go, who has experience actually doing this? Well, almost no one. Surgeons who claim to have don it, usually means they did it on a cadaver with a team in medschool, or assisted on some example case with a senior surgeon. Actually having it as a regular part of your practice is almost nill. Schendel who probably has more experience than ANYONE save for Arnett (who has never done it by the way) --well Schendel told me he has don it three times and this is a guy who has done over 2000 jaw surgeries and countless other craniofacial operations. So listen, when you're dealing with the zygoma, orbital rim or anything above a lefort I, you are going into uncharted territory. Be warned. Even Earl's operation, it was a first time for Sinn doing a cut like that. It was an experiment for him and luckily it turned out okay. If you wanna do it, just know you're in the 99th percentile of "far out" surgeries.
