Author Topic: hi all,what do u guys think i should do?  (Read 11389 times)

Macros

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Re: hi all,what do u guys think i should do?
« Reply #15 on: May 22, 2015, 07:15:41 AM »
frontal pic,u can see the mid face problem
u say there is no vertical grow but in fact my appereance seems to suffer form some sort of that.
myabe is coz of my mid face defiance but look at this u see a "tired long unaestethic face"
and in fact im looking to find the best way to enchant my appereance

maybe some sort of "chin wing" can give me better rounded wide lower third ,tryng to fix the long problem?

[attachment deleted by admin]

Gregor Samsa

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Re: hi all,what do u guys think i should do?
« Reply #16 on: May 22, 2015, 08:04:22 AM »
Is that a Sailer patient?  ::)

Gregor Samsa

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Re: hi all,what do u guys think i should do?
« Reply #17 on: May 22, 2015, 08:12:24 AM »
I think it's a pretty good result if his intention was to become a woman.  :o

This is exactly the kind of feminizing result that I'm worried that a zygomatic osteotomy or implants can result in.

Macros

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Re: hi all,what do u guys think i should do?
« Reply #18 on: May 22, 2015, 09:18:44 AM »
In my opinion, just by looking at your cephalometric shot, you have some vertical growth judging by suspiciously increased distance between your eyes and mouth (long midface). Then you have increased gonial angle, which is just a another school sign of increased vertical growth. You also mentioned word "tired" which is TYPICAL sign of mid-face deficiency. You also have under eye pooling which can have many causes, but in your case I'd link it with midface deficiency since it's almost always part of this condition.

As I've probably said it before - this condition is very hard to treat. You can do lefortI advancement, you can augment malar/submalar region...whatever you do, it'll be worthless, if you won't address eye area as well and this is almost impossible using implants, in my opinion. Altough there are infraorbital implants intended for solving eye-area related issues, but they may look unnatural and spooky as you'll be able to hear the same opinion from many maxfac surgeons. Eye area is very sensitive place to mess with with, thus probably hardest to improve effectively. Despite this, infraorbital implants may be viewable option, probably depending of severity of the problem. Maybe submalar implants + fat graft/fillers would be a more suitable option. Again,hing else "fubared" whatever you'll do later, you'll probabably have to solve AT LEAST, otherwise you may end looking like this guy (notice eyes, besides everyt):






what a horrible result.



as i said in my first post my first consult with a maxillo he suggest me a Sarpe+ Lefort 1+BSSO,but he didnt talk about my mid face and in reality i wasnt satisfied by his plan .
then i went to Raffaini and he said sarpe daouble jaw surgerey  he also said my main prob is mid face , he only talks about fat garft . i dnt know whay he said nothing about implants,maybe he thinks they are dangerous?

what the difference between submalar implants and ifraoral implants? do u think is an invasive risky procedure ?
so in the end u think whatever i do unless a mid-face osteotomy like a mod lfort3 or zsso i  can end like look that guy?









Macros

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Re: hi all,what do u guys think i should do?
« Reply #19 on: May 22, 2015, 09:23:20 AM »
plus i would ask u if u know someone who can do a really good 3D ceph analysis with some morph before and after.


geijutsu

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Re: hi all,what do u guys think i should do?
« Reply #20 on: May 22, 2015, 09:40:16 AM »
Holy smoking toledos. Sailer really outdid himself on that one!

Macros

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Re: hi all,what do u guys think i should do?
« Reply #21 on: May 22, 2015, 10:19:50 AM »
so whats ur plan for fix ur problem? lf1 and zygoma bone graft? u know, eevry time i  think about some malar osteotomy my blood in the veins become cold.do u rellay would u go for a lefor 3?

im not telling u are arnett and gunson,but i can see u have knowledges much more than me

in the end i know myself and i have not the balls for doing a lefort 3,maybe im worng i dnt know but i wanna look to find some alternatives.

so u are assuming a lefort 1 fracture have more risky than every malar implants,good to know,i really was thinking about the opposite






Mark505

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Re: hi all,what do u guys think i should do?
« Reply #22 on: May 22, 2015, 10:28:24 AM »
so whats ur plan for fix ur problem? lf1 and zygoma bone graft? u know, eevry time i  think about some malar osteotomy my blood in the veins become cold.do u rellay would u go for a lefor 3?
bone graft is not osteotomy. bone graft is applaying a bone material on bone. i haven't seen any results of zygo bone graft, so I can't tell you anything.

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im not telling u are arnett and gunson,but i can see u have knowledges much more than me
well i know some stuff about midface problems, because I have similar.

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in the end i know myself and i have not the balls for doing a lefort 3,maybe im worng i dnt know but i wanna look to find some alternatives.
not only you won't have balls, there might be not many surgeons willing to perform this stuff on you.

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so u are assuming a lefort 1 fracture have more risky than every malar implants,good to know,i really was thinking about the opposite
Well puting an implant on a bone and cutting a bone's nerves sound pretty much difference to me. I might be wrong.

now seriously, no more "advices" from me. wait for more knowledgeable guys to come.

Macros

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Re: hi all,what do u guys think i should do?
« Reply #23 on: May 22, 2015, 10:38:28 AM »
yes yes i know bone grafts isnt an osteotomy,mone was only an emotional though i confuse u due to my bad english

the last question,have u thinked about the future?i mean live with something who arent part of ur face for the rest of ur life?

infection etc?

Macros

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Re: hi all,what do u guys think i should do?
« Reply #24 on: May 22, 2015, 11:10:54 AM »
look what i have found.
what about ?

https://www.youtube.com/watch?v=U99p9KAF10I#t=210 

molestrip

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Re: hi all,what do u guys think i should do?
« Reply #25 on: May 24, 2015, 10:09:13 PM »
Yes, I'm familiar with this guy in Australia. He charges like $30k for those cheekbone augmentations. He looks young in the video, I thought he was in his 60s.

His point about skeleton pulling back in your 40s is a good one. It could mean a few things. First, that you'll blend in more by that point. Second, that any corrections done while younger need to be redone as you age, as what's appropriate while young will be insufficient when old (to still look young). I spoke to a plastic surgeon who does this work too and he said that HA augmentation was popular in the 80s but that most surgeons abandoned it because the results were terrible. He said only older surgeons still use it because that's what they're comfortable with and it sells well. He mentioned that it's only useful for lateral augmentation but not for projection, which is what we really need. And he said it's just as foreign to the body as other implant materials. They don't solve one of the bigger problems with augmentations - symmetry. Studies are mixed on resorption but I think there's truth to that, just from talking to a few people who had it done. Asymmetric resorption is a real possibility. Heck, it's a problem even when using cavalier bone while still having the problem of how they look as you age. My cheekbones are already asymmetric but only in projection fortunately, not in position (much worse IMO).

To the extent that you need to fix it, earl's approach is probably the way to go. But don't be fooled by his success. He knew it was a big gamble and he was ok with it. It's still a very big gamble IMO. You haven't seen patients 5, 10, 15, etc years out yet. Even earl doesn't know (wish him the best of course :) ). Otherwise, I think the options just suck here. Surgeons are right, implants suck. My position is, I need jaw surgery for health reasons so I'm gonna do that. As for the cheeks and infraorbital rims, yes it's unaesthetic but we're not syndrome patients really. While we lack the advantages more attractive people possess, we pass for normal and can navigate life roughly to the same extent as everyone else. I'll keep an eye out for improvements in this space, we have time on our side and there's a lot of money on the table for anyone who can solve the problem. Sad but it'll probably be solved before Lupus is cured, just because there's that much money on the table. A compromise position might be long term face pulling for a middle ground but once you do surgery that's not gonna be a good option unless you want to repeat surgery to move the maxilla back.

Mark505

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Re: hi all,what do u guys think i should do?
« Reply #26 on: May 25, 2015, 12:03:42 AM »
Yes, I'm familiar with this guy in Australia. He charges like $30k for those cheekbone augmentations. He looks young in the video, I thought he was in his 60s.

...

30k for malars only? Daaamn, but still better than Sailer.

MrFox

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Re: hi all,what do u guys think i should do?
« Reply #27 on: May 25, 2015, 06:24:20 AM »
You only think that patient looks feminine because he is wearing makeup in the afters, the face structure isn't feminine.

molestrip

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Re: hi all,what do u guys think i should do?
« Reply #28 on: May 25, 2015, 10:36:08 AM »
He's right, there's volume definitely but it's not a great outcome. I think it's better than before though.

Apotheosis

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Re: hi all,what do u guys think i should do?
« Reply #29 on: May 26, 2015, 05:41:42 PM »
That sailer patient was actually an incredible success, but it doesn't seem so at first glance because he is still not attractive(Due to his eye are a still being underdeveloped)