Revision zygomatic osteotomy: anyone?

[skippy]

OP, my consultation with Dr. Zarrinbal was kind of interesting. We talked about bimax surgery, chin wing and ZSO. I mentioned your case and that you weren't happy with the result but he couldn't remember you. Are you italian? Anyway, he showed me ZSO and chin wing patients of him, many of them. The male ZSO results did infact look like you described; it seems to augment the lower part of the cheek, giving it a fuller convex type of shape instead of a more high angular look many desire.

[skippy]

This is not good form.

nah, he was asking me why i suddenly didn't want to get the ZSO so i told him the truth about OP not being happy with the result, making me not wanting it.

[ncharm]

Lets be real here : I had a consult with Zarrinbal before about this surgery, He showed me exactly where the cut was made, and a pictures of results, etc. I did not choose Zarrinbal in the end, and still had the same operation with another surgeon, I think to suggest that OP was somehow scammed into it is really stretching it, but he just confirms the importance of this forum, and that we all need to do our research, and that there is no "turn me into a model" surgery out there.

[hellohello]

Yeah, I think it's a bit uncool to use me and my post here as a tool to communicate your concerns to the surgeon. You could have intensified your own research using the information I gave here if you felt what I am discussing might be a concern for you too; and you could have used that information and your own research to ask the surgeon yourself about the concerns you have (and whether the zyg. sandwich osteotomy could give you the result you desire) instead of referring to me.

Since this post was not about my surgeon and I did not question his competence. (In fact I didn't even remember I mentioned his name and had to search through the topic to see if and where his name was even mentioned). This post was intended to be an informative post about the zygomatic sandwich osteotomy, and how I feel it can not yield the result some members here seem to think. Describing why I feel it can not, and using my own result as an example for that. In the process hoping to find some answers myself too about other osteotomies or options and surgeons that perform different types of osteotomies.

Also since some members seem to think this procedure can give high cheekbones as seen in some male models, whereas the cut for the zygomatic sandwich osteotomy is over the lower part of the zygomatic bone. The upper part of the zygomatic bone is not fractured and thus you will get some fullness of the lower part of the cheekbone, not the higher part/the part above the malar prominence extending into the inferior orbital rim. Not the high or masculine cheekbone most of us seem to aim for.

If you can't make a post without risking the surgeon is informed whereas you didn't even write about him in the first place, that is not so cool. I doubt anyone would feel comfortable to write anything about their surgery result this way. If I would have said anything about the competence of the surgeon, it would be a different story. But my post focuses on the zygomatic sandwich osteotomy.

That being said, I am not happy with the result but I will stay clear from posting about it. Whereas NCharm writes that it was clear for her where the cuts were made and that only the lower cheek would get fullness, that was not nearly so clear-cut for me. And ending up with some fullness at the lower cheek was certainly not what was anticipated as a result of my surgery.

[hellohello]

Send him a PM to get the surgeon's names.

Thanks, I will do so.

[Lazlo]

Okay, I've been looking into a surgery called the "lamellar split osteotomy," which apparently tons of models have had and it looks excellent, gives the high cheekbone look. Who can find out more about it? I have some good inside sources that say it delivers.

[meepmeepmeep]

Okay, I've been looking into a surgery called the "lamellar split osteotomy," which apparently tons of models have had and it looks excellent, gives the high cheekbone look. Who can find out more about it? I have some good inside sources that say it delivers.

male or female models? both? does this achieve masculine angular cheekbone?

[Bobbit]

Okay, I've been looking into a surgery called the "lamellar split osteotomy," which apparently tons of models have had and it looks excellent, gives the high cheekbone look. Who can find out more about it? I have some good inside sources that say it delivers.

Looking at some of the pictures on the net - -  I am not sure where the surgical incisions are taking place.

     

[PloskoPlus]

Okay, I've been looking into a surgery called the "lamellar split osteotomy," which apparently tons of models have had and it looks excellent, gives the high cheekbone look. Who can find out more about it? I have some good inside sources that say it delivers.

AFAIK it predates zo and is considered inferior.

[carlos30]

@OP: I think it should be clear that ZSO can not give you high cheek bones, which is associated with masculine look. By googling around you should find that ZSO likely achieves in fact the opposite - feminization of face due to low-set cheek prominence. I suspect this surgery can only look good on females and males with more rounded (feminine) look.

I'm not even sure if there exists a procedure for getting "high cheek bones"?You'd probably have to cut whole zygomatic arch and move it laterally and it's also questionable how moving around that chunk would translate into aesthetic sense. It's about shaping not just linearly moving chunks around. Only way how I see it could be done is fillers or custom implants, maybe.

this is the case malar augmentation using fillers only:


Also, haven't you done simulation of surgery result (3dcone beam+soft tissue imaging) to get idea what are you getting into?If you didn't consider this, that's pretty ignorant, especially due to high unsatisfactory rate in jaw and plastic surgery domain.

[Lazlo]

lol that woman above looks so much better in the before. If I were her doc I'd be embarassed to pose those pics.

Yeah, honestly the more I think about this....I'm gonna get some pretty sophisticated imaging done but I think some form of soft tissue augmentation and or other augmentation will be needed. Not sure what this will translate to.... I'm gonna wait till my imaging results are in....

[carlos30]

lol that woman above looks so much better in the before. If I were her doc I'd be embarassed to pose those pics.

That's likely true. She already had good zygos and they got over augmented. Some plastic surgeons still don't know what a subtle result means (the best results are those you can't notice, IMO) and it's questionable how much can these results look natural in first place, as it is commonly the case with plastic surgery. Still this doesn't mean that jaw surgery is better  as it should depend on the application.

Yeah, honestly the more I think about this....I'm gonna get some pretty sophisticated imaging done but I think some form of soft tissue augmentation and or other augmentation will be needed. Not sure what this will translate to.... I'm gonna wait till my imaging results are in....

If I was you, I'd check thoroughly inside-out possible solution with many maxfacs and plastic surgeons. If they were unable to show me an accurate simulation model of post-surgery results, I'd run out of office. Even with simulation it's hard to predict final outcome due to soft tissue uncertainty, let alone judging end result by few before-after pics shown by maxfac, possibly on opposite sex.

[Lazlo]

That's likely true. She already had good zygos and they got over augmented. Some plastic surgeons still don't know what a subtle result means (the best results are those you can't notice, IMO) and it's questionable how much can these results look natural in first place, as it is commonly the case with plastic surgery. Still this doesn't mean that jaw surgery is better  as it should depend on the application.

If I was you, I'd check thoroughly inside-out possible solution with many maxfacs and plastic surgeons. If they were unable to show me an accurate simulation model of post-surgery results, I'd run out of office. Even with simulation it's hard to predict final outcome due to soft tissue uncertainty, let alone judging end result by few before-after pics shown by maxfac, possibly on opposite sex.

yeah good points. i trust sinn quite a bit, but I'll get the imaging done for sure. brother, i've done more research than a max fac by now.

[Bobbit]

If I was you, I'd check thoroughly inside-out possible solution with many maxfacs and plastic surgeons. If they were unable to show me an accurate simulation model of post-surgery results, I'd run out of office. Even with simulation it's hard to predict final outcome due to soft tissue uncertainty, let alone judging end result by few before-after pics shown by maxfac, possibly on opposite sex.

I think it comes down to what you want to pay for. 

Rational expectations

Doing those simulations (doing them carefully) takes a lot of time from the surgeon. 

Or you have a surgeon who hires a "service"  to do that work - - - in which case you don't really get the expertise you were originally hoping for.

So if a surgeon in Santa Barbara does a double jaw surgery for $50K and it takes 4 or 5 hours - -   that is ~ $10K / hour.   (yes, that has to cover the patient consult and work up time - -  so figure half that .  Still a big   $/hour number. )

Do you want to pay that surgeon to spend  an hour or ?  (even with great software) to personally do that  "morph" ?   When ultimately the morph is just educated artwork ?

If the patients are not willing to pay the surgeon to stop seeing patients in order to take the time to do that work - -  how does one rationally expect to get that done ?

Better - -  in my view - - is:

To find the right surgeon.   One that does digital skeletal modeling (routinely as part of the pre-surgery work up) from the CT scans  and to thereby very accurately define  the intended new surgical location for the jaws and get the SOTA  3-D printed splints so that the results are as predictable as possible.   

It helps if the  orthognathic surgeon is also a good plastic surgeon and they can address any other cosmetic issues at the same time. Those plastic surgeons will have a full bag of surgical tools to address any of the other aesthetic issues,  which the  dental/oral max/fac will not normally have.

[Lazlo]

i'm pretty sure sinn does the 3-D simulation.