Author Topic: Cheekbone and orbital rim augmentation using HA  (Read 6981 times)

baldguy83

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Cheekbone and orbital rim augmentation using HA
« on: December 04, 2015, 12:05:43 PM »
I've (sadly) got poorly defined cheekbones, and for that reason I had a malar osteotomy performed by Dr. Z. a while ago. However, I'm not really satisfied with the results - I've gotten more lateral projection, but the cheekbone still sits too 'low' on the face. For that reason I'm looking into having my cheekbones (and possibly orbital rims) augmented with hydroxyapatite (HA) paste. Has anyone ever had something similar performed? If so, are you satisfied with the results? Any bone erosion horror stories to share perhaps?

I know one person had HA paste applied to his midface by dr. Van Dussen, but he only had minor augmentation work done I believe. Also, he's only had this surgery a few months ago, so can't really comment on any stability/erosion issues.

Schrödingers Jaw

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #1 on: December 04, 2015, 01:32:45 PM »
This seems to be a common complaint among male ZO patients, the cut needs to be made higher up to enhance the zygomatic arch which is what makes men good looking but that cannot be done without putting the visual nerve in the riskzone. I have poor orbitals and cheekbones myself, not catastrophic but it is something people notice and I've grown tired of living with droopy eyes and cheeks.

Assuming you have the same issue HA paste will not give enough augmentation, nor will a ZO (but you already know that). To follow in earls footsteps and do a modified L3 which will move the lower and lateral orbitals along with the upper part of the zygomatic process is exactly what I need but the questions are:

-Who will do it for cosmetic reasons?
-What are the risks?

Please join me finding the answers to these questions, earl had orbital issues and he spent years trying to find the best solution before finally settling for the modified L3 procedure and the more I learn the more I am starting to think he was right. For weak orbitals and cheeks a mod L3 is the only way to truly "fix" the problem once and for all.

Optimistic

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #2 on: December 06, 2015, 01:39:10 AM »
I've (sadly) got poorly defined cheekbones, and for that reason I had a malar osteotomy performed by Dr. Z. a while ago. However, I'm not really satisfied with the results - I've gotten more lateral projection, but the cheekbone still sits too 'low' on the face. For that reason I'm looking into having my cheekbones (and possibly orbital rims) augmented with hydroxyapatite (HA) paste. Has anyone ever had something similar performed? If so, are you satisfied with the results? Any bone erosion horror stories to share perhaps?

I know one person had HA paste applied to his midface by dr. Van Dussen, but he only had minor augmentation work done I believe. Also, he's only had this surgery a few months ago, so can't really comment on any stability/erosion issues.

I avoided getting a malar osteotomy precisely because of what schrödinger said - the only fix is a mod. le fort III. Seeing as you've already had a ZSO I'm not sure how this would then effect trying to get that done. Assuming you don't have the motivation the alternatives I've found haven't been spectacular.

You could try bone grafting and see if MAYBE some would convert to real bone, however chances are not good. Likewise HA paste just isn't going to do the trick. The stuff is not designed to augment areas. It's for filling in gaps only.

Maybe look at implants, custom ones such as titanium or that CT bone stuff coming out soon for infraorbital rims. For malar prominence itself idk maybe ha paste could work to add the illusion of it being higher up, but it's hard to say.
01/10/14 - Last night I spilt spaghetti sauce on my chin for the very first time in my life and cried.

Schrödingers Jaw

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #3 on: December 06, 2015, 08:40:07 AM »
I avoided getting a malar osteotomy precisely because of what schrödinger said - the only fix is a mod. le fort III. Seeing as you've already had a ZSO I'm not sure how this would then effect trying to get that done. Assuming you don't have the motivation the alternatives I've found haven't been spectacular.

You could try bone grafting and see if MAYBE some would convert to real bone, however chances are not good. Likewise HA paste just isn't going to do the trick. The stuff is not designed to augment areas. It's for filling in gaps only.

Maybe look at implants, custom ones such as titanium or that CT bone stuff coming out soon for infraorbital rims. For malar prominence itself idk maybe ha paste could work to add the illusion of it being higher up, but it's hard to say.

Do you have weak orbital structure?

If so what are your plans to deal with it?

ForeverDet

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #4 on: December 16, 2015, 07:48:05 PM »
I had HA done to my cheekbones in conjunction with double jaw surgery. It made them really prominent. However apparently it's not consistent, at least in jaw surgery patients.

So yes the paste can give a good result but beware that HA paste may cause severe swelling and leave residual swelling even years after. Not sure if this is minimized if it's done an isolation without jaw surgery.

Lazlo

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #5 on: December 16, 2015, 08:36:02 PM »
I had HA done to my cheekbones in conjunction with double jaw surgery. It made them really prominent. However apparently it's not consistent, at least in jaw surgery patients.

So yes the paste can give a good result but beware that HA paste may cause severe swelling and leave residual swelling even years after. Not sure if this is minimized if it's done an isolation without jaw surgery.

Yeah but isn't the swelling good on the cheekbones since it? Also, Mommaerts does crazy augmentations with HA --i mean he's a crap doctor, but it's doable with HA paste.

Optimistic

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #6 on: December 17, 2015, 02:09:38 AM »
Do you have weak orbital structure?

If so what are your plans to deal with it?

Modified le fort III. Only solution.

Yeah but isn't the swelling good on the cheekbones since it? Also, Mommaerts does crazy augmentations with HA --i mean he's a crap doctor, but it's doable with HA paste.

When I was considering Mommaerts I researched so much, even looked over all his published papers and books, every patient photo online. There are no documented cases which demonstrate even acceptable augmentation via HA paste. That's without even taking into consideration long-term stability. Would not recommend as a first resort.
01/10/14 - Last night I spilt spaghetti sauce on my chin for the very first time in my life and cried.

Schrödingers Jaw

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #7 on: December 17, 2015, 06:17:15 AM »
I wonder though, Rico recently had an osteotomy done on his zygoma, where the whole complex was mobilized, like in a modified le fort III and his eye sunk in due to the increase in orbital volume.

Obviously this procedure seems like the best option for those with a deficiency in the area, but I wonder how common these problems are and if there are reliable ways to avoid them...

Wasn't that the point, Rico needed additional volume didn't he?

And I've actually seen a decent result from MM in one of his older papers. It said "infraorbital onlay of HA granules" and was combined with a ZSO. I would attach the PDF but it's too large, got it from Rico actually he posted it in an older thread

molestrip

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #8 on: December 17, 2015, 10:19:43 AM »
I had HA done to my cheekbones in conjunction with double jaw surgery. It made them really prominent. However apparently it's not consistent, at least in jaw surgery patients.

So yes the paste can give a good result but beware that HA paste may cause severe swelling and leave residual swelling even years after. Not sure if this is minimized if it's done an isolation without jaw surgery.

I spoke to two patients who complained of residual swelling. Subclinical inflammation likely persists in all cases and probably for much longer than that. While it does make the face look better, a chronic  "infection" like this could easily have whole body ramifications, even if they're difficult to measure. There's reasons certain surgeries aren't common on the market.

ForeverDet

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #9 on: December 17, 2015, 10:24:08 AM »
Yeah but isn't the swelling good on the cheekbones since it? Also, Mommaerts does crazy augmentations with HA --i mean he's a crap doctor, but it's doable with HA paste.

It's not really swelling on my cheekbone but right next to it, I guess the malar pad. It's just one one side so I have a very "model"qsg left side, the contour is really great and the other is more rounded and moderately class II looking despite the prominent cheekbone. Part of it is my chin is also off center to the non-residual swelling side so it adds to the other side looking not as good.

molestrip

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #10 on: December 17, 2015, 10:28:05 AM »
It's not really swelling on my cheekbone but right next to it, I guess the malar pad. It's just one one side so I have a very "model"qsg left side, the contour is really great and the other is more rounded and moderately class II looking despite the prominent cheekbone. Part of it is my chin is also off center to the non-residual swelling side so it adds to the other side looking not as good.

One thing I've noticed from imaging provided by patients is that HA augmentations aren't smooth like you see in Mendelson's papers. It's more like a lump added in one spot. While I can see how that'd help drape up the soft tissue, I can't help but wonder if the true underlying contour will show with age and look odd. Thoughts?

ForeverDet

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #11 on: December 30, 2015, 10:01:20 PM »
One thing I've noticed from imaging provided by patients is that HA augmentations aren't smooth like you see in Mendelson's papers. It's more like a lump added in one spot. While I can see how that'd help drape up the soft tissue, I can't help but wonder if the true underlying contour will show with age and look odd. Thoughts?

Honestly I have no idea, I only hope it's not true for most cases since I had it done already! However as far as it not looking smooth and like a lump, check out my thread in the overbite section. My pics should still be up. I'm extremely self-critical to the point that it can become pathological (altho it's been fairly mild since surgery) yet they look like totally normal cheekbones. Nothing seems off in sensation or structure.

carlos30

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #12 on: January 15, 2016, 11:29:39 AM »
this mendelson guy may be the only hope for those with weak cheekbones and rims. Everything else looks like s**t.

Rico

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #13 on: January 15, 2016, 11:58:18 AM »
I UPDATED MY POSTS, THAT MY EYE IS NOT SUNKEN. AESTHETICALLY THE BONE IS SET QUITE OK or even PERFECT, who knows too early !
That time, I judged too early (2 week after surgery). Now it's 7 weeks.
Of course you can get sunken eye after such surgey if a surgeon is not enough experienced
You have to choose surgeon who is experienced in orbitozygomatic area.
My surgeon performes corrections after bad healed fracture and after botched surgeries

He performes CAS (computer assisted surgery) He takes many reference points, and on the computer he move the bones as he wants.
During surgery he checks new position based on selected reference points. That gives more predictible results
He has not damaged any nerve. I mean only one but because i needed decompression, so the surgery was performed near that nerve and was stretched. You do not need cuts crossing any nerve

Moreover i;m not gonna have any foreign object. My surgeon likes to remove miniplates after a few months post op.

However my masseter muscle still has not adjusted to new position. I'm gonna discuss about this with my surgeon in next week.

THAT KIND OF SURGERY IS LITTLE TRICKY BUT AT THE SAME TIME GIVES THE BEST RESULTS. IT'S THE MOST PROFESSIONAL OPTION

AND ALSO FULL ZO OSTEOTOMY IS NOT SO CLOSE TO LF3 AS I THOUGHT. IT'S LITTLE MORE COMPLICATED
I CAN SAY I HAD THE MOST DIFFICULT SURGERY ON THIS FORUM

Zygoma bone is the most difficult to set, This is part of orbit, many muscles are connected to the zygoma and there is the largest number of imprtant nerves. Moreover it's tiny line between good and bad result. This is why most max-fac surgeons won't do Zygomatic (full complex) osteotomy on you

About author post, it's that because you didn't have zygomatic bone osteotomy, what you had is 1/3 - 1/2  of cheek osteotomy.. some sandwiches and other bulls**ts

Here you have my results:

before: [overlooked fracture]


after:


It won't give you full picture... but something

i even believe i'm little too symmetric. The bone was moved about 5mm , now i believe slight beter would be 4mm
i used not t be symmetric , even before fracture

i'm not overcorrected.. but i think 1mm less would be better comparing to my old photos. but it;s still too early to judge. What I know it's for sure between good and perfect. I can judge better much later.

I had consultation with Z.  He told me full osteotomy is too dangerous, I may get persistent diploplia and other things., that simple surgeries are more predictible.
So now I see the opposite effect. Mine more complicated surgery was more predictible, and I did not have even temporary diploplia :P

but I can get full information after few months. I have to wait how my masseter muscle is gonna work a few months later
If muscles connected to jaw do not work properly then you can get TMJ disorder. My joint now is overloaded.
I will put some more info many weeks later

Interesting is fact that my surgeon has 0 opinions on the Internet, and Z. a lot good ones. Both are from Eest Germany

HOWEVER I do not recommend such surgery if your aesthetic problem is minor.  for example if you need only 2mm od advancement. Too big surgery for such minor changes
« Last Edit: January 15, 2016, 01:50:12 PM by Rico :) »

Rico

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Re: Cheekbone and orbital rim augmentation using HA
« Reply #14 on: January 15, 2016, 01:47:10 PM »
Oops, error,  East Germany not West :)

On Progenica I put the name of my surgeon and I got no response. That means really noone from Progenica was operated by him.
Eventually they were banned :P

hmm perhaps it's good to not find any opinion :P

no good and no bad

I just got opinion about him from other surgeon from Poland who knows him, that he is very good surgeon and good man. The last one is important. Good man means I have less risk he will left me when something will be not OK.
However I don't believe too much in surgeon's opinion about other surgeon. Only real patients matter.
Generaly I always devide by 2 what a surgeon tells me. For instance, some surgeons from Italy told me they could do this surgery without damaging nerve too much, my surgeon told me it's more tricky, that he is not gonna even touch this nerve, but it will be stretched.  and I chose the one who promised me less. I will nerve know if  chose better option :P

But that's strange a surgeon can edit rating. In Polish rating service one well known max-fac surgeon  still have some bad and some good opinions. I remember them, nothing has changed.
« Last Edit: January 15, 2016, 02:09:09 PM by Rico :) »