UPDATED-Lazlo's surgeries --UPDATED WITH RHINO INFO AT THE END

[terry947]

Good luck lazlo! I hope the surgeries go well for you. I'd kill  to see an after since a mod Lf3 is sort of a dream procedure I'd wish to have.

[mike888miller]

you said in the first surgery that you expect the jaw to be widened and the ramus dropped - how will achieve together with the le fort and genio? are you talking about the chin wing style genio (did not know that sinn did these), or implants? optimist also asked about the ramus, would be interesting for me as i am fighting with my doc, he only wants to do the chin wing but i want the bsso plus genio.

the rest sounds like a good plan. you should look into getting some fat grafting done, as many surgens can do this as an easy add on, and since you will be going under a few times they can fill up and top off as needed. i had this done in korea with stem cell enrichment and it made my skin look 5 to 10 years younger.

[mike888miller]

one more - which doc was your 2nd option? why did you decide on sinn?

good luck, and just do it!

[Optimistic]

you said in the first surgery that you expect the jaw to be widened and the ramus dropped - how will achieve together with the le fort and genio? are you talking about the chin wing style genio (did not know that sinn did these), or implants? optimist also asked about the ramus, would be interesting for me as i am fighting with my doc, he only wants to do the chin wing but i want the bsso plus genio.

the rest sounds like a good plan. you should look into getting some fat grafting done, as many surgens can do this as an easy add on, and since you will be going under a few times they can fill up and top off as needed. i had this done in korea with stem cell enrichment and it made my skin look 5 to 10 years younger.

Strongly disagree with this approach. You really need to wait and see how everything settles before you go playing with the soft-tissue. Very risky otherwise imo

[Schrödingers Jaw]

Strongly disagree with this approach. You really need to wait and see how everything settles before you go playing with the soft-tissue. Very risky otherwise imo

Exactly soft tissue is more important than one might think and there are bone mass pulling and interacting with it all over the skull. Surgery should be done in steps because your looks will change successively and your needs will change with it.

[Bobbit]

yeah i meant i'd have the fat injection done after, but mikemiller did your fat stay?

Everyone I know who had fat injections --they're fat eventually resorbed in like a few weeks/months?? i did hear it improves the skin quite a bit though.

Done properly (note: "properly") - - most (but not all) of the fat grafting will remain and become permanent.  Some of the transferred fat cells will not survive and will be re-absorbed.   There will be some local swelling and sometimes as that swelling goes down - - there is a perception that a larger portion of the transferred fat has been re-absorbed than is the actual case. 

From the results I have seen, and some conversations with some plastic surgeons who do and do not do fat grafting - -  the MOST important considerations in obtaining aesthetically pleasing fat grafting are:

1) training;
2) experience - - 
         AND
3) Bluntly - - an artist on the surgeon side of the long needle being used to transfer the fat tissue. 

And if the patient has thin or aged skin,  the fat grafting often works an absolute miracle for their skin texture and condition.

[PloskoPlus]

Done properly (note: "properly") - - most (but not all) of the fat grafting will remain and become permanent.  Some of the transferred fat cells will not survive and will be re-absorbed.   There will be some local swelling and sometimes as that swelling goes down - - there is a perception that a larger portion of the transferred fat has been re-absorbed than is the actual case. 

From the results I have seen, and some conversations with some plastic surgeons who do and do not do fat grafting - -  the MOST important considerations in obtaining aesthetically pleasing fat grafting are:

1) training;
2) experience - - 
         AND
3) Bluntly - - an artist on the surgeon side of the long needle being used to transfer the fat tissue. 

And if the patient has thin or aged skin,  the fat grafting often works an absolute miracle for their skin texture and condition.

The problem is that it's very hard to get a consistent result - multiple injections sites are required and it's a gamble how it will stick.  And it can randomly calcify years later.

[Bobbit]

The problem is that it's very hard to get a consistent result - multiple injections sites are required and it's a gamble how it will stick.  And it can randomly calcify years later.

Plasko,

Re:  ". . consistent result".   Yes. You are right.  It is hard to do well.  It appears to be deceptively simple and straight forward.  But it is really more involved than it appears.

That is where the training, experience and artistic ability come into outcomes.    I hear reports of  recent horribly "over done" fat grafting outcomes.

However,  it also remains true that a few of  the best plastic surgeons do get remarkably good and consistent results.   

But you are right, other surgeons do also get inconsistent and mediocre results.

Checking the reports on the internet - - calcifications appears to be pretty rare and more often associated with the donor site in liposuction - - rather than simple fat harvesting for transfer.  However,  it is reported.


   

[carlos30]

OP, your plan sounds very hardcore and pretty unrealistic from all views. Still I hope you achieve your goals. Good luck

[2jawkorea]

is sinn really that good?

[carlos30]

^
Apparently he's not formally trained plastic surgeon, let alone aesthetic-plastic surgeon, but he seem to be very respected craniomaxillofacial surgeon. He's one of few guys who are willing to do high-lefort and custom osteotomies on non-syndrome patients.

[SJay]

I'm totally with Lazlo here, contemporary rhinoplasty needs grafts! Reduction rhinoplasty clearly does have its uses too, such as a boxy tip or very high dorsal hump, but it's like a house... if you remove all the foundations, it will eventually collapse, causing both aesthetic and functional issues. Grafts are an excellent tool, they add structure and support and can actually make noses look more defined by pushing out against thick skin (African American noses often look puffy due to insufficient cartilage pushing out against the skin).

For those who want to know more, there's a lot of information about rhinoplasty involving grafts (usually revisions) over on Dr Davis' site – http://www.davisrhinoplasty.com/

But to anyone thinking of rhino, I'd say go with a revision specialist – they generally do the best primary rhino too... because they understand grafts!

[SJay]

And if you just want to check out some awesome work - http://www.rhinoplastyrevisions.com/photo-gallery/rhinoplasty-revision-photos

Although I may be a little biased.

[Schrödingers Jaw]

^
Apparently he's not formally trained plastic surgeon, let alone aesthetic-plastic surgeon, but he seem to be very respected craniomaxillofacial surgeon. He's one of few guys who are willing to do high-lefort and custom osteotomies on non-syndrome patients.

I think this is what makes him so valuable to us really, not that I doubt his skill.

[Optimistic]

Any surgeon will tell you too you will look like da bomb a week after sliding genioplasty, two weeks after facelift surgery and whatever-else-is-sold. Doesn't mean it's a matter of fact. You said you wanted to get a Lefort III 3 months after jaw surgery. That, my friend, is insanity. But you'll have to go through that rollercoaster yourself to know why we're saying that since you're not willing to accept what is said by patients that have been there, had the osteotomies, jaw surgeries e t c e t e r a.
For the sake of your plan it might help to now already read and believe that people are not saying that just to be a bully though, but to help you to be more realistic. Of course we all want you to accomplish in what you want but a bit of realism is needed.
As to grafting to your complete alveolar ridge in 2016, resorting to guided bone/tissue regeneration: great, let us know about that. Apparently you know things about bone/soft tissue regeneration nobody knows as of yet including the medical field, so I'm sure all of us would like to hear your secret first-hand info.

lol.

You're forgetting hair multiplication too.

Honestly I'd love for Lazlo to respond to the questions raised in this thread as I'm really curious as to what surgeons have told him. I asked my own but was thoroughly ignored. I'm definitely wanting to know more about this so-called ramus drop.