RealSurgerymax
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On September 3, 2024 we performed the first subcranial Orbital Box Osteotomy with Tripod Osteotomies, and the 2nd Custom Subcranial Orbital Box Osteotomy.
(The first ever was collaborated with Dr Ercin, designed & assisted by me in Dec 2023. I collaborate with 3 independant surgeons for this procedure but we were the first.)
This thread will focus on the most recent OBO/Tripod Case.
The patient originally approached this service requesting a cosmetic facial bipartition. It was explained this isn't possible as facial bipartitions don't uniformly widen the face but rotate it (widen palate and narrow the orbits.) The patient also had a proposed plan in the USA with another surgeon. The USA OBO price quoted in cosmic's thread is long outdated and included no special modifications, custom guide or fixation system, or custom facial implants. Quote for the plan below, proposed by USA OBO surgeons using a custom system was well over $100,000.00 USD.
I came up with something else which we did for less than half the above cost.
Surgeon: Celal Candirli, Istanbul
Designer, Inventor, and Assistant: Liam/Giant (Me)
We planned two combined unicorn surgeries: Cosmetic OBO, and Tripod Osteotomies. Multiple facial implants including Infraorbital-Malar-Zygomatic, Supraorbital-Glabella-Nasion, and Parietal/Temporal Implants were combined for a total aesthetic facial recontouting & head widening effect.
This approach, including the guides necessary to execute it subcranially, was invented by myself with a patent-pending.
The movements were +2mm Lateralization of MOW (Medial Orbital Wall) and +4mm Lateralization of the LOR (Lateral Orbital Wall) per orbit, with Medial Orbital Wall Bone Grafts.
The goal for this segmental OBO plan was to increase the ICD (Intercanthal Distance) by approximately 4mm, IPD (Interpupillary Distance) by 6mm, PFL (Palpebral Fissure Length) by 1-2mm, and bizygomatic width by 12mm (8mm without zygomatic augmentation implants.) The way soft tissue, including the eye movement (IPD change) is a rough expectation since it doesn't follow skeletal movement exactly 1:1.
Orthognathic surgery is a long established field and soft tissue predictions are still not 100% accurate. Cosmetic Orbital Reconstruction is a no man's land so we are still honing in on all that. However I don't believe anyone living today has a better idea than this service given the special interest and exclusive availability of the applied Giant innovations.
This surgery required no oral incisions, simplifying the surgery with only coronal and eyelid incisions.
Patient was discharged to hotel on day 3. No ICU or blood transfusions were necessary. Double vision is expected in the immediate post op period as the brain adjusts to the new pupillary distance and is already nearly self resolved (Post Op Day 8). As of now there is no strabismus. Patient has been able to go outside and walk around since discharge.
So far, enopthalmos is not present. The Orbital Volume gained by the 2mm expansion (tripod osteotomies) was "refilled" with bone grafts in order to lateralize the globe within the orbit to create a greater IPD change than ICD change (Which hopefully stays like that.)
Simply, all the criticisms (including self criticisms) and things I/everyone was afraid could happen - didn't. This is to demonstrate proof of success, not to insinuate we have found a way to forever avoid this complication moving forward. If we do 10 OBOs, a couple of those will probably have minor strabismus in need of correction. Let me be clear. If one absolutely cannot do (take time off, pay for, and recover from) a minor corrective surgery after OBO, then they absolutely cannot get an OBO. Period.
I realize this surgery is not for everyone even if you're objectively a candidate for a little more/ little less IPD/ICD. If hearing about & seeing the reality of this operation helps you decide you don't want it - that's great. I want to be as transparent as possible about the risks, recovery and realistic things the procedure can achieve.
For those who really "need" to alter the IPD/ICD to achieve a better base for facial harmony, and can accept a second stage of more minor and inexpensive surgery can be needed: here is a much safer OBO that exponentially reduces the risk of death by keeping it subcranial (no craniotomy, no brain exposed) and is aesthetically optimized as an aesthetic OBO can be (Glabella contour preserved, 360-degrees, some other minor things I'll keep to myself for now.)
- Do not ask for public Before/Afters. Have some situational awareness.
- I'll be happy to post YOUR OBO/LF2/LF3 before and afters on the forum.
- Most of you trying to bully & manipulate your way into getting public b/a's ("it must be botched then") would have a meltdown if your pics got leaked on the forum.
- You can see before and afters privately if you are a serious candidate for that surgery. Before and Afters are viewable on zoom by vetted candidates only. For example if you are a candidate for bimax but not OBO, we can't show you OBO B/A's on zoom just because you're curious. This is out of respect for patient privacy.
- For me to agree to work on any case surgical/heavy blurred/non-identifying footage/photo release, anonymized skull/scan/design release, non-identifying case details release, and private/vetted b/a display (not circulation), is mandatory. Public B/A release is not mandatory and not surprisingly, 99% of people don't want to. One great b/a I had publicly posted asked to be taken down recently because of how some of you act.
Anonymized Strabismus Demo:
(The first ever was collaborated with Dr Ercin, designed & assisted by me in Dec 2023. I collaborate with 3 independant surgeons for this procedure but we were the first.)
This thread will focus on the most recent OBO/Tripod Case.
The patient originally approached this service requesting a cosmetic facial bipartition. It was explained this isn't possible as facial bipartitions don't uniformly widen the face but rotate it (widen palate and narrow the orbits.) The patient also had a proposed plan in the USA with another surgeon. The USA OBO price quoted in cosmic's thread is long outdated and included no special modifications, custom guide or fixation system, or custom facial implants. Quote for the plan below, proposed by USA OBO surgeons using a custom system was well over $100,000.00 USD.
I came up with something else which we did for less than half the above cost.
Surgeon: Celal Candirli, Istanbul
Designer, Inventor, and Assistant: Liam/Giant (Me)
We planned two combined unicorn surgeries: Cosmetic OBO, and Tripod Osteotomies. Multiple facial implants including Infraorbital-Malar-Zygomatic, Supraorbital-Glabella-Nasion, and Parietal/Temporal Implants were combined for a total aesthetic facial recontouting & head widening effect.
This approach, including the guides necessary to execute it subcranially, was invented by myself with a patent-pending.
The movements were +2mm Lateralization of MOW (Medial Orbital Wall) and +4mm Lateralization of the LOR (Lateral Orbital Wall) per orbit, with Medial Orbital Wall Bone Grafts.
The goal for this segmental OBO plan was to increase the ICD (Intercanthal Distance) by approximately 4mm, IPD (Interpupillary Distance) by 6mm, PFL (Palpebral Fissure Length) by 1-2mm, and bizygomatic width by 12mm (8mm without zygomatic augmentation implants.) The way soft tissue, including the eye movement (IPD change) is a rough expectation since it doesn't follow skeletal movement exactly 1:1.
Orthognathic surgery is a long established field and soft tissue predictions are still not 100% accurate. Cosmetic Orbital Reconstruction is a no man's land so we are still honing in on all that. However I don't believe anyone living today has a better idea than this service given the special interest and exclusive availability of the applied Giant innovations.
This surgery required no oral incisions, simplifying the surgery with only coronal and eyelid incisions.
Patient was discharged to hotel on day 3. No ICU or blood transfusions were necessary. Double vision is expected in the immediate post op period as the brain adjusts to the new pupillary distance and is already nearly self resolved (Post Op Day 8). As of now there is no strabismus. Patient has been able to go outside and walk around since discharge.
So far, enopthalmos is not present. The Orbital Volume gained by the 2mm expansion (tripod osteotomies) was "refilled" with bone grafts in order to lateralize the globe within the orbit to create a greater IPD change than ICD change (Which hopefully stays like that.)
Simply, all the criticisms (including self criticisms) and things I/everyone was afraid could happen - didn't. This is to demonstrate proof of success, not to insinuate we have found a way to forever avoid this complication moving forward. If we do 10 OBOs, a couple of those will probably have minor strabismus in need of correction. Let me be clear. If one absolutely cannot do (take time off, pay for, and recover from) a minor corrective surgery after OBO, then they absolutely cannot get an OBO. Period.
I realize this surgery is not for everyone even if you're objectively a candidate for a little more/ little less IPD/ICD. If hearing about & seeing the reality of this operation helps you decide you don't want it - that's great. I want to be as transparent as possible about the risks, recovery and realistic things the procedure can achieve.
For those who really "need" to alter the IPD/ICD to achieve a better base for facial harmony, and can accept a second stage of more minor and inexpensive surgery can be needed: here is a much safer OBO that exponentially reduces the risk of death by keeping it subcranial (no craniotomy, no brain exposed) and is aesthetically optimized as an aesthetic OBO can be (Glabella contour preserved, 360-degrees, some other minor things I'll keep to myself for now.)
- Do not ask for public Before/Afters. Have some situational awareness.
- I'll be happy to post YOUR OBO/LF2/LF3 before and afters on the forum.
- Most of you trying to bully & manipulate your way into getting public b/a's ("it must be botched then") would have a meltdown if your pics got leaked on the forum.
- You can see before and afters privately if you are a serious candidate for that surgery. Before and Afters are viewable on zoom by vetted candidates only. For example if you are a candidate for bimax but not OBO, we can't show you OBO B/A's on zoom just because you're curious. This is out of respect for patient privacy.
- For me to agree to work on any case surgical/heavy blurred/non-identifying footage/photo release, anonymized skull/scan/design release, non-identifying case details release, and private/vetted b/a display (not circulation), is mandatory. Public B/A release is not mandatory and not surprisingly, 99% of people don't want to. One great b/a I had publicly posted asked to be taken down recently because of how some of you act.
Anonymized Strabismus Demo:
