MARPE / MSE - When should be considered

[Usurper]

So we know that MARPE or other MSEs are indicated primarily for nose breathing problems or as an alternative to multi-segment Lefort I, with some advantages and disadvantages.

But would there be a case for it for aesthetical purposes only for midface enhancement. Let's say a patient with no significant transversal deficiency, does it make any sense at all. Vs let's say, midface implants.

 

[tyler1234]

Implants if no deficiency

 

[duduboy]

So we know that MARPE or other MSEs are indicated primarily for nose breathing problems or as an alternative to multi-segment Lefort I, with some advantages and disadvantages.

But would there be a case for it for aesthetical purposes only for midface enhancement. Let's say a patient with no significant transversal deficiency, does it make any sense at all. Vs let's say, midface implants.

FME for Holy Appeal and implants for psl

 

[Gittes]

But would there be a case for it for aesthetical purposes only for midface enhancement. Let's say a patient with no significant transversal deficiency, does it make any sense at all. Vs let's say, midface implants.

No, not really. Unless you want a super wide palate. Outside of that, you're risking asymmetry for minimal advancement of the maxilla.
You can't compare midface implants vs MSE. That's sort of like asking if a hammer or a screwdriver is better.

 

[Usurper]

After some research I concluded that there is very little use for these expanders for cosmetic purposes. You pretty much need to have breathing issues and/or a narrow palette and serves as an alternative to multi-segment Lefort.

The aesthetic impact of an expander is all over the place, and there needs to be a very specific list of conditions that all need to be met for an expander to provide a net improvement. And ultimately I believe the vast vast majority (think 95%+) won't meet these:
- Very short midface.
- Narrow lips
- Narrow nose alar base
- No pre-existing asymmetry unless asymmetry is carefully managed and correctable later with surgery
- Narrow Bizygomatic width in relation to bigonial width
- Good upper lip support or one that can be properly managed properly afterwards with Lefort I movement
- Good plane angle, or one that can be managed properly again with Lefort I (considering correction limits with joint/condyle)

 

[gravlek]

True hardmaxxers know the value of marpe in the bigger surgical plan https://looksmax.org/threads/result-from-mse-and-facemask-free-leforte-3.1441898/

 

[Usurper]

True hardmaxxers know the value of marpe in the bigger surgical plan https://looksmax.org/threads/result-from-mse-and-facemask-free-leforte-3.1441898/

Fine but again the impact it has on other metrics, makes it hard to justify for a lot of people.

 

[Gittes]

True hardmaxxers know the value of marpe in the bigger surgical plan https://looksmax.org/threads/result-from-mse-and-facemask-free-leforte-3.1441898/

No studies of FM + MSE corroborate this. A study of 16 subjects with a mean age of 10 using MARPE + FM averaged around 3mm in maxillary length.

The scans in your link seem misleading to me. The guy seems his head to the left in the post-MSE scan. Something's not right.

 

[gravlek]

No studies of FM + MSE corroborate this. A study of 16 subjects with a mean age of 10 using MARPE + FM averaged around 3mm in maxillary length.

The scans in your link seem misleading to me. The guy seems his head to the left in the post-MSE scan. Something's not right.

 

[Gittes]

There are no proper before and after pics. I'd want a lateral ceph with pre and post op measurements before I could conclude that a true mid facial advancment has taken place - which no-one else has managed to achieve in 10 year olds whose sutures haven't even fused yet.

 

[gravlek]

There are no proper before and after pics. I'd want a lateral ceph with pre and post op measurements before I could conclude that a true mid facial advancment has taken place - which no-one else has managed to achieve in 10 years whose sutures haven't even fused yet.

It’s mostly a meme what he did, but his midface did advance. That’s pretty clear for even a blind person

 

[Gittes]

It’s mostly a meme what he did, but his midface did advance. That’s pretty clear for even a blind person

Yes but it's likely far more limited than people think, based on all the studies of FM + MARPE that we have. Most of the advancement will have taken place at the LF1 level.