Maxillary Hypoplasia: Limitations of Jaw Surgery

[Snicket]

As you can see, this guy has maxillary hypoplasia.
Bimax corrected his occlusion but the rest of his midface is retruded and left behind.

Would anything other than a high level LeFort Osteotomy have corrected his midfacial retrusion?

Obviously, a LeFort 2 advancment would make his nose much larger and require a post surgical rhinoplasty but is there any other way?

I don't think implants alone can address the rest of his hypoplasia properly without it.

 

[Snicket]

I'd prefer no comments that he's sub-5 or LTN.
He is but that's not the point of this thread.

The basic question is whether a high level LeFort is the only way to eradicate his midface retrusion.

Implants can only offer some much projection. Augmenting the rest of the maxilla with implants would look uncanny imo.

 

[Snicket]

As you can see, this guy has maxillary hypoplasia.
Bimax corrected his occlusion but the rest of his midface is retruded and left behind.

Would anything other than a high level LeFort Osteotomy have corrected his midfacial retrusion?

Obviously, a LeFort 2 advancment would make his nose much larger and require a post surgical rhinoplasty but is there any other way?

@Lefor3Laser @lurking truecel

 

[geenk worg]

he looks perfectly fine imho. I don't see what you see.

 

[Snicket]

he looks perfectly fine imho. I don't see what you see.

The smile reveals the true position of the maxilla:

His maxilla is horizontally deficient and incredibly flat at the central section.

The lack of bone support means the soft tissue just hangs off his face when he smiles.

The rest of the midface was obviously left behind when the upper jaw was advanced.

The result is certainly an improvement but still leaves a lot to be desired for a more aesthetic result.

 

[Lefor3Laser]

As you can see, this guy has maxillary hypoplasia.
Bimax corrected his occlusion but the rest of his midface is retruded and left behind.

Would anything other than a high level LeFort Osteotomy have corrected his midfacial retrusion?

Obviously, a LeFort 2 advancment would make his nose much larger and require a post surgical rhinoplasty but is there any other way?

I don't think implants alone can address the rest of his hypoplasia properly without it.

He indeed could benefit from a high le fort cut, the most sunken area is the under eye from what i see, when he smiles, it's much more visible, he needs many procedures, not just a higher le fort cut, and it would still not be enough imo, but it would be closer to normalization.

 

[smallgromp123]

The safest route with the best functional result for this guy would be:

1. MSE (would give him SOME under eye support + horizontal visual weight to the upper maxillary region)
2. High LF1 (cut as high as possible)
3. fat grafts (just to at least even out the deficiency)

Implants? (doubt infras would sit right on him)

All in all, a tough case, I agree that he needs more procedures, but I bet his life is way better now.

 

[genes_reroll]

I have the same issue but i didn't have bimax my teeth just compensated hard for the hypoplasia so my mouth is fine , i'm doing structural fat grafts for upper maxilla since i don't have money anyway to coinflip implants.
Anyway you have implants or fat grafts to create volume there high cut lf1 is never high enough to address the issue

 

[chrishell]

Implants and projection rhinoplasty

Dont get a “high cut lf1” it will get in the way of implants

 

[thereallegend]

They take out wisdom teeth to do bimax. That could also play a factor here.

 

[HorseMan7]

They take out wisdom teeth to do bimax. That could also play a factor here.

I doubt it.

 

[Foreverbrad]

Implants and projection rhinoplasty

Dont get a “high cut lf1” it will get in the way of implants

Lefort 1 + infra implants + projection rhinoplasty is the dollar store version of Lefort 3 in terms of effect.

I don’t know if all of that is even less risky than a Lefort 3 in the end tbh. In terms of botch risk / bad aesthetic outcomes.

 

[chrishell]

Lefort 1 + infra implants + projection rhinoplasty is the dollar store version of Lefort 3 in terms of effect.

I don’t know if all of that is even less risky than a Lefort 3 in the end tbh. In terms of botch risk / bad aesthetic outcomes.

Mental masturbation take

 

[Foreverbrad]

Mental masturbation take

It’s not really, Giant does LF3 and I have a few months before finishing the braces decompensation to make a final decision on my surgery plan…

 

[chrishell]

It’s not really, Giant does LF3 and I have a few months before finishing the braces decompensation to make a final decision on my surgery plan…

You're syndromic. It makes sense. Best of luck and hope it goes well!

 

[HorseMan7]

Implants and projection rhinoplasty

Dont get a “high cut lf1” it will get in the way of implants

Why do you think implants are superior to higher cut leforts?

 

[chrishell]

Why do you think implants are superior to higher cut leforts?

Assuming if by "Highcut Lefort 1" as some discrete procedure we mean the LF1 variation that extends almost all the way to the infraorbital rim (and it's not like like everyone ITT is on the same page of what that "Highcut Lefort 1" means anyway), then if you are interested in that procedure implies you have an infraorbital deficiency, and in the vast majority of cases if you have an infraorbital deficiency then you also have a zygomatic bone deficiency, but you cannot advance the zygomatic bone with a Highcut Lefort1, and by getting a Highcut Lefort 1 you make it difficult to design an implant that can harmonize your new infraorbital contour with your zygomatic contour. The procedure also makes your nose look more sunken in since you advance the bones surrounding the nose but not the nose itself, and since most people getting LeFort 1 are hypoplastic they probably also have a relatively recessed nose. In sum the conditions required for "Highcut Lefort 1" to make sense for a patient are rarely met. With implants the EXACT areas you need advanced are advanced and nothing more, nothing less, assuming proper placement of course. As with all procedures the surgery is good only if you need it, and bad if you don't.

 

[Snicket]

It’s not really, Giant does LF3 and I have a few months before finishing the braces decompensation to make a final decision on my surgery plan…

You’re getting or considering a higher level LeFort?

 

[Snicket]

Lefort 1 + infra implants + projection rhinoplasty is the dollar store version of Lefort 3 in terms of effect.

I don’t know if all of that is even less risky than a Lefort 3 in the end tbh. In terms of botch risk / bad aesthetic outcomes.

Lefort 3 cuts into the orbitals. It is clearly the more risky surgery.

 

[Foreverbrad]

Lefort 3 cuts into the orbitals. It is clearly the more risky surgery.

I’m considering higher Lefort.

Lefort 3 is certainly more “technically” risky than the multiple procedures I proposed, but in terms of botch risk you are just taking what is already there and moving it forward, which seems rather simple compared to having to place two infra implants correctly (notwithstanding getting the design right) and carry out a successful rhinoplasty which is notoriously prone to botching.

For most incels a botch result is essentially death anyway, we cannot afford to redo surgery and in many cases are going into debt to have it done in the first place.

 

[Snicket]

I’m considering higher Lefort.

Lefort 3 is certainly more “technically” risky than the multiple procedures I proposed, but in terms of botch risk you are just taking what is already there and moving it forward, which seems rather simple compared to having to place two infra implants correctly (notwithstanding getting the design right) and carry out a successful rhinoplasty which is notoriously prone to botching.

I don’t think it’s “technically” more risky, it’s practically more risky.

You cut into the orbitals and there are certain cosmetic trade-offs that come with the procedure, such as sunken eyes and step-offs.

At least with implants, you can do revisions.

If you really are syndromic (?) then it’s definitely a serious consideration though.

Whatever, you decide to do, best of luck and I hope it goes smoothly.

 

[lookmaxxer998]

No there is not otherwise it would be discussed more often. There are full maxilla implants, but I doubt you can add a saddle to something that big, so the under eyes would be a giveaway that you've had something done. And these full maxilla/upper full maxilla implants will likely cause you to have a bloated look. There are also paranasal implants etc which if combined with infra-malar+submalar implants can give the effect of midface advancement, but once again it can give a bloated look and you need to be careful with submalars bc they can feminize the face if too big.

A consistent trend I see with infras done by users here is there tends to be a step off inferior to the implant. Usually bc the surgeon wants to avoid placing it over the plates attaching the upper maxilla (idk if you can place over those plates) and as such there is a very sudden drop off in thickness- this usually makes it easy to tell you've had something done.
And the second most common issue is over/under sizing- sometimes a good design looks really bloating in practice and other times it doesn't give any meaningful result- these software companies really need to make simulation software for facial implants in the same way they do for breast implants.

 

[Foreverbrad]

I don’t think it’s “technically” more risky, it’s practically more risky.

You cut into the orbitals and there are certain cosmetic trade-offs that come with the procedure, such as sunken eyes and step-offs.

At least with implants, you can do revisions.

If you really are syndromic (?) then it’s definitely a serious consideration though.

Whatever, you decide to do, best of luck and I hope it goes smoothly.

I am not syndromic unless you count mild SFS.
The cosmetic benefits of higher lefort for me are that my nose bridge and nasal base areas are currently not well projected. It would also support a more masculine brow ridge and longer jaw without exceeding the facial convexity limits.

Trimax can sort out the jaw issues, infras can sort out the under eye hollowing and apparent low cheekbones, fat grafting can sort out the UEE… but it will still be a recessed, suboptimal face in general, just without the glaring failos that currently exist.

I won’t have the financial wherewithal for revisions so I’ll need to be conservative with implants, besides my face can’t support large implants anyway, the overall picture is of hypoplasia.

 

[greycel]

Implants and projection rhinoplasty

Dont get a “high cut lf1” it will get in the way of implants

Agree with Implants disagree with projection rhino
Would say he needs lyophilized cartilage for projecting nasal base. It accumulates and I think only loses 30% of projection in 3yrs, and keeps permanently over 50%. Also there's no bone resorption

 

[chrishell]

Agree with Implants disagree with projection rhino
Would say he needs lyophilized cartilage for projecting nasal base. It accumulates and I think only loses 30% of projection in 3yrs, and keeps permanently over 50%. Also there's no bone resorption

Yes he needs to project the nasal base and this is included in what i mean by projection rhino (bridge, tip, and base) but the you dont need lyophilized cartilage for that can just use nose cartilage or a peek implant

 

[greycel]

Yes he needs to project the nasal base and this is included in what i mean by projection rhino (bridge, tip, and base) but the you dont need lyophilized cartilage for that can just use nose cartilage or a peek implant

I've seen people say that peek Implant there looks uncanny when smiling/talking/yawning

Do you know any other substitutes for midface projection?

 

[Snicket]

No there is not otherwise it would be discussed more often. There are full maxilla implants, but I doubt you can add a saddle to something that big, so the under eyes would be a giveaway that you've had something done. And these full maxilla/upper full maxilla implants will likely cause you to have a bloated look. There are also paranasal implants etc which if combined with infra-malar+submalar implants can give the effect of midface advancement, but once again it can give a bloated look and you need to be careful with submalars bc they can feminize the face if too big.

A consistent trend I see with infras done by users here is there tends to be a step off inferior to the implant. Usually bc the surgeon wants to avoid placing it over the plates attaching the upper maxilla (idk if you can place over those plates) and as such there is a very sudden drop off in thickness- this usually makes it easy to tell you've had something done.
And the second most common issue is over/under sizing- sometimes a good design looks really bloating in practice and other times it doesn't give any meaningful result- these software companies really need to make simulation software for facial implants in the same way they do for breast implants.

Yes. I’ve seen so many results here where users have caked their midface in implants and they look like plastic dolls.

A higher level cut seems to be the only way to get true facial depth.

Now finding a first world surgeon that would do it is the real ordeal.

 

[chrishell]

I've seen people say that peek Implant there looks uncanny when smiling/talking/yawning

Do you know any other substitutes for midface projection

Cartilage from nose is preferable

 

[chrishell]

No there is not otherwise it would be discussed more often. There are full maxilla implants, but I doubt you can add a saddle to something that big, so the under eyes would be a giveaway that you've had something done. And these full maxilla/upper full maxilla implants will likely cause you to have a bloated look. There are also paranasal implants etc which if combined with infra-malar+submalar implants can give the effect of midface advancement, but once again it can give a bloated look and you need to be careful with submalars bc they can feminize the face if too big.

A consistent trend I see with infras done by users here is there tends to be a step off inferior to the implant. Usually bc the surgeon wants to avoid placing it over the plates attaching the upper maxilla (idk if you can place over those plates) and as such there is a very sudden drop off in thickness- this usually makes it easy to tell you've had something done.
And the second most common issue is over/under sizing- sometimes a good design looks really bloating in practice and other times it doesn't give any meaningful result- these software companies really need to make simulation software for facial implants in the same way they do for breast implants.

you are right that step off typically occurs due to the implant not being able to extend low enough due to the plates

I dont think its a good idea to do bimax at the same time as infrazygos for that reason

 

[Napoleon1800]

@Snicket can u rate me in dms?

 

[billyxxx]

Implants and projection rhinoplasty

Dont get a “high cut lf1” it will get in the way of implants

What exactly is done in a projection rhinoplasty? Is it just paranasal implants + cartilage grafts or something like that?

 

[chrishell]

What exactly is done in a projection rhinoplasty? Is it just paranasal implants + cartilage grafts or something like that?

They can take cartilage from the nose or ear and build up your nose base, bridge, tip, and radix

You can find examples on many South Korean surgeon pages where they perform this procedure

I have seen a good result by Steinbacher recently.

If you get this with lefort 1 and a conservative infrazygo implant you can mimic lf3

 

[billyxxx]

They can take cartilage from the nose or ear and build up your nose base, bridge, tip, and radix

You can find examples on many South Korean surgeon pages where they perform this procedure

I have seen a good result by Steinbacher recently.

If you get this with lefort 1 and a conservative infrazygo implant you can mimic lf3

Ah got it that makes sense, thanks

 

[Xx_gloomy_bison_xX]

I say infra or zygomatic implants may help a bit! though he needs high lefort cut for projection. I think they fid bimax for functionality rather than aesthetics yet his base was so terrible that even a slight adjustment increased his psl

 

[Xx_gloomy_bison_xX]

I say infra or zygomatic implants may help a bit! though he needs high lefort cut for projection. I think they fid bimax for functionality rather than aesthetics yet his base was so terrible that even a slight adjustment increased his psl

 

[Naris030]

They can take cartilage from the nose or ear and build up your nose base, bridge, tip, and radix

You can find examples on many South Korean surgeon pages where they perform this procedure

I have seen a good result by Steinbacher recently.

If you get this with lefort 1 and a conservative infrazygo implant you can mimic lf3

Could you dm the steinbacher result I’m im interested

 

[sham66]

Yes. I’ve seen so many results here where users have caked their midface in implants and they look like plastic dolls.

A higher level cut seems to be the only way to get true facial depth.

Now finding a first world surgeon that would do it is the real ordeal.

bro, how badly is ur maxilla recessed? many surgeons will perform lefort 3 if needed

here are their prices:
fearon 84k
sailer 100k
pagnoni 70-80k
and steinbacher is 125-150k i believe

 

[chrishell]

Could you dm the steinbacher result I’m im interested

I cant but you can consult steinbacher and ask him
The patient told me he showed him several other projection rhino results fwiw
He's not typically viewed as a rhino guy but he did author a book on rhinoplasty and since he is a maxfac surgeon first and foremost he understands the nose as it harmonizes with the jaws and midface which may be a more desirable background anyway

 

[Acne Victim]

I don’t know if all of that is even less risky than a Lefort 3 in the end tbh. In terms of botch risk / bad aesthetic outcomes.

 

[Mr.Proper]

What kind of high cut Lefort do you mean? There are various kinds, iirc. Can you show how it looks?