Question about le fort 1

[Lefor3Laser]

Everyone knows that the Le Fort I osteotomy can be performed in two variations: a two-piece Le Fort I and a three-piece Le Fort I.

The three-piece Le Fort I is typically performed on individuals with an open bite or other related issues.

This leaves the two-piece Le Fort I, which raises an interesting question. Since it involves widening, does it achieve the same effect as MSE or SARPE but with greater precision and less asymmetry? In theory, it should, as surgical expansion allows for controlled movement, and if performed correctly, it could even help correct asymmetry.

I’m aware of its impact on the alar base, but that can be easily addressed with rhinoplasty.

I’d love to hear some opinions on this.

 

[Snicket]

Everyone knows that the Le Fort I osteotomy can be performed in two variations: a two-piece Le Fort I and a three-piece Le Fort I.

Interesting topic. Not very well informed on this topic but will try. MSE honestly seems the worst to me by far. There's less precision than a surgical procedure and complaints of asymmetry are quite common.

The three-piece Le Fort I is typically performed on individuals with an open bite or other related issues.

This leaves the two-piece Le Fort I, which raises an interesting question. Since it involves widening, does it achieve the same effect as MSE or SARPE but with greater precision and less asymmetry?

For SARPE vs 2/3 piece it's more complicated on more research: the answer on seems to depend on the severity.

2/3 piece is apparently used when there is a traverse discrepancy or deficiency between 3-6mm, while SARPE is considered for a discrepancy of greater than 6mm.

Basically, too much palatal expansion during LF1 is unstable. So you need to basically perform distraction,
SARPE is like a lot like limb lengthening. The surgeon makes an incision and an expander is used to gradually widen the it.

Of course, 2/3 piece LF actually deals with rotation and advancement of lower maxilla at the same time as expansion while SARPE is just single purpose. So maybe it's not an entirely fair comparison. Depends on your needs.

 

[Lefor3Laser]

Interesting topic. Not very well informed on this topic but will try. MSE honestly seems the worst to me by far. There's less precision than a surgical procedure and complaints of asymmetry are quite common.

For SARPE vs 2/3 piece it's more complicated on more research: the answer on seems to depend on the severity.

2/3 piece is apparently used when there is a traverse discrepancy or deficiency between 3-6mm, while SARPE is considered for a discrepancy of greater than 6mm.

Basically, too much palatal expansion during LF1 is unstable. So you need to basically perform distraction,
SARPE is like a lot like limb lengthening. The surgeon makes an incision and an expander is used to gradually widen the it.

Of course, 2/3 piece LF actually deals with rotation and advancement of lower maxilla at the same time as expansion while SARPE is just single purpose. So maybe it's not an entirely fair comparison. Depends on your needs.

Very good point, I'll research more on this and see, sarpe isn't good as it also has asymmetries, le fort 1 2 piece seems the best option if you aren't to narrow.

 

[Snicket]

le fort 1 2 piece seems the best option if you aren't to narrow.

Exactly and most people who have narrow palates usually need maxillary advancement and rotation of some kind as well - which SARPE doesn't address.

I don't know it's possible to get SARPE after 2/3 piece LF. It doesn't instinctively sound like a good idea to break your palate again.

I'm pretty sure MSE is the worst out of all three options by some margin though.

The only reasonable counters I can think of are that it's cheaper, less invasive than LF or SARPE and nothing precludes you from getting them later. Not very convinced by the last two points but it's an answer.

 

[quantitativePSL]

Dr Alfi splits the maxilla and widens it during his jaw surgeries as he isn't a fan of MSE. Additionally, there is a new procedure called FME that is suppose to have a lot more control over expansion and limit assymetry but im not sure if this is actually the case for FME

 

[Snicket]

Dr Alfi splits the maxilla and widens it during his jaw surgeries as he isn't a fan of MSE. Additionally, there is a new procedure called FME that is suppose to have a lot more control over expansion and limit assymetry but im not sure if this is actually the case for FME

Funny you should say that, pretty much all the surgeons I've spoken to universally hate MSE.
I know MSE advocates will say it's because it means less business for surgeons but you're drilling an appliance into the roof of your mouth for asymmetric expansion and less control over the process!

 

[Lefor3Laser]

Dr Alfi splits the maxilla and widens it during his jaw surgeries as he isn't a fan of MSE. Additionally, there is a new procedure called FME that is suppose to have a lot more control over expansion and limit assymetry but im not sure if this is actually the case for FME

It’d be interesting to see how it would turn out. Yeah, it’d probably be for extreme cases since Le Fort I can’t be done the same way as FME by gradually adding width and bones wich gives time for bones to heal. At max, I think it allows for 6 mm of widening, as Snicket said.

I think widening the maxilla through a Le Fort I 2 piece could be done by first cutting the maxilla at the midline and then proceeding with the side cuts.

What’s your take on this?

 

[quantitativePSL]

It’d be interesting to see how it would turn out. Yeah, it’d probably be for extreme cases since Le Fort I can’t be done the same way as FME by gradually adding width and bones wich gives time for bones to heal. At max, I think it allows for 6 mm of widening, as Snicket said.

I think widening the maxilla through a Le Fort I 2 piece could be done by first cutting the maxilla at the midline and then proceeding with the side cuts.

What’s your take on this?

I think that's how it would be done Dr.Alfi spoke about it on Jawhacks podcast and went into how it's done but I just can't remember exactly what he said but he how he spoke was that MSE is essentially obsolete and he would never let a patient do it simply because he can get a better result through surgery

 

[quantitativePSL]

Yo also question, have you found out who the best jaw surgeons are? I like Dr.Alfi but I think he's quite conservative, he knows about the looksmaxxing world and knows giant implants but don't think he fucks w that level of stuff

 

[Lefor3Laser]

Yo also question, have you found out who the best jaw surgeons are? I like Dr.Alfi but I think he's quite conservative, he knows about the looksmaxxing world and knows giant implants but don't think he fucks w that level of stuff

There are many great surgeons that are not popular and yet to be found, the best surgeon for me is Dr.Valerio Ramieri since he has an eye for aesthetics and pretty cheap compared to many, but again, you can find many surgeons that aren't renamed who can produce the same results.

Dr.Alfi is smart but on his podcasts i feel like he is a salesman, yeah he does jaw widening with bimax wich is something that not many surgeons are willing to do, saw a video on his ig page where was asked for implants and he suggested jaw widening.

 

[quantitativePSL]

There are many great surgeons that are not popular and yet to be found, the best surgeon for me is Dr.Valerio Ramieri since he has an eye for aesthetics and pretty cheap compared to many, but again, you can find many surgeons that aren't renamed who can produce the same results.

Dr.Alfi is smart but on his podcasts i feel like he is a salesman, yeah he does jaw widening with bimax wich is something that not many surgeons are willing to do, saw a video on his ig page where was asked for implants and he suggested jaw widening.

Interesting, I saw a video with him and jawhacks where he said he is against MSDO which is like MSE for the mandible and that the jaws look narrow because they are recessed and advancement will create a wider jaw so I'm not sure what widening he meant in the video you refer to

 

[Lefor3Laser]

Interesting, I saw a video with him and jawhacks where he said he is against MSDO which is like MSE for the mandible and that the jaws look narrow because they are recessed and advancement will create a wider jaw so I'm not sure what widening he meant in the video you refer to

It's true, MSDO is the only way to widen the lower palate but it's the riskiest, imo not worth the risk, many people just tend to have canted theeths that go inward, fixing them will give you space for tongue and also benefit you for wider upper palate since your bite changed, back to MSDO, i am with him on it since there are many nerves down there.