Saddled mesh titanium infraorbital implants and facial expressiveness.

[MazeFly]

Hi,

I know this might not be the ideal place to ask as I know it's most populated by clueless teenagers, but I suppose the question can not hurt. I've gone through bimax twice (had moderate sleep apnea, main indication was genuinely functional but the aesthetic part was also huge to me), somewhat considering a third, but mostly assuming I won't do that at the moment. The second bimax also included a ZSO. The large-ish maxillary advancement reduced my ogee curve despite the ZSO (4ish mm lateral expansion iirc). I'm considering having the hardware of the second bimax removed, and combining this hardware removal with the installation of a saddled titanium mesh infrarorbital implant, extended to the zygomatic arch to restore the ogee curve, fill out the area below the eyes (I have a slight negative orbital vector) and perhaps, if I feel confident this can actually be done this way, raise the margin of the lower lid a bit.

Firstly, how is the community viewing saddled infras these days? Do you think they can persistently raise lower lid resting margin? This was a very ongoing debate back when I last checked, people kept disagree, some saying they clearly could, others claiming that any results showing that are a result of swelling.

Besides your assessment of its utlity, how safe do you think this is? Feel free to elaborate on complications you know of or anecdotes you heard.

Lastly, I'm concerned this might negatively affect my facial expressiveness in subtle ways that have a large impact on how I'm perceived by people who are attuned to subtle cues. I don't know enough about the anatomy involved to know whether it could alter the way eye muscles behave. I can say that since my 2 bimaxes and ZSO, I have a bit more of a creepy "mister beast" type smile when smiling with teeth. I'm trying to-train myself out of that. I'm not sure why this happened exactly, but my smile looks more strained. My maxilla is a bit too tall right now but I'm trying my best to work with what I have now by whitening my teeth, getting composite resin bonding (maybe veneers in the future) and possibly a bit of gum grafting as well.

I'm looking ideally to have slightly verically more narrow and supported eyes at rest, and am fine if they scrunch up more when smiling, this is seen as cute generally.

The implant would obviously be custom designed and receive approval from various people who are decently knowledgeable on this sort of thing, and I'll do some tissue simulations in pirate surgery software myself.

Anyone have any input on how well-designed, conservative, saddled infra implants may interact subtle expressions of the eyes?

I'm deliberately wanting to avoid direct soft tissue to the eyes, as I consider the risk of an uncanny outcome too high. I look decent-ish, and wouldn't want to end up looking even slightly uncanny as a result of this, especially not when it comes to the eyes, as people project a lot of meaning/intent onto them.

Thanks for any input.

 

[svarddre]

Not one greycel

 

[MazeFly]

Not one greycel

Well I was active in these communities about a decade ago in the PSL era. I'm very checked out of such forums and just living life. Definitely not interested in lingering around, but if someone has useful input here, that'd be nice.

EDIT: For what it's worth, I had thousands of posts, but feel free to call me a greycel on this particular iteration, I guess.

 

[svarddre]

Well I was active in these communities about a decade ago in the PSL era. I'm very checked out of such forums and just living life. Definitely not interested in lingering around, but if someone has useful input here, that'd be nice.

EDIT: For what it's worth, I had thousands of posts, but feel free to call me a greycel on this particular iteration, I guess.

Based off your post you know more about surgery than 99% of the forum. I don’t know that much and I know pretty much nothing about infras. Although I should probably learn bc I need them

 

[billyxxx]

@chrishell

 

[chrishell]

First off, there is a much higher chance of uncanny result with implants than with fat grafts. Implants have a 40-50% revision rate regardless of what surgeon and implant designer you use. Anyone who claims otherwise without mentioning controlled peer-reviewed studies is being dishonest. You will also need fat grafts after implants anyway to smooth out edges especially with a material like PEEK or titanium that does not have feathered edges. You need to be mentally ready to need 1-2 implant revisions, waiting at least 6 months in between each one, as well as 2-3 rounds of fat grafts (the fat often dies). You are looking at 4-5+ surgeries and for most it will take 2-3 years to see good results. This is the honest picture that very few people are willing to confront. Moreover given the high revision rate of implants, benefits like osseointegration and soft tissue integration that mesh implants become less beneficial. The integration makes replacement more difficult: more scarring, more swelling, more dissection, etc.

Your smile likely looks off because of scar tethering or contraction in your midface preventing completely natural expressiveness. The ZSO may have also caused muscle displacement inhibiting natural expressiveness. Inserting an implant will make the scarring worse, but it is unpredictable how much worse. Some surgeons may be able to revise or reduce the scars when inserting your implants but it is unpredictable how much this could help and can even make things worse. After so many operations--2-3 bimaxes, ZSO, and potentially 2-3 implants--you are bound to have soft tissue sagging necessitating a midface lift as well.

Whether you can expect your lower eyelid to raise from a saddled implant depends on the existing height of your bony orbit and lower lid tightness. Heavily downgrown orbits and loose lids predispose you to getting the raising effect. Even then it is not predictable. It is seriously overplayed. I would say do not get it if that's your only complaint. Get it for the ogee curve and orbital vector improvement but the only surefire way to raise your lower eyelid is lower lid retraction surgery. Depending on your starting point the implant can also give you the bony foundation to make the results of a lower lid retraction surgery last longer.

they look good when done right though! just make sure you have a ton of money and time. Meow!

 

[ostri99]

Hi,

I know this might not be the ideal place to ask as I know it's most populated by clueless teenagers, but I suppose the question can not hurt. I've gone through bimax twice (had moderate sleep apnea, main indication was genuinely functional but the aesthetic part was also huge to me), somewhat considering a third, but mostly assuming I won't do that at the moment. The second bimax also included a ZSO. The large-ish maxillary advancement reduced my ogee curve despite the ZSO (4ish mm lateral expansion iirc). I'm considering having the hardware of the second bimax removed, and combining this hardware removal with the installation of a saddled titanium mesh infrarorbital implant, extended to the zygomatic arch to restore the ogee curve, fill out the area below the eyes (I have a slight negative orbital vector) and perhaps, if I feel confident this can actually be done this way, raise the margin of the lower lid a bit.

Firstly, how is the community viewing saddled infras these days? Do you think they can persistently raise lower lid resting margin? This was a very ongoing debate back when I last checked, people kept disagree, some saying they clearly could, others claiming that any results showing that are a result of swelling.

Besides your assessment of its utlity, how safe do you think this is? Feel free to elaborate on complications you know of or anecdotes you heard.

Lastly, I'm concerned this might negatively affect my facial expressiveness in subtle ways that have a large impact on how I'm perceived by people who are attuned to subtle cues. I don't know enough about the anatomy involved to know whether it could alter the way eye muscles behave. I can say that since my 2 bimaxes and ZSO, I have a bit more of a creepy "mister beast" type smile when smiling with teeth. I'm trying to-train myself out of that. I'm not sure why this happened exactly, but my smile looks more strained. My maxilla is a bit too tall right now but I'm trying my best to work with what I have now by whitening my teeth, getting composite resin bonding (maybe veneers in the future) and possibly a bit of gum grafting as well.

I'm looking ideally to have slightly verically more narrow and supported eyes at rest, and am fine if they scrunch up more when smiling, this is seen as cute generally.

The implant would obviously be custom designed and receive approval from various people who are decently knowledgeable on this sort of thing, and I'll do some tissue simulations in pirate surgery software myself.

Anyone have any input on how well-designed, conservative, saddled infra implants may interact subtle expressions of the eyes?

I'm deliberately wanting to avoid direct soft tissue to the eyes, as I consider the risk of an uncanny outcome too high. I look decent-ish, and wouldn't want to end up looking even slightly uncanny as a result of this, especially not when it comes to the eyes, as people project a lot of meaning/intent onto them.

Thanks for any input.

this guy looks more youthful in a natural way 6 months after surgery