Surgery Questions

[Carl-o]

kinda have a short face with very weak lower third.
I fraud alot by putting the point of my tongue between by theet to add a bit of vertical length

according to people here it bumps me from 2.5 to 3.5~4.

1) is CW rotation the only way to add verticality? I knew that it also recedes you and im recessed so it worse the situation

2) Is a lengthening of 3 cm possible?

Moving on my next big falio is the eye area kinda buggy. I would like to do orbital decompression + bimax lefort 1 high cut or modified lefort 3 to obtain the hooded eye

3) Is orbital decompression aways possible?
4) Beside dr Sinn anyone knows someone else for the modified lefort 3?

Last but not least the zygomatic area; i heard that MSE is the only way to add zygomatic width

5) Have you heard of zygomatic split osteotomy? Should work as well

 

[Deleted member 8988]

Bump

 

[Carl-o]

Bump

 

[Carl-o]

Bumpety bump

 

[MansNotHot]

Bumperhino

 

[Carl-o]

ok just showing you my subhumanity; maybe gonna recive some answers

 

[Carl-o]

Can relate to this guy for eye area; orbital decompression seems the way

 

[RealSurgerymax]

kinda have a short face Lower third is slightly short when compared against other facial thirdas and also stomion ratio. Your tomion ration is about 1:1.5 eyballed and could be brought to 1:2 but you do not have a short midface with very weak lower third Yes I agree with that.
I fraud alot by putting the point of my tongue between by theet to add a bit of vertical length

according to people here it bumps me from 2.5 to 3.5~4 mhm...

1) is CW rotation the only way to add verticality? I knew that it also recedes you and im recessed so it worse the situation
No and I highly recommend against this. If you are open to jaw surgery I recommend straight double jaw advancement.

You should get an extended genioplasty with CCW vertical movement instead.

2) Is a lengthening of 3 cm possible?
Without countercloskwise rotation, in absense of overjet, your maxillary-mandibular will be restricted to 1-to-1. The highest a LeFort 1 can be advanced without risking instability as well as palpable and vasible step-off deformity through the skin at the osteotomy site is about 6mm, 7 to 9 with bone grafts but that is more surgery with an incision at the hip or scalp for bone graft harvest site. The bone grafts would allow larger maxillary advancment by adding stability, and smoothing contour irrgeularities.

Since you might have a skeletal class II with dental compensation (to be determined) then orthdontic decompensation may gain a few more millimeters of mandibular advancemsnt.

In combination with a 6-8mm genioplasty, I think you can gain 1.5cm of mandibular advancment. Or you could do more aggressive approaches like the bone-graft assited LeFort I Double Jaw advancment with a larger genioplasty of 10mm and gain closer to 2cm of lower third projection.

Moving on my next big falio is the eye area kinda buggy. I would like to do orbital decompression + bimax lefort 1 high cut or modified lefort 3 to obtain the hooded eye

You definitely seem like a good candidate for modified LeFort III depending which modification you seek. Another option is custom infraorbital implant with vertical augmentation.

3) Is orbital decompression aways possible?

No but it seems so in your case.

4) Beside dr Sinn anyone knows someone else for the modified lefort 3?

Email some. In the USA and Western Europe it will be harder to find surgeons willing to do this because the modern west is more litigous and aesthetic practitioners are more consious to limiting risk. And more reasons I have written about before.
Last but not least the zygomatic area; i heard that MSE is the only way to add zygomatic width

Custom implants. This would be an even better option if you decide to do the custom infraorbital implants with vertical augmentation as the zygomatic portion could be an estension of the same implant design.

5) Have you heard of zygomatic split osteotomy? Should work as well

Yes it could but implants are probably a more controlled approach.

 

[000]

kinda have a short face with very weak lower third.
I fraud alot by putting the point of my tongue between by theet to add a bit of vertical length

according to people here it bumps me from 2.5 to 3.5~4.

1) is CW rotation the only way to add verticality? I knew that it also recedes you and im recessed so it worse the situation

2) Is a lengthening of 3 cm possible?

Moving on my next big falio is the eye area kinda buggy. I would like to do orbital decompression + bimax lefort 1 high cut or modified lefort 3 to obtain the hooded eye

3) Is orbital decompression aways possible?
4) Beside dr Sinn anyone knows someone else for the modified lefort 3?

Last but not least the zygomatic area; i heard that MSE is the only way to add zygomatic width

5) Have you heard of zygomatic split osteotomy? Should work as well

Bumpity bumparoo

 

[Deleted member 3679]

ok just showing you my subhumanity; maybe gonna recive some answers

You look average not subhuman... if you fixed your lower third with BSSO and genio, got orbital rim implants, and did the eye decompression thing you could be above average.

 

[baruch]

kinda have a short face Lower third is slightly short when compared against other facial thirdas and also stomion ratio. Your tomion ration is about 1:1.5 eyballed and could be brought to 1:2 but you do not have a short midface with very weak lower third Yes I agree with that.
I fraud alot by putting the point of my tongue between by theet to add a bit of vertical length

according to people here it bumps me from 2.5 to 3.5~4 mhm...

1) is CW rotation the only way to add verticality? I knew that it also recedes you and im recessed so it worse the situation
No and I highly recommend against this. If you are open to jaw surgery I recommend straight double jaw advancement.

You should get an extended genioplasty with CCW vertical movement instead.

2) Is a lengthening of 3 cm possible?
Without countercloskwise rotation, in absense of overjet, your maxillary-mandibular will be restricted to 1-to-1. The highest a LeFort 1 can be advanced without risking instability as well as palpable and vasible step-off deformity through the skin at the osteotomy site is about 6mm, 7 to 9 with bone grafts but that is more surgery with an incision at the hip or scalp for bone graft harvest site. The bone grafts would allow larger maxillary advancment by adding stability, and smoothing contour irrgeularities.

Since you might have a skeletal class II with dental compensation (to be determined) then orthdontic decompensation may gain a few more millimeters of mandibular advancemsnt.

In combination with a 6-8mm genioplasty, I think you can gain 1.5cm of mandibular advancment. Or you could do more aggressive approaches like the bone-graft assited LeFort I Double Jaw advancment with a larger genioplasty of 10mm and gain closer to 2cm of lower third projection.

Moving on my next big falio is the eye area kinda buggy. I would like to do orbital decompression + bimax lefort 1 high cut or modified lefort 3 to obtain the hooded eye

You definitely seem like a good candidate for modified LeFort III depending which modification you seek. Another option is custom infraorbital implant with vertical augmentation.

3) Is orbital decompression aways possible?

No but it seems so in your case.

4) Beside dr Sinn anyone knows someone else for the modified lefort 3?

Email some. In the USA and Western Europe it will be harder to find surgeons willing to do this because the modern west is more litigous and aesthetic practitioners are more consious to limiting risk. And more reasons I have written about before.
Last but not least the zygomatic area; i heard that MSE is the only way to add zygomatic width

Custom implants. This would be an even better option if you decide to do the custom infraorbital implants with vertical augmentation as the zygomatic portion could be an estension of the same implant design.

5) Have you heard of zygomatic split osteotomy? Should work as well

Yes it could but implants are probably a more controlled approach.

Why do you highly recommend against CW?

 

[RealSurgerymax]

Why do you highly recommend against CW?

• Would make you look downward grown
• My subjective aesthetic opinion