Music to listen to while reading this
Introduction: To the oldest and most experienced part of this community this most likely gonna be a water thread as it explains simply but in depth all that is related to maxillofacial surgery, to the most advanced users of this community this is all water and bs, but there is still some misinformation about some of this procedures and about what can you expect of them in terms of aesthetics and if they are worth your time, money and effort and ofc how dangerous they are, so i decided to examine and explain as clear possible all of this procedures in the following aspects:
1. What are they and how they work.
2. Expectations/Results
3. Level of danger/risk
4. Things to look out for
Disclaimer: i am not a doctor or your doctor and i do not advice/encourage you to do any of this procedures without consulting a legit certified OMFS, and if you decide to perform any of this surgeries and you get botched or anything goes wrong i am not responsible.
So that being said, without any further ado, let's jump right into it niggers
Lefort Osteotomies
Le Fort osteotomies are a very common surgical procedure used amongst Oral & Maxillofacial Surgeons or "OMFS", they consist of controlled bone cutting procedures of the midface that allow surgeons to reposition the facial skeleton in three dimensions and move it forward, depending on what type of Le Fort osteotomy is, there are limits to the amount of advancement that can be achieved with each one of this osteotomies, now i will proceed to list the range of movement/advancement that is achievable with each of them, important clarification for what each of them do
Le Fort I affects only the maxilla.
Le Fort II advances the central midface including the nasal bridge.
Le Fort III is a craniofacial disjunction that advances the entire midface and orbits (very very rarely used for aesthetics alone and it's almost used for syndromic cases like hypoplasia, there are surgeons that still do it, but the risk taken is extremely high for a patient that really doesn't need it.)
Le Fort 1:
3–6 mm : very safe and predictable, almost never gets an uncanny result or appearance
7–9 mm : best looking results stay in this range of advancement.
10–12 mm : it's possible, but higher risk for aesthetic imbalance unless it's combined with other movements (mandibular advancement)
General Note/advice: it´s is important to know that each case is different and depending on the recession presented it can require more or less advancement, so its important to asses this with your surgeon, to see what a realistic before and after would look like.
Le Fort 2
4–8 mm is the typical and expected advancement
Distraction osteogenesis (gradual movement):
10–15 mm+ is possible but depends on the patient, the surgeons technique and procedure
Lefort 3
It is primarily functional and reconstructive surgery, it's not done for cosmetic enhancement most of the time, unless the case is severe and it's actually needed.
Distraction is common as a technique to achieve more advancement, single-stage advancement is rare.}
the procedure goes like this:
-A rigid external frame (halo) or internal distractors are placed
-The midface is moved forward ~1 mm per day
-Total advancement possible and obtained ranges from: 10–20+ mm
-New bone forms in the gap as it moves.
For single stage advancement the movement obtained is way less.
the process is
The midface is moved forward all at once.
Fixed with plates and screws
There's a higher limitation to the advancement (usually <8–10 mm)
(and the relapse risk is higher*)
*important note: A Le Fort 2 and 3 osteotomies are usually reserved for severe cases of mid face recession or hypoplasia, and few surgeon do it for aesthetic enhancement, specially when it comes to Le Fort 3, Le Fort 2 can be done for aesthetics but not all surgeons are willing to, but it's waaaayyyy more common than Le Fort 3.
and are typically used in the treatment of conditions such as:
1.Underbite / overbite
2.Midface hypoplasia
3.Facial asymmetry
4.Obstructive sleep apnea (Bimax)
5.flat midface/midface recessions
And also to enhance facial aesthetics ofc, this is because they restore true forward skeletal projection, as when you reposition the midface the maxilla, zygomas, nasal base, and orbital rims all of this moves forward and the soft tissues (nose, cheeks, upper lip, lower eyelids) adapt to follow the craniofacial structure, so not only you are fixing recessions but also repositioning all the tissue that covers your face.
This reposition gives the "forward growth pattern" that all people crave for, as a forward grown face is not only better functional but also aesthetically.
Expectations/Results: Le Fort osteotomies with proper planning and evaluation are generally a very safe procedure and one of the procedures that creates the most change in the appearance as they have a very high impact in the craniofacial structure, and can produce life changing results in your appearance.
Level of danger/risk: Low risk (if performed by a qualified and experienced surgeon)
Life threating complications are only seen in the 0.1% of patients who get this procedure done, other complications such as permanent nerve damage make up for 3 to 5% of the patients who get this surgery done and severe infection or union is also very low at a 1-2%, major bleeding is insanely rare and 99% controlled and " a relapse needing revision" can occur depending how much advancement was made to a 5-10% rate, so moderate to low risk and a very high reward.
IMPORTANT DISCLAIMER: The rates in which any of this side effects occurs highly depend on the skills and experience of your surgeon and the complexity of your case and what results you were aiming for.
Things to look out for: its important to do a proper assessment of your case to see who much advancement is required and also to avoid the croc face which (is the result of too much maxillary advancement without pairing it with mandibular advancement), how to avoid it? never move it past the mma and respect the occlusal plane and angle, don't exceed the aesthetic limit of the advancement.
Extra: best surgeons for this surgery are: Dr. Mirco Raffaini and Valerio Rammieri
Here's a before and after example:
Bimax and trimax
Bimax it simply the double advancement of the mandible and the maxilla, it's used to treat patients with severe airway issues and sleep apnea, it also can be used to fix and correct poor forward growth as a way to enhance it, it's a BSSO (Bilateral Sagittal Split Osteotomy) and a (Le Fort 1 osteotomy)
Expectations/Results: it can be expected a complete enhancement of all the facial structure as the advancing of both jaws will correct a poor forward grown structure and also a lot of reposition of the soft tissue is expected, it's generally a very safe procedure and the results achieved are lifechanging and very impressive specially if your face is underdeveloped and has a lack of forward growth.
8–14 mm combined: gives a very natural and good-looking result and rarely turns out uncanny
15–18 mm combined: it's possible when properly assessed and still can give a aesthetic result.
20+ mm it's usually only in airway-focused MMA or severe skeletal retrusion, but if done good can give a pleasing result.
Level of risk/danger: Moderate risk, when done by a qualified and experienced professional, swelling and numbness is experience by everything and recovery takes about 6-8 months but with modern pharmacology that span of time can usually be decreased, the risk of permanent numbness or nerve damage is pretty low at a 1-3% rate, (uncommon but still need to be mentioned) Mild relapse: 5–10% and Significant relapse: <5%, infection 3-5%
Things to look out for: surgeons qualifications and surgical planning, that again you will have to discuss with, any crazy advancement that is not required for your case is a warning sign, but overall just reviewing your expectations and what your surgeon has planned.
Example:
View attachment bimax-3-weeks-post-op-v0-oo2ixhcmmfve1.webp
Trimax
Same as bimax but with a occlusal plane rotation or vertical changes and sometimes a genioplasty (but this does not mean trimax), this changes mean adding a Le Fort 2 or 3 depending on how severe the case is to be able to complete the ccw rotation, a zygomatic osteotomy is also used depending on the case.
Expectations/ Results: life changing procedure and has a nuclear impact on facial aesthetics, especially for severe midface recessions and hypoplasia, this meaning that is harder to get a surgeon to perform this on you when you do not fit the qualifications for it ofc, a thing to take into account it to find your failos and fix them but don't get a procedure that you do not need, as the risk increases and its just overkill.
Level of danger/risk: Very high, there's a very high chance of nerve injury, blood loss and swelling lasts way longer, the hospital has to monitor you in the ICU the days after the surgery, and if not necessary should be avoid, as the aesthetic error margin is much much higher.
Thing to look out for: you have to find the best surgeon possible and to find a hospital with a good ICU and to be sure this procedure is need.
WARNING NOTE: this is a major surgery when it involves a Le Fort 2 & 3 and a zygomatic osteotomy, when its a bimax plus a mentoplasty the risk drops down to moderate to low risk, again this procedure should only be done for insane recessions and medical conditions.
Anyways, this is the end of the thread, hope you enjoyed reading this, and will do a thread on craneofacial surgeries and minor surgeries too, if you enjoyed or found valuable info on this thread rep me, peace out.
Sources:
https://www.institutomaxilofacial.com/en/
https://esmed.org/orthognathic-surgery-enhancing-function-aesthetics/?utm
Pubmed https://pubmed.ncbi.nlm.nih.gov/31255372/
and wikpedia
Introduction: To the oldest and most experienced part of this community this most likely gonna be a water thread as it explains simply but in depth all that is related to maxillofacial surgery, to the most advanced users of this community this is all water and bs, but there is still some misinformation about some of this procedures and about what can you expect of them in terms of aesthetics and if they are worth your time, money and effort and ofc how dangerous they are, so i decided to examine and explain as clear possible all of this procedures in the following aspects:
1. What are they and how they work.
2. Expectations/Results
3. Level of danger/risk
4. Things to look out for
Disclaimer: i am not a doctor or your doctor and i do not advice/encourage you to do any of this procedures without consulting a legit certified OMFS, and if you decide to perform any of this surgeries and you get botched or anything goes wrong i am not responsible.
So that being said, without any further ado, let's jump right into it niggers
Lefort Osteotomies
Le Fort osteotomies are a very common surgical procedure used amongst Oral & Maxillofacial Surgeons or "OMFS", they consist of controlled bone cutting procedures of the midface that allow surgeons to reposition the facial skeleton in three dimensions and move it forward, depending on what type of Le Fort osteotomy is, there are limits to the amount of advancement that can be achieved with each one of this osteotomies, now i will proceed to list the range of movement/advancement that is achievable with each of them, important clarification for what each of them do
Le Fort I affects only the maxilla.
Le Fort II advances the central midface including the nasal bridge.
Le Fort III is a craniofacial disjunction that advances the entire midface and orbits (very very rarely used for aesthetics alone and it's almost used for syndromic cases like hypoplasia, there are surgeons that still do it, but the risk taken is extremely high for a patient that really doesn't need it.)
Le Fort 1:
3–6 mm : very safe and predictable, almost never gets an uncanny result or appearance
7–9 mm : best looking results stay in this range of advancement.
10–12 mm : it's possible, but higher risk for aesthetic imbalance unless it's combined with other movements (mandibular advancement)
General Note/advice: it´s is important to know that each case is different and depending on the recession presented it can require more or less advancement, so its important to asses this with your surgeon, to see what a realistic before and after would look like.
Le Fort 2
4–8 mm is the typical and expected advancement
Distraction osteogenesis (gradual movement):
10–15 mm+ is possible but depends on the patient, the surgeons technique and procedure
Lefort 3
It is primarily functional and reconstructive surgery, it's not done for cosmetic enhancement most of the time, unless the case is severe and it's actually needed.
Distraction is common as a technique to achieve more advancement, single-stage advancement is rare.}
the procedure goes like this:
-A rigid external frame (halo) or internal distractors are placed
-The midface is moved forward ~1 mm per day
-Total advancement possible and obtained ranges from: 10–20+ mm
-New bone forms in the gap as it moves.
For single stage advancement the movement obtained is way less.
the process is
The midface is moved forward all at once.
Fixed with plates and screws
There's a higher limitation to the advancement (usually <8–10 mm)
(and the relapse risk is higher*)
*important note: A Le Fort 2 and 3 osteotomies are usually reserved for severe cases of mid face recession or hypoplasia, and few surgeon do it for aesthetic enhancement, specially when it comes to Le Fort 3, Le Fort 2 can be done for aesthetics but not all surgeons are willing to, but it's waaaayyyy more common than Le Fort 3.
and are typically used in the treatment of conditions such as:
1.Underbite / overbite
2.Midface hypoplasia
3.Facial asymmetry
4.Obstructive sleep apnea (Bimax)
5.flat midface/midface recessions
And also to enhance facial aesthetics ofc, this is because they restore true forward skeletal projection, as when you reposition the midface the maxilla, zygomas, nasal base, and orbital rims all of this moves forward and the soft tissues (nose, cheeks, upper lip, lower eyelids) adapt to follow the craniofacial structure, so not only you are fixing recessions but also repositioning all the tissue that covers your face.
This reposition gives the "forward growth pattern" that all people crave for, as a forward grown face is not only better functional but also aesthetically.
Expectations/Results: Le Fort osteotomies with proper planning and evaluation are generally a very safe procedure and one of the procedures that creates the most change in the appearance as they have a very high impact in the craniofacial structure, and can produce life changing results in your appearance.
Level of danger/risk: Low risk (if performed by a qualified and experienced surgeon)
Life threating complications are only seen in the 0.1% of patients who get this procedure done, other complications such as permanent nerve damage make up for 3 to 5% of the patients who get this surgery done and severe infection or union is also very low at a 1-2%, major bleeding is insanely rare and 99% controlled and " a relapse needing revision" can occur depending how much advancement was made to a 5-10% rate, so moderate to low risk and a very high reward.
IMPORTANT DISCLAIMER: The rates in which any of this side effects occurs highly depend on the skills and experience of your surgeon and the complexity of your case and what results you were aiming for.
Things to look out for: its important to do a proper assessment of your case to see who much advancement is required and also to avoid the croc face which (is the result of too much maxillary advancement without pairing it with mandibular advancement), how to avoid it? never move it past the mma and respect the occlusal plane and angle, don't exceed the aesthetic limit of the advancement.
Extra: best surgeons for this surgery are: Dr. Mirco Raffaini and Valerio Rammieri
Here's a before and after example:
Bimax and trimax
Bimax it simply the double advancement of the mandible and the maxilla, it's used to treat patients with severe airway issues and sleep apnea, it also can be used to fix and correct poor forward growth as a way to enhance it, it's a BSSO (Bilateral Sagittal Split Osteotomy) and a (Le Fort 1 osteotomy)
Expectations/Results: it can be expected a complete enhancement of all the facial structure as the advancing of both jaws will correct a poor forward grown structure and also a lot of reposition of the soft tissue is expected, it's generally a very safe procedure and the results achieved are lifechanging and very impressive specially if your face is underdeveloped and has a lack of forward growth.
8–14 mm combined: gives a very natural and good-looking result and rarely turns out uncanny
15–18 mm combined: it's possible when properly assessed and still can give a aesthetic result.
20+ mm it's usually only in airway-focused MMA or severe skeletal retrusion, but if done good can give a pleasing result.
Level of risk/danger: Moderate risk, when done by a qualified and experienced professional, swelling and numbness is experience by everything and recovery takes about 6-8 months but with modern pharmacology that span of time can usually be decreased, the risk of permanent numbness or nerve damage is pretty low at a 1-3% rate, (uncommon but still need to be mentioned) Mild relapse: 5–10% and Significant relapse: <5%, infection 3-5%
Things to look out for: surgeons qualifications and surgical planning, that again you will have to discuss with, any crazy advancement that is not required for your case is a warning sign, but overall just reviewing your expectations and what your surgeon has planned.
Example:
View attachment bimax-3-weeks-post-op-v0-oo2ixhcmmfve1.webp
Trimax
Same as bimax but with a occlusal plane rotation or vertical changes and sometimes a genioplasty (but this does not mean trimax), this changes mean adding a Le Fort 2 or 3 depending on how severe the case is to be able to complete the ccw rotation, a zygomatic osteotomy is also used depending on the case.
Expectations/ Results: life changing procedure and has a nuclear impact on facial aesthetics, especially for severe midface recessions and hypoplasia, this meaning that is harder to get a surgeon to perform this on you when you do not fit the qualifications for it ofc, a thing to take into account it to find your failos and fix them but don't get a procedure that you do not need, as the risk increases and its just overkill.
Level of danger/risk: Very high, there's a very high chance of nerve injury, blood loss and swelling lasts way longer, the hospital has to monitor you in the ICU the days after the surgery, and if not necessary should be avoid, as the aesthetic error margin is much much higher.
Thing to look out for: you have to find the best surgeon possible and to find a hospital with a good ICU and to be sure this procedure is need.
WARNING NOTE: this is a major surgery when it involves a Le Fort 2 & 3 and a zygomatic osteotomy, when its a bimax plus a mentoplasty the risk drops down to moderate to low risk, again this procedure should only be done for insane recessions and medical conditions.
Anyways, this is the end of the thread, hope you enjoyed reading this, and will do a thread on craneofacial surgeries and minor surgeries too, if you enjoyed or found valuable info on this thread rep me, peace out.
Sources:
https://www.institutomaxilofacial.com/en/
https://esmed.org/orthognathic-surgery-enhancing-function-aesthetics/?utm
Pubmed https://pubmed.ncbi.nlm.nih.gov/31255372/
and wikpedia
