My surgeon is offering me a lefort 1 on top of MSE

[Slayerino]

He keeps pushing for the lefort instead of the facepuller.

But wouldn't a lefort 1 nullify the expansion of the other bones around the maxilla?

If the maxilla is completely cut out and repositioned during the lefort, then with the slow expansion of the mse, will the zygos and IPD be still affected?

Tagging the most competent users here:
@OOGABOOGA @GetThatBread @nelson @Golden Glass @SayNoToRotting @Sergio-OMS @betamanlet

 

[Deleted member 3202]

Don't forget @Wincel .

 

[Slayerino]

Don't forget @Wincel .

And you @AleksVs I summon you, what do you think of this case?

 

[Hades]

Not if you do the lefort after you complete the MSE. It won’t mess with the other bones.

 

[Barbarossa_]

MSE before the lefort to expand the midface and the maxilla

 

[Deleted member 3990]

@SayNoToRotting answer

 

[Deleted member 3202]

And you @AleksVs I summon you, what do you think of this case?

I'm not an expert when it comes to this subject, all I'm aware of is that MSE (by itself) should widen palate (this is obvious, it's even in the name), mouth, alar base, zygos and IPD.
IPD is last on the list though, you may only gain a mm or two at best (maybe more, but there isn't enough information on IPD increase with MSE yet).

 

[Slayerino]

@SayNoToRotting answer

You too bro. Share your take on this.

 

[Deleted member 3990]

dont book LeFort immediately

get MSE

and then another MSE if beneficial

because it is hard to expand the palate after LeFort (only midline osteotomy)

 

[Golden Glass]

According to @Sergio-OMS , its not really known exactly what would happen if you get MSE after a Lefort, in all likelihood, you will end up only being able to expand the palate, and nothing else above where the Lefort 1 Cut was made. Could have some odd effects.

So try to get MSE first.

 

[Deleted member 3990]

According to @Sergio-OMS , its not really known exactly what would happen if you get MSE after a Lefort, in all likelihood, you will end up only being able to expand the palate, and nothing else above where the Lefort 1 Cut was made. Could have some odd effects.

So try to get MSE first.

not only that, I think the cut of the LeFort is endangered to break again

 

[Golden Glass]

not only that, I think the cut of the LeFort is endangered to break again

Well I was working under the assumption that you would have waited plenty of time for the osteotomy line to fully heal. But regardless, it’s not a good idea to get MSE after a Lefort IMO. Maybe if you got one years in the past.

 

[Slayerino]

According to @Sergio-OMS , its not really known exactly what would happen if you get MSE after a Lefort, in all likelihood, you will end up only being able to expand the palate, and nothing else above where the Lefort 1 Cut was made. Could have some odd effects.

So try to get MSE first.

not only that, I think the cut of the LeFort is endangered to break again

So, it should be better mse & msdo first, then at that point shouldn't it be more efficient to get a bimax?

 

[Golden Glass]

So, it should be better mse & msdo first, then at that point shouldn't it be more efficient to get a bimax?

Totally depends on your goals.
Bimax won’t give you what MSE and MSDO give you. And vice versa.

 

[Deleted member 3990]

So, it should be better mse & msdo first, then at that point shouldn't it be more efficient to get a bimax?

you could do

MSE
Bimax (or in your case solely LeFort 1)
then do midline osteotomy for both jaws

 

[Slayerino]

Totally depends on your goals.
Bimax won’t give you what MSE and MSDO give you. And vice versa.

Ofcourse, that's why I have to have all of them. The issue is that I'm already 35, I don't want to wait a year for the second operation. I would like everything to be done at once.

 

[Golden Glass]

you could do

MSE
Bimax (or in your case solely LeFort 1)
then do midline osteotomy for both jaws

Why do midline first upper if he already expands it through MSE, assuming he doesn’t need more than the maximum 12mm MSE provides? Or even if he does need more than 12mm, why not then get MSE done twice, and then MSDO for lower, and just a Lefort 1, to avoid midline for upper?

 

[Sergio-OMS]

Ofcourse, that's why I have to have all of them. The issue is that I'm already 35, I don't want to wait a year for the second operation. I would like everything to be done at once.

just bimax then

 

[Deleted member 3990]

Why do midline first upper if he already expands it through MSE, assuming he doesn’t need more than the maximum 12mm MSE provides? Or even if he does need more than 12mm, why not then get MSE done twice, and then MSDO for lower, and just a Lefort 1, to avoid midline for upper?

he can do segmental LeFOrt 1 too

but the first MSE will suffice anyways

 

[Golden Glass]

Ofcourse, that's why I have to have all of them. The issue is that I'm already 35, I don't want to wait a year for the second operation. I would like everything to be done at once.

Ah I see, you’re quite old. It may even be a gamble to try MSE since your suture May not open, though it definitely can—it’s opened for patients much older than you, and if you get cortipunctures done it will increase the odds of suture opening

 

[Luke LLL]

Anything but lefort 3 is retarded.

 

[Golden Glass]

Anything but lefort 3 is retarded.

A bit extreme of a mindset. To our knowledge, Not even facepulling on an adult can achieve what a Lefort III can. So that would render facepulling as “retarded” as well.

 

[GetThatBread]

He keeps pushing for the lefort instead of the facepuller.

But wouldn't a lefort 1 nullify the expansion of the other bones around the maxilla?

If the maxilla is completely cut out and repositioned during the lefort, then with the slow expansion of the mse, will the zygos and IPD be still affected?

Tagging the most competent users here:
@OOGABOOGA @GetThatBread @nelson @Golden Glass @SayNoToRotting @Sergio-OMS @betamanlet

It depends on what you’re going for, typically a lefort 1 is used on patients with an under bite and palatinal recession. If you’re going for Zygo expansion go for two rounds of MSE for lateral expansion and widened palate. I think this doc is trying to Jew you out of your money tbh. Because clearly a lefort 1 cost way more than MSE and it’s only really performed on patients that physically need it. I’m assuming you’re taking the aesthetic route along with some health benefits

A bit extreme of a mindset. To our knowledge, Not even facepulling on an adult can achieve what a Lefort III can. So that would render facepulling as “retarded” as well.

Don’t speak for everyone; I’m getting a Lefort 3 next Tuesday

 

[highT]

Lefort is definitely waaay more effective than a face puller and you should get that. Your surgeon sounds legit btw. I had something similar to MSE back when I had braces etc. when I was young and it helps your palette expand but nothing drastic. Especially didn’t affect my cheekbones etc. But improved palette width. Ask your doc if he can expand your maxilla during the lefort, because that’s something my surgeon did and it was a HUGE improvement aesthetically and functionally.

 

[curryslayerordeath]

I hate to say it, but I highly doubt the MSE will affect anything else other than your upper palette itself. Lefort is definitely waaay more effective than a face puller and you should get that. Your surgeon sounds legit btw. I had MSE back when I had braces etc. and it helps your palette expand but nothing drastic. Especially not going to affect your cheekbones etc. Ask your doc if he can expand your maxilla during the lefort, because that’s something my surgeon did and it was a HUGE improvement aesthetically and functionally.

Did your nasal breathing ability improve? Also, did you see any changes in either your facial width or your IPD?

 

[highT]

Did your nasal breathing ability improve? Also, did you see any changes in either your facial width or your IPD?

nasal breathing improved quite a lot, and it was really bad previously. my overall facial width didn’t seem to change, however, my palette and thus my upper row of teeth (which obviously affects the smile) is noticeably wider and it had a huge affect on my aesthetics. I get complimented on my smile all the time now. I forget the exact terminology because I had surgery 7 years ago but my surgeon did something to widen my maxilla in addition to the typical forward movement. Highly recommended if you have a relatively narrow palette. Again, I don’t think my entire face was widened, but having a wider smile and palette definitely creates an illusion that does suggest a wider face. However I will state that I am still not 100% happy regarding my infraorbital/zygomatic area and am planning on having custom implants designed and have consulted with Eppley. Jaw surgery is indeed life changing though.

 

[GetThatBread]

nasal breathing improved quite a lot, and it was really bad previously. my overall facial width didn’t seem to change, however, my palette and thus my upper row of teeth (which obviously affects the smile) is noticeably wider and it had a huge affect on my aesthetics. I get complimented on my smile all the time now. I forget the exact terminology because I had surgery 7 years ago but my surgeon did something to widen my maxilla in addition to the typical forward movement. Highly recommended if you have a relatively narrow palette. Again, I don’t think my entire face was widened, but having a wider smile and palette definitely creates an illusion that does suggest a wider face. However I will state that I am still not 100% happy regarding my infraorbital/zygomatic area and am planning on having custom implants designed and have consulted with Eppley. Jaw surgery is indeed life changing though.

Wow that seems like some suifuel; that’s the main reason I’m even getting MSE. I need my flat Zygos to fan out more and produce an ogee curve. Ronald Eads zygos have increased a lot and also his ogee curve. Also fanning out the Zygos would help with my dark circles. I’m going to go for 12-14mms of expansion and then FacePull using that suture anchor for bone borne expansion

 

[curryslayerordeath]

nasal breathing improved quite a lot, and it was really bad previously. my overall facial width didn’t seem to change, however, my palette and thus my upper row of teeth (which obviously affects the smile) is noticeably wider and it had a huge affect on my aesthetics. I get complimented on my smile all the time now. I forget the exact terminology because I had surgery 7 years ago but my surgeon did something to widen my maxilla in addition to the typical forward movement. Highly recommended if you have a relatively narrow palette. Again, I don’t think my entire face was widened, but having a wider smile and palette definitely creates an illusion that does suggest a wider face. However I will state that I am still not 100% happy regarding my infraorbital/zygomatic area and am planning on having custom implants designed and have consulted with Eppley. Jaw surgery is indeed life changing though.

Hm so for me, a few factors have resulted in a narrow face/palate, maxillary excess (gummy smile), a weirdly tilted(?) maxilla, and a bit of recession. Would u recommend palate expansion via MSE followed by some type of CCW surgery along with infraorbital/zygomatic implants if the goal is to fix my recession along with maybe creating the appearance of a wider, less long face?

thx for the help

 

[Golden Glass]

I hate to say it, but I highly doubt the MSE will affect anything else other than your upper palette itself. Lefort is definitely waaay more effective than a face puller and you should get that. Your surgeon sounds legit btw. I had MSE back when I had braces etc. and it helps your palette expand but nothing drastic. Especially not going to affect your cheekbones etc. Ask your doc if he can expand your maxilla during the lefort, because that’s something my surgeon did and it was a HUGE improvement aesthetically and functionally.

nasal breathing improved quite a lot, and it was really bad previously. my overall facial width didn’t seem to change, however, my palette and thus my upper row of teeth (which obviously affects the smile) is noticeably wider and it had a huge affect on my aesthetics. I get complimented on my smile all the time now. I forget the exact terminology because I had surgery 7 years ago but my surgeon did something to widen my maxilla in addition to the typical forward movement. Highly recommended if you have a relatively narrow palette. Again, I don’t think my entire face was widened, but having a wider smile and palette definitely creates an illusion that does suggest a wider face. However I will state that I am still not 100% happy regarding my infraorbital/zygomatic area and am planning on having custom implants designed and have consulted with Eppley. Jaw surgery is indeed life changing though.

Are you sure you got MSE? Or MARPE? How long ago did you get it done?

 

[Sergio-OMS]

nasal breathing improved quite a lot, and it was really bad previously. my overall facial width didn’t seem to change, however, my palette and thus my upper row of teeth (which obviously affects the smile) is noticeably wider and it had a huge affect on my aesthetics. I get complimented on my smile all the time now. I forget the exact terminology because I had surgery 7 years ago but my surgeon did something to widen my maxilla in addition to the typical forward movement. Highly recommended if you have a relatively narrow palette. Again, I don’t think my entire face was widened, but having a wider smile and palette definitely creates an illusion that does suggest a wider face. However I will state that I am still not 100% happy regarding my infraorbital/zygomatic area and am planning on having custom implants designed and have consulted with Eppley. Jaw surgery is indeed life changing though.

so it looks like you were describing a 2 or 3 piece Le Fort.

But I don’t get were the MSE part fits in your past surgical and orthodontic history

 

[Golden Glass]

so it looks like you were describing a 2 or 3 piece Le Fort.

But I don’t get were the MSE part fits in your past surgical and orthodontic history

Yeah I think he’s confusing MSE for SARPE or 3 piece Lefort.

 

[varbrah]

Haven't read all replies ITT but you should be fine getting a LeFort 1 after you complete the retention phase of MSE. I'm going to be playing around with some additional bone-anchored protraction, but in case the results from that are unsatisfactory, jaw surgery is also part of my looksmaxing plan.

 

[highT]

so it looks like you were describing a 2 or 3 piece Le Fort.

But I don’t get were the MSE part fits in your past surgical and orthodontic history

I had something similar to MSE during adolescence, possibly not MSE but the precursor, according to google i believe i had MARPE, I was probably like 13-14 years old or something. I had braces for a while like several years. It works sure but its not a huge change compared to surgery. I had the surgery at 19.

basic timeline: I had braces from ages 12-15 which included MARPE and got my braces off freshman year of high school but I still had bite issues despite my straight teeth. So after high school at age 18 I had braces put in again in preparation for jaw surgery, then had the surgery right after turning 19, and the braces then came off 6 months after surgery.

Are you sure you got MSE? Or MARPE? How long ago did you get it done?

my mistake i believe I had the MARPE for a while but I was young, I estimate I was approximately 13. It is often given during basic orthodontic treatment. Even at age 13 I had an underbite (among other issues such as narrow palette hence the MARPE) and so that was basically one of the first steps in my overall plan to achieve a better set of jaws/teeth

Yeah I think he’s confusing MSE for SARPE or 3 piece Lefort.

I had MARPE during early adolescence (12 - 14 years old) and it helped but certainly wasn’t enough by itself. So I had the jaw surgery at age 19 and that was the game changer.

 

[Golden Glass]

I had MSE during adolescence, I was probably like 13-14 years old or something. I had braces for a while like several years. MSE works sure but its not a huge change compared to surgery. I had the surgery at 19. People here are nuts for thinking the MSE is going to magically give you huge zygomatic arches lol



I had the MSE for a while but I was young, I estimate I was approximately 13. It is often given during basic orthodontic treatment. Even at age 13 I had an underbite (among other issues such as narrow palette hence the MSE) and so the MSE was basically one of the first steps in my overall plan to achieve a better set of jaws/teeth

I had MSE during early adolescence (12 - 14 years old) and it helped but certainly wasn’t enough by itself. So I had the jaw surgery at age 19 and that was the game changer.

Hold on, how long ago did you have what you’re calling MSE done?

 

[varbrah]

Hold on, how long ago did you have what you’re calling MSE done?

Might just be referring to a regular MARPE

 

[Golden Glass]

Might just be referring to a regular MARPE

My thoughts exactly. Maybe even a normal palatal expander.

MSE has demonstrably proven increase in bizygo width. This is why it’s called Maxillary Skeletal Expander. It’s more than palatal expansion.

 

[highT]

Might just be referring to a regular MARPE

possibly yes I know they are similar but different and I apologize for any lack of accuracy on my part. I basically had a metal appliance installed in my upper palette that would be cranked once a day to slowly force maxilla to expand. This was approximately 13 years ago so I barely remember tbh

Hold on, how long ago did you have what you’re calling MSE done?

I was 13ish and am 26 now. I apologize if I used incorrect terminology, that is my mistake

My thoughts exactly. Maybe even a normal palatal expander.

MSE has demonstrably proven increase in bizygo width. This is why it’s called Maxillary Skeletal Expander. It’s more than palatal expansion.

this is very interesting and again I apologize for any misinformation! this shit happened so long ago for me.

edit: I see the MSE is essentially a new and improved version of what i had, and only has been available for 10 years so it definitely wasn’t what I had. Fuck. gotta go edit my posts lmfao. This sounds badass though if it can truly affect more of the facial skeleton.

 

[Golden Glass]

possibly yes I know they are similar but different and I apologize for any lack of accuracy on my part. I basically had a metal appliance installed in my upper palette that would be cranked once a day to slowly force maxilla to expand. This was approximately 13 years ago so I barely remember tbh


I was 13ish and am 26 now. I apologize if I used incorrect terminology, that is my mistake

It’s understandable. MARPE is fairly new, and MSE is incredibly new.

Was your appliance just “installed”, or actually drilled into the palate like MARPE and MSE are, as below?

For what it’s worth, here’s a scan before and after of MSE, demonstrating increase in Bizygomatic width through a sort of outward rotation of the zygos and zygo arches that happens along a pivot point—the orange circle (after is white)

 

[varbrah]

My thoughts exactly. Maybe even a normal palatal expander.

MSE has demonstrably proven increase in bizygo width. This is why it’s called Maxillary Skeletal Expander. It’s more than palatal expansion.

MARPE at that age would definitely yield a similar result I'd think, but still inferior to MSE.

 

[highT]

It’s understandable. MARPE is fairly new, and MSE is incredibly new.

Was your appliance just “installed”, or actually drilled into the palate like MARPE and MSE are, as below?
View attachment 258307

For what it’s worth, here’s a scan before and after of MSE, demonstrating increase in Bizygomatic width through a sort of outward rotation of the zygos and zygo arches that happens along a pivot point—the orange circle (after is white)
View attachment 258303

Damn, I don’t remember having mine actually drilled into me. JFL that is hardcore. I feel like a dumbass for saying I had this when in reality I just had the PG-rated version of it lmfao. Seems pretty cool though, those are some legit before and after results!

 

[Luke LLL]

A bit extreme of a mindset. To our knowledge, Not even facepulling on an adult can achieve what a Lefort III can. So that would render facepulling as “retarded” as well.

Face Pulling with MSE is comparable.

 

[Slayerino]

@nelson @Shekelberg @Golden Glass @GetThatBread @Sergio-OMS

I said to him that I wanted the usual mse,msdo and either imdo or something else to slide the mandible forward. And from there I would have used the facepuller to bring the maxilla in line with the mandible.

He's response was:
"Why do you want to use the distraction? It's a long process with a difficult rehabilitation. Traditional orthognathic surgery is more simple and predictable."

I don't know what to think. Isn't it more "natural" and less invasive to displace the maxilla with the facepuller rather than with a cut? Also, I plan to advance the mandible 5mm. Do you guys the facepuller can give me 5mm of maxilla displacement?

 

[Sergio-OMS]

@nelson @Shekelberg @Golden Glass @GetThatBread @Sergio-OMS

I said to him that I wanted the usual mse,msdo and either imdo or something else to slide the mandible forward. And from there I would have used the facepuller to bring the maxilla in line with the mandible.

He's response was:
"Why do you want to use the distraction? It's a long process with a difficult rehabilitation. Traditional orthognathic surgery is more simple and predictable."

I don't know what to think. Isn't it more "natural" and less invasive to displace the maxilla with the facepuller rather than with a cut? Also, I plan to advance the mandible 5mm. Do you guys the facepuller can give me 5mm of maxilla displacement?

No, I don't think it will give you that advancement.
Yes, midface protraction is more "natural" and less invasive.

 

[Deleted member 39]

I shouldn't have watched a lefort 1 surgery video on Youtube, it looks brutal.
I might be able to get lefort 1 covered by insurance. My orthodontist gave me a facepuller to avoid surgery, but I'm open to getting lefort 1, especially if it widens my narrow palate a bit as the users above me have stated.

@nelson @Shekelberg @Golden Glass @GetThatBread @Sergio-OMS

I said to him that I wanted the usual mse,msdo and either imdo or something else to slide the mandible forward. And from there I would have used the facepuller to bring the maxilla in line with the mandible.

He's response was:
"Why do you want to use the distraction? It's a long process with a difficult rehabilitation. Traditional orthognathic surgery is more simple and predictable."

I don't know what to think. Isn't it more "natural" and less invasive to displace the maxilla with the facepuller rather than with a cut? Also, I plan to advance the mandible 5mm. Do you guys the facepuller can give me 5mm of maxilla displacement?

Never 5mm, you can hope for 2mm at max

 

[Sergio-OMS]

@nelson @Shekelberg @Golden Glass @GetThatBread @Sergio-OMS

I said to him that I wanted the usual mse,msdo and either imdo or something else to slide the mandible forward. And from there I would have used the facepuller to bring the maxilla in line with the mandible.

He's response was:
"Why do you want to use the distraction? It's a long process with a difficult rehabilitation. Traditional orthognathic surgery is more simple and predictable."

I don't know what to think. Isn't it more "natural" and less invasive to displace the maxilla with the facepuller rather than with a cut? Also, I plan to advance the mandible 5mm. Do you guys the facepuller can give me 5mm of maxilla displacement?

There another distraction type way you might want to dig into. It is a combination of SARPE + intraoral (bone anchored) protraction.

You might want to look at this presentation

 

[GetThatBread]

@nelson @Shekelberg @Golden Glass @GetThatBread @Sergio-OMS

I said to him that I wanted the usual mse,msdo and either imdo or something else to slide the mandible forward. And from there I would have used the facepuller to bring the maxilla in line with the mandible.

He's response was:
"Why do you want to use the distraction? It's a long process with a difficult rehabilitation. Traditional orthognathic surgery is more simple and predictable."

I don't know what to think. Isn't it more "natural" and less invasive to displace the maxilla with the facepuller rather than with a cut? Also, I plan to advance the mandible 5mm. Do you guys the facepuller can give me 5mm of maxilla displacement?

Really depends on you; whether you want the distraction process or the surgery route. I thought the distraction process was quick? 10 days for the expansion, 40-90 days of new bone consolidation. MSE only takes 90 days