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Now while I’ve got your attention, this particular video topic is very niche and jargon
heavy by nature and I’ll do my best to keep it simple and relevant.
I want to give a huge thanks to our medical research team, especially Dr Sherpa.
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The midface is incredibly important for aesthetics because as research has shown our initial
perceptions of a person are quickly formed from a seemingly innocuous part of their face.
This region from the brow to the nasal base determines the shape of your most important
facial features, namely the eyes and nose.
Wider midfaces tend to develop wider eye openings, as in the distance from corner to corner and
not the eyeball itself, to stay in proportion.
This creates a masculinized frontal profile helping to achieve better brow ridge projection,
deep set eyes, a projected under eye region and a square face shape, truly a 4 for 1.
This begs the question, is there any way to bring the upper jaw responsible for the midface,
forwards to address the underlying problem?
Conventionally aesthetic medicine applies implants and fillers to recessed or hypoplastic
(incomplete development) regions which addresses one cosmetic flaw at a time but is more of
a band aid solution than an actual fix.
With technological advancements in internal rods, it may actually be viable for distraction
osteogenesis, an alternative procedure to be discussed, to advance the midface for less
severe cases and maybe even cosmetically.
Distraction osteogenesis, callous distraction, callotasis or osteodistraction, are all names
for a medical procedure that is often used in orthopedic and reconstructive surgery to
repair skeletal deformities.
The aim of the procedure is to make a longer bone out of a smaller one and was initially
used for the treatment of unequal leg length.
While watching a video on the history of limb lengthening by Dr Dror Paley, the man who
basically wrote the book on the topic, multiple times, he mentioned something very interesting.
According to him, the future of osteogenic surgery will include internal rods that are
so small and strong, they can be used to lengthen craniofacial bones.
For facial aesthetics, one of the biggest bottlenecks is in moving about already set
bone structure.
Someone with a recessed midface, or unusual facial convexity are basically stuck with
it unless they resort to an incredibly invasive osteotomy that cuts the bone and repositions
it which is traumatic for the body.
For the lower jaw, recessed or malformed mandibles have to go through genioplasty or double jaw
surgery but neither of these options actually physically lengthen the jaw with new growth,
they only move around what is already there.
What if there was a way to create new bone growth in the face, to get the ideal bone
structure?
As it turns out since the early 1980s, osteogenesis, or the process of cutting the bone to encourage
new bone growth, was considered for use in the treatment of congenital and acquired jaw
deformities.
The difference being that they used external fixators on the face which are bulky, heavy
and restrictive whereas Dr Paley is suggesting that in the future we will see a greater use
of advanced internal fixators such as smaller rods that go in the bone itself, or can provide
biofeedback and are much stronger than current technology.
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Back to distraction osteogenesis, the procedure begins with the cutting of bone after which
a distractor device is placed in between the two cut edges and the bone is allowed to heal
naturally on both ends.
Orthopedic surgeons quite literally 100 years ago knew of the possibility of this outlandish
but logical procedure working but they didn’t know how much to lengthen by or how to encourage
better growth.
Using intramedullary rods to correct fractures and bone deformities is standard procedure
for most orthopedic surgeons but these are more focused around the limbs and not the
face.
The technology and research isn’t new, but its application in tiny facial bones is an
entirely different game of risks.
Before the bone starts to heal, the device is activated and it starts pulling the bones
away at around 1mm or less per day to mimic natural growth rates during puberty.
This allows for new bone callus to fill the distance between the cut edges, hence elongating
a shorter bone.
This bone comes back stronger and thicker, much like muscles at the gym, which isn’t
noticeable on your limbs but could be unsightly on the face.
The surgery itself is commonly reserved for severe cases of oral and maxillofacial surgery,
especially for jaw deformities.
In fact, a retrospective analysis[ of 13 subjects with micrognathia (a malformation where the
lower jaw basically doesn’t grow at all) who underwent distraction osteogenesis showed
that 10 out of 13 subjects achieved correct distractor placement and final mandibular
position.
In other words it was successful.
In more severe cases like these, placing an implant won’t magically correct for a large
chunk of missing bone.
The osteogenesis procedure has been performed for years as it has a high success rate in
treating deformities like craniosynostosis where a baby’s skull fuses too quickly,
causing the brain to push against it and make it mishapen.
According to the Indian dental academy, osteogenesis is used in 6 cases.
For aesthetics, we’re concerned with the first two, but all 6 have the general theme
of closing gaps in the bone.
1.
To lengthen the mandible 2.
To advance the maxilla / midface 3.
Bone segment transportation 4.
Trifocal distraction 5.
Distraction for alveolar augmentation 6.
Distraction implantology The type of tools that are most commonly used
by maxillofacial surgeons to improve midface growth are either internal or external fixators.
They anchor to a stable part of the skull and apply very slow mechanical traction to
redirect the forward growth, but as you can imagine, this stretches muscles, skin, bone
and nerve tissue all the same.
While the bone, muscles and skin can handle it, nerve tissue is much more temperamental
and excessive friction can cause function loss altogether.
With the face being absolutely packed with nerves, this is no easy ordeal and having
this temporarily attached during distraction, is a special type of hell.
This rules out the procedure being viable for cosmetic surgery as no doctor would take
that kind of liability for a perfectly healthy face that wants a minor improvement.
However, with better internal fixators, the process could become more tolerable and thus
reduce the threshold for what a doctor would consider acceptable to operate on.
So how do these internal fixators work?
The first known cases of internal use were in 1993 and since then, they’ve delivered
some truly miraculous results to faces with no other hope.
This particular version uses biodegradable base plates reducing the need for a more invasive
operation when it comes time for removal.
This is a very simple version that still has a screwhole for the key to go in and turn
the screw daily.
What we’re expecting to come out in the future are electromagnetic distractors that
do not rely on mechanical turns of the screw, but rather on electromagnetic pulses to turn
tiny gears with astronomically high gear ratios which turns a small amount of force into a
big enough one that can physically remodel bone.
This way, your face is fully sealed off and apart from tiny scars on the surface as its
buried deep in the face.
In a comparative clinical study performed by doctors at UCLA medical center and Temple
University Hospital, the researchers compared two equally divided groups, one of which had
undergone midface advancement using internal distractors while the other one had undergone
the same procedure using external distractors.
Both groups were analyzed and it was found that the facial appearance, distraction length,
and functionality were all scored the same for both groups.
However, scores for quality of life as in dental anxiety, social function, and so on
were remarkably higher for internal devices than external devices, which is the whole
point of this video.
Basically speaking, patients had a higher rate of satisfaction with internal devices
than external devices.
The point of this video wasn’t to cover a medical degrees worth of distraction osteogenesis
techniques in 10 minutes.
Instead it shows an appreciation for what aesthetic medicine is capable of, where technology
is facilitating the normalization of surgery, whether for functional or cosmetic reasons.
The only real way of changing your bone structure after it's done growing is with tractional
force, whether it be with braces in conventional orthodontics, or with fixators to build new
bone as we’ve covered.
Osteogenesis over the years has been applied to clavicles to make the shoulders wider,
arms and legs to correct length asymmetries, and now faces to correct everything from the
top down.
As the tools improve, what was once a radical surgery will slowly become normalized and
more bearable on its patients.
What was once done for the worst of cases may even be performed for cosmetic reasons
because the risks will have been greatly reduced over-time.
As it turns out, it is possible to change the once unchangeable parts of your face,
but it wont come easy or cheap just yet.