Creating cheek bones after advancement LeFort jaw surgery - using human bone grafts

Doing advancement lefort maxilla surgery as part of Orthognathic surgery, often leaves a sense of small cheek bones. There can be an original cheek bone asymmetry too, and people may complain that they don’t have a sense of cheek bone prominence after BIMAX or double jaw surgery (DJS). I routinely remove plates and augment lefort and osteotomy lines to aid further healing and encourage natural smoothness. More recently, and only in Australia, we have encouraged use of human donor derived bone shavings. These come packaged in syringes, requiring hydration with the patients own blood, and which also provides needed stem cells to generate natural living bone. We don’t know how much of the graft material will actually convert to naturally living bone either - or if we get the sufficient soft tissue support the patient seeks… so facial reconstruction where we are trying to create living natural bones, is all a very watch-and-see and add-and-improve kind of long term approach to surgical care. The syringes come in 5CC volumes, which does not sound a lot. But I use 5CC on each side, rebuilding the lateral face of the cheek bone which gives a nice fullness to the cheekbones itself. It’s a harder overall technique, that requires a lot of experience and forethought and planning… you see that we even print the skulls and surfaces so that we can make reasonable predictions for the reconstruction steps - but it results in natural bone which later can be further added to - or carved backwards. Cheek bones - and creating perfect symmetrical volumes - is the last frontier of the true facial reconstruction surgeon. They require special patients who are comfortable with often multiple staged procedures, as we layer-cake and build the various volume deficits of the facial components towards natural normality.