Principles
Our principlesWe are here to name the limits.
A small incision is a result, not a goal.
Inside a limited incision, the nerves and vessels, the fascia and the periosteum must be seen, and the plane the instrument will travel must be separated.
Only then does a small incision mean anything.
Where a large movement or rigid fixation is needed, a different approach may suit the face better.
The plane first. The incision follows.
The patient is not fitted to the operation.
The path and the tool are fitted to the anatomy.
From the temporal incision, the distance and the curve to the arch and to the body are different.
The instrument and the route are chosen for the depth and the angle of the bone that is the target — which is why, when stock instruments could not reach both, a saw was made.
The problem becomes the tool.
What is left behind becomes the axis.
Rather than freeing the fragment entirely and moving it a long way, the cortical connection that stays in place is used as the axis of rotation.
Not less surgery — a decision about what to leave, so that the stability and the movement the face needs are both kept.
Decide what stays. Then move.
The limits of a method come before its name.
The temporal approach, the L-rotation, the intraoral incision with plate fixation — these are not competing names.
They are different tools, chosen by where the prominence sits and how far the bone must move.
Every technique page on this site carries a section on the faces it does not suit. A beginner talks about advantages; experience talks about boundaries.
The limits are named first.
A revision is not a further reduction. It is a reading of the last operation.
Whether what remains is bone, a fragment that has dropped or failed to unite, or soft tissue that has descended is separated first.
In the nose, the same: the tissue that is left, its blood supply, the materials used before, the inflammation, the contracture and the breathing decide whether a twelfth operation is possible — not the count.
The diagnosis of the cause comes before the amount removed.
Every plan begins with the layer.
Consultations begin with examination and 3D CT, and ultrasound where needed.
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