jawsurgeryforums.com
General Category => Aesthetics => Topic started by: babyjaw206 on January 25, 2018, 07:02:13 AM
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First time poster here. I have my first consultation with a maxfax surgeon in a couple of weeks but would also like to get feedback from members of this forum.
After over 20 years of being self-conscious about my jaw/chin area I've finally resolved to do something about it. I've always been fine with the way I look from the front even though I know my facial proportions aren't perfect. My main concern has always been the lower third of my face, especially in profile. Shortly after my braces came off in high school I began jutting my lower jaw forward constantly to make it look stronger. This causes strain on my jaw, but I think the worst part is the psychological space it takes up. Just the constant awareness of it is exhausting. As I get older, it's clear that a lack of bone structure in the chin/jaw area is causing me to look prematurely jowly even though I take good care of my skin. I also have extra skin/fat under my neck even though I'm in good shape
and not overweight.
Despite my braces as a teen, I still have an overbite. I've had my wisdom teeth out but no other extractions. I have a dead tooth in the front that I haven't done anything with because it's only mildly discolored.
Based on the research I've done, it sounds like there is a compelling case for me to go the route of jaw advancement surgery (not sure if I'd need just the lower or both). However I'm concerned about going that route on a couple of fronts.
First off, my husband and I are planning to try for our second child this year, and I'm not at a point in my life where I want to push that timeline out while I wait months or even years for orthodontia and surgery. I'll probably have to wait another two years at least to be ready to start the jaw surgery journey, if that's the route I end up going.
Secondly, I'm concerned about undergoing a surgery that could potentially cause a permanent change in my
appearance for the worse.
Ultimately it may be worth it to correct the underlying structural issues, both from a functional and aesthetic perspective, but I just don't know that I'm there yet.
Other options I've considered are a chin implant, neck lipo, and sliding genio. In some ways I'd rather err on the side of something that wasn't drastic enough, but that still kept me looking like "me", even if it meant being further away from ideal proportions. I've also thought about doing chin fillers as a one-time thing to "test drive" what a chin implant might look like.
I'd welcome any personal experiences or feedback.
I've attached some pictures for reference. The first ones are with my jaw pushed out like normal, the second ones are
my real bite if my back molars touch.
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NOTE from mod: The user requested deletion of her photos. That is why they are gone.
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I think neck lipo would be my first step. Not as involved. I find so often aesthetic issues being corrected that could have been done by weight loss. Hell I wanted better cheek bones but as I lost weight I liked what was starting to emerge. Of course neck fat can be random and doesn't always go up or down with body weight always. It could make a huge difference for you if your skin has laxity...sharper edges and lines from side and front. When I saw your pics its the first thing that came to me. As for the more complicated surgeries I will let the experts on here chime in. But IMO after neck lipo I would follow with sliding genio or do them at the same time which can make a big difference in appearance especially the jowls.
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You have a receded chin. You should consider to get a chin implant, or better a sliding genioplasty to correct it.
A sliding genioplasty was performed on me and I could go home after the surgery. I had some pain but after like 2-3 weeks I was back to normal and it just costs about $4,000-$5,000 depending on your country.
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You would benefit by advancing the lower jaw in addition to the chin which usually resolves to double jaw surgery, the upper jaw needing to be shifted to accommodate movements and/or rotations to the lower jaw. The 'alternative' is what you've been doing for 20 years which is jutting your jaw forward.
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Would it be crazy to consider a chin implant to tide me over for the next 2-3 years until I was ready for jaw surgery? It seems like appearance-wise it would be better than doing nothing.
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I see a little lower lip recession relative to the upper, but withstanding any functional reasons, it's not that bad?
Before any ceph info, most of her problem, to me, looks to be from an overly small chin. Ergo an SG or chin implant would solve a large majority of the recession. Do you like how advanced your chin looks jutted forward though, or is it still too recessed for you?
The under-chin area will change depending on what you do to the jaw/chin, so wouldn't necessarily bother with that right now.
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It’s just a tad more recessed than I’d like it with my jaw pushed forward. I’m not looking for perfect alignment though.
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Perhaps a custom chin implant then because you need to really see how much augmentation your going to get beforehand in planning stage, and you are also lowering your chin bone when you jut forward. A custom chin implant might be able to provide that downward augmentation you're mimicing - 99% of off the shelf chin implants won't. Shooting in the dark here but if the chin implant can extend/taper to your jowl area, that might?? improve the jowling as well. Stuff to research.
Also go silicone instead of medpor for ease of removal in case you choose jaw surgery later.
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Would it be crazy to consider a chin implant to tide me over for the next 2-3 years until I was ready for jaw surgery? It seems like appearance-wise it would be better than doing nothing.
Not crazy. IMO, imprudent. If you are to get bi max, it's best to let them balance all the displacements in same surgery and chin displace is one.
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Nice features.
You need jaw surgery, most likely with CCW rotation. You have a long midface and genioplasty alone will improve your profile but not change much from the front. CCW rotation will bring balance from the front.
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You have a long midface and genioplasty alone will improve your profile but not change much from the front. CCW rotation will bring balance from the front.
I know I have a long midface but am not looking to change that. My goal would be to have nothing else about my face change but my lower jaw and chin area.
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I know I have a long midface but am not looking to change that. My goal would be to have nothing else about my face change but my lower jaw and chin area.
Well, bi max would not tend to change the 'long' midface (which is not really that long) too much anyway. But it's highly likely there would need to be some CCW to the upper jaw IN ORDER to advance the lower jaw so IT does not add extra length to the whole face. Then comes the diagonal cut to the CHIN where it's advanced both (horizontally) forward AND up so that the displacements there don't give extra length to the whole face either.
So, anything done to the upper jaw would be to correct the retrusion to both the lower jaw and the chin. IF the main GOAL is to correct the lower jaw and chin, then UNLESS your cephs show you can have a single jaw movement, movement of the upper jaw would be needed.
Basically, if you put a CONSTRAINT that your upper jaw is not to be moved or changed and if that's needed to address the retrusion of both the lower jaw and chin, then you must FORFIET the 'goal' of correcting the main imbalance you have. Your ceph would have to show you are one of the 'lucky ones' where they could move JUST the lower jaw and chin.
OK, let's say that your upper jaw would also need to be moved in order to advance your lower jaw (and also chin with that) in a maxfax surgery. PROBABILITY is on the side of that being the case. A CONSTRAINT on your part that the upper jaw should NOT be changed, PRECLUDES you from even having the 'goal' of the lower jaw being advanced forward.
If I were a maxfax, I'd say 'BY BY' to you or to come back when you understand the concept of one thing having to move for the other thing to move and look better. Why? Because you are NOT 'resolved' to correcting the salient problem. You're putting constraints on correcting it.
So, your constraints put you in the venue of plastic surgeons where you will probably find the 'garden variety' ones usually most active on Real Self who will be 'blind' to the recession to the jaw and be more than happy to give you a chin implant. (kind of like some of the other responses you got here) The blindness will most likely also spill over to the suggestion to remove fat from your neck where they too won't see the relationship of soft tissue being POOLED there because it's crammed into a small space which if OPENED via advancing the jaw forward, that loose HAMMOCK area would stretch and the pooled apparant excess would be re-uptaken by the advancement.
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If I were a maxfax, I'd say 'BY BY' to you or to come back when you understand the concept of one thing having to move for the other thing to move and look better. Why? Because you are NOT 'resolved' to correcting the salient problem. You're putting constraints on correcting it.
So, your constraints put you in the venue of plastic surgeons where you will probably find the 'garden variety' ones usually most active on Real Self who will be 'blind' to the recession to the jaw and be more than happy to give you a chin implant. (kind of like some of the other responses you got here) The blindness will most likely also spill over to the suggestion to remove fat from your neck where they too won't see the relationship of soft tissue being POOLED there because it's crammed into a small space which if OPENED via advancing the jaw forward, that loose HAMMOCK area would stretch and the pooled apparant excess would be re-uptaken by the advancement.
Point taken. A couple of follow up questions:
1. In your opinion, what are the real risks involved in masking this type of structural issue with plastic surgery?
2. You mention that it's extremely rare not to need both jaws moved. Do you think a surgeon would try to "sell" me by telling me I only need the bottom jaw moved if I express that as my desire? Or will most reputable surgeons be clear about the treatment they think is appropriate and refuse to operate on you if that does not match your expectations?
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You have a receded chin. You should consider to get a chin implant, or better a sliding genioplasty to correct it.
A sliding genioplasty was performed on me and I could go home after the surgery. I had some pain but after like 2-3 weeks I was back to normal and it just costs about $4,000-$5,000 depending on your country.
And you also appear to have permanent nerve damage, no?
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Point taken. A couple of follow up questions:
1. In your opinion, what are the real risks involved in masking this type of structural issue with plastic surgery?
2. You mention that it's extremely rare not to need both jaws moved. Do you think a surgeon would try to "sell" me by telling me I only need the bottom jaw moved if I express that as my desire? Or will most reputable surgeons be clear about the treatment they think is appropriate and refuse to operate on you if that does not match your expectations?
1: Having to UNDO what was best not done in the first place in order to do the right thing the second time around.
2: Most reputable surgeons would be clear about the treatment and show you on a ceph displacement proposal what the plans were and how they were aimed to change the profile contour.
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1: Having to UNDO what was best not done in the first place in order to do the right thing the second time around.
Intuitively it seems that correctly repositioning the jaw(s) would provide a result that holds up better over time than an implant would. Have you actually seen this play out? I’d be interested to hear if there are people out there who had a chin implant when they should have had jaw surgery and then later regretted it (and why specifically).
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Intuitively it seems that correctly repositioning the jaw(s) would provide a result that holds up better over time than an implant would. Have you actually seen this play out? I’d be interested to hear if there are people out there who had a chin implant when they should have had jaw surgery and then later regretted it (and why specifically).
Yes. Of course I have. But there is no way to transfer to someone else my many many years of this type of observation.
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Intuitively it seems that correctly repositioning the jaw(s) would provide a result that holds up better over time than an implant would. Have you actually seen this play out? I’d be interested to hear if there are people out there who had a chin implant when they should have had jaw surgery and then later regretted it (and why specifically).
I would fit that description. Had a very large chin implant put in (10mm) a few years back, and even after multiple revisions it looked horrible. I had a steep mandibular angle, and the chin implant more or less just added bulk and length to my face, rather than anterior projection. Looked ridiculous. I had it removed and just lived with my recessed jaw for a few years until I decided to have double jaw surgery + genioplasty, which I'm currently ~ 1 year post-op. Chin implant is a horrible solution when the issue is anything beyond a slightly recessed chin.
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I would fit that description. Had a very large chin implant put in (10mm) a few years back, and even after multiple revisions it looked horrible. I had a steep mandibular angle, and the chin implant more or less just added bulk and length to my face, rather than anterior projection. Looked ridiculous. I had it removed and just lived with my recessed jaw for a few years until I decided to have double jaw surgery + genioplasty, which I'm currently ~ 1 year post-op. Chin implant is a horrible solution when the issue is anything beyond a slightly recessed chin.
Hi swsee, how are you TMJ's doing after your massive advancement? Were they able to close the posterior open bite? Would you say your jaw narrowed from the nature of jaw advancement or could it be from the teeth extractions? Did you notice your tongue get more cramped since the extractions supposedly narrow the arch? Thanks?! Your an interesting case to me, given your doc choice (near me) and sort of similar starting point and journey.
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Hi swsee, how are you TMJ's doing after your massive advancement? Were they able to close the posterior open bite? Would you say your jaw narrowed from the nature of jaw advancement or could it be from the teeth extractions? Did you notice your tongue get more cramped since the extractions supposedly narrow the arch? Thanks?! Your an interesting case to me, given your doc choice (near me) and sort of similar starting point and journey.
Sorry to OP for taking this off topic....
Posterior open bite closed up no problem, and my bite fits perfectly. Have another 6 weeks of invisalign to fine tune everything, and then I'm done. TMJs feel fine. I honestly thought they were screwed, since I was still having pain and restricted ROM up until ~ October. Fortunately that resolved itself, almost out of nowhere. ROM still isn't at where it was pre-op, but I can eat burgers and don't have pain, so for all intents and purposes it's not an issue. Also, I gained a good amount of width back in my jaw angles, that I assume was caused by masseter atrophy after surgery. Now that I'm chewing, and FINALLY getting back to a "normal" life they sort of bulked back up. Main complaint would be the large notching as a result of the rather significant advancement. Not sure how/if I'm going to address that yet. Feel free to PM me with any other questions. I still pop in here occasionally and am happy to share the ups and downs of my procedure. I might make a thread at some point with pictures,details,etc.
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Thanks everyone for your feedback. It’s given me a lot to think about. I’ll post an update after my consultation.
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I think it's a bit strange for people to be recommending that you get a bimax surgery to fix an aesthetic issue. That's at least a hundred thousand dollars and really only makes sense in cases where there are functional issues involved such as sleep apnea, TMJ, problems with chewing food, etc. You would indeed benefit from such a surgery, but it really doesn't make sense to do in your case unless you don't mind dishing out 100 grand. You look good. So I'd recommend camouflaging the maxillary-mandibular recession by either: sliding genio, and paranasal implants OR filler in your nasolabial folds / upper lip and on the anterior part of your cheekbones. Filler is probably a good first step because you can at least have something of a "preview" of what implants would look like should you decide to go down that route. Not the best long-term solution, however, because they're only temporary. You could also get filler done around your jaw and chin which can help mask the submental fat you're referring to and give you the look you try to achieve regularly by moving your jaw forward. Just so you know, by the way, it's normal for women to have SOME fat underneath the chin, even if your lower jaw is very well developed; this has to do with the fact that women store their fat subcutaneously. It's very important to understand this because its presence can lead to dysmorphia if it's thought to be abnormal rather than something that's found in the vast majority of women. You can diminish its appearance on your own right now by just contouring the area.
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I think it's a bit strange for people to be recommending that you get a bimax surgery to fix an aesthetic issue. That's at least a hundred thousand dollars and really only makes sense in cases where there are functional issues involved such as sleep apnea, TMJ, problems with chewing food, etc. You would indeed benefit from such a surgery, but it really doesn't make sense to do in your case unless you don't mind dishing out 100 grand. You look good. So I'd recommend camouflaging the maxillary-mandibular recession by either: sliding genio, and paranasal implants OR filler in your nasolabial folds / upper lip and on the anterior part of your cheekbones. Filler is probably a good first step because you can at least have something of a "preview" of what implants would look like should you decide to go down that route. Not the best long-term solution, however, because they're only temporary. You could also get filler done around your jaw and chin which can help mask the submental fat you're referring to and give you the look you try to achieve regularly by moving your jaw forward. Just so you know, by the way, it's normal for women to have SOME fat underneath the chin, even if your lower jaw is very well developed; this has to do with the fact that women store their fat subcutaneously. It's very important to understand this because its presence can lead to dysmorphia. You can diminish its appearance on your own right now by just contouring the area.
Costs will vary depending if one has insurance and also which maxfax. Not all maxfax work is 100 grand.
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Costs will vary depending if one has insurance and also which maxfax. Not all maxfax work is 100 grand.
Right, that's why I said bimax, which is usually that expensive (MMA or Lefort I + BSSO) after you factor in the OR cost, the anesthesiologist fee, etc. Unless you get it done somewhere outside the US or Europe, which is risky if you don't do your homework right
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It’s been quite a while since I’ve posted an update, but it took a few months for me to fully explore my options and come to a decision. I was initially very hesitant to go the jaw surgery route, given the time commitment and risks involved. I went to a PS and got filler in my chin to explore the chin implant route and while the filler didn’t look terrible, it made it pretty obvious that a bigger chin would look weird and unnatural on me. I met with a couple of orthodontists who recommended jaw surgery to fix my bite. After finding a local ortho/maxfac team I felt comfortable with and getting insurance preauthorization I decided to bite the bullet and go for the jaw surgery. I have about 9 months left in braces and will be doing surgery next year. Initial general plan is Lefort 1 and bsso with ccw rotation.
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Thanks for the update. Curious if the team allowed you to get preauthorization before you committed to do the surgery/ortho with them? That's partly been my problem with the bimax prospect. Docs don't want to battle with insurance for preauth if I'm not willing to front the whole cost of the surgery upfront regardless of where my insurance stands.
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My surgeon’s office submitted the request for preauthorization after my initial consultation. I expressed interest in moving forward with them but no hard commitment. They did explain that if insurance wouldn’t cover it then they would require full payment prior to surgery (but I’m not clear on at what point they would have required the payment). If the initial preauthorization request had been rejected and they had to appeal, then I’m not sure how that would have played out.