My appearance took a significant hit after my first bimax a year ago. Most obviously my mandible is too physically long (99 percentile length now), leading to excess vertical and diagonal lower third projection, and a narrow adenoid look. However, the operation was a success from a functional and surgical perspective. No operating incompetence from what I understand, no deviation from the surgery plan. Just an unfortunate aesthetic result amplified by my unique face and the limitations of jaw surgery. I have considered facial implants but firmly believe they should come after a revision.
I was a CCW + advancement case, large posterior downgraft, very slight 0.5mm anterior impaction (too little in hindsight) then 3mm linear advancement of MMC complex. My nasolabial angle is still obtuse, and my smile is slightly gummy which it wasn't pre-op. Genio was overdone too. My surgeon used the traditional metrics and landmarks for surgery planning and nothing out of the ordinary, however my faces "vertical centreline" projects a lot (nose etc) then falls away either side (ie convexity) drove the large advancement when I really didn't need it. My side profile looks okay, but from the 3/4 and front the disharmony and undesirable facial length is very apparent.
The result has improved slightly compared to the first 3 and 6 months. After failure many times trying to accept the result I have deemed a revision the only solution to my pain. For what its worth, I know exactly where my surgeon went wrong in planning, and prospective surgeons will need to agree with my plan. My maxillo-mandibular complex needs to be brought back 2-3mm to cancel out the original linear advancement, and impacted 1-1.5mm anteriorly, and 2mm posteriorly to slightly steepen my now overly flat occlusal plan. Basically what I'm asking is how deluded am I into thinking a surgeon will (i) agree to a revision for my case of no major botching, and (ii) agree and stick to my surgical plan.
