Need opinions on operation timing. Am I prepared?

[Optimistic]

I have the choice between this coming September or November for surgery. Applied to my own situation:

Flights are practically all booked out in September for some reason. I'd be lucky to get a seat in economy there and back. Overall the process of getting there in September would be moderately rushed, albeit completely achievable. Alternatively I can wait until November. As stupid as this sounds I really want to get it over and done with so waiting two extra months would suck.

At least this way if the procedure is completely f**ked up and I hate my face I have two more months to scramble for my next step 





Regarding the operation I feel I've done all the research I possibly can to prepare. My situation is relatively straight forward and the interventions available to address it are limited (in a good way). I believe the doctor I have chosen will give be the best chance of success based on results I've seen.

Cosmetically there really is only chin wing (with chin visor) and malar osteotomy.

Functionally there may be a lefort I involved to achieve a better bite. Right now I am leaning towards just doing this if my surgeon feels it's appropriate. I say this because it'll give me a correct amount of overjet and fix canting, which has been a concern of mine for a while. I don't see myself getting adequate overjet orthodontically. So even if not 'necessary' I'm not at all opposed to going down that path for the sake of having a shot at perfection (a bad word when talking about surgery I know. I refer only to my bite and the minor qualms I still have about it)

The only thing I still wonder about is infraorbital rim augmentation. I'll be raising this with the surgeon soon to get his opinion. Either way I can' t see it influencing my decision to see him or have the operation.


So there is my rant. If anyone would like to give their opinion I'm open to it.

[Gregor Samsa]

I googled for malar osteotomy before/after pictures and I can't see any difference in the after pictures. Are you sure it's worth it and will it have the change you desire on your face?

At least this way if the procedure is completely f**ked up and I hate my face I have two more months to scramble for my next step 

That's just not very realistic. If something goes wrong then your surgeon may offer to correct it immediately, but in most cases you can forget about having something done as early as two months after your surgery. Your surgeon will tell you to wait and see how it turns out when the swelling goes down and no sane surgeon will take on a new patient who just had surgery.

[BlueShark7]

I have the choice between this coming September or November for surgery. Applied to my own situation:

Flights are practically all booked out in September for some reason. I'd be lucky to get a seat in economy there and back. Overall the process of getting there in September would be moderately rushed, albeit completely achievable. Alternatively I can wait until November. As stupid as this sounds I really want to get it over and done with so waiting two extra months would suck.

Are you traveling on your own for this? Like, is it a major operation for you to do on your own in a foreign country. That would be my concern as well as being rushed. Only you can really know if you're prepared time wise. Also, what is a chin visor?

[Gregor Samsa]

You're going with Triaca right? Have you had a chance to ask him about whether or not HA can be removed?

[Optimistic]

I googled for malar osteotomy before/after pictures and I can't see any difference in the after pictures. Are you sure it's worth it and will it have the change you desire on your face?

That's just not very realistic. If something goes wrong then your surgeon may offer to correct it immediately, but in most cases you can forget about having something done as early as two months after your surgery. Your surgeon will tell you to wait and see how it turns out when the swelling goes down and no sane surgeon will take on a new patient who just had surgery.

Google isn't much help. A few that show up under images had no malar osteotomy done at all. Such as a few that link back to a thread where people were discussing the ogee curve and leforts. Aside from those the rest are just asians who've had reductions.


I've spoken with a number of people who've had it done. The results are good when done right. The key is to not go for too much width or advancement else it looks unnatural.

---

As for the two months I'm just saying I have a two month headstart on solving any issues lol. I know it would take a long time to know if the result is any good or to even be able to correct it. I'm joking more than anything

[Optimistic]

Are you traveling on your own for this? Like, is it a major operation for you to do on your own in a foreign country. That would be my concern as well as being rushed. Only you can really know if you're prepared time wise. Also, what is a chin visor?

I will travel a bit for it yes, however I will have someone with me. In that sense I'm not concerned.

Chin visor is used to improve the sublabial fold. I believe Triaca invented it (could be wrong). Either way it helps a lot with creating a natural appearance in profile when larger sliding genios or chin wings are performed.

http://www.springerimages.com/Images/MedicineAndPublicHealth/1-10.1007_s12631-012-0202-3-5

[Optimistic]

You're going with Triaca right? Have you had a chance to ask him about whether or not HA can be removed?

Hi I haven't consulted since I last spoke to him. I will do that again soon so thank you for the reminder. I'll make a note and try to ask him for you. Sometimes we're only able to talk for 10-15 minutes at a time so I'll need to discuss what I need to first. If I can get through that I'll ask. Worst case I'll ask him during our face to face consult.

[sean89]

Good luck mate. Your contribution to this forum has been massive and I'm not sure I would have had my surgery had you not specifically made the chin-wing thread (along with the contributions of other posters) so I genuinely hope you get what you want from the surgery because I think you deserve it.

You're probably well aware of the basics when it comes to recovery, but just to reiterate some things that might make your recovery easier and a few other stuff:

• Buy plenty of food/liquid supplies before your operation and if you're staying in a hotel (make sure your fridge is adequately stacked) because the swelling will be so bad that you won't want to go out and if you have a hip graft, you really need to do as little walking as possible
  Avoid strenuous activity for first few weeks because you might clench your jaw
  Flying will make your swelling worse
  Although probably not advised by your surgeon, if you are struggling with liquid diet, I found that I could swallow small portions of scrambled egg, tiny pasta, mashed potato, sponge, bread dipped in soup, porridge etc., without chewing. For the first three/four days though, stick to soup, but I doubt you will have the appetite for anything substantial because of the anasthesia
  Looking at the thread about the U shape jaw after BSSO, I will say that, in my opinion, chin wing will also provide you with more of a U shape even if it remains technically possible to create V-shape with chin wing because most surgeons tend to mobilise all of the mandibular border. I don't think you will be unhappy with outcome though because I think your jaw will look more sturdy with U-shape and this will look just as good as the v-shape that you covet. For women, it might be a problem.
  My jaw sometimes looks unsuitable for someone with a narrow palate so I would try and sort that out as well if you have a problem with it.
   

[sean89]

Also, if you are making an international financial payment, you really need to use transferwise.com. It will save you upwards of £500, as it did when I used it. I could send you a referral code and it will give you a free transfer of up to £3000, but they've deactivated my account for some reason, but if you want me to chase it up with customer services and send you the code, I will do so because it will save you a lot of money.

[nrelax11]

Try and see if you can rent a spit suction device too. It came in handy for me when I couldnt spit things out well at first. If you can get one, dont become dependant on it though, just use it when necessary. It also helped when I threw up a couple times.

[Optimistic]

Thank you for the advice Sean. I'll be interested to see how things to pan out post-op. Ultimately I'm not too concerned as I know there is a lot that can be done to tweak such a result. For example, if I really hated the shape of my mandible there is always bone bossing to create a more ideal shape, chin visor or filler for sublabial folds and so on. Besides, considering my current profile I don't think anything that happens will be a step backwards. At worst just a less-than-ideal step forward which I can work on over time.

As for transferring money, I have one that allows for a free exchange the first time you use it. So I'll take advantage of that for this.


@nrelax11 Sounds like a good idea. Sadly I can't see how I'd be able to organise that given the short space of time I'll be there before flying back. I think I'll simply need to deal with any problems like that

[nrelax11]

Thank you for the advice Sean. I'll be interested to see how things to pan out post-op. Ultimately I'm not too concerned as I know there is a lot that can be done to tweak such a result. For example, if I really hated the shape of my mandible there is always bone bossing to create a more ideal shape, chin visor or filler for sublabial folds and so on. Besides, considering my current profile I don't think anything that happens will be a step backwards. At worst just a less-than-ideal step forward which I can work on over time.

As for transferring money, I have one that allows for a free exchange the first time you use it. So I'll take advantage of that for this.


@nrelax11 Sounds like a good idea. Sadly I can't see how I'd be able to organise that given the short space of time I'll be there before flying back. I think I'll simply need to deal with any problems like that

How long will you be in your location post op for recovery?

[Optimistic]

How long will you be in your location post op for recovery?

I was planning on going there and within the first week consulting, confirming the surgical plan, then having the operation. Which would leave about two weeks before I fly back home.

[Optimistic]

Dear Sean,

Thank you very much for your contribution.
However, Your comments on how your U Shape has been exacerbated by the chin wing concern me a lot.
I will have the same surgery of OP around the same time.

Sean, are you happy of the surgeon you chose? Going back would you change him?

Thanks

You have to think about it logically.

Start with a U-shape that is recessed. It's going to look less U-like the more of the rear end of the shape is hidden. Advancing the entire U will pronounce its shape.

It all depends on your starting point. What shape is your mandible to begin with? To what degree can you flare the rare angles of the jaw? How broad is the front of the mandible such as chin? All these are going to contribute to the end result.

I would just say get a chin wing, see how you end up. If you really care that much you could get the bone shaved down to form a certain shape. Such things are commonplace in Korea, and therefore well within the realm of possibility.



On that note I should stress that it seems unlikely anyone ever gets just one operation and is completely content with the result. More often than not, based on my time on forums, it requires a degree of tweaking afterwards with the first operation(s) laying the foundation of what's to come next.

I'm optimistic that I'll be content with this single operation given from an aesthetic standpoint it's only my lack of chin projection that is a concern. Everything else is fine-tuning. My gonial angles, ramus length, and jaw width are all decent.


I believe Sean's result is very good, especially given it is attempting to conceal functional issues with his occlusion. If I was to be super nitpicky I would say he could benefit from a chin visor osteotomy to improve the sublabial fold, however as it stands he's well within the realms of what is considered normal. Besides, such an operation would be cheap and easy to perform if he ever wanted to go down that path.

The best chin wing results I've seen were performed either at the same time as other operations to correct bite, or on someone who already had a decent occlusion. When the jaws are malpositioned I think surgeons are limited with what can be done.

[nrelax11]

You have to think about it logically.

Start with a U-shape that is recessed. It's going to look less U-like the more of the rear end of the shape is hidden. Advancing the entire U will pronounce its shape.

It all depends on your starting point. What shape is your mandible to begin with? To what degree can you flare the rare angles of the jaw? How broad is the front of the mandible such as chin? All these are going to contribute to the end result.

I would just say get a chin wing, see how you end up. If you really care that much you could get the bone shaved down to form a certain shape. Such things are commonplace in Korea, and therefore well within the realm of possibility.



On that note I should stress that it seems unlikely anyone ever gets just one operation and is completely content with the result. More often than not, based on my time on forums, it requires a degree of tweaking afterwards with the first operation(s) laying the foundation of what's to come next.

I'm optimistic that I'll be content with this single operation given from an aesthetic standpoint it's only my lack of chin projection that is a concern. Everything else is fine-tuning. My gonial angles, ramus length, and jaw width are all decent.


I believe Sean's result is very good, especially given it is attempting to conceal functional issues with his occlusion. If I was to be super nitpicky I would say he could benefit from a chin visor osteotomy to improve the sublabial fold, however as it stands he's well within the realms of what is considered normal. Besides, such an operation would be cheap and easy to perform if he ever wanted to go down that path.

The best chin wing results I've seen were performed either at the same time as other operations to correct bite, or on someone who already had a decent occlusion. When the jaws are malpositioned I think surgeons are limited with what can be done.

Hey id just like to say im very content with my outcome from just having one surgery and I dont think I'll need any further procedures. So its not always the case that further tuning is required. Its also does depend on the foundation though and how ones starting canvas was before surgey. Id say for me I just happened to have had a small skeletal deformity that only required one surgery to fix, so I guess I cant talk much. Point is though, like Disillusioned said, go with chin wing and see how things turn out and then go from there. Hoepfully that will be the tweak you have to do to your face.