Midface defficiency

[Mark505]

wiped.

[Optimistic]

My personal opinion is that bone structure plays a minimal role in ageing. It's just good facial morphology holds up ageing skin better. In other words, one's skin is the primary factor in ageing.

Why don't young children with recessed midfaces and mandibles get nasolabial folders and saggy faces? Their skin is still in tact. Problems start when your skin ages and you don't have anything there to prop it up.

That is my take on it at least.

Of course you could also have poor genetics which make you prone to premature ageing, though it's hard to say how much is genetics and how much is environment (UV exposure, diet, lifestyle)

[Optimistic]

few facts:
-everyone in my family with this condition have asthma, allergies and nasal airway problems. This might imply that unfortunate vertical growth has to do something with breathing and tongue posture. If my father and my  grand father show same symptoms as me and my sister do, why my father's brother doesn't show this problems?I guess because he's the only one without asthma, allergies and similar
-distance between my eyes and mouth increased from my 23. year till now and this is not by any mean normal. Obviously we're not only dealing with soft tissue change.
-soft tissues started sag and from  lateral view it looks like jaws rotated, being more steep. Probably this is exactly what happened so soft tissues are losing support and thus slipping down. One more indication that bones indeed are changing.
 
I'm not a doc, but I think I'm dealing with either genetically inherited syndrome or just maldevelopment of jaws due to airway problems.

I have to get some geneticist and other maxillo facial specialist to sort this out. In fact, I was recently at maxillo facial specialist, but from other reason. I thought that my head was growing - I have large skull and from middle school I'm depressed because of that, but now on top of that I get my face  wasted, just horrible. Anyways, he told me that I was wrong about head growth, because by his words a recently taken dental xray is the same (2mm difference actually) comparing to the one taken two years ago (in time, before "face melting" symptoms started to show) and this implies no significant bone growth/changing in 2 year period. Also I tend to think that my head got bigger due to loss of facial fat, which made my face smaller compared to cranium and top of head.

Regarding facial bone structure, lets assume it changed, for instance eyes and mouth getting more apart why dental xray doesn't show this?It's so contradicting or maybe specialist was just fooling me to calm me down. Or maybe because dental xray doesn't show whole face,  changes can not be seen?Just a bunch speculation from me since I'm not a doc, but make your own conclusions with objective clue that recent dental xray is practically (2mm difference) the same to the one taken 2 years back .

Despite everything I am amazed how surgeon didn't see my hypoplasia. I showed him before and now pic, but nothing. I am just "normally" ageing. If this is normal, then pigs can fly.

I hear you.

My point wasn't about whether or not you have jaw problems, or whether there is vertical growth from mouth breathing. Granted from the few photos I quickly saw you looked more or less normal. What I was trying to get at is that IF your skin quality had remained exceptional you wouldn't have the issue of facial sagging that you're complaining about now.

In your case perhaps it could be described as such:
Skin ageing ---> Lack of bone structure to support lack of elasticity ---> Facial sagging

And in a good case:
Skin ageing ---> Bone structure to support decreased elasticity ---> Face retains similar appearance

Like I said, young children with poor jaw development don't get sagging faces, only adults with ageing skin do.

By all means pursue the route of maxillofacial surgery if it can be of benefit of you, just don't forget that the case of facial sagging is ALWAYS an issue of skin ageing first and foremost. Even if that sagging is accelerated by poor facial support. It would be wise to consider ways of improving skin quality in addition to jaw surgery.

[Bazarov]

I'm sorry to hear that. It's always painful to find out that something is 'incorrect' about you.

I'm somewhat surprised that a LFIII is indicated for what you have. Which treatment path would you take?

[PloskoPlus]

But the other dude said I have malocclusion (I think he mentioned malocclusion type II of something, but I need to see orthodontist for more accurate evaluation), dental crowding, mid face deficiency, slight ear deformity and that I need orthodontic treatment + orthognathic surgery, and that involves Le Fort I + zygoma or Le fort III. But at first, I have to go to geneticist to exclude sydromatic disease.

Wow!  Who was the second surgeon?

[PloskoPlus]

Probably none, but if that would happen, I'd steer away from LFIII at all costs. Doc said that aim is to avoid LFIII and as far as I understood him, this depends of what are orthodontics able to do. In such case bone grafting my be possible.

 I may consider face pulling and similar non-invasive stuff, before doing anything surgical. But at this moment I'm more concerned about suspicion of faulty genetics, so visiting a geneticist is a first thing to do.

What could a geneticist possibly do, except say yes you have "syndrome X"?  Face pulling, orthotropics, etc., are a scam.  I'm really surprised by the LFIII.  When it comes to non-syndrome cases, I've only seen them done on severe Class III patients (underbite, very recessed mid faces).

[Alue]

Yea, you do seem to have a little midface deficiency.  You could contact earl25, I think he had similar issues, he got a modified lefort III without moving the maxilla.  Your jaws don't seem that recessed, then again I have a different metric than most people.

[needadvancement]

My personal opinion is that bone structure plays a minimal role in ageing. It's just good facial morphology holds up ageing skin better. In other words, one's skin is the primary factor in ageing.

Why don't young children with recessed midfaces and mandibles get nasolabial folders and saggy faces? Their skin is still in tact. Problems start when your skin ages and you don't have anything there to prop it up.

That is my take on it at least.

Of course you could also have poor genetics which make you prone to premature ageing, though it's hard to say how much is genetics and how much is environment (UV exposure, diet, lifestyle)

I gotta agree with you on this. I've seen many people with impressive bone structure that would make you think they'd age amazingly but they didn't, despite the bone support the skin quality just deteriorated prematurely for whatever reason(probably too much sun).  And I've seen people with weak bone structure still age well(though they probably would have looked even younger if they had greater bone support).

[PloskoPlus]

one thing that I would like to hear your opinion about; as I already said and we had discussed the issue about my rapid skin sagging (nasolabial folds), could it be the consequence of ONLY facial fat loss and not the suspected bone structure change in so short time (24 months), especially at age 23?

I've talked with few orthos about the issue and they said it's like 90% of chance that it was facial fat loss which exposed weak bone structure. They don't believe that bone structure actually changed in my mid 20s, the only one who added a bit different opinion was university max fac surgeon who said that I should check myself for an ongoing syndrome due to other suspicious signs (small hands, ears, slight deformed ear besides midface deficiency...), but he mostly leaned on facial fat loss theory too. I also talked with my long knowing friends about the issue and they said that I lost a lot of material in my face, whatever that is and also judging by old images one can see that I had way more cheeks and rounded face as I do have now.

I was class III pre-Le Fort I.  Losing 10 kg aged me 10 years.  Fat is awesome camouflage.  But even in the 3-4 years pre weight loss I was looking more and more "off" without being able to explain it (even as everyone said I looked about 4-5 years younger than my age (probably lying to me).)  I'm 37, however.  I'm the same weight after the operation, but look younger now.

So your options are are: get fat or get surgery.  BTW, I've seen a modified Le Fort III on a severe class III case (eyes bulging in profile).  The dude looked like a walking corpse pre-op.  Like a super haggard terminal alcoholic.  I have no idea how old he was, but he looked at least 50 years old pre-op and the operation took like 10-15 years off his appearance.

[dantheman]

If you think s**t went south after the age of 23, blame your environment and not your genetics. Your skeleton stops growing in your late teens and certainly by your early 20s there simply is not much room for anatomical change.