Can you have a flat midface and still be considered attractive?

[itsallgenetics]

Hey guys, please read some background info on me first, I'd really appreciate any honest feedback. Thanks!

I am of asian descent and am 21 years old. I have a class III underbite with slight asymmetry, from left profile view I look pretty fine, however, my right side has grown more and is slightly prognathic - I will be getting jaw surgery in 6 months. It is not that severe, camouflage orthodontics means that to most people it is almost unnoticable unless i smile with both upper and lower teeth showing (incisors are edge to edge).
My maxfax's report says that '[I am] mildly flat in the midface, but this is not marked and [I am] happy with [my] appearance.' Also my mandible is 'only slightly prognathic'. He recommends mandibular rotation with or without repositioning of the maxilla. When I saw him in person I'm pretty sure he said my maxilla was on the right plane.

When I first saw my orthodontist, his exact first words were to me: 'You look great - you are a very handsome young man.' Initially he didn't even think I needed to undergo orthognathic surgery, just a genioplasty to correct my slightly asymmetric chin.
Over the years, I have received generally positive comments from a variety of people - very occasionally a girl might tell my friend she thinks I'm hot, sometimes people tell me I look like a Korean actor, etc. One girl told me I have sharper, more defined features than the usual chubby asian face.

Reading this you would think I'm very confident in myself, but the reality is I'm not at all, I'm extremely self-conscious and really only care about what I see staring back in the mirror. I think I look a lot better at night under artificial lighting as the shadows show the angles and definition in my nose, cheekbones and jaw, yet I think I look real bad in broad daylight as my face looks washed out and flat, definition of bone structure is completely gone.

What does a 'mildly flat' midface man? I have fairly strong lateral projection of my cheekbones, how can I tell if my forward projection is adequate? I feel my maxilla projection is okay for someone of asian background, yet maybe could be improved. And finally, is it strange that most people consider me decent looking even though I seem to have a flattish face? I really need to know as all these answers will determine whether or not I get my maxilla repositioned along with my lower jaw. At first I was only concerned with my asymmetric lower jaw, but will a more forward projecting maxilla help improve my appearance?

Thanks heaps for your input guys. No pics for now, sorry... i just can't bring myself to do it, you'll have to trust everything I've said.

[PloskoPlus]

Since you're Asian, you should be really careful about advancing your maxilla.  FWIW, maxillary setbacks are performed almost exclusively on Asians for a good reason.  Heck I'm white, and I look somewhat chimpy after my advancement.

[itsallgenetics]

That's interesting I never even knew of maxillary setbacks... can you please elaborate?

My maxfax was originally like 'jaw surgery involves moving lower jaw back and upper jaw forward, blah blah..' then I interrupted and asked if I could only have my lower jaw adjusted. He said he was inclined to agree that that would probably be fine in my case, but the option of maxilla advancement is still on the table. My case is minor compared to most others so if my maxilla were advanced it would only be very slight.

I'm not sure what would produce the most aesthetic result, maybe i'll just have to post profile photos..

[Vic]

You can't set back the Maxilla. You can rotate it or impact it, but you can move it back like the mandible

[PloskoPlus]

You can't set back the Maxilla. You can rotate it or impact it, but you can move it back like the mandible

http://eng.plasticsurgerybeijing.com/shouyezhixing/shangheqiantu.htm

[itsallgenetics]

http://eng.plasticsurgerybeijing.com/shouyezhixing/shangheqiantu.htm

Very interesting, an Asian guy in my uni course looks like this, something about him seemed off but could never put my finger on exactly what it was till now... no wonder some people referred to him as 'fish lips'

So my understanding is, because asians have flatter faces overall the maxilla should not be too protrusive, as this will just look wrong, whereas it would look fine or even aesthetic on a caucasian person?

[PloskoPlus]

So my understanding is, because asians have flatter faces overall the maxilla should not be too protrusive, as this will just look wrong, whereas it would look fine or even aesthetic on a caucasian person?

There are no guarantees even for caucasians. Maxillary advancement can have a huge impact on ones's looks... for better or worse.  The nose can tip up and the upper lip elongate and become convex (controlled with Anterior Nasal Spine reduction or complete removal of), nostrils may flare (mitigated with an alar cinch), upper lip vermillion may thin (VY plasty to the rescue) - all of these things interacting in complex ways require a good surgeon.  The upside is that the chance of permanent numbness is much less than with lower jaw surgery...  But as I'm typing this my upper lip is still stiff and partially numb 3 months after surgery.  Also maxillary advancement increases the airway, while mandibular setback decreases it (you may end up snoring post-op if you didn't before).  Advancement stretches the skin and gives it more support.  Any kind of setback does the opposite, of course.

Having your upper jaw more forward may make your upper lip look longer (even if it's exactly the same length) - objects closer to the viewer appear bigger.  And a short upper lip is very important for good looks.

tldr; IMO, the eye area is 80% of good looks - strong orbits, cheekbones.  If those are weak, advancing the maxilla may produce a chimp look.  However, if you have a gummy smile or conversely a weak smile, then some kind of maxillary surgery is required.

[itsallgenetics]

Wow, if only my orthodontist or maxfax had such a conversation with me... Seems like people here are far more knowledgable, or at least more willing to discuss the aesthetic side of surgery rather than occlusion.

Thanks a lot for your info Plosko. So far my inclincation is that if I and others generally perceive myself to be decent looking, and my class III occlusion is basically unnoticable to the average person, then it would make sense to only undergo a mandibular rotation and slight setback. Playing around with the maxilla seems far too risky given what you've told me, I would probably just increase my chances of having bimaxillary protrusion and reducing my facial aesthetics.

[terry947]

In my opinion the reason why Asians as stereotyped as having flat faces is because you maxilla and upper eye area doesn't protrude forward enough, be it because of environmental or genetic factors. I'm leaning towards the first one.

It's safe to assume that a majority of people who have jaw surgery have some sort of maxillary retrusion. So when the the upper maxillary area is retruded and you get a lefort I its looks off or chimp like. Especially if you have a bimaxillary protrusion.

[PloskoPlus]

Wow, if only my orthodontist or maxfax had such a conversation with me... Seems like people here are far more knowledgable, or at least more willing to discuss the aesthetic side of surgery rather than occlusion.

Thanks a lot for your info Plosko. So far my inclincation is that if I and others generally perceive myself to be decent looking, and my class III occlusion is basically unnoticable to the average person, then it would make sense to only undergo a mandibular rotation and slight setback. Playing around with the maxilla seems far too risky given what you've told me, I would probably just increase my chances of having bimaxillary protrusion and reducing my facial aesthetics.

FWIW, this guy was probably in the same boat as you pre-surgery, has regretted it, but I think he may have reconsidered his feelings about it since.

http://www.realself.com/review/Facial-Jaw-surgery-regret

However, I wouldn't rely on anything I say.  I'm just a random guy off the internet.  I would consult with other max fac surgeons that have more interest in the aesthetic aspect, rather than bite, bite, bite.  The bite is important, but virtually all surgeons should give you a good bite, unless your case is very severe (and with a mild underbite, I don't think it's severe).  One sign (but no guarantee) that the surgeon has at least an interest in the mid face aesthetics is that he also does rhinoplasties (nose jobs).

BTW, I didn't have a massive underbite either - my LeFort was 5-6 mm, forward 1-2 mm down and my teeth just touched pre-braces. I don't think anyone noticed, but my smile was really really weak.  It wasn't until I got older and also lost weight that my mid face flatness became really objectionable.  But even this small movement completely changed my profile. 

tldr;  seek other professional opinions.  If you have a weak (poor tooth show) or conversely gummy smile you may need some kind of upper jaw surgery anyway.