First of all thank you for all the responses so far. I'll answer them all individually.
if you ask me, you may have pretty good basis for attractive face, but as you had noticed, it's not in it's full potential. You seem to own exactly the same features of midface defficiency (that typical tired look, as you mentioned) as I do, but in a way lesser extend;
-you may have tendency of negative canthal vector (tendency of down slanting eyes), but you don't seem to have increased visible sclera (that nasty white space between iris and lower eye lid)
- nasolabial folds (that skin lines around your nose)
- you have recessed lower jaw (recessed mandibula), as you can see your upper and down lip don't match, so I guess your bite isn't good as well
You may be ClassII patient.
Fixing your mandibula is done by pretty straightforward and standard BSSO surgery, while midface defficiency is one of the toughest aesthethic problems to improve. Options are:
- orthognatic surgery of midface advancement (modified LeFort II or LeFort III, maybe zygomatic osteotomy). This option would obviously improve your face and would give best results, but it's potentially a very dangerous surgery. There are few surgeons who may be willing to do this for only aesthethic purposes. I 'm not sure that you would need this tough.
- orthognatic surgery of LeFort I + bone graft or implants . This is less invasive, but I wasn't that impressed at seeing results of treating midface deficiency this way. It may work for you since your eye area doesn't seem to be affected that much.
It really depends on how much your eye area is busted, because if it's not that bad and in your case it doesn't seem to be, you can get away with LFI and bone graft/implants. But at least what you should get in my opinion based on those pics, is a BSSO to advance your mandibula.
Btw, were you a mouth breather as kid, do you have allergies,asthma, did you have problems with enlarged adenoids?Did you lose facial fat?
The negative tilt is pretty obvious. I do have minimal scleral show when my face is fully relaxed and I tilt my head a bit forward, I guess it's just the tilt that makes it, though I don't know if even that is supposed to be that way.
The nasolabial folds are my main concern, they literally drive me mad. Alone for that I would do the surgery.
The relation of the jaws to each other is for sure not good, my bite itself is okay I think. My teeth are not crooked and look pretty straight with a bit of inward flare. I may post a picture of my teeth later.
I don't think that a Lefort II is a good solution for me. I actually only saw one result of (a modified) Lefort II 'til now. Lefort III would maybe help, but I don't know if my recession is severe enough for surgeons not to throw me out of their hospital and telling me I to go see a psychotherapist.
Where are these bone grafts made? Are they put on the cheeks (paranasally) or how? (Sorry, probably a dumb question but I have no idea).
I don't really know if I was a mouthbreather. I guess at some point I was, but not for long. I only found a couple of pictures from my childhood (age 8-10) where I have sometimes my mouth open, but that must have stoped before I was 12, because I can't find any pictures after that age range I mentioned where I had my mouth opend.
I do not have any allergies known of. I had an allergie-test done when I was 13 because sometimes I would sneeze to many times in a row, but I had no reaction on the typical allergens.
I did however lose wight. I lost 19 kg last year in 4 months. (I stoped eating because I was depressed, the only thing I would consume at that time was water). I guess that's another reason why I developed severe folds. Even my temples hollowed out as you can see on my picture.
I really think that I'm a genetic case. My father has a s**tty jaw, too and so do both my sisters (but they have luck that our mother was gorgeous when she was young and inhertied her good features to still be considered attractive in our society, if they would have jaw surgeries they would become total models). I recenty saw a picture of my father when he was in his early twenties, his mandible looked like it came out of his ears, his mandible looked sharp though, whereas mine is not visible at all.
Can you just get genio? I think that would help a lot.
No, that is not an option for me. My main concern is my middle third. A genioplasty would do literally nothing, most of the times it's not even that much of a change. Plus I didn't really like the outcomes of casual genios.
Don;t be too hard on yourself.
You're not bad off at all. Don't put yourself through too much for chasing perfection.
Maybe do the genio and braces and put the rest of your time and money into your person and future.
Good luck!
I'm not too hard on myself. I know exactly what I look like and that is ugly.
You know, when you live so much years knowing that you have nothing, you want to have it all. I don't have a future if I remain looking how I look. I'm going to do everything or I'm going to die soon.
Thank you.
Dr Zarrinball in Berlin
You should be in good hands with Zarrinbal. Please update us on what he suggests to you. If your bite is bad, my guess he will suggest - double jaw surgery, chin wing osteotomy and maybe zygomatic osteotomy. If your bite is good, then just a chin wing and maybe zygomatic osteotomy. BTW, how is your bite?
I already have an appointment with him in May, where I want to get a consultation about exactly those thing, but these are just things I want to do to 'perfect' it up. My question was rather aimed at finding somebody that does good, modified/personalized versions of Lefort surgeries. Zarrinbal only does basic ones.
There are two university hospitals near me with maxfax departments, I'm going to try it there.
I will post my ceph when I have it done here.
My plans were to get a SARPE to widen the upper arch, and braces for the lower arch to straighten the teeth up. I somewhere read that the lower arch should be 91% of the width the upper arch has, so that might work, since my upper arch is visibly narrower.
Then I would want my jaws rotated a bit, to make them more horizontal and then bring them forward a bit, with the Lefort I region cut to be higher, to bring the sub-malar region of the cheeks more forward.
Since the maxilla got moved, my mandible would auto-rotate a slight bit, having jawangles that flare out a bit more.
I would need to get my jaws rotated a bit, since my lower third would get too long. Even though on the picture it looks like my lower third is short, it's nearly if not exactly the same lenght as my middle third.
At the end of this, I would get ching wing and malar osteotomies on top of it.
I konw this is not a plastic surgery forum, so my question could be out of place. But are there no other possibilities to fix the lower eyelids, like a bleraphoplasty or something like that?
