Should i or shouldn't I? (pics inside)

[Marco90]

Hi everyone, I am considering undergoing a second Jaw surgery and am looking for peoples opinions on the likely benefits or lack there of.
To sum things up I had Jaw surgery four years ago and the surgeon decided to move my lower jaw forward 4mm to match my upper jaw and correct my bite. This worked fairly well but since my main concern was i didn't show much of my top teeth when i smiled it was a bit of a failure.
So I have contacted the best surgeon in my area and he suggested Lowering the maxilla but also moving it forward and moving the mandible forward too. As moving just the maxilla down would put my chin and lower jaw too far back. I also believe he said advancing the maxilla while bringing it down is far more stable.
I have a few questions, judging from my pics would advancing my maxilla be beneficial and look good? In my case does it seem worth going through a double jaw surgery for ideal teeth show? My nose is not the best (too wide) which i'm fine with but if it widens more do you think i'll still look better than before surgery considering the jaw improvement?
Thanks for reading, I have full confidence in the surgeon I have chosen but it seems silly not to take some advice from the experience of people on this board. 
Also I haven't yet discussed this with my surgeon but I think i may have sleep apnea because I have always been overly fatigued compared to my peers and my blood tests have come back as normal although i'm aware there's other possible causes of this. 
   

[Picollo30]

Before commiting to a major surgery like this please ask your doctor for a sleep test, the symptoms you describe (extreme fatigue) are just like mine, so please do the sleep test and this warning coming from a severe OSA patient.

Do you wake up tired, like you didnt sleep at all during the night? Do you know if you snore? Do you feel sleepy during the day?

[stupidjaws]

i think it's a terrible idea, it would lenghten your philtrum, make your malars look weaker and your face more narrow. i think you need rhino, then you may evaluate if some jaw enhancement and/or malar enhancement procedure could be considered

[Picollo30]

i think it's a terrible idea, it would lenghten your philtrum, make your malars look weaker and your face more narrow. i think you need rhino, then you may evaluate if some jaw enhancement and/or malar enhancement procedure could be considered

but what if he has obstructive sleep apnea? dont you think he should do a sleep test to see whats going on?

[stupidjaws]

Aesthetically speaking it's a bad idea.

[Marco90]

@Picollo Thanks for the reply, I do feel tired throughout the day and also i do snore and wake up tired so I think there's a good chance sleep apnea is involved. I'll try to organize a sleep test.

@stupidJaws Thanks for your advice, I agree rhino would make my nose look way better but as it is now it doesn't affect me too much since i'm not trying to look like a movie star or anything but yeah if it got much worse after surgery that would be bad. My lack of incisor show on the other hand makes me pretty insecure whenever i'm talking or smiling.

[stupidjaws]

i don't think it's a good idea, your philtrum would look huge.

[Marco90]

I appreciate your advice, I may re think the idea btw are malars the same as cheek bones? I thought mine were okay as they are to be honest.

[Picollo30]

i also think you would benefit from under eye area implants, i can see there's no great bone projection in that area, although you dont have dark circles i notice that area is kinda hollow. you can try fat grafting to fill in that area and also the malar area but fat grafts usually dont stay for long (max 6 months). implants are the superior choice.

[stupidjaws]

(removed pics as requested by OP)

second photo is if you have orthognatic surgery: philtrum gets longer because of advancement and downgrafting, nose gets even wider and nostrils flared out.

first photo is Chin wing + rhinoplasty + under eye fillers (restylane).

No brainer really.

[molestrip]

Where do you get that the philtrum gets longer after advancement? I thought the opposite, due to tissue thinning. If it could be lengthened, then you wouldn't hear people complaining about incompetence.

[stupidjaws]

Downgrafting+advancement

[jawregret]

philtrum gets longer because of advancement and downgrafting, nose gets even wider and nostrils flared out.

If it's only downgrafting, does the philtrum get longer? Does the nose get wider?

[Milli_Meters]

This patient with cleft lip had substantial downward movement and advancement of the maxilla done. (18mm horizontal and 14 mm vertical) but his philtrum seems alright. Maybe he got a lip lift as well?

[attachment deleted by admin]

[Lord-of-the-Cartilage]

Yeah he definitely had a lip lift.