Jaw surgery/any other surgery recommendations?

[skullremodel]

I included two x-rays. One is just my skull. I'm wondering if anyone can tell me if I need zygo work done as well.
The biggest concerns I have are aesthetic concerns of my receded jaws, my weak zygos, poor browridge, poor eye area, and sloped forehead - but the sloped forehead is impossible to fix I'm guessing. Ideally I'd fix everything. But I'm looking for some solid advice. Not really seeking implant recommendations I don't want them. Heard iffy things about HA paste too....

Does counterclockwise movement of the jaw tend to enlarge the philtrum? Does it also tend to make the face appear longer as wouldn't the FWHR change and the mandible moving forward create a appearance of a longer face? Won't I be risking loss of upper third and midface prominence undergoing jaw surgery - meaning I'd have a really poor / odd look as the lower third would be strong but everything else weak. How reliable is jaw surgery? I mean it's got relapse issues and some bone issues - say 2-5 years down the line could be looking at another procedure? Ages you quicker?


Images: https://imgur.com/5MVAQeP

[skullremodel]

Bump. Any advice appreciated

[Milli_Meters]

CCw will not elongate your face. It should generally do the reverse.

Some of the stuff you asked is kinda subjective depending on your soft tissue position/movements. To me it looks like you could benefit from MMa/ccw based on your x ray.

Consult with a few good surgeons and glean out the commonalities.

[skullremodel]

Thanks. I guess I need to start consulting with more than one surgeon. I consulted with my local oral surgeon and he suggested lower jaw surgery alone

But I'm not too sure. My bite is ok.

[skullremodel]

It looks like my gonial angle is around 125...

From my reading it seems like BSSO can't change that. Would something else be able to reduce this?

Also, from double jaw surgery would the midface be "left behind" meaning I would lose any concavity from the cheek region and gain a chim look?

[Milli_Meters]

BSSO will align your mandible in a proper relationship to your maxilla and lengthen the mandible which makes the face look  well developed from the profile and slightly wider from the front. For jaw angles you might need some other intervention down the line Chin wing , medpor implants etc.

Ya , well it is subjective. I am also concerned about mid face being "left behind". But it depends on what exactly the surgical plan entals and what the starting point is like.Look at this lefort 1 advancement -http://jawsurgeryforums.com/index.php?topic=6688.msg56190#new

His midface is anything but "left behind". Looks fuller and healthier over all.

[skullremodel]

Can chin wing reasonably reduce the gonial angle?

Right, but it looks like he had a decent midface to begin with. My cheeks are very flat and my midface looks recessed. I would be worried about having a procedure (10mm BSSO + 6mm Lefort 1) and then having a set back midface.

Extremely cumbersome to think about all this. I wish there was a way to see exactly how i would look post surgery and then decide versus taking a leap of faith.

[slysurfz]

You could get some HA paste cheekbone augmentation if you go to somebody like Gunson. That way your midface concerns can be addressed.

I Agree the guy in the other post has good midface before surgery.

[skullremodel]

You could get some HA paste cheekbone augmentation if you go to somebody like Gunson. That way your midface concerns can be addressed.

I Agree the guy in the other post has good midface before surgery.

I have reservations about HA paste. I've heard there's swelling that doesn't go away, inflammation, asymmetry, and bone issues.