Long and asymmetrical face - seeking advice on procedures and surgeons

[FranksMonster]

Hello everyone,

I'm in need of surgery and would like to hear some opinions, suggestions, ideas etc. of what to do and also which surgeon would be appropriate for me. Note that I'm from a country in the middle of Europe.

About me and my problems: I'm in my early 30s and over the past 2-3 years I have been working out extremely hard, transforming my body, I even had an orthodontic treatment done (had braces for 2 years), but everything only made me realize just how messed up my face truly is.

My main problem is my long and asymmetrical face, with a clearly tilted jaw. My bite is OK, just tilted, that's probably the reason why no doctor ever even mentioned the possibility of surgery, so I never knew it's an option.

As you can see from the photos, my face just looks terrible, especially on photos. So much that I have a severe phobia of being photographed. Mirrors aren't that bad, but looking at my own photos just makes me sad.

I threw away my 20s sitting behind the computer all the time, I would like to at least live the rest of my 30s and 40s and I don't feel like I can truly do that with my current look.

I have 6 figures saved, so Swiss surgeons are also an option, I guess. Life is cheap when all you do is sit at home in-front of your computer for a decade.

Attaching photos.

Regards,
FranksMonster

P.s.: What type of scans/x-rays do I need to do?

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[FranksMonster]

Attaching also left and right profile.

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[FranksMonster]

Found a beard-less selfie, attaching that also.

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[notrain]

Your profile is normal but you have a terribly canted upper jaw. You need bimax to level out and align both jaws. Go see Zarrinbal in Berlin or Triaca in Zurich. It's likely that you don't need a lot of orthodontics to prepare for surgery.

[David_D]

I'm in need of surgery and would like to hear some opinions, suggestions, ideas etc. of what to do and also which surgeon would be appropriate for me.

...

My main problem is my long and asymmetrical face, with a clearly tilted jaw. My bite is OK, just tilted, that's probably the reason why no doctor ever even mentioned the possibility of surgery, so I never knew it's an option.

As far as scans go, a full skull CAT scan may be helpful.  That would enable different physicians to view whatever area may be of interest to the analysis he or she might perform.

You define your problem as facial length and facial asymmetry.  I think that upper and lower jaw surgery can certainly address jaw asymmetry.  If there is other asymmetry that is of interest to you, it would be good to identify that.

The structural/bone aspect of facial length can be addressed through jaw and chin osteotomies.  I recommend getting clear on the magnitude (specific measurements) and type (location) of changes you might find desirable.  Also, I think it would be important to understand the potential soft tissue changes that may occur due to the bone-related surgeries.

If your goal is to get within "normal ranges" as defined by a surgeon, you may already be there.  If you have a specific goal other than that, then you can use that as a point of discussion with anyone with whom you consult.

You might get more feedback here if you define a specific outcome you might like to achieve surgically.

[FranksMonster]

Your profile is normal but you have a terribly canted upper jaw. You need bimax to level out and align both jaws. Go see Zarrinbal in Berlin or Triaca in Zurich. It's likely that you don't need a lot of orthodontics to prepare for surgery.

Yes, that's what I thought. Bimax for jaw alignment is a must.

Zarrinbal and Triaca were already at the top of my list (based on reading this forum). Is there any significant difference between them? I wouldn't be too thrilled about paying those ridic Swiss hospital day fees.

Considering that I just had braces (got them off a couple months ago), would I maybe even be a candidate for "surgery first" procedure?

[FranksMonster]

As far as scans go, a full skull CAT scan may be helpful.  That would enable different physicians to view whatever area may be of interest to the analysis he or she might perform.

Can you be a bit more specific, please? Which version of CT scan, CBCT?

Also, is full skull needed, or would eyes and under be enough? I'm asking because I have that available, not sure about full skull.

You define your problem as facial length and facial asymmetry.  I think that upper and lower jaw surgery can certainly address jaw asymmetry.  If there is other asymmetry that is of interest to you, it would be good to identify that.

Area around temples also looks asymmetrical, but I honestly don't really care that much for complete perfection, I just want to have somewhat normal facial proportions.

I have been playing a bit with PhotoShop (very amateurish "skills") and even just simply tilting the jaws back and slightly up brings ok results.

The structural/bone aspect of facial length can be addressed through jaw and chin osteotomies.  I recommend getting clear on the magnitude (specific measurements) and type (location) of changes you might find desirable.  Also, I think it would be important to understand the potential soft tissue changes that may occur due to the bone-related surgeries.

What are the potential soft tissue changes? Can you elaborate?

[David_D]

Can you be a bit more specific, please? Which version of CT scan, CBCT?

Also, is full skull needed, or would eyes and under be enough? I'm asking because I have that available, not sure about full skull.
Area around temples also looks asymmetrical, but I honestly don't really care that much for complete perfection, I just want to have somewhat normal facial proportions.

I have been playing a bit with PhotoShop (very amateurish "skills") and even just simply tilting the jaws back and slightly up brings ok results.
What are the potential soft tissue changes? Can you elaborate?

I don't know what type of CT scan.  I think that a full skull scan may be useful if you're working with a surgeon who wants a total view.  I had a full skull model made at the request of a surgeon.  Other surgeons may find that not at all useful.

As far as soft tissue changes: it depends on what bone movements occurred.  For instance, significant vertical reduction in the jaws through LeFort, genioplasty or "shaving" of bone may leave what might seem to be excess soft tissue; for me, I found that to be the case under the chin and in the areas lateral to the mouth.  Maxillary impaction may leave the upper lip appearing too long relative to the teeth.

[FranksMonster]

I don't know what type of CT scan.  I think that a full skull scan may be useful if you're working with a surgeon who wants a total view.  I had a full skull model made at the request of a surgeon.  Other surgeons may find that not at all useful.

As far as soft tissue changes: it depends on what bone movements occurred.  For instance, significant vertical reduction in the jaws through LeFort, genioplasty or "shaving" of bone may leave what might seem to be excess soft tissue; for me, I found that to be the case under the chin and in the areas lateral to the mouth.  Maxillary impaction may leave the upper lip appearing too long relative to the teeth.

OK, thanks. I'm going to try finding if I can get full skull.

I have a bit of gummy smile on one side, so I'm guessing I have a bit of room there, at the very least leveling the gummy side with the other side.

As for possibly creating excess soft tissue: that's unfortunate, but if it does happen, we can at least cover it with a beard. Personally I wouldn't mind that too much as I'm already using beard to create a bit of an illusion.

[PloskoPlus]

Imo, the length of your face is a bit of an illusion. I don't think it can be shortened significantly. Widening your face could make it look shorter. But even that has limits and its own side effects (like making the eyes look more close set). BTW how long is your upper lip to the vermilion?

[CCW]

You don't have a gummy smile or any of the other earmarks for LFS. Bimax projection could be increased and the cant leveled with CCW bimax, no genio. HA on the cheeks. Schedule a consultation with Gunson if you don't mind the travel. He's the best, and you have the money.

[Rich guy]

Hi, you're not very ugly in my humble opinion, for sure you need surgery to become more attractive.
I think a surgeon might consider a bimax and u might shorten the length of you face with the impact of the maxilla and maybe with a sliding genioplasty

[FranksMonster]

Imo, the length of your face is a bit of an illusion. I don't think it can be shortened significantly. Widening your face could make it look shorter. But even that has limits and its own side effects (like making the eyes look more close set). BTW how long is your upper lip to the vermilion?

The thing is, when I look at before and after photos of people with similar features, even just moving the jaws up like 5mm creates a very noticeable difference. Same if I play around in PhotoShop. (btw., is there any good software out there that I can use?)

I have no idea how long is my "upper lip to the vermilion".

Btw., shortening the face isn't a priority, asymmetry due to severely canted jaw is. Face shortening would just be a nice bonus.

You don't have a gummy smile or any of the other earmarks for LFS. Bimax projection could be increased and the cant leveled with CCW bimax, no genio. HA on the cheeks. Schedule a consultation with Gunson if you don't mind the travel. He's the best, and you have the money.

There is some gummy smile on one side. And a lot more if I truly smile.

When it comes to US surgeons, I'm more worried about the possible costs if something goes wrong ... US healthcare system scares me. Is Gunson that much better than top European surgeons?