Small and Weak Jaw - Help and Advice Please

[chrisj2002]

Hi Guys,

I'm a 33 year old male looking for some advice please.

I'm considering getting implants/surgery to improve the aesthetics and balance of my face.

My main issue is that my lower jaw is small and narrow. When I look forward or down my face and neck blend together like a double chin, but also the same kind of unattractive look on the sides of my jaw where my neck meets my face. It's extremely unattractive as if my jawline is non-existent.

When getting my photo taken I always try to push my jaw out to try and make myself appear better.

The smallness of my jaw actually also affects my body fat level in the sense that I keep my body fat higher as when I drop down to lower body fats my face goes so thin and unattractive I look like I have an eating disorder. The angle of my jaw is very steep from the sides, which makes my face appear half-moon like if you know what mean. It sort of looks like I may have an under-bite, but I don't.

I was guessing I maybe needed custom chin and mandibular implants, and possibly some form of custom mid-face implants (Malar, Sub-malar, paranasal,infra-orbital rim?), but obviously I don't really know so wanted to seek the advice of guys who know are a lot more knowledgeable than myself.

These are procedures I wish I'd considered years ago, but have only recently found the courage and saved the money to actually look to take further.

Below is a link to some photos that hopefully will help you see what I mean. I no longer have the long hair and beard so don't appear as bad as I look in the photos. But you should get the jest:

https://m.imgur.com/a/BxD6f

Any advice, blunt or not is most welcome. I can post more recent photos if they'd help also.

Many thanks!

[chrisj2002]

Right guys, I've been looking at Dr Yaremchuk and Dr Eppley in the USA. Does anyone have any experience with them or no anyone that has?

I live in Europe and although have seen a few Drs who do the surgery, I can't see too many reviews etc.

I'm thinking custom midface and Jaw/chin implants.

Thanks,

Chris.

[GJ]

Do you have sleep apnea? I ask because your under eye is very dark. Maybe get a sleep study done if you haven't.
Trimming the hair off your neck would tidy you up a lot and refine the jawline that you do have. I'd like to see photos after you do that.

From what I see, your upper jaw looks in an okay position, lower looks recessed. I see two ways to go about fixing this: CCW rotation both jaws, or extract two teeth from the lower jaw and move it forward as much as possible (this won't affect the steepness, but would bring it out more). Plastic surgery won't address the steepness of your lower jaw, which is what is causing the problems. Implants might give an illusion of width from the front, but would probably look unnatural given how narrow the bone structure is. Keep asking questions here as you learn more, but also see some surgeons so you understand what's going on. Good luck, man.

[diculo]

You would need Bimax w/ CCW rotation by a different doctor (maxillofacial surgeon) and then custom chin and mandibular implant in another surgery (eppley or yaremchuk).

[chrisj2002]

Hi Guys, here's a link to some more recent pics if this helps (I do usually shave my facial hair to give the illusion of a jawline):

https://m.imgur.com/a/LiWCx

GJ my under eyes have always been dark since I was a teen but I never considered sleep apnea. I have been told I grind my teeth in my sleep. Would sleep apnea affect your jaw?

Being fairly new to this I've never actually heard of bimax w/cow rotation so will have a read up. I'm assuming that is a more invasive surgery than just implants?

I just assumed implants would fix it, didn't realise how complex my issue was.  Do you think it's worth getting consolations with Yaremchuk and Eppley or do you think they will ignore the actual issues and just try and sell the custom implants?

Do you think anything midface such as malar, sub-malar, paranasal or infraorbital rim is needed?

Many Thanks both for your input!

Kind Regards,

Chris.

[chrisj2002]

Just to note I'm looking certain ways on some of the photos to accentuate what I see as my main issues.

Kind Regards,

Chris.

[Jilkster]

Aesthetically your upper eyelid show is an even worse feature than your jaw, in my opinion. Much safer and easier to fix, too.

[Freeways]

Aesthetically your upper eyelid show is an even worse feature than your jaw, in my opinion. Much safer and easier to fix, too.

You really think having 3 mm too much upper eyelid show is worse than having badly recessed jaws? Cmon now, don't mislead the guy. OP, you need double jaw surgery with ccw, which should significantly improve your looks and breathing. If you are still not happy after this, then you can think about implants for midface, eyes etc.

[chrisj2002]

I've always had the "dopey" eye look as my friends call it ha, but it's never really bothered me. Maybe it's something to look into after the other issues.

Please forgive my limited knowledge but I thought double jaw surgery was for if you had an actual underbite etc? My bite aligns fine as far as I know. I had a brace when I was younger and nothing was ever mentioned or suggested by my orthodontist. Do you think what I need is more than just aesthetic?

Thanks for the input guys.

Regards,

Chris.

[Jilkster]

You really think having 3 mm too much upper eyelid show is worse than having badly recessed jaws? Cmon now, don't mislead the guy. OP, you need double jaw surgery with ccw, which should significantly improve your looks and breathing. If you are still not happy after this, then you can think about implants for midface, eyes etc.

I added that it's my opinion, I do think it's even more striking than his jaw retrusion.

[Jilkster]

I've always had the "dopey" eye look as my friends call it ha, but it's never really bothered me. Maybe it's something to look into after the other issues.

Please forgive my limited knowledge but I thought double jaw surgery was for if you had an actual underbite etc? My bite aligns fine as far as I know. I had a brace when I was younger and nothing was ever mentioned or suggested by my orthodontist. Do you think what I need is more than just aesthetic?

Thanks for the input guys.

Regards,

Chris.

I think both your upper and lower jaw are quite retruded, and therefore may have an ok relationship.

[GJ]

I added that it's my opinion, I do think it's even more striking than his jaw retrusion.

I found your opinion odd. Nobody cares about eyelids. In your post history, you talk about eyelids a bit. I think you're projecting. Since you want eyelid work you're focusing on it. His eyelids are fine, so don't send this guy down a crazy PS path because of your own issues.

I've always had the "dopey" eye look as my friends call it ha, but it's never really bothered me. Maybe it's something to look into after the other issues.

They're fine, and right you are to not care about eyelids. Try to keep it that way.

GJ my under eyes have always been dark since I was a teen but I never considered sleep apnea. I have been told I grind my teeth in my sleep. Would sleep apnea affect your jaw?

Being fairly new to this I've never actually heard of bimax w/cow rotation so will have a read up. I'm assuming that is a more invasive surgery than just implants?

Dark eyes could be a sign of that, but other things cause it. I just wondered. Maybe get an at home test. They're pretty cheap and can usually tell you if you have apnea. Apnea would be a good justification to have the surgery. Otherwise, you'd just be doing it for aesthetics. The thing about CCW rotation is it will take steepness off your jawline, and in doing so from the front it won't look as narrow. I do think that's better than implants because it addresses the core problem. BUT, it comes with all the risk of double jaw surgery. Very invasive procedure, so it sounds like you have a lot of research ahead of you. Unfortunately, you opened a can of worms by realizing the issues.

BTW, much better with the shave. Sharpen the blade to clean up the neck more next time.
And in the photos, you have your head so far back it is exaggerating the jaw issues.

[Wheatsnax]

I had a brace when I was younger and nothing was ever mentioned or suggested by my orthodontist.

did you extract teeth? it sure looks like it (retrusive mouth area and deep labiomental fold). your bite is most likely a compensated one at the moment you might think its "fine".

btw that is perfect neck posture

[Lefortitude]

Ya orthodontics most certainly compensated any skeletal differences in the jaws.  However, i think theyre both recessed.  Cosmetically your midface is long, inferior orbital rims receeded and jaws small, narrow and recessed.  All indicative of a downward growth pattern.  My recommendation is orthognathic surgery, bimaxillary with a ccw rotation.  The specifics are to be discussed with a surgeon based on your goals.  I do not recommend seeing eppley or yaremchuk for custom implants, until after your jaws sit in a correct position relative to your skull.  Its an invasive procedure but has been done by maxillofacial surgeons for decades.  Theyre pretty good at it, and take on numerous cases each year.  Risks are low compared to the benifits. 

[chrisj2002]

Hi Guys,

Thank you all so much for your comments, I really appreciate the input and advice.

Jilkster, regarding both my jaws, would make sense that my bite appears to be ok if they're both retruded. Although I can easily spot a retruded lower jaw, I don't really know what I'm looking for in terms of a retruded upper jaw to be honest.

GJ, I'll definitely get an at home sleep apnea test to see if that's happening, obviously I've read that double jaw surgery can open up your airways. I will continue researching into this!

Wheatsnax, prior to having my train track braces fitted (between the ages of 14-17) I did actually have to have 4 teeth removed (one upper left, one lower left, one upper right, one lower right). I may be wrong, but it may have been that they said I had too many teeth in my mouth. Do you think this has adversely affected my jaw position?

Lefortitude, what would a downward growth pattern indicate? What actually is it? Would you have any suggestion for my long mid face and infra-orbital rim areas?

Stupid question guys but I'm assuming bimax and double jaw surgery are the same thing? What benefit would the counter clockwise rotation add to this? I have read up but don't really properly understand it yet. I'm assuming that bimax with ccw wouldn't help with narrowness as no width would be added?

It seems that most people agree I need bimax with ccw then over implants? I'm assuming this wouldn't be something I could get done at my age on the NHS if I don't have any real bite problems? Does anyone have any idea how much this would cost in the UK?

I have to say I'm pretty annoyed that my orthodontist didn't point this out to me when I was 14 so it could've all been sorted out then. What can you do I suppose.

Many thanks again for the advice and support guys!

Kind Regards,

Chris.