Final Jaw Surgery Results/opinions

[ScottMalkinson]

Hey everyone,

So it's been about 5 months since I had double jaw surgery, so everything should pretty much look like what it's going to look like for the rest of my life. Functionally, the surgery went great. No numbness, pain, loss of function, teeth lined up great, etc. Aesthetically, I'm still not sure how things turned out. To me my face doesn't really look better, it just looks different. My eyes and midface still seem extremely hollow and recessed, and to me my lower third looks off. Its almost like my face got longer and thinner post surgery, at least that's how it looks to me anyway. I've attached some final before/afters and appreciate any thoughts, opinions, or suggestions. Thanks for the help!

Befores:
http://i.imgur.com/EvLdwtn.jpg
http://i.imgur.com/wPz9s5U.jpg
http://i.imgur.com/muSTQ0o.jpg

Afters:
https://imgur.com/mkHw8hp
https://imgur.com/nGLUOIT
https://imgur.com/uNDjLAw
https://imgur.com/qQP0Czd
https://imgur.com/w4zhmyz

[kavan]

Hey everyone,

So it's been about 5 months since I had double jaw surgery, so everything should pretty much look like what it's going to look like for the rest of my life. Functionally, the surgery went great. No numbness, pain, loss of function, teeth lined up great, etc. Aesthetically, I'm still not sure how things turned out. To me my face doesn't really look better, it just looks different. My eyes and midface still seem extremely hollow and recessed, and to me my lower third looks off. Its almost like my face got longer and thinner post surgery, at least that's how it looks to me anyway. I've attached some final before/afters and appreciate any thoughts, opinions, or suggestions. Thanks for the help!

Befores:
http://i.imgur.com/EvLdwtn.jpg
http://i.imgur.com/wPz9s5U.jpg
http://i.imgur.com/muSTQ0o.jpg

Afters:
https://imgur.com/mkHw8hp
https://imgur.com/nGLUOIT
https://imgur.com/uNDjLAw
https://imgur.com/qQP0Czd
https://imgur.com/w4zhmyz

There is no improvement to the areas that the surgery isn't aimed at improving. For example you still have recession to the orbital rim and cheek bone area.  Lefort 1 does not improve that area.  As to the long, up swept jaw, BSSO doesn't make that shorter, more angular or increase the width from posterior jaw to jaw. There is definitely improvement to what looks to be a lot of bi-max protrusion in the oblique photos though.

[ditterbo]

I think some people over-hyped what you could expect from jaw surgery here, when you first posted.  But then idk if you shared your cephs? Better info in, better info out.  Your previous jaw issue looks pretty much normalized now, leaving you to naturally steer your eyes towards other deficiencies instead.  Seems to me you would benefit from some kind of augmentation to the jaw angles (personally I wouldn't bother with those risky things, think jaw angle implants are the only permanent solutions) and now your previous-to-surgery-noted recession to your mid-face. It was there before surgery but the jaw deformity was just one more thing to kind of distract you from honing in as much on the mid-face issue (at least from my pov). Maybe look into filler before considering anything more permanent? IMO there's no good solutions to the mid-face - they're money pits with long term higher complication risks and maintenance (filler/fat), or high risk upfront, crappier results long term (implants).

Maybe whoever familiar with Sinn's modified lf3 can chime in on how applicable that may be.

[kavan]

I think some people over-hyped what you could expect from jaw surgery here, when you first posted.  But then idk if you shared your cephs? Better info in, better info out.  Your previous jaw issue looks pretty much normalized now, leaving you to naturally steer your eyes towards other deficiencies instead.  Seems to me you would benefit from some kind of augmentation to the jaw angles (personally I wouldn't bother with those risky things, think jaw angle implants are the only permanent solutions) and now your previous-to-surgery-noted recession to your mid-face. It was there before surgery but the jaw deformity was just one more thing to kind of distract you from honing in as much on the mid-face issue (at least from my pov). Maybe look into filler before considering anything more permanent? IMO there's no good solutions to the mid-face - they're money pits with long term higher complication risks and maintenance (filler/fat), or high risk upfront, crappier results long term (implants).

Maybe whoever familiar with Sinn's modified lf3 can chime in on how applicable that may be.

Great post. As to the modified Lf3, one of the first posts I made to him was to suggest he show his doctor on a skull model which parts to the upper midface he feels would look better if advanced.  (The doctor had--or used to have--this cool skull model where the parts were attached via springs and you could pull at it to displace bone parts.) I did not say 'modified L3'. I got BLASTED (by another poster) for saying something that could resolve to modified Lf3 (could have resolved to miface implants too) even though I didn't use the term; 'mLf3' or say 'implants'. So, glad someone else introduced this possibility.

[ScottMalkinson]

Would a combination of like a chin wing, ZO/HA paste, and nose straightening have solid results? Just from the limited reading I've done on it a lf3 or modified lf3 is very risky and almost impossible to find someone willing to perform it.

[GJ]

Clearly your class 2 jaw looks improved after. The rest, that you seemingly don't like, is simply your features and how they look. Jaw surgery isn't going to change all the things you don't like and turn you into a model. Your jaw looks corrected.

[ScottMalkinson]

I know I'm never going to look even close to a model and I'm totally fine with that, I just want to be the best looking version of myself that I can be because my looks have held me back from certain things in the past. Having done some looking around on here, it seems like lefort 1 gives the best results when combined with other procedures during or after it, especially if you have a bad starting point like myself. Jaw surgery definitely helped, but it left behind some things that I think could be improved with a few other procedures.

[ScottMalkinson]

Also just read through the thread about earls modified lf3 and it seems like it might be less risky than it has been made out to be. Would it be able to fix some of my midface problems? I'd have to do a lot more research on it, but if its actually not incredibly risky its definitely something I'd consider with the right surgeon

[kavan]

Earl didn't have the ml3  handed to him on a platter. He researched and read academic papers, noted who wrote them or who were in the references and consulted with many docs about it concerning his risks. Besides, implants for what he had could have worked but he was overly averse to them.  You got options in the Mass area (I saw the Patriot's hat) to consult about midface implants.

[ScottMalkinson]

I'm pretty anti-implant for a lot of the reasons other people are and would prefer anything that's done to my face to be my own bone. Looking at my before pictures compared to like the Obwegeser girl I just think my midface/eyes really needed something to be done and a mlf3 seems like it would directly address that issue, while a chin wing/ZO combo seems like it could at least camouflage it while touching up jaw asymmetries from post jaw surgery. I have my last post-op appointment with my surgeon in January, so I'll get his opinion and see what he says

[kavan]

I'm pretty anti-implant for a lot of the reasons other people are and would prefer anything that's done to my face to be my own bone. Looking at my before pictures compared to like the Obwegeser girl I just think my midface/eyes really needed something to be done and a mlf3 seems like it would directly address that issue, while a chin wing/ZO combo seems like it could at least camouflage it while touching up jaw asymmetries from post jaw surgery. I have my last post-op appointment with my surgeon in January, so I'll get his opinion and see what he says

My advice would be to avoid terms such as 'Modified Lefort 3' and 'Chin Wing'.

It is better to demonstrate you are in the capacity to SHOW him where on your face and/or on a skull model which parts of your face you would like displaced with what ever oestetomy that can do that as to let him suggest which oesteotomies would/could apply.

Even though he might not be able to offer those oesteotomies to you, (either because he doesn't do them or even IF he did, he's precluded from doing them for insurance patients), IMO, you are more likely to get better guidance from him by showing him the other changes you would like. Being able to demonstrate what you would like is preferable to bandying about terms you pick up on the internet, especially since there can be different 'modifications' of a L3 and other types of osteotomies aside from a 'chin wing'.

[fulcanelli]

I think you look better 100%. Now that your lower jaw has come forward it has revealed that your chin is quite long and pointed. I’d look into something to shorten and square off the chin and call it a day at that with the surgeries.

[Lazlo]

totally better, almost perfect. if you really wanna nit pick i would have advanced your chin and curled it up a bit to give you a bit more of submental groove (which people think they don't want but in fact they do want a bit, all really good looking guys have that). So he, chin a bit more forward.

[Lefortitude]

dude you look freakin awesome! congratulations on your successful surgery.  The change is subtle so people who dont know will never guess you had surgey, but it makes such a difference when looking at you.  People pick up on things like imbalanced facial features subconsciously.  youre looking at your own face and judging it consciously, yeilding a very differnt perspective.  I would be thrilled if i was you.

[ScottMalkinson]

Appreciate the comments everyone! I took a good chunk of time off worrying about this stuff as I felt I needed a mental break from it all. Quality of life has definitely improved slightly, but looking at my pictures again now, I still think that I could benefit from additional surgeries. Looking at my original pre-op pictures, I definitely think that I could've used a LF3 seeing as my entire face was sunken and recessed, and while the LF1 that I got fixed some issues, there are still others that need to be addressed.

midface and lack of cheekbones, long chin, long philtrum and crooked nose, and narrow/steep lower jaw angle are all still prevalent after my bimax, and now it just seems like I'm at the point where I need to figure out which surgeries are the best bang for my buck for the above issues. Lip lift, vertical chin reduction, zygomatic osteotomy, and chin/side wing all seem like they have the potential to at least improve what still needs to be fixed. It's also been suggested that I look into a second round of bimax with a lip lift so more rotation can be done on the jaws. I dont have expectations of being a model, but feel like the best double jaw results are often when it's combined with other procedures, so i just want to be the best version of me that I can and then stop all this and finally move on with my life. Thanks for all the help! Any thoughts?

Also, if I do go through with any of these, I will post before/after pictures here like /I did before