Getting custom 3D CT-designed wraparound jaw and cheek implants in a few weeks

[ben from UK]

That's interesting.

[kavan]

That's interesting.

Yes. Indeed. Before the advent of VSP programs to custom design implants, Dr. Y used to use off the shelf porex ones and hand shape them. But soft tissue coverage would limit the extent of the augmentation, lest too much augment with 'bone look' material would give too much of a bone look (skeletal) look to face. So, he had to be more conservative with the augments than were some other docs using the silicone where the silicone mimicked both bone shape but soft tissue coverage on top of that.

As for the jaw implants, which did IMPROVE patients, there were always those who would gripe; 'Oh he's too conservative.' or 'I got a 'U' shaped jaw and not an 'angular' 'square' look'.  Well, for one, he had to be conservative as to extent of jaw augment due to soft tissue coverage being a limitation of extent to do with porex. For two, that 'angular' square from the front look didn't arise in patients where the border of their posterior jaws were kind of going 'inwards'. It's because the implants augmented but they kind of 'followed' the native inward oriented jaws. So in patients having that type of anatomy, the implants widened, dropped down and all but the end contour (from the front) was not what you see in say Brad Pitt or the MMs. WAs not that 'square from the front' or 'angled' look. It was just a wider 'U' shape.

So, with advent of the VSP programs to design implants, they are able to design ones (here for the jaw) that sort of 'WING OUT' the posterior jaw which is what gives the angled out from the front look. The advent of the VSP programs, I guess, came with the drive of jaw implant docs getting more requests to have the MM look (which usually is the jaw angles sticking out from the front) and/or complaints from patients hoping jaw augments would do that but finding out they didn't do that but not realizing they couldn't do that IF the person's native jaw angled inwards too much.

To that regard, the act of angling outward the posterior jaw and also dropping it down as to accommodate requests of; 'I want the type of jaw the MM has'--especially in someone who starts with them angling inward and/or starts with HIGH set jaw angles-- can constitute a SIGNIFICANT augmentation. If all that were done with a HARD material with NO 'cushioning' look to it, it could look weirdly skeletal, gargoylish or just look like someone with 'great bone structure' BUT who has AGED a lot.  Again, too much bone coming out of face with no cushion over it can look AGING. Like aesthetic risk could be something like going from young looking guy with not the best bone structure to OLD MAN look with GREAT bone structure. Too much bone jutting out of the face with no soft cushioning over it looks AGING.

Since the silicone DOES have a 'cushioning' effect to it as to mimick soft tissue coverage over the bone, that's why it's often selected for some of the SIGNIFICANT augmentations where implants have to be bigger, broader to FULFILL a request of a patient wanting a PART that a model has (midface area, jaw line usually). I mean, more often than not, a patient who in NO WAY has a start point that looks anything like a MM, is going to need a significant augmentation to fufill the REQUEST of wanting 'this or that' PART that a MM has.

So, that's ONE of the reasons silicone is selected over porex for a significant augmentation and don't ya know that those requests are inherent to guys with the 'I want what the MM has' requests. The OTHER reason for it being selected is that it's easier to put in via a smaller incision because it can be collapsed/squeezed in hand for entry and they  can FEEL the FIT once it's in there. But of course ANOTHER reason for it's selection is the ease of REMOVAL in the event a patient might not like the look of what he asked for, (perhaps from a subconscious desire to see himself looking a LOT like the MM in the mirror where that doesn't happen or that the implants don't change the part of his life he was hoping would change with them). But aside from the type of patients who have hidden or 'ausgef**ked' goals for how those implants are going to change their lives, silicone ones can provide significant augmentations that could look TOO bony or skeletal if done with porex.

[Reality]

@Kavan This was a very insightful reply which has somewhat "demystified" the argument between medpor & silicone. It has also given greater clarity to Silicone (at-least for me).

I needed significant augmentation to bring me to where I wanted to be aesthetically and I loved my design/look but became extremely averse to silicone after infection. I inquired to my surgeon to have the same/similar design in porex but he basically advised we stay with silicone: I didn't understand why at the time as he was known for working with porex, almost exclusively but now it makes sense.

Thanks!

[ben from UK]

What's the reason they couldn't do it if the jawline was inwards, Kavan?

[kavan]

What's the reason they couldn't do it if the jawline was inwards, Kavan?

The (porex) implant that made the jaw both wider and gave a drop was Epker style with 10mm width and drop increase (also increased back of ramus) along border of mandible. It's just that those dimensions alone just FOLLOW the native orientation of the jaw. But they don't 'wedge out' laterally the back jaw angle if person has native inwardly inclined back of the jaw angles. They did a good job on jaws with little inward incline though. Although they did give significant improvement to people with inward inclined back of jaw angles, it was something better seen in profile and oblique views. It's just that it's hard to create that 'flip out' to the jaw angle for them to square from the FRONT unless you DESIGN flip out on the skull model either directly or with a VSP program.

[ben from UK]

Hi Kavan, I think you're talking about Medpor (porex), am I right? What about PEEK and Titanium? They seem to give superior aestethic results (putting aside the size factors).

[kavan]

Hi Kavan, I think you're talking about Medpor (porex), am I right? What about PEEK and Titanium? They seem to give superior aestethic results (putting aside the size factors).

I'm talking about medpor (porex). Titanium is HARD substance. So same holds like medpor as to using it for a significant augmentation. I've never held a PEEK implant in my hand whereas I've done so with titanium and porex/medpor. But if it's a hard material, than same holds as to what I stressed about why HARD materials are not good for significant augmentations.  I just hope you understand the general CONCEPT I covered because I can't write everything about every possible material.

[Post bimax]

I'm talking about medpor (porex). Titanium is HARD substance. So same holds like medpor as to using it for a significant augmentation. I've never held a PEEK implant in my hand whereas I've done so with titanium and porex/medpor. But if it's a hard material, than same holds as to what I stressed about why HARD materials are not good for significant augmentations.  I just hope you understand the general CONCEPT I covered because I can't write everything about every possible material.

I believe PEEK is both hard and porous, like porex.

[kavan]

I believe PEEK is both hard and porous, like porex.

Thanx. Then the same general rule of thumb would apply where LARGE of SIGNIFICANT augments are best avoided with the hard materials for the reasons I elaborated on in my prior (long) post.

[SurgerySoon]

He might not have BDD but he does have some kind of 'issue' that concern his motivations to look like 'Superman' and also his FLOUNDERING in indecision about this for many years. He's been on RS for like 6 years deliberating this and asking doctors what procedures will kick up the Superman face. Think I may have seen his posts on MMH too where he was getting surgery 'soon'. Now this, with all the implants made and he's still floundering. I took a look at his 'Lookism' posts where the reveal is the fantasy/expectation that this surgery will result in a stream of hot promiscuous chicks falling at his feet wanting one night stands with him and with no work or charm or personality on his part to offer them.

Not passing judgment on the fantasy because what guy (other than another super MM) wouldn't want to look like Cavill and what guy, handsome or homely, wouldn't want hot chicks falling at their feet. But when THAT is the GOAL of having the surgery, it's called an 'UNREALISTIC EXPECTATION'. So the fantasy is normal. But the expectation of surgery turning that fantasy into a reality is ABNORMAL.

My take is that he wants to transform from 'incel' to 'in and out cell' but the surgery isn't going to help him pump it up and pump it up real good if he can't pump it up at all without surgery. I take that he thinks that ONLY a nice face is THE ticket to a high lay count of hot promiscuous chicks. So, after his surgery, not only should he wear his cape to the clubs but he might also have to sport a T shirt that says; 'Got Viagra' or 'Got a sex manual'.

I don't think he should cancel though. I think he should go through with it. No flies on Y when Y accommodates a request that the implants be (some of) the PARTS a MM has. Y still has some restraint and won't go overboard. As long as Y didn't tell him 'Oh yes, you will look just like Cavill and this will increase your lay count dramatically.'

So, maybe not BDD. But I think you may have picked up on something in the venue that veers from reality.

To be fair, what you refer to as "floundering" over the years (since I started posting on RS way back in 2013) is simply the result of a pretty standard combination of factors that would make pursuing (and eventually having) such a dramatic surgery a long, drawn-out process for almost anyone: finding the time to take off from work/school (I am in graduate school and also have a job with an all-over-the-place schedule), securing the finances, deciding on a surgeon, etc. In all honesty, I'm glad it has taken me 6+ years to finally schedule the surgery, because over the past half decade, my face (especially my midface) has started exhibiting some very obvious early signs of aging -- e.g., nasolabial folds, worsening eyelid retraction, a generally more "tired" look, etc. If I had actually gotten the surgery done when I originally wanted to 6+ years ago, I probably wouldn't have been a candidate for a midface lift back then. Now, I at least have the opportunity to have this procedure done concurrently with the implant surgery so that I can at least partially reverse some of these signs of aging.

Another reason I took so long to finally pull the trigger on getting the surgery is because I had a hard time settling on a surgeon for a year or two. For a while, I was leaning towards Eppley, but there's just something that seems so... off about many of his surgical outcomes. It's like he has the technical skill of a surgeon, but he lacks the aesthetic eye. On the other hand, Yaremchuk might have had a few somewhat unnatural-looking outcomes over the years, but overall, he seems to have a more tasteful aesthetic sensibility than Eppley.

Say what you want about my goals and motives to become a so-called "hookup guy" at bars and clubs, but there really IS such a thing as guys who are so good-looking that women all but offer themselves up to them in those kinds of social venues, especially when alcohol is involved. I'm not saying these surgeries are going to turn me into one of those guys (in fact, I'm pretty sure they won't, unless Dr. Y is some sort of miracle-worker). Simply visit a busy bar/club on a Friday or Saturday night and actively observe which kinds of guys tend to get the most unprovoked, low-/no-effort attention from girls.

BTW, I don't where all this talk about me wearing a cape is coming from. When it came to getting inspiration for the type of "look" I'd like to have, I simply selected photos of an actor who happened to play the character of Superman in a couple movies. Even if he hadn't been cast as Superman, I still would've considered him an aesthetic "ideal" to emulate.

BTW, Dr. Y didn't promise to make me look just like Henry Cavill or to increase my lay count. During the consultation appointment, he just said, "I can't make you look *just* like that guy, but we'll see how close we can get you." I just hope that he designed the implants with the imperative in mind to ensure that regardless of how close he gets to making me "look" like Henry Cavill, the outcome is still generally attractive according to most peoples' tastes.

[kavan]

To be fair, what you refer to as "floundering" over the years (since I started posting on RS way back in 2013) is simply the result of a pretty standard combination of factors that would make pursuing (and eventually having) such a dramatic surgery a long, drawn-out process for almost anyone: finding the time to take off from work/school (I am in graduate school and also have a job with an all-over-the-place schedule), securing the finances, deciding on a surgeon, etc. In all honesty, I'm glad it has taken me 6+ years to finally schedule the surgery, because over the past half decade, my face (especially my midface) has started exhibiting some very obvious early signs of aging -- e.g., nasolabial folds, worsening eyelid retraction, a generally more "tired" look, etc. If I had actually gotten the surgery done when I originally wanted to 6+ years ago, I probably wouldn't have been a candidate for a midface lift back then. Now, I at least have the opportunity to have this procedure done concurrently with the implant surgery so that I can at least partially reverse some of these signs of aging.

Another reason I took so long to finally pull the trigger on getting the surgery is because I had a hard time settling on a surgeon for a year or two. For a while, I was leaning towards Eppley, but there's just something that seems so... off about many of his surgical outcomes. It's like he has the technical skill of a surgeon, but he lacks the aesthetic eye. On the other hand, Yaremchuk might have had a few somewhat unnatural-looking outcomes over the years, but overall, he seems to have a more tasteful aesthetic sensibility than Eppley.

Say what you want about my goals and motives to become a so-called "hookup guy" at bars and clubs, but there really IS such a thing as guys who are so good-looking that women all but offer themselves up to them in those kinds of social venues, especially when alcohol is involved. I'm not saying these surgeries are going to turn me into one of those guys (in fact, I'm pretty sure they won't, unless Dr. Y is some sort of miracle-worker). Simply visit a busy bar/club on a Friday or Saturday night and actively observe which kinds of guys tend to get the most unprovoked, low-/no-effort attention from girls.

BTW, I don't where all this talk about me wearing a cape is coming from. When it came to getting inspiration for the type of "look" I'd like to have, I simply selected photos of an actor who happened to play the character of Superman in a couple movies. Even if he hadn't been cast as Superman, I still would've considered him an aesthetic "ideal" to emulate.

BTW, Dr. Y didn't promise to make me look just like Henry Cavill or to increase my lay count. During the consultation appointment, he just said, "I can't make you look *just* like that guy, but we'll see how close we can get you." I just hope that he designed the implants with the imperative in mind to ensure that regardless of how close he gets to making me "look" like Henry Cavill, the outcome is still generally attractive according to most peoples' tastes.

OK, fair enough.  Some of my statements were sarcastic.

[SurgerySoon]

OK, fair enough.  Some of my statements were sarcastic.

I figured. I guess for me, my main point of apprehension (or what you referred to as floundering) regarding these procedures is that there's a risk I'll end looking WORSE after the surgery. Like most of you guys said, I'm decent-looking now, so what if I spend all this money to end up looking legitimately bad?

For example, I would consider the procedure to be a failure if I came out looking like this guy (cheek implant patient of Dr. Niamtu's; before pic is on left, after is on right):

https://www.lovethatface.com/files/2017/05/Untitled-12.jpg

That's why I keep asking everyone, even if I don't come out of the surgery looking like Henry Cavill or an MM, will I at least get SOME improvement in the sense that I will be a generally more attractive male?

[kavan]

I figured. I guess for me, my main point of apprehension (or what you referred to as floundering) regarding these procedures is that there's a risk I'll end looking WORSE after the surgery. Like most of you guys said, I'm decent-looking now, so what if I spend all this money to end up looking legitimately bad?

For example, I would consider the procedure to be a failure if I came out looking like this guy (cheek implant patient of Dr. Niamtu's; before pic is on left, after is on right):

https://www.lovethatface.com/files/2017/05/Untitled-12.jpg

That's why I keep asking everyone, even if I don't come out of the surgery looking like Henry Cavill or an MM, will I at least get SOME improvement in the sense that I will be a generally more attractive male?

That guy in the photo needs OUTplants.

[SurgerySoon]

That guy in the photo needs OUTplants.

I agree; he looked more defined/angular in the "before" photo. I'm hoping that Dr. Y has enough aesthetic sense to know how to design cheek implants to look more sharp/defined/masculine. I'm assuming he does, since mine don't really look soft or rounded at all.

[SavingFace]

I could see you benefiting from some Malar augmentation. But I share the sentiments of others on the jaw implants. I think it looks like overkill. That’s a big jaw implant! And you already have a good, strong jawline.

Let me know how this turns out! I just consulted with Dr. Y also for custom orbital, cheek, paranasal, and jaw implant. But I have more of a need of them, as I have midface hypoplasia and less jaw angularity. Happy to share my implant design when he makes them. I just sent him the CT scan.