What do I need for the best aesthetic outcome?

[IconVillage]

Here is an album of my pictures: https://imgur.com/a/wjn1Irn

I'm not happy with my profile and lack of projection overall. When I first went to a surgeon (Gunson) he wanted to remove teeth prior to jaw surgery, due to the protrusion of my teeth. He said that because my maxilla was too small to fit my teeth, my orthodontist forced the front teeth to protrude out in order to make my bite fit. As it stands right now my bite is perfect and there's no big orthodontic issues.

I had a second opinion with Sinn who said that extractions wouldn't be necessary and he could do a bimax surgery anyway, but he said looking at my pictures that a 6-7mm sliding genioplasty would probably be enough of an aesthetic outcome and jaw surgery wouldn't offer much more (thinks my issue is more of a chin issue than jaw issue), but that he'd have to re-evaluate me in person and would still be willing to do jaw surgery if that's what I wanted.

What do you guys think? Is a genio enough? There is also a lack of midface project which Sinn says he can fix with a malar osteotomy. Is it worth it to get jaw surgery in my case. I'm looking for the best aesthetic outcome regardless of the cost or invasiveness. 

[kavan]

In GENERAL (but not always the case), if a person has had ortho (braces) prior to 'make the bite right', the surgeon might need them to have the bite made' WRONG'(via a period on braces or tooth extraction)in the event they pursue maxfax surgery later down the line. Making a bite 'wrong' that was once made 'right' via prior orthodonture is called; DECOMPENSATION.

That's the very basic concept (which I hope I made simple to understand here) behind why someone with his 'bite made right' (prior via ortho) would be required to have transitional changes to his bite in preparation to have a maxfax (or bimax). One surgeon might elect to decompensate one way. Yet another surgeon might elect to decompensate another way.

Gunson's suggestion to you would resolve to what he would need to do to maximize the advancement of your lower jaw but to ALSO minimize unfavorable changes to the nose base that could arise by moving the upper jaw forward IN ORDER to maximize advancement to the lower jaw. Gunson also likes to to maximize lower jaw advancement so he can limit the extent he has to move the chin. He has a preference to move the chin point out via the lower jaw advancement so that dependence on the genio alone to do it is minimized. Basically, his chin advancements are not that much because he does some pretty 'elaborate' surgery to both jaws in accordance to his preferred aesthetic.

Assuming that you were seeking Gunson out for the same reason others seek him out which is BECAUSE you have ALSO familiarized yourself with his preferred aesthetic AND want that for yourself, he's informed you of what the contingency would be in order to have surgery with HIM. Hence, in order to have the type of aesthetic people SEEK him out for, he will need you to have the type of DECOMPENSATION he told you would be needed in your case.

Sinn telling you that you didn't need extractions reflects what I mentioned prior which is that surgeons may DIFFER in what they require for DECOMPENSATION which in turn is in accordance with a surgeons preferred aesthetic. So, BOTH can advance out both of your jaws for more overall projection and have different decompensation requirements to do so. It depends on their preferred aesthetic and also your OWN preference for one doctor's aesthetic over the other.

Sinn is telling you that your chin is recessive (YES,true it is) and he can advance it independant of any bimax surgery and of course, that won't require any decompensation prior change your bite in preparation for it. He also sees that BOTH jaws could be advanced (YES, true that is too.) without tooth extraction. It's certainly possible to advance both jaws EQUALLY (which is called 'linear advancement') and with that NOT change the bite at all before hand (and certainly not extract teeth to do it). BUT there is a LIMIT to how much to advance that way where unfavorable changes to the nose base would be the limitations.

Conclusion: 

Both doctors could improve your aesthetic. Of the two, Gunson is associated with MAXIMIZING one's aesthetic for patients who might not 'need' all the surgery he does to do it and could 'get away' with still having improvements via LESS 'elaborate' surgery. Sinn is giving you the option to 'get away' with less surgery and/or FEWER contingencies than is Gunson.

So, WHO'S aesthetic outcome is 'best' and which option to choose, can't be answered FOR you. You would need to to at least see enough aesthetic outcomes of MANY patients of BOTH doctors and enough so to align a PERSONAL PREFERENCE for the type of outcomes EACH doctor kicks up so YOU could THINK about this more. What I can tell you is what I've already said here which was to explain why suggestions from different doctors can DIFFER.

[IconVillage]

Thanks for the reply, what would you say Gunson's "preferred aesthetic" is out of curiousity. I don't think I'm going to go with him as I have no desire for extractions. Looking at his website's results I see some cases I liked and some I didn't like that much (felt a better aesthetic outcome could've been achieved). Sinn doesn't have results on his website but I saw in person pictures of malar augmentation's that he's done and I thought they looked good.

If I were to go with Sinn, what would you do if you were in my position. Just a large sliding genioplasty or bimax surgery as well? Is it more of a chin or jaw issue? Would the chin alone give me a desired outcome like in the attachment photos ?

[kavan]

What Gunson's preferred aesthetic is is up to YOU to explore and decide if it aligns with your own preferences. In general, it has to do with bringing the face out in accordance to a 'True Vertical' (of his preference) and balancing that out with a horizont.
Here's a link describing the type of aesthetic analysis Gunson uses (Arnett aesthetic analysis). https://www.sciencedirect.com/science/article/pii/S2395921516300575

However, the choice of any doctor over the other for AESTHETICS ALONE depends on whether or not their outcomes for other patients look good to YOU and enough so that you are willing to go through what ever DECOMPENSATION they need for them to kick up the aesthetics they are know for.

Malar augmentation is NOT the bimax surgery. It's a separate 'add on'. Gunson's add on is via hydroxyappatite GRANULES and Sinn augments via BONE cuts.

Other personal preferences also come into play. For example; 'I don't want extractions'. So if you don't want what would be needed to have Gunson's aesthetic, yet alone not having enough familiarity with the type of aesthetic he kicks up (where OTHERS seek him out just for that), then you need to just do more research which could be as simple as just looking at more of their outcomes.

As to your 'desired outcomes'. NEITHER the chin alone NOR the bimax with chin will make you look like a male model or super jock.

[IconVillage]

As to your 'desired outcomes'. NEITHER the chin alone NOR the bimax with chin will make you look like a male model or super jock.

Results like that are not achievable through surgery?

Here's Gunson's morph and surgical plans btw, I was expecting more projection.

https://imgur.com/a/GEycYHt

[Post bimax]

Results like that are not achievable through surgery?

No

Here's Gunson's morph and surgical plans btw, I was expecting more projection.

This is Gunson's aesthetic.  Some say they prefer Gunson's female results for this reason.  I suppose you could ask for a stronger genio but I'm not sure if he accepts requests like that.

[kavan]

Results like that are not achievable through surgery?

Here's Gunson's morph and surgical plans btw, I was expecting more projection.

https://imgur.com/a/GEycYHt

The diagram is not a 'surgical plan'. It's an ORTHODONTURE plan. He wants the teeth moved backwards so he can advance out both jaws. The front teeth angle forward TOO MUCH but they can't be moved back because the pre molars are in the way. To move them backwards, the pre-molars need to be removed. IF he didn't push the teeth backwards (and hence require tooth removal to do so), he would NOT be able to advance the jaws forward as much as they could be. Your lips would scrunch up onto your NOSE if he just moved the jaws forward but did NOT decompensate as he requires.

Assuming he provided you with the morph, he's SHOWING you his anticipated improvement which is CONTINGENT on tooth removal first. It is an EXCELLENT improvement and NOT one you would be getting with genio 'ALONE'. Nor one you can expect from another doctor (eg. Sinn) who will be LIMITED in how much forward bimax advancement he can get and BECAUSE he's NOT requiring tooth extraction as a means to MAXIMIZE forward bimax advancement.

You do NOT have the 'starting point' to look like a male model. Not that I can see. So, IF that is your EXPECTATION or motivation to get surgery, we need to CLOSE further discussion of that objective because it's an unrealistic expectation.

[Post bimax]

You do NOT have the 'starting point' to look like a male model. Not that I can see.

FYI, Kavan is not saying you are 'ugly' or something like that.  The MM aesthetic that many people seek with surgery is nearly impossible to achieve for 95% of the population.  You CAN get a significant improvement, and your morph shows that.  But do not expect to look like the other images you shared.

[IconVillage]

FYI, Kavan is not saying you are 'ugly' or something like that.  The MM aesthetic that many people seek with surgery is nearly impossible to achieve for 95% of the population.  You CAN get a significant improvement, and your morph shows that.  But do not expect to look like the other images you shared.

Ah good to know, I just used those as reference picture because I believe that’s the best possible jawline. I understand surgery has some limitations, but what would you consider possible for a genie or bimax? I really like the projection on the photo I’ve attached and that’s with a bimax, with ccw and a sliding genioplasty. Honestly I think that projection is similar to the model photos (especially the David Beckham picture) I posted earlier. Is such a result possible for me though?

[kavan]

Ah good to know, I just used those as reference picture because I believe that’s the best possible jawline. I understand surgery has some limitations, but what would you consider possible for a genie or bimax? I really like the projection on the photo I’ve attached and that’s with a bimax, with ccw and a sliding genioplasty. Honestly I think that projection is similar to the model photos (especially the David Beckham picture) I posted earlier. Is such a result possible for me though?

What is it about the rest of your face that you feel ALREADY looks like a male model? Show us the other parts that have anything in common with what those MMs have. If the part of your face and skull you DON'T show in the photos such as the eyes and forehead and rest of head actually has NOTHING in common with what those models have, then jaw surgery won't make you look like one.

That is just BASIC INTELLIGENCE (or lack thereof) whether or not you can see on your own face whether or not the REST OF IT (that we can't see on your photos) looks like the models. Well, does the everything ELSE about your face, head shape, eyes, forehead ect look like the models EXCEPT for the jaw advancement?  If you put a bandits mask over your lower face and asked people if the rest of it looked like a model, what would they say?

[IconVillage]

What is it about the rest of your face that you feel ALREADY looks like a male model? Show us the other parts that have anything in common with what those MMs have. If the part of your face and skull you DON'T show in the photos such as the eyes and forehead and rest of head actually has NOTHING in common with what those models have, then jaw surgery won't make you look like one.

That is just BASIC INTELLIGENCE (or lack thereof) whether or not you can see on your own face whether or not the REST OF IT (that we can't see on your photos) looks like the models. Well, does the everything ELSE about your face, head shape, eyes, forehead ect look like the models EXCEPT for the jaw advancement?  If you put a bandits mask over your lower face and asked people if the rest of it looked like a model, what would they say?

I’m strictly talking about the profile of the lower third. I realize jaw surgery is not going to turn me into a male model, just used those reference pictures as they were what I consider flawless jawlines.

[kavan]

I’m strictly talking about the profile of the lower third. I realize jaw surgery is not going to turn me into a male model, just used those reference pictures as they were what I consider flawless jawlines.

Then you were either expecting to look like a model or not sharp enough just to show ONLY the lower 1/3rd of their faces if, in fact, you were 'strictly' talking about the profile of lower 1/3rd.

So. NO. Don't expect to have their lower 1/3rd on your face either....and what's so mentally difficult for you to align your expectations and or possibilities with what a surgeon, HIMSELF, with whom you consulted with SHOWS you?

[IconVillage]

So. NO. Don't expect to have their lower 1/3rd on your face either....and what's so mentally difficult for you to align your expectations and or possibilities with what a surgeon, HIMSELF, with whom you consulted with SHOWS you?

Different surgeons have different aesthetic preferences, especially those who prefer surgery for more functional reasons rather than aesthetic or cosmetic details. I also don't have a moprh from Sinn to compare the difference between bimax + genio vs just genio, or to compare the difference to Gunson's proposed plan. That's why I asked the question of whether bimax + genio vs just genio would make a significant difference.

[kavan]

Different surgeons have different aesthetic preferences, especially those who prefer surgery for more functional reasons rather than aesthetic or cosmetic details. I also don't have a moprh from Sinn to compare the difference between bimax + genio vs just genio, or to compare the difference to Gunson's proposed plan. That's why I asked the question of whether bimax + genio vs just genio would make a significant difference.

Best of luck in what ever you decide. Focus session with me is over.

[Lefortitude]

Looks like you had some unrealistic expectations. A good exercise is to morph a photo yourself with photoshop.  See what certain modifications make you look like.  This exercise saved me from getting a genio or a chin wing in my early days of research.