First post here - please advice of auesthitics of jaw

[tie]

Hi all

I'm new here, My first post  But i have read the threads for the a while , n try to educate myself on many terms i knew nothiong about 
(and I still  will say i don't get them all )

My storyis a bit long and compliated . Sorry in advanced (it's the shortest i could - but it's still totally long - i know)
If someone is willing to read i'll be glad .

My English is  NOT my main langaue so PLEASE FORGIVE ME IN ADVANCED for my not the best english.

My problem is both auesthetic and medical.
 I prcaticly live in hell - i'll expalin.

I'm 42 yo guy. Till age 32 i was healthy more or less
- i looked ok . Always looked totally younger then i am .

At the age of 32 i had an health disaster of chronic debilitating pain syndrome.
It started when I  went to a dentist to do simple dental procedures.. and after that got home and EXTREME UNBELIEVABLE PAIN started ...
Pain was mostly in the tooth i was like all day going for years with pain that felt like the tooth being extracted out my mouth without anesthesia...
I lived with teeth pain all day. n ( i will also mention that 2 years before it all started  i got hit severly on my  my left cheeck.  maybe it's connected.
I'll SKIP many many many stages in to make it  shorter- since that day I 'm living with chronic pain which is almost 24/7 extreme pain in my teeth and gums...
It has started on the left side.. and severeal years later Its also on only 2 specific teeth on the upper right side in the back (theeth since than been extracted) .

What also had happened is that i also noticed  my jaw has totally changed its look like got crooked to the right
About my chronic pain contidion - over the years i've  I've been to tens and tens and tens  of doctors in all fields . pain clinics... I was given all on the meds possible
neurologiclal meds.. .pshychiatric meds.. strong opiates (narcotics) , medical marijuana many done many procedure that are irrelevant to here... etc) did all the scans (CT MRI) etc that are possible (BUT not cepg scan - cause it wasn't related to the medical problem)
Doctors don't know what it is - even thought there are many many cases like mine.
For the last 10 years i baically live in hell - and  I've quit my job 2 years ago - a job which i was at for 12 years because of
the extreme pain. I basically have no life.

What other thing that hads happened - is that i have totally lost my look - and i've noticed it just right after my pain started.. even a doctor in the ER noticed it than.

My face got so weird to look at , so UNPLEASANT  which totally DEVASTATES
I can't look at who i have become in the mirror anymore .
 It's totally extreme to me -
 
I've posted pictures of me i know they're  not ideal - but i don't have much "old" pictures of me to show  .
I have  never would have thought i'll publish pictures of me of nowdays anywhere - cause to me they look terrble - I  totally can't look at my currnet picture...
and of course not to publish them .
In my facebook profile - I don't have any pics of me.

There is an important point i must say -
If you give advice - I have  always had a gentle look, boyish.. you can say feminite if you want - and that was OK for me.
I liked the harmonic - nice to the eye, unique shape of me jaw -
I'm not looking into "manly jaws look " ,
 i know many times when you give advice here you refer to manly models jaws , square jaws - i'm not into that .
 That's not my characther . And it's ok for me. I don't need squrish jaw.. .i just like harmonic jaw with nice proportoion to look at.
Please consider this.

https://imgur.com/a/hYfMDxx


What i have observed about myself over the years (and doctors in my country WON'T admit it they have no auesthtic eye)  :

1. Jaw got larger, rough in a way (the angles of mandiblue got rougher ) and jaw height/legnth   got shroter. Ramus got shroter. and like pulled more backwards .
2. Let's talk about the "elephant" in the room. I  know i have gotten bald. Lost all my hair  i'm getting totally bald . I know that. 
I know it contributes to the bad look but lets talk about the jaw.
3 . Under eye got  sunken - more tired look. I need maybe filler theres .
5. Eyebrows fallen - cheeck falling - like sagging - i'm sure it's not natural again - but it's due to face getting shorter . Need probobaly fillers in cheek
than the skin got sagging - it it less "streched" because face is shorter.
4. My CHIN got about 50% SMALLER  , less dense .   :/ Dont know why. it can defintly seen in some pics. My feeling is  due to my bone totally getting thiner... the skin on it gets less strech.. cause no bone to hold it neneath.
5. My face will look thinner to you in the pics; . but i didn't lose weight - if any i've gained body weight because of all medications.

Last of all - i've added my PANO picture. I don't have ceph . 2 years ago i've lost 2 upper back molars . I've extracted there because of the extreme pain in my mouth. It didn't help - i still have pain there inside in the bone -
So - there is no way i can do implants any soon . So it might be - that you would say that without these teeth -  i can't do anything. I don't know.
I'm also aware - due to my medical situation - i doubt anyone will operate me - i just wonder - if there could be any connection between pains in my mouth .. to this chnage of shape.. of collapsing of face.. shortherning of ramus.

I feel - my jaw need to get lowered even a cm (make jaw longer) and to the left (this can't much be seen in the pics) like the ramus bone longer and to make more pleasing to the eye proportions between it to the bone that goes from under the ear to chin.

Will be glad to your aueathetic advices regards all kinds of jaw surgeries (i have no knowledge what i need to do - i just know i wish i could give back my jaw to the one it was 10 years ago)

There are such great members here that i totally love reading their insights they have much more auesthtic eye than many many of the surgeons i see online. (i never had any surgery myself).
Be gentle with the remarks please i know my look has changed drastically .
Sorry for the length if you read it this far .
Great thanks you all

https://imgur.com/a/hYfMDxx
 



 

[kavan]

Firstly, 10 years worth of aging is not going to look as good as it did 10 years ago.
Secondly, a pain condition is going to increase the rate of that faster than someone who doesn't have one.
Thirdly, with BONE LOSS to the jaws which is what happens with tooth loss, there is not same support as was prior to the soft tissue.

So, all those things contribute to the changes you're describing.  The salient one is BONE LOSS to the face attributable to TOOTH LOSS. The tooth bearing part of bone shrinks. With that there is loss of muscle and/or soft tissue support.

If this type of pain started after DENTAL WORK and this pain persisted such that you got more DENTAL WORK to actually EXTRACT the teeth yet it still persisted, it would call into question the DENTISTS who did it especially the second one IF he extracted based on just a description of pain BUT NO actual infection to tooth or absence of seeing a normal cause for tooth pain which is usually an infection. However, I don't know the facts and circumstances of why more teeth were extracted other than to tell you if they were pulled PURELY on your description of pain BUT in ABSENCE of their seeing any CAUSE (pathology to the tooth) for the pain (infection to the root of tooth for example), that's called; 'FAILURE TO DIAGNOSE'.

The most likely thing failed to be diagnosed could be TRIGEMINALNEURALGIA.  Of course, I can't diagnose or identify what you have from here. But just to say TN is something dentists like to say they don't cause. They just like to believe TN comes 'out of nowhere' even if you first notice extreme pain that lasts forever soon after a dental procedure. BUT if they actually DON'T find any pathology to a tooth they extract and just extract based on complaints of pain there, then THAT is 'failure to diagnose' IF you do have TN and had it at the time of extraction.

Here's a link to TN but you can find many others.
http://trigeminalneuralgia-ronaldbrismanmd.com/Dental-Issues.html

IMO, you should explore further whether or not you have TN. If you do, you might have a legal case against the dentist who extracted (if he extracted but did not find any pathology to the tooth). It could mean he failed to diagnose TN.

Again, I DON'T know what you have or if you have TN. But since you relay it's a 'mystery' that 'no one knows what it is', it should be the FIRST thing you explore further.

IF you didn't have a 'mystery' pain condition that resulted in bone loss, then the treatments for bone loss would first be bone grafting to the jaws for the GOAL of putting in tooth implants. Loss of bone prominence elsewhere such as cheeks, jaw line and chin could be addressed via face implants.

Although there might be things you could do that don't operate on the bones which are things in the venue of what people get when they have aging (eg. face lifts and fat grafts which improve look of aging but really don't make one look just like they did when younger), ANY kind of operation you get to the face will hinge on your getting a diagnosis of what this pain condition could be, if the meds for it are ok to be on when getting anesthesia and most importantly, IF it's something that would be triggered even MORE in any pursuit of a type of procedure to improve aesthetics.

Bottom line is that you have to pursue a diagnosis as to what this pain condition is and get some kind of medical CLEARANCE in order to have a surgery/surgeries to the face.

[tie]

Hi kavan -
First - Thanks for taking the time and answer with such details. It' not taken for granted .

You are totally right - of course natural aging + being ten years in sorrow- in pain - (also face muscles being in pain and not stimulating  my face
due to pain- of course - all this increases face atrophy etc.
But the change was real drastic - i'm conviced there is more - and it's all
conacted - the fact that my pain is in the mouth area - and the fact my facial features have changed - i think it might be connected (i might be wrong).
You are right totally saying that the extractions can cause bone loss. I've read here in the archive some stories of that. People saying their face
got real sunken even after one tooth extraction.
 I DO think my face got worse even BEFORE the extractions due.
But i do belive some of the things you wrote - ARE the cause of this.
I wonder what cause this bone loss except the extractions... i did a full bone scan - and they have seen slight osetopany . But what causes it - unknown.

You are very VERY observant about the how things happened with the teeth. (about the dentits etc. - and  the fact that dentists shouldn't have pulled healthy teeth ).
You are totally right . But it was more complicated than this .
 I just couldn't write here  my whole medical journey and the nightmare i've lived
for 10 years..

About - TN - many thanks.
I know about TN - from the start they have suspected that. But I don't have the claasic TN - so it's more complicated . I have the Atypical type (meaning the cause is unknown)
(the charactheristic of my pain doesn't fit the classic TN.. and i didn't respond to any of the TN meds. It's complicated - again - i don't want to eleborate here to spare you all the length.

Yes - the reason of the pain must be found.. .over the years i've talked to MANY people which have exactly the same situatation as me .. and there are many  facebook groups with people like that .. many live in the same hell (trivia fact : TN is called "the suicide disease" cause the pain is that bad).

Anyway - the pain is totally 100% the thing that in my mind all day- BUT to be  honest with myself  the change in my look devastates me akmost the same as the pain.
I can't look at my self in the mirror... i don't go out because of the pain - but even if i did - i don't want to because i look so different and wierd.. totally unatractive .
So yes - i start to think - "they can't help my pain - but maybe at least in the "look front" i can fight it and do something , at least in THAT
front - to cure myself give back at least 50% of my looks. I deserve this .
But , as you smartly observed again - yes Im aware any surgery on my face can aggrevates the pain (even due what frightned me most is the CUTS INSIDE MOTUTH-
since my pain is in the soft tissue and part of bone inside mouth - that's where i fear most of the cuts - other areas of face - i don't care).
I do know that if i look at the mirror , and pull my jaw DOWN (not even forward) just down and give it a little "twist" to the left , it's giving to
me a more pleasing look in my eyes .  After finding this forum - i started thinking it might be possible even.
If you have time - lets put the pain aside for a moment- if you look at my pics the metamorphisiz i've had .. and a person would asked you to analyse what can be done
if surgically in the field of jaw surfery something should be done - what would you have said ?
And anyway - much thanks for the detailed answer !

[kavan]

Hi kavan -
First - Thanks for taking the time and answer with such details. It' not taken for granted .

You are totally right - of course natural aging + being ten years in sorrow- in pain - (also face muscles being in pain and not stimulating  my face
due to pain- of course - all this increases face atrophy etc.
But the change was real drastic - i'm conviced there is more - and it's all
conacted - the fact that my pain is in the mouth area - and the fact my facial features have changed - i think it might be connected (i might be wrong).
You are right totally saying that the extractions can cause bone loss. I've read here in the archive some stories of that. People saying their face
got real sunken even after one tooth extraction.
 I DO think my face got worse even BEFORE the extractions due.
But i do belive some of the things you wrote - ARE the cause of this.
I wonder what cause this bone loss except the extractions... i did a full bone scan - and they have seen slight osetopany . But what causes it - unknown.

You are very VERY observant about the how things happened with the teeth. (about the dentits etc. - and  the fact that dentists shouldn't have pulled healthy teeth ).
You are totally right . But it was more complicated than this .
 I just couldn't write here  my whole medical journey and the nightmare i've lived
for 10 years..

About - TN - many thanks.
I know about TN - from the start they have suspected that. But I don't have the claasic TN - so it's more complicated . I have the Atypical type (meaning the cause is unknown)
(the charactheristic of my pain doesn't fit the classic TN.. and i didn't respond to any of the TN meds. It's complicated - again - i don't want to eleborate here to spare you all the length.

Yes - the reason of the pain must be found.. .over the years i've talked to MANY people which have exactly the same situatation as me .. and there are many  facebook groups with people like that .. many live in the same hell (trivia fact : TN is called "the suicide disease" cause the pain is that bad).

Anyway - the pain is totally 100% the thing that in my mind all day- BUT to be  honest with myself  the change in my look devastates me akmost the same as the pain.
I can't look at my self in the mirror... i don't go out because of the pain - but even if i did - i don't want to because i look so different and wierd.. totally unatractive .
So yes - i start to think - "they can't help my pain - but maybe at least in the "look front" i can fight it and do something , at least in THAT
front - to cure myself give back at least 50% of my looks. I deserve this .
But , as you smartly observed again - yes Im aware any surgery on my face can aggrevates the pain (even due what frightned me most is the CUTS INSIDE MOTUTH-
since my pain is in the soft tissue and part of bone inside mouth - that's where i fear most of the cuts - other areas of face - i don't care).
I do know that if i look at the mirror , and pull my jaw DOWN (not even forward) just down and give it a little "twist" to the left , it's giving to
me a more pleasing look in my eyes .  After finding this forum - i started thinking it might be possible even.
If you have time - lets put the pain aside for a moment- if you look at my pics the metamorphisiz i've had .. and a person would asked you to analyse what can be done
if surgically in the field of jaw surfery something should be done - what would you have said ?
And anyway - much thanks for the detailed answer !

Although I don't volunteer to do an in depth detailed analysis on here, I've already said within my past post what could be done if you didn't have the pain. Reread it.

[tie]

Thanks Kavan

[ben from UK]

You're 42 years old. Do you really expect to look like 32 again? You deal with sagging skin etc. because like most people, you're just ageing. Also, you have like norwood 4, so if you want to look younger and healthier, you should do a ht as well. And besides that, take a decent haircut and live healthy to lose some fat in the face before you consider doing something about the jaw.

I see sunken eye when people get older. You can take an implant or something like that, but do you really want to do that at age 42? I do understand your dissatisfaction, but imo 90 percent of people look not so good at age 42.

You looked good when you were younger (you still don't look really bad, just normal for a 42 year old). Treasure that.

I don't know, maybe it will make you happier to move bones or take implants to bring back more bonestructure, but it might also be just normal ageing process. Doing sports and taking hair implant with a decent haircut might improve your looks too.

[tie]

Hi Ben -
Thanks for responding.
Yes - of course the hair plays a major rold here.. even in the lengthy of my face. Thanks.

Yes - of course we are againg - but look again at this link i've attached..

https://imgur.com/a/fvLIt9M

In pics  4 + 6 look at just at the chin.. and ramus.. like the face totally lost the vertical dimention in chin .
I look at my brother he is 2 year younger than me (40) and my mother (70) they still have good shape of bones - proportional ..my brother is 40 had good strong chin that didn't change for the last 10 years...
I think my face has reallt dramaticall changed . And i don't care the "Change" - i care that i look bad. i realy it's worse. I see people avoiding eye contact with me.. i mean people takling with me .. not just people ... doctors etc... no one can look at me my face look so unproportinal to look at.. .they are also "off" you can see in it pic no 4 +6 .. they are "off" to the left and the lips like the mouth "swallows" the upper lip. But mostly the bertical dimention lost . I know many people here looking to "forward" to jaw . In my case i totally feel in need to down + the left a bit .
you can even see my nose - that was proportional - now looks way bigger -beacuse of the third part of mouth lowering.
That's my view. And of course i'm not happy to move bones in face.. not in my medical condition for sure.. but the emotinal suffering is also terrible.
Anyway - thanks again

https://imgur.com/a/fvLIt9M

[ben from UK]

Hi Ben -
Thanks for responding.
Yes - of course the hair plays a major rold here.. even in the lengthy of my face. Thanks.

Yes - of course we are againg - but look again at this link i've attached..

https://imgur.com/a/fvLIt9M

In pics  4 + 6 look at just at the chin.. and ramus.. like the face totally lost the vertical dimention in chin .
I look at my brother he is 2 year younger than me (40) and my mother (70) they still have good shape of bones - proportional ..my brother is 40 had good strong chin that didn't change for the last 10 years...
I think my face has reallt dramaticall changed . And i don't care the "Change" - i care that i look bad. i realy it's worse. I see people avoiding eye contact with me.. i mean people takling with me .. not just people ... doctors etc... no one can look at me my face look so unproportinal to look at.. .they are also "off" you can see in it pic no 4 +6 .. they are "off" to the left and the lips like the mouth "swallows" the upper lip. But mostly the bertical dimention lost . I know many people here looking to "forward" to jaw . In my case i totally feel in need to down + the left a bit .
you can even see my nose - that was proportional - now looks way bigger -beacuse of the third part of mouth lowering.
That's my view. And of course i'm not happy to move bones in face.. not in my medical condition for sure.. but the emotinal suffering is also terrible.
Anyway - thanks again

https://imgur.com/a/fvLIt9M

Oh yeah, I totally agree with your judgement. Everything you say is true and I totally believe you when you say people treat you differently. If you are unhappy with it, which is totally understandable, you should certainly do something about it.

I agree that your lower third looks shorter and your nose looks bigger. To be honest, I find it a strange case cause your bonestructure was very good a couple of years ago. It seems there's not only the ageing process but also a hormonal thing or something like that. Maybe a drastic decrease in testosteron, I don't know.

[Post bimax]

That’s a drastic change..I’m so sorry. Fixing your hairline would be a start. Implants or JS could make a difference but I’m perplexed by what looks to be a large amount of bone loss. Man..

[GJ]

This kind of thing isn't my forte, and pictures are a bad gauge, but honestly all I am seeing is a guy who got older, lost hair, and gained weight. The weight gain seems to be causing all the perceived changes to the jaw. I bet if you lost 15lbs and put on a hat you'd look similar, and your jaw and chin would look similar. People age, though, unfortunately. And weight is a b*tch for the jaw.

My suggestion: lose 10-15lbs, then reassess.

[tie]

Oh yeah, I totally agree with your judgement. Everything you say is true and I totally believe you when you say people treat you differently. If you are unhappy with it, which is totally understandable, you should certainly do something about it.

I agree that your lower third looks shorter and your nose looks bigger. To be honest, I find it a strange case cause your bonestructure was very good a couple of years ago. It seems there's not only the ageing process but also a hormonal thing or something like that. Maybe a drastic decrease in testosteron, I don't know.

Ben , Thanks for seeing that (what i see) . Yes - I was never never saw myself as "beautiful" and never was - but i had a unique look i liked.. .as you wrote - i totally had cheekbones .. and now it's all gone . I feel i've lost 50% of the volume of my face.. and i have no idea how to stop it. And all in about 8 years...  feel this kinda change should take...30 years.. it's no real. Im really devestated.
About the hormones - yes - right  -  good thought - i thought so too - but did testo blood tests and hormones - and it came out in the range . Like i've got no one to ask  . When i saw doctors in my country about this - they don't understand... they see me now .. weird looking guy - they think - that's who i am .. .they tell me "nah.. nothing is wrong" "stop looking in the mirror so much". It's totally BS.. .they understand nothing in auesthetics.  For the modren doctors - all improtant is health.. they don't undresant that lost of look can be devastating to people just as health. And more sometimes. especially when it's justified and not just a person complaining about random pimple he has that no one sees.

[tie]

This kind of thing isn't my forte, and pictures are a bad gauge, but honestly all I am seeing is a guy who got older, lost hair, and gained weight. The weight gain seems to be causing all the perceived changes to the jaw. I bet if you lost 15lbs and put on a hat you'd look similar, and your jaw and chin would look similar. People age, though, unfortunately. And weight is a b*tch for the jaw.

My suggestion: lose 10-15lbs, then reassess.

Thanks GJ.. look at the pictures i've posted to BEN FROM UK.. look at the chin there - maybe you'll see it. But may be not. About the weight - it hasn't changed. ..since ago 20 i'm at the same weight .. just the same.. if so i've added maybe 2-3 kg.. no more.. my body is totally thin as it was

[GJ]

Thanks GJ.. look at the pictures i've posted to BEN FROM UK.. look at the chin there - maybe you'll see it. But may be not. About the weight - it hasn't changed. ..since ago 20 i'm at the same weight .. just the same.. if so i've added maybe 2-3 kg.. no more.. my body is totally thin as it was

Huh, weird. Muscle weighs more than fat, so did you lose muscle tone?
You could be the same weight, then, but still look fatter if you've lost muscle. You mention medication, too, and I know when people get on some medications they look totally different and lose muscle/atrophy.

Bones can change over time, but usually that's in the 60s or 70s. It's hard to imagine that happened, but I guess it's possible.

I'll defer to others because this is out of my realm.

[tie]

Huh, weird. Muscle weighs more than fat, so did you lose muscle tone?
You could be the same weight, then, but still look fatter if you've lost muscle. You mention medication, too, and I know when people get on some medications they look totally different and lose muscle/atrophy.

Bones can change over time, but usually that's in the 60s or 70s. It's hard to imagine that happened, but I guess it's possible.

I'll defer to others because this is out of my realm.

Yes - i guess it can be both . Muscles - because of my illness - i didn't use my facial muscles sometimes for monthes (!) - i didn't talk or smile - cause it hearts. So yes - atrophy could have happened. And from what i know - the bone needs active pressure on it - to keep rebuliding - so this might explain SOME of it. I'm sure there is a reason behind all this - cause my look deterorates dramaticly every few monthes..  I've ordered some special splints from the web - to excersise my jaw (we'll see -i doubt if it can ever REALLY do a dramatic change that i need).
Totally right about the medications - from a healthy 32 yo guy - being 10 years on different meds - yes- totally can be from meds. I'm also sure the meds accelerates my hair shedding. I totally noticed it- some DRAMASTICALLY increased my hair shedding. I totally had VERY unique big harmonic bones on face and it's like beneath average now - and decreased in like 50% my face shrunk.
Thanks for your thoughts on this GJ.

BTW - anyone knows plastic surgerons in Europe (not ths US  - can't travel there) That have great auesthetic eye - and know about implant s ? Thanks all

[ben from UK]

Huh, weird. Muscle weighs more than fat, so did you lose muscle tone?
You could be the same weight, then, but still look fatter if you've lost muscle. You mention medication, too, and I know when people get on some medications they look totally different and lose muscle/atrophy.

Bones can change over time, but usually that's in the 60s or 70s. It's hard to imagine that happened, but I guess it's possible.

I'll defer to others because this is out of my realm.

People lose bonemass after the age of 35. This can go quite fast. Combine this with sagging skin and soft tissue loss due to ageing, and the face can change dramatically. Facial beauty is about millimeters here and there.

I mean, look at most 40 year old men. Even the very good looking men can turn into bad looking rapidly past a certain age. Women age drastically beginning at the age of 30, men a couple of years later (35). From there on, it usually goes quite fast.

He has bad ageing genetics, combined with some other thing maybe. I do believe he can rebuild bonemass though. How to do it is another question. Most people don't care about their looks anymore past a certain age, but if you do, and looks has been a major part of your identity, life can become a nightmare. I totally understand OP.

Thing is, implants are a very tricky and delicate procedure. Very very few surgeons know the art. Most of them are conmen who don't know anything about aestethics and this guy seems to need some changes in different parts of his face.