I'm having surgery

[fullofsoubts]

Hello!

First of all, english is not my first language so I'll try my best to explain myself 

I'm a female, 39 years old. I've been thinking about having orthognathic surgery for more than 10 years. This was me before having any procedure done:



Hated my profile, my weak chin and my long lip. But I loved my teeth show. So last year I decided to have a sliding genioplasty and a lip lift. And this is me right now:



My profile looks much better now but still have a weak chin. My proportions are better after the lip lift but now I show too much teeth (although I'm starting to like it). These are the pictures that I had taken in Alfaro consult 1 month ago:



And last week I had my gums fixed (he asked for it because he prefered that I had it done before invisalign and surgery) and now I don't have a super gummy smile like before:




I still have to start the invisalign process next month. The thing is I'm having serious doubts about doing this. I'm 39 years old and I've always looked younger. My biggest fear is to look older and to show little teeth after impaction. Also the changes in my nose and to show too lower teeth. I've seen pictures of his surgeries and they generally end up with little show of teeth. I know showing too much teeth may not be the ideal but I love it. And I prefer too much teeth over over impaction a million times) So after more than 10 years wanting to do this, I'm having serious doubts right now. I consider myself attractive and I'm afraid to lose that, also to look less cute. I'm going crazy thinking about this and I need some honest opinion. Because there are also some things about my face that I hate, like my profile.

He agreed my genioplasty doesn't look good because now my chin sticks out to much of my face. He didn't tell me much but he is going to fix it, also impaction and bsso.

After fixing my gums (gingivectomy ?) my orthodontist think that maybe is not a good idea to have maxillary impaction and that she can impact my teeth like 2 or 3 millimeters with invisalign. But I'm not sure if he will perform only bsso on me, because I'm sure to his standards I still show too much teeth/gums.

Does anybody knows if he performs alar stitch to avoid the changes in the nose ? Almost in all the before afters of his patients I see a lot of changes in the nose. And that is one of the biggest reasons that I'm having so much doubts, because I love mine. By the way, I need to fix my septum and he offered to do that in the same surgery.

Sorry for the super long post and the spam of pictures and I hope it makes sense 

Thank you in advance!!


Edit: I edited the title of the post, hope you don't mind 

[PloskoPlus]

Did the lip lift make it harder for you to close your lips? If you have no functional issues, do nothing. It's very hard to prevent the nose from changing. The alar cinch can lengthen the upper lip - the flesh has to go somewhere when the nostrils are "pinched".

[PloskoPlus]

BTW, that lip lift looks amazing. No scarring at all and you have really youthful tooth show.

[Post bimax]

Did the lip lift make it harder for you to close your lips? If you have no functional issues, do nothing. It's very hard to prevent the nose from changing. The alar cinch can lengthen the upper lip - the flesh has to go somewhere when the nostrils are "pinched".

Side question, but do alar base reductions (not cinches) also lengthen the lip?  I haven't seen that side effect for a reduction.

As for OP, if you like your nose and don't mind a bit of a gummy smile, don't do JS IMO.  Maybe a custom implant could augment your lower jaw if that's something you really want.

[fullofsoubts]

Hello PloskoPlus!

Thank you for your answer 

Yes, now I have lip incompetence and can not close my lips properly. Also have a class 2 and my bite is no good.

I mean, if I had to live with this face for the rest of my life (class 2, lip incompetence, weak jaw, gummy smile, and a bad genioplasty) would not be the end of the world. (I‘ve been through a lot in my life to know what is really important) Although I’ve always been really self concious about it and never let anyone take a pic of me. But on the other side I would love to fix it and have a normal life. I’ve always wanted this so so hard, but the closer I am to do it the scarier it gets.

My fear is to look uglier after the surgery. I tried to Photoshop my face to see a possible outcome but I’m not sure if it’s close to reality. I know my profile will improve 100%, my fear is how will I look from the front.

[fullofsoubts]

BTW, that lip lift looks amazing. No scarring at all and you have really youthful tooth show.

Thank you! But It does not look too good if you look closer. I’ve always had one nostril bigger than the other But after the lip lift my small nostril is much much smaller and the big one now is too big. It’s been 1 and a half years and I’m still healing and have not regain all sensibility.

The first year was terrible because I couldnt speak or esta properly. I still can not speak 100% as I did before.

I asked Alfaro if he would fix it during septoplasty and he said no. He said first septoplasty and then We will see. Anyway I don’t like his rhynoplasties.

[fullofsoubts]

Side question, but do alar base reductions (not cinches) also lengthen the lip?  I haven't seen that side effect for a reduction.

As for OP, if you like your nose and don't mind a bit of a gummy smile, don't do JS IMO.  Maybe a custom implant could augment your lower jaw if that's something you really want.

Hello Post Bimax! 

Thank you for your opinion.

Implants are a big NO for me. I dont want anything plastic or whatever in my face (autoimmune issues). And I’m not sure that would fix my bite.

[kavan]

With so many photos, you really should post them all on the SAME link and add TEXT below them to describe what each one is. Otherwise people have to keep open a zillion tabs just to look and give you advice.

I flipped through a few of them but did not study each one of them which I never do when someone puts up a zillion different links instead of putting all the photos--with descriptions--on ONE link.

Looks like you still have too much tooth show, a gummy smile, long teeth, recessive jaw and chin that could be fixed. There will always be some nose changes or how it looks to you when other things are changed even if the nose changes are minor. The surgery he proposes will probably make you look a lot better even if it changes the nose somewhat which you can later get rhino for.

[PloskoPlus]

Thank you! But It does not look too good if you look closer. I’ve always had one nostril bigger than the other But after the lip lift my small nostril is much much smaller and the big one now is too big. It’s been 1 and a half years and I’m still healing and have not regain all sensibility.

The first year was terrible because I couldnt speak or esta properly. I still can not speak 100% as I did before.

I asked Alfaro if he would fix it during septoplasty and he said no. He said first septoplasty and then We will see. Anyway I don’t like his rhynoplasties.

Wow! Increased tooth show was the main reason I had a lefort 1 advancement. It improved some, but my lip got longer as well. My surgeon suggested a lip lift even as I have permanent numbness in the upper lip (a real scandal). I don't think I can take anymore numbness there.

[fullofsoubts]

Hi Kavan!

Thank you for your answer   



(Sorry I think they are not in order and don't know how to change it  )

I agree with you. I know my profile will look ten million times better (it is impossible to look worse), not so sure about the front and the nose. I guess I'm scared that what makes me cute are my imperfections and when I fix them I will lose my appeal. I guess changes will be a wider shorter face ??

I have to fix my nose anyway because I need a septoplasty. If surgery was not changing my nose, I would have the septoplasty done at the same time. But I guess I will have to wait after surgery to have a rhinoseptoplasty and fix whatever changes jaw surgery will cause.

[fullofsoubts]

Wow! Increased tooth show was the main reason I had a lefort 1 advancement. It improved some, but my lip got longer as well. My surgeon suggested a lip lift even as I have permanent numbness in the upper lip (a real scandal). I don't think I can take anymore numbness there.

I'm so sorry that happened to you PloskoPlus. How long ago was the surgery ?

I've had 2 genioplasties, last one more than a year ago and I still haven't regain all my sensibility but each day it gets better, but it is soooo slow.

The thing with the lip lift is that now I have hyper sensibility in my columella. I don't know if it will stay like that forever or it will get better because with my lower lip it was the same after genioplasty and now I don't have that hypersensibility anymore.

I didn't know lip would get longer with a lefort, that's scary.

I would have the lip lift again, I think it has improved my proportions a lot but I would choose another surgeon because this one was a nightmare and I've been crying for so long. I hope I find a surgeon that can fix my scar. Luckily he did the scar inside the nostrils, that way its more difficult to see, because it is really bad done.

[kavan]

Hi Kavan!

Thank you for your answer   

You are right, I made an album:

https://imgur.com/a/ldmuLiP

(Sorry I think they are not in order and don't know how to change it  )

I agree with you. I know my profile will look ten million times better (it is impossible to look worse), not so sure about the front and the nose. I guess I'm scared that what makes me cute are my imperfections and when I fix them I will lose my appeal. I guess changes will be a wider shorter face ??

I have to fix my nose anyway because I need a septoplasty. If surgery was not changing my nose, I would have the septoplasty done at the same time. But I guess I will have to wait after surgery to have a rhinoseptoplasty and fix whatever changes jaw surgery will cause.

The genio you got did not do much for you. But it probably can be revised during bimax and/OR the BSSO advancement alone would help a lot. Alfaro sometimes elects to get the chin point out more just with the BSSO.

The after gum fixing still has it that there is excess gum show. I doubt the gum surgery addressed the slack area UNDER the chin and the problem with the genio you got prior which are visible in the Alfaro shots. 

So, ya, you could say that the residual excess gum show you got after gum fixing is 'cute'. But you'd also have to deem the slack under the chin and the overly acute (no pun intended) lip/chin FOLD angle from the genio you got also 'cute'. IMO, those 2 other things don't add to any cuteness.

It's possible your nose tip could rotated down a tad from the impaction. But IF so, it might not be such a bad thing because something like that would tend towards VISUALLY making the upper lip (labial ledge) look shorter and help make to overly open nose holes less visible. In fact some rhino guys sometimes de-rotate the nose tip (rotate it down a tad) to help offset that sort of thing.

What type of lip lift did you get? I ask because I don't see any SILLS below your nose holes. Sills are little ledges right below the nose holes. There is a type of LL, sometimes called the 'Italian' LL or 'no scar' LL which ends up removing the sills because they cut through them to put the scars inside the nostrils whereas the 'bullhorn' LL goes right under base of nose, does not destroy sills and leaves an imperceptible scar.

[fullofsoubts]

Yes, he told me he would revise the genioplasty because he didn't like how it looks right now because it sticks out too much and I agree. So I hope he fixes it.

When I say that I like a little gum and teeth show I don't mean that I'm happy with what I got now. I think I show too much gum and too much teeth. But I mean I'm scared the impaction will let me with little to no teeth show and with an older person smile. I would just cut off 3 mm of my gum but I don't know if that is possible. And also 3 mm of teeth show. That would be perfect. I'm unhappy with my gummy smile but I think I would be unhappier with an older woman smile.

I also agree with what you say about the deep chin fold, I hate it and I hope it can be fixed with the bsso. He also told me it would be like a little lifting to my neck.

Before I did the genioplasty, I used to have a smooth transition between my jaw and chin. Now it looks like I have jowls. I was a lot worse before because it was really swollen and now looks better but I still have that and I think it is because now my chin sticks out too much and looks separated from my face. I hope the jaw surgery can fix this also 

Also I'm scared about my lower lip because it is like really separated from the teeth, like it hangs out when I open my mouth. When I got the surgery what will happen ? It will stay like that ?

If my nose tip rotated down I would have it fixed because that is something I'm certainly not looking forward to.

You are sooooooo right about my lip lift!!!! oh my god, during all this time I thought he performed a bullhorn lip lift but on the inside of the nose, but he did exactly what you say!! an italian lip lift!! He removed my sills (I didn't know there was a word for it) and I hate it.

Do you think a plastic surgeon can reconstruct that part of my nose ? I've cried a lot because of this, and I hope one day I can fix it.

Thank you so much for taking your time answering me 

[Lefortitude]

I think it will be worth it for you.  Alfaro is a great choice for you because hes one of the few worldwide who really puts a big emphasis on aesthetics in his clinical practice.  Theres no way to know for sure how you will look after, but most often it's favorable!

best of luck, keep us posted on your experience if you decide to proceed.

[kavan]

Yes, he told me he would revise the genioplasty because he didn't like how it looks right now because it sticks out too much and I agree. So I hope he fixes it.

When I say that I like a little gum and teeth show I don't mean that I'm happy with what I got now. I think I show too much gum and too much teeth. But I mean I'm scared the impaction will let me with little to no teeth show and with an older person smile. I would just cut off 3 mm of my gum but I don't know if that is possible. And also 3 mm of teeth show. That would be perfect. I'm unhappy with my gummy smile but I think I would be unhappier with an older woman smile.

I also agree with what you say about the deep chin fold, I hate it and I hope it can be fixed with the bsso. He also told me it would be like a little lifting to my neck.

Before I did the genioplasty, I used to have a smooth transition between my jaw and chin. Now it looks like I have jowls. I was a lot worse before because it was really swollen and now looks better but I still have that and I think it is because now my chin sticks out too much and looks separated from my face. I hope the jaw surgery can fix this also 

Also I'm scared about my lower lip because it is like really separated from the teeth, like it hangs out when I open my mouth. When I got the surgery what will happen ? It will stay like that ?

If my nose tip rotated down I would have it fixed because that is something I'm certainly not looking forward to.

You are sooooooo right about my lip lift!!!! oh my god, during all this time I thought he performed a bullhorn lip lift but on the inside of the nose, but he did exactly what you say!! an italian lip lift!! He removed my sills (I didn't know there was a word for it) and I hate it.

Do you think a plastic surgeon can reconstruct that part of my nose ? I've cried a lot because of this, and I hope one day I can fix it.

Thank you so much for taking your time answering me 

Although I can't predict your outcome, as to your fears of having NO tooth show, he would factor tooth show at rest and smiling, how much, into the surgery. You still have gummy smile and long teeth.

Lower lip hang gets addressed/alleviated when the bone is advanced forward which gives more support, from BSSO and chin.

Even if the nose doesn't change much, the new relationship that the jaws have to the face (which should be an improvement) can make the nose look different. For example, same nose on parts of the face that changed can look different.

If you'd be seeking out a nose guy after surgery, it's possible to compensate if issue is loss of nose support. Rebuilding sills, I'm not so sure. Maybe possible to have micro injections of either fat, filler or silicone to construct a small ledge like the sill was.

ETA: Bullhorn is always performed SUBNASA. Not inside the nostrils. So, ya, you got that 'Italian LL' where the LURE is to tell patients it's 'no scar' LL.