Considering bimax (pics and X-rays attached)

[ko1a]

Hi,

I had a chin wing osteotomy and am now considering double jaw surgery with CCW to fix my recessed jaws.

However, I'm not sure how recessed I am and also see a few potential aesthetic issues if I were to get bimax.
- Would my chin become too prominent with the CCW rotation?
- I have a very deep labiomental fold. Would this improve from bimax?
- Would my already upturned nose get too upturned?

I consulted 2 maxfacs.

One suggested frontblock distraction to solve the labiomental fold (and maybe SARPE) before possibly proceeding to bimax later. He said bimax alone would do nothing to improve the labiomental fold.

The other proposed bimax with CCW rotation. He thinks this will also improve my labiomental fold somewhat.

What do you guys think about the above issues? And would I benefit aesthetically overall from bimax?

https://imgur.com/a/BnxxtAu

[ben from UK]

Front.

[ko1a]

Front.

Front and 3/4 added to images.

[PloskoPlus]

You have some asymmetry at the eye and mouth level. Fixing that would be the biggest boon to your looks. But that's hard to impossible to fix. Unless you have functional issues with your jaws, do nothing. Jaw surgery is unpredictable hell and you already look very good.

[Post bimax]

Yeah I wouldn’t touch anything. Maybe a CCW bimax BEFORE the CW could have given you some projection while avoiding the deeper fold, but I’d leave it as is now. Your jaw looks already above average

[ghiggson90]

Hi,

I had a chin wing osteotomy and am now considering double jaw surgery with CCW to fix my recessed jaws.

However, I'm not sure how recessed I am and also see a few potential aesthetic issues if I were to get bimax.
- Would my chin become too prominent with the CCW rotation?
- I have a very deep labiomental fold. Would this improve from bimax?
- Would my already upturned nose get too upturned?

I consulted 2 maxfacs.

One suggested frontblock distraction to solve the labiomental fold (and maybe SARPE) before possibly proceeding to bimax later. He said bimax alone would do nothing to improve the labiomental fold.

The other proposed bimax with CCW rotation. He thinks this will also improve my labiomental fold somewhat.

What do you guys think about the above issues? And would I benefit aesthetically overall from bimax?

https://imgur.com/a/BnxxtAu

Don’t mess with it. Fold is good, tradeoffs would be not worth it.

[kavan]

I would leave well enough alone.

[ko1a]

Thanks to everyone's responses, much appreciated as I'm struggling with this decision.

You have some asymmetry at the eye and mouth level. Fixing that would be the biggest boon to your looks. But that's hard to impossible to fix. Unless you have functional issues with your jaws, do nothing. Jaw surgery is unpredictable hell and you already look very good.

Thank you. I think the mouth asymmetry comes from my severe crowding and bucked out front incisor so I was hoping this could be fixed through surgery though. Either that or extractions which I would like to avoid.

Yeah I wouldn’t touch anything. Maybe a CCW bimax BEFORE the CW could have given you some projection while avoiding the deeper fold, but I’d leave it as is now. Your jaw looks already above average

Thanks. Yes, if I got bimax first I probably wouldn't have needed as much advancement of the chin and avoided the deeper fold. But I'm confused since I got conflicting advice from the surgeons on whether CCW bimax would improve the fold. I take it you wouldn't expect bimax to help the fold? Do you think my chin would become too prominent if the jaws were rotated?

Don’t mess with it. Fold is good, tradeoffs would be not worth it.

Thanks for your response. Don't you think the fold is a problem? And are the tradeoffs you are mentioning the same as I mentioned in OP?

I would leave well enough alone.

Thank you. Does that mean you don't consider my jaws very recessed? I find this hard to judge objectively myself, but for what it's worth my own assessment is that both jaws are lacking in forward projection. Maxilla is vertically long, mandibular angle is steep. I also have a lot of teeth crowding and slight lip incompetence. I would like to fix all these issues but not sure if it's worth the tradeoffs so any input is highly valued.

[Post bimax]

Thanks. Yes, if I got bimax first I probably wouldn't have needed as much advancement of the chin and avoided the deeper fold. But I'm confused since I got conflicting advice from the surgeons on whether CCW bimax would improve the fold. I take it you wouldn't expect bimax to help the fold? Do you think my chin would become too prominent if the jaws were rotated?

I don't think CCW is going to affect the fold much unless you get some sort of genio as well.  I don't really think it's an issue though because a somewhat overly-deep fold isn't devastating for men.  In your case it will be interperated by the average person as a strong jaw/chin.

Your jaw looks sharp and strong from the front and you don't look recessed in profile.  I wouldn't mess with further JS for aesthetic reasons.

Out of curiosity, did you get a 'widening' movement as part of your CW? The squareness is impressive.

[notrain]

Leave it be. For jaw surgery, you'd need to extract 2 lower jaw premolars to upright the incisors properly and relieve crowding. This uprighting would also affect the chin prominence, but with the aggressive chin wing, you'd be looking at a revision of that too.

You should have either directly gone for full fledged jaw surgery or decided at the start that camouflage is good enough. Now you went one route and it is really not ideal to do the jaw surgery now, especially since you have a decent bite which you would need to tear up as well. Try to get some filler or maybe a graft for the labiom. fold.

You also still have all your wisdom teeth, these would need to come out before any jaw surgery. Bro, honestly, you'd be looking at a total treatment time of ~ 3 years including the wisdom teeth and a ton of discomfort and risks. Don't do it.

[kavan]

Thank you. Does that mean you don't consider my jaws very recessed? I find this hard to judge objectively myself, but for what it's worth my own assessment is that both jaws are lacking in forward projection. Maxilla is vertically long, mandibular angle is steep. I also have a lot of teeth crowding and slight lip incompetence. I would like to fix all these issues but not sure if it's worth the tradeoffs so any input is highly valued.

It means I think you look GOOD and good enough to leave well enough alone. Pursuing an 'ideal' for 'aesthetics only' where your lower jaw would come out further than it is now, although possible, might/would involve a lefort 1 where your upper wisdom tooth looks to be in the way. Your lower wisdom tooth in way of BSSO. Not to mention braces as prelude to surgery or other things they might want to do as prelude to bimax.

So, I don't think all that is worth it just to improve the lip to chin fold. Personally, I would NOT suggest all that surgery to someone who looked GOOD and enough so already DESPITE the lip to chin fold.

[ko1a]

Thanks guys.

Out of curiosity, did you get a 'widening' movement as part of your CW? The squareness is impressive.

No widening, I had decent jaw width to begin with and some strong masseters I think as well.

Leave it be. For jaw surgery, you'd need to extract 2 lower jaw premolars to upright the incisors properly and relieve crowding. This uprighting would also affect the chin prominence, but with the aggressive chin wing, you'd be looking at a revision of that too.

You should have either directly gone for full fledged jaw surgery or decided at the start that camouflage is good enough. Now you went one route and it is really not ideal to do the jaw surgery now, especially since you have a decent bite which you would need to tear up as well. Try to get some filler or maybe a graft for the labiom. fold.

You also still have all your wisdom teeth, these would need to come out before any jaw surgery. Bro, honestly, you'd be looking at a total treatment time of ~ 3 years including the wisdom teeth and a ton of discomfort and risks. Don't do it.

You're right that I would have been better off having bimax to begin with than I am now. Either way I would like to have my teeth fixed so I'll have to deal with braces regardless, and I'm afraid extractions without surgery would make me more recessed. And thanks for your suggestion re labio fold, I also have the option of having the frontblock distraction to fix both the labio fold and lower teeth crowding btw.

It means I think you look GOOD and good enough to leave well enough alone. Pursuing an 'ideal' for 'aesthetics only' where your lower jaw would come out further than it is now, although possible, might/would involve a lefort 1 where your upper wisdom tooth looks to be in the way. Your lower wisdom tooth in way of BSSO. Not to mention braces as prelude to surgery or other things they might want to do as prelude to bimax.

So, I don't think all that is worth it just to improve the lip to chin fold. Personally, I would NOT suggest all that surgery to someone who looked GOOD and enough so already DESPITE the lip to chin fold.

Thank you, point taken. Although I have to add it's not just to improve the labiomental fold but also the recession, steep mandibular plane, vertically long maxilla and slight lip incompetence. But I appreciate your view that my recession is not severe enough to justify surgery.

[ditterbo]

Just fix the nutty labiomental fold if you're going to do anything, that stands out the most to me. Fillers, HA, whatever but not new bone cuts just for that. The eyes are weird being so asymmetric but maybe it's just how you looked at that exact second and it's not as obvious day to day.

[ko1a]

Just fix the nutty labiomental fold if you're going to do anything, that stands out the most to me. Fillers, HA, whatever but not new bone cuts just for that. The eyes are weird being so asymmetric but maybe it's just how you looked at that exact second and it's not as obvious day to day.

Thanks. An advantage with a bone cut for the labio fold would be that it would also facilitate space to align my lower teeth properly, or else I would need extractions. It would also fix my slight lip incompetence according to the surgeon. So I'm still leaning towards doing that if not bimax.

I agree my eyes are weird due to asymmetry and unfortunately it's not just in that pic. I've consulted a surgeon about it and trying to fix it would risk horizontally shortening the eye and potentially creating another asymmetry. That's yet another thing I'm not sure is worth the tradeoffs or not. Not sure how obvious it currently is IRL as opposed to a full frontal still image like this.

[Post bimax]

The eye asymmetry is there but not far outside the normal range. I wouldn’t stress it. My eyes are just as asymmetric and nobody has ever commented on it. Eyes are tough to fix and get right so IMO you should disregard that.