Could I benefit from further upper jaw surgery?

[Walsandrew]

Hey folks, sorry for the slightly long post, but I've had a bit of a journey, surgery-wise, and would really appreciate any support with my predicament and the following question.

Could I benefit from further maxillofacial surgery to widen and and advance my upper jaw?

(I would be really interested to hear if anyone has experience of having upper jaw surgery/advancement for a second time, or whether good maxillofacial surgeons these days are more experienced/capable of controlling the nose in upper jaw advancement)
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I had  maxillofacial surgery for a class three underbite aged 20 (in 2010), which gave me a functioning bite, but sub-optimal results for appearance. I believe my upper jaw is still sunken in my face, giving me a weak profile, over-strong lower jaw and a poor smile (my upper teeth/jaw is very narrow). I also rely on my beard to give definition to my upper jaw area.

I believe my lower teeth are still leaning back and that they need to be brought forward to accommodate my upper jaw moving forward and being widened (decompensation by orthodontics). In my original jaw surgery, I believe my upper jaw was moved forward by roughly 8mm and my lower jaw moved back by about 5mm, so I do understand there are certain limits to further movement (however I believe it is only my upper jaw which needs to be moved).

Since my original jaw surgery, I have decided to pursue other procedures on the advice of cosmetic surgeons, which have not principally addressed or disguised my concerns. I have undergone an advancement genioplasty (for a weak chin) and cheek implants.

Whilst the genioplasty did achieve a strong chin, I think the cheek implants weren't that well designed and didn't even come close to replicating the definition  of cheek fillers, which I had done once before. Instead they mostly seemed to give me sideways/profile projection and I would could consider having them removed if I was to ever have more surgery (although I would only do so tentatively).

I also had a rhinoplasty, advancement and lengthening of nose in 2019 with a London specialist, a procedure I was happy with, given how short/upturned and sunen my nose was previously and after my original maxillofacial surgery The nose was lengthened and advanced using rib cartilage to create soft tissue behind the nose, so that it is set further forward. In these photos, there remains some swelling as it was taken only 2 months after the operation.

Whilst I don't think my original surgeons did anything to control my nose, this rhinoplasty specialist has assured me he works with maxillofacial surgeons and has developed techniques to combat this upturn, and would happily consult with a maxillofacial surgeon if I went down this route. Obviously there would be no point in going down the route of further jaw surgery, if it was significantly affect my nose again.

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[GJ]

The best record you posted is the scan. It does show what appears to be the lower jaw slightly out in front of the upper. However, I think if you moved the upper a few mm your bite would be poor and also you risk the chimp look. I'm not sure your starting position, so it's hard to say if the original surgeon had a planning/execution error or was limited in his movements by something. Regarding your nose, it looks upturned currently, and I think advancing the upper jaw would exaggerate that. This is mostly based off observation (probably thousands of cases running this forum almost a decade).

My immediate advice would be to take better care of your teeth. For your age, that is too much gum recession. Secondly, work to clear up your skin. Third, trim your neck hair and tighten the beard. All three of this would make you spiffy. You should be the best version of yourself before considering these more extreme procedures.

[Walsandrew]

Hey man, I appreciate your thoughts. You're right in your initial observations and thoughts before considering invasive surgery. Since I had these dental photos taken last year, I've been visiting the hygienist, trying to improve my dental hygiene, and will try to visit the periodontist for the gum recession. At the time of those photos, my acne was a little flared too (WORK STRESS).

I know it can be difficult to make a judgement purely based on one set of photos, plus my class 3 underbite as a child was SERIOUS. It's just the frustration of having been through all that, and the other procedures, and still feeling like, wow, I'm so setback in my upper jaw - such a fundamental aspect of one's features and balance and what has always worried me the most - and have no confidence in my smile.

Do you really think bringing the the upper jaw forward would risk the 'chimp look'? I guess my judgement is that my upper jaw is significantly further back than most other men and certainly in relation to my lower jaw/chin. Also, I would only consider moving it forward if I'd had orthodontics to ensure the bite was correct and not as tight/squashed as it is now. But very much agreed, I would have to be very careful given the current position of my nose.

All thoughts greatly appreciated!

[GJ]

Do you really think bringing the the upper jaw forward would risk the 'chimp look'?

I do think it's a risk in your case, but I don't want to bias other opinions by harping on it. Let others chime in.
It's a question I'd harp on with any surgeon you consult with.

I showed my lady your photos, and she said "looks normal", and didn't see any evidence of jaw surgery or rhino. So keep in mind nobody sees things the way you do. Even here on the forum we're all biased because we're looking for your flaws.

I disagree your upper is extremely recessed. Maybe a little, but again, that could have been a limitation of starting position and not an error. Did you ever ask the original surgeon why he left it in that position? It might have been the movement to get the bite lined up best and/or some other limitation. It would be good to know that for yourself in deciding if you want to do another surgery.

[Walsandrew]

Thanks man. It's so long since I saw him for a follow-up where I did ask this: but I think I remember him being a little dismissive, mentioning that he couldn't bring it forward any more, due to my teeth or nose or some reason like that.

I always find surgeons make it so incredibly difficult to have conversations like that - as in they seem to wilfully not want to hear about your concerns post-op, or genuinely asking could something have been done differently. I know it's a difficult 'game' but surgeon's pride should be a diagnosis in itself (even if I may have some BDD).

I'd really be interested if anyone else had further thoughts!

I think if I'm unable to do anything further to my upper jaw, I might have my cheek implants removed and just revert to using cheek fillers, because I have always been unhappy with them, how they only seem to give me lateral, rather than medial definition, and a certain flatness across my cheeks - the exact opposite of what cheek fillers achieved for me when I trailed them before having the implants!

[GJ]

I think "Bowie" knows a lot about fillers, so you might want to PM him.

[Walsandrew]

Thanks will do!

Also, any recommendations on how I can get more advice from others on this thread?

[GJ]

Thanks will do!

Also, any recommendations on how I can get more advice from others on this thread?

Just be patient.

[Post bimax]

To be honest I don't see any need for further upper jaw advancement.  You don't look recessed.  As GJ said, advancing the upper jaw further will cause your nose to upturn more, which is really the main issue.  Your philtrum is already flat/slightly convex from your prior surgery and I think further advancement will put you in chimp territory.  It may also make your lower jaw look recessed by comparison which is far worse.

Your nose isn't 'bad', but it is pretty upturned for a guy.  I have a similar issue due to maxillary over-advancement.  Although you don't seem to have a flaring issue, which is good.

My advice, if anything, is to masculinize your nose

[Walsandrew]

Thanks man, I think it's reassuring to hear that further jaw surgery isn't likely to 'solve' anything, because I think for a long time I have seen it as the potential answer. And completely get your point about the upturn, but it's probably quite relevant for me to show some photos from previous to the rhinoplasty from late last year, advancement and lengthening. My nose was VERY short, upturned and recessed after by bimax, and possibly exaggerated my other surgeries I had.

It is still only 3 months ago, so I'm hoping the swelling may go down a bit and bring the tip down a little further, but in my opinion, he has done a pretty excellent job. He's managed to get a lot more length, remove some of the flaring and very significantly, he's managed to remove the recession in the upper lip/behind the nose, by placing rib cartilage behind it.

I wish I had known that this was a procedure that could make such a difference to my appearance sooner after my bimax, but hardly any surgeons ever seem to mention or consider it, and you don't even read about it easily online, because I guess there isn't a formal name for it.

Now that i'm looking at the comparisons of the photos (especially in profile), I am starting to realise how big a change it is - almost resembling a lefort 1 advancement. And I'm probably still adjusting to these changes in some ways - it's always about 2 -3 months that my brain starts to find new things to criticise

Anyway, I'm attaching some of the befores.

https://i.imgur.com/D7mVsT2.jpg
https://i.imgur.com/lcepXRW.jpg

[Post bimax]

Thanks man, I think it's reassuring to hear that further jaw surgery isn't likely to 'solve' anything, because I think for a long time I have seen it as the potential answer. And completely get your point about the upturn, but it's probably quite relevant for me to show some photos from previous to the rhinoplasty from late last year, advancement and lengthening. My nose was VERY short, upturned and recessed after by bimax, and possibly exaggerated my other surgeries I had.

It is still only 3 months ago, so I'm hoping the swelling may go down a bit and bring the tip down a little further, but in my opinion, he has done a pretty excellent job. He's managed to get a lot more length, remove some of the flaring and very significantly, he's managed to remove the recession in the upper lip/behind the nose, by placing rib cartilage behind it.

I wish I had known that this was a procedure that could make such a difference to my appearance sooner after my bimax, but hardly any surgeons ever seem to mention or consider it, and you don't even read about it easily online, because I guess there isn't a formal name for it.

Now that i'm looking at the comparisons of the photos (especially in profile), I am starting to realise how big a change it is - almost resembling a lefort 1 advancement. And I'm probably still adjusting to these changes in some ways - it's always about 2 -3 months that my brain starts to find new things to criticise

Anyway, I'm attaching some of the befores.

https://i.imgur.com/D7mVsT2.jpg
https://i.imgur.com/lcepXRW.jpg

Wow, what an incredible job he did.  Very dramatic result.