General aesthetics on what needs to be done and what I should ask of Dr Z

[nomad]

Hi there! I just wanted to ask for some advice on what aesthetic features you guys would think needed changing? Also I wanted to ask realistically what would you guys think is possible, one of the big problems that I have with my face is I feel like I have POTENTIAL to look good. But something just never seems to turn out right. So what I'm asking I guess is...can I go to well above average in looks?

Anyway, some other things too. I have may appointment with Dr Z in August. I think I will also try to book a consultation with Dr R. In terms of drastic aesthetic improvement does anyone know whether these two or perhaps any other surgeons in Europe would be best? I know Dr Gunson in USA but cost is an issue and also location regarding follow ups, aftercare etc.

As for what needs to be improved currently, my mid face is far too long at the moment. And my gonial angle needs correction. My lower jaw is also completely narrow. Also have asymmetry in face. My maxilla seems to be recessed to which gives my eyes a bug look if I'm not squinting. I think there is a big difference in my face when I squint and do not squint. I also lack cheekbone projection. There are also nasolabial folds which seems a bit early for my age (24).

What procedures do you guys think need to be done? What should I discuss with Dr Z?

Sorry if I'm asking a lot too! Just a bit overwhelmed with the whole process and how much of an overhaul needs to be done. I also have videos if that would help with anything.

https://app.photobucket.com/u/nomad666666/a/33bda526-f9f2-49da-9f22-46f3f6ee51f9

[nomad]

Also one other thing I would like to add. I think my face seems concave? As in my eyes and centre seem to sink in rather than go out. This becomes extremely noticeable in certain lighting or under certain lenses. Is this something that is fixable?

[nomad]

Just adding something I had in my notes which I thought I should post.
What I need to talk to Dr Zarrinbal about
- Narrowness of face
- Longness of face
- Lack of cheekbones
- Lack of protection of face
- Wonky smile
- Asymmetry
- Extremely poor gonial angle
- Extremely narrow jaw
- Lack of under eye support

[kavan]

On one hand you are ASKING what others think you need. On the other hand you are TELLING others what you think you need. IF you can TELL others what you think you need, then you can tell Dr. Z. SAME and ask him WHICH of the the things you think you need are those he agrees with and/or actually does.

So, what I will do here will be LIMITED to what I see on your face that could benefit from some improvement and I shall do so in the ABSENCE  of what you think you need.

Needs I see:

Otoplasty to pin your ears back. When ears stick out that far, the face can look more narrow.

ORBITAL RIM ADVANCEMENT along with some cheek advancement. Something in the venue of either what they call a 'modified Lefort 3' or orbital rim implants with midface lift to 'close in' on the eyes and make appear less prominent. However, those things don't really resolve to what Dr. Z is recognized for.

Needs I DON'T see:

I don't really see any problems on your face that Dr. Z is known to address or what people seek him out for such as chin wings and some maxfax surgery.

[simonsjaw11]

IMO you look already great, especially the frontal pic. I'd be happy if I can archieve a narrow and v-shape lower jaw like you after my surgery...

That being said, your maxilla does look slightly recessed and ears are too projected. That would be an extra bonus if you get them fixed..

As for gonial angle, I really didn't see what's the problem?

[GJ]

The images aren't working for me.

[nomad]

On one hand you are ASKING what others think you need. On the other hand you are TELLING others what you think you need. IF you can TELL others what you think you need, then you can tell Dr. Z. SAME and ask him WHICH of the the things you think you need are those he agrees with and/or actually does.

So, what I will do here will be LIMITED to what I see on your face that could benefit from some improvement and I shall do so in the ABSENCE  of what you think you need.

Needs I see:

Otoplasty to pin your ears back. When ears stick out that far, the face can look more narrow.

ORBITAL RIM ADVANCEMENT along with some cheek advancement. Something in the venue of either what they call a 'modified Lefort 3' or orbital rim implants with midface lift to 'close in' on the eyes and make appear less prominent. However, those things don't really resolve to what Dr. Z is recognized for.

Needs I DON'T see:

I don't really see any problems on your face that Dr. Z is known to address or what people seek him out for such as chin wings and some maxfax surgery.

Thanks for your reply. Well that's one of the main issues I'm not sure ENTIRELY what I need those were just things I think I needed. And I wanted a few other opinions on general aesthetics and things that could be done to improve the face.

For the ears, this might sound weird but that's one thing I don't really want to touch at the moment. I like the way they stick out in that kind of way.

The reason I wanted to see Dr Z was for the lack of width my jaw has and also perhaps to lower/elongate the ramus so my lower third doesn't seem more pointy. Along with that ideally to shorten the mid face is general but I'm not sure if that's possible. My palate is also extremely narrow and I know that's something he can help with I think?

For the orbital rim advancement, could you recommend any Dr that would be specialised in doing something like that? As for mid face lift, do you mind skin lift ? Also, do you think I would benefit from zygomatic bone correction which again I see is something Dr Z does.

Would Dr R be a better option then for the improvements that I am going for? What I'm really going for is more WIDTH and less LENGTH.

[nomad]

IMO you look already great, especially the frontal pic. I'd be happy if I can archieve a narrow and v-shape lower jaw like you after my surgery...

That being said, your maxilla does look slightly recessed and ears are too projected. That would be an extra bonus if you get them fixed..

As for gonial angle, I really didn't see what's the problem?

I think the problem here is that the pictures are in a vacuum. But when alongside other people the narrowness of my face becomes more apparent especially with how narrow and v shape my jaw is along with its asymmetry, it's something I would like to fix. I don't want a complete block jaw, something still that remains natural looking, just a slightly more symmetrical jaw, wider projected jaw and wider upper face.

My gonial angle is very poor, my lower jaw comes down at even more than a 45 degree angle I think however I think my thyroid is slightly swollen + my beard helps with hiding it from how bad it is. But yes, maxilla recession is definitely a thing.

[nomad]

The images aren't working for me.

https://imgur.com/a/vfHPUzh

Do these show up?

[kavan]

Thanks for your reply. Well that's one of the main issues I'm not sure ENTIRELY what I need those were just things I think I needed. And I wanted a few other opinions on general aesthetics and things that could be done to improve the face.

For the ears, this might sound weird but that's one thing I don't really want to touch at the moment. I like the way they stick out in that kind of way.

The reason I wanted to see Dr Z was for the lack of width my jaw has and also perhaps to lower/elongate the ramus so my lower third doesn't seem more pointy. Along with that ideally to shorten the mid face is general but I'm not sure if that's possible. My palate is also extremely narrow and I know that's something he can help with I think?

For the orbital rim advancement, could you recommend any Dr that would be specialised in doing something like that? As for mid face lift, do you mind skin lift ? Also, do you think I would benefit from zygomatic bone correction which again I see is something Dr Z does.

Would Dr R be a better option then for the improvements that I am going for? What I'm really going for is more WIDTH and less LENGTH.

I see. You like an aspect of your visage (ears sticking out) that contribute to your face looking more narrow. But instead addressing that aesthetic flaw, you wish to compensate for it by making part of the face wider in addition to comments where you want Dr. Z to make an area of your face that's already long, longer. Sorry but can't help with that kind of reasoning.

Flaws in reasoning ability and aesthetic blindness are demonstrated by your NOT noticing that your LOWER '1/3rd' is actually disproportionately LONG compared to your midface (your midface length isn't your problem) and is a contributor to the longness (an narrowness) of your face. Yet you're asking for your lower '1/3rd' to be made LONGER in some hair-brain assumption this will make a part of your lower 1/3rd (chin and lateral chin) 'less pointy' when that area is NOT 'pointy' at all. The CLINCHER here in observational ability is that you want to make your lower 1/3rd LONGER in the process of having MORE WIDTH to the jaws.

For orbital rim advancement whether it be from what they call a 'modified Lefort 3' or implants with midface lift (not skin only but subperiosteal), I have no idea if you know much as to the relationship my suggestion has to making the eyes look less prominent. I just know that patients who DO know the relationship can readily find out who they are.  I'm extremely reserved as to giving 'open recs' for doctors when I don't see much insight at all on the part of the person asking about them.

[IconVillage]

Disagree on the bit about the ears needing to be pinned. I think pinning would accentuate the narrowness of the face, while the ears are adding some width at the moment. Your lower third is a bit long, but I do believe the biggest problem here is the length of your midface. The best ways to address a long midface is by adding width to the face, which you could do with malar augmentation or lengthening of the ramus to add proportionality between the three 3rds of your face.

[kavan]

Disagree on the bit about the ears needing to be pinned. I think pinning would accentuate the narrowness of the face, while the ears are adding some width at the moment. Your lower third is a bit long, but I do believe the biggest problem here is the length of your midface. The best ways to address a long midface is by adding width to the face, which you could do with malar augmentation or lengthening of the ramus to add proportionality between the three 3rds of your face.

Here's a shot for those who would like to cross reference their perceptive abilities.

For those who think the midface is 'long' (or relatively long compared to the other distances near equal to each other) but the lower face is 'only a little long', how does your perception stack up when it's referenced with relative distance relationships? Likewise, how does your perception of the ears 'enhancing' his midface look to you when they are corrected?

ETA: photo shot included in this post.

[nomad]

I see. You like an aspect of your visage (ears sticking out) that contribute to your face looking more narrow. But instead addressing that aesthetic flaw, you wish to compensate for it by making part of the face wider in addition to comments where you want Dr. Z to make an area of your face that's already long, longer. Sorry but can't help with that kind of reasoning.

Flaws in reasoning ability and aesthetic blindness are demonstrated by your NOT noticing that your LOWER '1/3rd' is actually disproportionately LONG compared to your midface (your midface length isn't your problem) and is a contributor to the longness (an narrowness) of your face. Yet you're asking for your lower '1/3rd' to be made LONGER in some hair-brain assumption this will make a part of your lower 1/3rd (chin and lateral chin) 'less pointy' when that area is NOT 'pointy' at all. The CLINCHER here in observational ability is that you want to make your lower 1/3rd LONGER in the process of having MORE WIDTH to the jaws.

For orbital rim advancement whether it be from what they call a 'modified Lefort 3' or implants with midface lift (not skin only but subperiosteal), I have no idea if you know much as to the relationship my suggestion has to making the eyes look less prominent. I just know that patients who DO know the relationship can readily find out who they are.  I'm extremely reserved as to giving 'open recs' for doctors when I don't see much insight at all on the part of the person asking about them.

Sorry I must have misunderstood one of the things I noted. I don't wish for Dr Z to make anything longer at ALL. I see my mistake, I didn't want a chin wing for elongation of the chin. What I did want was something to widen the lower third of my face. The picture I posted is with my jaw fully clenched as well so perhaps it doesn't seem as bad. I will post completely relaxed one soon but there is almost no definition to where my jaw. I've also lost considerable amounts of body fat and it is still not there.

But yes, you've nailed that on the head. I don't want ANY length at ALL added to my chin, it's horribly long but I do want width. Is there a procedure available for this apart from implants? Another big problem seems to be that my mandible slopes downwards far toooo much. Which causes the elongation of the lower third so that would need to be rotated slightly?

I really don't have the knowledge of that Kavan. But I would appreciate if you could point me in the right direction. At the moment I am just very worried and confused on what procedures need and just going to a surgeon and getting something done that doesn't improve the overall aesthetic of my face.

Disagree on the bit about the ears needing to be pinned. I think pinning would accentuate the narrowness of the face, while the ears are adding some width at the moment. Your lower third is a bit long, but I do believe the biggest problem here is the length of your midface. The best ways to address a long midface is by adding width to the face, which you could do with malar augmentation or lengthening of the ramus to add proportionality between the three 3rds of your face.

I'm not sure about the pinning now after seeing Kavan's changes. I feel like it does look better after. But perhaps they are just something I am attached to out of comfort. But yes the lower third and mid face is long.Would Malar augmentation help with width even? Or just more protection? I wonder if something were to be done to the zygomatic area it would give the illusion that the face is a bit wider.

Here's a shot for those who would like to cross reference their perceptive abilities.

For those who think the midface is 'long' (or relatively long compared to the other distances near equal to each other) but the lower face is 'only a little long', how does your perception stack up when it's referenced with relative distance relationships? Likewise, how does your perception of the ears 'enhancing' his midface look to you when they are corrected?

ETA: photo shot included in this post.

Thank you so much for the photoshop. It's a big big help in visualising. Yes I definitely see the improvement but I think my attachment to the ears is a more of a childhood attachment one. Just something I enjoy seeing but definitely an aesthetic improvement I can see. And I see the longness in the lower third.

Again, I'd really appreciate any direction to the correct procedures on what to solve. Thanks. Will also post a non jaw tensed photo so you can get a better view of what my jaw is like.

[nomad]

I've tried to attach a video and photos. As you can see, the angle of my lower jaw is to see and ramus is almost no existent given making it look like I have no jaw. The lower jaw also begins to narrow to extreme amounts when it goes towards my jaw. And yes now as Kavan has pointed out I can see my orbitals are also quite recessed.

[nomad]

Here is a video of my face in motion

https://vimeo.com/441936022

I've tried to highlight my jaw angle and the lack of ramus there is. Just an overall long narrow long with sunken eyes which I wish to change. Again I would greatly greatly appreciate if you could point me in some direction as to how I could change these things.