HA granules - swelling or permanent 'chubby cheeks'?

[InvisalignOnly]

Dear All, I had double jaw surgery 3.5 weeks ago and have a question about HA (hydroxyapatite) granules. I am a very skinny woman and had a thin face before surgery (was planning to get fillers after the operation to make my face look less thin actually). After the surgery, the doctor told me that when they moved my maxilla backwards, my face looked so sunken in that they decided on the spot to place some HA granules to fill in the nasiolabial folds and surrounding area.

A few weeks later, it looks like I have 'chubby cheeks' which becomes particularly noticeable when I try to smile - see pictures attached. I am wondering if this is just swelling (maybe extra swelling because of the HA) or am I more or less permanently stuck with these chubby-looking parts? It's definitely not infected or anything as I do not have any pain or discomfort anywhere, and everything feels soft, just like fat basically. I feel like I still have a lot of swelling in general, especially in the mid-face area. Can the chubbiness just be part of normal swelling and will it improve over time, or is it more likely that the doctor overdid the HA granules and the 'chubby' look is permanent? If the latter, is there any way to reduce that a few months later without cutting my face up again?

Thanks for you input in advance.

[Gadwins]

I think it is not possible to say without before pictures. I have a thin face myself and swellings seems not to be noticeable as swelling on a thin face. Why I ask for before pictures, because it is unlikley that a thin face will tranform to a bulky face overall.

Also 3.5weeks is a really a very very short period.

[InvisalignOnly]

You are right, it's early days. I didn't even notice the chubby cheeks until a friend made a tacktless joke about my face looking fat despite the liquid diet 🙈. I told her it was swelling, then started thinking, those cheeks really do look big 🤣. Anyway, I attached a picture for comparison taken just before my surgery (I wasn't in the mood to smile then, my overbite looked the absolute worst because of decompensation, hated it so much and so happy to see it gone).

[kavan]

HA granules are KNOWN for extra swelling and it takes some time for the swelling they kick up to go down. I don't know the time frame. I just know they are known for long term swelling.

[Gadwins]

It looks like swelling to me, because you look bulkier to me. I don't think that this is fat, then you had really to outeat me and I counted calories and put extra wheat bran in my soups.
 Despite liquid diet, you can easily gain weight if you don't count calories. Normally if it is just soups, without any wheat bran for extra calories what I did, you shouldn't get enough calories to gain extra weight. You will even loose weight, because just soups aren't enough.

[InvisalignOnly]

I am 170cm tall and was 44 kilos when I left the hospital 3 weeks ago (I think that's less than 100lbs) so it's safe to say I'm not overweight 🤣. Attached a photo taken yesterday to illustrate. I've been counting calories like crazy because the doctors were very worried about me losing more weight and I've been making a massive effort to keep my calorie intake up since. I think it's safe to conclude that you're both right, it's really just swelling and I have to wait for it to go down and see what it looks like after several weeks.

[kavan]

On a post 17 Aug (to someone freaked out about swelling) you said:

..... I had BSSO plus LeFort 1 plus genio 3 weeks ago and the doctor warned me beforehand that the LeFort area will be swollen for much longer than the mandible area, and I am glad he did, otherwise I would have panicked too. My upper lip and the whole area surrounding the nose is still very swollen and looks 'bigger' than the lower jaw area, but I can clearly see and feel (I did not lose feeling) that it is swelling, and this is after 3 weeks.

So, ya. It's swelling from Lefort 1 and extra swelling from the HA granules.

[InvisalignOnly]

So, ya. It's swelling from Lefort 1 and extra swelling from the HA granules.

You're absolutely right! I mean I knew for sure that the top lip etc was extra swollen from the Lefort but started wondering about the cheeks. Anyway, I'm clearly still very swollen everywhere, need to relax and pay less attention to friend's comments etc for the next few weeks.

[GJ]

pay less attention to friend's comments etc for the next few weeks.

Sounds more like a "frienemy" than a friend.

I'm not sure about the result yet. My biggest concern would be the lack of upper tooth show at this point.

[Lazlo]

Honestly, I'm a bit concerned about your result.

I wonder if it was necessary to move the maxilla back, instead of moving the lower jaw more forward, perhaps with some CCW. It seems like you have lost a lot of midface support in the process. Yes, this may all be swelling and we may need to wait a few months to see a final result. But the deep nasolabial folds you now have are concerning me.

If you want to pm me full before and after pictures of your full face I would be able to give you a better answer, but I think moving the maxilla back at all was an aesthetic mistake.

Not sure though. Hate to add to your concern. I'm not a surgeon and I may be totally wrong.

[InvisalignOnly]

My biggest concern would be the lack of upper tooth show at this point.

I see what you mean but my upper lip and the whole surrounding area is still incredibly stiff, I can hardly move it, and despite that, I have like 5mm tooth show when smiling and 1-2mm at rest. I had an extremely gummy smile before and used to get Botox for my upper lip to stop it from going up too much.

At this stage I'm thinking that when the muscles start working properly, I'll probably show enough teeth and most likely some gum too when smiling. Time will tell - at the moment I can't drink from a cup yet because my upper lip is so stiff, hopefully it will not stay that way! Otherwise I'm stuck with a baby bottle forever

[InvisalignOnly]

Honestly, I'm a bit concerned about your result.

I wonder if it was necessary to move the maxilla back, instead of moving the lower jaw more forward, perhaps with some CCW. It seems like you have lost a lot of midface support in the process. Yes, this may all be swelling and we may need to wait a few months to see a final result. But the deep nasolabial folds you now have are concerning me.

If you want to pm me full before and after pictures of your full face I would be able to give you a better answer, but I think moving the maxilla back at all was an aesthetic mistake.

Not sure though. Hate to add to your concern. I'm not a surgeon and I may be totally wrong.

Hey, thanks for the honest input, and do not worry, I am not oversensitive about the whole thing so feel free to comment! It's a strange situation, I started the whole process thinking I had no real functional problems and wanted to do it for aesthetics. Now it's done, my breathing is SO MUCH BETTER and my bite is better, I never thought it would make such a difference - if I knew this, I would have done it ages ago just for these functional benefits. So far recovery has been a lot easier than I expected and no major numbness, no pain, so any aesthetic improvement will be an added bonus as far as I am concerned.

Regarding the maxilla: I would say that normally, moving the maxilla back instead of lower jaw more forward would be a mistake in the majority of cases, especially for men. In my particular case, however, the maxilla was just too far forward and in such a weird angle that if they left it like that and tried to match it with the lower jaw, I honestly do not think that would have looked good, the jaw / chin would have been too strong for a woman in my opinion. Might be wrong but that's the way I see it and the doctor said the same. At the end of the day, if the jaw or chin is not strong enough, I can always work on that with fillers or even an implant or something, but if it's too strong, there is nothing I can do apart from a new osteotomy and I really do not want that.

I attached x-rays taken just before and 3 weeks after surgery; and another file with profile pictures, taken before and after (today). On the profile picture taken today you can probably see that there's still a lof of swelling everywhere; I imagine the jawline will be more defined eventually, and the cheeks and upper lip will go down too. Obviously I might be wrong, we'll see.

[InvisalignOnly]

If you want to pm me full before and after pictures of your full face I would be able to give you a better answer, but I think moving the maxilla back at all was an aesthetic mistake.

I tried to send you a PM but can't seem to attach pictures? I'm lame, can someone tell me how to attach or insert pictures in PMs? Thank you!

[GJ]

I asked my lady for an opinion last night, and she thinks you're very swollen but look much better after. Wanted to get her take, because she has seen a lot of cases. So, chin up!

[InvisalignOnly]

I asked my lady for an opinion last night, and she thinks you're very swollen but look much better after.

Thanks, I appreciate that! I asked friends and family for honest opinions today because the one month consultation with the surgeon is coming up soon, and everyone says it looks good and much better than before. I asked specifically if it would look better if the maxilla plus mandible was more forward and they all said no, I'd just look like a 'duck face'. I guess there are always trade offs, in my case it might be less mid-face support. Will see if there's a way of dealing with that after a few months (maybe fillers or something).