HA granules - swelling or permanent 'chubby cheeks'?

[Lazlo]

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.

yeah your profile does look better --probably just over-concern on my part. also everything will be fine once your swelling reduces. Honestly, my swelling didn't really subside until 3 months after surgery --or at least only then could I see the full result.

[GJ]

It's hard to fell if those folds are actually worse, or it's just the lighting. Folds can look way worse in bad lighting. I kind of see them in the pre-op photo, just way better lighting that's blowing them out.

[kavan]

It's hard to fell if those folds are actually worse, or it's just the lighting. Folds can look way worse in bad lighting. I kind of see them in the pre-op photo, just way better lighting that's blowing them out.

If the maxillary and cheek area lateral to the folds is all swollen up, the folds will appear more prominent. The folds themselves are tacked down by fascia. But the 'cheek' area is a space that can get occupied by swelling. So relative comparison between a tacked down facia area (where the actual fold area is) an an area blown up beside it is what you see, not bad lighting.

[InvisalignOnly]

If the maxillary and cheek area lateral to the folds is all swollen up, the folds will appear more prominent. The folds themselves are tacked down by fascia. But the 'cheek' area is a space that can get occupied by swelling. So relative comparison between a tacked down facia area (where the actual fold area is) an an area blown up beside it is what you see, not bad lighting.

Oh wow, thanks for the analysis!!! That explains it. The folds bothered me even before the surgery and was planning to get fillers for them; they look worse now than before, regardless of lighting, but as you explained, it's most likely related to swelling. Will just have to wait and see.

[InvisalignOnly]

yeah your profile does look better --probably just over-concern on my part. also everything will be fine once your swelling reduces. Honestly, my swelling didn't really subside until 3 months after surgery --or at least only then could I see the full result.

It took you 3 months? I see. Obviously I just have to wait. I think your comments about my mid-face loosing some support are valid, at the same time I don't think bringing my mandible and / or chin even more forward would have looked good so I guess the surgeon had to make a compromise. I was very worried about looking more masculine or getting a witch chin so at this stage I'm just relieved that didn't happen.

[InvisalignOnly]

I saw the surgeon today for the one-month follow-up and we discussed the whole surgery in detail, including mid-face support etc. and I'm now even more convinced that what he did was the best 'solution' for my particular case. He confirmed that the cheek and upper lip areas are particularly swollen, probably because of the HA, and that the nasolabial folds should become a lot less deep when the swelling goes down which will probably take months in my case. He also suggested some possible solutions in case I'll still not be 100% happy so I'm now more relaxed about the whole chubby cheek thing.

On another note, I want to take this opportunity to thank you - GJ, kavan and Lazlo -, I vaguely remember we had some silly disagreements in the past but today I just want to say I'm really grateful because when I first came across this forum, I did not know even basic things about jaw surgery and I got so much useful information and advice here, from many people but particularly from the three of you. Without that input, I don't think I'd have gotten the surgery and / or not with this surgeon, and now it's done I'm so happy, I'm kicking myself for not doing it years ago. Luck had probably been on my side too but I haven't had any complications so far, my breathing and bite is so much better than before it's amazing, I look better, I just feel so much better overall and it was so worth it for me. Thanks for your contribution to that.

[kavan]

I saw the surgeon today for the one-month follow-up and we discussed the whole surgery in detail, including mid-face support etc. and I'm now even more convinced that what he did was the best 'solution' for my particular case. He confirmed that the cheek and upper lip areas are particularly swollen, probably because of the HA, and that the nasolabial folds should become a lot less deep when the swelling goes down which will probably take months in my case. He also suggested some possible solutions in case I'll still not be 100% happy so I'm now more relaxed about the whole chubby cheek thing.

On another note, I want to take this opportunity to thank you - GJ, kavan and Lazlo -, I vaguely remember we had some silly disagreements in the past but today I just want to say I'm really grateful because when I first came across this forum, I did not know even basic things about jaw surgery and I got so much useful information and advice here, from many people but particularly from the three of you. Without that input, I don't think I'd have gotten the surgery and / or not with this surgeon, and now it's done I'm so happy, I'm kicking myself for not doing it years ago. Luck had probably been on my side too but I haven't had any complications so far, my breathing and bite is so much better than before it's amazing, I look better, I just feel so much better overall and it was so worth it for me. Thanks for your contribution to that.

Glad to hear the advice was helpful.

[GJ]

On another note, I want to take this opportunity to thank you - GJ, kavan and Lazlo -, I vaguely remember we had some silly disagreements in the past

We did?
Old age must be kicking in...

[Lazlo]

I saw the surgeon today for the one-month follow-up and we discussed the whole surgery in detail, including mid-face support etc. and I'm now even more convinced that what he did was the best 'solution' for my particular case. He confirmed that the cheek and upper lip areas are particularly swollen, probably because of the HA, and that the nasolabial folds should become a lot less deep when the swelling goes down which will probably take months in my case. He also suggested some possible solutions in case I'll still not be 100% happy so I'm now more relaxed about the whole chubby cheek thing.

On another note, I want to take this opportunity to thank you - GJ, kavan and Lazlo -, I vaguely remember we had some silly disagreements in the past but today I just want to say I'm really grateful because when I first came across this forum, I did not know even basic things about jaw surgery and I got so much useful information and advice here, from many people but particularly from the three of you. Without that input, I don't think I'd have gotten the surgery and / or not with this surgeon, and now it's done I'm so happy, I'm kicking myself for not doing it years ago. Luck had probably been on my side too but I haven't had any complications so far, my breathing and bite is so much better than before it's amazing, I look better, I just feel so much better overall and it was so worth it for me. Thanks for your contribution to that.

yeah not having complications is almost close to a miracle. so I'm really glad for you. plus-60 percent of people who have this surgery have some kind of sensory loss near their chin or bsso site. you should be incredibly happy you have full sensation. and yeah, there are lots of ways to improve nasolabial folds, even if you still have them, fillers do wonders.

[InvisalignOnly]

Update on the chubby cheek situation: so I'm almost 2 months post op now and swelling has been going down but there's still some left in my cheeks and chin area. Looking at old pictures, I realise I had almost the same 'chubby cheek' issue pre-op, without the swelling - before and after pictures of my smile attached.

Some of it should go down over the next few weeks / months but I can't help wondering, if it doesn't get much better, is there anything a plastic surgeon can do about it, like fat removal (is this even fat?), or maybe a face lift (sounds drastic as I'm not that old and no wrinkles / sagging yet), or even cheek implants or something (to 'pull' that area up)? I can get fillers for the nasolabial folds but it's actually the 'fatty' parts that are bothering me if that makes sense.

[GJ]

I'm not seeing any issue, but you're looking good from what I can tell.
You should do a full before and after.

[kavan]

There's not a whole lot of difference in the b/a shots as to the chub in the cheeks.

[InvisalignOnly]

There's not a whole lot of difference in the b/a shots as to the chub in the cheeks.

I agree, now that swelling is going down I realised I had this 'excess fat' in the same area all along. Which means it's not likely to disappear even after swelling resolves.

[InvisalignOnly]

I'm not seeing any issue, but you're looking good from what I can tell.
You should do a full before and after.

Thanks, I shouldn't complain! It seems that overall I got a good result - functionally it's definitely good and aesthetically an improvement. I am worried about posting full face pictures for privacy reasons but the feedback I'm getting from people re: looks is consistently positive and the surgeon asked to put my before-after pictures on his website (I had to politely decline) so these are good signs. Seeing jaw surgery is a huge gamble I really should count myself lucky.

What bugs me is that these 'fat' cheeks - that I apparently had all along - are suddenly really 'in my face' (literally). Nobody noticed or commented on them before (myself included), but now several people asked if I had 'something done to my cheeks' like fillers or an implant (?) and it throws off the aesthetic result. When I pull my skin on the sides so these 'fat pads' disappear, I look much better and I showed that to a few people and they all said 'wow that looks amazing' (my face with the skin pulled) so I feel like it makes the difference between a good result and a really good result.

Anyway, I guess I wait for a few months for all the swelling to go and then will visit a few plastic surgeons to ask for their take on it. I can now see that this is how it works with getting surgery to improve your looks: you solve one problem (if you're lucky) but pretty much create another and it's probably never ending.

[GJ]

I'd have to see the before and after and in the same lighting to see if the cheeks are an issue. Lighting makes a big difference with concave areas/step offs of the face and all that. There's even a Seinfeld about it. So it's likely nothing and someone commented while you were swollen or just that things look different to them, and now it's stuck in your head.