Recessed Jaw or Bad Lighting

[Mossy]

Hi everyone,

This is my first post I'm trying to determine if my jaw is recessed and I would benefit from surgery, or if it is normal to look this bad under certain lighting.

Some quick history: In the link I've added some childhood photos which show that I definitely had some jaw development issues as a child.
When I was around 10 or 12 years old (? can't remember perfectly).. I had upper palate expansion, and then after that I had braces in highschool.
After the braces I looked good, had a great bite, and was happy. Unfortunately though, my teeth relapsed after a few years back into a cross-bite and so I started seeing an orthodontist again in my mid-twenties. One ortho I saw told me my palate was still a little undersized, but he gave me invisalign and straightened them out again. The thing is, I can see now that I am lacking some midface support and so I'm interested in just getting the surgery that I probably should have had 10 years ago, rather than getting braces every 5-10 years to correct the relapse.

I had a ceph done a few months ago and ran it through cephx, so if anyone wants to know any of the values I can give them to you. I'm not going to list all the deviations from normal range, but some that stuck out to me were:
-my upper front teeth are tipped forward a bit,
-bottom front teeth are tipped back a bit (compensation),
-occlusal plane is only 2 degrees (10 is average ? - slight class 3 tendency)
-gonial angle is 118 degrees (130 is average??)

like i said feel free to ask for other values that will help you give advice.

So like I mentioned, the way I look under overhead lighting bothers me so much that I've already consulted with 3 max-fac surgeons. The first one didn't want to do anything because my bite is still "ok-good." Its honestly a little crowded with my canine teeth jutting forward and up a bit out of line, and it also has a little bit of an edge to edge character in that my front teeth don't totally overlap the bottom, they slightly touch on one side - especially the lateral incisors and canines. I'm also pretty prone to gum recession and have already had to get a gum graft.

Anyway,The second surgeon also didn't want to do jaw surgery because the jaw recession wasn't 'bad enough' but did try to sell me paranasal and cheekbone implants (this actually really upset me because I always thought I had above average cheek bones, but I know now that my cheekbones are more prominent laterally but flat in the anterior).

Finally though, the third surgeon I saw was totally on-board with giving me a lefort 1. He actually told me that because my teeth are quite straight right now I am a candidate for the surgery first method, and that my surgery would only take 2 hours so he would be able to fit me in pretty soon! I asked him about how this would affect my nose and he really did a great job of assuring me that he would take care of everything very competently. He said that after practicing for over 30 years he has never given anyone a piggy nose, and he would give me the alar cinch and take out some cartilage to stop the nose from tipping too much if need be. No wiring shut either.

I left his office feeling super grateful and ready to move forward with him. However when I talked to my boyfriend about it later on, even though he said he would support my decision what ever it was, he also said that he really doesn't see anything wrong with jaw/midface and totally didn't agree that I had a 'deformity' in this area. I mean he's my bf so he kind of has to say that, but he was really convinving. It seemed like he was kind of insinuating that I had BBD. It put a little doubt in my mind and now I'm not sure. I mean, I know I'm not like a model tier beauty but I guess it does scare me that what beauty I do have could be destroyed by this surgery, just because I got greedy and wanted more.

So I'm hoping you can weigh in and help me determine if I should move forward with this. Thanks

In the image link below I've added lots of photos in all kinds of lighting. The photos in the bad lighting where the midface deficiency is more apparent are closer to the bottom.

https://imgur.com/a/R5Qf9M8

So what do you guys think? Yes to Le Fort advancement? Or No?
If the answer is no then I'll probably try out therapy for BDD. :/

[kavan]

The enemy of good is 'better' and I think you look very good. So, no suggestion of surgery from me.

[Mossy]

Thanks Kavan, your opinion means a lot.

[GJ]

Firm no here.

Everyone looks awful with overhead lighting. Literally everyone. There's even a Seinfeld about it.

By the way, every Class I patient I've seen who has had jaw surgery has come out looking worse. And I've seen a lot of cases on here and privately via email.

[Lazlo]

i think you're hot. would definitely hit it.

[Yoroshiku]

You are gorgeous!!!  Stay away from surgery.  Love yourself!     

[InvisalignOnly]

I could write a long post but in short: please don't do it, any doctor willing to do jaw surgery on you is after the money and doesn't have your best interest in mind. Just don't do it.

[mindwitch]

Hi everyone,

This is my first post I'm trying to determine if my jaw is recessed and I would benefit from surgery, or if it is normal to look this bad under certain lighting.

Some quick history: In the link I've added some childhood photos which show that I definitely had some jaw development issues as a child.
When I was around 10 or 12 years old (? can't remember perfectly).. I had upper palate expansion, and then after that I had braces in highschool.
After the braces I looked good, had a great bite, and was happy. Unfortunately though, my teeth relapsed after a few years back into a cross-bite and so I started seeing an orthodontist again in my mid-twenties. One ortho I saw told me my palate was still a little undersized, but he gave me invisalign and straightened them out again. The thing is, I can see now that I am lacking some midface support and so I'm interested in just getting the surgery that I probably should have had 10 years ago, rather than getting braces every 5-10 years to correct the relapse.

I had a ceph done a few months ago and ran it through cephx, so if anyone wants to know any of the values I can give them to you. I'm not going to list all the deviations from normal range, but some that stuck out to me were:
-my upper front teeth are tipped forward a bit,
-bottom front teeth are tipped back a bit (compensation),
-occlusal plane is only 2 degrees (10 is average ? - slight class 3 tendency)
-gonial angle is 118 degrees (130 is average??)

like i said feel free to ask for other values that will help you give advice.

So like I mentioned, the way I look under overhead lighting bothers me so much that I've already consulted with 3 max-fac surgeons. The first one didn't want to do anything because my bite is still "ok-good." Its honestly a little crowded with my canine teeth jutting forward and up a bit out of line, and it also has a little bit of an edge to edge character in that my front teeth don't totally overlap the bottom, they slightly touch on one side - especially the lateral incisors and canines. I'm also pretty prone to gum recession and have already had to get a gum graft.

Anyway,The second surgeon also didn't want to do jaw surgery because the jaw recession wasn't 'bad enough' but did try to sell me paranasal and cheekbone implants (this actually really upset me because I always thought I had above average cheek bones, but I know now that my cheekbones are more prominent laterally but flat in the anterior).

Finally though, the third surgeon I saw was totally on-board with giving me a lefort 1. He actually told me that because my teeth are quite straight right now I am a candidate for the surgery first method, and that my surgery would only take 2 hours so he would be able to fit me in pretty soon! I asked him about how this would affect my nose and he really did a great job of assuring me that he would take care of everything very competently. He said that after practicing for over 30 years he has never given anyone a piggy nose, and he would give me the alar cinch and take out some cartilage to stop the nose from tipping too much if need be. No wiring shut either.

I left his office feeling super grateful and ready to move forward with him. However when I talked to my boyfriend about it later on, even though he said he would support my decision what ever it was, he also said that he really doesn't see anything wrong with jaw/midface and totally didn't agree that I had a 'deformity' in this area. I mean he's my bf so he kind of has to say that, but he was really convinving. It seemed like he was kind of insinuating that I had BBD. It put a little doubt in my mind and now I'm not sure. I mean, I know I'm not like a model tier beauty but I guess it does scare me that what beauty I do have could be destroyed by this surgery, just because I got greedy and wanted more.

So I'm hoping you can weigh in and help me determine if I should move forward with this. Thanks

In the image link below I've added lots of photos in all kinds of lighting. The photos in the bad lighting where the midface deficiency is more apparent are closer to the bottom.

https://imgur.com/a/R5Qf9M8

So what do you guys think? Yes to Le Fort advancement? Or No?
If the answer is no then I'll probably try out therapy for BDD. :/)

Girl you look very stunning. Those cheekbones!

[PloskoPlus]

You look good now.  You won't look any better after surgery, possibly worse.

[Mossy]

Thanks guys.

The first surgeon I saw told me I was underdeveloped in the paranasal area and in the anterior portion of the cheekbones, it made me really self conscious as I do have a pretty flat face. My cheek pads started sagging and my nasolabial folds started becoming quite prominent when I was just 26 years old. I would really like to do something about it but i'm not interested in filler (at all).

Would having HA or bio-oss put into the paranasal area be helpful?

[kavan]

No. You shouldn't get stuff done by a surgeon who made you self conscious and most certainly NOT with stuff that can't be easily removed or reversed IF you don't like it.

[Gadwins]

No. You shouldn't get stuff done by a surgeon who made you self conscious [...]

Does such a surgeon exist? I think every surgeon does do that in a certain way, some more subtel and some more direct.

[kavan]

Does such a surgeon exist? I think every surgeon does do that in a certain way, some more subtel and some more direct.

Oh, I see we have somewhat of a transcendental or 'higher plane' question here that borders on the broader philosophical question of 'Does such an honest man exist?'I would refer you to Diogenes of Sinope (Ancient Greek Cynic philosopher) for further pondering.

However, if you would like to engage in the more pragmatic question here, maybe try a response that borders on whether or not the OP should get a surgery that might be hard to undo if she didn't like the result.

[Gadwins]

I understand the last part of your previous post. She shouldn't really get something permanent, because she could be unhappy with the result. Especially if she was made unhappy about her look by a surgeon and not by herself.

I just didn't understand the recommendation of the first part of your previous post. Of course she should get more opinion (also from other surgeons) before she decide to do that. But if she liked the surgeon who made her self conscious, then she should go with him.

I asked this question, because I interpreted your recommendation that she shouldn't get stuff done by surgeons who made her self conscious. But which surgeon doesn't do that at all? That would mean she couldn't do that with any surgeon. If that was your point, because any surgeon who thinks she should get something done is an idiot, then ok.

[kavan]

I understand the last part of your previous post. She shouldn't really get something permanent, because she could be unhappy with the result. Especially if she was made unhappy about her look by a surgeon and not by herself.

I just didn't understand the recommendation of the first part of your previous post. Of course she should get more opinion (also from other surgeons) before she decide to do that. But if she liked the surgeon who made her self conscious, then she should go with him.

I asked this question, because I interpreted your recommendation that she shouldn't get stuff done by surgeons who made her self conscious. But which surgeon doesn't do that at all? That would mean she couldn't do that with any surgeon. If that was your point, because any surgeon who thinks she should get something done is an idiot, then ok.

Firstly, my response takes into consideration what SHE specifically conveys and your question wants to  extrapolate my response to her, to ALL or EVERYONE as to INDULGE your 'out in left field' type question. So, your question is one that doesn't take into consideration the CONTEXT of the situation and of my response to it which is specific to her. You just want to know 'which surgeon does not do that?' (makes patients feel self conscious)

Your IMPLICIT ASSUMPTION to ask that question must be that ALL surgeons go about making a patient feel self conscious. So, you're wanting an 'answer' to a question that reflects a faulty assumption that 'ALL surgeons make patients feel self conscious'. Well, not all surgeons go about making someone feel self conscious. But the ones who do try to SELL the patient on something else which what was done here. That is the DIRECT CONTEXT here. So, your out of context question inherent with an IMPLICIT ASSUMPTION that YOU have that 'all surgeons make people self conscious' is not my assumption given that there are plenty of patients walking out of consults who DON'T come out with a feeling of being made self conscious in the act of the surgeon trying to sell them on something they didn't go in there to buy. OK.  Hence, there's no answer to it from me other than to leave you with your own implicit assumptions and which ever conclusions you want to make from them.

Although she says the 'first' surgeon told her something that made her feel really self conscious which is often a tactic to get someone to have surgery, in a LATER question (that I answered), she's probably referring to the 2ncd surgeon who told her that her paranasal area and cheeks were flat. Quote from her first post:

"Anyway,The second surgeon also didn't want to do jaw surgery because the jaw recession wasn't 'bad enough' but did try to sell me paranasal and cheekbone implants (this actually really upset me because I always thought I had above average cheek bones, but I know now that my cheekbones are more prominent laterally but flat in the anterior)."

So, despite her mixing up which surgeon was first and second, the CIRCUMSTANCES are those of a surgeon MAKING her feel self conscious and ALSO trying to sell her on implants of some sort.

In essence, and as is consistent with all the other responses (except yours of course), I'm ADMONISHING her AGAINST getting surgery.