Double jaw yes or no?

[KitKat20]

Hello guys, I had a consultation for double jaw surgery with genio before (in Italy) and was advised against it. However I do think I need it, I have both jaws set back with quite visible paranasal hollowing giving me a flat face. But (unfortunately haha) my bite is perfect - as noted by a few doctors before .. could any of you have a look at my xray and tell me what you think? I would send my full face and bite pics privately if needed. I know I definitely need a rhinoplasty, due to my retruded maxilla my nose kind of "fell down" with time and looks horrible... and a few doctors told me already I have great chin and they wouldnt touch it, personally I am not happy with it and also with my nasolabial angle.. I know many of you have been researching jaw surgery for years so I would really value your opinion so much, thank you <3

[kavan]

Your ceph reveals a very short curled up upper lip and a downward rotated nose tip as in maxillary recession. So, maxillary advancement would be of great aesthetic benefit to you. It would unfurl the lip and address the overly downward rotated nose tip.

I read your other post (in absence of ceph) where Dr. R told you would get a monkey face in a surgery that would advance your maxilla. Personally, I think he could have been more forthright with you as to tell you your bite would be 'wrong' if he made your maxillary recession right via a Lefort 1.

As to a 'rhinoplasty', did he give you an explanation of how he would go about it?  I'm not sure but I think there might be a way to selectively cut the paranasal area and anterior nasal spine to move a selected section forward. That would tend to address the retrusion you see to the nose tip/upper lip area in absence of changing the bite via an entire lefort 1. Thing is that you RULED OUT a consultation with the doctor that I think does something like that; Alfaro.

[KitKat20]

Thank you for your reply Kavan, very informative. I crossed out Alfaro because most of his results didn't seem.. dramatic enough? I dont know I will definitely consult with him and see what he says. What dr. R told me that as I have a good bite I don't need jaw surgery but he agreed my jaws are set back. He said for the few mm advancement it is not worth the money or long healing time and I would likely not be happy with the result as it wouldn't be very noticeable and more advancement would give me a monkey face. He said I am a beautiful girl and I shouldn't play with my face because I dont need it, it made me very happy hearing that from him but I still want to have jaw surgery. He said I definitely need rhinoplasty but I think with time my nose would fall back again not having proper support from my maxilla.

[GJ]

I disagree your bite is perfect. Looks like an exaggerated curve of spee with the upper teeth compensating for that. You can get by with that, but look at the angle of the back upper molars in their effort to adjust to the extreme curves. Not ideal. Your teeth are clearly compensating for a jaw issue, so if they see that as perfect it's different than my definition of perfect.

To me it looks like you need all your dental curves straightened out, and then a linear advancement. Agree with them your chin looks good, at least on x-ray. I'd have to see it in a photo.

[kavan]

Thank you for your reply Kavan, very informative. I crossed out Alfaro because most of his results didn't seem.. dramatic enough? I dont know I will definitely consult with him and see what he says. What dr. R told me that as I have a good bite I don't need jaw surgery but he agreed my jaws are set back. He said for the few mm advancement it is not worth the money or long healing time and I would likely not be happy with the result as it wouldn't be very noticeable and more advancement would give me a monkey face. He said I am a beautiful girl and I shouldn't play with my face because I dont need it, it made me very happy hearing that from him but I still want to have jaw surgery. He said I definitely need rhinoplasty but I think with time my nose would fall back again not having proper support from my maxilla.

What you say here about Dr. R said  is what I read in your other post. So, I'm going to repeat here what I said in my prior post which is that I don't think Dr. R was forthright (honest) with you as to getting a 'monkey face' from a surgery aimed at bringing the maxillary area forward. Quite the contrary; bringing the maxillary area forward (or the part of it directly associated with supporting  the base of the nose would IMPROVE your profile by offsetting the down turned nose and also the extremely short and furled upper lip area. The maxillary relationship seen on your ceph is that of Class 3 skeletal pattern where maxilla is RETRUDED.

I'm not denying that you could be very attractive (in front view). I'm telling you that I don't think Dr. R was being up front with you and also that his showering you with compliments in addition to telling you that IF he attempted to correct the maxillary retrusion by a Lefort 1, then you would get the monkey face. IMO (and I admit I don't know for sure and can't prove it), he didn't want to admit that your case was EITHER outside of HIS CAPACITY to fix OR one IF he did fix it, your bite would not be right. Also, I agree with GJ as to stuff being OFF with your bite.

So, here you have this Dr. R who's results you are impressed by and we can leave it at your consult with him resolved to something HE CAN'T FIX via maxfax surgery. The reasoning of 'monkey face','perfect bite', showering with compliments, presently I, myself, view as SUBTERFUGE. OK.  I would like to see a second opinion from Alfaro whether or not the Class 3 LOOK to the maxilla area is fixable by an isolated surgery to the maxillary area responsible for NOSE SUPPORT and better nose to lip angle. The chin area is OK.

[KitKat20]

Yes I do realize my bite is not really perfect and my side profile is horrid, hence I understood dr. R's compliments as a way of reasoning him not wanting to operate on me. I do not understand it as it is clearly visible my jaws are recessed and I could benefit from jaw surgery, I got a lot more insight from you guys here than I got from my consultation. I left Italy disappointed, I finally decided to proceed with jaw surgery and I got turned down.. I wouldn't need to go to a maxfac surgeon for simple rhino with fillers which is what he proposed. However he is a great guy, very nice and friendly and no doubt he is a very knowledgeable surgeon, too bad he couldn't do anything for me.. some docs want to operate only on people with severe bite problems, maybe he is one of them and I am just not his type of patient. I was set on going with R I didn't even have a second option really so thank you for recommending Alfaro, I set up a consult with him for October 8th (they are quite busy apparently). Thank you again guys, I will update with more pics and hopefully a plan later

[kavan]

Yes I do realize my bite is not really perfect and my side profile is horrid, hence I understood dr. R's compliments as a way of reasoning him not wanting to operate on me. I do not understand it as it is clearly visible my jaws are recessed and I could benefit from jaw surgery, I got a lot more insight from you guys here than I got from my consultation. I left Italy disappointed, I finally decided to proceed with jaw surgery and I got turned down.. I wouldn't need to go to a maxfac surgeon for simple rhino with fillers which is what he proposed. However he is a great guy, very nice and friendly and no doubt he is a very knowledgeable surgeon, too bad he couldn't do anything for me.. some docs want to operate only on people with severe bite problems, maybe he is one of them and I am just not his type of patient. I was set on going with R I didn't even have a second option really so thank you for recommending Alfaro, I set up a consult with him for October 8th (they are quite busy apparently). Thank you again guys, I will update with more pics and hopefully a plan later

I'd like to clarify here that I suggested a consult with, second opinion from Alfaro as to an isolated osteotomy aimed at supporting the base of the nose and improving the nose to lip angle.

[KitKat20]

Hello again guys, my consult with prof. Alfaro got pushed back a bit due to covid travel restrictions but today I finally managed to meet him in Barcelona. I have a class 1 bite and we agreed on moving both of my jaws forward with ccw rotation (without touching my chin which disappointed me a bit as I wanted a genioplasty originally as well). He also advised against rhinoplasty saying that my nose will be fixed by maxillary advancement.. well I can still get it later if anything I don't know about the exact movements yet but I got the 3D scan & planning already done at the clinic and they should send it to me soon. As my reason for jaw surgery is mainly aesthetic and not functional I am still a bit nervous about the actual outcome (as Raffaini told me before there wouldn't be much change to my face anyway). I am sending my pics as well so you can see how recessed my jaws are 

[GJ]

You look good in the flesh. Maybe a slight underbite that the teeth compensated for.
I'm not convinced moving the jaws forward more will look good. But maybe that is a look you want?
What I'm seeing is the lower jaw looks fine where it is, and the upper jaw looks a little recessed. Seems a better plan would be to decompensate the teeth (they are very compensated in that x-ray), straighten the curves in the arches, and then possibly move the upper jaw forward a bit.

[kavan]

I think you are extremely attractive as is. The maxillary retrusion is minimal and no need for lower jaw/chin advancement. I think you would be all set with just the ISOLATED 'U shape' osteo he does. You didn't report what he said about that which was my basis for consulting with him.

[LeFort 3000]

you do NOT need double jaw surgery. It is NOT guaranteed you will look better after. Leave it as it is, its not worth the gamble nor the money

[InvisalignOnly]

You look so good already and in particular, your lower jaw and chin are perfect. I agree with the previous posters - either you should not do anything or if you really insist, then just upper jaw surgery. That's still a gamble and there is no guarantee it will work out, but at least the risk of nerve damage is way lower, plus I really cannot see how you could gain anything aesthetically by moving your lower jaw.

[Gadwins]

So I guess Dr. R was right afterall.

[InvisalignOnly]

So I guess Dr. R was right afterall.

He was, wasn't he? If I was OP, I wouldn't trust Alfaro after he offered to do double jaw surgery on someone that looks like this. Then again if I had a face like OP, I would not let any surgeon touch it for a billion dollars so my opinion probably doesn't count.

[JawSeeker]

Then again if I had a face like OP, I would not let any surgeon touch it for a billion dollars so my opinion probably doesn't count.

Totally agree.