Chimp look reversal

[jawsurgery029184]

Can a chimp look resulting from an over advanced maxilla be reversed in a second surgery, if the upper jaw is set back to the original position? I will consult with surgeons but I wanted to see if anyone here has anything to say about it

[GJ]

Yes it can be reversed. I've seen personally some patients where they fixed it.

[jawsurgery029184]

That’s very relieving to hear. It’s hard to get information about revision surgeries because they seem to be uncommon or not talked about as much, even on Facebook groups.

[GJ]

Yeah. As the founder I see lots of things in private that people don't want to share.
I think the reason you don't see these cases on FB is people feel shame about their results. Especially when on many of these groups people are just sharing great results.

[jawsurgery029184]

*edited for privacy reasons*

[Gadwins]

Just looking at your x-ray, everything looks good. I think nobody can give you an advise if you don't show us some real pcitures.

[GJ]

Looks good on x-ray. Though the head angle is slightly different.

[kavan]

I've gotta wonder if you have an eye for being on target for aesthetic improvement or not. I say this because of your prior post about some celeb that got a rhino where as aesthetic standards would have it, her nose was improved. Yet you viewed the improvement as as an aesthetic problem and wanted to know how to reverse it.

Presently, you are perceiving your nose bridge as 'flat' or saddled in when the aesthetic situation is one where the advancement de-rotated the somewhat downward rotation and resulted in the type of nose bridge strived for in rhinos. Given the nose bridge (near top) did NOT changed and what changed was advancement at the base, what you're looking at is the RELATIVE RELATIONSHIP given the change at base. But where the PROFILE of the nose is good and where from the front the bridge it would be unlikely that an onlooker to your face would 'see' your nose bridge as 'flat' and there would be NO 'empty space between your eyes' to be seen by an objective onlooker. (This assumes you did NOT get a rhino which breaks the bridge of the nose.) Although your result isn't 'perfect', it's a significant improvement. Yet what looks most improved; the NOSE you're perceiving as a problem.

You also do NOT have a 'chimp lip' from the surgery. Yet want a reversal of it. So, this very much looks (to me) the issue is PERCEPTUAL CONFUSION and quite possibly one of the 'red flag' perceptual issues where the person views what would be seen by other onlookers as an improvement but views as an aesthetic problem. 'Red flag' refers to your having a higher chance of NOT liking the outcome of a revision than would a patient having a revision BUT who had an outcome that the average onlooker would also not perceive as a good one. In the event, things actually look IN THE FLESH as you describe or how you see it in the mirror, the only way to cross reference that would be in the flesh photos.

Now all that doesn't preclude you from getting a revision but based on how you perceive things (and describe) that do not appear to be that way at all, you might need to think about the liklihood of not seeing it as an improvement even if it is and hence being further dissatisfied. Did you know that some people are so attached to their prior appearance and they don't even know they are/were attached to it UNTIL it's actually improved. That plays a role and a significant one with a subset of patients who view improvements as something they want 'undone'.

[jawsurgery029184]

*edit for privacy reasons *

[kavan]

I will probably decide to post some photos later after my consultations and if I proceed with a revision. But the perceptions of my nose bridge are not in my head, multiple people have mentioned it to me because it’s a desirable quality to have a high nose bridge in Asian culture. I used to have one that was higher than average for an Asian and it was often commented on in a positive light. Now it is very flat, and me and my family and friends are all shocked.

After I asked about the nose changes and why my nose appears so much flatter and smaller (and I don’t mean relative to the whole face, I mean it looks much smaller and flatter as an isolated feature, such as when covering the lower half of my face), I was told I had a septorhinoplasty in addition to DJS. I am not sure if the bridge of my nose was altered (or if it could even be altered in a septorhinoplasty) because my surgeon does not want to discuss it, just says that I should enjoy the new airway. I  am very grateful to him for that and how I have no nerve damage. And I am not saying that he necessarily did alter my nose bridge and decrease it in height, I simply don’t know because he does not confirm or deny, and other people on fb forums don’t appear to complain about this issue.

I guess I shouldn’t have referred to it as a chimp look. It’s not the lip that is the issue, but the nose and mouth area is very heavy looking and the eyes seem set back, and I also am an Asian who does not have high cheekbones. The impaction was probably too much and I have more facial fat bunched up in the front of my face than I did before the surgery when my lower jaw was 15mm back than it is now. When I give a full smile, I do not show any gum and must strain ridiculously hard to show the tops of my teeth. I am not sure if proper tooth show can be determined in an X-ray.

It is true that there is an aesthetic improvement due to moving the lower jaw forward, but I do think there was overcorrection. The original surgeons I consulted with suggested only moving the upper jaw up 1-2mm to fix a gummy smile and slight cant, Posnick suggested it not be moved at all, and definitely no advancement, this is the only surgeon that decided to do such drastic movements (and that should have been a red flag). I think the act of moving the upper jaw 4mm forwards when it is unnecessary and impacting more than is necessary to fix a gummy smile is not going to result in a good aesthetic outcome. There is probably good reason why the standard treatment for vertical maxillary excess is impaction instead of impaction + advancement.

Yes while I agree that I am still attached to the upper part of my old face, for these reasons I don’t necessarily think a revision is wrong for me. The nose issue can’t be solved by a revision DJS, but I don’t think the issue is solely me being attached to my old face.

OK, so if you did have some kind of rhino, the upper bridge didn't change. What changed was advancement of the base and this would be perception based on RELATIVE relationship. But perhaps something from the front changed also.

I'm not advising against a revision. But am pointing out it might not be what you 'want to see' even if addresses what you say you want it to do.

[jawsurgery029184]

Could you explain what you mean by “But am pointing out it might not be what you 'want to see' even if addresses what you say you want it to do”? And by the way I really appreciate your insights and comments

[kavan]

Could you explain what you mean by “But am pointing out it might not be what you 'want to see' even if addresses what you say you want it to do”? And by the way I really appreciate your insights and comments

It relates to your wanting to see something in the mirror that's in your mind's eye that might not be what you say you want.

[InvisalignOnly]

OP, don't take it the wrong way - I am not trying to 'victim blame' you and not saying your concerns aren't valid, but I think it is difficult to give advice when you are describing your issues in ways that are contradictory, it makes it difficult to understand what the problem is. So far you mentioned chimp look, punched in old lady look, and sagging facial tissues (the latter in spite of the fact that you had a large advancement so hard to imagine). I am finding it impossible to imagine what the problem is, based on your description and the x-ray (where I cannot see the chimp look or punched in look or sagging tissue etc).

I think a large part of the problem here is the fact you are Asian and were operated on by a doctor that had no concept of what is considered a good look in your particular community. I am Caucasian but happened to have bimax protrusion more typical for Asians, so did quite a bit of research on surgeries they typically do in Asian countries and saw many before and after photos from Korea in particular. I must say that in many cases, I was stunned because to me personally, the patient looked better before than after, yet it was presented as a success story so clearly what looks good to me likely does not look good to a typical Korean person etc.

For example what you mention about the bridge of your nose - I am sorry but I don't even understand what that is about, I never consciously noticed the bridge of my nose and could not care less. I understand this is important to you and the people around you but most likely your surgeon is clueless about this. I often notice that Western jaw surgeons have no idea how to work with non Caucasian people - they just do the thing they were trained to do but do not take it into account that it looks different on someone with a different ethnicity, or it is perceived differently. I am not saying this was the case with you but might be a possibility. If you really want a revision, you might want to consider getting it done in an Asian country and / or by a surgeon that really understands what your preferred look is like and how to achieve it. Maybe it can be achieved by much less invasive procedures than a full jaw surgery revision? For example, fillers in the nose, lip lift, face lift etc.

[jawsurgery029184]

Yes I definitely agree about different aesthetic standards, generally speaking there is no pursuit of forward grown look from the profile. A straight profile and a slightly weak chin are fine esp for women. There is less pursuit of a sharp jawline and super angular features because a lot of times it doesn’t look natural for the ethnicity. There is also the issue of Asians generally have more facial fat, and having large impactions/advancements can result in the face being ‘squishy’ and having no facial definition, in addition to the usual tooth show / nose flaring complaints.

Although user “jawregret” had issues I felt like were similar and I’m not sure what ethnicity she was. Large CCW movements that don’t use a posterior downgraft but rely on impaction have a large potential to make you look worse. I would urge people with overbites with are overall satisfied with their upper face to consider only the lower jaw being moved forwards.

[kavan]

The FOLLOWING statement also RELATES to what I've been conveying.

....I think it is difficult to give advice when you are describing your issues in ways that are contradictory, it makes it difficult to understand what the problem is. So far you mentioned chimp look, punched in old lady look, and sagging facial tissues (the latter in spite of the fact that you had a large advancement so hard to imagine). I am finding it impossible to imagine what the problem is, based on your description and the x-ray (where I cannot see the chimp look or punched in look or sagging tissue etc).....

....I'm not advising against a revision. But am pointing out it might not be what you 'want to see' even if addresses what you say you want it to do.

Could you explain what you mean by “But am pointing out it might not be what you 'want to see' even if addresses what you say you want it to do”? And by the way I really appreciate your insights and comments

It relates to your wanting to see something in the mirror that's in your mind's eye that might not be what you say you want.