What can be done about mid-face hypoplasia? (Pictures included)

[GinaKhan]

Here is my side profile: https://imgur.com/a/iZ5JjzF

What can be done? My midface is completely flat. I have a follow-up consult for jaw surgery coming up. During the first consult my surgeon talked about moving my lower jaw backward. But I feel like the rest of my face needs to be brought forward. I feel like I would benefit from a lefort 3 but very few jaw surgeons are capable/willing to do it. Are implants the move?

I want there to be more projection in my nose and cheeks like https://media.istockphoto.com/photos/profile-of-a-beautiful-woman-with-fresh-clean-skin-picture-id521157631?k=6&m=521157631&s=612x612&w=0&h=91zVCupUd1zKODADBaETq52ULYYclg0izUmdXS0J7Ok=

[Sergio-OMS]

Here is my side profile: https://imgur.com/a/iZ5JjzF

What can be done? My midface is completely flat. I have a follow-up consult for jaw surgery coming up. During the first consult my surgeon talked about moving my lower jaw backward. But I feel like the rest of my face needs to be brought forward. I feel like I would benefit from a lefort 3 but very few jaw surgeons are capable/willing to do it. Are implants the move?

I want there to be more projection in my nose and cheeks like https://media.istockphoto.com/photos/profile-of-a-beautiful-woman-with-fresh-clean-skin-picture-id521157631?k=6&m=521157631&s=612x612&w=0&h=91zVCupUd1zKODADBaETq52ULYYclg0izUmdXS0J7Ok=

Don’t get a mandibular setback done. Bad for your aesthetics, bad for your airway.

[summer]

Don’t get a mandibular setback done. Bad for your aesthetics, bad for your airway.

I never understood, why would surgeons ever do this? Or is it outdated now

[kavan]

Your SNA and SNB angles are approximately the same because the A point and B point are found on the same line. So SNA and SNB angles are approx 82 degrees.

NORMS:

SNA (°)   Sella-Nasion to A Point Angle   82 degrees
SNB (°)   Sella-Nasion to B Point Angle   80 degrees

So, the lower jaw is a little more forward than the norm. But that's NO REASON to move it backwards.

I don't see anything in your profile CEPH to suggest any BIMAX surgery. Besides, midface hypolasia or 'flat' MIDFACE usually refers to an area ABOVE the Lefort 1 area used to advance the  part of the maxilla that is technically below the midface area.

ETA: oK I do see some midface hypoplasia which is viewed via soft tissue profile relative to the eyeball. But that is NOT fixed by any bimax or maxfax surgery. Options include orbital rim implants with midface lift, modified Lefort 3 type surgery or judicious soft tissue filler injections. So, those would be the options to explore via your own independent research.
 If you expect to look just like the model, I would bag that expectation.

[GinaKhan]

Interesting analysis on the side profile. I always felt that my jaws were recessed. I know I didn't include any frontal pictures, but they would show my narrow upper arch, asymmetry, and gummy smile.

I am definitely interested in a lefort 3 if it was the in the $20k range, but it's hard to find any information on the price or even many before and afters.

I know I will not look like a model, but I was just wondering if it's possible to correct my lack of forward growth as demonstrated by that girl.

[kavan]

Interesting analysis on the side profile. I always felt that my jaws were recessed. I know I didn't include any frontal pictures, but they would show my narrow upper arch, asymmetry, and gummy smile.

I am definitely interested in a lefort 3 if it was the in the $20k range, but it's hard to find any information on the price or even many before and afters.

I know I will not look like a model, but I was just wondering if it's possible to correct my lack of forward growth as demonstrated by that girl.

There's no bimax recession to your jaws that I can see. The recession seen in soft tissue profile is an area that would look MORE recessed if you had bimax. It's the modified L 3 to look into. Not the whole one. That and/or orbital rim implants with midface lift or soft tissue injections.

[GinaKhan]

Thank I really appreciate your advice! It's so relieving to hear that my jaws are likely not recessed. I always thought my midface was flat because of my jaws. But now I'm thinking it's because I'm half Asian and that's just the way my dad's face is too.

[GJ]

Looks like a very easy case of doing nothing.

Were you diagnosed as class 3? If so that's usually fixed by bringing the lower jaw back and upper jaw forward, not just the lower back (could result in excess neck skin, etc). I'm surprised someone recommended lower only. It's possible but that skin issue can be real.

Just based on the photo, my concern would be your inability to seal your lips at rest. This usually is a sign of maxillary excess. Any breathing or functional issues? Only surgery that would make sense to me is a very slight impaction, lower jaw back just a hair, upper forward a hair, chin forward a hair. It's all probably ~1 to 2mm movements, and IMO not worth the risk given you look well within normal. Your lips appear to be naturally fleshy and protruding, so that's also giving an illusion of a flat midface, relative to them.

This is all fine, IMO, and my vote is do nothing unless you have functional problems.

[GJ]

I never understood, why would surgeons ever do this? Or is it outdated now

Because it's easier and cheaper than double jaw? Or, maxilla is in a good position, patient doesn't want both, etc.
I've seen some cases were the person looked good, but they did have excess skin under the neck.

[GinaKhan]

Sorry I should've made it clear that he didn't just mention moving the lower jaw back. He was also going to do an impaction, genioplasty, and potentially some rotation? Not totally sure though. Once I have my follow-up appointment I'll have a better idea. And yes I do have some lip incompetence

[InvisalignOnly]

You have such a unique and interesting face, doing nothing is definitely a way better option than messing it up with the wrong surgery. I can't imagine why they would want to move the lower jaw back. Advancing your maxilla might not be a good move either, it could have a negative effect on your nose etc. You have a good bite too. Maybe a genioplasty could be a good option to help with your lip incompetence and change the shape of your chin? And some work on your cheeks / midface (maybe fillers to start with, see how you like that look).

[kavan]

Sorry I should've made it clear that he didn't just mention moving the lower jaw back. He was also going to do an impaction, genioplasty, and potentially some rotation? Not totally sure though. Once I have my follow-up appointment I'll have a better idea. And yes I do have some lip incompetence

Well, join the club where posters on this board elect to withhold all of the relevant information in order to get feedback on ONE part of it and instead prefer to provide the rest of it after feedback is given based on the info they initially provided. So, you will be needing to incorporate the feedback you already got on here to that would directly relate to bimax surgery to what ever the consulting doctor told you relative to BIMAX surgery.

Your title question was what could be done about MID-FACE HYPOPLASIA. Said deficiency was found to the UPPER midface in your photo. So, what I told you about that still holds which is that an upper midface deficiency is found ABOVE the area that a Lefort 1 changes and is not an area that bimax surgery with Lefort 1 is going to address by improving it because that particular deficiency is not a JAW deficiency.