Clueless And Looking For Advice.

[Kote]

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[GJ]

Can you put all photos and records in one imgur link?

[kavan]

Can you put all photos and records in one imgur link?

In addition to all the photos not being on ONE (imgur) link, the other problems with the presentation are:

a: lack of appropriate profile photo/s. Twisting the neck is wrong profile posture. Proper profile posture is a photo shot taken from the side and not one taken from front via twisting the head and neck to the side.

b: Wants an assessment of an area covered with a beard and markings.

c: cocked leaned down head circling an area.

I'm declining for those reasons.

[Kote]

Apologies about the photos. I can take some new ones later this evening after finishing work. I can't, however, shave my face for the purpose of these photos as I'm insecure enough about my face as it is,  even with the facial hair. I think the best thing for me to do is to wait until I have the CT images.

[Kote]

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[Dutcherhatcher]

Dr. Birbe is great, But if I had to choose a Spanish surgeon I would go with Alfaro.

Your profile picture are not correct, you tilt your face up to mask the recession. Use the Frankfurt plane, shave and post photos again.

[kavan]

Declined.
Did not post new photos on Jan 30 as indicated.

Med link says there are 100's of scans on there but the type we look at on this board are profile CEPHS that show the soft tissue profile in addition to the bone structure.

The only ceph like photo that could be 'harvested' from there lacks soft tissue profile.

For others who would like to give you some advice, I'm including your profile X ray.

[Kote]

It says there are hundreds of images, however, each are divided into separate scans. The third one across is what you're looking for, a 3D representation of my skull which can be rotated around. I really thought this would have been more beneficial rather than sending a couple of images.

[kavan]

It says there are hundreds of images, however, each are divided into separate scans. The third one across is what you're looking for, a 3D representation of my skull which can be rotated around. I really thought this would have been more beneficial rather than sending a couple of images.

Well, an explanation as to which one to look at and how to rotate it would have been helpful from the get go, ya think?

But still, #1 doesn't rotate 90 deg to the right with the bar and dot rotation device used to rotate.

NEITHER of the those 2 photos out of the 100s on there show the soft tissue profile along with the bony landmarks which are seen in a CEPH.

Looking at your link of frontal  https://imgur.com/s0ORIMX that shows SOFT TISSUE along with looking at #3 and rotating that to look at profile bone structure, I'm inclined to agree with your doctor's basic suggestion that a genio would advance out your chin to address retrusion of it. I'm also inclined to agree with his suggestion for jaw implants because you have a very HIGH SLOPED mandibular plane angle. The jaw implants would 'drop down' the lower border of the mandible, more in the back and less in front to decrease the high slope of the mandible. From a front perspective the jaw implants would also WIDEN the (lower) jaw to jaw distance. That is because in frontal view, your lower face, jaw to jaw distance is VERY NARROW relative to the very WIDE upper cheek to cheek distance. It's the very NARROW distance from jaw to jaw compared to the wide distance from upper cheek to cheek that visually contributes to your face looking long from the front.

I tend to agree with your self assessment that you are 'clueless'. That is because shooting botox into the MASSETER muscle SHRINKS the muscle whereas masseter muscle bulk increases the soft tissue jaw to jaw distance of lower face. Also buccal fat removal can narrow the lower face in frontal perspective. So the CLUE here is that you have done things to NARROW the lower part of your face which contributes to why the LOWER face is DISPROPORTIONATELY narrow compared to the UPPER cheeks. The other contributor is the HIGH slope of the mandible. Those things contribute significantly to the DISPROPORTION to your face and it looking long from the front.

No surprise to me that your doctor would want to place jaw implants to both WIDEN the narrow jaw to jaw distance and to also LOWER the HIGH 'slope' of the mandibular plane angle in addition to a genio to advance out the chin.

[Kote]

Hi Kavan,

Thank you for for taking the time out of your day to give your input, it's very much appreciated.

It's much more obvious to me what you point out now that I have someone else's perspective. As for the masseter injections, these were not done for cosmetic reasons in the beginning. I've had bruxism for the last several year's and the botox helps relax the muscle for a few month's to give me temporary relief from night grinding. I just thought the "narrowing jawline effects" that came with the treatment was beneficial to reducing that fat face appearance, obviously not now. I'll need to rethink of other treatment options now, if there are any.

Thanks again.

[kavan]

Hi Kavan,

Thank you for for taking the time out of your day to give your input, it's very much appreciated.

It's much more obvious to me what you point out now that I have someone else's perspective. As for the masseter injections, these were not done for cosmetic reasons in the beginning. I've had bruxism for the last several year's and the botox helps relax the muscle for a few month's to give me temporary relief from night grinding. I just thought the "narrowing jawline effects" that came with the treatment was beneficial to reducing that fat face appearance, obviously not now. I'll need to rethink of other treatment options now, if there are any.

Thanks again.

Yes. Botox is often used for bruxism because bruxism causes hypertrophy (bulking up) of the masseter from the over use of it with night grinding and clenching. It weakens the muscle and decreases it's bulk. Even though you didn't get it for 'cosmetics', when people get it FOR cosmetics, the specific objective IS bulk shrinkage. Botox weakens facial muscles that are OVER USED. It does NOT work to decrease fat. The fat stays there over weakened muscle and just kind of 'sloshes' around over it

Perhaps you should look into getting a night guard which will allow the muscle to get strong (bulk up) again. Night guards don't stop bruxing. They just prevent the teeth from grinding together (and wearing down) while bruxing. Botox is best used when there is UNWANTED masseter hypertrophy WITH the bruxing.

[GJ]

Yeah, I can't go fishing through 100s of images.

Based on the original photos you posted, it looks like you need CCW rotation. Definitely something is off with your face, but I can't pinpoint if it's hard tissue, soft tissue, or both. Something with the lips/mouth area isn't right. In profile, mandible looks steep. Teeth look a bit retroclined. The beard is awful and should be trimmed down (i.e. setting 1 on your trimmer). You have coarse, pube hair on your face, so you shouldn't grow a beard, or you should grow it very short. The latter can look good if well-maintained.

Non surgical, I'd procline the teeth and use a genio to get a little more projection. Surgical, I think you're looking at CCW of both jaws.

This is based off the poor records and is subject to change with better records. Cephs and x-rays are best.

[kavan]

Yeah, I can't go fishing through 100s of images.

Based on the original photos you posted, it looks like you need CCW rotation. Definitely something is off with your face, but I can't pinpoint if it's hard tissue, soft tissue, or both. Something with the lips/mouth area isn't right. In profile, mandible looks steep. Teeth look a bit retroclined. The beard is awful and should be trimmed down (i.e. setting 1 on your trimmer). You have coarse, pube hair on your face, so you shouldn't grow a beard, or you should grow it very short. The latter can look good if well-maintained.

Non surgical, I'd procline the teeth and use a genio to get a little more projection. Surgical, I think you're looking at CCW of both jaws.

This is based off the poor records and is subject to change with better records. Cephs and x-rays are best.

I extracted the only thing on there that looked like it could be a ceph BUT it doesn't show the soft tissue profile or have the ceph stat on it. So, not the type we can use here. Kind of strange the doc took all the CT stuff but there was not the type of ceph we look at here.