Surgery in 2 weeks - how to maximize outcome? (sever asymmetry/downswung jaw)

[skybizz]

I made this https://www.reddit.com/r/jawsurgery/comments/lqfllw/official_before_pictures_finally_scheduled_a/ reddit post a while back detailing my situation and attached an image album of my face to that post.
Here is the image album of my face (close up front facing camera might not be true to life appearance): https://imgur.com/a/ZcbNnlv
I'll summarize everything here again with a few minor updates.

I got braces for the first time at age 12, wore them for 1.5 years, got them off and didn't wear my nightly retainers, teeth shifted back into wrong positions.

Got Invisalign again at age 22, finished my Invisalign treatment at age 24 (last fall), been wearing my retainers regularly, teeth are in the right place.

There are 3 issues I am trying to correct through Jaw surgery.

I cannot open my jaw all the way without discomfort. Attempting to open it wider than ~1.5 inches results in my jaw hitting a point of resistance. Opening my jaw beyond this point of resistance requires me to snap/pop it through, which makes my jaw to make an audible *pop* noise and slide sideways and up in an unnatural way. Doing this several times in a row results in bad jaw pain.

Migraines/headaches. I have suffered from almost daily headaches for over 10 years, usually at least 4-5 days a week I have one. I don't remember getting these headaches before my teenage years. Usually my headaches start off mild when the day starts and worsens throughout the day. Sometimes taking Excedrin helps the pain, sometimes it doesn't. My headaches are usually sensitive to light, but not always. Sometimes I wake up with the headaches, but not usually. My headaches are usually located around my temples, behind my eyes, near my eyebrows or near the back of my skull (in order of most to least frequent areas).

Lastly, I figured I might as well pursue the best aesthetic outcome of my face as possible. I have severe asymmetry, downward growth and a poor jaw line.

I don't grind my teeth at all, my orthodontist confirmed I don't grind by inspecting my molars recently. I also got a brain MRI recently and the neurologist told me everything about my brain was normal. I sleep plenty every night, exercise regularly and drink healthy amounts of water.

I know jaw surgery is not guaranteed to help with my chronic migraines, but its the only option I haven't explored yet, I am fine going through with surgery even if my headaches are not fixed, as long as my Jaw functionality & appearance is restored to normal or even improved.


After meeting with my surgeon, his plan for me is the following: upper and lower jaw surgery - lefort 1, likely bsso, genioplasty.
I inquired about CCW during my consultation; my surgeon made it clear that I have very little room for ccw rotation due to the flare of my teeth. He said they could get more CCW rotation by extracting 2-4 teeth and moving thing around, but I REALLY don't want to pursue camouflage orthodontics/don't like the idea of removing my teeth.


I have a surgical planning meeting in less than 2 weeks where I will be allowed to give input on the outcome of my face. I am hoping to use this meeting to maximize the aesthetic outcome of my face.
Some potential areas of concern:
-Improving chin profile/prominence (genioplasty should cover this?)
-Reducing downswung mandible appearance (is there a way to get past the ccw rotation limits without removing teeth?)
-Increasing jaw width/line appearance from the front (are there ways to do this without implants/fillers?)
-Increasing jaw width/line appearance from the side profile
-Reducing the overall round appearance of my face/cheeks
-improving the gonial angle for a more "square" appearance

Does anyone have advice on things I should mention to my surgeon to help my achieve a the bets aesthetic outcome possible? Thanks!

[kavan]

There is asymmetry to the chin, so that should be on the table for correction whether it's coming from the jaw/s or chin itself.

The lips are already ahead of a reference line they use, perhaps due to proclination of teeth in addition to soft tissue thickness which probably factors into their judgement not to do the CCW.

Even IF they accommodated CCW via plucking out the teeth to push backwards, it's not as if it would counter the high mandibular plane angle (MPA) you have (high slope to the jaw line). I think what I'm calling 'high slope' of jaw line and high MPA is what you are calling; 'downswung mandible appearance'. Some of the high slope to the jaw line would be countered by the genio (sliding) that moves the chin both outward and upward (in addition to how they move to address the asymmetry).

Increasing jaw width; intergonial distance for a 'more square' gonial angle would not be on the discussion table since such a request would resolve to decreasing the high angle of the MPA much more than what they can do via a BSSO and augmenting by 'dropping down' the posterior jaw angles and also flaring them outwards. So, I would bag that as an expectation. What you can expect with the BSSO is the lower jaw coming more forward, more into the foreground and that will give appearance of looking visually wider. Also, the sliding upward and outward aspect of the genio would tend towards making it look less 'downswung'.

Your cheeks might look less prominent or round due to other areas being addressed with the surgery. But the surgery is not with aim to 'deround' the cheeks.

In general, not all of the aesthetic goals you've stated you'd like to have from this type of surgery can be accommodated. But let's hope the surgery relieves you of the jaw pain you've expressed.

[GJ]

It's unfortunate the condyles aren't shown in that scan, because it would be helpful to see their condition. You mention not being able to open your mouth and popping - relapse could be a real risk for you if your condyles aren't in okay shape.

I agree with Kaven that your lips are ahead of the reference line. This is likely due to their thickness. Thick tissue will disguise movements, so in your case you might see something like 1mm of soft tissue movement for every 3 to 4mm of bony movement.

Ideally I'd like to see CCW to help with the angle of the lower jaw, but I agree again with Kavan here that there are limitations. Rotating the chin CCW might be the best you can do while also trying to get your condyles seated in a better position for function. If you have any more scans of your condyles please post.

-Improving chin profile/prominence (genioplasty should cover this?) - likely achievable with a CCW rotation of the chin, or forward and up as Kavan says.

-Reducing downswung mandible appearance (is there a way to get past the ccw rotation limits without removing teeth?) - I don't think so, but rotating the chin should help a bit.

-Increasing jaw width/line appearance from the front (are there ways to do this without implants/fillers?) - Shortening the chin (upward) might do this.

-Increasing jaw width/line appearance from the side profile - I have no idea on this one.

-Reducing the overall round appearance of my face/cheeks - Again, not my area.

-improving the gonial angle for a more "square" appearance - Without CCW of the jaws, I don't see this happening, but moving the chin CCW (forward/up) could/should help.

Are you set on this surgeon? You might want to see if any feel CCW is an option for you since many of your concerns would be addressed with that.

[kavan]

It's unfortunate the condyles aren't shown in that scan, because it would be helpful to see their condition. You mention not being able to open your mouth and popping - relapse could be a real risk for you if your condyles aren't in okay shape.

I agree with Kaven that your lips are ahead of the reference line. This is likely due to their thickness. Thick tissue will disguise movements, so in your case you might see something like 1mm of soft tissue movement for every 3 to 4mm of bony movement.

Ideally I'd like to see CCW to help with the angle of the lower jaw, but I agree again with Kavan here that there are limitations. Rotating the chin CCW might be the best you can do while also trying to get your condyles seated in a better position for function. If you have any more scans of your condyles please post.

-Improving chin profile/prominence (genioplasty should cover this?) - likely achievable with a CCW rotation of the chin, or forward and up as Kavan says.

-Reducing downswung mandible appearance (is there a way to get past the ccw rotation limits without removing teeth?) - I don't think so, but rotating the chin should help a bit.

-Increasing jaw width/line appearance from the front (are there ways to do this without implants/fillers?) - Shortening the chin (upward) might do this.

-Increasing jaw width/line appearance from the side profile - I have no idea on this one.

-Reducing the overall round appearance of my face/cheeks - Again, not my area.

-improving the gonial angle for a more "square" appearance - Without CCW of the jaws, I don't see this happening, but moving the chin CCW (forward/up) could/should help.

Are you set on this surgeon? You might want to see if any feel CCW is an option for you since many of your concerns would be addressed with that.

I tend to think CCW (posterior downgraft) would not be the magic bullet for him. It's because in his ceph, his lower lip is somewhat AHEAD of his upper lip. CCW w PDG minimizes upper jaw advancement and allows for maximization of lower jaw advance. But if that happened (without extractions), his lower lip soft tissue would be MORE ahead of his upper lip and it could look like class 3 soft tissue profile contour. It's possible to get the CCW but possible= removing lower pre-molars to push the lower teeth backwards as the surgeon told him. However, I don't see that possibility accommodating (all of) the aesthetic desires he'd like.

[skybizz]

There is asymmetry to the chin, so that should be on the table for correction whether it's coming from the jaw/s or chin itself.

The lips are already ahead of a reference line they use, perhaps due to proclination of teeth in addition to soft tissue thickness which probably factors into their judgement not to do the CCW.

Even IF they accommodated CCW via plucking out the teeth to push backwards, it's not as if it would counter the high mandibular plane angle (MPA) you have (high slope to the jaw line). I think what I'm calling 'high slope' of jaw line and high MPA is what you are calling; 'downswung mandible appearance'. Some of the high slope to the jaw line would be countered by the genio (sliding) that moves the chin both outward and upward (in addition to how they move to address the asymmetry).

Increasing jaw width; intergonial distance for a 'more square' gonial angle would not be on the discussion table since such a request would resolve to decreasing the high angle of the MPA much more than what they can do via a BSSO and augmenting by 'dropping down' the posterior jaw angles and also flaring them outwards. So, I would bag that as an expectation. What you can expect with the BSSO is the lower jaw coming more forward, more into the foreground and that will give appearance of looking visually wider. Also, the sliding upward and outward aspect of the genio would tend towards making it look less 'downswung'.

Your cheeks might look less prominent or round due to other areas being addressed with the surgery. But the surgery is not with aim to 'deround' the cheeks.

In general, not all of the aesthetic goals you've stated you'd like to have from this type of surgery can be accommodated. But let's hope the surgery relieves you of the jaw pain you've expressed.

Thanks for the response. I see, yeah my lips are naturally really thick, and the outward flare of my teeth probably contribute to some of the size.
Will moving the lower jaw forward have a noticeable impact in how wide my jaw looks? I know bone movements don't translate directly to soft tissue movement/appearance, and on top of that I have really round/chubby cheeks.
Is there some general guidance in how much mm advancement bsso actually impacts visual appearance?

[kavan]

Thanks for the response. I see, yeah my lips are naturally really thick, and the outward flare of my teeth probably contribute to some of the size.
Will moving the lower jaw forward have a noticeable impact in how wide my jaw looks? I know bone movements don't translate directly to soft tissue movement/appearance, and on top of that I have really round/chubby cheeks.
Is there some general guidance in how much mm advancement bsso actually impacts visual appearance?

Can't predict how 'noticeable' it will be.

[skybizz]

It's unfortunate the condyles aren't shown in that scan, because it would be helpful to see their condition. You mention not being able to open your mouth and popping - relapse could be a real risk for you if your condyles aren't in okay shape.

I agree with Kaven that your lips are ahead of the reference line. This is likely due to their thickness. Thick tissue will disguise movements, so in your case you might see something like 1mm of soft tissue movement for every 3 to 4mm of bony movement.

Ideally I'd like to see CCW to help with the angle of the lower jaw, but I agree again with Kavan here that there are limitations. Rotating the chin CCW might be the best you can do while also trying to get your condyles seated in a better position for function. If you have any more scans of your condyles please post.

-Improving chin profile/prominence (genioplasty should cover this?) - likely achievable with a CCW rotation of the chin, or forward and up as Kavan says.

-Reducing downswung mandible appearance (is there a way to get past the ccw rotation limits without removing teeth?) - I don't think so, but rotating the chin should help a bit.

-Increasing jaw width/line appearance from the front (are there ways to do this without implants/fillers?) - Shortening the chin (upward) might do this.

-Increasing jaw width/line appearance from the side profile - I have no idea on this one.

-Reducing the overall round appearance of my face/cheeks - Again, not my area.

-improving the gonial angle for a more "square" appearance - Without CCW of the jaws, I don't see this happening, but moving the chin CCW (forward/up) could/should help.

Are you set on this surgeon? You might want to see if any feel CCW is an option for you since many of your concerns would be addressed with that.

Unfortunately I don't have more images of my condolytes, but I might be getting more soon in one of my upcoming appointments, i'll make sure to post them if I do.
Should I ask my surgeon to specifically check the condition of my condolytes/do anything specific with them during surgery? He seemed to be under the impression that the jaw surgery wouldn't do much to help my mobility/popping/discomfort.

I'm pretty set on this surgeon since he seems to be the best guy in my area, all the appointments are set in stone at this point and my paid leave has been submitted.
i'll inquire again about CCW rotation and dig in to see if he knows of any techniques that could help us achieve a larger ccw movement

[GJ]

Should I ask my surgeon to specifically check the condition of my condolytes/do anything specific with them during surgery? He seemed to be under the impression that the jaw surgery wouldn't do much to help my mobility/popping/discomfort.

He should have checked them already, but you can ask if (a) the condyles can handle his movement without relapse or erosion/mottling and (b) if he will reseat them in a way to help the TMJ issues.

[thedude]

You have a really nice and pretty interesting jaw structure. You have a flat occlusal plane but tempered with a nice angular lower jaw. It's a unique combination that I think works really well for you.

It also ties your hands a bit. If you rotate counterclockwise you're going to get that look where the planes of your teeth and your eyes are crossing. You don't want that. And if you rotate clockwise your lower jaw angle will get too steep which you've stated you don't like and it's going to impact your airway. Not worth it. I think in your case if you want to go ahead with this straight advancement is probably your best bet. It's a little more straightforward a surgery as well. A genioplasty like others suggested would probably be to your liking.

If you're set on doing this I would do a 10mm advancement so that you improve your airway at the same time. You don't realize it but you're really getting jaw surgery because you want a bigger airway. All mammals subconsciously fixate on jaw structure as a measure of attractiveness because the ability to get deep sleep is the most reliable way nature has to make you a smart and healthy individual. Most people that get jaw surgery for cosmetic reasons are not happy with the outcome. You probably won't be either. But at least if you do a large advancement you will know you did the surgery for the right reason and that you made a decision that will allow you to live a longer and healthier life. Remember everyone gets sleep apnea eventually and only a tiny percentage of the population even in their younger years can complete their entire REM sleep cycle without their airway collapsing. How advantageous is that? Well I don't see too many great athletes, great mathematicians, great politicians, etc, that don't have very strong lower jaws, so probably more advantageous than is generally appreciated.

I'm not encouraging you to do it though. It sounds unnecessarily risky given the problems with your jaw joints and it seems like you're doing too much last minute planning. If there is one hard lesson I have learned over time it's that no matter how bad things seem now, they can always get a whole lot worse. A simple genioplasty would get you most of the cosmetic improvement you're looking for without much risk.

Also make sure your surgeon is familiar with African anatomy. People of African descent naturally have larger jaws that are arranged a little bit differently. That's why people here are telling you that you're already ahead of their "reference line." It's a reference line for average white Europeans. The last thing you want is a surgeon setting your jaws back because they don't understanding that.

[Dutcherhatcher]

You have a really nice and pretty interesting jaw structure. You have a flat occlusal plane but tempered with a nice angular lower jaw. It's a unique combination that I think works really well for you.

It also ties your hands a bit. If you rotate counterclockwise you're going to get that look where the planes of your teeth and your eyes are crossing. You don't want that. And if you rotate clockwise your lower jaw angle will get too steep which you've stated you don't like and it's going to impact your airway. Not worth it. I think in your case if you want to go ahead with this straight advancement is probably your best bet. It's a little more straightforward a surgery as well. A genioplasty like others suggested would probably be to your liking.

If you're set on doing this I would do a 10mm advancement so that you improve your airway at the same time. You don't realize it but you're really getting jaw surgery because you want a bigger airway. All mammals subconsciously fixate on jaw structure as a measure of attractiveness because the ability to get deep sleep is the most reliable way nature has to make you a smart and healthy individual. Most people that get jaw surgery for cosmetic reasons are not happy with the outcome. You probably won't be either. But at least if you do a large advancement you will know you did the surgery for the right reason and that you made a decision that will allow you to live a longer and healthier life. Remember everyone gets sleep apnea eventually and only a tiny percentage of the population even in their younger years can complete their entire REM sleep cycle without their airway collapsing. How advantageous is that? Well I don't see too many great athletes, great mathematicians, great politicians, etc, that don't have very strong lower jaws, so probably more advantageous than is generally appreciated.

I'm not encouraging you to do it though. It sounds unnecessarily risky given the problems with your jaw joints and it seems like you're doing too much last minute planning. If there is one hard lesson I have learned over time it's that no matter how bad things seem now, they can always get a whole lot worse. A simple genioplasty would get you most of the cosmetic improvement you're looking for without much risk.

Also make sure your surgeon is familiar with African anatomy. People of African descent naturally have larger jaws that are arranged a little bit differently. That's why people here are telling you that you're already ahead of their "reference line." It's a reference line for average white Europeans. The last thing you want is a surgeon setting your jaws back because they don't understanding that.

Woah, so much pseudo science in one spot. You don’t see mathematicians and politicians without great jaws? Haha

[kavan]

Also make sure your surgeon is familiar with African anatomy. People of African descent naturally have larger jaws that are arranged a little bit differently. That's why people here are telling you that you're already ahead of their "reference line." It's a reference line for average white Europeans. The last thing you want is a surgeon setting your jaws back because they don't understanding that.

That's not why he was told his lips were ahead of a reference line. Presently, they happen to be within the norms for African background. But if they go any further to the extend of the 10mm you are suggesting to him they will be way too far out.

[skybizz]

You have a really nice and pretty interesting jaw structure. You have a flat occlusal plane but tempered with a nice angular lower jaw. It's a unique combination that I think works really well for you.

It also ties your hands a bit. If you rotate counterclockwise you're going to get that look where the planes of your teeth and your eyes are crossing. You don't want that. And if you rotate clockwise your lower jaw angle will get too steep which you've stated you don't like and it's going to impact your airway. Not worth it. I think in your case if you want to go ahead with this straight advancement is probably your best bet. It's a little more straightforward a surgery as well. A genioplasty like others suggested would probably be to your liking.

If you're set on doing this I would do a 10mm advancement so that you improve your airway at the same time. You don't realize it but you're really getting jaw surgery because you want a bigger airway. All mammals subconsciously fixate on jaw structure as a measure of attractiveness because the ability to get deep sleep is the most reliable way nature has to make you a smart and healthy individual. Most people that get jaw surgery for cosmetic reasons are not happy with the outcome. You probably won't be either. But at least if you do a large advancement you will know you did the surgery for the right reason and that you made a decision that will allow you to live a longer and healthier life. Remember everyone gets sleep apnea eventually and only a tiny percentage of the population even in their younger years can complete their entire REM sleep cycle without their airway collapsing. How advantageous is that? Well I don't see too many great athletes, great mathematicians, great politicians, etc, that don't have very strong lower jaws, so probably more advantageous than is generally appreciated.

I'm not encouraging you to do it though. It sounds unnecessarily risky given the problems with your jaw joints and it seems like you're doing too much last minute planning. If there is one hard lesson I have learned over time it's that no matter how bad things seem now, they can always get a whole lot worse. A simple genioplasty would get you most of the cosmetic improvement you're looking for without much risk.

Also make sure your surgeon is familiar with African anatomy. People of African descent naturally have larger jaws that are arranged a little bit differently. That's why people here are telling you that you're already ahead of their "reference line." It's a reference line for average white Europeans. The last thing you want is a surgeon setting your jaws back because they don't understanding that.

I see, my surgeon seemed pretty knowledgeable in general so I think I'm in good hands.
I'm not sure I understand exactly what you mean when you say "If you rotate counterclockwise you're going to get that look where the planes of your teeth and your eyes are crossing" Could you maybe link an example of what this looks like?
Is there any amount of ccw movement I could afford to perform safely, judging by the picture I posted?

That's not why he was told his lips were ahead of a reference line. Presently, they happen to be within the norms for African background. But if they go any further to the extend of the 10mm you are suggesting to him they will be way too far out.

Does a ccw movement always result in the lips moving forward relative to the reference line? I think at this point i'm 100% set on going through with the sliding genioplasty (forwards and upwards), just trying to nail down my decision on pursuing CCW rotation of the lower and upper jaws.
Also, how would a lefort 1/bsso affect my nose? I've seen many examples of people's nostrils getting wider at the base (permanently) after surgery, but i'm not sure if that is a result of the upper jaw surgery/lefort or a result of ccw movement, or both.
I know there's something called an alar stitch that can reduce widening, but not sure if that is applicable if i'm not getting ccw at all (though I would really like to)

Edit: Also wanted to ask, is there some kind of reference line they use to determine how large a portion of the chin to cut and slide forward? After watching some videos/looking at some before and after picture, I think the genioplasty might actually make the ccw less necessary in terms of my aesthetic goals, but that would depend on the outcome and whether it (negatively) impacts the appearance of my lower lip

[kavan]

...

Does a ccw movement always result in the lips moving forward relative to the reference line? I think at this point i'm 100% set on going through with the sliding genioplasty (forwards and upwards), just trying to nail down my decision on pursuing CCW rotation of the lower and upper jaws.
Also, how would a lefort 1/bsso affect my nose? I've seen many examples of people's nostrils getting wider at the base (permanently) after surgery, but i'm not sure if that is a result of the upper jaw surgery/lefort or a result of ccw movement, or both.
I know there's something called an alar stitch that can reduce widening, but not sure if that is applicable if i'm not getting ccw at all (though I would really like to)

I'm not suggesting you pursue CCW movement. So, you would need to direct your questions to those suggesting that for you. Read my prior response to GJ on that. My prior post was to 'the dude'. With reference to his suggestion of a 10mm bimax advancement, your nose base would get ultra wide and your lips would go beyond where they are now.

ETA: The genioplasty would improve your profile though. Again, all my assessments were prior described.

[thedude]

That's not why he was told his lips were ahead of a reference line. Presently, they happen to be within the norms for African background. But if they go any further to the extend of the 10mm you are suggesting to him they will be way too far out.

Okay and I agree with you this is the conventional wisdom and what most doctors would say. I would certainly say to give your advice much more weight than mine for that reason. And I hoped I infused my post with enough hyperbole that it made clear I was giving some things to consider which are outside the normative thinking about the issue but which I personally came to value in planning my own jaw surgery. And that is to say that if you don't mind looking a little bit too projected, this surgery also affords you an opportunity to improve your airway and as you get older it might be something you value more than your appearance. Not so long ago everyone wanted the "anteface" and frankly I think they had the right idea. I think it lost favor when people realized over-advancing didn't actually make you better looking - probably a little worse. Maybe a lot worse in the eyes of depressed young men that thought they were going to come out of this looking like models. I would argue though that you look more dominant with a more forward face. Uglier, but more "alpha" as the young men would say. Better to over-advance and be a little ugly but look dominant than under-advance and look classically attractive in my unpopular opinion. Especially when you factor in the improved airway, which just maybe if you come to believe in some of my pseudoscience is more important than is generally appreciated. I mostly brought this up because you can obviously get away with more advancement than most because you have larger lips and thicker tissues. Unlike everything else I said that is something I think most people here would agree with.

I'm not sure I understand exactly what you mean when you say "If you rotate counterclockwise you're going to get that look where the planes of your teeth and your eyes are crossing" Could you maybe link an example of what this looks like?
Is there any amount of ccw movement I could afford to perform safely, judging by the picture I posted?

I've never looked at it as an exact science and certainly wouldn't be comfortable telling you how much you could safely do, except to say that any amount of rotation is inherently a little more unsafe than straight advancement with all but a few very top surgeons and nothing about your face jumps out at me as being off in a way you would need to rotate your jaws to fix. So my comment was more along the lines of why make a surgery more complicated when you're not even sure if it's necessary? Every once and a while a new aspect of jaw surgery starts getting discussed online and all of a sudden it's the hot new thing and a lot of people want it without fully understanding its purpose.

Another aspect of jaw rotation I rarely see discussed is that it completely changes the way you look. Straight advancement you look like the same person afterwards. You'll look different but you would not be mistaken for a stranger, whereas rotation cases that often happens. I'm surprised more celebrity jaw surgeries aren't discussed on the forums. Kylie Jenner should obviously go down in the history books for having the most successful cosmetic jaw surgery of all time, but I'd like to draw your attention to the one Khloe Kardashian just did to help you understand rotation. Nobody in the media could figure out that's what she did but you'll find a ton of articles speculating why she looks like a completely different person. None of the celebrity plastic surgeons ever pin it on jaw surgery which is funny because I'm sure it's obvious to anyone on this forum that she had jaw surgery. Study her before and after pictures and note that she had clockwise rotation. That's what it looks like. It looks like she is looking more downward and forward at you as opposed to before where it's like her face was kind of pointing upwards and looked a little off. You'll notice her lower jaw is now a little shorter and it's the only reason she doesn't look even better - that is the downside with clockwise rotation. She started with an occlusal angle close to where you were (probably rotated a little more backwards, what I called the "crossfaced" look) and without the nice angled lower jaw that you have, but then she went the opposite direction you want to go and her appearance improved a bit in my opinion. So my fear for you is that if you rotate counterclockwise you're going to look like the before picture of Khloe Kardashian. To really get an idea of what counterclockwise rotation could do to you just google clockwise jaw rotations and study the before faces and you'll quickly notice why you want an occlusal angle this is slightly downward. I'm in the Bay Area and 49ers GM John Lynch always catches my eye as someone with a naturally backwards rotated upper jaw. He has huge jaws though and looks like a strong confident man which is why I always feel men should just maximally advance and accept being a little ugly.

FYI Elon Musk did his jaw surgery exactly the way I like - he over-advanced big time. He did a CCW rotation (but unlike you started with a steep occlusal plane so for you it would be like straight advancement ) and on top of that looks like he advanced the upper jaw a good 15mm. If you see pictures of him standing around you'll notice he has trouble keeping his lips closed because he over advanced so much. Look at him from his Paypal days if you want to see what he looked like before the jaw surgery. My hunch is he had his surgery to improve his sleep apnea but although he's not attractive and frankly looks kind of weird now, certainly not natural, he looks much more dominant with the strong lower jaw and it probably helped people accept him as a leader. Maybe it's a coincidence but he only became hyper successful after he had the surgery. Note Elton Musk has very small lips and thin tissues. His surgery would look quite a bit better on you since you don't have his problem.

[skybizz]

I'm not suggesting you pursue CCW movement. So, you would need to direct your questions to those suggesting that for you. Read my prior response to GJ on that. My prior post was to 'the dude'. With reference to his suggestion of a 10mm bimax advancement, your nose base would get ultra wide and your lips would go beyond where they are now.

ETA: The genioplasty would improve your profile though. Again, all my assessments were prior described.

Okay and I agree with you this is the conventional wisdom and what most doctors would say. I would certainly say to give your advice much more weight than mine for that reason. And I hoped I infused my post with enough hyperbole that it made clear I was giving some things to consider which are outside the normative thinking about the issue but which I personally came to value in planning my own jaw surgery. And that is to say that if you don't mind looking a little bit too projected, this surgery also affords you an opportunity to improve your airway and as you get older it might be something you value more than your appearance. Not so long ago everyone wanted the "anteface" and frankly I think they had the right idea. I think it lost favor when people realized over-advancing didn't actually make you better looking - probably a little worse. Maybe a lot worse in the eyes of depressed young men that thought they were going to come out of this looking like models. I would argue though that you look more dominant with a more forward face. Uglier, but more "alpha" as the young men would say. Better to over-advance and be a little ugly but look dominant than under-advance and look classically attractive in my unpopular opinion. Especially when you factor in the improved airway, which just maybe if you come to believe in some of my pseudoscience is more important than is generally appreciated. I mostly brought this up because you can obviously get away with more advancement than most because you have larger lips and thicker tissues. Unlike everything else I said that is something I think most people here would agree with.

I've never looked at it as an exact science and certainly wouldn't be comfortable telling you how much you could safely do, except to say that any amount of rotation is inherently a little more unsafe than straight advancement with all but a few very top surgeons and nothing about your face jumps out at me as being off in a way you would need to rotate your jaws to fix. So my comment was more along the lines of why make a surgery more complicated when you're not even sure if it's necessary? Every once and a while a new aspect of jaw surgery starts getting discussed online and all of a sudden it's the hot new thing and a lot of people want it without fully understanding its purpose.

Another aspect of jaw rotation I rarely see discussed is that it completely changes the way you look. Straight advancement you look like the same person afterwards. You'll look different but you would not be mistaken for a stranger, whereas rotation cases that often happens. I'm surprised more celebrity jaw surgeries aren't discussed on the forums. Kylie Jenner should obviously go down in the history books for having the most successful cosmetic jaw surgery of all time, but I'd like to draw your attention to the one Khloe Kardashian just did to help you understand rotation. Nobody in the media could figure out that's what she did but you'll find a ton of articles speculating why she looks like a completely different person. None of the celebrity plastic surgeons ever pin it on jaw surgery which is funny because I'm sure it's obvious to anyone on this forum that she had jaw surgery. Study her before and after pictures and note that she had clockwise rotation. That's what it looks like. It looks like she is looking more downward and forward at you as opposed to before where it's like her face was kind of pointing upwards and looked a little off. You'll notice her lower jaw is now a little shorter and it's the only reason she doesn't look even better - that is the downside with clockwise rotation. She started with an occlusal angle close to where you were (probably rotated a little more backwards, what I called the "crossfaced" look) and without the nice angled lower jaw that you have, but then she went the opposite direction you want to go and her appearance improved a bit in my opinion. So my fear for you is that if you rotate counterclockwise you're going to look like the before picture of Khloe Kardashian. To really get an idea of what counterclockwise rotation could do to you just google clockwise jaw rotations and study the before faces and you'll quickly notice why you want an occlusal angle this is slightly downward. I'm in the Bay Area and 49ers GM John Lynch always catches my eye as someone with a naturally backwards rotated upper jaw. He has huge jaws though and looks like a strong confident man which is why I always feel men should just maximally advance and accept being a little ugly.

FYI Elon Musk did his jaw surgery exactly the way I like - he over-advanced big time. He did a CCW rotation (but unlike you started with a steep occlusal plane so for you it would be like straight advancement ) and on top of that looks like he advanced the upper jaw a good 15mm. If you see pictures of him standing around you'll notice he has trouble keeping his lips closed because he over advanced so much. Look at him from his Paypal days if you want to see what he looked like before the jaw surgery. My hunch is he had his surgery to improve his sleep apnea but although he's not attractive and frankly looks kind of weird now, certainly not natural, he looks much more dominant with the strong lower jaw and it probably helped people accept him as a leader. Maybe it's a coincidence but he only became hyper successful after he had the surgery. Note Elton Musk has very small lips and thin tissues. His surgery would look quite a bit better on you since you don't have his problem.

I looked up the people you mentioned, thanks for the providing visual references. I'm somewhat becoming more convinced that I won't be getting any significant CCW movement at all, and I almost definitely won't be getting a drastic straight advancement because of the effect it might have on my other facial attributes. I suppose I value how I look over maximizing my airway for old age. I'll ask my surgeon about what's possible, whether he thinks a very small ccw/forward advancement is worth pursuing and if it would help towards my personal goals and go with what he suggests.


Is a bimax advancement likely to have a better aesthetic outcome because of my thick soft tissue around my lips/nose, or worse because of my thick lips/wider nose? I was under the impression that thicker tissue disguises boney movement more than thinner tissue, but i'm also getting the sense that people here think the outcome would be worse because of this.

Just to clarify, better in this context for me would mean minimal increase in lips size/nose width.

Kavan I know you're advocating against any bimax advancement, but I'm quoting you because you seem like you have a huge store of knowledge on this topic and I also like getting opinions from someone who doesn't necessarily have the same philosophy on the topic.