Bimax+CCW (New Ceph and X-Ray)

[jshelp]

Hi guys,

I started a thread some time ago, but now I have new Ceph data and a new X-Ray, as the old one was apparently done in a wrong position, as noted by a surgeon. This probably caused the eyebrow bone to be further forward than it really is.

Old X-Ray: https://i.imgur.com/8dLXeEn.png
New X-Ray: https://postimg.cc/t7J3NJjc
Ceph: https://postimg.cc/gallery/HT9YXJ0
Soft Tissue Pics are included in the Attachment.

Both my jaws are a little too far back, so I have some excess skin and nasobial folds. Also my philtrum could be a bit shorter.

I have already consulted several surgeons who have confirmed that I would benefit from advancement of both jaws and a small CCW rotation. The CCW rotation could be done by a small impaction (have a bit of a gummy smile) and the rest by downgraft. One user/surgeon advised against this because his concern was that any Lefort1 advancement would be absorbed by my very thick skin and the rotation would give me a too dominant chin, which in combination with my eyebrow bone would create a moon crest concave face.

I specifically asked Dr. Z about this, but he was not worried because it is only a small rotation and the rest is done by advancement, so both jaws could be moved forward relatively evenly.  However, he strongly recommended that I have an additional rhinoplasty in the same surgery, since I already have an upturned and wide nose.

What I hope from the surgery:
- reduction of the nasobial folds
- more defined jawline
- to "catch" excess skin under the chin
- slight reduction of the philtrum

What I hope will not happen:
- a too concave upper lip aka the well known monkey look
- overimpaction since i only have a very mild gummy smile
- a too dominated witch chin
- general destruction of the face harmony (for example espacially a receded upper midface look)
- of course hopefully no strong surgery complications

Would be grateful for suggestions and opinions!

[jshelp]

More Attachments

[GJ]

What is moncrater?

You really don't need jaw surgery based on what I'm seeing.

But if you are intent on getting it, a small advancement with CCW rotation seems right. I doubt you'd get the chimp look from a CCW movement. But they'll probably want to procline your teeth a bit with orthodontics, which will help even more with that. Right now they appear retroclined.

I think your goals are reasonable expectations from their proposed surgery, and I don't think "witch chin" is a risk unless they really mess up. I personally wouldn't do rhino at the same time because you don't want swelling or other jaw issues to interfere with the diagnosis or execution, but some people believe in that. I don't. I think it's best to do a secondary procedure when the first is healed and you know fully what you're dealing with.

[jshelp]

What is moncrater?

You really don't need jaw surgery based on what I'm seeing.

But if you are intent on getting it, a small advancement with CCW rotation seems right. I doubt you'd get the chimp look from a CCW movement. But they'll probably want to procline your teeth a bit with orthodontics, which will help even more with that. Right now they appear retroclined.

I think your goals are reasonable expectations from their proposed surgery, and I don't think "witch chin" is a risk unless they really mess up. I personally wouldn't do rhino at the same time because you don't want swelling or other jaw issues to interfere with the diagnosis or execution, but some people believe in that. I don't. I think it's best to do a secondary procedure when the first is healed and you know fully what you're dealing with.

I mean a moon crest concave looking face

And yeah probaly dont need bimax health reason wise since i am class 1 and have good airwaves. Thats why its important to me to have a good risk profile in terms of Aestethical Outcome. And yeah i also think my teehts are retroclined and would look better more procline.

Yeah Rhino afterwards seems like a wiser Choice. Even though it is tempting to do everything in one procedure with only one anesthesia. Dr Z said he could do Rhino+Bimax or Genio+Bimax in one procedure. I dont know in which way i could benefit from a Genio (even tho some Surgeons adviced me to do, probaly to have more freedom it terms of movements? Maybe even a chin reduction?)

[Gadwins]

Don't you mean moon crest concave face, what kavan was referring in some topics.

[jshelp]

Don't you mean moon crest concave face, what kavan was referring in some topics.

yeah exactly

[kavan]

I didn't see a difference at all between your 'old' and 'new' X rays. In FACT the file name for BOTH of them is the SAME. Those 'X-rays' are CEPHS and are EXACTLY THE SAME.

The files called 'cephs' DON'T show the top of the skull where the brow boss is.

I don't see the outcome of double jaw advancement accommodating your goal for it to pick up the thick fleshy areas so all hugs tight to the bone structure which you have prior stated is your primary goal for it to do.  Nor do I think it's the thing to do just because a protruding brow bone area might make the area look relatively recessed when it really isn't. Soft tissue profile line up looks pretty good. Nose looks FINE. But probably WON'T with maxillary advancement. Hence suggestion of rhino just to do the DJS. DJS is not really the 'solution' for nasial labial folds and skin that does not hug tight to the chin and lower jaw line. Some people get what is called an EARLY FACE LIFT (with neck lift) to get the soft tissue to hug tighter to the jaw line. Also, according to past posts, it doesn't seem like you would be at the level of understanding to make a good decision for yourself since it does appear that your primary goal is to pick up slack and skin excess, 'stretch skin so bones pop out' and you seemed to need validation of that from here which can't really be validated for you.

You could get double jaw surgery on grounds that they found your jaws 'a little recessed' relative to SNA and SNB angles. It could certainly address what ever recession they find. But if your goal is for the surgery to make your thick skin HUG TIGHT to bone structure, there is no guarantee that particular goal would be entirely accommodated by the surgery. Hence, if your jaws are a 'little recessed', that means they could be advanced 'a little' or 'somewhat' which would in turn mean you would get some improvement to the skin slack of the thick skin. But it's not going to mean it's going to get the skin to hug really tight or pick up all of the skin excess.  People with very thick soft tissue don't get a highly sculpted 'bone pop out' look with bone remodeling procedures. So, better DOUBLE CHECK if that's what you are expecting.

[jshelp]

I didn't see a difference at all between your 'old' and 'new' X rays. In FACT the file name for BOTH of them is the SAME. Those 'X-rays' are CEPHS and are EXACTLY THE SAME.

The files called 'cephs' DON'T show the top of the skull where the brow boss is.

I don't see the outcome of double jaw advancement accommodating your goal for it to pick up the thick fleshy areas so all hugs tight to the bone structure which you have prior stated is your primary goal for it to do.  Nor do I think it's the thing to do just because a protruding brow bone area might make the area look relatively recessed when it really isn't. Soft tissue profile line up looks pretty good. Nose looks FINE. But probably WON'T with maxillary advancement. Hence suggestion of rhino just to do the DJS. DJS is not really the 'solution' for nasial labial folds and skin that does not hug tight to the chin and lower jaw line. Some people get what is called an EARLY FACE LIFT (with neck lift) to get the soft tissue to hug tighter to the jaw line. Also, according to past posts, it doesn't seem like you would be at the level of understanding to make a good decision for yourself since it does appear that your primary goal is to pick up slack and skin excess, 'stretch skin so bones pop out' and you seemed to need validation of that from here which can't really be validated for you.

You could get double jaw surgery on grounds that they found your jaws 'a little recessed' relative to SNA and SNB angles. It could certainly address what ever recession they find. But if your goal is for the surgery to make your thick skin HUG TIGHT to bone structure, there is no guarantee that particular goal would be entirely accommodated by the surgery. Hence, if your jaws are a 'little recessed', that means they could be advanced 'a little' or 'somewhat' which would in turn mean you would get some improvement to the skin slack of the thick skin. But it's not going to mean it's going to get the skin to hug really tight or pick up all of the skin excess.  People with very thick soft tissue don't get a highly sculpted 'bone pop out' look with bone remodeling procedures. So, better DOUBLE CHECK if that's what you are expecting.

you're right I accidentally pasted the same link. Here is the new x-ray what I meant:  https://postimg.cc/t7J3NJjc

And yeah my thick Skin on its own is a problem but sadly i dont know if there is a solution to that. I am just unhappy how my lower face looks to be honest. I am a healthy, sporty guys but my face just doenst reflect that at all. You can even see on the ceph front the soft tissue roundness around my jaws: https://postimg.cc/Wd4jdf8Y
I dont know in which way for example brow reduction would help with that.


And maybe djs+ccw is not the only solution for a visible/good jawline but a importan piece to archieve it in my opinion. Also i have the feeling that my nasalbase and mouth area could be a bit more forward.
Other options i thought about: masseter reduction with botox, and maye kybella/liposuction under the chin and yeah maybe a mini facelift. But for me its strange to get a facelift at a such young age somehow.

Thanks for your input!

[kavan]

you're right I accidentally pasted the same link. Here is the new x-ray what I meant:  https://postimg.cc/t7J3NJjc

And yeah my thick Skin on its own is a problem but sadly i dont know if there is a solution to that. I am just unhappy how my lower face looks to be honest. I am a healthy, sporty guys but my face just doenst reflect that at all. You can even see on the ceph front the soft tissue roundness around my jaws: https://postimg.cc/Wd4jdf8Y
I dont know in which way for example brow reduction would help with that.


And maybe djs+ccw is not the only solution for a visible/good jawline but a importan piece to archieve it in my opinion. Also i have the feeling that my nasalbase and mouth area could be a bit more forward.
Other options i thought about: masseter reduction with botox, and maye kybella/liposuction under the chin and yeah maybe a mini facelift. But for me its strange to get a facelift at a such young age somehow.

Thanks for your input!

The new X ray ceph isn't that good because it doesn't give clear view of soft tissue profile. Also, head position doesn't matter when measuring SNA and SNB angles (angles relative to recession) because head position does not change those angles. If a surgeon is looking for a 'true vertical' to plan a surgery around, they can just rotate the ceph to 'define' the horizontal they want to be perpendicular to the vertical. Your bone structure looks pretty good with the exception of some asymmetry to the chin area which is seen in the FRONTAL X ray.

It would not be a 'mini' face lift I was referring to. It would be something where they kind of reconstruct, shave down and resuspend the DEEP structures of lower face and neck with a bunch of advanced techniques where they can put strong 'vectors' on the soft tissue for it hug snugly against the bone structure. But few (plastic) surgeons do that to that extent. It's done to lower face/neck area.

Although the SNA and SNB angles do suggest you could have upper and lower jaw advanced more forward and they could do that with a CCW rotation and I'm not denying that couldn't be done to compensate for minor recession, I'm just saying that it won't compensate for the skin thickness or give a chiseled look. In fact good rhino surgeons often tell patients with thick skin that despite the nose bones themselves being well chiseled and refined with a rhino, the thick skin can hide that. So, that concept would apply to getting DJS with the goal of getting a refined chiseled look out of it. But it wouldn't preclude getting DJS to address what ever recession is there.

[jshelp]

The new X ray ceph isn't that good because it doesn't give clear view of soft tissue profile. Also, head position doesn't matter when measuring SNA and SNB angles (angles relative to recession) because head position does not change those angles. If a surgeon is looking for a 'true vertical' to plan a surgery around, they can just rotate the ceph to 'define' the horizontal they want to be perpendicular to the vertical. Your bone structure looks pretty good with the exception of some asymmetry to the chin area which is seen in the FRONTAL X ray.

It would not be a 'mini' face lift I was referring to. It would be something where they kind of reconstruct, shave down and resuspend the DEEP structures of lower face and neck with a bunch of advanced techniques where they can put strong 'vectors' on the soft tissue for it hug snugly against the bone structure. But few (plastic) surgeons do that to that extent. It's done to lower face/neck area.

Although the SNA and SNB angles do suggest you could have upper and lower jaw advanced more forward and they could do that with a CCW rotation and I'm not denying that couldn't be done to compensate for minor recession, I'm just saying that it won't compensate for the skin thickness or give a chiseled look. In fact good rhino surgeons often tell patients with thick skin that despite the nose bones themselves being well chiseled and refined with a rhino, the thick skin can hide that. So, that concept would apply to getting DJS with the goal of getting a refined chiseled look out of it. But it wouldn't preclude getting DJS to address what ever recession is there.

It is interestingly the opposite of what I have heard most surgeons say. They often said that if you have excess skin, you would probably benefit more from djs than a facelift. Dr. Z also said that djs can often achieve better results than facelifts ever can.

Would say my approach is not to technically correct the calculated recession but rather to get aesthetic benefits from the surgery. Therefore, one could go beyond normal as long as it does not lead to undesirable appearance. Dr. Z, for example, gave his recommendation without looking directly at the X-Ray but based on the Soft Tissue. I know that actually a DJS is meant to fix recession, whereas there are doctors who perform it just for an aesthetic point to get a more harmonious facial profile/face. For example alot of Surgeons actually do a DJS even on not receded x-Rays.
And I think it would look better if everything below the nasal base was more forward and it would have the positive side effect of tightening excess skin.

Would you say I would benefit more aesthetically from a facelift than from a DJS? Do you have any idea how I could get rid of the nasobial folds? And what I could do about the roundness that is visible from the front?

edit: you are right that my chin is from the front asymetrical but it somehow never bothered me and i think its not that noticeable on soft tissue level. I just find that my left side is better looking then the right so maybe there is some causality

[kavan]

It is interestingly the opposite of what I have heard most surgeons say. They often said that if you have excess skin, you would probably benefit more from djs than a facelift. Dr. Z also said that djs can often achieve better results than facelifts ever can.

Would say my approach is not to technically correct the calculated recession but rather to get aesthetic benefits from the surgery. Therefore, one could go beyond normal as long as it does not lead to undesirable appearance. Dr. Z, for example, gave his recommendation without looking directly at the X-Ray but based on the Soft Tissue. I know that actually a DJS is meant to fix recession, whereas there are doctors who perform it just for an aesthetic point to get a more harmonious facial profile/face. For example alot of Surgeons actually do a DJS even on not receded x-Rays.
And I think it would look better if everything below the nasal base was more forward and it would have the positive side effect of tightening excess skin.

Would you say I would benefit more aesthetically from a facelift than from a DJS? Do you have any idea how I could get rid of the nasobial folds? And what I could do about the roundness that is visible from the front?

edit: you are right that my chin is from the front asymetrical but it somehow never bothered me and i think its not that noticeable on soft tissue level. I just find that my left side is better looking then the right so maybe there is some causality

Well, if what I say sounds to you like it's the OPPOSITE of what you heard most surgeons (maxfax) say, consider that I'm NOT trying to SELL YOU on surgery and I'm not selectively LEAVING OUT parts of information that would be directly applicable to you. So, YES, I'm telling you something that the doctors DON'T seem to be telling you

As to Dr. Z, he is referring to a 'reverse face lift' something that is applicable to someone (older) with soft tissue VOLUME LOSS to the face whereas the volume loss sags more on people who don't start out with good bone structure. VOLUME LOSS is a key factor in the AGING face. Muscles shrink/atrophy and fat padding is lost. Most of the volume loss is to the SOFT TISSUE and some to the bone structure and this volume loss shows itself as sag and droop and more so on people who don't start out with good bone structure. So, ya, a reverse face lift is of good benefit to THAT type of person.

Seems like he left out the part about VOLUME LOSS to someone who has TOO MUCH (soft tissue) volume and already has pretty HEFTY bones. Did Dr. Z also leave out the part about one side of your chin being BIGGER than the other side? Guess what happens when someone has some asymmetry to the chin and the chin goes forward with a BSSO and/or genio? The asymmetry one didn't see before gets MORE noticeable.

Assuming that the left side of the frontal ceph photo where the chin is BIGGER is the RIGHT side of your face and you like the LEFT side of your face better, then you should consider that a HEFTY bone structure (that you already have) is going to factor into the volume you see on the face. People with a hefty or large bone structure--even if there is some recession to it-- generally have HEFTY soft tissue; bigger muscles.

So, your face is HEFTY because your BONES are HEFTY and hefty bone structure is good but also associated with bigger and stronger MUSCLE tissue as in MORE muscle VOLUME. You don't have 'gravitational' sag and droop due to VOLUME LOSS (muscle atrophy, fat loss) coupled with poor bone support as do older candidates benefiting from a 'reverse face lift'. Again, YOU DON'T HAVE 'EXCESS SKIN' or sag and droop associated with volume loss or weak bone structure. Most likely, you have THICK STRONG MUSCLE TISSUE which is consistent with having BIG and STRONG BONES!

Yet it sounds like you are consulting with doctors (including Z) that are extolling the virtues of reverse face lifts but leaving out selective parts of information such that it is more applicable to people with aging faces with VOLUME LOSS and weakened bone structure than it is to those with HEFTY bone structure and THICK muscle tissue around that.

Hence, when you get your HEFTY bone structure and THICK muscle tissue shifted MORE FORWARD you will see MORE heftiness to the face. So, if you wanted to look more like a foot ball player or wrestler to have more 'BIGNESS' to the face, that would be a great surgery to do that. But the message I'm picking up from you is that you want a more chisled look where your 'bones pop out' (kind of like models have). Well, bones pop out more and show 'chisel' with THINNER soft tissue. But with thick soft tissue, that's going to pop out with the bone advance. So, that goes in direction of MORE HEFTY than more chiseled.

As to 'face lifts', as I said prior, the type would resolve to doctors who do very DEEP tissue reconstruction, some of which involve shaving excess muscle and using very advanced techniques and strong vectors to 'girdle' or 'corset' the muscle tissue to hug closer to the bone. So, that stuff is limited to highly specialized plastic surgeons and outside of the venue of this board.

Moral of story:

Got thinned out soft tissue from muscle atrophy and fat loss that is actually sagging due to aging along with WEAK bone structure? Then a get a 'reverse face lift'.

Already have HEFTY and STRONG bone structure and THICK muscle tissue along with it and also want to pronounce all of that out MORE to look more like a foot ball player or a wrestler, then pronouncing all that more forward will do that for you.

[jshelp]

Well, if what I say sounds to you like it's the OPPOSITE of what you heard most surgeons (maxfax) say, consider that I'm NOT trying to SELL YOU on surgery and I'm not selectively LEAVING OUT parts of information that would be directly applicable to you. So, YES, I'm telling you something that the doctors DON'T seem to be telling you

As to Dr. Z, he is referring to a 'reverse face lift' something that is applicable to someone (older) with soft tissue VOLUME LOSS to the face whereas the volume loss sags more on people who don't start out with good bone structure. VOLUME LOSS is a key factor in the AGING face. Muscles shrink/atrophy and fat padding is lost. Most of the volume loss is to the SOFT TISSUE and some to the bone structure and this volume loss shows itself as sag and droop and more so on people who don't start out with good bone structure. So, ya, a reverse face lift is of good benefit to THAT type of person.

Seems like he left out the part about VOLUME LOSS to someone who has TOO MUCH (soft tissue) volume and already has pretty HEFTY bones. Did Dr. Z also leave out the part about one side of your chin being BIGGER than the other side? Guess what happens when someone has some asymmetry to the chin and the chin goes forward with a BSSO and/or genio? The asymmetry one didn't see before gets MORE noticeable.

Assuming that the left side of the frontal ceph photo where the chin is BIGGER is the RIGHT side of your face and you like the LEFT side of your face better, then you should consider that a HEFTY bone structure (that you already have) is going to factor into the volume you see on the face. People with a hefty or large bone structure--even if there is some recession to it-- generally have HEFTY soft tissue; bigger muscles.

So, your face is HEFTY because your BONES are HEFTY and hefty bone structure is good but also associated with bigger and stronger MUSCLE tissue as in MORE muscle VOLUME. You don't have 'gravitational' sag and droop due to VOLUME LOSS (muscle atrophy, fat loss) coupled with poor bone support as do older candidates benefiting from a 'reverse face lift'. Again, YOU DON'T HAVE 'EXCESS SKIN' or sag and droop associated with volume loss or weak bone structure. Most likely, you have THICK STRONG MUSCLE TISSUE which is consistent with having BIG and STRONG BONES!

Yet it sounds like you are consulting with doctors (including Z) that are extolling the virtues of reverse face lifts but leaving out selective parts of information such that it is more applicable to people with aging faces with VOLUME LOSS and weakened bone structure than it is to those with HEFTY bone structure and THICK muscle tissue around that.

Hence, when you get your HEFTY bone structure and THICK muscle tissue shifted MORE FORWARD you will see MORE heftiness to the face. So, if you wanted to look more like a foot ball player or wrestler to have more 'BIGNESS' to the face, that would be a great surgery to do that. But the message I'm picking up from you is that you want a more chisled look where your 'bones pop out' (kind of like models have). Well, bones pop out more and show 'chisel' with THINNER soft tissue. But with thick soft tissue, that's going to pop out with the bone advance. So, that goes in direction of MORE HEFTY than more chiseled.

As to 'face lifts', as I said prior, the type would resolve to doctors who do very DEEP tissue reconstruction, some of which involve shaving excess muscle and using very advanced techniques and strong vectors to 'girdle' or 'corset' the muscle tissue to hug closer to the bone. So, that stuff is limited to highly specialized plastic surgeons and outside of the venue of this board.

Moral of story:

Got thinned out soft tissue from muscle atrophy and fat loss that is actually sagging due to aging along with WEAK bone structure? Then a get a 'reverse face lift'.

Already have HEFTY and STRONG bone structure and THICK muscle tissue along with it and also want to pronounce all of that out MORE to look more like a foot ball player or a wrestler, then pronouncing all that more forward will do that for you.

I agree with you that of course surgeons have monitary interest, which is why I weight opinion that has no financial interest much stronger. Therefore, a big Thanks  for your input! However, I find it a real shame that surgeons point out relatively few risks or generally talk them down.

Dr. Z has pointed out that my Chin is larger on one side. He has therefore probably recommended either DJS+Genio or DJS+Rhino. Whereby he would have meant that he would recommend rather to DJS+Rhino. I told him that the current asymtery doesn't really bother me. Unfortunately he didn't mention that it could become more prominent.

And yes I think I prefer the left side (from my point of view, on the Ceph the right side so), because there is generally more HEFTY soft tissue. Also characterized by more roundness, which is more straight on the left side (like visible on the front Ceph).

So you don't see me in higher risk of aging "worse" either? It is also often used as an argument that people who are receded show faster signs of aging due to the lack of bone support. That worries me a bit, because I already have deep nasobial wrinkles.

And yes my goal is not to achieve a MORE HEFTY look, like a wrestler or something, but more like you said a more chiseled "model" look.

My burxism probably contributes a part to the HEFTY look right?

Specifically, do you have any recommendations on how to achieve this more chiseled look? Since I thought the enough forward growth is a basic requirement to get a chiseled look at all especially to the jawline.

I am concerned that no matter what doctor/plastic surgeon I go to, he will recommend the procedure he practices himself without using a hollistic approach.

[kavan]

I agree with you that of course surgeons have monitary interest, which is why I weight opinion that has no financial interest much stronger. Therefore, a big Thanks  for your input! However, I find it a real shame that surgeons point out relatively few risks or generally talk them down.

Dr. Z has pointed out that my Chin is larger on one side. He has therefore probably recommended either DJS+Genio or DJS+Rhino. Whereby he would have meant that he would recommend rather to DJS+Rhino. I told him that the current asymtery doesn't really bother me. Unfortunately he didn't mention that it could become more prominent.

And yes I think I prefer the left side (from my point of view, on the Ceph the right side so), because there is generally more HEFTY soft tissue. Also characterized by more roundness, which is more straight on the left side (like visible on the front Ceph).

So you don't see me in higher risk of aging "worse" either? It is also often used as an argument that people who are receded show faster signs of aging due to the lack of bone support. That worries me a bit, because I already have deep nasobial wrinkles.

And yes my goal is not to achieve a MORE HEFTY look, like a wrestler or something, but more like you said a more chiseled "model" look.

My burxism probably contributes a part to the HEFTY look right?

Specifically, do you have any recommendations on how to achieve this more chiseled look? Since I thought the enough forward growth is a basic requirement to get a chiseled look at all especially to the jawline.

I am concerned that no matter what doctor/plastic surgeon I go to, he will recommend the procedure he practices himself without using a hollistic approach.

Well, I 'pick up' on what you want which is the more chiseled look where as doctors 'pick up' and kind of just selectively 'hear' what they can do. So, ya, they (including Z) can advance your jaws and they can advance them more than the recession you actually have and they bring in the 'reverse face lift' that applies to people with VOLUME LOSS and poor bone support but really isn't 'on target' for someone with HEFTY bone structure and thick muscle tissue. Although bringing out the jaws and bringing them out even more than the recession actually is, will resuspend the muscle tissue, it's still resuspending thick muscle tissue. It won't be thinning it to see chisel.

As I said before, the look of aging is due to VOLUME LOSS in people who also have poor bone support. You don't have both of those things. You have the opposite of the former and as to the latter, not too much recession at all. Also, I think the prominent brow bossing might throw them off and who knows, they might want to really advance both jaws a lot to match up with the prominent brow bossing. So, they might be 'hearing' that you want more prominence to the jaws to look MORE HEFTY. No doubt it would give a 'stronger' look as in 'uber masculine' but more in the venue of foot ball player or wrestler rather than a refined chisel that the models have.

Advancement that is just enough to address what ever recession there is would be OK. But once you get into OVER ADVANCEMENT with goal to make the bones really 'pop', that can veer away from territory of model with refined chisel and more into the look of wrestler. Check out the 'Great Khali'. His bones really support his thick muscles because they are so thrusted out. So, I guess someone could say he looks 'chiseled' for that reason.

https://en.wikipedia.org/wiki/The_Great_Khali



And ya, bruxism contributes to thick muscle tissue. So, consider getting THAT treated.

[jshelp]

Well, I 'pick up' on what you want which is the more chiseled look where as doctors 'pick up' and kind of just selectively 'hear' what they can do. So, ya, they (including Z) can advance your jaws and they can advance them more than the recession you actually have and they bring in the 'reverse face lift' that applies to people with VOLUME LOSS and poor bone support but really isn't 'on target' for someone with HEFTY bone structure and thick muscle tissue. Although bringing out the jaws and bringing them out even more than the recession actually is, will resuspend the muscle tissue, it's still resuspending thick muscle tissue. It won't be thinning it to see chisel.

As I said before, the look of aging is due to VOLUME LOSS in people who also have poor bone support. You don't have both of those things. You have the opposite of the former and as to the latter, not too much recession at all. Also, I think the prominent brow bossing might throw them off and who knows, they might want to really advance both jaws a lot to match up with the prominent brow bossing. So, they might be 'hearing' that you want more prominence to the jaws to look MORE HEFTY. No doubt it would give a 'stronger' look as in 'uber masculine' but more in the venue of foot ball player or wrestler rather than a refined chisel that the models have.

Advancement that is just enough to address what ever recession there is would be OK. But once you get into OVER ADVANCEMENT with goal to make the bones really 'pop', that can veer away from territory of model with refined chisel and more into the look of wrestler. Check out the 'Great Khali'. His bones really support his thick muscles because they are so thrusted out. So, I guess someone could say he looks 'chiseled' for that reason.

https://en.wikipedia.org/wiki/The_Great_Khali



And ya, bruxism contributes to thick muscle tissue. So, consider getting THAT treated.

Okay, it makes sense from the doctor's point of view to offer what they themselves can provide. Unfortunately, it is difficult to choose a generally appropriate approach. It makes sense, for example, to treat bruxism with the help of Botox and thus to athrophy the masseter muscles, which already removes some heaviness from the face.

But how to proceed? For example, Buccal fat could be an option, but how do I know if I would really benefit from it or if it could be detrimental, since some surgeons advise against it because it ages faster.

Or for example the excess skin/fat under the chin, I personally believe that this is more of a "skin" problem and there is not much excess fat there. So it would make more sense what you recommended before looking towards "pseude-facelift" instead of liposuction.

So you think the recession I have should not hold me back from achieving a defined look? And doesn't move a frame in which it is visually very negative?

And yes I don't want to achieve an extreme masculine look or anything like "Great Khali".

[kavan]

Okay, it makes sense from the doctor's point of view to offer what they themselves can provide. Unfortunately, it is difficult to choose a generally appropriate approach. It makes sense, for example, to treat bruxism with the help of Botox and thus to athrophy the masseter muscles, which already removes some heaviness from the face.

But how to proceed? For example, Buccal fat could be an option, but how do I know if I would really benefit from it or if it could be detrimental, since some surgeons advise against it because it ages faster.

Or for example the excess skin/fat under the chin, I personally believe that this is more of a "skin" problem and there is not much excess fat there. So it would make more sense what you recommended before looking towards "pseude-facelift" instead of liposuction.

So you think the recession I have should not hold me back from achieving a defined look? And doesn't move a frame in which it is visually very negative?

And yes I don't want to achieve an extreme masculine look or anything like "Great Khali".

All, I wanted to stress here in this string is to be careful of what you ask for, in particular using advancement with the goal of the bones being far forward enough to stretch out the soft tissue and to the extent the 'bones pop' because that would take a lot of advancement and if doctors started interpreting your requests for advancement to stretch all out so there was absolutely no 'excess', you would end up looking close to the Great Khali. So, bottom line is that you DID NOT KNOW what you COULD be getting into if you expressed to doctors you wanted to use advancement to go BEYOND your minor recession and to go beyond it to use it as a means of stretching all out for bones to 'pop'. Because you were on your way to asking for s**t you WOULD NOT WANT.

As to what's under your chin, it could be DEEP fat, muscle tissue and probably not 'excess skin'. As to buccal fat, you DON'T know. 'Re-upholtering the soft tissue to the bones and being braced to deal with DEEP structures under the neck--what ever they are and there are many types--is the stuff of ADVANCED plastic surgeons KNOWN for working very deep to areas under the chin/neck and jaw line. They know what's in there and how to deal with it WHEN THEY OPEN UP THE FACE. Likewise with buccal fat. The pad could be LARGE, medium or small and they only know when they make the incision.

Again, my telling you to be CAREFUL and cautious about the 'reverse face lift' stuff and doctors telling you they can OVER ADVANCE wasn't an 'invitation' to coach you about other stuff.

I think you could get some MODEST improvement with bimax to address what ever modest to minor recession you have. But the more you try to go overboard with advancement to get your bones to 'pop', and for all the tissue to be stretched out, the closer you will get to the wrestler look.

Enclosed is a side by side photo of what you DON'T WANT. Bring it with you to your consults.

(photo removed at the request of the OP).