How much would DJS help me aesthetically?

[nbl589]

I have minor sleep apnea but am considering jaw surgery for aesthetic purposes. I consulted with a surgeon and he seemed to agree it would be useful aesthetically but wanted to get some other opinions. From what I can tell I have recession on both sides of my face but my right side is more recessed than my left, which is obviously a big problem as I think the asymmetry compounds the recession. It seems to me like both my zygomatic arch and maxilla are more recessed on the right side. Furthermore, this makes my septum look as though it is deviated to the left, although I’m unsure if there is actual deviation or it is because the right side of my mid face is just more retruded than the left. The recession also makes my hairline look too high and I am considering having it lowered after all other surgeries are complete. My eye area has pretty bad asymmetry as well due to ptosis and a negative canthal tilt so I will be getting that fixed as well.

I have x-rays attached in the Imgur link, although the ceph was taken about a year after the photos and my BF% is higher at the time of the ceph. I would say overall I’m aiming for a similar result as the case in Figure 5 in this paper: https://www.thepmfajournal.com/features/features/post/mid-facial-augmentation-with-malar-implants

My current surgical plan is:

Bimax

Malar-infraorbital rim implants to fix upper mid face asymmetry and correct hollow under eyes

Eyelid surgery (lower eyelid retraction, ptosis surgery, canthopexy)

And then if needed hairline lowering and rhinoplasty

I had a couple questions and was wondering if these surgeries sound like they would help aesthetically:

1. My surgeon seemed to imply that a bimax could also fix a deviated septum - is this really true?
2. Can a bimax fix depth asymmetry? What I mean by that is I know the jaws can be moved left or right, but if one aspect of the maxilla and mandible is more recessed, can a bimax bring them into symmetry?
3. Aesthetically, do you think a bimax is needed, or will midfacial implants be enough to correct the asymmetry and recessed look?
4. What would the best order be to do these surgeries? I would assume bimax -> infraorbital+malar implants -> eyelid surgery?

[GJ]

This isn't a surgical case. If a surgeon is willing to operate, I'd be skeptical of that person.

To answer your question, though: I think you're taking on risk of looking worse. The odds you will look better are very slim. If you're doing it for apnea then it could be justified, but I think the probability is that you'll look worse.

[nbl589]

This isn't a surgical case. If a surgeon is willing to operate, I'd be skeptical of that person.

To answer your question, though: I think you're taking on risk of looking worse. The odds you will look better are very slim. If you're doing it for apnea then it could be justified, but I think the probability is that you'll look worse.

Do you think looking into something like an MSE treatment would be worth it, or is there really no benefit to be gained for me personally by altering the maxilla?

[InvisalignOnly]

OP, you're really good looking. Please don't get any surgeries, especially not jaw surgery. Any surgeon willing to do jaw surgery on you is simply unethical. If you have money to spend, maybe invest in counselling instead.

[GJ]

Do you think looking into something like an MSE treatment would be worth it, or is there really no benefit to be gained for me personally by altering the maxilla?

I'm not really sure. MSE is not my forte.

But I'd think if your airway/apnea problem is in the upper airway that could help, in theory. But wait for someone who knows more about MSE to chime in.

[kavan]

DJS can only help what it's aimed to correct which does NOT include everything on your bucket list such as cheeks, eye ptosis, tilt or nasal septum asymmetry, hair line recession etc. which are all above the Lefort 1 cut line area of the maxilla.

Aesthetic issues above the Lefort 1 area are best addressed separately and AFTER DJS. So, I won't be opining on those other than to tell you the ORDER of surgeries is DJS first and areas above the L1 cut line are addressed afterwards. I shall limit my opinion to DJS only since that is the title of the thread. Furthermore, I shall limit my opinion to HIGHLY GENERAL info ONLY given that your question alone reveals to me that you know very little about DJS. So, nothing in your question/presentation gives me any indication that you would have the research/foundation underbelt for me to 'spring board' off of when rendering information.

That said, all I can say here is that DJS would advance out both of your jaws which would correct some recession you have there. Braces would be needed to prepare for it. The L1 would tend to advance out the base of your nose and help de-rotate the tip area somewhat. The BSSO would of course, advance out your lower jaw and in general, that would tend to be beneficial to the areas they aim to correct. Asymmetries to the L1 area of the maxilla can be addressed via 3 piece Leforts.

DJS advancement will indeed make any recession you have above the area (cheeks, eyes) look MORE recessive to you than they look already and LATER would come in the persuit of correcting those separately. Likewise with the nose which might be helped by the advancement at it's base (some derotation of the tip) but further rhino refinements might be needed afterwards.

Please realize that jaw surgery is an incredibly SPECIFIC surgery which involves a MULTITUDE of specific displacements, rotations, orthodontic preparation and PERMUTATIONS thereof which all need to be CALCULATED for each unique individual's situation in a highly specific surgical plan. It is a MULTI-VARIABLE 'equation' that can have a RANGE of appropriate displacements and movements in accordance to the surgeons ability and/or aesthetic preferences. Surgical abilities and aesthetic preferences VARY from surgeon to surgeon and even among the REALLY GOOD ones, aesthetic preferences can differ.

You bring NO specifics to the table here such as a displacement plan from a surgeon. Nor do you even name the surgeon. So no way to tell if you have an advanced one or a run of the mill 'garden variety' guy. But you want to know 'specifically' or 'how much' DJS would help you. There is NO WAY to answer that for you and the fact you need that answered here is the VERY THING that tells me you lack the foundational knowledge to be pursuing this type of surgery.

So, if you really want to know how much DJS will help you, sorry to say that the answer will depend on how good of a surgeon you have and how 'on target' his PLAN is for you. None of that info is available to any of us here to reference.

[nbl589]

DJS can only help what it's aimed to correct which does NOT include everything on your bucket list such as cheeks, eye ptosis, tilt or nasal septum asymmetry, hair line recession etc. which are all above the Lefort 1 cut line area of the maxilla.

Aesthetic issues above the Lefort 1 area are best addressed separately and AFTER DJS. So, I won't be opining on those other than to tell you the ORDER of surgeries is DJS first and areas above the L1 cut line are addressed afterwards. I shall limit my opinion to DJS only since that is the title of the thread. Furthermore, I shall limit my opinion to HIGHLY GENERAL info ONLY given that your question alone reveals to me that you know very little about DJS. So, nothing in your question/presentation gives me any indication that you would have the research/foundation underbelt for me to 'spring board' off of when rendering information.

That said, all I can say here is that DJS would advance out both of your jaws which would correct some recession you have there. Braces would be needed to prepare for it. The L1 would tend to advance out the base of your nose and help de-rotate the tip area somewhat. The BSSO would of course, advance out your lower jaw and in general, that would tend to be beneficial to the areas they aim to correct. Asymmetries to the L1 area of the maxilla can be addressed via 3 piece Leforts.

DJS advancement will indeed make any recession you have above the area (cheeks, eyes) look MORE recessive to you than they look already and LATER would come in the persuit of correcting those separately. Likewise with the nose which might be helped by the advancement at it's base (some derotation of the tip) but further rhino refinements might be needed afterwards.

Please realize that jaw surgery is an incredibly SPECIFIC surgery which involves a MULTITUDE of specific displacements, rotations, orthodontic preparation and PERMUTATIONS thereof which all need to be CALCULATED for each unique individual's situation in a highly specific surgical plan. It is a MULTI-VARIABLE 'equation' that can have a RANGE of appropriate displacements and movements in accordance to the surgeons ability and/or aesthetic preferences. Surgical abilities and aesthetic preferences VARY from surgeon to surgeon and even among the REALLY GOOD ones, aesthetic preferences can differ.

You bring NO specifics to the table here such as a displacement plan from a surgeon. Nor do you even name the surgeon. So no way to tell if you have an advanced one or a run of the mill 'garden variety' guy. But you want to know 'specifically' or 'how much' DJS would help you. There is NO WAY to answer that for you and the fact you need that answered here is the VERY THING that tells me you lack the foundational knowledge to be pursuing this type of surgery.

So, if you really want to know how much DJS will help you, sorry to say that the answer will depend on how good of a surgeon you have and how 'on target' his PLAN is for you. None of that info is available to any of us here to reference.

My surgeon was Derek Steinbacher, who as far as I am aware is renowned for this aesthetic knowledge. But I am definitely not going to go through with it if it is not warranted - but such a highly regarded surgeon recommending it made me think I am

[LeFort 3000]

you wont benefit from djs

[kavan]

My surgeon was Derek Steinbacher, who as far as I am aware is renowned for this aesthetic knowledge. But I am definitely not going to go through with it if it is not warranted - but such a highly regarded surgeon recommending it made me think I am

So, what aesthetic knowledge did he share with/convey to you as to 'how much' DJS  would help you aesthetically?
Did you ask him the same questions you ask here?  All you convey is that he 'seemed to agree it would be useful aesthetically'. Be that as it may, it doesn't 'seem' you came out of the consult with much information at all.