Advice on surgical plan - chin wing + buccal fat?

[Complex]

Hi there!

I am planning to undergo aesthetic surgery in one month.

My aim is to look conventionally more attractive. I think the 'worst' features of my face are that my chin is recessed and that I generally don't appear lean despite having a relatively low BF % (and due to both of these I don't really have a defined jawline).
The surgery I was originally planning to undergo is chin wing + buccal fat removal, but I am now having some second thoughts about whether that is the right procedure for me.

In particular, I would like to gather some more opinions of whether I should opt for a more drastic procedure, such as bimax to achieve better results. I am aware that this a decision I ultimately have to make myself and would just love to get some more input.

Here is an imgur link to pictures of... a CT scan (I know, poor quality), myself in relative good angles, myself in poor angles (aka situations where I would like to look better), and morphs/technical drawings I got from my surgeon. For the technical drawing, left is me currently, middle is after chin wing + buccal, right is after jaw implants + genio. I was between ~13-15% body fat for all of these pictures (abs slightly visible). I sadly don't have a ceph right now (hopefully will receive it tmrw).

https://imgur.com/a/w9wOS02

What do you think? In particular, I would be curious if you believe whether for me the potential aesthetic (+ functional) benefits of a bimax would outweigh the extra costs involved with a more invasive procedure (all costs; monetarily, risk, duration) compared to chin wing + buccal?
Thank you for reading! Any comments are appreciated

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Some more details follow here. I would love to put these into a spoiler but I couldn't find the option. 

• I consulted with five maxillo-facial surgeons. All agreed that surgery could make sense in my case. None of the five surgeons I talked to really suggested a bimax to me though. (I am not traumatised by how I currently look - I just want to look better if possible). However, when talking to the surgeons I also didn't really know the "options" I had yet, or what is commonly done, so I didn't explicitly ask either. However, if the end result is likely gonna be a lot better (perhaps 1 point on a 1-10 attractiveness scale), then I would be willing to take on the extra cost and effort.
• I have a slight overbite but had braces when I was younger and have retainers. I never had any functional problems with my teeth.
• I've been told that I have large masseter muscles and this may contribute to why my face doesn't look lean despite low bf. I don't grind my teeth but my cheeks can be tense when I am stressed (but I am not stressed that often tbh). When around people, I also automatically tend to fake that my lip competence (which I don't have otherwise) which means that my cheeks tend to feel sore when socialising for 5 hours+
  
• I am 24, pics are from 23-24 mostly.
• I also talked about jaw implants with my surgeon. He strongly suggested against these because they wouldn't fit my small face (according to him). I also favor the option without implants, hence the plan to go with chin wing.
• I don't think I have severe sleep apnea. I never snored or experienced excessive daytime sleepiness (although I do sometimes tend to nap when not sleeping exceptionally well, I am exclusively a side sleeper). Since I don't have the symptoms, I wasn't able to get tested in a sleep lab yet. I have asthma (or generally: ~20% below average lung function and volume) - one surgeon even suggested that I don't asthma but only narrow airways.
• I also posted this on another ('looksmaxx'...) forum and there the consensus was that chin wing is not a good option for me, and I should opt for bimax. I have now arranged for another consultation with a maxillo-facial surgeon to talk about this specifically.

[Tomasjohn]

I think the 'worst' features of my face are that my chin is recessed and that I generally don't appear lean despite having a relatively low BF % (and due to both of these I don't really have a defined jawline).

The reason you don't have a defined jawline is because you don't have a defined jawline (the bone structure of the jaw) and not because you don't appear lean. So the problem in your case (my opinion) is the bone structure and not the other way around. A stronger chin does not result in a stronger jawline but will help with double chin and stretch the soft tissue a bit and could make you appear leaner I guess.

Here is an imgur link to pictures of... a CT scan (I know, poor quality), myself in relative good angles, myself in poor angles (aka situations where I would like to look better), and morphs/technical drawings I got from my surgeon.

I would just post neutral pictures. The collage is confusing in my opinion.

I also posted this on another ('looksmaxx'...) forum and there the consensus was that chin wing is not a good option for me, and I should opt for bimax. I have now arranged for another consultation with a maxillo-facial surgeon to talk about this specifically.

If I assess this correctly I would say you have a rather steep mandibular plane (steep angles). Most good chin wing results I have seen had steep angles as a starting point. Because they benefit from vertical movement. You would probably be a good candidate aesthetically speaking.

Out of curiosity: Who is the cw surgeon?

Btw:
- No to bimax
- No to b-fat removal

[GJ]

It's hard to justify bimax in a case like this (i.e. normal looks) without any bite problem. Will have to have another look in the morning when I have more time. General impression is a genio should work well. I've never seen a good buccal fat removal case. I'm not sure what the goal would be in your case, but if it's to look more masculine or chiseled just grow a beard instead. This would help with the boyish looks, and it's much safer than buccal fat removal.

[kavan]

The reason you don't have a defined jawline is because you don't have a defined jawline (the bone structure of the jaw) and not because you don't appear lean. So the problem in your case (my opinion) is the bone structure and not the other way around. A stronger chin does not result in a stronger jawline but will help with double chin and stretch the soft tissue a bit and could make you appear leaner I guess.

  Very on target statement and observation.

I would just post neutral pictures. The collage is confusing in my opinion.

Collage photos not good ones. But he has a front and profile on his imgur page if you scroll down.
 

If I assess this correctly I would say you have a rather steep mandibular plane (steep angles). Most good chin wing results I have seen had steep angles as a starting point. Because they benefit from vertical movement. You would probably be a good candidate aesthetically speaking.

Not really steep MPA but mostly looks like short ramus. But still, the chin wing allows for a 'drop down' to increase vertical height of mandible. So, vertical elongation along mandibular border along with some advancement of the segment. So, ya, basically correct.

Out of curiosity: Who is the cw surgeon?

Btw:
- No to bimax
- No to b-fat removal

If the bite is good than no bimax needed and decision as to buccal fat removal can be made at a later time.
The 'drawings' or morphs show some cheek augmentation as in something one would get with cheek implants. They DON'T depict buccal fat removal. That is to say buccal fat removal would not make the cheeks look they look in the 'drawings'. Also, the back angle of the jaw (post chin wing) in the drawings would not be as 'square' or sharp as the second drawing. It would be closer to the first drawing.  So, first drawing of both sets is more realistic communication tool for the JAW. But not good realistic communication tool for buccal fat removal. (because that procedure does not 'chisel' the cheek bones).

[Tomasjohn]

Not really steep MPA but mostly looks like short ramus. ...

Thank you for clarifying.

Also, the back angle of the jaw (post chin wing) in the drawings would not be as 'square' or sharp as the second drawing. It would be closer to the first drawing.  So, first drawing of both sets is more realistic communication tool for the JAW. ...

The first drawing is actually the chin wing prediction and the second one is genio + jaw  implants if i understand the initial post correct. And i agree that it is not unrealistic.
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For the technical drawing, left is me currently, middle is after chin wing + buccal, right is after jaw implants + genio. ...

[Complex]

Thank you already everyone for your thoughts!

The reason you don't have a defined jawline is because you don't have a defined jawline (the bone structure of the jaw) and not because you don't appear lean. So the problem in your case (my opinion) is the bone structure and not the other way around. A stronger chin does not result in a stronger jawline but will help with double chin and stretch the soft tissue a bit and could make you appear leaner I guess.

I will try to create a morph of myself to better visualize this, but taking a random picture of google images: https://i.pinimg.com/originals/58/ee/47/58ee47ad9d9345c4a7f3996bce01d4df.jpg
My profile is currently closer to the lower right, but I would like to change it to be more like the upper right image (I care more about my 3/4 profile instead of my side profile, but I think my 3/4 profile would also be significantly improved if the side profile is changed like that).
So what would conceptually need to happen for me to have a defined jawline is that my literal jawline would need to be moved 'down', correct (whether via BSSO/chin wing/whatever)?
[EDIT: Trying to create a morph now but struggling a little bit. Is there a recommended way to do so? (I'm just trying to use photoshop right now, e.g., https://helpx.adobe.com/photoshop/how-to/face-aware-liquify.html, and some Apps like AirBrush.]

I'm not sure what the goal would be in your case, but if it's to look more masculine or chiseled just grow a beard instead. This would help with the boyish looks, and it's much safer than buccal fat removal.

So generally my goal is literally to look more 'conventionally attractive' (because I think it would increase my QOL). But your guess is correct: I think what would help me most with being more conventionally attractive is acquiring a more masculine or chiselled appearance. And I think what most keeps me from having a masculine or chiselled appearance is that I don't have a defined jawline and that I have very round (opposed to more hollow, see also the top left vs bottom left in the picture above) cheeks.
(I sadly can't grow a proper beard yet. But I will probably look into a beard transplant after I try to improve my bone structure haha)

I think a mistake I made so far is that I didn't really properly show surgeons what 'after' picture I want. I consulted with a surgeon today and she also mentioned that a bimax would definitely be a risky (and costly) operation for purely aesthetic purposes but she didn't completely reject the idea (especially because I might have some slight functional issues that will be improved by it - apparently I have a slight open bite as well as potentially upper airway resistance syndrome (UARS)). The third option she sees (apart from chin wing or a form of bimax) is doing a long genio/short chin wing (that doesn't include the jaw angles) and jaw angle implants - so the third option I also discussed with my surgeon I was planning to operate with. I acknowledge that so far from the forum it's a clear 'no' to bimax and will take that into account, thank you everyone.


Is there a particular reason why you dissuade me from a bichectomy (buccal fat removal)? I know of the usual risks and asked my surgeon about them but he said that I would be a good candidate nonetheless (and the idea was initially suggested by him because I mentioned the round appearance of my cheeks). I also explicitly told him to NOT remove a lot of buccal fat and basically only do the removal if it appears to make sense when he is operating me. According to the same surgeon, hollow cheeks are generally achieved via forward growth + high, forward zygos + prominent jaw angles + thin skin and very little buccal fat - this appears plausible to me. Would you suggest I only do buccal fat removal, if at all, separately after the initial surgery (or that I even go the opposite route and instead augment my cheekbones)?

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The first drawing is actually the chin wing prediction and the second one is genio + jaw  implants if i understand the initial post correct. And i agree that it is not unrealistic.

This is correct; apologies I will try to make it clearer now.

Out of curiosity: Who is the cw surgeon?

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PMed you. If anyone else is curious, feel free to PM me.

Also, apologies if some of my questions are still very naive. I have not found a good comprehensive resource about jaw surgery yet and most of what I know comes from checking the most common face surgeries on realself or seeing a surgery mentioned somewhere in a forum, then googling it.

[GJ]

Is there a particular reason why you dissuade me from a bichectomy (buccal fat removal)?

Mainly because I've never seen or heard of a good result, and only have seen and heard the opposite. I don't go looking for results online, so maybe there are good results there, but on this forum the few people who have done buccal fat removal ("Jay" comes to mind, but there were a few others. Maybe five total so a small sample) didn't like the results at all. I'm biased because of that.

[kavan]

Thank you for clarifying.

The first drawing is actually the chin wing prediction and the second one is genio + jaw  implants if i understand the initial post correct. And i agree that it is not unrealistic.
-->

OK, you are correct. I now see he wrote that in his post but he didn't write that directly under the morph presentation and what ever was written under the drawings on the link was too small for me to read. Thing is (at least for me), it's best to describe which is which, especially a morph, directly on the photo presentation. Lest the description of which is which is on a separate link than the photo presentation within a bunch of other verbal stuff. None the less, I could tell right off the bat that the first morph (lower jaw) would be closer to a chin wing than the second one.

[IconVillage]

I am in a similar position as you. Not a typical bimax candidate and have decided against it due to the potential complications and changes to the nose. I had a genioplasty and buccal fat removal previously and I'm happy with both the results, although the buccal fat removal has highlighted just how narrow my jaw actually is. I was thinking my next step would be a chin wing/side wing, but I believe I am going to do filler on the jawline first to emulate any potential changes to see if I would even like the results of increased mass on the mandible the first place. I'd also been considering a jaw implant, but there have been so many disastrous and unrealistic cases that I am weary.

[Tomasjohn]

I am in a similar position as you. Not a typical bimax candidate and have decided against it due to the potential complications and changes to the nose. I had a genioplasty and buccal fat removal previously and I'm happy with both the results, although the buccal fat removal has highlighted just how narrow my jaw actually is. I was thinking my next step would be a chin wing/side wing, but I believe I am going to do filler on the jawline first to emulate any potential changes to see if I would even like the results of increased mass on the mandible the first place. I'd also been considering a jaw implant, but there have been so many disastrous and unrealistic cases that I am weary.

I am glad you are happy with the results.
Just broadcasting my thoughts here: Filler do not necessarily emulate CW results. There is at least one CW doctor who also sometimes uses filler in his clinic. So you can maybe combine a consultation for CW and also discuss the use of filler in regard to your goals.

[IconVillage]

I am glad you are happy with the results.
Just broadcasting my thoughts here: Filler do not necessarily emulate CW results. There is at least one CW doctor who also sometimes uses filler in his clinic. So you can maybe combine a consultation for CW and also discuss the use of filler in regard to your goals.

Yeah, thinking it over it would probably be useless to get filler first as it wouldn't fully emulate the CW results (chin wing wouldn't have the same angularity that fillers could produce). It would also be a pain to dissolve it all as jawline filler is usually a lot more than what is used on the rest of the face. I will probably just opt for the chin wing first and use filler down the line to define the angles if I'm not fully happy with the CW result. It's just scary to have a seemingly irreversible procedure without many reference points, as the procedure is only performed by a few doctors and the results are relatively unpredictable.

[Complex]

Yeah, thinking it over it would probably be useless to get filler first as it wouldn't fully emulate the CW results (chin wing wouldn't have the same angularity that fillers could produce). It would also be a pain to dissolve it all as jawline filler is usually a lot more than what is used on the rest of the face. I will probably just opt for the chin wing first and use filler down the line to define the angles if I'm not fully happy with the CW result. It's just scary to have a seemingly irreversible procedure without many reference points, as the procedure is only performed by a few doctors and the results are relatively unpredictable.

Just curious: I have read a few times now that chin wing has relatively unpredictable results. Is there a reason why chin wing would be more unpredictable than other similar surgeries (implants, genioplasty) or are you just saying because surgeries like these are generally unpredictable?