Disappointing simulations, bad facial thirds and lower face ratio.

[Optimistic]

Just got some frontal simulations back and I have to say I'm pretty disappointed with the result. I'll definitely be leaving out rhinoplasty as it made me realise my nose is just fine as it is, although I already knew that. I was mostly a little bit curious. In fact, the nose they simulated for me made me look like that freak Luka Magnotta (weird triangular nose from a bad rhino).  The most striking thing I noticed was how "long" it made my face look.

Originally I thought maybe I just wasn't used to how my face would look post-op, however now I've been able to work out exactly what it is. When my chin is recessed as it is now it gives my face a more balanced facial thirds front on. When the chin is brought forward it reveals that it's ever so slightly too low. I played around with the simulations in photoshop a little bit and the results of raising the chin a tiny amount to give the lower face a correct ratio of 43:57 are staggering.

I didn't want to bother the person doing the simulations asking him to re-do anything as I'd already replicated the desired result, instead I think I'll speak to the surgeons a bit more about whether or not this can be achieved.

My questions are:

1. Say it can be done, how close to that ratio can they get? I've read here that anything involving bone can be predicted with 100% accuracy and it's just a question of the soft tissue which is at times more unpredictable.

2. How would this effect the chin in profile? Could raising it up make the chin look too big and "squashed up"? Would they also need to make the chin fractionally smaller and more proportionate too?

3. Finally, I had to draw this part out, but they made my face look very "boxed" which doesn't suit me at all. 1. Is how it was simulated by them. 2. Was how it would look if I left that initial sort of tapering in and then adding in the stronger more angular jawline. I felt #2 suited my face far more, and also appeared natural. I hope this makes sense to you all. I might throw some of the real simulations up later if this gets all too complicated. I know what ultimately matters is my opinion as it's my face, but based on what I've drawn could anyone comment on what they feel is objectively the more aesthetic result as a rule. I've seen people with chin implants that have a similar facial shape to 1. and it always strikes me as weird and unnatural.

[jusken]

By simulations do you mean there is a soft tissue component along with the skeletal movements?

[Optimistic]

Yes, like morphs of medical photos taken there.

[jusken]

I don't really see how anyone can put too much value on those right now.  These types of simulations would have to be unbelievably accurate to be of any use at all to someone in my opinion.  This is an inaccurate image that you then make a decision on?

I work in the game industry, and a soft tissue simulator for governing aesthetics is just ludicrous at this state.  Imagine the day games or movies use generated models of human skeletons for their characters as one of the primary inputs for their appearance.  Then a computer would simulate the motion and position of their skin and tissues - and that would be the character you saw instead of how it is now... which is basically modeling outward-in.

It's a long, long way off from being useful in my opinion. 

[Optimistic]

I would have to disagree with you on that. I've read quite a few different surgeons books as well as seen a lot of morph vs result type things around the web. When you're talking about things like chin projection it's very accurate (about 80-85% like the end result). Sure for rhinoplasty and malar osteotomy that can be near impossible to properly do, so take that with a grain of salt.

I feel that soft-tissue simulations present a good general idea of what to expect along with what the surgeon is hoping to achieve aesthetically. If you don't believe me then it might be worth looking some comparisons. In the end all it really is is making realistic assumptions and from that simulations with photoshop.

Edit: I suppose what I'm trying to say is that even if it isn't 100% what the end result will look like it still allows me as a patient to visualise what changes the doctor had in mind, and so with that we can discuss further my goals with surgery. And with the lower-face ratio I think that would have to be pretty accurate as it's really just bringing what's there forward, so soft tissue wouldn't play that large of a role, would it? In any case I'm not too worried, anything will be a big improvement over what I've got now.

[Lazlo]

I would have to disagree with you on that. I've read quite a few different surgeons books as well as seen a lot of morph vs result type things around the web. When you're talking about things like chin projection it's very accurate (about 80-85% like the end result). Sure for rhinoplasty and malar osteotomy that can be near impossible to properly do, so take that with a grain of salt.

I feel that soft-tissue simulations present a good general idea of what to expect along with what the surgeon is hoping to achieve aesthetically. If you don't believe me then it might be worth looking some comparisons. In the end all it really is is making realistic assumptions and from that simulations with photoshop.

Edit: I suppose what I'm trying to say is that even if it isn't 100% what the end result will look like it still allows me as a patient to visualise what changes the doctor had in mind, and so with that we can discuss further my goals with surgery. And with the lower-face ratio I think that would have to be pretty accurate as it's really just bringing what's there forward, so soft tissue wouldn't play that large of a role, would it? In any case I'm not too worried, anything will be a big improvement over what I've got now.

this is interesting stuff. who did the simulations for you? a PS? which one?

[overbiter]

Where did you get that info about the 43:57 ratio from? You're saying the lower two thirds should be 57 percent of the face? What are you basing this aesthetics data on?

Image number 2 seems the more classical shape for a male jaw line, but image 1 is similar to what Ryan Gosling has and he's one of the biggest movie stars in the world right now.

[Optimistic]

Where did you get that info about the 43:57 ratio from? You're saying the lower two thirds should be 57 percent of the face? What are you basing this aesthetics data on?

Image number 2 seems the more classical shape for a male jaw line, but image 1 is similar to what Ryan Gosling has and he's one of the biggest movie stars in the world right now.

What I meant was that the lower face should be divided into a 43:57 ratio. So if we take the entire lower face to be 100%, then from the nasion to the subnasale should comprise 43% of that 100%, and from the subnasale to the menton should be the remaining 57%. Or to make it easier, from the glabella to the subnasale should be the same distance as from the subnasale to the menton (that would be true facial thirds, or a ratio of 50:50 for the lower face using those measures)

I don't know who Ryan Gosling is, but I believe the jaw-type shown in image 1 is far riskier. I really think you've just got to be born with it. This could be pseudo-science, but if you have a jawline that strong and harsh it's likely you posess other very masculine and high-test-indicative features such as a strong brow, wider face. idk. In any case, it's safer to go with #2 starting off as it's closer to my face as it is now, so I don't risk looking too different. I also feel it's better to do too little than too much which this stuff.

this is interesting stuff. who did the simulations for you? a PS? which one?

The simulations were done by a doctor who works with Prof Mommaerts. When I had my consultation there they took photos and mm spoke to him and explained what I wanted done. Later on that doctor e-mails you with the simulations. Because he hasn't personally done these, as well as taking into account the fact that they are just morphs, I'm not taking it too seriously. As said above though, it will give me something to go back to him with regarding the aesthetic outcome.

A question for you Lazlo, if I may... I have mild lip incompetence. I was looking at the distance between my lips when totally relaxed and the amount by which I raised my chin in the morphs, and they're about the same. Would I be right in assuming that to fix it they'll have to raise the chin up? Or do they do something else?

[Lazlo]

What I meant was that the lower face should be divided into a 43:57 ratio. So if we take the entire lower face to be 100%, then from the nasion to the subnasale should comprise 43% of that 100%, and from the subnasale to the menton should be the remaining 57%. Or to make it easier, from the glabella to the subnasale should be the same distance as from the subnasale to the menton (that would be true facial thirds, or a ratio of 50:50 for the lower face using those measures)

I don't know who Ryan Gosling is, but I believe the jaw-type shown in image 1 is far riskier. I really think you've just got to be born with it. This could be pseudo-science, but if you have a jawline that strong and harsh it's likely you posess other very masculine and high-test-indicative features such as a strong brow, wider face. idk. In any case, it's safer to go with #2 starting off as it's closer to my face as it is now, so I don't risk looking too different. I also feel it's better to do too little than too much which this stuff.

The simulations were done by a doctor who works with Prof Mommaerts. When I had my consultation there they took photos and mm spoke to him and explained what I wanted done. Later on that doctor e-mails you with the simulations. Because he hasn't personally done these, as well as taking into account the fact that they are just morphs, I'm not taking it too seriously. As said above though, it will give me something to go back to him with regarding the aesthetic outcome.

A question for you Lazlo, if I may... I have mild lip incompetence. I was looking at the distance between my lips when totally relaxed and the amount by which I raised my chin in the morphs, and they're about the same. Would I be right in assuming that to fix it they'll have to raise the chin up? Or do they do something else?

I don't understand what distances you're referring to, could you show me a pic and tell me what distances are the "same length"

[Optimistic]

I don't understand what distances you're referring to, could you show me a pic and tell me what distances are the "same length"

You mean for the lip thing, or the facial ratios?