Author Topic: observations and suggestions for recessed face  (Read 1922 times)

December

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observations and suggestions for recessed face
« on: May 01, 2022, 03:31:17 PM »
Hi I’ve lurked the forums for a few years now. I’m an early 30s male who’s still trying to figure out his options. I’d like to know what the knowledgeable amateurs here see in my pics (link at bottom)

A bit of background: I’ve had serious oral health problems since early childhood until my early teens. I suffered from serious periodontal disease and had several teeth extracted. My first attempts at self-improvement of my face and smile was at 17, when I requested braces in my desperation.

Nov 2009 – dental braces
April 2012—consulted dental surgeon for crown lengthening
May 2012—braces come off
July 2012—interest in chin augmentation
early 2013—first consultation for chin augmentation w implants with plastic surgeon
early 2014—crown lengthening done
mid 2014—tried injectible fillers to augment chin
2013—2017 tried injectible fillers to “even up” crooked smile
2016—consulted Barry Eppley for sliding genioplasty

I don't have more authoritative records with me at the moment. My orthodontist said I had a significant overbite. I don't believe there was ever any mention of orthognathic surgery. The two plastic surgeons I've met remarked on my very small facial bones. I've contacted real maxfacs in my area and so far nobody willing to operate on a healthy patient.

Since 2019 I’ve realized that much of my face is recessed and this is not limited to my chin. That brought me here. Though I’m of East Asian descent, our average regional phenotypes involve stronger facial features than the stereotypical Manchu-Korean type look. My parents and grandparents on both sides had relatively strong features and forward facial growth. Remarkably none of my siblings have as strong features, and I’m the weakest of the bunch.

I've been paying more attention to the upper half of my face, which I believe is the most important for aesthetics, but as I understand it, surgical work in this area comes with the most risks. I think in an ideally safe world, I'd go for a modified LF3 under an experienced surgeon (I suppose we all would).

IMGUR: https://imgur.com/a/h0nBYqG
 
I've been leaning towards maxillomandibular advancement for years now, but two major concerns of mine are the feasibility of this movement given my tooth position relative to the tip of my chin (seems most people who get jaw advancement done have a relatively normal chin; it's just retruded). The other concern is what my malar/infraorbital area would end up looking like. As you can see, my eyes are almost bulging, especially when I squint [pic 2]. There's such a serious lack of support and I'm wondering whether my orbits, like the rest of my face, are smaller than they should be to hold my eye in, if that makes sense. This article (https://www.joms.org/article/S0278-2391(17)31419-2/pdf)I read a few years ago seems to suggest there can be some subjective improvement in malar appearance after just a LF1, but I have a feeling that I'm not in the camp that can get away with this. There is the frequent suggestion of implants to correct this, but I've been against them for years now.

There is also a curious little asymmetry going on with my nasolabial folds [5] and eyebrows and I'm wondering whether it's a cheekbone asymmetry causing this or the orbits, or some interaction I'm not understanding. Left side of my face is noticeably better looking than the right, where my soft tissues seem to uniformly balloon across that whole side [4].

kavan

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Re: observations and suggestions for recessed face
« Reply #1 on: May 01, 2022, 04:54:35 PM »
Some information:

1: If you (still) have periodontal disease, the disease is caused by periodontal PATHOGENS. Those pathogens can get into EITHER a cut to place an implant OR a cut to perform a bone cutting surgery to the jaws and to the chin. They can enter via the blood stream to infect either an implant or a bone cut. So, treatment with aim to ERADICATE the condition (if it still exists) is needed before any surgery through the mouth where cuts are made inside the mouth. Periodontists treat periodontal disease. A 'clearance' from one is best pursued before undertaking any surgery where cuts through the mouth are made.

2: 'Prominent eye', ie. orbital recession can be addressed either by 'modified L3' OR implants. However, this is best reserved for AFTER jaw surgery to best assess the extent of augmentation needed. That is because a Lefort 1 to advance the maxilla can make recessed orbitals (and cheek bones) look MORE recessive by relative comparison. L1s do not advance orbital rims or cheeks. Hence options for upper midface advancement are best evaluated AFTER jaw surgery.

3: Your mandible (including the chin) looks small in ALL directions; anterior-posterior, vertical and go-go (width from jaw to jaw). Plastic surgery aka jaw implants DO NOT address the A-P direction (advancing the jaw forward). It is highly likely you could benefit from the type of jaw/chin implants some PSs do AFTER your mandible is brought forward in the AP direction.

4: Mandible advancement may or may not be achieved as a SINGLE jaw surgery. It would depend on whether or not your maxilla had to be displaced (forward) to achieve the advancement goal set for the mandible and for the BITE to mesh. Chin augmentation alone would not correct the problem of of your mandible being small in all directions.

5: A long time in braces is needed to prepare for a jaw surgery. Prior brace work is 'undone' meaning the bite has to be decompensated to prepare for jaw surgery.

6: smile correction is also a goal of jaw surgery.

7: Soft tissue fillers will not address the extent of recession you have at BOTH the lower jaw and chin.

ETA: as to the statement: "I've contacted real maxfacs in my area and so far nobody willing to operate on a healthy patient." The statement does not ring right to my ears because being in a good state of health (especially dental health) is usually a CONTINGENCY for elective  maxfax  surgery.
« Last Edit: May 01, 2022, 05:11:31 PM by kavan »
Please. No PMs for private advice. Board issues only.

December

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Re: observations and suggestions for recessed face
« Reply #2 on: May 01, 2022, 06:32:59 PM »
Thanks for the reply kavan.

Some information:

1: If you (still) have periodontal disease, the disease is caused by periodontal PATHOGENS. Those pathogens can get into EITHER a cut to place an implant OR a cut to perform a bone cutting surgery to the jaws and to the chin. They can enter via the blood stream to infect either an implant or a bone cut. So, treatment with aim to ERADICATE the condition (if it still exists) is needed before any surgery through the mouth where cuts are made inside the mouth. Periodontists treat periodontal disease. A 'clearance' from one is best pursued before undertaking any surgery where cuts through the mouth are made.

Oh for sure. I plan to meet with my dentist a couple times before even considering this. If I have any left, it's certainly not nearly as bad as it once was.

Quote
3: Your mandible (including the chin) looks small in ALL directions; anterior-posterior, vertical and go-go (width from jaw to jaw). Plastic surgery aka jaw implants DO NOT address the A-P direction (advancing the jaw forward). It is highly likely you could benefit from the type of jaw/chin implants some PSs do AFTER your mandible is brought forward in the AP direction.

4: Mandible advancement may or may not be achieved as a SINGLE jaw surgery. It would depend on whether or not your maxilla had to be displaced (forward) to achieve the advancement goal set for the mandible and for the BITE to mesh. Chin augmentation alone would not correct the problem of of your mandible being small in all directions.

5: A long time in braces is needed to prepare for a jaw surgery. Prior brace work is 'undone' meaning the bite has to be decompensated to prepare for jaw surgery.

Probably a long road ahead for me then. Kind of depressing yet rejuvenating at the same time.

Quote
ETA: as to the statement: "I've contacted real maxfacs in my area and so far nobody willing to operate on a healthy patient." The statement does not ring right to my ears because being in a good state of health (especially dental health) is usually a CONTINGENCY for elective  maxfax  surgery.

I was being sloppy. Come to think of it, I remember asking whether they do cosmetic procedures as well, which could have triggered the misunderstanding, though on a couple surgeons' bios it listed cosmetic surgery as one of their specialties. These were all over the phone, and I think I sold my situation poorly. I think it's more than just a cosmetic issue.

December

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Re: observations and suggestions for recessed face
« Reply #3 on: May 21, 2022, 05:08:28 AM »
Just to be clear, and I think the first reply was talking past me a bit, my brief history there was just that, my history. And I'm not pursuing anything but actual maxfax authorities right now.

PloskoPlus

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Re: observations and suggestions for recessed face
« Reply #4 on: May 21, 2022, 02:59:56 PM »
My guess is that you need a large CCW advancement of your jaws. That would be the most bang for buck aesthetically by far.

December

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Re: observations and suggestions for recessed face
« Reply #5 on: May 22, 2022, 04:22:14 PM »
My guess is that you need a large CCW advancement of your jaws. That would be the most bang for buck aesthetically by far.

Interesting guess. I always had this lingering thought just from moving my jaws back and forth that my lower jaw should swing CCW to meet my upper, which itself seems small.

Any thoughts on the orbits/cheeks?

PloskoPlus

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Re: observations and suggestions for recessed face
« Reply #6 on: May 24, 2022, 01:51:36 AM »
Interesting guess. I always had this lingering thought just from moving my jaws back and forth that my lower jaw should swing CCW to meet my upper, which itself seems small.

Any thoughts on the orbits/cheeks?
Only if you have bulging eyes, popping out of your orbits. In any case, infraorbital advancement would only fix negative vector.  It can't create high cheekbones.  Eye aesthetics are all about shape, size and spacing.  All that surgery can do is make eyes smaller.  If you need that, great. Otherwise you may end up looking worse.

December

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Re: observations and suggestions for recessed face
« Reply #7 on: May 25, 2022, 03:30:44 PM »
Only if you have bulging eyes, popping out of your orbits. In any case, infraorbital advancement would only fix negative vector.  It can't create high cheekbones.  Eye aesthetics are all about shape, size and spacing.  All that surgery can do is make eyes smaller.  If you need that, great. Otherwise you may end up looking worse.

In pic 4 of my link you see how much support my eye lacks it's not truly proptosis but it looks pretty close for not being it.

There's a distinct hollowness/lack of volume around my entire undereye and lateral rim if that's what it's called. I compared this to my siblings, who seem to have similarly shallow orbits, at least my sisters, but they make up for it with something I lack around there that gives them a more lifted and less awkward default facial expression.

I'm not necessarily looking for "high" cheekbones. Well I've been told by everyone I have high cheekbones like the rest of my family...they are just flat.

jawgraphy

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Re: observations and suggestions for recessed face
« Reply #8 on: June 05, 2022, 01:46:49 PM »
IMGUR: https://imgur.com/a/h0nBYqG
 
Not sure why but the image doesnt appear when i click the link...? Has it been removed?

December

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Re: observations and suggestions for recessed face
« Reply #9 on: June 09, 2022, 06:46:05 PM »
IMGUR: https://imgur.com/a/h0nBYqG
 
Not sure why but the image doesnt appear when i click the link...? Has it been removed?

Yes I removed the link lemme repost for you.

https://imgur.com/a/qVju072