How can I fix my face

[Tomasjohn]

Main issue here is that you have a prominent nasal spine (ANS) which is the thing that contributes to the appearance of your lower jaw looking relatively recessed compared to your upper jaw. So, ANS would need to be cutdown/reduced. That would resolve to what's called a DEPROJECTION RHINOPLASTY. So, if you got that, your lower jaw area would look MORE in balance with the upper jaw.

With the PROMINENT ANS as it is now, you would look TERRIBLE if the upper jaw was advanced BUT the ANS was not reduced in the process. So IF you got a double jaw surgery and ALSO IF the upper jaw needed to be advanced to 'mesh' with a lower jaw advancement, you would need to have a surgeon who could DEPROJECT the ANS as part of the process.

Most jaw surgeries for people who have had prior ortho (or even those who have not), the bite  needs to be DECOMPENSATED. But INSTEAD of using that term, let's keep it SIMPLE and just say it's more likely than not that the teeth will need to be put in BRACES to prepare for the displacements of the surgery.

Aesthetically speaking, you look like a candidate for SINGLE lower jaw surgery and deprojection rhinoplasty. It's also looking like if you found a good rhino surgeon to perform the deprojection rhino and did that first, your lower jaw would look LESS recessive than it does now when compared to the prominent ANS that makes your upper jaw look too PROTRUSIVE, in which case, you could re-evaluate the jaw balance and perhaps decide not to get a single lower jaw advancement at all.

In closing your PROMINENT ANS is what's throwing off aesthetic jaw to jaw balance and contributing to the LOOK/appearance of your maxila area looking TOO protrusive which in turn makes your lower jaw look retrusive via RELATIVE COMPARISON.

By the way, thanks. Always cool to hear about this stuff. First time I heard about the nasal spine for example. It would be really cool if there is a checklist / guideline for users if one wants to analyze his/her or other faces that includes all those details.

[kavan]

By the way, thanks. Always cool to hear about this stuff. First time I heard about the nasal spine for example. It would be really cool if there is a checklist / guideline for users if one wants to analyze his/her or other faces that includes all those details.

Glad to hear that, as usual, you are receptive and understand the info I provide. You observed the large nasolabial angle and predicted the angle would get more obtuse with advancement and no conceptual problem for you to relate the large NLA to the prominent ANS when that was mentioned. However, as you have seen on this thread, when ever I provide info to the OP which I break down to make as intuitive as possible and then I find they can't 'digest' it, I give up on those types.

[TheGerman]

Glad to hear that, as usual, you are receptive and understand the info I provide. You observed the large nasolabial angle and predicted the angle would get more obtuse with advancement and no conceptual problem for you to relate the large NLA to the prominent ANS when that was mentioned. However, as you have seen on this thread, when ever I provide info to the OP which I break down to make as intuitive as possible and then I find they can't 'digest' it, I give up on those types.

I don't know why you imply I am dumb I simply don't really agree? I don't think shaving the ANS is a good idea. My main problem seems to be downward growth.

[kavan]

I don't know why you imply I am dumb I simply don't really agree? I don't think shaving the ANS is a good idea. My main problem seems to be downward growth.

I have no objection to what ever you think the solution to your problem is.

[TheGerman]

I have no objection to what ever you think the solution to your problem is.

I have consulted surgeons and I will consult a few more. Noone mentioned ANS shaving. So make of that what you will

[Gadwins]

I have consulted surgeons and I will consult a few more. Noone mentioned ANS shaving. So make of that what you will

Du solltest lieber dein Leben leben und diese ganze Geschichte schleunigst vergessen, bevor du dich in irgendwas hier rein reitest.

[TheGerman]

Du solltest lieber dein Leben leben und diese ganze Geschichte schleunigst vergessen, bevor du dich in irgendwas hier rein reitest.

Was meinst du? Ich brauche doch bimax + genio, wo ist das Problem? Lebe ja trotzdem mein Leben müsste halt nur etwas Geld nebenbei ansparen. Wo soll man sich denn reinreiten?

[Gadwins]

After this answer it is obvious, that you have no clue about the seriousness of this processing. Saying, that something is "needed" in this forum, is obvious wrong. Your life does not depend on it. Lass es gut sein, bevor du dir ernsthafte Schäden zufügen lässt.

[TheGerman]

After this answer it is obvious, that you have no clue about the seriousness of this processing. Saying, that something is "needed" in this forum, is obvious wrong. Your life does not depend on it. Lass es gut sein, bevor du dir ernsthafte Schäden zufügen lässt.

Ich verstehe wirklich nicht was du meinst. Ich bin recessed und downward grown, das ist halt Fakt. Wie soll ich mir damit Schäden zufügen, wenn ich in Erwägung ziehe, zu einem der weltbesten Chirurgen zu gehen? Was soll ich denn sonst sagen, brauchen tut man nur die wenigsten Dinge, aber bei mir liegt ein Problem vor, das ich eben gerne lösen würde.

[Gadwins]

Sometimes I think, that kavan is too harsh, but in this case he is totally right to stop communication.

This will be my last reply: You are one of this people, who are many in this world, who think, that some surgeons with a big reputation understand everything. That is not the case, many jaw surgeons don't have any clue about ANS or even if they have, they don't perform any surgery to reduce it. You have to understand, that surgeons just learn something and apply it. They aren't special. Myself have a academic background and I only have clue about my specific topic, but I am an average human if it comes to other topics even if it is same subject, which I studied.

Surgeons will always tell you what they learnt and glorifie their specific skills. You have the big luck, that someone like kavan tells you some serious alternatives, which no maxfac surgeon have ever told you. Either you wake up from your childlish dream, that doctors are "halbgötter in weiß" or go for the so called "world-best surgeon" and get your face change and be happy for some months, because you just changed your face and fall into a deep hole after realising, that you looked better and got now maybe even some issues due to the surgery itself.

[kavan]

Gadwins,

Thank you for your entry here. You've given some good cautionary advice. It's true that I'm harsh. But that's usually AFTER a post where I provide enough about what the main problem is and find the person is not receptive to the info provided. At that point, I leave them to their own devices.

[TheGerman]

Sometimes I think, that kavan is too harsh, but in this case he is totally right to stop communication.

This will be my last reply: You are one of this people, who are many in this world, who think, that some surgeons with a big reputation understand everything. That is not the case, many jaw surgeons don't have any clue about ANS or even if they have, they don't perform any surgery to reduce it. You have to understand, that surgeons just learn something and apply it. They aren't special. Myself have a academic background and I only have clue about my specific topic, but I am an average human if it comes to other topics even if it is same subject, which I studied.

Surgeons will always tell you what they learnt and glorifie their specific skills. You have the big luck, that someone like kavan tells you some serious alternatives, which no maxfac surgeon have ever told you. Either you wake up from your childlish dream, that doctors are "halbgötter in weiß" or go for the so called "world-best surgeon" and get your face change and be happy for some months, because you just changed your face and fall into a deep hole after realising, that you looked better and got now maybe even some issues due to the surgery itself.

It's not like I don't think the additional input is good but in the end I need a surgeon that has a clue about the stuff he will perform on me and the surgeon also needs to agree to do it. I looked into ans shaving online and aesthetically speaking it looks like a risky procedure, way more room for big errors than a bimax already has (only aestheticwise).

Also top tier surgeons are way more likely to know about this stuff. If I want a good result who else should I go to besides surgeons with much experience and good reputation?

I 100% need surgery and I am just trying to get it done right. I will book two more consultations and specifically ask the surgeons about the ANS situation

[kavan]

Here is the deal with an ANS prominence situation:

It is best addressed by a good rhinoplasty surgeon who would be in the capacity to ALSO make further adjustments to the nose. That's because reducing a prominent ANS is PART of what is called a DEPROJECTION RHINOPLASTY. It isn't the 'all' of the deprojection rhino.

For that reason, the surgeon performing the maxfax procedure would ALSO have to be conversant in RHINOPLASTY (good at it) and enough so to make further adjustments to the nose which might have to be performed along WITH the reduction of the ANS. Otherwise, the surgeon will have to work around the prominent ANS situation.

If the maxfax surgeon, especially in a case of DOUBLE JAW surgery is NOT conversant in performing a DEPROJECTION RHINO, than that could LIMIT the type of CCW that can be performed and the extent the maxilla can be brought forward. So, the person getting the CCW would need to have a situation where he/she was a candidate for the type of CCW-r that brings the ANS somewhat BACKWARDS and also a situation where the maxilla was not brought forward.

For example:

1: Forward advancement of the maxilla in a double jaw surgery.

IF the maxilla needed to be brought forward to maximize the extent the lower jaw could be brought forward, the aesthetic TRADE-OFF with maximizing lower jaw advancement would be unfavorable aesthetic changes to the base of the nose (because the ANS already prominent would come more forward and look WORSE).

2: CCW-r around the ANS point.

IF CCW-r around the ANS point is needed to maximize the extent the lower jaw can be brought forward, the ANS stays where it is (in its prominent position) but the soft tissue of the lips will go more forward.

3: CCW-r around the incisor point.

IF CCW-r around the incisor point is needed to maximize the extent of the lower jaw can be brought forward, then that would bring the ANS backwards and and soft tissue projection of nose base (including upper lip) would remain the same.

CONCLUSION: In light of the above relationships, someone with a prominent ANS wanting to KEEP the ANS as is AND ALSO wanting/needing double jaw surgery to maximize lower jaw advancement would also need to be a candidate for CCW around the incisor point but with no added maxilla advancement.

[TheGerman]

Here is the deal with an ANS prominence situation:

It is best addressed by a good rhinoplasty surgeon who would be in the capacity to ALSO make further adjustments to the nose. That's because reducing a prominent ANS is PART of what is called a DEPROJECTION RHINOPLASTY. It isn't the 'all' of the deprojection rhino.

For that reason, the surgeon performing the maxfax procedure would ALSO have to be conversant in RHINOPLASTY (good at it) and enough so to make further adjustments to the nose which might have to be performed along WITH the reduction of the ANS. Otherwise, the surgeon will have to work around the prominent ANS situation.

If the maxfax surgeon, especially in a case of DOUBLE JAW surgery is NOT conversant in performing a DEPROJECTION RHINO, than that could LIMIT the type of CCW that can be performed and the extent the maxilla can be brought forward. So, the person getting the CCW would need to have a situation where he/she was a candidate for the type of CCW-r that brings the ANS somewhat BACKWARDS and also a situation where the maxilla was not brought forward.

For example:

1: Forward advancement of the maxilla in a double jaw surgery.

IF the maxilla needed to be brought forward to maximize the extent the lower jaw could be brought forward, the aesthetic TRADE-OFF with maximizing lower jaw advancement would be unfavorable aesthetic changes to the base of the nose (because the ANS already prominent would come more forward and look WORSE).

2: CCW-r around the ANS point.

IF CCW-r around the ANS point is needed to maximize the extent the lower jaw can be brought forward, the ANS stays where it is (in its prominent position) but the soft tissue of the lips will go more forward.

3: CCW-r around the incisor point.

IF CCW-r around the incisor point is needed to maximize the extent of the lower jaw can be brought forward, then that would bring the ANS backwards and and soft tissue projection of nose base (including upper lip) would remain the same.

CONCLUSION: In light of the above relationships, someone with a prominent ANS wanting to KEEP the ANS as is AND ALSO wanting/needing double jaw surgery to maximize lower jaw advancement would also need to be a candidate for CCW around the incisor point but with no added maxilla advancement.

Appreciate the input. I guess I understand your point better than before. I definitely need to look for a capable rhinoplasty surgeon that teams up with a maxfac..
I had a consultation with an Italian maxfac a while ago. Sadly he didn't tell me what point will be the centre of his proposed ccwr bimax. It's not really possible for me to tell from the simulations but maybe you can tell. Otherwise I will consult with him again and ask him for more details. His planned movements are: upper jaw only ccwr of 7 degrees which would result in a 2mm increase of the forward projection of the ANS. 8mm BSSO. 4mm ramus widening on the one and 5mm ramus widening on the other side. 6mm genio with downgrafting.

Here is the plan he gave me:
https://imgur.com/a/wkq0B2c

[kavan]

Appreciate the input. I guess I understand your point better than before. I definitely need to look for a capable rhinoplasty surgeon that teams up with a maxfac..
I had a consultation with an Italian maxfac a while ago. Sadly he didn't tell me what point will be the centre of his proposed ccwr bimax. It's not really possible for me to tell from the simulations but maybe you can tell. Otherwise I will consult with him again and ask him for more details. His planned movements are: upper jaw only ccwr of 7 degrees which would result in a 2mm increase of the forward projection of the ANS. 8mm BSSO. 4mm ramus widening on the one and 5mm ramus widening on the other side. 6mm genio with downgrafting.

Here is the plan he gave me:
https://imgur.com/a/wkq0B2c

Can't see your IMGUR plan because it's set up for people to sign in and I'm not an IMGUR member.
Any increase to the ANS projection will make an already prominent ANS more prominent.