Recommend a surgeon for CCW DJS

[Glassjaw]

Here’s some pics, all post-rhinoplasty.

https://imgur.com/a/DDo1NuS

How i see my problem:

As a result of having a crossbite for 25 years, everything down from my eyebrows is slightly recessed and the angles and the symmetry are a bit f*cked up. My face looks a bit long, the eye area/midface looks "molten" and the jaws/chin are too far back. As you can see from the photos, my nostrils are at a slightly different height and my nose slightly crooked despite of already having a rhinoplasty. Before i had my rhino, my nose was also pointing downwards and had a visible bump on the left side.

A lot of people (in the internet) have told me that i don’t need surgery. I disagree. No point in discussing this any further. I've pondered on whether to have jaw surgery, and what kind of surgery that would be, for years now. At first i thought the rhino i had 4 years ago would fix my issues, but in some ways it only made the real problem more apparent for me. I considered genioplasty for a long time after this, but recently came to the conclusion that double jaw is my only hope of achieving the kind of results i'm after: A better looking midface, a better looking smile, more prominent jaws and a chin, and a better overall symmetry. I've seen milder cases than me getting the surgery, with great results.

How i see my options:

My surgery would be as much about rotating the jaws, as about bringing them forwards. That's why i need to pick a surgeon who has a lot of experience with CCW rotation. I see a lot of people in places like this forum who have a very detailed approach to what they are after. They seem know the exact amount of millimeters they would like to move their jaws around etc. The way i see it, it's the surgeons job to know the details. That's why i'm paying them. My job is to pick the right surgeon.

I already had a consultation with Ramieri, aside from some minor problems he had with his english he seemed all right. He was my first pick because i've seen some pics of his work, and he seems to be experienced with this kind of surgeries. Alfaro, an another popular european surgeon, is not the man for my case i think. That’s based on his work ive seen, he seems to do a pretty lousy job whenever there is a clear need for CCW.

I don’t even know what other good alternatives for a DJS surgery there would be in europe (i live in the nordic countries). I’m avoiding going to the US, because i have no one to look after me, so i think it would be too much for me to make a 12 hour flight right after having surgery. I trust there are perfectly competent surgeons for this kind of procedures in europe as well.

Sorry for the possibly bad english and thanks for reading and commenting, much appreciated.

[Glassjaw]

I would like to add that if you really think that i don't need CCW rotation or even DJS based on my photos, please let me know. But i don't consider "no surgery" an option.

[kavan]

From what you say, it looks like you are looking for an opinion that is the SAME as yours. Let the board know when you are open to all opinions.

[Glassjaw]

From what you say, it looks like you are looking for an opinion that is the SAME as yours. Let the board know when you are open to all opinions.

What a strange conclusion/comment to make.

All i said was i don't consider "no surgery" an option. So there is no point in trying to convince me otherwise. I've heard all that: "you have body dysmorphia", "you need psychological help" etc. stuff already, and it's bulls**t.

Those comments mostly come from people who are projecting their own insecurities to me. Just because their problems might be worse, that doesn't mean i don't have any. It's very annoying to look for advice and get that kind of answers.
 

[TheGerman]

Do you have any scans?

[Glassjaw]

Do you have any scans?

No CT scans or the like yet.

One thing i forgot to add to my original post:

I have braces on the outside of both my upper and lower teeth, and have been going through orthodontic treatment on the public side for the past 3 years. I know that in most cases orthodontic treatment has to be reversed before having surgery. It's also my understanding that most surgery cases are either overbites or underbites. Mine was a crossbite.

I think that in my case the reversion of former work wouldn't necessarily be required, because both of my jaws are at the same level and my teeth mostly straight. (the upper front teeth had to be slightly dented outwards to make the jaws fit shut). This is just me though, and this needs to be confirmed by a professional.

The problem is not a functional one but purely aesthetic, the position of my jaws in relation to the rest of my face.

[kanko]

Here’s some pics, all post-rhinoplasty.

https://imgur.com/a/DDo1NuS

How i see my problem:

As a result of having a crossbite for 25 years, everything down from my eyebrows is slightly recessed and the angles and the symmetry are a bit f*cked up. My face looks a bit long, the eye area/midface looks "molten" and the jaws/chin are too far back. As you can see from the photos, my nostrils are at a slightly different height and my nose slightly crooked despite of already having a rhinoplasty. Before i had my rhino, my nose was also pointing downwards and had a visible bump on the left side.

A lot of people (in the internet) have told me that i don’t need surgery. I disagree. No point in discussing this any further. I've pondered on whether to have jaw surgery, and what kind of surgery that would be, for years now. At first i thought the rhino i had 4 years ago would fix my issues, but in some ways it only made the real problem more apparent for me. I considered genioplasty for a long time after this, but recently came to the conclusion that double jaw is my only hope of achieving the kind of results i'm after: A better looking midface, a better looking smile, more prominent jaws and a chin, and a better overall symmetry. I've seen milder cases than me getting the surgery, with great results.

How i see my options:

My surgery would be as much about rotating the jaws, as about bringing them forwards. That's why i need to pick a surgeon who has a lot of experience with CCW rotation. I see a lot of people in places like this forum who have a very detailed approach to what they are after. They seem know the exact amount of millimeters they would like to move their jaws around etc. The way i see it, it's the surgeons job to know the details. That's why i'm paying them. My job is to pick the right surgeon.

I already had a consultation with Ramieri, aside from some minor problems he had with his english he seemed all right. He was my first pick because i've seen some pics of his work, and he seems to be experienced with this kind of surgeries. Alfaro, an another popular european surgeon, is not the man for my case i think. That’s based on his work ive seen, he seems to do a pretty lousy job whenever there is a clear need for CCW.

I don’t even know what other good alternatives for a DJS surgery there would be in europe (i live in the nordic countries). I’m avoiding going to the US, because i have no one to look after me, so i think it would be too much for me to make a 12 hour flight right after having surgery. I trust there are perfectly competent surgeons for this kind of procedures in europe as well.

Sorry for the possibly bad english and thanks for reading and commenting, much appreciated.

I can totally see what bothers you aesthetically regarding your jaws being back. But your nose is also back and your jaws are actually arround the perfect place comparing it to the lower part of your nose. So I believe if you try moving the jaws ahead to fix your current problem, you will probably mess up other things in your face (nose and lips)

[kanko]

I can totally see what bothers you aesthetically regarding your jaws being back. But your nose is also back and your jaws are actually arround the perfect place comparing it to the lower part of your nose. So I believe if you try moving the jaws ahead to fix your current problem, you will probably mess up other things in your face (nose and lips)

Sorry i said that from only looking at your first picture. After looking at the rest i got conflicted. It all looks close to the right place to me. What does actually bother you? Is it the definition of your jaw? If the problem is the midface jaw surgery probably doesnt fix it, although  other surgeries will

[Tomasjohn]

With the same eyes, lips, hair, colors and aging (coming soon) you wont become handsome by having DJs. I dont say you look bad. But i'm saying with regard to your goal (only to look better) it would not be worth the investment.

This is just my personal opinion tough. Often i missjudge how people look.

However to be honest, if you actually do it (surgery) i would be very pleased to be proved wrong. 

- Something i like is the slightly angled eyes you have. I LOVE it in women. Its funny, i see it very often in people from south america with indigenous heritage. But i also notice it often in people from far up the north in europe (Island, norway).
Anyone else?

[kanko]

With the same eyes, lips, hair, colors and aging (coming soon) you wont become handsome by having DJs. I dont say you look bad. But i'm saying with regard to your goal (only to look better) it would not be worth the investment.

This is just my personal opinion tough. Often i missjudge how people look.

However to be honest, if you actually do it (surgery) i would be very pleased to be proved wrong. 

- Something i like is the slightly angled eyes you have. I LOVE it in women. Its funny, i see it very often in people from south america with indigenous heritage. But i also notice it often in people from far up the north in europe (Island, norway).
Anyone else?

He just has so many other areas tô improve like hairline/ orbitals/ gonion and he instead focuses on the good part he has

[kavan]

The angle relationships don't really justify double jaw surgery and especially NOT given your complaints of recession are ABOVE the yellow line.

For example, SNA and SNB are above the norm which is quite OK and double jaw advancement would put those angle relationships even MORE above the norm. Also, your OP is NOT 'steep'. So, that's not an indicator for CCW to reduce the OP angle. The MPA is within norm.

Maybe possible for CCW around ANS point of approx 4 degrees which would reduce OP to approx 5 deg and reduce MPA to approx 20 and that could maybe improve the lower face area as to bring things further forward. HOWEVER, the double jaw surgery, as far as advancement and rotation goes, takes place BELOW THE YELLOW LINE (Lefort 1 line). So, the advancement would be BELOW that line. Since your complaints of recession take place ABOVE the yellow line (Lefort 1 cut), what ever recession you have ABOVE the yellow line will look MORE recessive to you via relative comparison, the more you advance the jaws BELOW the yellow line.

In short, CCW, DJS don't appear to be the 'magic bullet' you're hoping for. Also, whatever goals you have for DJS to do for you, you really should articulate them and in reference to the changes you would like to see BELOW the yellow line. Because DJS is not going to improve anything above the Lefort 1 area where you have the recession.

You could have some chin advancement though via sliding genio.

ETA: Illustration included with this post.

[kanko]

The angle relationships don't really justify double jaw surgery and especially NOT given your complaints of recession are ABOVE the yellow line.

For example, SNA and SNB are above the norm which is quite OK and double jaw advancement would put those angle relationships even MORE above the norm. Also, your OP is NOT 'steep'. So, that's not an indicator for CCW to reduce the OP angle. The MPA is within norm.

Maybe possible for CCW around ANS point of approx 4 degrees which would reduce OP to approx 5 deg and reduce MPA to approx 20 and that could maybe improve the lower face area as to bring things further forward. HOWEVER, the double jaw surgery, as far as advancement and rotation goes, takes place BELOW THE YELLOW LINE (Lefort 1 line). So, the advancement would be BELOW that line. Since your complaints of recession take place ABOVE the yellow line (Lefort 1 cut), what ever recession you have ABOVE the yellow line will look MORE recessive to you via relative comparison, the more you advance the jaws BELOW the yellow line.

In short, CCW, DJS don't appear to be the 'magic bullet' you're hoping for. Also, whatever goals you have for DJS to do for you, you really should articulate them and in reference to the changes you would like to see BELOW the yellow line. Because DJS is not going to improve anything above the Lefort 1 area where you have the recession.

You could have some chin advancement though via sliding genio.

ETA: Illustration included with this post.

Just be wary of Kavan advice because he used your head position in your ceph as your natural head posture, and from your other pictures your head is on a different position, as in, you are looking more up. In that way if your natural head position is the one on the pics and not on the xray when your head looks up your chin gets more projected and you may not need the genio, or less of it. From my perspective it would be a very small one and hardly worth the trouble

Still, great exposure of why you dont need anything bimax related

[kavan]

Just be wary of Kavan advice because he used your head position in your ceph as your natural head posture, and from your other pictures your head is on a different position, as in, you are looking more up. In that way if your natural head position is the one on the pics and not on the xray when your head looks up your chin gets more projected and you may not need the genio, or less of it. From my perspective it would be a very small one and hardly worth the trouble

Still, great exposure of why you dont need anything bimax related

All angle measures are approximate to convey my basic observation.

All angles measured with reference to the VERTICAL which is a true vertical with reference to the ceph stat.

Angles; SNA, SNB and OP remain CONSTANT no matter what the head position.

Angle MPA is measured with reference to a horizontal (perpendicular to the vertical)


But thanks for confirming that it's a WASTE OF MY TIME to give any advice on here and people should be 'WARY' of it because now I know not to spend any of it looking and advising on your case.

[kanko]

All angle measures are approximate to convey my basic observation.

All angles measured with reference to the VERTICAL which is a true vertical with reference to the ceph stat.

Angles; SNA, SNB and OP remain CONSTANT no matter what the head position.

Angle MPA is measured with reference to a horizontal (perpendicular to the vertical)


But thanks for confirming that it's a WASTE OF MY TIME to give any advice on here and people should be 'WARY' of it because now I know not to spend any of it looking and advising on your case.

Its ok if you dont, although I would greatly appreciate your take on it as you are extremely knowledgeble on the subject. I meant no offence by my comment and seeked only to contribute to the debate, which i believe you are open to

My only take on the subject was that he should view his need to a genioplasty by (arnette standards) by looking at the true vertical line, which is created by his natural head posture. After he gets that he would view if his chin is 2-3mm away from it and from this result see if he truly needs it. My intent was to discourage op from it since it does not look like he needs it (at least to me)/ doesnt even know what a true vertical line is, and would proably get better results from surgeries in other areas(if thats whats his set on getting).

Still i complimented your analysis and agree with you on your take/ do not seek disagreements on this forum

[kavan]

Its ok if you dont, although I would greatly appreciate your take on it as you are extremely knowledgeble on the subject. I meant no offence by my comment and seeked only to contribute to the debate, which i believe you are open to

My only take on the subject was that he should view his need to a genioplasty by (arnette standards) by looking at the true vertical line, which is created by his natural head posture. After he gets that he would view if his chin is 2-3mm away from it and from this result see if he truly needs it. My intent was to discourage op from it since it does not look like he needs it (at least to me)/ doesnt even know what a true vertical line is, and would proably get better results from surgeries in other areas(if thats whats his set on getting).

Still i complimented your analysis and agree with you on your take/ do not seek disagreements on this forum

OK,OK. Gunson can rotate the head (in the photo) CW to find a desired horizontal. But how much he rotates it can differ from case to case. But here, I've gotta look at the head aligned with the vertical and horizont of the ceph which will give me the same angles I would get if the head were in a different position.  The only angle that would change would be the MPA if the head in the picture frame was rotated.

Anyway, except for his chin which he could get vertically shortened and brought forward horizontally (upward sliding genio), double jaw surgery won't change the area where he has recession (upper midface).

I'll get to your case a little later.