Recommend a surgeon for CCW DJS

[Glassjaw]

- 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?

My eyes used to be far more angled when i was younger, i think that because of the recession it became less apparent. I have aspergers and i have heard that it's more common for us to have angled eyes.

I was a good looking kid, a real shame no-one warned me about what would happen if i didn't fix my bite.

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

I have to study some of the terms you use in your message to understand it better, but i appreciate your detailed analysis.

My jaws being too set back was one of the main complaints, and DJS would surely fix this. I'm not sure i understand what you meant with "the area above the yellow line looking more recessive." Based on the photos ive seen, DJS changes the look of the upper midface/eye area as well, because the skin around the area "loosens up" and gets slightly lifted as the jaws get moved forwards/upwards. In my case the change this would bring would probably be all positive.

I have pretty well defined cheekbones despite of the recession, so i think DJS wouldn't do too much damage to how my midface looks. Sure, i would probably lose the cheekbones, but gain so much more in overall symmetry.

[Glassjaw]

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)

This is a possibility. I had my rhinoplasty before considering any of these things. However, my nose is not upturned as it so i think it still has plenty of space to move. I wouldn't mind a slightly upturned nose. Also, my jaws would ideally be moved forwards just a bit, since it's just as much about rotating them.

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

I actually like my hairline, it looks great with a flattop. I just have a seriously bad haircut in some of the pics. Imo, DJS could vastly improve my looks, especially the side profile.

[kavan]

......

I have to study some of the terms you use in your message to understand it better, but i appreciate your detailed analysis.

My jaws being too set back was one of the main complaints, and DJS would surely fix this. I'm not sure i understand what you meant with "the area above the yellow line looking more recessive." Based on the photos ive seen, DJS changes the look of the upper midface/eye area as well, because the skin around the area "loosens up" and gets slightly lifted as the jaws get moved forwards/upwards. In my case the change this would bring would probably be all positive.

I have pretty well defined cheekbones despite of the recession, so i think DJS wouldn't do too much damage to how my midface looks. Sure, i would probably lose the cheekbones, but gain so much more in overall symmetry.

The yellow line was to (simply) illustrate the Lefort 1 cut area. The Lefort 1 is the cut used in bimax to displace the upper jaw. So, the illustration was meant to convey that there is a 'cut off line' regarding WHICH parts of the face are displaced/moved 'forward' and that the main RECESSION to your face won't be moving forward with the bimax. But rather, they would look MORE recessive to you via relative comparison when both of your jaws are moved forward via a bimax procedure.

I just give the information as to how things work. I will also mention that it's a very common complaint of people who start with recession to the upper midface area to notice MORE of it subsequent to bimax advancement. Your recession isn't to what is called the 'cheek bones'. It's to the (lower) orbital rim area below the eyes.

In closing, I've given my 'take' on the matter. Subsequent my giving my take, people can 'take it or leave it' and do what they want to do anyway. Like it's not my style to try to 'convince' anyone to NOT to this or that after I give an assessment as to why I would not encourage it.

 ETA:

The basic angle measures; SNA and SNB, which are relative to the anterior cranial base, don't convey your jaws are set 'backwards'. They DON'T convey you are RETROGNATHIC (backward set jaws). That said, what sounds like you are wanting is a more PROGNATHIC appearance.

[kanko]

This is a possibility. I had my rhinoplasty before considering any of these things. However, my nose is not upturned as it so i think it still has plenty of space to move. I wouldn't mind a slightly upturned nose. Also, my jaws would ideally be moved forwards just a bit, since it's just as much about rotating them.

I actually like my hairline, it looks great with a flattop. I just have a seriously bad haircut in some of the pics. Imo, DJS could vastly improve my looks, especially the side profile.

I mean, you like what makes you worse and dislike what makes you good. If you want to look worse thats what you Will probably get from bimax. You are probably mistaking the orbital implants/ fat grafting most aesthetic surgeons do with bimax with the result of bimax itself (for example. Most of raffainis great transformations). Bimax Wont  give you better eye area.

[kavan]

I mean, you like what makes you worse and dislike what makes you good. If you want to look worse thats what you Will probably get from bimax. You are probably mistaking the orbital implants/ fat grafting most aesthetic surgeons do with bimax with the result of bimax itself (for example. Most of raffainis great transformations). Bimax Wont  give you better eye area.

Good point. I've done a morph of him giving him a more PROGNATHIC look which seems to be what he wants. His angle measures, by no means are consistent with retrognathic (backwards jaws) which he thinks he has. So his desire for DJS via CCW 'translates' into his wanting a more prognathic appearance. Now, I'm not claiming that the morph makes him look much better. I'm just saying it's a representation or 'translation' of MORE FORWARD jaws which would kick up INCREASED SNA and SNB angles that are very consistent with PROGNATHIC jaws.

Illustration included in this post.

[Glassjaw]

I mean, you like what makes you worse and dislike what makes you good. If you want to look worse thats what you Will probably get from bimax. You are probably mistaking the orbital implants/ fat grafting most aesthetic surgeons do with bimax with the result of bimax itself (for example. Most of raffainis great transformations). Bimax Wont give you better eye area.

Well i guess there is a possibility there's some subjectivity involved in the matter. Bimax could very well give me a better eye area, because my main concern here is the "stretched" look of the lower orbital rim area, that is the "long shadows" under my eyes. The setback look in the area after surgery is unfortunate, but you guys are concentrating on this way too much, it is a minor concern compared to all other aesthetic issues i have right now that the bimax might solve.

In any case, bimax wouldn't make this issue any worse.

Good point. I've done a morph of him giving him a more PROGNATHIC look which seems to be what he wants. His angle measures, by no means are consistent with retrognathic (backwards jaws) which he thinks he has. So his desire for DJS via CCW 'translates' into his wanting a more prognathic appearance. Now, I'm not claiming that the morph makes him look much better. I'm just saying it's a representation or 'translation' of MORE FORWARD jaws which would kick up INCREASED SNA and SNB angles that are very consistent with PROGNATHIC jaws.

Illustration included in this post.

That's actually not far from the change i'm going for.

There is clearly a cant on my occlusal plane, so prognathic or not, the look i'm going for is closer to the natural look i would have if i hadn't lived the first 25 years of my life with a malocclusion.

[kavan]

Well i guess there is a possibility there's some subjectivity involved in the matter. Bimax could very well give me a better eye area, because my main concern here is the "stretched" look of the lower orbital rim area, that is the "long shadows" under my eyes. The setback look in the area after surgery is unfortunate, but you guys are concentrating on this way too much, it is a minor concern compared to all other aesthetic issues i have right now that the bimax might solve.

In any case, bimax wouldn't make this issue any worse.

That's actually not far from the change i'm going for.

There is clearly a cant on my occlusal plane, so prognathic or not, the look i'm going for is closer to the natural look i would have if i hadn't lived the first 25 years of my life with a malocclusion.

Well, the morph I provided is a pretty good communication tool to use as a spring board to discuss basic preferences with a surgeon.  You will be hard pressed to find a doctor who would 'know how you would have looked if you didn't have a malocclusion for 25 years.'  Good luck on finding one.

[Glassjaw]

Well, the morph I provided is a pretty good communication tool to use as a spring board to discuss basic preferences with a surgeon.  You will be hard pressed to find a doctor who would 'know how you would have looked if you didn't have a malocclusion for 25 years.'  Good luck on finding one.

My point was that you are putting way too much emphasis on those SNA/SNB lines, look at the big picture. Everything below my eyebrows is slightly canted and my posture is bad mainly because of my set back jaws. If you had seen my nose before rhino you would understand the amount of the recession better, the tip of my nose was pointing downwards because of lack of natural support. It's the symmetry that matters to me, not the prognathism/lack of it.

That's why there has to be CCW rotation, regular bimax would probably do just what kanko said, make the problem worse.

Anyway thanks for the pic

[kavan]

My point was that you are putting way too much emphasis on those SNA/SNB lines, look at the big picture. Everything below my eyebrows is slightly canted and my posture is bad mainly because of my set back jaws. If you had seen my nose before rhino you would understand the amount of the recession better, the tip of my nose was pointing downwards because of lack of natural support. It's the symmetry that matters to me, not the prognathism/lack of it.

That's why there has to be CCW rotation, regular bimax would probably do just what kanko said, make the problem worse.

Anyway thanks for the pic

My morph incorporated CCW. You will need to study up on the terms and geometrical relationships associated with bimax surgery if you wish to communicate effectively as to what you are seeking. Surgeons consider the SAME angles I mentioned here. Maxfax is all about POINTS, ANGLES, ROTATION and PLANES.....alterations/changes thereof towards goal of balancing the jaw to jaw relationship and bite. So, I need to move on to other posters who are more receptive to the type of communication that is used to describe maxillofacial relationships.
Best of luck finding a surgeon you have a rapport with as to what you want.

[kanko]

My point was that you are putting way too much emphasis on those SNA/SNB lines, look at the big picture. Everything below my eyebrows is slightly canted and my posture is bad mainly because of my set back jaws. If you had seen my nose before rhino you would understand the amount of the recession better, the tip of my nose was pointing downwards because of lack of natural support. It's the symmetry that matters to me, not the prognathism/lack of it.

That's why there has to be CCW rotation, regular bimax would probably do just what kanko said, make the problem worse.

Anyway thanks for the pic

We have looked at the bigger picture and said bimax wont fix it. You just cant take it.  To improve your eyes you either get implants or fill them with fat.
Your posture is not bad because of your jaws, your airways are Huge.
I mean from what you are saying it looks like you read the mew camp for crazies brochure, took it as true and obsessed with it.

[Glassjaw]

We have looked at the bigger picture and said bimax wont fix it. You just cant take it.  To improve your eyes you either get implants or fill them with fat.
Your posture is not bad because of your jaws, your airways are Huge.
I mean from what you are saying it looks like you read the mew camp for crazies brochure, took it as true and obsessed with it.

I can take it just fine, your arguments just arent all that convincing. There are other measurements to consider than just the SNA/SNB lines. A genioplasty wouldnt fix the overall lack of symmetry any more than the rhinoplasty i had did. I know about the eye fillers and i will consider them after i have my bimax.

[Glassjaw]

My morph incorporated CCW. You will need to study up on the terms and geometrical relationships associated with bimax surgery if you wish to communicate effectively as to what you are seeking. Surgeons consider the SAME angles I mentioned here. Maxfax is all about POINTS, ANGLES, ROTATION and PLANES.....alterations/changes thereof towards goal of balancing the jaw to jaw relationship and bite. So, I need to move on to other posters who are more receptive to the type of communication that is used to describe maxillofacial relationships.
Best of luck finding a surgeon you have a rapport with as to what you want.

I must say I hope it didn’t seem like i wasn’t being receptive. There's just a lot i don’t know how to put into words effectively.

I don't have any other exact measurements to give, but what the previously discussed SNA/SNB lines don't seem to entail, are the appearance of my nose and the overall appearance of my mid/lower face, as if some supportive structure was missing.

The lines might say "there is no recession", but to the eye something is off, the skin around the midface is too saggy and the edges of the nostrils are too downward pointing, this would indicate that the problem is the position of the jaws being too backwards. Even if the lines don't concurr.

I think that in your morph many of these questions are answered and the overall symmetry appears vastly improved to me. The result might be PROGNATHIC, but i believe this is closer to the position my jaws would have taken in relation to the rest of my face if not for my malocclusion, as was my point in some previous messages. This would pretty much confirm my beliefs that the DJS surgery together with CCW rotation is aesthetically the right choice for me.

I will either update this post or make a new one once i get plans from my surgeon

[kavan]

Glad the morph was somewhat helpful.

[Glassjaw]

I must add that the prognathism in the morph gives a nice counter to the rather ”back heavy” elongated alien/neanderthal shape of my skull. It's a big reason why a relatively mild recession makes such a great difference in my side profile.

[Glassjaw]

Its been a while, but it finally looks like my orthodontic treatment is getting close to finishing. The plan is still the same: dj surgery with a slight ccw rotation. With any luck with the finances, i will be having the surgery this year.

Which takes us to the original point of this thread: which surgeon to pick? As i understand, Alfaro is a bit overrated, and in addition as expensive as they come. I would very much like to keep the costs below 20k euros, but don't really know if this is realistic.