Author Topic: I don't know how to fix the overadvanced jaw my DJS gave me, please help  (Read 7881 times)

aamonk99

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Re: I don't know how to fix the overadvanced jaw my DJS gave me, please help
« Reply #30 on: August 06, 2022, 04:09:53 PM »
Overall the position of the jaws looks appropriate. Your profile appears flat, with the upper and lower lips more or less vertically in line with eachother, your forehead (good), and overall normative look in relation to your skull.

Your chin is behind your upper lip so it is not over-projected relative to your lower maxilla and mandible. I definitely wouldn't do a setback genioplasty - this would make your lower lip look more protrusive and potentially exacerbate your lower lip incompetence. An upsliding genioplasty would reposition the muscle and may actually improve the lower lip incompetence. https://exploreplasticsurgery.com/the-effects-of-chin-augmentation-on-mentalis-muscle-strain-and-lower-lip-incompetency/

The jaw angle implants were also a net improvement, so I wouldn't touch them either.

IMO - The main aesthetic issue is your nasal under-projection. Due to your shallow nasal bridge, following the large advancement Subnasale now looks materially ahead of your nasal bone. This causes your jaws to visually overpower your midface and makes your maxilla appear slightly hypoplastic.

I think radix/dorsal augmentation would make a world of difference in improving harmony - plus cheaper than revision bimax and less downtime/recovery too. Quick edits:

https://imgur.com/a/wd8hZiY
https://imgur.com/a/VADiDC0

Secondary to that, you could use just a little bit more volume in the upper midface/zygomatic area. From your recent pics it looks like you mostly took care of it with filler. Infra-orbital/cheek implants would be the more permanent option and also not a bad idea.

Thank for your response. Yes, my main concern is that my profile seems flat, like a rectangular shaped face instead of more of a square with better forward growth.

I will follow your advice and won't consider chin setback. However, I've been thinking more and more about setting lower jaw back again in a revision jaw surgery. I wouldn't move upper jaw, just lower jaw a few milimiters back. That would improve my bottom lip a bit.

The jaw implants made a good improvement in the side profile, but I really hate the result from the front. My lower third looks too long and masculine, and I have no definition at the jawline as I had before the implants bc they are too high at the antegonial notch. I want to replace them with much smaller implants, but I think it would only be worth it by doing something else in the same intervention. eg. chin reduction.

Supposedly I ALREADY HAD DORSAL AUGMENTATION TO THE NOSE. The surgeon said he transfered some cartilage from the septum and also reduced the tip. I think he lied and he only did the alarplasty. I agree it still lacks projection. I'm pretty sure I can consult a surgeon and ask if it can be done again. I can't see the pics btw, nor mine, for some reason imgur is not working for me.

About the upper midface part, the filler took care mostly of the submalar area. I insisted to get some on the infraorbital area which still looks recessed, but the doctor kept saying something about it not being feasible bc of how I would look when gesticulating.


aamonk99

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Re: I don't know how to fix the overadvanced jaw my DJS gave me, please help
« Reply #31 on: August 06, 2022, 04:14:42 PM »
I dont like your suggestion. OP is already complaining he is getting the unfriendly look from the people he meets, Filling out the radix will give him more of the masc/ogre look and do the opposite of what op wants to do.

I agree with kavan on the subject of him looking unfriendly due to other factors, not uncaninnes. His mouth is also downturned which also gives the unfriendly/ not approachable vibe.

Regarding your face i dont see reason to mess with it. You have a great gonial angle and your face looks good. What throws me off a little bit on the “bad pictures” is you have a masc face but your neck doesnt seem to match it. This doesnt happen on the “good photos” and your neck/ body seem proportionate, so i guess it would be more of if you have the body that matches the face.

I would also be cautious of reducing your chin vertically as that changes your mandibular plane angle. Yours looks to be arround 15 degrees with the implants, lowering it more will have a bad aesthetic result from the side and from the front

I'm really desperate to reduce the masculinity of my face. But I think dorsal augmentation wouldn't make it worse. I think I really need to reduce my chin vertically and possibly get the jaw implants removed.

Yes I agree with the chin thing. If I only reduce the height of my ching my gonial angle will get too close to 90º. That's why I wouldn't only do it along with the jaw implants removal, which are giving me a much higher ramus and changed my gonial angle completely.

varbrah

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Re: I don't know how to fix the overadvanced jaw my DJS gave me, please help
« Reply #32 on: August 08, 2022, 07:16:20 PM »
I will follow your advice and won't consider chin setback. However, I've been thinking more and more about setting lower jaw back again in a revision jaw surgery. I wouldn't move upper jaw, just lower jaw a few milimiters back. That would improve my bottom lip a bit.
Have you spoken to someone (ortho/surgeon) about this?

https://imgur.com/a/7DfHbaK

Looking at your scans, you basically have a Class I molar relationship so I'm not sure there's a lot of room to set the mandible back too far. Maybe a few mm depending on how decomp goes. Might be feasible and then you could combine with upsliding genio which would probably improve the lower lip further and save your profile from looking too retro.

The jaw implants made a good improvement in the side profile, but I really hate the result from the front. My lower third looks too long and masculine, and I have no definition at the jawline as I had before the implants bc they are too high at the antegonial notch. I want to replace them with much smaller implants, but I think it would only be worth it by doing something else in the same intervention. eg. chin reduction. 

I'd say the jaw implants are appropriate for the current state of your mandible, but yeah I can imagine the front view looking iffy since you can't exactly attach the masseters to the 'new' mandibular angle. Because the muscle is attaching at your 'old' mandibular angle, the belly of the muscle seemingly bulges in the middle of your ramus, causing a slight rounded look. IMO it doesn't look terrible though.

If you decide on the BSSO setback + upsliding genioplasty, then yes I would go smaller on the implant with less ramus augmentation for sure.

Supposedly I ALREADY HAD DORSAL AUGMENTATION TO THE NOSE. The surgeon said he transfered some cartilage from the septum and also reduced the tip. I think he lied and he only did the alarplasty. I agree it still lacks projection. I'm pretty sure I can consult a surgeon and ask if it can be done again. I can't see the pics btw, nor mine, for some reason imgur is not working for me.

Looked at your pics again and I can see it now - I don't think he's lying. Since it was septal cartilage, it was definitely a small amount hence minimal augmentation. I would've done more, but that would more than likely require cartilage harvested from elsewhere.

Attaching gif, see if imgbb works for pics
https://ibb.co/RC6d4Zf
https://ibb.co/bQXZ1wL

eastcoastian1

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Re: I don't know how to fix the overadvanced jaw my DJS gave me, please help
« Reply #33 on: August 18, 2022, 11:12:53 AM »
Dude, you look fantastic. You’re probably just getting used to new face. In fact, can I ask who your surgeon is?

downwardgrowth

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Re: I don't know how to fix the overadvanced jaw my DJS gave me, please help
« Reply #34 on: November 26, 2022, 02:43:39 PM »
OP is a bit over advanced, and maybe his teeth our crooked and maybe they are not, he didnt show in OP, but if it was even possible for to to look like OP's befores I would give everything. OP is clearly an above average looking man, and the implants and fillers bring him to way above average tier. I am in group chats with men like myself who are severely downward grown and recessed with underbites, who even after all of OP's surgeries, would be lucky to be a 5.5/10. OP is a solid 8/10, and is complaining. Maybe his smile looks very bad, I dont know, but OP needs psychological help and not more surgery

If I looked like OP I would be enjoying life and living the life of my dreams.