I don't know how to fix the overadvanced jaw my DJS gave me, please help

[aamonk99]

Hello everyone. Sorry if this is too long, I made it as short as I could as I’m in desperate need for help. My face completely changed 2 times in 1 year and I don’t know who I am/how do I look any more. I can’t talk to people bc I developed severe SA and agoraphobia after my surgery. I haven’t spoken to any one in months, and I’ve become completely isolated. Please help. 


I had DJS on may 2021, to fix mild sleep apnea and for cosmetic benefit. I had a normal bite, but both my jaws were recessed. It was a surgery first approach and they advanced 10mm each jaw and did CCW. My maxilla was much more recessed than the lower jaw preop.


The result of the DJS was an underbite appearance with an overadvanced jaw and chin that I really disliked. My alar nostrils widened A LOT. My teeth became completely crooked; if you combine that with a small mouth and small teeth my smile was horrifying and I looked like a monkey. I developed severe social anxiety, depression and body dismorphia to the point of considering suicide.
 

Now, objectively it could be said that the surgeon made a mistake in the planning, since my POINT B IS AHEAD OF POINT A. But other people told me this was done on purpose to improve philtrum appearance (leaving upper lip vermillion border forward of subnasale), risking a “slighty protusive” chin.


10 months later I decided to have a rhino, and jaw angle implants both the same day. The implants were intented to reduce the gonial angle (which was huge and made the protusive chin look even worse) and cover the big notch the BSSO left me.


And now I have a huge jaw, a very long ramus that makes all my face look longer, with more of a rectangular shaped face on the side profile instead of a good horizontal forward grown face. The jaw implants completely rounded my face in the front making me look WORSE than before; the masseter muscle is still attached further up and there’s a gap which is noticeable a lot of times. But there was a slight improvement in the side profile.


I feel like I have a very weird face IRL, whereas in pictures I look moderately attractive. People avoid eye contact with me or look at me weird. People seem weirded out after interacting with me and never smile. I think the problem is nothing in my face matches, making me look uncanny:
-   High nasolabial angle and slightly feminin nose with a strong jaw.
-   The wide square jaw with slightly protusive chin doesn’t match a narrow smile and palate (even with a small mouth, bucal corridors are visible when I smile), and a downturned mandible/chin.


I think I’ve (almost) given up on looking more attractive, since my maxilla still seems downsung on a lot of angles, which means I’ll never be really good looking unless I did MSE or whatever.


I’ve considered 1 or more of:
-   Setting lower jaw back a bit
-   Reduction genio (both vertically- to reduce the downturned look, and horizontally- to reduce the protusive/underbite look. 
-   Cheek implants
-   Removing the jaw angle implants and replace them with a much smaller one that doesn’t elongate the ramus as much. But then my gonial angle would be really high again, so i would have to combine this with a chin vertical reduction in the same procedure.

What’s driving me crazy is, even with the same neutral posture and angles, on some pictures I look completely normal and attractive, and in other like a complete alien. I’m almost convinced that the alien look is the one I have IRL. People never acted this weird/umcofortable around me before the surgery.

PICTURES

b & a DJS  https://imgur.com/a/L9m5kte      for some reason, everything looks ok here....

AFTER DJS and BEFORE jaw implants + rhino  https://imgur.com/a/E6wp45z      doesn't look that bad, but at the time just the crooked smile alone would give me a lot of anxiety

AFTER DJS AND jaw implants + rhino + a bit of filler on cheeks  https://imgur.com/a/Q0Y96FP   this is how I look right now, but like I said, people avoid making eye contact with me (even people I have to interact with), no one is really nice to me or smiles to me as they normally used to before DJS. I'm somewhat convinced this IS NOT HOW I LOOK IRL.

IRL, I think the downturned mandible + protusive chin and the excessive jaw implants are MUCH more obvious, and people perceive me like in these pictures (still me now, but bad angles): https://imgur.com/a/pB4OvSq

Unfortunately I can't find the scans preop/postop. But I got the scan for the jaw implant (post DJS): https://imgur.com/a/7DfHbaK

I just can't get over not knowing how I look to others in public. I'm always convinced that I MUST look like an alien, specially bc I've done 3 major cosmetic procedures. There's no way I look normal.

I really ask for your help. Is it just very severe body dismorphia?

[kavan]

You look fine given the procedures you had, one of which was for apnea where lower jaw was advanced out a lot in addition to upper jaw and improved breathing. Implants gave a strong appearance which is not bad and the nose looks OK. What you have is RELATIVE recession of the area the combined jaw surgeries DON'T CHANGE. That is to say, the advancement you got makes areas that were not advanced like upper mid face look recessed by RELATIVE COMPARISON.

The changes you got are quite DRAMATIC and you look good in FRONTAL perspective. But since you are freaked out by the changes you got, I would NOT ADVISE pursuing any more cosmetic changes. Basically, you have what WOULD BE HAD, you had changes that WOULD CHANGE with the types and extent of surgeries you got.

I would just suggest to work on ADAPTING to your new look and to stop pursuing further surgeries, lest you get on the 'revision treadmill', chasing yet more things you could end up dissatisfied with.

[aamonk99]

You look fine given the procedures you had, one of which was for apnea where lower jaw was advanced out a lot in addition to upper jaw and improved breathing. Implants gave a strong appearance which is not bad and the nose looks OK. What you have is RELATIVE recession of the area the combined jaw surgeries DON'T CHANGE. That is to say, the advancement you got makes areas that were not advanced like upper mid face look recessed by RELATIVE COMPARISON.

The changes you got are quite DRAMATIC and you look good in FRONTAL perspective. But since you are freaked out by the changes you got, I would NOT ADVISE pursuing any more cosmetic changes. Basically, you have what WOULD BE HAD, you had changes that WOULD CHANGE with the types and extent of surgeries you got.

I would just suggest to work on ADAPTING to your new look and to stop pursuing further surgeries, lest you get on the 'revision treadmill', chasing yet more things you could end up dissatisfied with.

Thank you. Yes, I do understand that simply forgetting about doing any more surgeries and adjusting to my new face would be the right way to go.

At the same time I do believe that my new plan might be good this time, and I need someone more knowledgeable than me to confirm what I want to do makes sense.

I didn't expect to end up with an underbite appearance, and I completely underestimated the change that the jaw implants would cause. So in a way, I was ignorant of the possible outcomes of those procedures.

I think I might be lucky enough this time with vertical and horizontal chin reduction, unless I'm missing something, to the point where I won't be shocked, but more pleased with the results than before, since I think it would really benefit the harmony of my face.

Like you said, the infraorbital and malar area are recessed in relative comparison to the area the DJS advanced. This doesn't stress me so much, since I would do malar/submalar implants only to try to become more attractive. For the moment I really need a more "normal" face.

[GJ]

Those jaw implants really filled in your anti-gonial notch, huh? I think they made a good improvement. Do you notice or feel those implants at all?

You look okay now, but I see the look of a slight underbite that you mentioned. You seem to have had that before, too. I'm not sure why people are not smiling. Maybe they always did that, and now you're noticing it more because you're looking for confirmation. Or maybe there is something to it. I don't know. Maybe seek out a therapist and figure that part out. And then when you figure that out, you can reassess if you want to do anything. If you do anything, I'd personally start with the chin procedure. It could make an impact to length, and it's the least invasive of all those you posted. There's no guarantee you'd like that so you need to get your mind right first.

I think what is freaking you out is the 3/4 view. If there is any disharmony it tends to be most noticeable in 3/4 view. Luckily people see us more in frontal or side view.

Where do you live/what team of surgeons is doing all this work?

[kavan]

Thank you. Yes, I do understand that simply forgetting about doing any more surgeries and adjusting to my new face would be the right way to go.

At the same time I do believe that my new plan might be good this time, and I need someone more knowledgeable than me to confirm what I want to do makes sense.

I didn't expect to end up with an underbite appearance, and I completely underestimated the change that the jaw implants would cause. So in a way, I was ignorant of the possible outcomes of those procedures.

I think I might be lucky enough this time with vertical and horizontal chin reduction, unless I'm missing something, to the point where I won't be shocked, but more pleased with the results than before, since I think it would really benefit the harmony of my face.

Like you said, the infraorbital and malar area are recessed in relative comparison to the area the DJS advanced. This doesn't stress me so much, since I would do malar/submalar implants only to try to become more attractive. For the moment I really need a more "normal" face.

Sorry dude. But I confirm only MY OWN opinion which is for you to refrain from pursuing further surgeries. The fact that you need confirmation of YOUR plan coupled with your history of being DISSATISFIED later down the line with the prior CHOICES you DECIDED to make/plan is RED FLAG you are headed toward REVISION TREADMILL and will continue chasing things and also continue being dissatisfied.

I don't think you are in the capacity to make good decisions for yourself and I don't take on the task of making decisions for people and 'coaching' as to what exactly to do.

If you want to make better decisions for yourself, I suggest you take some time off and study up on the relationships that procedures have on the face. For example, it appears you may not have studied up and known AHEAD OF TIME that a large advancement of the maxilla CAN kick up CHANGES to the BASE of nose. Also for SLEEP APNEA, a LARGE advancement of LOWER JAW may be needed to open up airway. If you had studied up before the surgery you would have had some CLUE of that particular relationship and would have been in capacity BEFORE the surgery to ask the right questions (to the doctor) like: 'will my nose base change, will my lower jaw look too pronounced for me?' In that way, adjustments could have been made to the surgical plan to avoid a look you could have been potentially dissatisfied with.

Your content here reflects very poor logistics in decision making behavior which is not something people here can compensate for you. It is not because you look bad. It is because you are victim of your own faulty logistics in the decision making department. IMO, it's because you don't take time to study up on the relationships procedures and displacements have on the face and you just jump into making a decision that results in your being dissatisfied with what ever you chose. So your choices are not backed by studying up on the RELATIONSHIPS procedures can have on the face. Instead, they reflect a quick value judgement of; 'If I do this or that thing, I'll look more attractive.

So, NO 'confirmation' on what ever you plan to do again with another procedure. But you need to recognize that the fact you NEED CONFIRMATION is a RED FLAG that your own future decisions for more procedures MIGHT be the WRONG choice.

That said, take some time off and study the relationship between things or go on consults and come back to the board AFTER the DOCTOR gives a PLAN. Better to get feedback based on a doctor's plan before hand than ask for confirmation you what ever your next haphazard 'plans' might be.

HENCE: REFRAIN from further surgeries until you are more knowledgeable about the relationships between which ever one you choose.

[aamonk99]

Those jaw implants really filled in your anti-gonial notch, huh? I think they made a good improvement. Do you notice or feel those implants at all?

You look okay now, but I see the look of a slight underbite that you mentioned. You seem to have had that before, too. I'm not sure why people are not smiling. Maybe they always did that, and now you're noticing it more because you're looking for confirmation. Or maybe there is something to it. I don't know. Maybe seek out a therapist and figure that part out. And then when you figure that out, you can reassess if you want to do anything. If you do anything, I'd personally start with the chin procedure. It could make an impact to length, and it's the least invasive of all those you posted. There's no guarantee you'd like that so you need to get your mind right first.

I think what is freaking you out is the 3/4 view. If there is any disharmony it tends to be most noticeable in 3/4 view. Luckily people see us more in frontal or side view.

Where do you live/what team of surgeons is doing all this work?

Yes, but to the point that they deleted a natural antegonial notch which I think everyone has to some degree. From the side it looks much better, but from the front you can see there's too much height exactly at that point, making my face rounder. That's why I'm considering replacing it with a much smaller one. I don't feel them at all btw.

FTM the chin reduction is my first priority. But even after 10mm lefort 1 advancement, my maxilla still looks flat and recessed (and more so on the upper maxilla ofc), which makes me think a reverse genio would just make my entire face look flat again. I just wish there was an easy way to expand the whole maxilla. Surgeon told me it was impossible to do another lefort bc I would look like a chimp. Cheek implants seems like a good option since my malar area is the most recessed, but they could emphasize the lack of nose projection.

There's too many things to consider and I posted here hoping I was just missing some easy solution to fix my face. OFC I didn't count on it, but who knows.

I did all of this in Barcelona

[aamonk99]

Sorry dude. But I confirm only MY OWN opinion which is for you to refrain from pursuing further surgeries. The fact that you need confirmation of YOUR plan coupled with your history of being DISSATISFIED later down the line with the prior CHOICES you DECIDED to make/plan is RED FLAG you are headed toward REVISION TREADMILL and will continue chasing things and also continue being dissatisfied.

I don't think you are in the capacity to make good decisions for yourself and I don't take on the task of making decisions for people and 'coaching' as to what exactly to do.

If you want to make better decisions for yourself, I suggest you take some time off and study up on the relationships that procedures have on the face. For example, it appears you may not have studied up and known AHEAD OF TIME that a large advancement of the maxilla CAN kick up CHANGES to the BASE of nose. Also for SLEEP APNEA, a LARGE advancement of LOWER JAW may be needed to open up airway. If you had studied up before the surgery you would have had some CLUE of that particular relationship and would have been in capacity BEFORE the surgery to ask the right questions (to the doctor) like: 'will my nose base change, will my lower jaw look too pronounced for me?' In that way, adjustments could have been made to the surgical plan to avoid a look you could have been potentially dissatisfied with.

Your content here reflects very poor logistics in decision making behavior which is not something people here can compensate for you. It is not because you look bad. It is because you are victim of your own faulty logistics in the decision making department. IMO, it's because you don't take time to study up on the relationships procedures and displacements have on the face and you just jump into making a decision that results in your being dissatisfied with what ever you chose. So your choices are not backed by studying up on the RELATIONSHIPS procedures can have on the face. Instead, they reflect a quick value judgement of; 'If I do this or that thing, I'll look more attractive.

So, NO 'confirmation' on what ever you plan to do again with another procedure. But you need to recognize that the fact you NEED CONFIRMATION is a RED FLAG that your own future decisions for more procedures MIGHT be the WRONG choice.

That said, take some time off and study the relationship between things or go on consults and come back to the board AFTER the DOCTOR gives a PLAN. Better to get feedback based on a doctor's plan before hand than ask for confirmation you what ever your next haphazard 'plans' might be.

HENCE: REFRAIN from further surgeries until you are more knowledgeable about the relationships between which ever one you choose.

I agree with all that you said tbh. I have ADHD and learnt most about jaw surgery AFTER the procedure. I acted really impulsively and probably didn't research for any more than 5 hours (even though I really wanted to). It's really hard for me to just sit down and read about each procedure in depth, study face proportions, make morphs, etc... I had mild sleep apnea and as you can see in the before picture a really recessed face. There was a functional reason and a cosmetic reason. None on their own justified going through DJS. But probably aesthetics was what I was really thinking about.

I should have gone through decompensation first, that seems obvious to me now. The doctor suggested malar implants along with DJS. I rejected them and I think it was a mistake.

I did go to a few doctors mentioning chin reduction/cheek implants, and also asking them to suggest anything to reduce the class III appearance. I feel like most surgeons I go to just agree to do anything I tell them I want to do, and they give me an estimate. They mostly all agreed I could benefit from cheek implants. But so far contradictory opinions on chin reduction. One jaw surgeon even suggested a 2nd jaw surgery to move the maxilla forward again with prior decompensation, but the one that operated on me said it was unfeasible. I guess it's my turn to study in depth whether it's feasible or not.

[kavan]

I would advise AGAINST doing anything to the area that looks relatively recessed via comparison to the double jaw advancement. Like NO CHEEK implants or any implants to to the area. This is because the slightly 'conCAVE' area below the eyes looks very GOOD in FRONTAL view. There is a scientific reason for that. Leonardo DaVinci explained it better than me in his treatise. But it has to do with a concave area 'catching' MORE LIGHT. For example in full frontal view, you have NO SHADOWING to the area below the eyes. So, if you start adding a conVEXity there via implants, you would look more 'off' to yourself.

I would not worry about the lower jaw looking more advanced than the upper area. At most, it makes you look a little 'tough' or maybe 'stand-offish'. But that, IMO, can be compensated for by getting some BOTOX to the FROWN area so you can't frown and so the eye and brow/forehead area looks more friendly. You hold TENSION between your brows which is probably the reason people don't look you in the eye. So it's the 'strong' facial appearance which is not bad in its own right that could be making you look 'unfriendly' which is NOT attributed to the lower jaw itself. Hence, NIXING the ability to use the frown muscles (via BOTOX) is all I would suggest to look a LESS 'stand-offish' to other people and MORE friendly.

So, just do that ONE THING and adapt to your new appearance.

[aamonk99]

I would advise AGAINST doing anything to the area that looks relatively recessed via comparison to the double jaw advancement. Like NO CHEEK implants or any implants to to the area. This is because the slightly 'conCAVE' area below the eyes looks very GOOD in FRONTAL view. There is a scientific reason for that. Leonardo DaVinci explained it better than me in his treatise. But it has to do with a concave area 'catching' MORE LIGHT. For example in full frontal view, you have NO SHADOWING to the area below the eyes. So, if you start adding a conVEXity there via implants, you would look more 'off' to yourself.

I would not worry about the lower jaw looking more advanced than the upper area. At most, it makes you look a little 'tough' or maybe 'stand-offish'. But that, IMO, can be compensated for by getting some BOTOX to the FROWN area so you can't frown and so the eye and brow/forehead area looks more friendly. You hold TENSION between your brows which is probably the reason people don't look you in the eye. So it's the 'strong' facial appearance which is not bad in its own right that could be making you look 'unfriendly' which is NOT attributed to the lower jaw itself. Hence, NIXING the ability to use the frown muscles (via BOTOX) is all I would suggest to look a LESS 'stand-offish' to other people and MORE friendly.

So, just do that ONE THING and adapt to your new appearance.

That's really interesting. But how can a concavity look better just because it somewhat reflects or catches more light? (I know it's more complex than that, sorry). Faces with prominent cheekbones and more convexity tend to look better from the front view too. I do have some filler in that area on the after pics though, just not a lot and I don't notice a lot of improvement on the frontal view. The lack of malar bone on the side profile though, it looks pretty bad. You can see the disconnexion between the upper and lower maxilla. Augmentation to the infraorbital and malar/submalar area seemed like the best improvement I could make because it solves both the lack of infraorbital support which gives me a bad lower eye area in the first place, and it harmonizes the rest of the face which is much more advanced.

I actually have been thinking about getting some botox to the glabella and forehead. I do hold a lot of tension between the eyes bc of all the anxiety all this process has given me. I probably I'm also acting less friendly bc I'm really afraid to smile. I have a quite narrow palate and small crooked teeth which have barely improved with Invisalign. I could look into palate expansion or just some veneers but there's so many things already to think about changing in my face and there's no way I see myself doing ALL these things we've been talking about.

So I should look into opening myself up again to other people and go back the the social life I had before, which would probably change my perspective and don't feel the need to change everything in my face anymore.

[kavan]

That's really interesting. But how can a concavity look better just because it somewhat reflects or catches more light? (I know it's more complex than that, sorry). Faces with prominent cheekbones and more convexity tend to look better from the front view too. I do have some filler in that area on the after pics though, just not a lot and I don't notice a lot of improvement on the frontal view. The lack of malar bone on the side profile though, it looks pretty bad. You can see the disconnexion between the upper and lower maxilla. Augmentation to the infraorbital and malar/submalar area seemed like the best improvement I could make because it solves both the lack of infraorbital support which gives me a bad lower eye area in the first place, and it harmonizes the rest of the face which is much more advanced.

I actually have been thinking about getting some botox to the glabella and forehead. I do hold a lot of tension between the eyes bc of all the anxiety all this process has given me. I probably I'm also acting less friendly bc I'm really afraid to smile. I have a quite narrow palate and small crooked teeth which have barely improved with Invisalign. I could look into palate expansion or just some veneers but there's so many things already to think about changing in my face and there's no way I see myself doing ALL these things we've been talking about.

So I should look into opening myself up again to other people and go back the the social life I had before, which would probably change my perspective and don't feel the need to change everything in my face anymore.

The conCAVE area (in frontal view) collects the light so no shadows are cast and that HIGHLIGHTS the area in frontal view when light source is coming from the front.  Other than that to frown less, which is sometimes unconscious, BOTOX stops the frowning. So that and smile more.

[varbrah]

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.

[kanko]

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.

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

[kanko]

Im not saying reducing the chin will absolutely be bad but its something you should have in mind because the closer your mandibular plane angle gets to 0 the closer you look like a square head minecraft character from the front. So if you end up messing with that i believe you would also change your gonial implants

[varbrah]

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.

OP himself mentioned he has social anxiety and is currently experiencing a severe bout of BDD - it's totally possible he's acting a bit skittish/self-conscious in public and people are catching a weird vibe. It may also simply be anxiety bleeding into and clouding his perception of how others are treating him.

Both scenarios are more likely than strangers actually treating him poorly due to him having masc/ogre looks (because he doesn't) or because he's frowning / his brow is furrowed. Is shooting dirty looks at people for having mild prognathism a consistent phenomenon or something? Do people act significantly weirded out and uncomfortable when interacting with anyone who looks slightly worried/stressed?

Anyway, no - The main aesthetic issue is the fundamental difference in projection between the LF1 area comprising the inferior maxilla/dentoalveolar ridge/anterior nasal spine vs. the superior nasomaxillary complex and anterior malar/zygomatic complex.

Filling out the radix/dorsum will give him back his natural, phenotype-appropriate nasal shape and compensate for the 'relative' loss of nasal projection due to his rather large 10mm advancement. OP is neither a Kpop star nor a woman - a de-projected, small and upturned nose does not occur on rather robust European male faces in nature.

Additionally, from a soft tissue perspective, Subnasale should be (or appear to be) in relative vertical alignment with the anterior-most edge of the nasal bridge. Subnasale appears more projected than the nasal bridge, therefore achieving appropriate balance between the two requires nasal augmentation.

Btw insane that you think an adequately-projected, elegant, straight nose will make OP look more like an ogre lmao.

[varbrah]

Im not saying reducing the chin will absolutely be bad but its something you should have in mind because the closer your mandibular plane angle gets to 0 the closer you look like a square head minecraft character from the front. So if you end up messing with that i believe you would also change your gonial implants

Shouldn't be a big deal to evaluate and potentially plan around for any halfway decent surgeon.