My face + possible surgery plan

[croutigne]

Hi,

is how I look from the left, right, and front.
It seems to me that I would benefit from a combination of:

- Rhinoplasty
- Cheek implants
- Wraparound jaw implants

Ideally, one surgeon would perform all of these together to save on time, travel expenses, etc. It seems that a good option may be Dr. Yaremchuk- his work on this patient in particular matches my desired result.

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There is also the matter of my narrow dental arches, which corresponds to the following functional concerns:

- Discomfort when fitting my tongue along the roof of my mouth. The left and right edges of my tongue press up against my teeth, hence the .
- Tendency to get easily congested when lying down somewhere without good ventilation. (If I'm not mistaken, a narrow upper arch leads to relatively narrow nasal passages.)

These are not pressing concerns, but I would like to fix them eventually.

The problem here is that my teeth fit perfectly together, so I would think that any operation such as SARPE will ruin my bite unless accompanied by a matching expansion of my lower arch. From my online searches, it does not seem that surgical lower arch expansion is a regularly performed procedure. So I expect this may have to wait for further advances in the field.

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I would appreciate hearing your opinions on any of the above. What would you do in my position? Have I missed something?

[GJ]

First off, you look super normal and even good. I don't consider this a jaw surgery case. Looks more like an orthodontic case to me.

You're correct that expanding the lower arch surgically is not common. It's possible to do, but it's usually only used in sever craniofacial deformity cases, and the reason being as you expand that arch it compresses the condyles. What an ortho might do is flair those teeth to the buccal side so it feels wider, and that might get rid of the scalloping. Usually the force of your tongue would do that naturally, but yours isn't for some reason (it's possible you have ankylosis, where the teeth fuse to the bone). That's pretty rare, though. Maybe you just have zero lateral tongue thrust. You should probably go get a preliminary diagnosis on all this stuff. That would be a good first step to see what you're dealing with.

[kavan]

I'll opine on the relationships as to how things work and the timing logistics of which surgeries/procedures done first before others.

1: Anything having to do with maxfax surgery or even orthodonture alone should be done FIRST. For example making the areas of the lower face WIDER.

a: Ortho alone could widen somewhat IF the back teeth were angled inward lingually (toward the tongue). So, as GJ mentioned, flaring the teeth outward toward buccal side (toward cheek) could address any inward lingual angling of the teeth IF that contributes to some narrowness.

b: Widening by SARPE is a surgical procedure that relates to widening the upper jaw. Widening the lower jaw can be done via vertical cut/s to the chin. When the chin gets widened that way, so does the jaw to jaw distance. Some surgeons in Germany do that.

EITHER WAY, width increase modalities in the venue of maxfax and/or ortho are done first IF you wish to pursue those things in addition to PLASTIC SURGERY.

2: Jaw implants and cheek implants can be put in during the same surgery. They have the capacity to MIMIC the look of a WIDER arch (when the mouth is CLOSED). So it's possible to widen THAT WAY given you elect NOT to do any arch widening procedures in the maxfax venue. But if you plan on doing BOTH, the maxfax and/or ortho procedures would be done FIRST.

3: The rhinoplasty is done LAST. That is because #1 and #2 CHANGE the relationship of HOW the nose LOOKS on the face. Hence changes to the nose should be in (aesthetic) REFERENCE to what the face looks like subsequent to the changes subsequent to #1 and/or #2. Also, in plastic surgery, rhino is said to be the hardest or one of the more complicated surgeries in the venue of plastic surgery. So, ALL of the surgery time is best devoted to rhino alone which is why logistically speaking it's done AFTER both maxfax surgeries and other plastic surgeries (eg. implants).

So, which ever ones you elect for yourself, the above mentioned reflects the logistics of which to do first and conveys how different procedures are best spaced out