CBCT SCAN AND PICS LINKED BELOW.
I am nearing the beginning of my surgery planning process, and it dawned on me, that, though my initial plan was simply to get Bimax and genioplasty to fix my issues with infraorbital rim implants, this may not be enough.
My issues include the following
-Super recessed upper maxilla (Lefort 2 and 3 area), giving me negative canthal tilt, deep tear troughs, and young, droopy appearing eyes
-Flat midface
-Long, narrow face
-Narrow lower third
-Narrow palate
-Mild bimaxillary protrusion
-Severely downward grown jaw
-Asymmetry
-Jowling due to recessed midface in my early 20s
-Fat cheeks even a low body fat
-Retruded chin compared to mandible (hard to tell with bear)
-Skeletal class 3 (although occlusion was corrected by braces)
-All these issues make me look like a young boy even tho I am in my early 20s and lower my confidence because I do not look my age at all (I will include pictures)
My goals with surgical intervention were to
-Fix underbite appearance and narrow palate with double jaw surgery
-Increase facial width to height ratio with 3 piece lefort 1 with impaction and eliminate long face appearance. Would also shorten lower third with downward growth corrction. This would also make my face and lower third appear to me more dimoprhic
-Get eye area correct by adding custom infra-orbital paranasal malar implants for midface definition and eliminating scleral show plus canthoplasty and blepheroplasty to eliminate tear troughs
I now realize, that due to a combination of bimax protrusion and severe upper midface recession, it is possible I will be hard to advance my jaws enough to make a difference. Additionally, I am not sure how much midface implants can fix my recession.
My goals are also follows:
-Decrease facial height and increase facial width
-Advance midface enoguh that jowling and tear troughs diminish and negative canthal tilt and scleral show can disappear with canthoplasty, and cheeks wont look fat anymore
-Decrease downward growth/gonial angle
-Make chin look non-retrude
-Make face look overall more dimorphic
-Make lower third appear wider
-Decrease facial "class III" look
-Fix asymmetry
-Overall look more forward grown than downward grown
I am wondering what I should due to accomplish these plans. I will list every procedure I was considering along with the pros and cons
MSE
+Widens palate and decreases complexity in bimax
+More stable than 3 piece lefort 1
-Only mildly changes FWHR
-Takes a bit to recover from before you can start bimax, and I wannabe done with all this surgery by 26
Bimax + Genio
+3 piece Lefort 1 can widen maxilla and be done at the same time as bimax
+Impaction plus clockwise rotation can widen face and make it shorter
+Genio can be done at the same time
+Can fix asymmetry
+Insurance would likely pay after decompensation
- Has no effect on upper midface
- Might potentially be not a huge aesthetic difference due to limits on advance due to bimax protrusion and recession of upper skull.
Midface implants
+Can advance midface area
-Midface implants often dont look good
- If I plan to do bimax, I have to wait until then to get them put in
Modified Lefort 3
+ Advances whole midface and presumably can be done at the same time as bimax + genio
+ Appears to be the best way to fix recessed upper maxilla
- Appears only Dr Sinn does this
- Is crazy expensive and will potentially take 2+ years to save for
- Risk level is semi unknown (risky of blindness?)
Based on my face and my goals, what combination of procedures should I get to accomplish said goals? I know I will never be a 10/10, but I would like to at least go from a 3-4/10 to a 6-7/10. Is any of the information I mentioned incorrect? It just sucks because I have every craniofacial flaw in existence. I wish I could jsut get bimax and be done like most ppl.
If anyone has an alternate set of procedures to recommend to me, please do so. I want to know all my options before I begin paying for surgery
https://imgur.com/a/v9NfvTB
