Hi everyone,
I’ve been interested in joining the forum for a while, but felt I needed to do a significant amount of my own research first so I could get the best answers once coming here.
To cut a long story short, I’ve arrived at the want to pursue jaw surgery following a recent dissatisfaction (within the last two years) concerning my looks. I started off believing it was my chin that was the issue, and after having several consultations for jaw and chin implants, I thankfully realized that it was my jaws that were the real issue before having that sort of work done.
This brought me to jaw surgery. Here's a side profile pic of my face:
https://imgur.com/DQbgJ5NI’m due to get a CBCT at some point, but in my own admittedly limited assessment of the problem, I see it as this: Bimaxillary retrusion – the need for DJS with counter-clockwise rotation. I think that much is quite obvious. My bite is fine and has been identified as class 1, but both jaws are set back.
As an aside, I do actually get complimented a fair bit on my looks. While I've been unfortunate in how my jaws have grown, I have been blessed with the ability to grow a very thick and impressive medium length beard. In learning what makes a good jaw and chin, I have been able to completely disguise the fact that my jaws are recessed by sculpting my facial hair to portray a jaw that has good width, length, and projection. You can't see through it, and I've even gotten compliments on how strong my jaw looks. The lack of the support under my nose also isn't really visible because of my moustache.
I think because I'm considered to have nice eyes and good eyebrows (areas universally considered crucial for good looks) I've been able to fraud my way to being complimented on my appearance.
In many ways, though, this has left me with an odd feeling. I grew the beard because of my insecurities about my jaw, and any compliments I get somehow only highlight to me how confident I would feel if I actually
did have a good jaw. Moreover, I've been reading about all the associated health issues that can arise from having a small jaw: I haven't been diagnosed with sleep apnoea, but I'll be looking into getting a sleep study done soon.
So it's clear DJS would be a good option for me, but the other issue, which seems inevitable in a case like mine, is that the jaws and chin are small from a width perspective -- something which wouldn’t be addressed by BSSO and LeFort 1. My ramus height is also characteristically short, which again wouldn’t be addressed. I’ve looked into several methods for rectifying this. Naturally, I've also got a relatively small pallet, and would like a wider smile if possible.
For the upper jaw, SARPE or a split LeFort are the options, it seems. From what I’ve read, a split lefort can be unstable, so SARPE would seem the better, albeit more long winded option (as I’d have to wait before having DJS).
As for the lower jaw, that seems more complicated. The first thing I looked into is an implant. I’d rather not use implants if possible, but if I want a longer ramus and wider jaw, a lengthening/widening implant would seem perhaps the best option. Unless it was a wrap-around – which I don’t really like the idea of – this would stop shy of the chin, however, leaving that portion of the jaw still small even after genioplasty (and possibly looking even narrower due to the sliding mechanism of the genioplasty).
Most providers do also perform widening genioplasty whereby the chin is divided and graft material is inserted into the middle, so maybe a combination of the jaw implants and widening genioplasty would be an option. Although, I’d be concerned about some sort of step-off between where the implant would end and the cut for the genioplasty begin – I can’t really conceptualise how it would work. I guess a wrap around implant might theoretically be the best for what I want, but I really don't like that idea. The ones I've seen look uncanny.
I’ve also looked into MSDO, but there doesn’t seem much information about it. It wouldn’t have the problem above and I imagine would provide a more subtle, natural result, but I can’t find many people who have had it to share their experiences. Apparently it can also be risky due to the rotational stress placed on the condyles. This is a shame, as this would’ve made both my chin and jaw wider naturally while expanding my lower pallet; I thought I could’ve got SARPE and MSDO done as one operation, and then when I was healed get DJS. Of course, I may still need some sort of lengthening implant for the ramus area.
The surgeon I have consulted with also does Zygomatic sandwich osteotomy, so in addition to whatever I decided with regarding the above, this would hopefully help complete the result to balance out the upper portion of my face without having to go down the infraorbital/cheek implant route.
It's difficult to articulate what I'm asking advice from the forum. I suppose just opinions on the above surgeries, what you think is best, what you think is, perhaps, not such a good idea. I know DJS is a good idea, but the other matters regarding palatal expansion and jaw/chin widening, I'm still confused as to which option would seem the best. While more forward grown jaws would unquestionably be a good idea if planned and performed properly, I feel there's more debate on the other stuff. But I do feel that DJS would give an incomplete result, and if I'm going to go for this, I'd like to address the other stuff if possible.
I've consulted with a few surgeons already, but all the consultations I've had so far have been free over video call. The next stage is getting a CBCT done and having a more in-depth, paid consultation, but I want to go in armed a little better than I am now.
I'd appreciate any advice you can give me. Thanks a lot!
