Need Advice for Optimizing Face

[LCM9001]

I'm looking to leverage surgeries to improve the way that I look.

I'd like to optimize the best that I can the way that I look with the most reliable procedures possible.

I think I'd like to go the route of implants only and a genioplasty for added chin height, however, if certain osteotomies were more likely to give me a substantially better outcome, I'm open to learning more and considering those as well.

I'm not open to anything that would require long-term braces though.  Invisalign is totally fine.  However, I'm 34, so I'm not looking to wear braces.

I know that I obviously need to get a revision rhino (this would be a 4th surgery).  I think that would be best to do after some initial procedure(s) so it fits any changes made to the size and shape of my face.

I'll also do a hair transplant to improve my hairline but would save that for last as it's more of an icing on the cake.

Here is a link to pictures that include my face, an x-ray from an orthodontic appointment and 3D pictures of my skull from a 3D CT Scan I got: https://imgur.com/a/mB8eUPt

If I need to include any other images or information just let me know.

Thank you in advance for taking the time to look and provide advice!

[mediumdrinkofwater]

you had three prior rhinoplasty surgeries?

[LCM9001]

you had three prior rhinoplasty surgeries?

yes, unfortunately, I shouldn't have touched it after the first one.

Even after my first, which was decent enough, I still didn't feel confident in the way that I looked but this was years ago and never considered getting other surgeries.

I know I'm never going to look like a movie star/model/whatever, that's fine, I'm just taking the approach that I want to optimize what I have.

I think the nose will have to come after any implants since it will need to fit my face.

I've seen some really level headed and considerate responses on this forum so hoping to get some feedback.

[GJ]

I think adding a bit of chin height would not be a bad idea. You don't really need it, but I can see why you would want it given you have a short face. The problem is that labio-mental grove is already pretty deep, and it will get deeper, so you need to discuss how that will be handled if you do go that route. Regarding jaw surgery...I mean, no. But I can see someone thinking you need clockwise rotation to lengthen your face. I don't think so, but that's a purely aesthetic/preference thing, and I personally I couldn't see doing surgery for that. Specifically: my concern would be chimp lip, and I also think you'd run into problems regarding the nose. Expect 1-2mm of widening if you move the upper jaw. Given you had so much nose work done already, I'd be super skeptical that would turn out well. I'll email you one more note.

[LCM9001]

I think adding a bit of chin height would not be a bad idea. You don't really need it, but I can see why you would want it given you have a short face. The problem is that labio-mental grove is already pretty deep, and it will get deeper, so you need to discuss how that will be handled if you do go that route. Regarding jaw surgery...I mean, no. But I can see someone thinking you need clockwise rotation to lengthen your face. I don't think so, but that's a purely aesthetic/preference thing, and I personally I couldn't see doing surgery for that. Specifically: my concern would be chimp lip, and I also think you'd run into problems regarding the nose. Expect 1-2mm of widening if you move the upper jaw. Given you had so much nose work done already, I'd be super skeptical that would turn out well. I'll email you one more note.

I appreciate you taking a look and posting your thoughts.

If I were to get a genio for added height, what would I need to do in order to avoid any issues with the labiomental area?

I've thought about paranasal/midface implant to reduce the nasolabial folds.  Any thoughts on that?

[kavan]

You have the type of profile that IMO that would benefit from double jaw surgery with clockwise rotation. Maxilla advancement would give better support to the base of your nose which looks collapsed due to lack maxillary support. You have short chin and a low mandibular plane angle. So, double jaw advancement in your case would look better with CW-r. However, you've ruled that out because it is something that requires braces to prepare for.

I'll repeat what I said in another post where person had somewhat similar profile as yours: "Double jaw advancement with clockwise rotation around the ANS point. CW-r around the ANS point will bring PNS up, push the chin point backwards and down. Soft tissue of the lips will go backwards and soft tissue at chin will go backwards and down. So, with the CW-r, it tends to reduce the type of 'stick out' you have with the lips. It also increases your LOW Mandibular plane angle and sets the chin point downwards so it doesn't look so short. CW-r is backwards and down and that is the best rotation to have (in your case) for the double jaw advancement."

In the event you would like to consider/consult about double jaw surgery (which requires time in braces), I'm just giving you a 'heads up' on what the maxfax doc might suggest for improvement. I don't think you have enough BASE OF THE NOSE SUPPORT (maxillary support) to risk another failed rhino and I think your rhino failures may have been attributed to lack of maxillary support in the first place.

[LCM9001]

You have the type of profile that IMO that would benefit from double jaw surgery with clockwise rotation. Maxilla advancement would give better support to the base of your nose which looks collapsed due to lack maxillary support. You have short chin and a low mandibular plane angle. So, double jaw advancement in your case would look better with CW-r. However, you've ruled that out because it is something that requires braces to prepare for.

I'll repeat what I said in another post where person had somewhat similar profile as yours: "Double jaw advancement with clockwise rotation around the ANS point. CW-r around the ANS point will bring PNS up, push the chin point backwards and down. Soft tissue of the lips will go backwards and soft tissue at chin will go backwards and down. So, with the CW-r, it tends to reduce the type of 'stick out' you have with the lips. It also increases your LOW Mandibular plane angle and sets the chin point downwards so it doesn't look so short. CW-r is backwards and down and that is the best rotation to have (in your case) for the double jaw advancement."

In the event you would like to consider/consult about double jaw surgery (which requires time in braces), I'm just giving you a 'heads up' on what the maxfax doc might suggest for improvement. I don't think you have enough BASE OF THE NOSE SUPPORT (maxillary support) to risk another failed rhino and I think your rhino failures may have been attributed to lack of maxillary support in the first place.

Thank you very much for the thorough response.

Is there any way to do the jaw surgery I would need, that you suggest, without braces?  Or could it be done with invisalign or a similar solution?  Or if braces were absolutely required, what is the shortest amount of time I could have them?

If not, is there any way to replicate (even if not fully) the aesthetic results I would get from your suggested procedure with implants and/or other alternatives?

[kavan]

Thank you very much for the thorough response.

Is there any way to do the jaw surgery I would need, that you suggest, without braces?  Or could it be done with invisalign or a similar solution?  Or if braces were absolutely required, what is the shortest amount of time I could have them?

If not, is there any way to replicate (even if not fully) the aesthetic results I would get from your suggested procedure with implants and/or other alternatives?

Braces can take over a year to get the teeth prepared for the jaw displacements in a maxfax surgery. They are needed to 'decompensate' a bite (to UNDO the present bite to prepare for future bite with jaw movements). Only an ortho who works with a surgeon could tell you how long or if invisalign. The nose and it's lack of maxillary support is key problem. Although there are implants that go under the nose base to project out the base of the nose, it doesn't hurt to consult with a maxfax surgeon about rotations along with advancements.