What should I do surgically for the best outcome ?

[Freddie54]

Hi, I’ve been looking for a few years now to get DJS (double jaw surgery) for aesthetic purposes only. Although I do have a skeletal Class II, my face looks very ugly from the front, and to me, I have the typical short face syndrome.

I live in France. I’ve seen five surgeons already; only one said no to me, and the others said yes.

Given that I thought I had short face syndrome, I was thinking about getting a clockwise rotation rather than a counterclockwise one, since I feel that my midface is already very short especially when I bite on my teeth (true Class II and natural face/bite). For a few years now, I’ve been pushing on my front teeth with my tongue, which gives me no teeth contact at rest and not my “true face”. Basically, my lower jaw juts forward automatically while doing this, which I don’t mind since it makes me look less ugly in my opinion.

The fourth surgeon I saw is probably the most skilled in France. I did not mention short face syndrome to him, but I mentioned that I thought it would be best to lower the maxilla, while showing him some people who had short face syndrome and benefited from DJS including cases from Raffaini.He said no to CW and explained that, to gain more density and support behind my upper lip (where I have my nasolabial folds), a CCW rotation plus maxillary advancement would be better. He also mentioned that showing other people’s results would be of no use since everyone is different, especially regarding soft tissue response. He added that he knows how to avoid the nose looking bigger from the front.

The last surgeon I saw (who is also renowned) said the total opposite and agreed with my initial thinking: a small CW rotation plus advancement of both jaws would be better. He warned that a CCW would make me lose even more tooth show and would probably result in a fatter/wider nose.

Now, I know from reading this forum that the CW/CCW distinction alone doesn’t fully determine whether the face gets longer or shorter, what matters is also whether an overall downgraft is involved and how it’s distributed across the maxilla. So I understand both surgeons could theoretically achieve elongation depending on the plan. What I’m genuinely confused about is why “surgeon 4” insists CCW with advancement is better for the nasolabial folds and midface support in my specific case, while “surgeon 5” thinks CW is the right call aesthetically.

I also told the last surgeon that aesthetically I’m looking for a little bump on my upper lip the kind you get when you pull your upper lip forward with your thumb. I don’t even know if this is achievable with surgery. He told me it could be dangerous as it risks creating a “monkey face,” but he acknowledged that some people look especially good with this feature. Personally, I think this bump simply reflects good maxillary forward and upward positioning, which is the goal for most attractive faces.

This last surgeon made me a bit more worried compared to the others, but I don’t know if that even matters in this kind of procedure, as my goal is purely aesthetic and I know the best surgeons aren’t necessarily the most easygoing.

I’m planning to see Dr. Mirco Raffaini for his opinion and then one last French surgeon.

Would gladly accept your opinion on my case.

Here’s an album with pictures, videos and x-rays of my own case: https://imgur.com/a/FOCCEpU

The pictures I was showing as “good case from raffaini” to surgeons the last bunch are people with short face syndrome done by another surgeon that I also showed  https://imgur.com/a/Eol367g

[GJ]

I think a linear advancement would be best. Maybe a very mild CW, but the problem with that, is it will actually result in more recession as the lower jaw goes down. It might be possible to offset that with the chin, but your chin already appears to be in a good spot. I don't see how CCW rotation would help. It seems to me it would make your face shorter.

I don't know. This is a tough case.

[Freddie54]

I think a linear advancement would be best. Maybe a very mild CW, but the problem with that, is it will actually result in more recession as the lower jaw goes down. It might be possible to offset that with the chin, but your chin already appears to be in a good spot. I don't see how CCW rotation would help. It seems to me it would make your face shorter.

I don't know. This is a tough case.

My main goal is really to kill off these nasolabial folds, I don’t know if I could avoid a thicker nose from front by having a linear advancement alone.

[GJ]

My main goal is really to kill off these nasolabial folds, I don’t know if I could avoid a thicker nose from front by having a linear advancement alone.

I don't think jaw surgery will fix the folds. For ever 3mm of bone movement, you get maybe 1mm of soft tissue support. The more likely result is the folds are still there but change somehow depending on the movement. Filler and such might be better? I'm not sure on that but Kavan might be able to chime in.

[Freddie54]

I don't think jaw surgery will fix the folds. For ever 3mm of bone movement, you get maybe 1mm of soft tissue support. The more likely result is the folds are still there but change somehow depending on the movement. Filler and such might be better? I'm not sure on that but Kavan might be able to chime in.

From what you say if I had to do it in france it’d be with the second surgeon who told me CW would be better than CCW, and I’d have to tell him to advance the maxilla as far as possible linearly ?
Idk about filler for the nasolabial fold. You can see that someone has a recessed maxilla and not from this area even if he had filler done. Honestly I’m just going to save to see Raffaini and hear his opinion.