jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: eastcoastian1 on August 26, 2019, 06:00:20 AM
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Hi everyone...
Had jaw/chin out in a few years ago and for the most part, have loved the look. That said, I knew I was camouflaging my actual jaw/bite issues but felt they weren’t bad enough where I’d run into any trouble.
Well I’m now starting to notice it looks like my bite, for whatever reason, is starting to shift badly and quickly.....particularly my maxilla seems to be turning lopsided. This really started becoming obvious really just within the last month or so, which makes me wonder if a condyle has dissolved or something.
Attached are some pics only a few months apart. You’ll see the now major discrepancy with the bite.
First two are just a few months ago and last one is current.
https://imgur.com/a/wUWkcc0
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I’m confused about what you had done. We need a better description of what operation you had. We also need more pictures from different angles.
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Had a full custom wrap around jaw implant put in. From the side I think I’m fine. It’s the bite that has become really bad.
Just loaded some side pics to the same link.
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Implants should not change your bite. If it has, something has likely gone terribly wrong. Id go see an expert about it ASAP
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Yeah I’m not sure what’s going on there. Implants should have no impact on the bite. How old are you? You look like you are past the normal stage for jaw growth so I’m very surprised to see your bite is changing.
You need to see an ortho/maxfax to see what is going on. I don’t think it can be determined via self-taken photos alone.
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Yeah the odd thing I’m just seeing the bite change dramatically within the last few months. I’ve always had bite issues and TMJ but I’ve never seen this extreme a change. I’m wondering if perhaps one of my condyles has dissolved.
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Well your maxilla would never "turn lopsided" under any circumstance. It's fused to your skull. The mandible could if your joints are deteriorating.
It's also possible you are looking at things more and starting to notice things that were always there.
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I'm having problems with my X-ray vision today and can't see your condyles.
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Well your maxilla would never "turn lopsided" under any circumstance. It's fused to your skull. The mandible could if your joints are deteriorating.
It's also possible you are looking at things more and starting to notice things that were always there.
Interesting....I thought the maxilla could shift just as bad as the mandible. As you can see in the photos, for whatever reason, everything looks like it’s is getting titled.
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Interesting....I thought the maxilla could shift just as bad as the mandible. As you can see in the photos, for whatever reason, everything looks like it’s is getting titled.
Not if you're done growing. It fuses to the base of the skull. The teeth can move and maybe give that illusion, but I'd say that's unlikely with anything close to normal occlusion.
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Not if you're done growing. It fuses to the base of the skull. The teeth can move and maybe give that illusion, but I'd say that's unlikely with anything close to normal occlusion.
Then I wonder if something is happening with the mandible to give the appearance of a drastic upper jaw tilt/shift......like the right side shifting up and left side shifting down.
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Yeah, best bet is to see an expert because they'll know what to look for and how to assess it. Make sure you bring along any previous records you have, any bite photos, xrays and cbct scans so they can compare them to your current state.
I had a bite change these past few months too and it happened with pain on one side. I have a history of this sort of thing though. Do you have pain? What are your current tmj symptoms?
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Yeah, best bet is to see an expert because they'll know what to look for and how to assess it. Make sure you bring along any previous records you have, any bite photos, xrays and cbct scans so they can compare them to your current state.
I had a bite change these past few months too and it happened with pain on one side. I have a history of this sort of thing though. Do you have pain? What are your current tmj symptoms?
Really bad clicking on the right side whenever I open my mouth and especially pronounced if I move jaw forward. But that’s been the case for a while.
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I should probably also mention I got a couple centers on my front two teeth back in May. Truly hope that didn’t mess everything up.
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I should probably also mention I got a couple centers on my front two teeth back in May. Truly hope that didn’t mess everything up.
What are centers?
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What are centers?
Ugh, auto correct. Meant veneers.
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Based on looking at your posting history which started in 2015, it looks like you had some pre-existing TMJ issues. So what ever issues you had 4 years ago could have progressed (gotten worse) as to what you see now. That would be so with or without the jaw implants.
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Based on looking at your posting history which started in 2015, it looks like you had some pre-existing TMJ issues. So what ever issues you had 4 years ago could have progressed (gotten worse) as to what you see now. That would be so with or without the jaw implants.
That’s what I’m potentially thinking. What confuses me is how there could be such a drastic change within a few months.
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That’s what I’m potentially thinking. What confuses me is how there could be such a drastic change within a few months.
Maybe a 'Straw that broke the camel's back' sort of thing.
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Be very carefull with taking implants out. It can lead to the masseter muscle detaching or retracting upwards, leaving you with an additional flaw which is superhard if not impossible to fix. Sometimes, implants exert alot of force on the masseter, which is comparable to stretching an elastic. When you let go of this elastic, the elastic/masseter might pull back (in this case upwards), creating a bulge, which ruins the ogee line. It isn't always the case, but it might happen, and then you have new problems.
When I look at your pics, I don't find your bite that bad or destracting. You seem to have facial harmony with the implants. So think about wanting to take risks of cutting, scar tissue and other problems, etc.
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Hi guys,
Thought I'd provide an update here.
I visited Dr. Relle and got an new images. My bite, as thought, has shifted significantly and my right condyle is showing signs of resorption. Relle basically told me there's no easy choice here and I kind of put myself in pickle by doing implants to camouflage major asymmetry issues instead of doing jaw surgery and THEN considering implants (take note guys). He told me all my options have risks. He said ortho only could "help" but it again would be more camouflaging and would take significant movement that could actually lead to more issues and theres a possibility I would need jaw surgery regardless and it would be for nothing. On the other hand, he said surgery would fix the functional issues but also said we would need to take the implants out first, wait six months, see how the soft tissue responds and then come up with surgical plan. He said when all is said and done, even with CCW, no way he can match the width of current implants.
So here I am.......needing to figure out what to do. Let me condyle and bite continue to worsen, try orthodontics alone and hope for the best, or bite the bullet and do the long process of jaw surgery then consider implants again if needed.
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Hi guys,
Thought I'd provide an update here.
I visited Dr. Relle and got an new images. My bite, as thought, has shifted significantly and my right condyle is showing signs of resorption. Relle basically told me there's no easy choice here and I kind of put myself in pickle by doing implants to camouflage major asymmetry issues instead of doing jaw surgery and THEN considering implants (take note guys). He told me all my options have risks. He said ortho only could "help" but it again would be more camouflaging and would take significant movement that could actually lead to more issues and theres a possibility I would need jaw surgery regardless and it would be for nothing. On the other hand, he said surgery would fix the functional issues but also said we would need to take the implants out first, wait six months, see how the soft tissue responds and then come up with surgical plan. He said when all is said and done, even with CCW, no way he can match the width of current implants.
So here I am.......needing to figure out what to do. Let me condyle and bite continue to worsen, try orthodontics alone and hope for the best, or bite the bullet and do the long process of jaw surgery then consider implants again if needed.
Did he say JS would relieve your condyle issues?
And you can always put implants back in after JS (not considering cost)
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Did he say JS would relieve your condyle issues?
And you can always put implants back in after JS (not considering cost)
Yeah. To fix bite, condyle, asymmetry......surgery. Particularly for the yaw and cant as my teeth on the right mostly don’t even connect.
The issue is we’re talking a LOT of surgery. Surgery to remove implants, surgery for bimax, then potential surgery again for new implants.
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Does he think the implants in any way made your issues worse?
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Does he think the implants in any way made your issues worse?
Didn’t imply that. Moreso that my original issue has gotten worse. My teeth on the right don’t even meet when biting now.
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Are there any stories or literature about patients who had implants removed then did jaw surgery?
I’m really struggling on deciding what to do here....
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Are there any stories or literature about patients who had implants removed then did jaw surgery?
I’m really struggling on deciding what to do here....
I never read something about it. I only read about soft tissue problems in some cases when taking implants out (chin ptosis and masseter bulge). It's very hard to fix soft tissue problems. Some people on this board had many revisions to fix for example chin ptosis. Soft tissue problems seem minor problems, but they are a hell of alot more difficult to fix than problems with bonestructure.
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I never read something about it. I only read about soft tissue problems in some cases when taking implants out (chin ptosis and masseter bulge). It's very hard to fix soft tissue problems. Some people on this board had many revisions to fix for example chin ptosis. Soft tissue problems seem minor problems, but they are a hell of alot more difficult to fix than problems with bonestructure.
Yeah that makes sense. Another piece I’d need to figure out is if do take the implant out first, wait for it to heal, THEN do jaw surgery....or take implant out and do surgery at same time. Relle is pushing me to get the implant taken out first and to wait, but I’m scared s**tless of contraction issues, skin sagging, problems with the capsule, and overall just looking awful between implant removal and jaw surgery. Plus it’s just an extra surgery. Plus I feel like there’s less chance of some of the issues you mentioned if I’m filling some of that empty space right away with movement/advancement from the jaw surgery, instead of letting dead space linger for 6+ months. But Relle says he wants to see how the soft tissue will respond.
Realistically though, I feel like I’ll end up getting implants again anyway as both Relle and Gunson both said they can’t replicate the look of the implant, especially the width, with jaw surgery alone. Prob do Medpor though this time.
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Yeah that makes sense. Another piece I’d need to figure out is if do take the implant out first, wait for it to heal, THEN do jaw surgery....or take implant out and do surgery at same time. Relle is pushing me to get the implant taken out first and to wait, but I’m scared s**tless of contraction issues, skin sagging, problems with the capsule, and overall just looking awful between implant removal and jaw surgery. Plus it’s just an extra surgery. Plus I feel like there’s less chance of some of the issues you mentioned if I’m filling some of that empty space right away with movement/advancement from the jaw surgery, instead of letting dead space linger for 6+ months. But Relle says he wants to see how the soft tissue will respond.
Realistically though, I feel like I’ll end up getting implants again anyway as both Relle and Gunson both said they can’t replicate the look of the implant, especially the width, with jaw surgery alone. Prob do Medpor though this time.
+ You could take implants again, but that doesn't mean they will look as good as these ones. The revision rate with implants is around 30 percent or even higher, so that means lots of people aren't happy with the results due to them being too big, too small, asymmetric or for other reasons. People with implants that do fit the face are very lucky, cause lots of surgeons that do these kind of procedures just have no clue what the hell they're doing aestethically. So many surgeons with absolutely zero knowledge about proportions and aestethics, and in the rare cases they do, they lack the artistic skills to perform it the right way. Oldskool surgeons still have 'the 80s mindset': the bigger the better; overdone nosejobs, extreme implants, etc. The really skilled ones know that the secret of beauty lies in the details.
That being said, if you're young, you can do alot of revisions without looking fake cause of the elasticity of the skin.
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+ You could take implants again, but that doesn't mean they will look as good as these ones. The revision rate with implants is around 30 percent or even higher, so that means lots of people aren't happy with the results due to them being too big, too small, asymmetric or for other reasons. People with implants that do fit the face are very lucky, cause lots of surgeons that do these kind of procedures just have no clue what the hell they're doing aestethically. So many surgeons with absolutely zero knowledge about proportions and aestethics, and in the rare cases they do, they lack the artistic skills to perform it the right way. Oldskool surgeons still have 'the 80s mindset': the bigger the better; overdone nosejobs, extreme implants, etc. The really skilled ones know that the secret of beauty lies in the details.
That being said, if you're young, you can do alot of revisions without looking fake cause of the elasticity of the skin.
33 so kind of borderline lol.
I went to Dr. Y and left the measurements up to him and he went pretty conservative. I believe 8mm width added each side (which when it settled is down to about 6mm according to a doc recently). To be fair, I was so deficient before, that ANY increase would have been an improvement, which it was. I essentially had a long mid face with small lower third, and narrow V-shaped jaw with zero angles. Just adding the extra bulk really helped.
That said, still had issues with the angles (width and drop down) and every 3 months or so I get Radiesse filled, which looks awesome initially but fades really quick. Truth be told, if I didn't do jaw surgery, I prob would redo the implants anyway.
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33 so kind of borderline lol.
I went to Dr. Y and left the measurements up to him and he went pretty conservative. I believe 8mm width added each side (which when it settled is down to about 6mm according to a doc recently). To be fair, I was so deficient before, that ANY increase would have been an improvement, which it was. I essentially had a long mid face with small lower third, and narrow V-shaped jaw with zero angles. Just adding the extra bulk really helped.
That said, still had issues with the angles (width and drop down) and every 3 months or so I get Radiesse filled, which looks awesome initially but fades really quick. Truth be told, if I didn't do jaw surgery, I prob would redo the implants anyway.
I don't know, they seem to look good on you. You'll never get perfection. There is no perfect face. A couple of minor flaws add to the uniqueness of the face and can make someone look more striking than an almost perfect face with generic beauty.
From what I can see, Yaremchuk did a really good job. Don't underestimate how hard it is to get implants right. Maybe he was a bit conservative to you, but I personally don't see that. I see a natural looking jaw and chin that have the right proportions.
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I don't know, they seem to look good on you. You'll never get perfection. There is no perfect face. A couple of minor flaws add to the uniqueness of the face and can make someone look more striking than an almost perfect face with generic beauty.
From what I can see, Yaremchuk did a really good job. Don't underestimate how hard it is to get implants right. Maybe he was a bit conservative to you, but I personally don't see that. I see a natural looking jaw and chin that have the right proportions.
Thanks. He did okay, but only with fillers do I get the result I really wanted. Figure I'll post some before and after examples: https://imgur.com/a/f9cxuWZ
First set is pre-surgery. Second is after surgery (notice more bulk but still no angles and rounded jawline). Third is set pretty much me the last few years as I'm pretty consistent with fillers (but spending a fortune doing them so often).
Do you have any before and afters? Especially interested in PEEK results.
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Why did Y do silicon? He always does medpor.
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Thanks. He did okay, but only with fillers do I get the result I really wanted. Figure I'll post some before and after examples: https://imgur.com/a/f9cxuWZ
First set is pre-surgery. Second is after surgery (notice more bulk but still no angles and rounded jawline). Third is set pretty much me the last few years as I'm pretty consistent with fillers (but spending a fortune doing them so often).
Do you have any before and afters? Especially interested in PEEK results.
Damn, that's quite a lifechanging difference. I do understand that you take additional fillers to lower the jawangles, but it doesn't mean that a broader implant would give the same effect. One needs to preserve the areodynamic look from the front. A bigger implant might ruin this and cause a bulky face. Not always, but it can happen, depending on the face. I think this is the reason why Yaremchuk is more conservative, but I'm not sure.
PEEK versus silicone: my personal opinion is that PEEK looks more natural overall, probably due to having a more rough surface (silicone is smooth), but the most important thing is the right size. Also, silicone is soft, screws can get loose over time due to the softness. But not alot of surgeons do PEEK and there's not much research about the results and long term effect.
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Why did Y do silicon? He always does medpor.
You’d think that, but for custom implants he only does silicone.
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Damn, that's quite a lifechanging difference. I do understand that you take additional fillers to lower the jawangles, but it doesn't mean that a broader implant would give the same effect. One needs to preserve the areodynamic look from the front. A bigger implant might ruin this and cause a bulky face. Not always, but it can happen, depending on the face. I think this is the reason why Yaremchuk is more conservative, but I'm not sure.
I think there’s a good middle ground without looking overdone. He pretty much didn’t lower mine at all. I think 7 or 8 more mm width and 6mm more drop down should work without looking over done or potentially boxy. I think the key here is ONLY changing the dimensions of the angles and not the rest of the implant.
Then again, who knows what’s gonna happen with the jaw surgery.
A note about Yaremchuk, he tends to be conservative with drop down mainly because he worries about “massester muscle disruption”.
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I think there’s a good middle ground without looking overdone. He pretty much didn’t lower mine at all. I think 7 or 8 more mm width and 6mm more drop down should work without looking over done or potentially boxy. I think the key here is ONLY changing the dimensions of the angles and not the rest of the implant.
Then again, who knows what’s gonna happen with the jaw surgery.
This area is crucial (see pic). It must remain 'lean'.
https://imgur.com/a/3R3Nhtt
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This area is crucial (see pic). It must remain 'lean'.
https://imgur.com/a/3R3Nhtt
Exactly! The problem I think was that my implant itself added width which essentially canceled out the angles. If I could redo just the angles alone and leave the rest of the implant the same, I think I would be set.
Or do it the other way, where I leave the angle implants the same and shorten the width of the jawline part. Whatever it takes to create those “lean, sharp” angles.
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You’d think that, but for custom implants he only does silicone.
Pretty sure his were custom medpor.
https://www.realself.com/review/boston-ma-custom-facial-implants-chin-jaw-cheek-rhinoplasty-fat-removal
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Pretty sure his were custom medpor.
https://www.realself.com/review/boston-ma-custom-facial-implants-chin-jaw-cheek-rhinoplasty-fat-removal
Nope, look at his first post. They were silicone. Plus that imaging software that’s used is only done with custom silicone.
He mentioned custom Medpor is an option but doesn’t do it much (says bespoke Medpor is fine) and runs upwards of 40k+.
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Exactly! The problem I think was that my implant itself added width which essentially canceled out the angles. If I could redo just the angles alone and leave the rest of the implant the same, I think I would be set.
Or do it the other way, where I leave the angle implants the same and shorten the width of the jawline part. Whatever it takes to create those “lean, sharp” angles.
I think it looks okay on you, I've seen far worse. The question is: what causes the bulk that I have seen with many implant results at the area I pointed out: is it an implant being too wide, or is it caused by the upper part of the implant underneath the upper masseter that is often needed to fix the implant (see pic)? If it's the former, then Yaremchuck has all the reasons to be conservative.
Basically the area I circled, isn't needed astaethically, but one surgeon said to me that it's needed to fix the implant. Still, I think: why not fix the implant only at the lower border?
https://imgur.com/a/kVX6CzA
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I think it looks okay on you, I've seen far worse. The question is: what causes the bulk that I have seen with many implant results at the area I pointed out: is it an implant being too wide, or is it caused by the upper part of the implant underneath the upper masseter that is often needed to fix the implant (see pic)? If it's the former, then Yaremchuck has all the reasons to be conservative.
Basically the area I circled, isn't needed astaethically, but one surgeon said to me that it's needed to fix the implant. Still, I think: why not fix the implant only at the lower border?
https://imgur.com/a/kVX6CzA
I honestly think it’s a combination of fatter soft tissue (people with genetically chubby faces should not get it. Those often have awful results) as well as swelling. My final result honestly didn’t come in until about a year later. First 6 months I was a straight up potato.
In regards to your photo, I’ve never thought of that area being clinically relevant. I’ve even felt an implant in my hand and that area is quite thin, so I can’t imagine it making much difference, but could be wrong.
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Pretty sure his were custom medpor.
https://www.realself.com/review/boston-ma-custom-facial-implants-chin-jaw-cheek-rhinoplasty-fat-removal
This is silicone. You can see a bit of 'fakeness' on some pics that is typical of silicone. Still looks good on him. Another good job from Yaremchuk.
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In regards to your photo, I’ve never thought of that area being clinically relevant. I’ve even felt an implant in my hand and that area is quite thin, so I can’t imagine it making much difference, but could be wrong.
Yes, it's often overlooked by most surgeons as well, but this result shows how important it can be:
https://imgur.com/a/6xRVtVN
And sometimes you get these freaky results by doing too much:
https://imgur.com/a/7HckHZi
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Yes, it's often overlooked by most surgeons as well, but this result shows how important it can be:
https://imgur.com/a/6xRVtVN
And sometimes you get these freaky results by doing too much:
https://imgur.com/a/7HckHZi
First one looks super solid. Fyi, Defraq only uses Medpor.
Second one looks like a joke....which is weird because it’s a textbook “model jawline” yet somehow just does not go with his face. Is it just too big?
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First one looks super solid. Fyi, Defraq only uses Medpor.
Second one looks like a joke....which is weird because it’s a textbook “model jawline” yet somehow just does not go with his face. Is it just too big?
Opinions differ on the first one. Most people on this board said it was too bulky. There is more width, but ogeeline and shadows are gone. Imo he looks fatter, not better.
Second one is too big. Jawangles too low, implant too wide (should be slightly less wide than zygos), chin too portuded. You can't just put a male model jaw and chin on every face, it's going too look unnatural.
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Opinions differ on the first one. Most people on this board said it was too bulky. There is more width, but ogeeline and shadows are gone. Imo he looks fatter, not better.
Second one is too big. Jawangles too low, implant too wide (should be slightly less wide than zygos), chin too portuded. You can't just put a male model jaw and chin on every face, it's going too look unnatural.
I think the elongation more than anything is what’s doing it. Looks like a pencil head.
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I think the elongation more than anything is what’s doing it. Looks like a pencil head.
Should have been something like this I think.
Still looks a bit fake imo, probably due to the material (silicone).
Does anyone know who the surgeon was who did this? Seems like a typical Eppley overdone thing.
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Should have been something like this I think.
Still looks a bit fake imo, probably due to the material (silicone).
Does anyone know who the surgeon was who did this? Seems like a typical Eppley overdone thing.
ROFL I think that's Eppley's work.
I think his issue is that he already had a chubby face with lots of fat. His midface was already too long to begin with. And his jaws seemed to be recessed to begin with.
This is why you can't just slap implants on recessed jaws. This is why I'm going to have bimax first
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ROFL I think that's Eppley's work.
Doesn't surprise me. I can spot E's work from a mile distance. One of the worst surgeons in the field, consistently creating these absurd freakish results. Eppley should work in a zoo.
This is why you can't just slap implants on recessed jaws.
This guy doesn't have recessed jaw.
And you obviously can cause you're proof. I think you are asking to be scammed.
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Doesn't surprise. I can spot E's work from a mile distance. One of the worst surgeons in the field, consistently creating these absurd freakish results. Eppley should work in a zoo.
This guy doesn't have recessed jaw.
And you obviously can cause you're proof. I think you are asking to be scammed.
Wait, explain how I am proof please.
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Wait, explain how I am proof please.
You had recessed jaw and put in implants and it looked decent. It still looks decent, even with the overbite.
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You had recessed jaw and put in implants and it looked decent. It still looks decent, even with the overbite.
I think you're confusing me with someone else. I've not had implants put in my face yet. Only fillers.
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I think you're confusing me with someone else. I've not had implants put in my face yet. Only fillers.
I'm sorry, lol. It wasn't you but OP ;)
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Also looks like he had cheek implants too, almost morphing into a woman. Just a gross result through and through.
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Yes, it's often overlooked by most surgeons as well, but this result shows how important it can be:
https://imgur.com/a/6xRVtVN
And sometimes you get these freaky results by doing too much:
https://imgur.com/a/7HckHZi
I'm not sure even the first guy looks 'better' after. He had great structure before. His jaw just looks unnaturally wide in the after.
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I'm not sure even the first guy looks 'better' after. He had great structure before. His jaw just looks unnaturally wide in the after.
I dunno, it’s subjective, but I’m all about the square, wide look. Girls seem to be to: https://bestlifeonline.com/heres-why-women-are-attracted-to-square-jawed-men/
I can vouch that for a week after filler or so when the angles are overly squared off, I get a pretty off the chart amount of female attention.
Overall though I’m getting laid 100x more and with prettier girls than I did prior to surgery....I simply can’t argue with it. Also I swear it’s not a placebo (“it’s just more confidence” kind of argument) cause my confidence is still s**t lol.
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I dunno, it’s subjective, but I’m all about the square, wide look. Girls seem to be to: https://bestlifeonline.com/heres-why-women-are-attracted-to-square-jawed-men/
I can vouch that for a week after filler or so when the angles are overly squared off, I get a pretty off the chart amount of female attention.
Overall though I’m getting laid 100x more and with prettier girls than I did prior to surgery....I simply can’t argue with it. Also I swear it’s not a placebo (“it’s just more confidence” kind of argument) cause my confidence is still s**t lol.
Girls don't give a s**t about confidence if you're gl.
Also, yes, women like square jaws, but square jaws without ogeeline don't improve looks compared to ogeeline + a bit less square. When you put fillers they only target the lower border of the jaw, so the ogeeline is never disturbed.
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That first guy looked so much better before. He had a good looking face. Now it just looks all squashed and bloated.
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That first guy looked so much better before. He had a good looking face. Now it just looks all squashed and bloated.
That’s what I see as well..
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That first guy looked so much better before. He had a good looking face. Now it just looks all squashed and bloated.
He would've looked like the after just by getting fatter.
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Quick update here.
Just left Gunson. He pretty much told me that, realistically, after all is said and done, I’d probably go and get another silicone implant which he seems to be fine with. He told me that while my mandibular plane is very high, my occlusal plane is close to 90 degrees, which means basically my teeth are too level compared to the jaw to do any kind of CCW rotation even with decompensation. So surgery would only be advancement and fixing the asymmetry. He also recommended NOT using HA during my surgery as he said that makes it almost impossible to get an implant afterwards, so if that’s something I wanted, he shouldn’t do.