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Thank you so much for your replies GJ and Kavan!

I always had excessive chin bone height. In 2021, I had Lefort1 + BSSO + sliding genioplasty. The surgeon attempted to shorten the chin by the sliding genioplasty. It has become a few mm shorter but still I have an excess of 4 mm*.

In the attachment you find:
- CBCT (post op)
- Measurement of vertical proportions (post op).

*I think lower subvisions should be 1:2 (upper lid 1/3, lower lip 2/3). My lip subdivion display a ratio of 1:2.2 (20mm:44mm) indicating 4 mm excess height in the chin.

@GJ: Thank you so much for warning me about the big risk of cutting the mentalis a 2nd time. I had a consultation with Dr Jeffrey Spiegel. He suggested shaving the chin bone a few mm shorter through an incision inside the mouth instead of removing a midsection. Does this technique also pose a risk of drooping or damaging the muscle?


@Kavan: Thank you for explaining that chin reduction is not a standalone specialty. I reasoned I should look for a max fac doc who specializes in FFS or V line surgery. I reasoned that they have more experience with chin reduction than most max fax docs. Could you please share your thoughts on that? Does my reasoning make sense or should I rather look for a general max fac?

Many thanks in advance!

OBSERVATIONS:

Scull scan reveals a 'tall' face which is consistent with the longish periform aperture (pear shaped hole of the nose area). Jaw balance and bite are great. Step off seen to the chin is well masked by the SOFT TISSUE envelope when looking at the frontal full FLESH photo. So, the outcome of the genio shortening the chin and advancing it forward was that your soft tissue HID visibility of the bone step off from the genio AND the genio (upward displacement of it) SUPPORTED the soft tissue of the chin area=GOOD OUTCOME.

DIVISION OF '1/3rds':

As someone who studied Fine Arts/Art History at Harvard, I will tell you that the division of 3rds arises from Leonardo and Durer. But as a basic guideline for DRAWING a face. However, it, in itself was not meant to DEFINE 'perfection'. In fact, Leonardo WARPED the ratios to draw hideous faces (as to demonstrate extreme deviations) and did not stick to that ratio when painting the Mona Lisa's face. I will also add that forensic studies of distance relationships inherent in normal to attractive faces reveal division ratios that DIFFER from equal thirds for normal to attractive faces. The point I'm making here is that you need to be cautious about using that as some kind of 'directive' to ALTER your own face via surgery. As to the division of thirds, as it can apply to an attractive face, art students are often encouraged to use different ratios that deviate somewhat from exact division of thirds to draw an aesthetically pleasing face.

YOUR DIVISION OF '1/3rds':

You got the lines right as to hairline, nasal base and chin. But the glabella line was too high. When I lowered this line to be approx at the 'root' of the nose, between the the medial brows, your upper 'third' was equal to the middle 'third'. Now as to the lower 'third' it was longer than upper and midface 'thirds'. For example my RELATIVE measures were 5 'units' for upper, 5 units for middle and 5.9 units for lower 'third'. HOWEVER, there is some leeway one can divide the lower 'third' into thirds in your case. For example, the division line is usually through the oral commissures (corners of mouth). You took some leeway in this because your line passes through where the lips part at CENTER of lips. Through the lower corners of mouth the dividing line would be LOWER than your dividing line. So, the corners of the mouth being LOWER than the parting of the central lip area allows some leeway to use a line lower than your division line but higher than a division line above the corners of the mouth. When I used such a line, I got a division of 3rds for the lower 3rd of face. So, there are some artistic 'liberties' one can take here as to the glabella line and the division at the LIP area and they bear out that the upper and middle areas equal each other and although the lower area is longer, the division of that can be seen as 1/3rd upper and 2/3 lower. So, the division I came up with is that of a TALL yet attractive face in terms of facial ratios. That is to say, it does NOT call for shortening the chin.

SOFT TISSUE OBSERVATIONS.

It looks like you may have had a rhino (if so, it looks good and well sculpted). It also looks like you may have had a lip lift. Perhaps the kind where they hide the scars INSIDE the nostrils. It looks that way because you don't have sills at nostril (little ledges) and the philtral ledges appear to be sucked into your nostrils. So, it looks characteristic of a type of lip lift that lifts the CENTRAL part of the lips where hiding the incision inside the nostrils involves cutting into the little ledges (sills) at nostril nose base. Also, the fact that the corners of your mouth are lower than the central area of where the lips part, that is also consistent with a lip lift. Now, the overall aesthetic GESTALT of the short upper lip area looks GOOD and as I said prior, there is some leeway as to where to set the dividing line to get a 1/3rd to 2/3 division of the lower 'third' of the face. But when you set the lip divide line where you did through central parting of the lips in a circumstance when the corners of the mouth are down lower, leeway has it that the divide line can be set lower than where you placed it but higher than the corners of the mouth to get a 1/3rd to 2/3rds division.

CONCLUSION:

You have a very attractive 'tall' face and although the tallness comes from the chin area, it's NOT a 'long' chin. Also, the contour curve of the lower face is a nice streamline curve (no scalloping) to it. So, there is excellent SOFT TISSUE to BONE STRUCTURE BALANCE to the lower face. The PREDICTIVE aesthetic risks that I see IF you shorten the chin to fit into 'equal division of 3rds' OR 'more feminized shorter chin' would tend to be similar to what I see in other people who pursue the chin shortening as to fit into some ratio they tell themselves they need to fit into. They end up losing soft tissue support. For example there is no guarantee that if you shorten your chin BONE that the soft tissue is going to hug that tightly for a stream line contour curve. The outcome could give appearance that the chin might not look shorter due to the soft tissue envelope surrounding the bone NOT getting shorter and if the soft tissue starts to 'hang' or droop around the bone removal, the chin would still look long to you. Hence your aesthetic risk is losing some of the present stream line contour curve you now have which is a good BALANCE of bone support and soft tissue contour. Basically, if you shorten the chin bone, your central chin BONE goes UP. So, you can be sure the chin BONE would be shorter (on an X ray). But you can't be sure that the SOFT TISSUE of the chin would go up along with it (or not droop down). Personally, I think the potential aesthetic loss of good soft tissue coverage (and good bone support of it) risk outweighs any aesthetic gain to be had from shortening the chin bone. I don't envision an aesthetic gain from shortening the chin bone.

Enclosed is an illustration.

I've seen this reply of yours before Kavan. I undertand where it's coming from. I assure you I've rented a TON of articles. I would appreciate to know if there are noteable articles on it that are hard to find. Like I said, i've even tried contacting said doctor of said article. I even had a consultation with one.

The take home message of my statement is that I don't spoon feed with help about pursuing ML3. So, those wanting this need to rely on their own smarts and ability to research and go on many consultations as did Earl. Not my task here to compensate for any lapses of abilities or luck in that regard.

My reply didnt register properly when I quoted you, but I said I will look into more articles.

I've seen this reply of yours before Kavan. I undertand where it's coming from. I assure you I've rented a TON of articles. I would appreciate to know if there are noteable articles on it that are hard to find. Like I said, i've even tried contacting said doctor of said article. I even had a consultation with one.

I'm not even sure if this is possible, but to avoid the step off it would require sculpting some type of graft (bone or HA) in the eye socket area - just seems super sketchy and un-probabilistic it would work. To imagine a step off, image a staircase with steps. As one step moves forward in relation to the other, there's a ledge that's left at that transition point. That's what makes them steps. So, I think you'd have this near your eye socket. My guess is your eyes would look more deep set as the bone in front moves forward, and if a ledge forms, that would be an entirely different look. Kavan, do you agree with this? I think a ledge would form...

I'll tell you what I don't agree with. I don't agree with spoon feeding people who fly in here seeking out MLF3 who need special advice because 'Earl had one'.  I'm including an entry to that effect that I made some time ago which applies to people who fly in here for any type of coaching in pursuit of what Earl had. Earl did this on his OWN. He is really smart guy to do on his own with NO coaching from anyone else. So, I use the same standard for other seeking what he had. Here is what I said long while ago and it still holds:
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"Ever since Earl's story, so many people come here wanting to be SPOON FED info about L3s and various permutations of 'modified' L3's.

Earl's real story is that he did research ON HIS OWN (medical journals), knew exactly what he wanted and WHY and had a very strong preference in favor of bone cuts over orbital rim implants and of course had the prominent eyes (bug eyes). I think he took a few years of lots of research into the medical papers and consulting around based on the knowledge he ACQUIRED on HIS OWN to cross reference with a good handful of doctors he traveled far to consult with and subsequently chose the doctor he chose.

So NONE of this stuff was handed to him on a platter (or spoon fed) on here as is the case of most of the people coming to JSF looking to be spoon fed info on L3s and various modifications thereof. In fact, a few people who just blindly fell into Earl's doctor's lap 'because Earl did it' could not have possibly been as well prepared as he was in terms of IDing themselves as ideal candidates for orbital rim area advancements this way because they didn't get the extent of improvement he got.

There is ample info out there on L3s and modifications thereof. But finding requires RESEARCH ABILITIES in addition to having the salient anatomy underbelt and ability to 'digest' medical articles and/or a long time to increase knowledge that way as to 'digest' conceptual material.

In essence Earl had the ability to FIND information on this (appropriate med journals) on HIS OWN and to PROCESS it in ACCORDANCE to his aesthetic situation and had all that UNDERBELT when he consulted with a variety of doctors. Also, he knew enough to pursue that surgery AFTER he got his jaw situation in balance.

Seriously, a LOT of the people flying in here wanting to know about L3s have acquired jacks**t info on their own, need to be spoon fed and demonstrate very little capacity to process information. Any doctor you consult with won't be spoon feeding it either and acquisition of knowledge, ON YOUR OWN (like Earl did) will be needed to increase the level of info you get from any consult you go on. That said, be careful about riding on someone else's coat tails for esoteric surgeries like chin wings and L3s . I find that people who are successful with the more esoteric surgeries are good researchers and good at processing complex information and don't need mother bird to chew up and spit out the worm for them.

That said, my policy on 'spoon feeding' is I will sometimes do it for people having a hard time with some of the JAW BALANCE relationships (Lefort1, BSSO and genio) but NOT for the L3s. This is because people coming to a JAW SURGERY forum demonstrate some to enough understanding of jaw to jaw relationships to fill in some of the blanks they have. But about 90-95% of those coming here wanting to know about L3s (or think they need them) are just TOO FULL of BLANKS to fill in for them.

Hence, my policy is for people wanting what Earl had is to BE LIKE EARL and do their own research as he did. Then come back with some demonstration of knowledge in that regard and only a FEW blanks needed to be filled in. Of course, my policy on this does not preclude others who want to tell you all about L3s in the absence of even seeing what you look like."