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You could probably lose any fat under your neck and chin by just exercising and save yourself the risk of a surgery there.

This is probably not a jaw surgery case, to be clear. But if you want jaw surgery, my first impression was either a linear advancement or a CWr. Your upper lip/philtrum looks flat, and then your lip curves. So he's probably concerned with the chimp look because of the part higher up. I kinda agree. Hard to say. You generally get about 1mm of soft tissue movement for 3mm of bone. So, you can think how that might turn out. I can't visualize it.

Hello everyone,

I've recently started seeking different maxfacs and thus far, i've seen one. I have a meeting next month with another one.

My face has always bothered me : I have a weak short chin (lacking in height and in my opinion, width) coupled with big lips (I don't hate them), which makes the problem look worse in my opinion. I've been sporting a beard which, when it's "put" well (often luck), hides my chin, gives structure and more height to my face. It gets tiring to always try to get the beard right and to mostly depend on it.

I also think I generally lack definition : both my mandible and my maxilla look puny to me, they lack robustness. I have the same problem with my zygomatic bones. If we add up all of this together we end up with a short face that lacks definition, as if the soft tissues are not stretched enough, all around.

The meeting with the maxfac, he trained under a well regarded maxfac in sweden, left me with a couple of interrogations

First off, he mentionned that my bite (I've had orthodontics treatment younger) and jaws were both in good positions despite a slight asymmetry. He mentionned they were both just a tiny bit behind.  About my maxilla, he mentionned two things : I have close to no tooth show while my lips are slightly open, and my maxilla is a little bit short. He said he couldn't do much moving around the jaws because of my lips : he warned me about the chimp look. This surprised me because what my face lacks possibly the most seems to be height, which if im not mistaken, would be a CWr and not a CCWr in the event I need Bimax. I've always understood, perhaps wrongly, that the chimp look is mostly a CCW problem. My philtrum is also pretty concave and not flat, which puts another interrogation about his chimp look claim.  About the genioplasty, he mentionned he wouldn't be able to advance it a crazy amount (10mm) because of the moon chin look. Again, I'm curious about this claim.

Near the end of the meeting, he said he could probably help me : I have another meeting scheduled next month, he decided this to give me some thinking time.

Other things he mentionned : the possibility of plastic surgery. Now I've heard about bone erosion and the likes, I'm not thrilled about it, but I'm not completely closed to the idea either if it would be better for my case. He also did say something about removing some of the fat under my neck and chin (which I always took as lack of bony support with possibly thick soft tissue) and around my cheeks, which also lack bony support. If I do anything about my cheeks, I'm already aware implants are inevitable. I want to do something about my lower third first before anything else.

I have a ceph that I'll link here : https://imgur.com/a/z5G7G1U

So I think that's it. Excited to hear all of your opinions

If you need more infos, no worries I'll add what's missing 

Thanks in advance  !

you had three prior rhinoplasty surgeries?

Hey guys,

My history: I’m a class 2 patient, 4mm overbite, deep bite, had chin wing 3 years ago. Mandible plane was decreased and chin was advanced about 5-6mm. Chin was rotated ccwr, making the whole face shorter and giving me that classic short face look. 

Horrible results, protruding mandible border, high chin fold. Now I have to reverse the damage.

I'm pretty sure I'm not a classic short face patient, since already have a light gummy smile, when I smile or laugh. Does this indicate that i do not suffer from vertical maxillary deficiency? For this reason, a surgeon told me that downgrafting of the maxilla or clockwise rotation of both jaws is not possible, since it would increase the gummy smile.

My occlusional plane is already quite flat, which is a reason why my surgeon didn't want to add any ccw-rotation. The consulted surgeon routinely does ccwr movements for sleep apnea cases, so this recommendation was not due to his personal limitations in surgery.

My mandible plane was made flatter during the chin wing surgery, since a bone graft was added in between the cut.

As of now there are two options:


Option 1:

1. Bimax ( see the plan at the end) and mandible shaving, due to the protruding mandible border.
- linear advancement (maxilla 5mm, the plan states 2-3mm, but it will probably end up being 5-6mm after revision of the plan, in order to correct overjet.

2. 1 year later revision genio: 2-3mm horizontal reduction, downgraft or deprojection of the pog


Option 2:

Would be to combine those two steps in one surgery. Which might be detrimental to the aesthetic result, since planning cant be as exact.

My questions:

1. Is linear advancement really the only option? My surgeon said no rotation possible, because of flat OP. No downgraft possible because of light gummy smile. Is there anything else in my case, that indicates a linear advancement?

2. Is there any way to down graft the maxilla without worsening the gummy smile?

3. Based on my recession, are 5mm linear maxillary advancement adequate? I'm afraid it might be to too much. Please don't base this question on the convexity of my current nose, since i had a rhinoplasty years ago as well. For this reason, I included an image of my face before all the surgeries in the link. I'm well aware that I will probably require another rhino after maxillary advancement. So please do not base your judgements of the maxillary advance length on my current nose, but rather on the original one, which was very convex and large.


Pictures, Scans and Surgery Plan:
https://imgur.com/a/aegcDPc

Greatly appreciate any piece of advice

Some basic info:

Option 1 gives you the option to choose at a LATER time whether or not you want to do anything more with the chin. So, it should be intuitively obvious that Option 1 is the better option.

'Short face' patient: There are 2 terms in maxfax concerning this; 'short FACE' and 'short CHIN'. They are not both the same. Because your maxilla is not short, the term to describe what you have is 'short CHIN'. Also, the term 'short CHIN' is associated with having the DEEP BITE, low mandibular plane angle and somewhat flat OP. So, correct, you are not a classic 'short FACE' patient and hence don't suffer from a short maxilla. Instead, you are a short chin patient. Not a short maxilla patient=no need to LENGTHEN the maxilla anywhere.

You are told your maxilla is NOT short. Your surgeon expects you to understand that making the maxilla longer ANYWHERE isn't going to solve anything. If he makes it longer in front (anterior downgraft) via a clockwise rotation, that will increase your gummy smile. If he makes is longer at the back (posterior downgraft), that is ccw-r which will just make your short chin appearance look even SHORTER.

Clockwise rotation of maxilla will increase your gum show. Counterclockwise rotation (posterior downgraft) will will make your short chin look even shorter. So, what is so hard for you to understand that the option of increasing the maxilla anywhere is NOT going to work for you? There are 3 options clockwise rotation, counterclockwise rotation and linear advancement. The rotations have been RULED OUT. So, what is so hard to understand that the only option left is linear advancement?

The plan proposal gives you sufficient VISUAL information to determine for yourself whether or not you like the profile CONTOUR CHANGES that are shown on the BLUE diagram they have provided to you. The easy to visualize- whether you like it or not- contour change proposal encompasses all of the various millimeter displacements within it. So, there is no need to discuss specific mm measures when the contour diagram lets you LOOK AT the proposed contour changes.

What I am getting at here is that you have enough info to answer your own questions. The doctor gave you ample information/explanation to CONCLUDE the only option is linear advancement and the contour diagram gives you ample VISUAL information to CONCLUDE whether or not it is to your liking.

3. Based on my recession, are 5mm linear maxillary advancement adequate? I'm afraid it might be to too much. Please don't base this question on the convexity of my current nose, since i had a rhinoplasty years ago as well. For this reason, I included an image of my face before all the surgeries in the link. I'm well aware that I will probably require another rhino after maxillary advancement. So please do not base your judgements of the maxillary advance length on my current nose, but rather on the original one, which was very convex and large.

I guess my biggest fear with linear advancement, is getting a chimp-face. Please let me know if this worry is uncalled for in my case.


After the genio revision, I would like the chin to look like this: https://imgur.com/a/1uKnkGO
What kind of genio cut would be necessary for this type of change?