jawsurgeryforums.com
General Category => Aesthetics => Topic started by: InvisalignOnly on August 22, 2020, 08:09:14 AM
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Dear All, I had double jaw surgery 3.5 weeks ago and have a question about HA (hydroxyapatite) granules. I am a very skinny woman and had a thin face before surgery (was planning to get fillers after the operation to make my face look less thin actually). After the surgery, the doctor told me that when they moved my maxilla backwards, my face looked so sunken in that they decided on the spot to place some HA granules to fill in the nasiolabial folds and surrounding area.
A few weeks later, it looks like I have 'chubby cheeks' which becomes particularly noticeable when I try to smile - see pictures attached. I am wondering if this is just swelling (maybe extra swelling because of the HA) or am I more or less permanently stuck with these chubby-looking parts? It's definitely not infected or anything as I do not have any pain or discomfort anywhere, and everything feels soft, just like fat basically. I feel like I still have a lot of swelling in general, especially in the mid-face area. Can the chubbiness just be part of normal swelling and will it improve over time, or is it more likely that the doctor overdid the HA granules and the 'chubby' look is permanent? If the latter, is there any way to reduce that a few months later without cutting my face up again?
Thanks for you input in advance.
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I think it is not possible to say without before pictures. I have a thin face myself and swellings seems not to be noticeable as swelling on a thin face. Why I ask for before pictures, because it is unlikley that a thin face will tranform to a bulky face overall.
Also 3.5weeks is a really a very very short period.
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You are right, it's early days. I didn't even notice the chubby cheeks until a friend made a tacktless joke about my face looking fat despite the liquid diet 🙈. I told her it was swelling, then started thinking, those cheeks really do look big 🤣. Anyway, I attached a picture for comparison taken just before my surgery (I wasn't in the mood to smile then, my overbite looked the absolute worst because of decompensation, hated it so much and so happy to see it gone).
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HA granules are KNOWN for extra swelling and it takes some time for the swelling they kick up to go down. I don't know the time frame. I just know they are known for long term swelling.
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It looks like swelling to me, because you look bulkier to me. I don't think that this is fat, then you had really to outeat me and I counted calories and put extra wheat bran in my soups.
Despite liquid diet, you can easily gain weight if you don't count calories. Normally if it is just soups, without any wheat bran for extra calories what I did, you shouldn't get enough calories to gain extra weight. You will even loose weight, because just soups aren't enough.
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I am 170cm tall and was 44 kilos when I left the hospital 3 weeks ago (I think that's less than 100lbs) so it's safe to say I'm not overweight 🤣. Attached a photo taken yesterday to illustrate. I've been counting calories like crazy because the doctors were very worried about me losing more weight and I've been making a massive effort to keep my calorie intake up since. I think it's safe to conclude that you're both right, it's really just swelling and I have to wait for it to go down and see what it looks like after several weeks.
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On a post 17 Aug (to someone freaked out about swelling) you said:
..... I had BSSO plus LeFort 1 plus genio 3 weeks ago and the doctor warned me beforehand that the LeFort area will be swollen for much longer than the mandible area, and I am glad he did, otherwise I would have panicked too. My upper lip and the whole area surrounding the nose is still very swollen and looks 'bigger' than the lower jaw area, but I can clearly see and feel (I did not lose feeling) that it is swelling, and this is after 3 weeks.
So, ya. It's swelling from Lefort 1 and extra swelling from the HA granules.
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So, ya. It's swelling from Lefort 1 and extra swelling from the HA granules.
You're absolutely right! I mean I knew for sure that the top lip etc was extra swollen from the Lefort but started wondering about the cheeks. Anyway, I'm clearly still very swollen everywhere, need to relax and pay less attention to friend's comments etc for the next few weeks.
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pay less attention to friend's comments etc for the next few weeks.
Sounds more like a "frienemy" than a friend.
I'm not sure about the result yet. My biggest concern would be the lack of upper tooth show at this point.
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Honestly, I'm a bit concerned about your result.
I wonder if it was necessary to move the maxilla back, instead of moving the lower jaw more forward, perhaps with some CCW. It seems like you have lost a lot of midface support in the process. Yes, this may all be swelling and we may need to wait a few months to see a final result. But the deep nasolabial folds you now have are concerning me.
If you want to pm me full before and after pictures of your full face I would be able to give you a better answer, but I think moving the maxilla back at all was an aesthetic mistake.
Not sure though. Hate to add to your concern. I'm not a surgeon and I may be totally wrong.
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My biggest concern would be the lack of upper tooth show at this point.
I see what you mean but my upper lip and the whole surrounding area is still incredibly stiff, I can hardly move it, and despite that, I have like 5mm tooth show when smiling and 1-2mm at rest. I had an extremely gummy smile before and used to get Botox for my upper lip to stop it from going up too much.
At this stage I'm thinking that when the muscles start working properly, I'll probably show enough teeth and most likely some gum too when smiling. Time will tell - at the moment I can't drink from a cup yet because my upper lip is so stiff, hopefully it will not stay that way! Otherwise I'm stuck with a baby bottle forever :)
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Honestly, I'm a bit concerned about your result.
I wonder if it was necessary to move the maxilla back, instead of moving the lower jaw more forward, perhaps with some CCW. It seems like you have lost a lot of midface support in the process. Yes, this may all be swelling and we may need to wait a few months to see a final result. But the deep nasolabial folds you now have are concerning me.
If you want to pm me full before and after pictures of your full face I would be able to give you a better answer, but I think moving the maxilla back at all was an aesthetic mistake.
Not sure though. Hate to add to your concern. I'm not a surgeon and I may be totally wrong.
Hey, thanks for the honest input, and do not worry, I am not oversensitive about the whole thing so feel free to comment! It's a strange situation, I started the whole process thinking I had no real functional problems and wanted to do it for aesthetics. Now it's done, my breathing is SO MUCH BETTER and my bite is better, I never thought it would make such a difference - if I knew this, I would have done it ages ago just for these functional benefits. So far recovery has been a lot easier than I expected and no major numbness, no pain, so any aesthetic improvement will be an added bonus as far as I am concerned.
Regarding the maxilla: I would say that normally, moving the maxilla back instead of lower jaw more forward would be a mistake in the majority of cases, especially for men. In my particular case, however, the maxilla was just too far forward and in such a weird angle that if they left it like that and tried to match it with the lower jaw, I honestly do not think that would have looked good, the jaw / chin would have been too strong for a woman in my opinion. Might be wrong but that's the way I see it and the doctor said the same. At the end of the day, if the jaw or chin is not strong enough, I can always work on that with fillers or even an implant or something, but if it's too strong, there is nothing I can do apart from a new osteotomy and I really do not want that.
I attached x-rays taken just before and 3 weeks after surgery; and another file with profile pictures, taken before and after (today). On the profile picture taken today you can probably see that there's still a lof of swelling everywhere; I imagine the jawline will be more defined eventually, and the cheeks and upper lip will go down too. Obviously I might be wrong, we'll see.
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If you want to pm me full before and after pictures of your full face I would be able to give you a better answer, but I think moving the maxilla back at all was an aesthetic mistake.
I tried to send you a PM but can't seem to attach pictures? I'm lame, can someone tell me how to attach or insert pictures in PMs? Thank you!
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I asked my lady for an opinion last night, and she thinks you're very swollen but look much better after. Wanted to get her take, because she has seen a lot of cases. So, chin up!
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I asked my lady for an opinion last night, and she thinks you're very swollen but look much better after.
Thanks, I appreciate that! I asked friends and family for honest opinions today because the one month consultation with the surgeon is coming up soon, and everyone says it looks good and much better than before. I asked specifically if it would look better if the maxilla plus mandible was more forward and they all said no, I'd just look like a 'duck face'. I guess there are always trade offs, in my case it might be less mid-face support. Will see if there's a way of dealing with that after a few months (maybe fillers or something).
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Hey, thanks for the honest input, and do not worry, I am not oversensitive about the whole thing so feel free to comment! It's a strange situation, I started the whole process thinking I had no real functional problems and wanted to do it for aesthetics. Now it's done, my breathing is SO MUCH BETTER and my bite is better, I never thought it would make such a difference - if I knew this, I would have done it ages ago just for these functional benefits. So far recovery has been a lot easier than I expected and no major numbness, no pain, so any aesthetic improvement will be an added bonus as far as I am concerned.
Regarding the maxilla: I would say that normally, moving the maxilla back instead of lower jaw more forward would be a mistake in the majority of cases, especially for men. In my particular case, however, the maxilla was just too far forward and in such a weird angle that if they left it like that and tried to match it with the lower jaw, I honestly do not think that would have looked good, the jaw / chin would have been too strong for a woman in my opinion. Might be wrong but that's the way I see it and the doctor said the same. At the end of the day, if the jaw or chin is not strong enough, I can always work on that with fillers or even an implant or something, but if it's too strong, there is nothing I can do apart from a new osteotomy and I really do not want that.
I attached x-rays taken just before and 3 weeks after surgery; and another file with profile pictures, taken before and after (today). On the profile picture taken today you can probably see that there's still a lof of swelling everywhere; I imagine the jawline will be more defined eventually, and the cheeks and upper lip will go down too. Obviously I might be wrong, we'll see.
yeah your profile does look better --probably just over-concern on my part. also everything will be fine once your swelling reduces. Honestly, my swelling didn't really subside until 3 months after surgery --or at least only then could I see the full result.
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It's hard to fell if those folds are actually worse, or it's just the lighting. Folds can look way worse in bad lighting. I kind of see them in the pre-op photo, just way better lighting that's blowing them out.
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It's hard to fell if those folds are actually worse, or it's just the lighting. Folds can look way worse in bad lighting. I kind of see them in the pre-op photo, just way better lighting that's blowing them out.
If the maxillary and cheek area lateral to the folds is all swollen up, the folds will appear more prominent. The folds themselves are tacked down by fascia. But the 'cheek' area is a space that can get occupied by swelling. So relative comparison between a tacked down facia area (where the actual fold area is) an an area blown up beside it is what you see, not bad lighting.
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If the maxillary and cheek area lateral to the folds is all swollen up, the folds will appear more prominent. The folds themselves are tacked down by fascia. But the 'cheek' area is a space that can get occupied by swelling. So relative comparison between a tacked down facia area (where the actual fold area is) an an area blown up beside it is what you see, not bad lighting.
Oh wow, thanks for the analysis!!! That explains it. The folds bothered me even before the surgery and was planning to get fillers for them; they look worse now than before, regardless of lighting, but as you explained, it's most likely related to swelling. Will just have to wait and see.
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yeah your profile does look better --probably just over-concern on my part. also everything will be fine once your swelling reduces. Honestly, my swelling didn't really subside until 3 months after surgery --or at least only then could I see the full result.
It took you 3 months? I see. Obviously I just have to wait. I think your comments about my mid-face loosing some support are valid, at the same time I don't think bringing my mandible and / or chin even more forward would have looked good so I guess the surgeon had to make a compromise. I was very worried about looking more masculine or getting a witch chin so at this stage I'm just relieved that didn't happen.
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I saw the surgeon today for the one-month follow-up and we discussed the whole surgery in detail, including mid-face support etc. and I'm now even more convinced that what he did was the best 'solution' for my particular case. He confirmed that the cheek and upper lip areas are particularly swollen, probably because of the HA, and that the nasolabial folds should become a lot less deep when the swelling goes down which will probably take months in my case. He also suggested some possible solutions in case I'll still not be 100% happy so I'm now more relaxed about the whole chubby cheek thing.
On another note, I want to take this opportunity to thank you - GJ, kavan and Lazlo -, I vaguely remember we had some silly disagreements in the past but today I just want to say I'm really grateful because when I first came across this forum, I did not know even basic things about jaw surgery and I got so much useful information and advice here, from many people but particularly from the three of you. Without that input, I don't think I'd have gotten the surgery and / or not with this surgeon, and now it's done I'm so happy, I'm kicking myself for not doing it years ago. Luck had probably been on my side too but I haven't had any complications so far, my breathing and bite is so much better than before it's amazing, I look better, I just feel so much better overall and it was so worth it for me. Thanks for your contribution to that.
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I saw the surgeon today for the one-month follow-up and we discussed the whole surgery in detail, including mid-face support etc. and I'm now even more convinced that what he did was the best 'solution' for my particular case. He confirmed that the cheek and upper lip areas are particularly swollen, probably because of the HA, and that the nasolabial folds should become a lot less deep when the swelling goes down which will probably take months in my case. He also suggested some possible solutions in case I'll still not be 100% happy so I'm now more relaxed about the whole chubby cheek thing.
On another note, I want to take this opportunity to thank you - GJ, kavan and Lazlo -, I vaguely remember we had some silly disagreements in the past but today I just want to say I'm really grateful because when I first came across this forum, I did not know even basic things about jaw surgery and I got so much useful information and advice here, from many people but particularly from the three of you. Without that input, I don't think I'd have gotten the surgery and / or not with this surgeon, and now it's done I'm so happy, I'm kicking myself for not doing it years ago. Luck had probably been on my side too but I haven't had any complications so far, my breathing and bite is so much better than before it's amazing, I look better, I just feel so much better overall and it was so worth it for me. Thanks for your contribution to that.
Glad to hear the advice was helpful.
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On another note, I want to take this opportunity to thank you - GJ, kavan and Lazlo -, I vaguely remember we had some silly disagreements in the past
We did?
Old age must be kicking in...
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I saw the surgeon today for the one-month follow-up and we discussed the whole surgery in detail, including mid-face support etc. and I'm now even more convinced that what he did was the best 'solution' for my particular case. He confirmed that the cheek and upper lip areas are particularly swollen, probably because of the HA, and that the nasolabial folds should become a lot less deep when the swelling goes down which will probably take months in my case. He also suggested some possible solutions in case I'll still not be 100% happy so I'm now more relaxed about the whole chubby cheek thing.
On another note, I want to take this opportunity to thank you - GJ, kavan and Lazlo -, I vaguely remember we had some silly disagreements in the past but today I just want to say I'm really grateful because when I first came across this forum, I did not know even basic things about jaw surgery and I got so much useful information and advice here, from many people but particularly from the three of you. Without that input, I don't think I'd have gotten the surgery and / or not with this surgeon, and now it's done I'm so happy, I'm kicking myself for not doing it years ago. Luck had probably been on my side too but I haven't had any complications so far, my breathing and bite is so much better than before it's amazing, I look better, I just feel so much better overall and it was so worth it for me. Thanks for your contribution to that.
yeah not having complications is almost close to a miracle. so I'm really glad for you. plus-60 percent of people who have this surgery have some kind of sensory loss near their chin or bsso site. you should be incredibly happy you have full sensation. and yeah, there are lots of ways to improve nasolabial folds, even if you still have them, fillers do wonders.
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Update on the chubby cheek situation: so I'm almost 2 months post op now and swelling has been going down but there's still some left in my cheeks and chin area. Looking at old pictures, I realise I had almost the same 'chubby cheek' issue pre-op, without the swelling - before and after pictures of my smile attached.
Some of it should go down over the next few weeks / months but I can't help wondering, if it doesn't get much better, is there anything a plastic surgeon can do about it, like fat removal (is this even fat?), or maybe a face lift (sounds drastic as I'm not that old and no wrinkles / sagging yet), or even cheek implants or something (to 'pull' that area up)? I can get fillers for the nasolabial folds but it's actually the 'fatty' parts that are bothering me if that makes sense.
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I'm not seeing any issue, but you're looking good from what I can tell.
You should do a full before and after.
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There's not a whole lot of difference in the b/a shots as to the chub in the cheeks.
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There's not a whole lot of difference in the b/a shots as to the chub in the cheeks.
I agree, now that swelling is going down I realised I had this 'excess fat' in the same area all along. Which means it's not likely to disappear even after swelling resolves.
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I'm not seeing any issue, but you're looking good from what I can tell.
You should do a full before and after.
Thanks, I shouldn't complain! It seems that overall I got a good result - functionally it's definitely good and aesthetically an improvement. I am worried about posting full face pictures for privacy reasons but the feedback I'm getting from people re: looks is consistently positive and the surgeon asked to put my before-after pictures on his website (I had to politely decline) so these are good signs. Seeing jaw surgery is a huge gamble I really should count myself lucky.
What bugs me is that these 'fat' cheeks - that I apparently had all along - are suddenly really 'in my face' (literally). Nobody noticed or commented on them before (myself included), but now several people asked if I had 'something done to my cheeks' like fillers or an implant (?) and it throws off the aesthetic result. When I pull my skin on the sides so these 'fat pads' disappear, I look much better and I showed that to a few people and they all said 'wow that looks amazing' (my face with the skin pulled) so I feel like it makes the difference between a good result and a really good result.
Anyway, I guess I wait for a few months for all the swelling to go and then will visit a few plastic surgeons to ask for their take on it. I can now see that this is how it works with getting surgery to improve your looks: you solve one problem (if you're lucky) but pretty much create another and it's probably never ending.
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I'd have to see the before and after and in the same lighting to see if the cheeks are an issue. Lighting makes a big difference with concave areas/step offs of the face and all that. There's even a Seinfeld about it. So it's likely nothing and someone commented while you were swollen or just that things look different to them, and now it's stuck in your head.
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Thanks, I shouldn't complain! It seems that overall I got a good result - functionally it's definitely good and aesthetically an improvement. I am worried about posting full face pictures for privacy reasons but the feedback I'm getting from people re: looks is consistently positive and the surgeon asked to put my before-after pictures on his website (I had to politely decline) so these are good signs. Seeing jaw surgery is a huge gamble I really should count myself lucky.
What bugs me is that these 'fat' cheeks - that I apparently had all along - are suddenly really 'in my face' (literally). Nobody noticed or commented on them before (myself included), but now several people asked if I had 'something done to my cheeks' like fillers or an implant (?) and it throws off the aesthetic result. When I pull my skin on the sides so these 'fat pads' disappear, I look much better and I showed that to a few people and they all said 'wow that looks amazing' (my face with the skin pulled) so I feel like it makes the difference between a good result and a really good result.
Anyway, I guess I wait for a few months for all the swelling to go and then will visit a few plastic surgeons to ask for their take on it. I can now see that this is how it works with getting surgery to improve your looks: you solve one problem (if you're lucky) but pretty much create another and it's probably never ending.
It is very COMMON for people, on their own faces, not to see other things that are already there when the FOCUS is on one thing. In this case the maxillofacial relationship/gummy smile. When the aesthetic culprit of focus is CORRECTED, the focus goes to other parts. So, much of this is not a 'creation of another problem' but rather being able to see what was not focused on prior when what was focused on prior is fixed and no longer visible.
ETA: As to people asking you if you've done something to your cheeks, it's because they 'see' something about you is DIFFERENT or CHANGED but they can't put their finger on what it is. It would be extremely RARE for the average person to notice what changed and say something like: 'Did you get your over bite fixed?'
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It is very COMMON for people, on their own faces, not to see other things that are already there when the FOCUS is on one thing. In this case the maxillofacial relationship/gummy smile. When the aesthetic culprit of focus is CORRECTED, the focus goes to other parts. So, much of this is not a 'creation of another problem' but rather being able to see what was not focused on prior when what was focused on prior is fixed and no longer visible.
ETA: As to people asking you if you've done something to your cheeks, it's because they 'see' something about you is DIFFERENT or CHANGED but they can't put their finger on what it is. It would be extremely RARE for the average person to notice what changed and say something like: 'Did you get your over bite fixed?'
Bingo.
Especially paragraph 1. This can work to the advantage of someone, too, and say bring out great eyes they had but were being obfuscated by a bad jaw that took the viewers' eye to that.
Eye will pretty much always go to the weakest link unless another feature is so great it overrides that, which is also possible, but more rare.
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It is very COMMON for people, on their own faces, not to see other things that are already there when the FOCUS is on one thing. In this case the maxillofacial relationship/gummy smile. When the aesthetic culprit of focus is CORRECTED, the focus goes to other parts. So, much of this is not a 'creation of another problem' but rather being able to see what was not focused on prior when what was focused on prior is fixed and no longer visible.
ETA: As to people asking you if you've done something to your cheeks, it's because they 'see' something about you is DIFFERENT or CHANGED but they can't put their finger on what it is. It would be extremely RARE for the average person to notice what changed and say something like: 'Did you get your over bite fixed?'
You are making good points. I am quite surprised by how nobody seems to know what changed about my face specifically. They say things like 'you look better but I don't know why'. Even when I point it out to close family members and friends that my chin used the be 1cm further back than where it is now, they look surprised and say they don't remember, it's quite funny how it works really.
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You are making good points. I am quite surprised by how nobody seems to know what changed about my face specifically. They say things like 'you look better but I don't know why'. Even when I point it out to close family members and friends that my chin used the be 1cm further back than where it is now, they look surprised and say they don't remember, it's quite funny how it works really.
Well, that is how it works. People just notice something different. It's a good sign if they also said you looked better even if with that they also asked if you did something to your cheeks.
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It's a good sign if they also said you looked better even if with that they also asked if you did something to your cheeks.
Everyone agrees I look (much) better, even the people that mention the cheek thing, so I guess I better get over it and find something else to worry about for the next few months.
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Everyone agrees I look (much) better, even the people that mention the cheek thing, so I guess I better get over it and find something else to worry about for the next few months.
yup
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When I pull my skin on the sides so these 'fat pads' disappear, I look much better and I showed that to a few people and they all said 'wow that looks amazing' (my face with the skin pulled) so I feel like it makes the difference between a good result and a really good result.
Haven't seen your pics, but what you're describing is saggy supranasolabial malar pads.
Makes the face look a lot older.
The solution is transtemporal subperiosteal midface lift in conjunction with kybella injections or micro liposuction to the supranasolabial pad.
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Haven't seen your pics, but what you're describing is saggy supranasolabial malar pads.
Makes the face look a lot older.
The solution is transtemporal subperiosteal midface lift in conjunction with kybella injections or micro liposuction to the supranasolabial pad.
Thanks, I'll look into that! Having said that, I definitely don't look older, in fact people are telling me I look younger since the surgery.
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I had HA placed on my cheeks with my surgery. I think it added far too much mass at too low of a position, but in terms of swelling/chubby cheeks look, I don't notice it as much in pictures anymore (6months post op) but I do notice it in videos. It looks like I have more "chipmunk" cheeks, though I was told there is still some residual swelling in that area even now.
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I had HA placed on my cheeks with my surgery. I think it added far too much mass at too low of a position, but in terms of swelling/chubby cheeks look, I don't notice it as much in pictures anymore (6months post op) but I do notice it in videos. It looks like I have more "chipmunk" cheeks, though I was told there is still some residual swelling in that area even now.
Thanks for that! Interesting what you say about the videos - I also noticed I look more of a chipmunk in real life than in pictures. It's been steadily improving though, hoping it will sort itself out over the coming months.
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I think it added far too much mass at too low of a position
This seems to be the big problem with it.
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This seems to be the big problem with it.
Yea, it isn’t the first time I’ve heard of it. My surgeon like to do it a lot... I think I’ll opt out.