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You have the type of profile that IMO that would benefit from double jaw surgery with clockwise rotation. Maxilla advancement would give better support to the base of your nose which looks collapsed due to lack maxillary support. You have short chin and a low mandibular plane angle. So, double jaw advancement in your case would look better with CW-r. However, you've ruled that out because it is something that requires braces to prepare for.

I'll repeat what I said in another post where person had somewhat similar profile as yours: "Double jaw advancement with clockwise rotation around the ANS point. CW-r around the ANS point will bring PNS up, push the chin point backwards and down. Soft tissue of the lips will go backwards and soft tissue at chin will go backwards and down. So, with the CW-r, it tends to reduce the type of 'stick out' you have with the lips. It also increases your LOW Mandibular plane angle and sets the chin point downwards so it doesn't look so short. CW-r is backwards and down and that is the best rotation to have (in your case) for the double jaw advancement."

In the event you would like to consider/consult about double jaw surgery (which requires time in braces), I'm just giving you a 'heads up' on what the maxfax doc might suggest for improvement. I don't think you have enough BASE OF THE NOSE SUPPORT (maxillary support) to risk another failed rhino and I think your rhino failures may have been attributed to lack of maxillary support in the first place.

Thank you very much for the thorough response.

Is there any way to do the jaw surgery I would need, that you suggest, without braces?  Or could it be done with invisalign or a similar solution?  Or if braces were absolutely required, what is the shortest amount of time I could have them?

If not, is there any way to replicate (even if not fully) the aesthetic results I would get from your suggested procedure with implants and/or other alternatives?

You have the type of profile that IMO that would benefit from double jaw surgery with clockwise rotation. Maxilla advancement would give better support to the base of your nose which looks collapsed due to lack maxillary support. You have short chin and a low mandibular plane angle. So, double jaw advancement in your case would look better with CW-r. However, you've ruled that out because it is something that requires braces to prepare for.

I'll repeat what I said in another post where person had somewhat similar profile as yours: "Double jaw advancement with clockwise rotation around the ANS point. CW-r around the ANS point will bring PNS up, push the chin point backwards and down. Soft tissue of the lips will go backwards and soft tissue at chin will go backwards and down. So, with the CW-r, it tends to reduce the type of 'stick out' you have with the lips. It also increases your LOW Mandibular plane angle and sets the chin point downwards so it doesn't look so short. CW-r is backwards and down and that is the best rotation to have (in your case) for the double jaw advancement."

In the event you would like to consider/consult about double jaw surgery (which requires time in braces), I'm just giving you a 'heads up' on what the maxfax doc might suggest for improvement. I don't think you have enough BASE OF THE NOSE SUPPORT (maxillary support) to risk another failed rhino and I think your rhino failures may have been attributed to lack of maxillary support in the first place.

I think adding a bit of chin height would not be a bad idea. You don't really need it, but I can see why you would want it given you have a short face. The problem is that labio-mental grove is already pretty deep, and it will get deeper, so you need to discuss how that will be handled if you do go that route. Regarding jaw surgery...I mean, no. But I can see someone thinking you need clockwise rotation to lengthen your face. I don't think so, but that's a purely aesthetic/preference thing, and I personally I couldn't see doing surgery for that. Specifically: my concern would be chimp lip, and I also think you'd run into problems regarding the nose. Expect 1-2mm of widening if you move the upper jaw. Given you had so much nose work done already, I'd be super skeptical that would turn out well. I'll email you one more note.

I appreciate you taking a look and posting your thoughts.

If I were to get a genio for added height, what would I need to do in order to avoid any issues with the labiomental area?

I've thought about paranasal/midface implant to reduce the nasolabial folds.  Any thoughts on that?

From the documents they gave me about the genioplasty, there is mention of titanium plates but nothing about paste or the likes. I asked them if they could do the type of genioplasty where they widen the chin by cutting and putting a bone graft in the cut, they said no. So I'm not certain about them using something for the groove except the plates and screws. In any case, I'll ask them.

Thank you for answering !

About the fat, I've already tried. I could probably be a little bit leaner (as I've already been), but I'm already pretty lean (I know most people say this and it's easy to say) : this is the only part of my body that's mostly like this.

I see what you mean about the philtrum, the lip curve was throwing me off. Thanks for the observation.

Do you think advancing the chin and giving it some height would be a good idea, like a kind of middle ground procedure ? Is the labiomental fold a worry here ?

Thanks again