jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: sean89 on June 20, 2014, 09:49:18 AM
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Just thought I'd let everyone know how I got on as a thank you for their contributions to the forum, especially those I have exchanged private messages with.
Anyway, I had chin-wing surgery with Ramin Zarrinbal. I am class 2, and didn't want to undergo BSSO because of the time to wait in braces, I didn't want to mess with my bite, and the fact that the proposed advancement wouldn't have been that significant (probably below 5mm). I also had a weak chin.
I'm a few weeks after surgery now, and my chin and lower lip is still probably 20% numb but getting better every day. By shortening my chin, my lower lip incompetence has improved, but for some reason, I have acquired a mild lisp and I have to speak by pushing my tongue to the front of my mouth. In relation to this aspect of the surgery only, I regret not getting a BSSO (because it would have created more room for my tongue).
Aesthetically, it has been a big improvement. Zarrinbal says he prefers to decide the movements during surgery and subscribes to the facial thirds theory as well as the idea that the chin should be around 85 degrees from the lower lip. But I told him that I wanted a big chin advancement, and was worried about shortening my face too much, and consequently, I think my chin was advanced about 7mm and shortened by 2mm. Though I'm still on the fence about the shortening, I think my chin has been advanced a perfect amount, and I am extremely satisfied with the outcome. Also, there is no issue with sublabial fold, and I think that, for men at least, having no sublabial fold is as bad as having huge sublabial fold.
My jaw angles have also improved significantly, but there is a limit to how much they can be improved without breaking the jaw. It isn't a case of being able to design your perfect jawline and asking the surgeon to recreate it. You are, to a certain extent, limited by what you've already got. But again, I'd probably score my satisfaction as an 8/10 in relation to the angular changes.
My jaw has also widened, but I think it looked better when I had a small amount of swelling. He also made me aware of the potential for the bone graft to recede over time, and for the jaw to get gradually narrower.
My lower lip is still behind my upper lip and, in that sense, the procedure has not completely camouflaged my class 2 skull. So while I haven't achieved the perfect jaw with the surgery (and possibly still require a BSSO to do so), I am at the stage where I am satisfied with my jaw, aesthetically at least, and cannot really foresee me spending any more money or time worrying about it. Because of my chin advancement, I have stopped posturing my jaw because I look worse if I do (chin looks too big even though lips align).
I asked Zarrinbal whether he is happy to take on overseas patients, but he said that he would be reluctant to take on those patients that want to fly out the next day, and he says that he is very busy at the moment but agrees that being busy is better than the alternative. He seems very caring, and I cannot recommend him enough, but I would be very cautious about using him for traditional orthognathic surgery (or any other overseas surgeon) due to the delay in responding to emails.
As for those on the forum considering Triaca, Zarrinbal was very positive about him and told me that he learnt the technique amongst others at Lake Constance (I think) around 10 years ago. But if you cannot afford Triaca, I would certainly recommend Zarrinbal.
I'll have to be brusk now, but my hip is fully healed (took 1 week) and overall I'd rate aesthetic improvement as 8/10. Also, I am not going to share photos (sorry) but there are photos already out there of post chin-wing patients.
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I'm glad it worked out well for you. Zarrinbal has always seemed competent to me but I've avoided him because of the practical problems you mentioned.
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Thanks for your report. Im considering Chin Wing surgery with Zarrinbal, too. If you could bring yourself to send me pics of your lower face, i would be very grateful.
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Congrats! Boy am I jealous. Based upon what you're saying about the jaw angle changes I wish I had pestered Zarrinbal a bit more for a surgery date and gotten a chin wing instead of sliding genio. Too late now I guess.
How noticeable are the changes from the front? Could you by any chance send me a picture by PM (or post one for everyone's benefit)?
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but my hip is fully healed (took 1 week)
Did you have a bone graft?
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Can you post your post-op X-ray? I'm interested to see what the gear looks like for the chin-wing.
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Wow, you kept that quiet, you sly old dog you!
So glad that you're pleased, it's about time we had some success stories on the board!
Congrats! ;)
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Congrats! I'm really happy for you.
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Thanks for taking the time to post your experience. So, so happy you're pleased with the results!
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Congrats! Boy am I jealous. Based upon what you're saying about the jaw angle changes I wish I had pestered Zarrinbal a bit more for a surgery date and gotten a chin wing instead of sliding genio. Too late now I guess.
How noticeable are the changes from the front? Could you by any chance send me a picture by PM (or post one for everyone's benefit)?
From the front, I look a lot better since the operation. My face used to be oval-shaped, now it is noticeably tapered. I haven't suddenly become Ashton Kutcher, but I am very pleased with the changes from the front even if I did prefer it when I had a little swelling.
Did you have a bone graft?
Yes, I was told it was a big bone graft given the scale of the chin advancement. After I first had it, it hurt to walk and sit up, and then after about two weeks, the only pain I got (in the hip area) was from sneezing. After about 3 weeks, I was back to normal and able to run.
On another note, I should say that, on day 3, my facial swelling was absolutely enormous and the people I saw clearly thought I was a freak and tried to avoid eye contact with me. Be prepared. Also, the liquid diet devastated me but I'm on soft-foods now.
Can you post your post-op X-ray? I'm interested to see what the gear looks like for the chin-wing.
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Good to hear that your hip healed relatively painlessly! What's your hip scar like?
I'm going to need one for maxillary downgraft, am really scared!
Also, I thought you were a fellow Manc, or at least from the UK. How come Z played ball?
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thanks for the x-ray, looks very interesting. how many mm did you have advanced?
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Good to hear that your hip healed relatively painlessly! What's your hip scar like?
I'm going to need one for maxillary downgraft, am really scared!
Also, I thought you were a fellow Manc, or at least from the UK. How come Z played ball?
My hip scar is pretty bad actually but I suppose it's early days yet, but it's not something I'm bothered about tbh.
Yeah, I'm from the north. I go to Manchester quite often - if you're ever in the city centre and are interested in the operation, I'll happily show you some before/afters.
I dunno why he took me on. I think I'm his first foreign patient to undergo surgery but he said he'd consulted with people from Israel and the Ukraine. It's obviously easier to treat Germans since the contract was in German, and the receptionists only speak German, but for whatever reason, he was happy to treat me.
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My hip scar is pretty bad actually but I suppose it's early days yet, but it's not something I'm bothered about tbh.
Wouldn't stress. Copper peptide serum and silicone gel now, then fraxel after. You're white, right? It won't show
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Wouldn't stress. Copper peptide serum and silicone gel now, then fraxel after. You're white, right? It won't show
I'm white as a snowflake and I scar real badly. Body scars tend to be worse since the skin there get stretched constantly. A scar on the hip is nothing to worry about though.
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I'm white as a snowflake and I scar real badly. Body scars tend to be worse since the skin there get stretched constantly. A scar on the hip is nothing to worry about though.
Hmmm, interesting. I'm pretty fair skinned and scars don't show much on me because the scar tissue is white, and so is my skin, so it doesn't show - would have thought you'd be the same
Anyway, I had no idea they do grafts for ching wing. Is it to prevent relapse? To stop the muscles from pushing the vertical augmentation backk up?
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Hmmm, interesting. I'm pretty fair skinned and scars don't show much on me because the scar tissue is white, and so is my skin, so it doesn't show - would have thought you'd be the same
Anyway, I had no idea they do grafts for ching wing. Is it to prevent relapse? To stop the muscles from pushing the vertical augmentation backk up?
I'm really fair skinned and scars take a little bit longer to turn from pink to white but when they do heal they're nice and flat and neat.
Think the harvesting scars are bigger than we're expecting though... :(
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I'm crazy about my skin, but with all the available technology I wouldn't be too worried about scarring. Down the road there's almost always something that can be done to help.
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Thanks for posting your experience Sean, so glad you are happy with the results.
Wondering if you speak German/ if it's a necessity?
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Why was bone grafting a necessity?
And why did he opt for bone grafting over HA paste? Do you think he holds the same opinion as Triaca, which is that HA paste has negative effects in the long-term?
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Also, if I need a mole removed, I see a Plastic Surgeon, not a Dermatologist.
Very good point.
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I learned that the hard way. Never again. Seriously, I could have done a better job with my left hand, and blindfolded. And she was supposed to be "the best."
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The pill keeps my skin clear, otherwise I get a small amount of acne on my chin. Top two things that make a direct and immediate difference (for me) are diet and sweating (sweating not necessarily exercise). I found a diet that I, and my skin, thrive on and I stick to it as much as possible. Organic makes a huge difference, but I'm pretty sure the culprit is dairy. Non-organic gives me that whole chin pimple thing, too. I eat a ton of daily, so I'm sure that's part of it.
The diet makes all the difference in the world. I've done elimination diets on a couple of occasions where you stick to a few safe types of food and then gradually add new types to test how you react to them. The changes to the skin and overall well-being are amazing but it's hard to sustain that kind of diet for practical reasons. This is also why I hate the food in hospitals since you basically only get bread and dairy products. I'm trying to recover here and all you can offer me is food that stimulates the inflammatory responses in my body? No thanks...
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Also, if I need a mole removed, I see a Plastic Surgeon, not a Dermatologist.
Moles on the body are going to leave scars no matter what. I had some removed with laser by a plastic surgeon a few years ago and the scars look like... moles (except red).
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Moles on the body are going to leave scars no matter what. I had some removed with laser by a plastic surgeon a few years ago and the scars look like... moles (except red).
Scars can be disguised to a degree. I had a huge mole above my eyebrow. The plastic surgeon removed it and made the scar align with the forehead lines. I saw a dermatologist a month later and he had to do a double take to see the scar.
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Facial moles are the exception since scars in the face can be made very subtle. Scars on the rest of the body tend to look much worse. I have facial scars that healed nicely and then I have scars on other parts of my body that look much worse despite having had over ten years longer to heal.
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Facial moles are the exception since scars in the face can be made very subtle. Scars on the rest of the body tend to look much worse. I have facial scars that healed nicely and then I have scars on other parts of my body that look much worse despite having had over ten years longer to heal.
Hmm... Never knew that. Although I cut my shin just below the knee a year ago, and the scar is still there and even looks quite fresh.
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Dairy is the worst thing in the world for my acne as well. I haven't drank milk in about 8 years because of it, even though I love milk. I don't take tablets for my skin and try to control it with my diet, but the amoxiclav I was given post-surgery completely cleared any residual acne that I had.
When I spoke to Zarrinbal about post-surgery foods, he told me to try and avoid milk and yoghurt because it leads to an increase in bacteria which might trigger an infection. I guess that same bacteria is responsible for acne.
Also, as I said to Modigliani, the hip graft scar is quite high up and would definitely be visible in a bikini.
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Revisions on body scars are very risky. My plastic surgeon told me a story about a young man that had a huge scar on his shoulder after an accident. His father was a plastic surgeon and refused to do a revision but eventually caved and sent his son to a different surgeon. The result was that he ended up with a scar three times as large and just as wide as the original scar.
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Why was bone grafting a necessity?
And why did he opt for bone grafting over HA paste? Do you think he holds the same opinion as Triaca, which is that HA paste has negative effects in the long-term?
The bone was used to fill in the gaps along the jawline and in the sublabial fold.
Thanks for posting your experience Sean, so glad you are happy with the results.
Wondering if you speak German/ if it's a necessity?
No, I don't. Zarrinbal speaks English fluently.
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When I spoke to Zarrinbal about post-surgery foods, he told me to try and avoid milk and yoghurt because it leads to an increase in bacteria which might trigger an infection. I guess that same bacteria is responsible for acne.
That's all I was given after my surgery. The dietist at the hospital even recommended drinking a lot of whole milk. ::)
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When I spoke to Zarrinbal about post-surgery foods, he told me to try and avoid milk and yoghurt because it leads to an increase in bacteria which might trigger an infection. I guess that same bacteria is responsible for acne.
Actually it's a different bacteria! Acne is caused by Propionibacterium acnes. The reason that dairy causes acne is mainly the hormones. Dairy, especially high fat dairy, contains tons of the stuff - growth hormones and oestrogens. Goat dairy isn't quite as bad
I never had any acne as a teen but as I got into my mid-20s I got hormonal flare ups. It was so bad at the start of this year and as I'm fair, red pimples are very obvious. Eventually I linked it to the cheese omelettes I was having every morning. I recently gave up dairy and it seems to be improving. I do miss butter though :(
Emish, for skincare I recommend Paula's Choice an SkinActives. Cosmeceutical formulas for a fraction of the cost. PC do a 2% BHA liquid that is really good
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Is your jaw more perpendicular to the floor now? If so how much more? Is the ramus longer? Does the jaw look square?
Kinda wish he would post pics. His right not to, but I don't see what harm posting just the lower third could do.
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Kinda wish he would post pics. His right not to, but I don't see what harm posting just the lower third could do.
Absolutely, except I will go further and say it's extremely obnoxious and inconsiderate especially considering all the time I spent PMing him trying to help him. He only knows about Zarrinbal because of me. There is not a single publicly available example of a guy who had chin wing alone without any other procedures except for one guy on a German messageboard and his chin wing was to reduce the size of his chin (and most of us who are interested in the procedure want to advance our chins). These photos could help a lot of people considering the procedure.
There is no way he could be identified by a picture of just his lower third and his anonymity is not in any way compromised. It's his ethical obligation to post these photos after the help he's received here and not "his right not to".
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Absolutely, except I will go further and say it's extremely obnoxious and inconsiderate especially considering all the time I spent PMing him trying to help him. He only knows about Zarrinbal because of me. There is not a single publicly available example of a guy who had chin wing alone without any other procedures except for one guy on a German messageboard and his chin wing was to reduce the size of his chin (and most of us who are interested in the procedure want to advance our chins). These photos could help a lot of people considering the procedure.
There is no way he could be identified by a picture of just his lower third and his anonymity is not in any way compromised. It's his ethical obligation to post these photos after the help he's received here and not "his right not to".
Yes, I would really appreciate seeing his results because as you say they simply aren't out there right now due to how new the procedure is.
The other thing too is often how detached people's assessment of their surgeries are from the actual result. People claiming a great result when there has been little aesthetic improvement, or those who are almost suicidal despite looking significantly better.
I didn't know you helped this guy so much. In fact, I don't remember seeing many of his threads around. I PM'd with him and he said some of his before photos were already posted online, so maybe that has him worried?
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Update:
I knocked my jaw yesterday putting on a tie and it was pretty painful so my jaw is still fragile even though I'm having no problems with eating. I can't see me playing sport competitively for another few months.
Also, I've become more conscious of the fact that my chin is slightly canted with the left side being lower than the right possibly because the left gonial angle was lowered more than the right due to my pre-op assymetry but it's not a massive deal to me given how minuscule the cant is.
And to the guy that asked, my gonial angles aren't perpendicular to the floor because there is only so much angle that the surgeon can create from your pre-existing bone structure. They will improve, but you can't just choose the jawline that you want.
And Mr Rochester, I appreciate your advice but I don't owe you anything. Kizarq started a thread about his consultation with Dr Zarrinbal which is what made me aware of his existence.
That said, I might eventually post after pictures of my lower third but I've not made my mind up yet.
Anyway, with the things I've mentioned, I'd probably downgrade my assessment of the results to a 7/10.
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sean, maybe you could post a little schematic of your surgery showing where they did the cuts and where they placed the bone grafts?
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Gregor, maybe you could post a little schematic of your surgery showing where they did the cuts and where they placed the bone grafts?
Which surgery are you talking about? All the cuts for the HA grafts were done inside the mouth. There's not much to say about it except that Paul Johnson was not impressed by how Mommaerts had made the incisions. I can still see the HA poking out inside the mouth by the way.
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Which surgery are you talking about? All the cuts for the HA grafts were done inside the mouth. There's not much to say about it except that Paul Johnson was not impressed by how Mommaerts had made the incisions. I can still see the HA poking out inside the mouth by the way.
Sorry I meant Sean!! But you can see the HA?! f**ked Up
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Sean, maybe you could post a little schematic of your surgery showing where they did the cuts and where they placed the bone grafts?
^This
I'm getting a chin wing so this is kinda a big deal. I'd appreciate any info that he can share.
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Update:
I knocked my jaw yesterday putting on a tie and it was pretty painful so my jaw is still fragile even though I'm having no problems with eating. I can't see me playing sport competitively for another few months.
Also, I've become more conscious of the fact that my chin is slightly canted with the left side being lower than the right possibly because the left gonial angle was lowered more than the right due to my pre-op assymetry but it's not a massive deal to me given how minuscule the cant is.
And to the guy that asked, my gonial angles aren't perpendicular to the floor because there is only so much angle that the surgeon can create from your pre-existing bone structure. They will improve, but you can't just choose the jawline that you want.
And Mr Rochester, I appreciate your advice but I don't owe you anything. Kizarq started a thread about his consultation with Dr Zarrinbal which is what made me aware of his existence.
That said, I might eventually post after pictures of my lower third but I've not made my mind up yet.
Anyway, with the things I've mentioned, I'd probably downgrade my assessment of the results to a 7/10.
The canting could be a result of asymmetrical swelling, or swelling going down asymmetrically. If not, bone burring would be an extremely simple procedure to resolve that. Or augmenting with HA paste bone grafting.
Could you perhaps get pictures of your jaw before and after, then trace lines to show where the jaw is. Then just show us teh lines so we can see the changes? You're literally the first person to ever get one in this way and post on a forum about it. As I will get one in a few months I'm keen to get all info I can.
Has the drop down of the jaw done anything to improve the hollowness of your cheeks? How sharp the angles of the jaw? Did your jaw and chin seem broader (more rounded) as a result of the chin wing? I have theorized that the chin wing may remove any V-shape of the jaw by advancing the entire mandibular border more than it does widen it. That probably makes no sense so if you don't get what I mean I'll post pics explaining it. I really want to keep my V-shape if possibl.
Finally, even though it's sensitive how does it feel when you touch it? Is there a weird kind of step off? Do you think this'll heal to be natural to the touch?