jawsurgeryforums.com
General Category => General Chat => Topic started by: PloskoPlus on June 22, 2014, 04:29:57 AM
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Just realised that the best that max fac can do is take away the deformity.
So:
ugly + deformed + surgery -> just ugly
beautiful + deformed + surgery -> beautiful
Case in point:
http://drrichardjoseph.com/photos/113.php
"Beauty is created in the womb, not on the operating table" - kizarq
The key to happiness is to have low expectations.
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Wise words indeed :)
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Wise words indeed :)
Yeah, now my expectation is to look no worse.
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Yeah, now my expectation is to look no worse.
LOL, I'd settle for that at this point. I think you can probably allow yourself to be a little more optimistic than that, PP ;)
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LOL, I'd settle for that at this point. I think you can probably allow yourself to be a little more optimistic than that, PP ;)
Well, the 6mm LeForte 1 advancement kind of worries me. I already have a negative profile. The fat loss hollowed out my cheeks and the mouth looks almost protrusive as it is from some angles (yet the maxilla is recessed - weak smile, no gum show... go figure). Then I read something like this:
http://www.jawsurgeryblog.com/forums/viewtopic.php?f=3&t=12303#p42381
And it won't fix the orbital rim weakness, possibly make it more obvious, if anything. Then all the funky stuff that happens to the nose. Class IIs have it so easy!
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Having no obvious flaws will go a long way to make a person attractive. Once you've reached that point then you can raise yourself above most of the male population simply by dressing well and taking care of your body. This becomes especially true as you age.
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Well, the 6mm LeForte 1 advancement kind of worries me. I already have a negative profile. The fat loss hollowed out my cheeks and the mouth looks almost protrusive as it is from some angles (yet the maxilla is recessed - weak smile, no gum show... go figure). Then I read something like this:
http://www.jawsurgeryblog.com/forums/viewtopic.php?f=3&t=12303#p42381
And it won't fix the orbital rim weakness, possibly make it more obvious, if anything. Then all the funky stuff that happens to the nose. Class IIs have it so easy!
I can understand why you're concerned, too much upper jaw advancement can wreak all sorts of havoc on the features themselves as well as surrounding soft tissue and the proportions of the rest of the face. On the other hand it if it's done right it can do wonders, such a fine line with it.
Have you consulted with a few different surgeons? While their opinions can vary wildly, if they're all proposing similar movements, there or thereabouts, then it's probably right for you.
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I remember reading about a Korean man that sued his wife when the children came out ugly because she had apparently transformed herself to a real beauty with plastic surgery. Jaw surgery alone will probably not make you look good unless you already have good features but if combined with other procedures then it can really transform a person.
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Having no obvious flaws will go a long way to make a person attractive. Once you've reached that point then you can raise yourself above most of the male population simply by dressing well and taking care of your body. This becomes especially true as you age.
True, an ugly person with a jaw deformity is much uglier than someone who just has bad features. Only someone with a serious jaw deformity can really appreciate this. Being an ugly person with a class I jaw is infinitely better than being a weirdo with a messed up jaw and an ugly face.
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I remember reading about a Korean man that sued his wife when the children came out ugly because she had apparently transformed herself to a real beauty with plastic surgery. Jaw surgery alone will probably not make you look good unless you already have good features but if combined with other procedures then it can really transform a person.
Ate you sure that story is not an urban myth?
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I can understand why you're concerned, too much upper jaw advancement can wreak all sorts of havoc on the features themselves as well as surrounding soft tissue and the proportions of the rest of the face. On the other hand it if it's done right it can do wonders, such a fine line with it.
Have you consulted with a few different surgeons? While their opinions can vary wildly, if they're all proposing similar movements, there or thereabouts, then it's probably right for you.
Yeah, I know, lefort 1 is probably the most transformative common procedure in existence. The first surgeon I saw said 6 mm advancement of the upper, 4 mm retraction of the lower. He's considered a top surgeon around here. The next one said wtf, you don't have that much of an under bite. 6mm upper only. I really liked him, but his or tho was lukewarm "you are gonna spend all that money to look different, but not better." My current surgeon said the same as the second one, but apparently he also trained him, so maybe in reality I have only two opinions to go by. My current surgeon is considered the best in town (yet he was also the cheapest of the lot). I'll be seeing another surgeon tomorrow, and another one in a couple of weeks.
Regarding aesthetics, the second surgeon said you'll look like yourself had you developed normally. People will still recognize you as you. My current surgeon was evasive regarding "will I look better, or just different". But he seems to be the most attuned to aesthetics of the lot. Or maybe it's because he was the last one I saw, so I had more questions to ask. What worries me is that I only saw a single before and after from his ortho. I saw him recently and he didn't want to show me any due to patient confidentiality.
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Regarding aesthetics, the second surgeon said you'll look like yourself had you developed normally. People will still recognize you as you.
I like that answer a lot, it's pretty much what I wanted from surgery - to look like I should have looked without distorting the decent features that I did have.
Glad you're getting some more opinions, will be interesting to hear what they come up with. You in the US? I only ask because I feel like I've seen your look a lot more in the UK, the hair and everything...nfact there's a woman who lives directly opposite me that has a really similar jaw set up to you...it's definitely more becoming on a man ;)
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Ate you sure that story is not an urban myth?
The story has been reported by several respected news sources:
http://www.examiner.com/article/man-sues-ex-wife-over-ugly-children-and-wins-daughter-s-looks-horrified-him
This news site claims it's false though: http://www.abc15.com/news/local-news/water-cooler/man-sues-over-ugly-baby-jian-feng-chinese-man-sues-wife-after-she-has-extremely-ugly-baby-girl1384191149764
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I like that answer a lot, it's pretty much what I wanted from surgery - to look like I should have looked without distorting the decent features that I did have.
This is basically all I want out of surgery too. I grew up having normal facial growth, and then somewhere along the way, things went south. I think its when I hit puberty, I started slowly getting verticle growth and it really sped up around 20 years old. My gummy smile kind of came out of nowhere. It seemed my maxilla just suddenly grew down over the course of a few years
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I remember reading about a Korean man that sued his wife when the children came out ugly because she had apparently transformed herself to a real beauty with plastic surgery. Jaw surgery alone will probably not make you look good unless you already have good features but if combined with other procedures then it can really transform a person.
I think this is a bit silly anyway, because features can skip a generation or two. I look absolutely nothing like my mother - not in face, figure or colouring
I think surgery (plus the right makeup) can make a significant difference. You can't make ugly beautiful but I think you can go from ugly to OK looking, and from attractive to pretty, and from pretty to beautiful. I did a little filler, a touch of botox, rhinoplasty (post accident but that's a moot point) and chin lipo and honestly...well as Lazlo said in my thread, it took me from about a 5 to about a 7.
Most surgeons do a lot more 'anti aging' surgeries than 'beautification' surgeries. In fact many are actually somewhat reluctant to do anything other than fillers, rhinos and chin implants if it's purely cosmetic and not anti-aging.
Posko, from what I've read it does seem that the 'class 3' facial set up doesn't really show itself until the late teens, especially in guys. I'd be cautious about reducing the chin/lower jaw too much because a) you're a guy and b) it's balancing your nose.
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I did a little filler, a touch of botox, rhinoplasty (post accident but that's a moot point) and chin lipo and honestly...well as Lazlo said in my thread, it took me from about a 5 to about a 7.
I don't think you're a good example since you've had some pretty attractive features all along. You weren't a 5 before and you're definitely above a 7 now. The girl from the Obwegeser thread is the best example I've ever seen:
(http://i.imgur.com/6toB1QD.jpg)
(http://i.imgur.com/yPWL2sU.jpg)
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The Obwegesser girl is the most remarkable case I've ever seen. The only case where the eyes went from potato to beautiful.
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Why have I never seen that before, it's an extraordinary transformation :o
What was done?
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Why have I never seen that before, it's an extraordinary transformation :o
What was done?
I believe Satan was involved. ;D
PloskoPlus has all the details of the surgery I believe.
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Why have I never seen that before, it's an extraordinary transformation :o
What was done?
BSSO, lefort I and iii. The paper is a bit sparse on details.
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I still don't understand why she has no external scarring if a Lefort III was performed.
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I still don't understand why she has no external scarring if a Lefort III was performed.
Modified lefort iii can be done intraorally and through the eyes.
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This is basically all I want out of surgery too. I grew up having normal facial growth, and then somewhere along the way, things went south. I think its when I hit puberty, I started slowly getting verticle growth and it really sped up around 20 years old. My gummy smile kind of came out of nowhere. It seemed my maxilla just suddenly grew down over the course of a few years
That's the only thing detracting from your appearance. You're a good looking guy otherwise. No homo.
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Modified lefort iii can be done intraorally and through the eyes.
I see. Still, it's almost impossible to find surgeon that is willing to perform it. Have you ruled out getting one?
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BSSO, lefort I and iii. The paper is a bit sparse on details.
I think there may have been something else, too, around the brow region. Look at her brow and eyes in the before picture - deepset eyes, heavy brow ridge and low eyebrows- features that are distinctly masculine. Part of the reason she looks so much better afterwards is that her forehead and brow region is much more feminine -- the brow ridge is gone and the forehead is smooth. It may be that they filed down the brow ridge, or added filler or HA above and below to disguise it. Her brows appear higher, too - maybe an illusion from the surgery but possibly some botox going on?
It's also interesting how much fuller her bottom lip is. The smaller chin and fuller lower lip again make her look a lot more feminine. Generally I think that female class 3s see more of an aesthetic improvement after surgery than males, and for class 2s its the opposite. For the same reasons, class 3 skeletal patterns look a lot "worse" on women than men, and class 2s look a lot "worse" on men than women.
I wonder why though, they decided to do a le fort 3 on her. Sure, her midface is recessed but I wouldn't say that it's loads worse than many other class 3s I've seen
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That's the only thing detracting from your appearance. You're a good looking guy otherwise. No homo.
Hahah thanks man.
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I see. Still, it's almost impossible to find surgeon that is willing to perform it. Have you ruled out getting one?
I'll be contacting Obwegesser and Sinn about it. My surgeon does them too, but only on syndrome cases AFAIK. He wouldn't even want to discuss anything like that. Like I mentioned before, after my weight loss he even changed his mind about doing a higher lefort to a normal one "to keep the face angular".
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Hahah thanks man.
Teling it like it is. When I first saw your pics, I thought what's this guy doing here? But then I saw your smile.
BTW, I'm somewhat concerned why your surgeon wants to advance your maxilla - it doesn't look recessed. Your profile is straight. I can see why in my case - mine is obviously recessed and i have an ante face naturally. Also I don't know why the lower jaw is "optional" in your case. I would have thought such a decision makes a huge difference to the bite at least.
But don't listen to me. I'm not a doctor and I have OCD (formal not self diagnosis).
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Teling it like it is. When I first saw your pics, I thought what's this guy doing here? But then I saw your smile.
BTW, I'm somewhat concerned why your surgeon wants to advance your maxilla - it doesn't look recessed. Your profile is straight. I can see why in my case - mine is obviously recessed and i have an ante face naturally. Also I don't know why the lower jaw is "optional" in your case. I would have thought such a decision makes a huge difference to the bite at least.
But don't listen to me. I'm not a doctor and I have OCD (formal not self diagnosis).
I totally forgot to change that the lower jaw advancement is not optional. After he was finally able to look at my molds he knew it had to be advanced with or without the upper advancement. And for my upper advancement, he said only around 4mm. It is a little recessed and especially after pulling my teeth back with braces, I've lost a lot of support in my upper lip. Both him and my ortho agreed that it could be advanced a little. Ive even asked a plastic surgeon who did some filler work on me about my upper jaw and he agreed its a little recessed. I wouldnt trust only his opinion though lol. Plus, my surgeon mention that most orthos like to see a 90 degree agle between the nose and upper lip and mine is over that amount.. Thanks for being concerned though. I'll talk to him more about it at my pre op appointment, but I trust his decision. He wants to keep all my movements pretty subtle. Nothing crazy.
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Nrelax11,
Good to know.
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I still don't understand why she has no external scarring if a Lefort III was performed.
You can see the scews above her nose in the post-op X-ray. Definitely Le Fort III.
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Posko, from what I've read it does seem that the 'class 3' facial set up doesn't really show itself until the late teens, especially in guys. I'd be cautious about reducing the chin/lower jaw too much because a) you're a guy and b) it's balancing your nose.
If anything I'd want a wider and slighter longer (vertically!) chng, though it's not so critical now that my face has thinned. IMO, good looking faces have a projected upper face. Reducing the lower jaw can make the upper look more projected. Just jut your lower jaw and see how the cheekbones recede. But I'm not keen on a BSSO at my age. Even if retraction of the mandible is supposedly much easier on the nerve than advancement.
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LeFort III requires a coronal incision, which is usually not visible especially with her hairstyle. If it is that visible, no one would do a rhytidectomy either.
And yes, there are intraoral approaches only but I thought only for LeFort II via piezoelectric devices (distraction osteogenesis).
To the thread: Yeah, you can't really fix ugly, there are some rare cases where it actually happens but you can't count on it. Worst thing is to be deluded and actually expect that it will change anything. It doesn't.
Lefort iii can be done without coronal incision.
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LeFort III requires a coronal incision, which is usually not visible especially with her hairstyle. If it is that visible, no one would do a rhytidectomy either.
And yes, there are intraoral approaches only but I thought only for LeFort II via piezoelectric devices (distraction osteogenesis).
To the thread: Yeah, you can't really fix ugly, there are some rare cases where it actually happens but you can't count on it. Worst thing is to be deluded and actually expect that it will change anything. It doesn't.
its true unfortunately if your guys odds are with all the surgery in the world u wont be attractive BUT you can still improve yourself tremendously . an example is I was born naturally with a bird nose. wasn't really that big but very very curved beak life, huge drooping/goopy tip, wide alar etc. people used to call me pigeon,bird,penguin etc(on top of generic ugly also). now after my rhino no one ever calls me bird like anymore. so although im still ugly I do feel better shedding the bird label.
you have a better chance of improvement (and risk also)with bone surgeries than implants and other ps fixes. when I first came onto cosmetic boards back in the early 2000's many ppl who had serious flaws mainly in jaw chin. so back then people would run off to r. y ,r,t,r and get jaw,chin, cheek ,sometimes orbital rim, necklift etc. they would look a bit better but they would still look off. then it came out that they really needed maxfax but it was too late because they had medpor. on the flip side maxfax has really taken off since 2005 and the ppl getting it (assuming successful outcome) do look much better than the groupwho go with implants or fat etc.
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the best all time results normally were maxfax followed by implant work
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the best all time results normally were maxfax followed by implant work
Agree. It surprises me that more surgeons aren't doing custom titanium yet
Before
(http://www.drwittenberg.com/_clientfiles/images/ram2a.jpg)
After
(http://www.drwittenberg.com/_clientfiles/images/ram2b.jpg)
(http://www.drwittenberg.com/_media/images/photo-gallery/ramal/7b.jpg)
(http://www.drwittenberg.com/_media/images/photo-gallery/ramal/7a.jpg)
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Those are some good results. Which doctor performed the surgery?
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Those are some good results. Which doctor performed the surgery?
Dr Wittenberg
If you look on his site, the results are very hit and miss. I'm not sure he is particularly clever wrt movements but he is one of the only docs who routinely combines jaw surgery with implants. Some of the results are pretty 'meh' but the good ones are very good
A fair number of class 2s are deficient vertically in the ramus - the only way to get a vertical enlargement is implants or chin wing. And hardly any surgeons are doing chin wing - and I think it can't be combined with a BSSO anyway? I would think that a ramus osteotomy with a bone graft would provide a stable result but I've never seen it done. For the people with the super steep lower jaws, like this woman, only an IVRO or an implant is going to improve it, yet you rarely see an IVRO done
Same with class 3 and the malar region. How many surgeons actually do the zygomatic osteotomy? If you look at this docs site though, the cheek implant results are really variable. Some look great but some look bad and just give a weird chubby cheek look rather than a high cheekbone
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I have heard he has a lot of lawsuits against him
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I visited his website and it started playing some porno music in the background so that alone warrants a lawsuit.
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Agree. It surprises me that more surgeons aren't doing custom titanium yet
Before
(http://www.drwittenberg.com/_clientfiles/images/ram2a.jpg)
After
(http://www.drwittenberg.com/_clientfiles/images/ram2b.jpg)
(http://www.drwittenberg.com/_media/images/photo-gallery/ramal/7b.jpg)
(http://www.drwittenberg.com/_media/images/photo-gallery/ramal/7a.jpg)
I think custom titanium implants are expensive. I asked a dr. once and said it's too costly. I know schendel has the option of using them
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I visited his website and it started playing some porno music in the background so that alone warrants a lawsuit.
;D
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Dr Wittenberg did Kristian - the YouTube poster boy for very large lefort I advancements - 9 mm.
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On the train ATM. Bags under the eyes are... Quite common. Is it just me or does like 30% of the population have recessed jaws?
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Dr Wittenberg did Kristian - the YouTube poster boy for very large lefort I advancements - 9 mm.
Consistent results are much more important to me than the occasional exceptional result. Would you really gamble on a surgeon that produces average to bad results at least half of the time even though his best results are beyond fantastic?
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Consistent results are much more important to me than the occasional exceptional result. Would you really gamble on a surgeon that produces average to bad results at least half of the time even though his best results are beyond fantastic?
Good point. Ive seen only one before and after of my surgeon. And I'm not even sure it's not another surgeon my ortho uses.
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I think custom titanium implants are expensive. I asked a dr. once and said it's too costly. I know schendel has the option of using them
Yeah, they are expensive. But so are A+G surgeries soooo.....
They will become less expensive as 3D printing technology
As for the limits of surgery - this girl had her entire upper jaw and teeth reconstructed. Amazing stuff
Before
(http://www.morningstarr.co.uk/forum/attachments/underworld/1116d1274122906-chinese-girl-born-without-jaw-gets-brand-new-face-wang-na-during-treatment.jpg)
After
(http://www.morningstarr.co.uk/forum/attachments/underworld/1117d1274122906-chinese-girl-born-without-jaw-gets-brand-new-face-wang-na-following-treatment.jpg)
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I don't know anything about titanium implants, but wouldn't they be too cold? Right? For anyone who lives in a chilly climate and/or does outdoor sports...brrr. I was skiing last winter and just can't imagine that would feel so good.
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I don't know anything about titanium implants, but wouldn't they be too cold? Right? For anyone who lives in a chilly climate and/or does outdoor sports...brrr. I was skiing last winter and just can't imagine that would feel so good.
when I asked dr. yaremchuck about that question he said that would be his concern
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Just had a consultation with another surgeon. Granted i let the cat out of the bag by mentioning my surgeon. Let's call this guy Z, by is admission he's more of a tmj specialist, but does orthognathic surgery as well.. But here's what he said. (X is my surgeon).
Z says he has no relation to X. Wasnt trained by him, isn't friends with him.
X is one of the best. You're in good hands.
People from all over the world to see him.
Your orthodontic preparation is excellent. Your orthodontist is very good.
X does absolutely everything including lefort iii.
If he doesn't suggest doing something, you don't need it.
Lefort iii is for severe cases. The precision is just not there compared with implants for standard cases. It may make your eyes look tiny. Implants can get infected, but so can jaw surgery plates. But their precision is far superior to the big leforts. In fact implants may be a bad idea in my case as well. Z once put a malar implant on a patient, and his eyes became "tiny dots".
X lives to operate. He's not in it for the money*. Registrars get paid by surgery item. They don't like assisting X because he often omits items, charging the patient less.
Trust X's aesthetic judgment.
X is right about leaving your lower jaw alone.
Higher lefort will kill the angles in your face. X is right again.
I told him X wanted to do the rhino at the same time as the jaw in the initial consultation, but changed his mind. Z said I spooked X. "It's probably because most orthognathic surgery is done in late teens, early 20s. They don't over think it". Suggested counseling. "You are a tough patient. I wouldn't take you. I would've sent you to X. Wait for 6, better 12 months after the lefort before doing anything else. You should benefit greatly from it alone"
Z said to puff up my upper lip and I'll know what I'll look like after surgery. (I don't like it). I asked him why Z charges so little for rhino. He asked what do PSs charge. I told him, and he nearly fell off his chair. "That's a one hour operation!" He said he's charging peanuts for TMJ joint replacement and should raise his prices then.
*X's price list is less than the guy he trained.
P.S.
Spent the train ride checking out people's philtrums, gonial angles, eye bags. Sat next to a poor mans blue eyed Javier Bardeem.
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Wow, today's consult was quite the endorsement for your current surgeon. Are you feeling a little more confident?
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Wow, today's consult was quite the endorsement for your current surgeon. Are you feeling a little more confident?
I'd still need to see a lot of before/after pictures to be confident in my choice of surgeon. I'm sure there are a lot of people out there that still recommend Mommaerts as one of the best and we all know that couldn't be further from the truth.
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I'd still need to see a lot of before/after pictures to be confident in my choice of surgeon. I'm sure there are a lot of people out there that still recommend Mommaerts as one of the best and we all know that couldn't be further from the truth.
I wouldn't particularly rely on B&As for that matter either - they're bound to show only the cream of the crop.
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I wouldn't particularly rely on B&As for that matter either - they're bound to show only the cream of the crop.
That's true but I didn't write that I went by them exclusively. My point was that a good reputation doesn't mean much and I wouldn't be comfortable without having also seen a lot of good before/after pictures from the surgeon.
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Don't know who your surgeon is but if I was in Aus, I'd be going to Profilo (Dr Paul Coceancig)
Actually, does anyone know roughly what they charge for bimax?
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I agree, Tiny. On that side of the world he would be the first person I would see. I don't know his price point, though.
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I agree, Tiny. On that side of the world he would be the first person I would see. I don't know his price point, though.
He has a YouTube video outlining the cost. About the same as other surgeons in Australia. Does not include the hospital costs which are assumed to be covered by your health insurance. IMO, he is over marketed.
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Wow, today's consult was quite the endorsement for your current surgeon. Are you feeling a little more confident?
Confident and I do not go in the same sentence. But I sort of knew before that X is a selfless workaholic.
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He has a YouTube video outlining the cost. About the same as other surgeons in Australia. Does not include the hospital costs which are assumed to be covered by your health insurance. IMO, he is over marketed.
They're precisely the surgeons to avoid, IMO.
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PP,
For whatever it's worth, so long as you're as comfortable as possible with his plan, selfless and workaholic sound like a pretty perfect combination.
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I agree, Tiny. On that side of the world he would be the first person I would see. I don't know his price point, though.
I guess I will have to ask them. If it's within my range then I will definitely shell out for a skype consult - it's 250 aus$ for 30 mins. It's a 12hr flight from the Middle East which is doable. At this stage I'm reluctant to pay for more consults because it's clear to me what needs doing with my jaws. The only "game changer" would be a surgeon who can do a ramus BSSO and stabilise it with a bone graft. If they can't then I'm just getting bimax with small custom jaw implants.
PP, if you think your surgeon is really good do you mind PMing me who it is?
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I guess I will have to ask them. If it's within my range then I will definitely shell out for a skype consult - it's 250 aus$ for 30 mins. It's a 12hr flight from the Middle East which is doable. At this stage I'm reluctant to pay for more consults because it's clear to me what needs doing with my jaws. The only "game changer" would be a surgeon who can do a ramus BSSO and stabilise it with a bone graft. If they can't then I'm just getting bimax with small custom jaw implants.
PP, if you think your surgeon is really good do you mind PMing me who it is?
For an osteogenesis pioneer, Coceancig has published very little. Heck, I think my surgeon has published more on osteogenesis alone. Btw, someone sent me this:
http://www.linkedin.com/groups/This-is-OMFS-surgeon-I-4289021.S.102509397
(Scroll down to the bottom)
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PP, if you think your surgeon is really good do you mind PMing me who it is?
Judging by my PMs, he is about to get a horde of "difficult patients" his way. That'll learn him.
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Judging by my PMs, he is about to get a horde of "difficult patients" his way. That'll learn him.
;D
Poor bugger!
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They're precisely the surgeons to avoid, IMO.
Believe it or not I once considered going to to MM.
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Believe it or not I once considered going to to MM.
Thank goodness 'considered' is all you did :)
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I agree, Tiny. On that side of the world he would be the first person I would see. I don't know his price point, though.
I think he is the Eppley of DO and Maxfac. Good on-line promotion but little innovation and actual results.
As mentioned above, he hasn't published much on the work he's supposedly pioneering.