jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Questioning_Options on July 10, 2015, 06:48:31 PM
-
We talk a lot about procedures that widen the mandible in these forums, but little about procedures that would widen the cheekbones, which seems important for keeping reasonable proportions during jaw surgery. From what I understand, the procedures are:
Natural tissues:
Orbital box osteotomy
Le Fort 3
Malar osteotomy (don't know much about this)
SARPE (controversial, but some people online seem to think that it has widened their cheekbones)
Unnatural:
Implants
HA Paste
Is there anything I'm missing?
-
Zygomatic osteotomies can give more later projection, a tiny bit anterior, but it will not make the cheekbones higher. This is from a surgeon who does a lot of them. And no, I have not seen any of his before and afters.
-
I wonder if there's a procedure that can rotate zygos or orbital rims CCW. So that they appear higher on the face or closer to the eyes. To give it more support. Also I noticed on good looking people that their zygos are more horizontal past the end of their eye brows if that makes sense. I'll post a pic later to show what I'm trying to say.
-
I wonder if there's a procedure that can rotate zygos or orbital rims CCW. So that they appear higher on the face or closer to the eyes. To give it more support. Also I noticed on good looking people that their zygos are more horizontal past the end of their eye brows if that makes sense. I'll post a pic later to show what I'm trying to say.
ditto
-
I wonder if there's a procedure that can rotate zygos or orbital rims CCW. So that they appear higher on the face or closer to the eyes. To give it more support. Also I noticed on good looking people that their zygos are more horizontal past the end of their eye brows if that makes sense. I'll post a pic later to show what I'm trying to say.
First part yeah ditto, second i have no idea what you're talking about. And I'm sick of you saying s**t like you'll post a pic later. Post it now motherf**ker and stop leaving us in ssuspense you goosefaced f**k. I'll annihilate you!
-
Okay heres an example of someone who is preternaturally good looking but let's use his as an ideal male face to discuss this. Obviously youth, steely blue yes etc. contribute to a lot hre but I'm interested in the relationship of cheekbones to jaw/chin. The face her is quite square. So what is it that creates that very almost gonial angle? I mean is it just density of bonee in that area? the chin is strong. Cheekbones wide, eyes very wide-set. It's Daniel Day-Lewis son, a guy who has one of the most sculptural, masculine and regal faces in the world.
[attachment deleted by admin]
-
Okay heres an example of someone who is preternaturally good looking but let's use his as an ideal male face to discuss this. Obviously youth, steely blue yes etc. contribute to a lot hre but I'm interested in the relationship of cheekbones to jaw/chin. The face her is quite square. So what is it that creates that very almost gonial angle? I mean is it just density of bonee in that area? the chin is strong. Cheekbones wide, eyes very wide-set. It's Daniel Day-Lewis son, a guy who has one of the most sculptural, masculine and regal faces in the world.
"All happy families resemble one another, each unhappy family is unhappy in its own way." Leo Tolstoy.
Replace "happy family" with "attractive face", and the the above is still true. Virtually all models have long ramus, high cheekbones, forward grown jaws. Both male and female. Once you notice this, it's hard to un-notice.
-
(http://i.imgur.com/WIgS6x7.jpg)
-
I see what you're saying terry but except for the blue square i have all those qualities more or less that you've outlined with the black lines. So unfortunately I'm not sure it's quite proving anything.
-
Your features look like Chris Prat's and you want surgery? Why?
No my jawline and chin are retrusive and not as chiselled at all and I have a larger more fleshy honker, I'm just saying my cheekbone WIDTH is similar and while I think I'm "okay" looking overall I don't have that degree of handsomeness (maybe after surgery!!).
-
(http://i.imgur.com/z9JtPPV.jpg)
I didnt have time yesterday to explain what the pictures mean. I've noticed this in of my good looking friends and people in real life. Though I doubt surgery can fix this? not sure...
I dont really know whats going on but from the looks of it seems that the zygos are past persons eye brows. Its the lateral/horizontal projection. If they were to lay their heads sideways on a desk their zygos would hit it before their eye brows ( if that makes sense). This is what gives them the s-curve. Lateral/horizontal projection. Obviously it has to also have some forwards projection.
(http://i.imgur.com/ezJaAj5.jpg)
also by ccw rotation I mean like CCW of the zygos and possibly lateral orbital rim to give more support to the corner of the eyes and possibly make the cheekbones look higher. impact alittle bone where the top of the blue circle to make it rotate? I have no idea if any of this is possible, just an idea ive been having....
check out this thread page: http://jawsurgeryforums.com/index.php/topic,857.msg17122.html#msg17122
and this one: http://jawsurgeryforums.com/index.php/topic,1010.msg18598.html#msg18598
also look at this guys who had implants placed near the bottom corner of his eye. He looks way better: http://www.makemeheal.com/pictures/cheek-implants-lift/orbital-rim-implants-a11436
-
yeah but basically all i need is my orbital rims moved up (i.e. closer to my eye, this will reduce scleral show?) and also moved forward. That'll give a bit more lateral projection. I already have good lateral projection, the zygos are just set too low.
This is definitely doable. ANDD I WILL f**kING DO IT!!!!
I really need to fix my skin though, I have some bad scarring, like boxcar, ice-pick s**t. Will probably need fillers.
Guys, I'm pretty scared about this first phase of surgery. Well I am and i'm not, part of me is like it's gotta be better than the f**ked up bite my ortho has given me by extracting teeth.
But what will it feel like having tons of metal in my face. I mean for the genio, the mandible, the ramus drop in my case, and then all over again for my orbital rim, and maxilla. Jesus, Plosko, do you now set off alarms at airports??
Does that happen cause of all the metal in people's faces.
I gotta tell you something else. I have only ever met three people who told me they had jaw surgery, some class 2, some class 3 and I have to tell you, they ALL looked noticeably weird and f**ked up.
-
Jesus, Plosko, do you now set off alarms at airports??
LF1 plates will have to come out for any infraorbital osteotomies. All maxillofacial plates are removable, alhough infraorbital plates may be harder to remove. I'll take plates over implants any day. Either move bones, or do nothing.
I gotta tell you something else. I have only ever met three people who told me they had jaw surgery, some class 2, some class 3 and I have to tell you, they ALL looked noticeably weird and f**ked up.
Yeah, my upper mid face looks like it's left behind. The reality is, quite often a bad bite is associated with other "distortions" that also need to be fixed. The best jaw surgery cases are where everything is good and only the bite is off. I wonder how often that's the case.
-
The best jaw surgery cases are where everything is good and only the bite is off. I wonder how often that's the case.
You can answer this question yourself: How many truly attractive people do you see in day to day life? Probably not many. Those few people have a class 1 bite and everything else fitting nicely in their faces. Now extrapolate that relationship onto all jaw surgery patients and you can see why there are so few good before and afters: People in general are pretty unattractive. If they have their skeletal malocclusion fixed they will still be unattractive afterwards.
Truth be told, there are a lot of real world before and afters over at progenica (german jaw surgery board) and among all of them there was 1 really good result (class 3 guy). Most results were meh, not because of a bad surgical outcome but rather the surgeon didn't have a good face to work with in the beginning. Some results are decent because they were young women caked in makeup. If I had to give numbers, I would say well below 5% of results were aesthetically worthwhile (i.e. patient will be perceived more favorably afterwards).
I gotta tell you something else. I have only ever met three people who told me they had jaw surgery, some class 2, some class 3 and I have to tell you, they ALL looked noticeably weird and f**ked up.
What exactly made them look f**ked up? How old were they? I don't think a sampling size of three people really means anything, but jaw surgery is performed so rarely that it is hard to meet anyone having had it done in day to day life.
My surgeon told me, if they (all maxillofacial surgeons in germany) were to operate on every skeletal malocclusion in the german population that could be justified by current medical parameters it would take 50-60 years until they were done with all cases. But that number only holds if no new cases were to occur in the population. I think this illustrates quite well how seldom this operation is carried out on people who might need / benefit from it.
-
You can answer this question yourself: How many truly attractive people do you see in day to day life? Probably not many. Those few people have a class 1 bite and everything else fitting nicely in their faces. Now extrapolate that relationship onto all jaw surgery patients and you can see why there are so few good before and afters: People in general are pretty unattractive. If they have their skeletal malocclusion fixed they will still be unattractive afterwards.
Truth be told, there are a lot of real world before and afters over at progenica (german jaw surgery board) and among all of them there was 1 really good result (class 3 guy). Most results were meh, not because of a bad surgical outcome but rather the surgeon didn't have a good face to work with in the beginning. Some results are decent because they were young women caked in makeup. If I had to give numbers, I would say well below 5% of results were aesthetically worthwhile (i.e. patient will be perceived more favorably afterwards).
It's my take on it as well. Max fac just takes away the deformity. So attractive with deformity becomes just attractive afterwards. Ugly with deformity -> just ugly. Although some manage to make a jump one rung up the ladder.
But for some people completely cosmetic operations like a chin wing can bring more aesthetic improvement than conventional "deformity-removing" jaw surgery.
What exactly made them look f**ked up? How old were they? I don't think a sampling size of three people really means anything, but jaw surgery is performed so rarely that it is hard to meet anyone having had it done in day to day life.
IRL, I'm the only one I know.
My surgeon told me, if they (all maxillofacial surgeons in germany) were to operate on every skeletal malocclusion in the german population that could be justified by current medical parameters it would take 50-60 years until they were done with all cases. But that number only holds if no new cases were to occur in the population. I think this illustrates quite well how seldom this operation is carried out on people who might need / benefit from it.
What percentage of the population would that be and what would be the most common deformity? I heard 30% have a deformity of some sort, half of which are worth operating on, so that would be 15%. I'd say various forms of class II go untreated the most. That's the least objectionable deformity and can be camouflaged with jaw jutting, but that's just a guess.
-
You guys said it perfectly. I'm sure most people would at least look the same or slightly better after fixing their deformity.
Id take a normal profile over a recessed jaw anyday regardless if JS made my mid face recession look more obvious.
-
I'll happily classify myself in the 95% of notrain's statistic of not attractive post-surgical results. But my face just grew all weird, so improvement I tend to think.
Seems like most people in here are actually fairly good looking people looking for a slight improvement. It actually seems pretty crazy to go through this if you're in this boat. Even just having braces as an adult I think has a higher chance of causing bone loss/gum recession. While slight improvements are the safest, I'd think most likely you'd get a lateral change in your overall appearance. Or even if you look better, your lips being slightly numb/stiff might make you feel worse about it.
On the other hand, if you're like me and had lots of problems with your facial development, there isn't a great solution. If you go too extreme on one type of movement, it's going to throw everything off as others have said. After going through all of this, I'd say to always go conservative(undercorrect) with everything unless you really just trusted your surgeon. Too much movement is bound to cause bad trade-offs elsewhere (such as your nose with a LeFort 1).
Certainly don't look at some very attractive person and try to figure out what movements you'd need to accomplish that look. Fixing a deformity seems like the only noble cause to me. A combination of functional+aesthetic seems to be the best case for surgery. I rarely see purely cosmetic surgery that I think is strictly an improvement, but that's partly because over the years I've learned to look very discerningly at before/afters. Guess I should add that more often I think they look slightly/moderately worse after in this case.
-
Man this thread is making me second guess getting JS. But for those who have seem my pics here, they said to get a regular LF1 with CWW rotation. I legit have a lower jaw deformity, it legit recessed. So for me a basic procedure would be good right? Also I have a narrow airway so I'll most likely have to get it when im in my 40's....
If i were to get any orbital/ zygo povements id just want 3-5mm of forwards and lateral movement. Nothing crazy...
-
I'll happily classify myself in the 95% of notrain's statistic of not attractive post-surgical results. But my face just grew all weird, so improvement I tend to think.
Your result is very good.
Even just having braces as an adult I think has a higher chance of causing bone loss/gum recession. While slight improvements are the safest, I'd think most likely you'd get a lateral change in your overall appearance.
A max fac book I have says in bold "adult patients should be informed of the risk of getting black triangles". I sure wasn't.
Too much movement is bound to cause bad trade-offs elsewhere (such as your nose with a LeFort 1).
True, very few will get away without some changes to the nose. All that tissue has to go somewhere when the bone behind is moved forward. It's not all bad. Noses tend to look smaller in profile after LF1 advancement.
BTW, did removing the plates help?
-
Man this thread is making me second guess getting JS.
Don't kid yourself. You need orthognathic surgery.
-
Many of you talk about some improvements, which would make you more attractive and based on this, you further decide which jaw surgery or plastic surgery approach would be good for you to achieve more attractive look.
And what is your motivation?
You have created an endless train of debates about various dangerous surgical approaches and are thinking about undergoing rare and eventually insane osteotomies, which were not performed even on monkey test subjects yet. Some of you appear to have studied every maxfac textbook and lurking this forum (and probably others as well) for years, yet nobody understands the basic concepts of human attractiveness and more importantly, nobody did a simple field research on aesthetic outcome of patients to get closer to the truth - you rather took a few good before-after images you found on internet and generalise that outcome to all cases or at least on your case, despite the fact that you may know the rubbish statistic behind aesthetic outcome, but yet you falsely believe or simply you want to believe that your case will be different. This is stupid or delusional, probably both.
Actually it's very simple: ugly and recessed is worse than just ugly even from a simple ageing point of view. Once you hit 35, you'll understand.
As far as success stories are concerned, we have a user who started as a deformed potato. Jaw surgery turned him into just a potato. ZO + chin wing + rhino turned him into a good looking guy. So miracles do happen.
-
c) Then there is a group of patients, who'd like to change their looks to be objectively more attractive to the opposite sex, or be better treated by people around, more successful with woman..etc. This group is one of the most lethal. I've came across few forums, where sanity doesn't exist and where people were discussing surgery approaches to be more successful with females, thinking that jaw surgery or plastic surgery will transform their faces into objectively attractive one (being in the top 20% of population aesthetically wise). They obviously don't understand how sexual attraction works and how many subtle changes (dozens of them) needs to be done not only on hard, but soft tissues as well, to become objectively attractive person. They just neglect a role of hormonal profile and genetics and think that simple anterior advancement (preferably of whole face, thus a LeFort 3) while make them objectively more attractive. This approach doesn't work, I would say that in 95% it doesn't work. Unless you are already a good looking, but with clear deformity, forget about this. When one will undergo this and figure out that thing in fact didn't work, he'll be disappointed, depressed and he may fall into never ending circle of surgery world. People apparently don't understand all components of attractive face and a psychology behind it, neither they understand how hard if not impossible is to achieve that.
Yeah, this is pretty much me. I had a pretty good bimax outcome, and I don't qualify for "ugly", but I would really, really, really like to be good-looking, that is something like a "7" or possibly even an "8". Thing is, I cannot envisage happiness sans an attractive face, hence I will attempt to accomplish simple bilateral expansion. I am satisfied with the general shape and outline of my features, only that they ought to be more widely spaced.
Another centimeter or so of zygomatic width, with proportionately increased jaw width and height (chin wing osteotomies can supposedly accomplish this), and orbital expansion. This along with a hair transplant and treatment of acne scarring would most likely produce a face with which I would be comfortable enough to become the man of my ideal world.
I don't neglect the importance of a virile hormonal profile, and will thus experiment with HGH and a WAP style diet. All things considered, I would rather try and fail than live the life of a mediocre-looking para-autist destined to fail with human interaction.
-
i guess im 1/2 except class II. Some people in real life say im good looking (LOL) but I don't consider myself good looking at all. I wish i could look at my face objectively, like seeing it for the first time or something. Im not gunna lie though, I'd like to fix my recessed jaw, I feel like I'd be less self conscious about it.
Also the rotating zygos was me, I said that its purely speculation, I'd never get it. But I thought I'd throw it in there, maybe some surgeon will see it some day and create it.
Also thanks for re-affirming I need JS plosko, I feel better lol...
-
Your result is very good.
A max fac book I have says in bold "adult patients should be informed of the risk of getting black triangles". I sure wasn't.
True, very few will get away without some changes to the nose. All that tissue has to go somewhere when the bone behind is moved forward. It's not all bad. Noses tend to look smaller in profile after LF1 advancement.
BTW, did removing the plates help?
I guess this topic has diverged enough now that I can talk about the plates lol. Yeah, it helped. It wasn't as dramatic as I hoped, but reduced the nasal flare a bit and reduced the volume under my tear troughs a bit as well (making my eyes look slightly less hollow if that makes sense). Zero additional numbness. Again, very subtle but worth it in my case.
-
@ jusken - Is getting the plates removed a whole hassle/ordeal? During my last consult I asked the surgeon about removing the plates and he said its like getting JS again. Which I thought was a little bulls**t, but I'm not sure...
-
@ jusken - Is getting the plates removed a whole hassle/ordeal? During my last consult I asked the surgeon about removing the plates and he said its like getting JS again. Which I thought was a little bulls**t, but I'm not sure...
I heard this a lot and it scared the s**t out of me. Asking a couple members on here about it reassured me though.
It swells up about the same as the original surgery about 6-8 hours after. It took about 10 days for the swelling to be almost completely unnoticeable to me. I took 5 days off work and no one else would notice a thing (very mildly puffy at this time). It was painless, I ate hard food an hour after surgery. Nothing at all like the original surgery - very easy.
Maybe for some people the swelling from jaw surgery is gone after 10 days, but for me it took like 3 months.
-
I guess this topic has diverged enough now that I can talk about the plates lol. Yeah, it helped. It wasn't as dramatic as I hoped, but reduced the nasal flare a bit and reduced the volume under my tear troughs a bit as well (making my eyes look slightly less hollow if that makes sense). Zero additional numbness. Again, very subtle but worth it in my case.
Only LF1 plates?
-
Also thanks for re-affirming I need JS plosko, I feel better lol...
You stand to gain a lot from JS.
-
severe recession of both jaws. want to look like human after.
But you just said JS is a hoax.
i already look 35+. saggy skin due to lack of bone support is a hell, i am similar to that michelin guy.
How is that supposed us, 35+ people, feel? Anyway, I had something similar happen, although I was already in braces. Losing facial fat confirmed my deformity and that surgery was the only answer.
sure they do, but rarely and that's why they're called miracles. then non-deformed ppl take this anecdotal success and extrapolate that into their case, thinking that same level of improvement it can be applied to them as well. that's ridiculous.
i bet that your anecdotal case was a good looking guy with deformity, a Class III underbite.
Nope. Class II LFS, no lower third to speak of, huge nose. Weak cheekbones, weak infraorbital rims. Like many such cases had rhino and chin implant first, which (as is always the case in such cases) did nothing.
Hard to believe the before turned into the after. He has nice features - eyes, lips. But you can't say that from his pre-op appearance. Only the infraorbital weakness remains, which is negligible, because the gestalt says "looks good".
But, yeah, before I used to think that Class IIIs were the best "show cases". Canonical case: http://drrichardjoseph.com/photos/113.php
Now I am not so sure. notrain thinks the most striking cases are where there is a change in the length of the face - short face syndrome, long face syndrome. He may be right.
-
Fixing the jaw deformity is obviously not going to make you look like a model unless the rest of your face has the features to match. If your goal is to be attractive and you don't have already have a solid foundation then you're going to need way more than just jaw surgery. Korean and to some degree Japanese surgeons are able to consistently produce amazing transformations but they're also willing to go to extremes to achieve it.
-
Well it sucks and it will suck more when u get older thanks to bone volumetric loss and skin quality.
This is where having non-recessed bones helps a hell of a lot, even if the face is not attractive.
Did you lose a lot of weight, or it was just that "pubertal" facial fat?
Went from 17% bf to 11%. I wanted to see what the bone structure was under my hamster cheeks - there was no bone structure.
Sounds like a typical "mouth breather" with already good features. Those cases are easily solvable due to affected only lower jaw and maxilla.
Not really. Few surgeons can do CCW well. There is a reason A&G charge so much. And even after CCW he had "banana gonial angles", which were fixed with a chin wing - even fewer surgeons do wing osteotomies.
It sounds like guy didn't have unacceptable weak midface, otherwise he'd come nowhere.
His infraorbital recession is still there, but it doesn't really matter. This guy does not have super strong infraorbital rims, but he still looks good:
http://www.rhinoplastyrevisions.com/photogallery/rhinoplasty/patient-18/
From what I saw, it was always CIII. But a precondition for every potentially good outcome is a not-weak midface, once that condition is not satisfied, one most likey won't fall under category "significant improvement".
i.e. only the maxilla recessed. But that's rarely the case with class IIIs. The recession is usually all the way to the eye balls, sometimes beyond (sloped forehead - one ugly feature).
-
Sloped for head aren't that bad on men. My good looking friends have sloped foreheads and they have developed faces. I think when you have a recessed jaw or mid face it makes the forehead look even more recessed. Not to mention most people tilt their heads back making it look even worse.
I have seen many before and after with CCW rotation but those seem have the best result fof class Ii that is.
Also brandon I'm sure everyone who post regularly on this forum has realistic expectations. I don't think anyone here is expecting to become hot s**t after.
Polsko what do you mean by bannana gonial angle
-
Polsko what do you mean by bannana gonial angle
Rounded jaw angles, short ramus, etc..
-
Sloped for head aren't that bad on men. My good looking friends have sloped foreheads and they have developed faces. I think when you have a recessed jaw or mid face it makes the forehead look even more recessed. Not to mention most people tilt their heads back making it look even worse.
To me it's the contrary. Maxilla is where it should be now, the sloped forehead looks even further back now.
I have seen many before and after with CCW rotation but those seem have the best result fof class Ii that is.
You know I think you might just have the same result as the aforementioned guy. I wouldn't skip JS, just because you're worried that it will make the infraorbital weakness more obvious. He too has biggish eyes and lips. He turned out freaking great. He inspired me to get moar surgery in the vain attempt (double pun?!) to look better.
-
This is in fact interesting and I would like to hear more about. By my knowledge a CCW should be a textbook surgery, relatively easy, routine and predictable. Maybe this is why I was said that "only few surgeons will do right what you need" and he was referring only to lefort1 manipulation. It still may be purely marketing involved, as I assumed in the early beginning.
I was surprised about that too and yet that's the case. You can ask terry. A top surgeon in his city did not offer him CCW, yet he is the ideal patient for it. But hey, modified LF3 are also described in textbooks.
What does high gonial angle to do with CCW? CCW just dictates the amount of rotation of lower jaw, while gonial angle is a relation between body and ramus of lower jaw.
Exactly right, BSSO does nothing to the gonial angle. CCW rotation does put the mandible at a more aesthetic angle to the horizontal, however.
My GA is horrible as well (135) and it perfectly fits in banana category. Was advised to use implants.
IMO, a chin wing is a better option. It may not give you L-shaped gonial angles, but the less foreign material the better (you can even remove the plates later on).
He has somehow weak infraorbitals (punched eye look), but his zygos are nice. His over all balance is nice. I don't have neither zygos, neither infraorbitals, nothing. My face is like potato, smashed potato.
That's exactly my (and your) point. Beauty is complicated. This guy may age poorly, but augmenting his upper mid face may throw everything off. Frankly, I don't know why he risked a nose job. But if you have little to lose, move bones. It may just work.
-
That's right. Probably the "best" jaw surgeon in Toronto said that he doesn't do CCW rotation, or at least for me he wouldn't. Which I find crazy. I have a steep occlusion angle and doing a forward advancement would look retarded. My face would get longer and I'd probably relapse since I'd probably still have lip incompetence.
Honestly I don't give a s**t if I have to pay out of pocket for JS as long as I feel the surgeon is top notch. In Canada we only have to pay ~5000 for Bimax/Trimax but is it really better if the surgeon is incompetent.
Also thanks plosko hopefully JS can make me attractive as a side effect. Either way I'm getting it.
Also sorry for the spelling mistakes guys. I usually reply on my
iPhone/iPad.
-
His nose was better before. Why the f did he get a nose job. Man some ppl....
-
His nose was better before. Why the f did he get a nose job. Man some ppl....
who?
-
http://www.rhinoplastyrevisions.com/photogallery/rhinoplasty/patient-18/
-
@Lazlo That is not at all normal. My cousin had jaw surgery, for a weak chin, and he looks great now. With my new expertise, I see that he will get the family tear through deformity but pretty mild. Someone in my office had it done in the early 90s, with wire fixation. Other than cutting a nerve, he looks pretty good. I think the surgeon could have reduced a bit more, he still looks a little angry. Most of the people on the jaw surgery group on FB look great. I don't know about in person, maybe I'd have a different opinion.
Very cool images btw, helps me understand the anatomy. My facial bones are all roughly in the right place I think but you all have told me that already. What I don't understand is that my maxilla appears to be normal yet most surgeons want to multi-segment and bring the front segment down 2mm. I've been wearing a night guard since I was early teens, seems to me you can't judge the stability of an orthodontic movement on teeth like mine, which have been held in their current position for so long. In someone not in an orthodontic appliance I'd agree.