jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Plasticman on July 18, 2018, 04:15:32 PM
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Hi Everyone,
I am about to have a bimax in 2 weeks to solve a facial asymmetry. I have no functional troubles so it's 100% aesthetic.
Today I went to my ortho and I told him about my fears of the jaw surgery. He answered me frankly, saying that if he was me, he wouldn't go for it. I am lost. I have prepared myself for this surgery for a year now.
Here's a picture of my front. What do you think ?
Thanks a lot for your advice
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Unless he gave you some reason, either disregard or ask the attending surgeon what concerns you. Also relay the ortho shook your confidence.
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Thanks for your reply
The ortho said I am good looking, that the Best is the enemy of the Good. He sees the asymmetry of course but in his opinion it is not strong enough to take the risk of a bimax. At the end it's up to me.
The thing is that I have a light asymmetry compared to what I can see in others, but still strong enough to be taken seriously by professionals.
My surgeon is the best here. A thousand of op / year. The counterpart of his success is that he is very expeditive during our meetings. In addition, my case seems to be an easy piece to him.
He plans a 2 - 3 mm impaction of the maxilla to shorten the longest side of my face.
To finish, I really trust his knowledge and experience, what scare me the most is not recognizing myself afterward.
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Do you have a ceph? Asymmetry is very hard to fix, and it may even become more noticeable after bimax.
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Yes, the front ceph is in my previous post. Here is the profile:
Clearly it seems that retrognathia or prognathia are easier to deal with. There's not so many before / after of asymmetry treatment (except extreme case which are always impressive.)
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How much of your asymmetry is soft tissue and how much of it is actual bone?
Does your maxilla/bite have a cant? If it does then there is clear unilateral overgrowth/undergrowth of the upper and lower jaws.
I have a very similar situation to you, except I don't really have a can't. My teeth are straight, but I have an edge to edge bite at the front, normal class i at the right and cusp to cusp/class ii on the left.
I am having scans and a 3D printed model in detail of my skull from the chin to mid orbit on Monday to determine what degree of my asymmetry is bone and what is soft tissue. I already know both are involved, but I want to know exactly how much my jaws are contributing to the issue.
I will likely have bimax to correct my bite/improve my profile and hopefully jaw related asymmetry, genio to move my chin slightly to the left. If the asymmetry is still prominent after that I will look into subtle fat grafting to the left cheek area and maybe buccal fat removal (not all just a bit) on the right.
You are the closest person I've seen to myself on this forum except for the bite.
Who is your surgeon?
I'm seeing 2 in Spain the week after next.
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It's mainly bone.
I have a malocclusion on the left side and yes, one side grew a bit much than the other.
My teeth are straight and aligned.
I didn't know about this technique to determine bone vs soft tissue degree of asymmetry. It looks impressive, what's the name of it?
Are you not afraid of the bimax to solve your problem?
I'll send you the name of the surgeon in private message.
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It's not something any Doctor recommended, I am just going out of my way to understand my own anatomy in it's entirety before I trust someone to operate on me.
If I feel like the asymmetry is primarily soft tissue then I'll go the route of fillers/fat transfer. The problem is that I already had a surgeon who concluded that my bite can't be corrected with orthodontics only, that I would need surgery to move my lower jaw.
I am going to bring the model and all the information/questions I have available to the surgeon and go from there.
It's a cost : benefit ratio.
My teeth are wearing, I can't fully bite through certain foods and aesthetically I know I could look better.
It comes down to the pros and cons. If I could fix my teeth without surgery, I might not get it. If I can't then I have to decide if I put up with the way they are for the rest of my life.
I'm sure it's not an easy decision to make, I sympathise with you. Have you written down exactly the reasons you want this? The pros and cons?
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The more developed side of your face is the more attractive side. Right side of face, left side of photo. The asymmetry is VERY apparent.
To my eye, it does not look like a situation where the salient problem is that one side is 'longer' than the other. Or at least that looks like the LESSER issue. To my eye, one side is more NARROW than the other and less developed which is SIDE of face including cheek area and jaw area. Also NOSE area where you don't see the nose hole (nostril) on the undeveloped side.
In essence, your asymmetry is MORE of a WIDTH issue than a length issue and from what you say, the doc will just be focusing on resolving the Length part of the asymmetry.
That said, you should establish that your doc will be prioritizing establishing more symmetry to the UNDEVELOPED side of your face.
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The more developed side of your face is the more attractive side. Right side of face, left side of photo. The asymmetry is VERY apparent.
To my eye, it does not look like a situation where the salient problem is that one side is 'longer' than the other. Or at least that looks like the LESSER issue. To my eye, one side is more NARROW than the other and less developed which is SIDE of face including cheek area and jaw area. Also NOSE area where you don't see the nose hole (nostril) on the undeveloped side.
In essence, your asymmetry is MORE of a WIDTH issue than a length issue and from what you say, the doc will just be focusing on resolving the Length part of the asymmetry.
That said, you should establish that your doc will be prioritizing establishing more symmetry to the UNDEVELOPED side of your face.
I think this is a really good point.
OP, with a technetium-99m nuclear medicine bone scan, a surgeon will be able to tell if your right side has an increase in uptake/increased activity compared to the left. There is a difference between hemimandibular hyperplasia and hemifacial microsomia. One is excessive growth of one side of the face/bones and one is underdevelopment of the otherside.
I'm sure your surgeon has considered all of this however. The OMENS classification takes into account the eye, cheek area, nose and ear.
Your asymmetry looks largely bone as you already stated.
Bimax seems like it makes the most sense. You can only move the jaw bones in so many directions without completely segmenting it, so this might be the best solution
https://www.youtube.com/watch?v=Oz4GWUI8SIU
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@strongjawman
Thanks for your message and your kind words.
It's a real mess in my head. There are a ton of cons but also the hope that one day I could just get rid of this problem and not have it always in mind especially in social situations. I am 35. I did a first attempt 10 years ago and I gave up. My goal is not to be perfectly symmetric. It's impossible and I guess it's part of who I am. But I would love to make it less important in my life.
You seems to do things very well. Without any doubts, it will help you to take the right decision.
@kavan
Thanks for your analysis and for having taking the time for it. The first picture is a little tricky, my nose is not straight (deviated) and it gives the impression the right side / left in picture is wider. I don't feel this is the case.
Both 3/4 views are different (like twins ;)). I find more attractive the other side (left side of face / right in pictures).
Looking at this makes me think that most of the asymmetry is in the nose and somehow, my deviated chin compensate the fact the nose is not well oriented. This also why I fear the surgery, it could break this fragile balance...
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Send me the name of the surgeon too please. My asymmetry is of a similar degree, I'll send you pics.
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@strongjawman
Thanks for your message and your kind words.
It's a real mess in my head. There are a ton of cons but also the hope that one day I could just get rid of this problem and not have it always in mind especially in social situations. I am 35. I did a first attempt 10 years ago and I gave up. My goal is not to be perfectly symmetric. It's impossible and I guess it's part of who I am. But I would love to make it less important in my life.
You seems to do things very well. Without any doubts, it will help you to take the right decision.
@kavan
Thanks for your analysis and for having taking the time for it. The first picture is a little tricky, my nose is not straight (deviated) and it gives the impression the right side / left in picture is wider. I don't feel this is the case.
Both 3/4 views are different (like twins ;)). I find more attractive the other side (left side of face / right in pictures).
Looking at this makes me think that most of the asymmetry is in the nose and somehow, my deviated chin compensate the fact the nose is not well oriented. This also why I fear the surgery, it could break this fragile balance...
I have the same problem when I look left and right. It's definitely your mandible/maxilla. Your nose and chin just follow your facial bone growth. My nose is slightly off as well.
Can you PM me the name of your surgeon please?
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@kavan
Thanks for your analysis and for having taking the time for it. The first picture is a little tricky, my nose is not straight (deviated) and it gives the impression the right side / left in picture is wider. I don't feel this is the case.
Both 3/4 views are different (like twins ;)). I find more attractive the other side (left side of face / right in pictures).
Looking at this makes me think that most of the asymmetry is in the nose and somehow, my deviated chin compensate the fact the nose is not well oriented. This also why I fear the surgery, it could break this fragile balance...
Well, your face is sort of on the 'long' side. So, that's why the more developed side (side with more width to it) would be considered more attractive by most people. It's because width or more width can visually offset some excess length. As to the nose, you might be looking at a rhinoplasty later down the line to address your nose issues. They use grafts for augmentation.
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I think this is a really good point.
OP, with a technetium-99m nuclear medicine bone scan, a surgeon will be able to tell if your right side has an increase in uptake/increased activity compared to the left. There is a difference between hemimandibular hyperplasia and hemifacial microsomia. One is excessive growth of one side of the face/bones and one is underdevelopment of the otherside.
I'm sure your surgeon has considered all of this however. The OMENS classification takes into account the eye, cheek area, nose and ear.
Your asymmetry looks largely bone as you already stated.
Bimax seems like it makes the most sense. You can only move the jaw bones in so many directions without completely segmenting it, so this might be the best solution
https://www.youtube.com/watch?v=Oz4GWUI8SIU
So if it's hemifacial microsomia it won't show any uptake? I've had this scan done (but to investigate condylar resorption), my left side had marginally higher uptake/activity compared to the right but they also said it was insignificant. I have asymmetry a bit like Plasticman - which no surgeon or ortho can seem to see :o Very different on 3/4 cheekbone/cheek view (like completely diff people), ears are at different heights (possible head tilt), deviated nose, and also strangely one eye is smaller than the other. Plasticman, how are your eyes out of curiosity? Symmetric or asymmetric?
Looking at this makes me think that most of the asymmetry is in the nose and somehow, my deviated chin compensate the fact the nose is not well oriented. This also why I fear the surgery, it could break this fragile balance...
I feel with the nose, unless it's corrected, it will always throw everything a bit off. I'm no expert, but I'd imagine after bimax the deviation might become more apparent. But its hard to say what will happen after the surgery. Some noses look better, other's become deviated. But you are obviously a good looking guy and not many people in daily life would be looking at you through such a microscope. I would just prepare myself for rhino or septo afterwards.
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@kavan: You're analysis is right concerning the side of the face. The wider is the more attractive. (Then I wonder what would be the effect of the bimax on each side width... It may accentuate the difference and makes the wider even wider...)
I saw a surgeon for my nose. Like the max fac, he is known to be the best one here. He told me we would do nothing. To much complicated, unpredictable results with deviated nose like this, he won't take the risk. So rhinoplasty is not an option. It's not perfect but im ok with it.
@strongjawman: I thought I did yesterday sorry. Did you receive it?
@april: Thanks for your answer! I havent done the bone scan. My surgeon told me it wasn't necessary in my case. (I have always been like this).
My eyes are symmetric. Same heights, same size. Eyelids have slightly different shapes when I'm tired but it's like everyone. Yes it is possible that the correction of the jaw would make the nose deviation more noticeable. It's a risk, one more among so many.
What a mind f ;) !!
ps: Here's a pic of a french TV journalist. He is a good-looking guy. I saw him many times on screen without having paid attention to his upper lip. Pictures emphasizes this kind of default...
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So if it's hemifacial microsomia it won't show any uptake? I've had this scan done (but to investigate condylar resorption), my left side had marginally higher uptake/activity compared to the right but they also said it was insignificant. I have asymmetry a bit like Plasticman - which no surgeon or ortho can seem to see :o Very different on 3/4 cheekbone/cheek view (like completely diff people), ears are at different heights (possible head tilt), deviated nose, and also strangely one eye is smaller than the other.
This is the part I'm not entirely sure about. My right condyl had slightly higher uptake which the surgeon said explained the difference in size between the mandible/ramus, but he said the problem was stable and that the difference was insignificant. He never simply diagnosed it as overgrowth on one side and didn't mention hemifacial microsomia at all.
But I read the OMENS classification and my soft tissue including cheek/left orbit, left ear (very subtle but noticeable difference in size) and amount of fat on left side of my face is less than the right.
I looked at photos since I was a child and I suspect it is a very mild level of hemifacial microsomia. The difference is that with this I will likely need some soft tissue improvement in addition to correcting the jaws.
It looks like OP will get away with only his jaws and maybe his nose.
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Despite your asymmetry and nose (mostly just the smaller nostril), you are actually good looking. So, that's a feat in itself. I think it's because you have excellent features otherwise (hair, skin, lips). These matter. Now, whether jaw surgery is worth it? Eh. In general fixing that kind of asymmetry is not going to work out. It might, but I'd put the odds on it not working out correctly, and then you'd be left with some other face, al the potential risks, and probably a worsening of your nose.
I personally don't find any of your issues offensive. Do they stray from standards? Yes. Is it offensive to look at? No.
I'm about as far from gay as a man can be, and I think you look (a little wonky) but attractive objectively.
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ps: Here's a pic of a french TV journalist. He is a good-looking guy. I saw him many times on screen without having paid attention to his upper lip. Pictures emphasizes this kind of default...
Yes, pictures certainly seem to bring out more asymmetry. I'm always surprised by how wonky I look in photos and on Skype etc.
In your second set of photos, your jaw asymmetry doesn't actually look as obvious compared to the first photo you posted.
Like GJ said - and similar to the TV guy you posted - if you have a bunch of good features, they'll dominate any mild deficient ones (read Arnett's 'The Essence of Beauty'). You're definitely very good-looking and I'm sad to hear it's always on your mind.
But I know how hard it is to mentally prepare yourself for jaw surgery for over a year and then to have doubts, questions, and complete uncertainty thrown into the mix too. Yes, really, this whole jaw surgery thing is the biggest mind f**k of all time. There just seems to be many trade-offs and you don't know what you're going to get. You need to be mentally prepared to accept all the risks and any aesthetic trade-off. I hope it works out for you.
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Thanks to all of you for having taken the time to reply and for your advice.
It's hard to talk about this subject, and I am glad I could discuss it openly with you.
I don't know yet what I'll do. I have 4-5 days to decide before I meet the ortho to put the chirurgical brackets.
Anywhow I feel I am not really ready for the bimax as it's still very unclear in my head.
I'll keep you in touch...
I understand that some of you are in the same situation, waiting for an operation or wondering if they need one.
I sympathize with you, it's a tough choice and a long journey.
@april: I'll read Arnetts, it looks interesting. Thanks for your words!
@GJ: Thanks for talking frankly. It's highly valuable to me right now!
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Despite your asymmetry and nose (mostly just the smaller nostril), you are actually good looking. So, that's a feat in itself. I think it's because you have excellent features otherwise (hair, skin, lips). These matter. Now, whether jaw surgery is worth it? Eh. In general fixing that kind of asymmetry is not going to work out. It might, but I'd put the odds on it not working out correctly, and then you'd be left with some other face, al the potential risks, and probably a worsening of your nose.
I personally don't find any of your issues offensive. Do they stray from standards? Yes. Is it offensive to look at? No.
I'm about as far from gay as a man can be, and I think you look (a little wonky) but attractive objectively.
Why is that? Rather, why is fixing this kind of asymmetry so far on the failing end? I have similar asymmetry to one side of my face (shorter, less volume etc). Makes on side of my face appear mutant, or boyish. I also have a bit of a can’t. Was hoping to fix mine with 3 piece le fort downgraft.
I’m not trying to ask a loaded question, but, as simply as possible (like I’m a child) 🙏🏻, why is asymmetry so difficult to get right? What are swaying the odds so much... Thanks
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I personally dont see why your asymmetry can't easily be sorted. My surgeon (Mr Piet Haers) was due to sort mine and gave me assurances it would look fine and also showed me before and afters of previous patients. They all looked great. One less so but they didn't really have a great deal of asymmetry to start with.
My asymmetry is similar to yours and some of the before and afters I was shown were very similar to our issues. Some of them had worse asymmetry and came out great. Unfortunately for me, I had to have part of my condoyle removed due to a bony spur a few years back and so bimax can no longer be done due to there not being enough support.
I presume you are all good in that respect so don't see why a competent surgeon couldn't obtain great results.
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You are good looking but also the asymmetry is very apparent. IMO it would be risky trying to correct that with jaw surgery, custom implants would be more precise and could also add width to the more narrow cheekbone.
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Why is that? Rather, why is fixing this kind of asymmetry so far on the failing end?
Because they have to lengthen one side or shorten the other, for starters. Which do you do? The wrong choice that could undermine any correction. If the surgical splints are off at all the bones will follow those. They have to make very precise cuts, which isn't easy. Then there's the issue that as you move the bones forward any apparent asymmetry becomes more noticeable. So getting that all correct...well, the odds are against it. Many people come out of surgery with MORE asymmetry, and these are some of the reasons why.
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Thanks to all of you for having taken the time to reply and for your advice.
It's hard to talk about this subject, and I am glad I could discuss it openly with you.
I don't know yet what I'll do. I have 4-5 days to decide before I meet the ortho to put the chirurgical brackets.
Anywhow I feel I am not really ready for the bimax as it's still very unclear in my head.
I'll keep you in touch...
I understand that some of you are in the same situation, waiting for an operation or wondering if they need one.
I sympathize with you, it's a tough choice and a long journey.
@april: I'll read Arnetts, it looks interesting. Thanks for your words!
@GJ: Thanks for talking frankly. It's highly valuable to me right now!
Hi Plasticman,
I would advise to go forward only if you're very very confidant in your surgeon.. make sure he's spending enough time with you and explaining exact movements IN DETAIL (to the tenths of mm). If possible, get the surgical plan beforehand and ruminate over it as long as you can. Something could be very obvious to you that perhaps your surgeon has overlooked. Yes, they're the professional, but you know your face better than anyone else.
K
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I must be taking crazy pills I don't think the overall asymmetry is that apparent, nor is it that important for attractiveness. I would do at most do something on the chin to make it horizontal and then rhinoplasty. That seems like a much less risky and more precise way to correct it than doing it this "indirect" way.
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Don’t do it. You look good mate, I really doubt you’ll look better if you have this surgery