jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Glassjaw on July 04, 2022, 02:13:12 PM
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Here’s some pics, all post-rhinoplasty.
https://imgur.com/a/DDo1NuS
How i see my problem:
As a result of having a crossbite for 25 years, everything down from my eyebrows is slightly recessed and the angles and the symmetry are a bit f*cked up. My face looks a bit long, the eye area/midface looks "molten" and the jaws/chin are too far back. As you can see from the photos, my nostrils are at a slightly different height and my nose slightly crooked despite of already having a rhinoplasty. Before i had my rhino, my nose was also pointing downwards and had a visible bump on the left side.
A lot of people (in the internet) have told me that i don’t need surgery. I disagree. No point in discussing this any further. I've pondered on whether to have jaw surgery, and what kind of surgery that would be, for years now. At first i thought the rhino i had 4 years ago would fix my issues, but in some ways it only made the real problem more apparent for me. I considered genioplasty for a long time after this, but recently came to the conclusion that double jaw is my only hope of achieving the kind of results i'm after: A better looking midface, a better looking smile, more prominent jaws and a chin, and a better overall symmetry. I've seen milder cases than me getting the surgery, with great results.
How i see my options:
My surgery would be as much about rotating the jaws, as about bringing them forwards. That's why i need to pick a surgeon who has a lot of experience with CCW rotation. I see a lot of people in places like this forum who have a very detailed approach to what they are after. They seem know the exact amount of millimeters they would like to move their jaws around etc. The way i see it, it's the surgeons job to know the details. That's why i'm paying them. My job is to pick the right surgeon.
I already had a consultation with Ramieri, aside from some minor problems he had with his english he seemed all right. He was my first pick because i've seen some pics of his work, and he seems to be experienced with this kind of surgeries. Alfaro, an another popular european surgeon, is not the man for my case i think. That’s based on his work ive seen, he seems to do a pretty lousy job whenever there is a clear need for CCW.
I don’t even know what other good alternatives for a DJS surgery there would be in europe (i live in the nordic countries). I’m avoiding going to the US, because i have no one to look after me, so i think it would be too much for me to make a 12 hour flight right after having surgery. I trust there are perfectly competent surgeons for this kind of procedures in europe as well.
Sorry for the possibly bad english and thanks for reading and commenting, much appreciated.
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I would like to add that if you really think that i don't need CCW rotation or even DJS based on my photos, please let me know. But i don't consider "no surgery" an option.
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From what you say, it looks like you are looking for an opinion that is the SAME as yours. Let the board know when you are open to all opinions.
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From what you say, it looks like you are looking for an opinion that is the SAME as yours. Let the board know when you are open to all opinions.
What a strange conclusion/comment to make.
All i said was i don't consider "no surgery" an option. So there is no point in trying to convince me otherwise. I've heard all that: "you have body dysmorphia", "you need psychological help" etc. stuff already, and it's bulls**t.
Those comments mostly come from people who are projecting their own insecurities to me. Just because their problems might be worse, that doesn't mean i don't have any. It's very annoying to look for advice and get that kind of answers.
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Do you have any scans?
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Do you have any scans?
No CT scans or the like yet.
One thing i forgot to add to my original post:
I have braces on the outside of both my upper and lower teeth, and have been going through orthodontic treatment on the public side for the past 3 years. I know that in most cases orthodontic treatment has to be reversed before having surgery. It's also my understanding that most surgery cases are either overbites or underbites. Mine was a crossbite.
I think that in my case the reversion of former work wouldn't necessarily be required, because both of my jaws are at the same level and my teeth mostly straight. (the upper front teeth had to be slightly dented outwards to make the jaws fit shut). This is just me though, and this needs to be confirmed by a professional.
The problem is not a functional one but purely aesthetic, the position of my jaws in relation to the rest of my face.
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Here’s some pics, all post-rhinoplasty.
https://imgur.com/a/DDo1NuS
How i see my problem:
As a result of having a crossbite for 25 years, everything down from my eyebrows is slightly recessed and the angles and the symmetry are a bit f*cked up. My face looks a bit long, the eye area/midface looks "molten" and the jaws/chin are too far back. As you can see from the photos, my nostrils are at a slightly different height and my nose slightly crooked despite of already having a rhinoplasty. Before i had my rhino, my nose was also pointing downwards and had a visible bump on the left side.
A lot of people (in the internet) have told me that i don’t need surgery. I disagree. No point in discussing this any further. I've pondered on whether to have jaw surgery, and what kind of surgery that would be, for years now. At first i thought the rhino i had 4 years ago would fix my issues, but in some ways it only made the real problem more apparent for me. I considered genioplasty for a long time after this, but recently came to the conclusion that double jaw is my only hope of achieving the kind of results i'm after: A better looking midface, a better looking smile, more prominent jaws and a chin, and a better overall symmetry. I've seen milder cases than me getting the surgery, with great results.
How i see my options:
My surgery would be as much about rotating the jaws, as about bringing them forwards. That's why i need to pick a surgeon who has a lot of experience with CCW rotation. I see a lot of people in places like this forum who have a very detailed approach to what they are after. They seem know the exact amount of millimeters they would like to move their jaws around etc. The way i see it, it's the surgeons job to know the details. That's why i'm paying them. My job is to pick the right surgeon.
I already had a consultation with Ramieri, aside from some minor problems he had with his english he seemed all right. He was my first pick because i've seen some pics of his work, and he seems to be experienced with this kind of surgeries. Alfaro, an another popular european surgeon, is not the man for my case i think. That’s based on his work ive seen, he seems to do a pretty lousy job whenever there is a clear need for CCW.
I don’t even know what other good alternatives for a DJS surgery there would be in europe (i live in the nordic countries). I’m avoiding going to the US, because i have no one to look after me, so i think it would be too much for me to make a 12 hour flight right after having surgery. I trust there are perfectly competent surgeons for this kind of procedures in europe as well.
Sorry for the possibly bad english and thanks for reading and commenting, much appreciated.
I can totally see what bothers you aesthetically regarding your jaws being back. But your nose is also back and your jaws are actually arround the perfect place comparing it to the lower part of your nose. So I believe if you try moving the jaws ahead to fix your current problem, you will probably mess up other things in your face (nose and lips)
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I can totally see what bothers you aesthetically regarding your jaws being back. But your nose is also back and your jaws are actually arround the perfect place comparing it to the lower part of your nose. So I believe if you try moving the jaws ahead to fix your current problem, you will probably mess up other things in your face (nose and lips)
Sorry i said that from only looking at your first picture. After looking at the rest i got conflicted. It all looks close to the right place to me. What does actually bother you? Is it the definition of your jaw? If the problem is the midface jaw surgery probably doesnt fix it, although other surgeries will
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With the same eyes, lips, hair, colors and aging (coming soon) you wont become handsome by having DJs. I dont say you look bad. But i'm saying with regard to your goal (only to look better) it would not be worth the investment.
This is just my personal opinion tough. Often i missjudge how people look.
However to be honest, if you actually do it (surgery) i would be very pleased to be proved wrong. :P
- Something i like is the slightly angled eyes you have. I LOVE it in women. Its funny, i see it very often in people from south america with indigenous heritage. But i also notice it often in people from far up the north in europe (Island, norway).
Anyone else?
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With the same eyes, lips, hair, colors and aging (coming soon) you wont become handsome by having DJs. I dont say you look bad. But i'm saying with regard to your goal (only to look better) it would not be worth the investment.
This is just my personal opinion tough. Often i missjudge how people look.
However to be honest, if you actually do it (surgery) i would be very pleased to be proved wrong. :P
- Something i like is the slightly angled eyes you have. I LOVE it in women. Its funny, i see it very often in people from south america with indigenous heritage. But i also notice it often in people from far up the north in europe (Island, norway).
Anyone else?
He just has so many other areas tô improve like hairline/ orbitals/ gonion and he instead focuses on the good part he has
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The angle relationships don't really justify double jaw surgery and especially NOT given your complaints of recession are ABOVE the yellow line.
For example, SNA and SNB are above the norm which is quite OK and double jaw advancement would put those angle relationships even MORE above the norm. Also, your OP is NOT 'steep'. So, that's not an indicator for CCW to reduce the OP angle. The MPA is within norm.
Maybe possible for CCW around ANS point of approx 4 degrees which would reduce OP to approx 5 deg and reduce MPA to approx 20 and that could maybe improve the lower face area as to bring things further forward. HOWEVER, the double jaw surgery, as far as advancement and rotation goes, takes place BELOW THE YELLOW LINE (Lefort 1 line). So, the advancement would be BELOW that line. Since your complaints of recession take place ABOVE the yellow line (Lefort 1 cut), what ever recession you have ABOVE the yellow line will look MORE recessive to you via relative comparison, the more you advance the jaws BELOW the yellow line.
In short, CCW, DJS don't appear to be the 'magic bullet' you're hoping for. Also, whatever goals you have for DJS to do for you, you really should articulate them and in reference to the changes you would like to see BELOW the yellow line. Because DJS is not going to improve anything above the Lefort 1 area where you have the recession.
You could have some chin advancement though via sliding genio.
ETA: Illustration included with this post.
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The angle relationships don't really justify double jaw surgery and especially NOT given your complaints of recession are ABOVE the yellow line.
For example, SNA and SNB are above the norm which is quite OK and double jaw advancement would put those angle relationships even MORE above the norm. Also, your OP is NOT 'steep'. So, that's not an indicator for CCW to reduce the OP angle. The MPA is within norm.
Maybe possible for CCW around ANS point of approx 4 degrees which would reduce OP to approx 5 deg and reduce MPA to approx 20 and that could maybe improve the lower face area as to bring things further forward. HOWEVER, the double jaw surgery, as far as advancement and rotation goes, takes place BELOW THE YELLOW LINE (Lefort 1 line). So, the advancement would be BELOW that line. Since your complaints of recession take place ABOVE the yellow line (Lefort 1 cut), what ever recession you have ABOVE the yellow line will look MORE recessive to you via relative comparison, the more you advance the jaws BELOW the yellow line.
In short, CCW, DJS don't appear to be the 'magic bullet' you're hoping for. Also, whatever goals you have for DJS to do for you, you really should articulate them and in reference to the changes you would like to see BELOW the yellow line. Because DJS is not going to improve anything above the Lefort 1 area where you have the recession.
You could have some chin advancement though via sliding genio.
ETA: Illustration included with this post.
Just be wary of Kavan advice because he used your head position in your ceph as your natural head posture, and from your other pictures your head is on a different position, as in, you are looking more up. In that way if your natural head position is the one on the pics and not on the xray when your head looks up your chin gets more projected and you may not need the genio, or less of it. From my perspective it would be a very small one and hardly worth the trouble
Still, great exposure of why you dont need anything bimax related
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Just be wary of Kavan advice because he used your head position in your ceph as your natural head posture, and from your other pictures your head is on a different position, as in, you are looking more up. In that way if your natural head position is the one on the pics and not on the xray when your head looks up your chin gets more projected and you may not need the genio, or less of it. From my perspective it would be a very small one and hardly worth the trouble
Still, great exposure of why you dont need anything bimax related
All angle measures are approximate to convey my basic observation.
All angles measured with reference to the VERTICAL which is a true vertical with reference to the ceph stat.
Angles; SNA, SNB and OP remain CONSTANT no matter what the head position.
Angle MPA is measured with reference to a horizontal (perpendicular to the vertical)
But thanks for confirming that it's a WASTE OF MY TIME to give any advice on here and people should be 'WARY' of it because now I know not to spend any of it looking and advising on your case.
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All angle measures are approximate to convey my basic observation.
All angles measured with reference to the VERTICAL which is a true vertical with reference to the ceph stat.
Angles; SNA, SNB and OP remain CONSTANT no matter what the head position.
Angle MPA is measured with reference to a horizontal (perpendicular to the vertical)
But thanks for confirming that it's a WASTE OF MY TIME to give any advice on here and people should be 'WARY' of it because now I know not to spend any of it looking and advising on your case.
Its ok if you dont, although I would greatly appreciate your take on it as you are extremely knowledgeble on the subject. I meant no offence by my comment and seeked only to contribute to the debate, which i believe you are open to
My only take on the subject was that he should view his need to a genioplasty by (arnette standards) by looking at the true vertical line, which is created by his natural head posture. After he gets that he would view if his chin is 2-3mm away from it and from this result see if he truly needs it. My intent was to discourage op from it since it does not look like he needs it (at least to me)/ doesnt even know what a true vertical line is, and would proably get better results from surgeries in other areas(if thats whats his set on getting).
Still i complimented your analysis and agree with you on your take/ do not seek disagreements on this forum
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Its ok if you dont, although I would greatly appreciate your take on it as you are extremely knowledgeble on the subject. I meant no offence by my comment and seeked only to contribute to the debate, which i believe you are open to
My only take on the subject was that he should view his need to a genioplasty by (arnette standards) by looking at the true vertical line, which is created by his natural head posture. After he gets that he would view if his chin is 2-3mm away from it and from this result see if he truly needs it. My intent was to discourage op from it since it does not look like he needs it (at least to me)/ doesnt even know what a true vertical line is, and would proably get better results from surgeries in other areas(if thats whats his set on getting).
Still i complimented your analysis and agree with you on your take/ do not seek disagreements on this forum
OK,OK. Gunson can rotate the head (in the photo) CW to find a desired horizontal. But how much he rotates it can differ from case to case. But here, I've gotta look at the head aligned with the vertical and horizont of the ceph which will give me the same angles I would get if the head were in a different position. The only angle that would change would be the MPA if the head in the picture frame was rotated.
Anyway, except for his chin which he could get vertically shortened and brought forward horizontally (upward sliding genio), double jaw surgery won't change the area where he has recession (upper midface).
I'll get to your case a little later.
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- Something i like is the slightly angled eyes you have. I LOVE it in women. Its funny, i see it very often in people from south america with indigenous heritage. But i also notice it often in people from far up the north in europe (Island, norway).
Anyone else?
My eyes used to be far more angled when i was younger, i think that because of the recession it became less apparent. I have aspergers and i have heard that it's more common for us to have angled eyes.
I was a good looking kid, a real shame no-one warned me about what would happen if i didn't fix my bite.
The angle relationships don't really justify double jaw surgery and especially NOT given your complaints of recession are ABOVE the yellow line.
Since your complaints of recession take place ABOVE the yellow line (Lefort 1 cut), what ever recession you have ABOVE the yellow line will look MORE recessive to you via relative comparison, the more you advance the jaws BELOW the yellow line.
In short, CCW, DJS don't appear to be the 'magic bullet' you're hoping for. Also, whatever goals you have for DJS to do for you, you really should articulate them and in reference to the changes you would like to see BELOW the yellow line. Because DJS is not going to improve anything above the Lefort 1 area where you have the recession.
You could have some chin advancement though via sliding genio.
I have to study some of the terms you use in your message to understand it better, but i appreciate your detailed analysis.
My jaws being too set back was one of the main complaints, and DJS would surely fix this. I'm not sure i understand what you meant with "the area above the yellow line looking more recessive." Based on the photos ive seen, DJS changes the look of the upper midface/eye area as well, because the skin around the area "loosens up" and gets slightly lifted as the jaws get moved forwards/upwards. In my case the change this would bring would probably be all positive.
I have pretty well defined cheekbones despite of the recession, so i think DJS wouldn't do too much damage to how my midface looks. Sure, i would probably lose the cheekbones, but gain so much more in overall symmetry.
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I can totally see what bothers you aesthetically regarding your jaws being back. But your nose is also back and your jaws are actually arround the perfect place comparing it to the lower part of your nose. So I believe if you try moving the jaws ahead to fix your current problem, you will probably mess up other things in your face (nose and lips)
This is a possibility. I had my rhinoplasty before considering any of these things. However, my nose is not upturned as it so i think it still has plenty of space to move. I wouldn't mind a slightly upturned nose. Also, my jaws would ideally be moved forwards just a bit, since it's just as much about rotating them.
He just has so many other areas tô improve like hairline/ orbitals/ gonion and he instead focuses on the good part he has
I actually like my hairline, it looks great with a flattop. I just have a seriously bad haircut in some of the pics. Imo, DJS could vastly improve my looks, especially the side profile.
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I have to study some of the terms you use in your message to understand it better, but i appreciate your detailed analysis.
My jaws being too set back was one of the main complaints, and DJS would surely fix this. I'm not sure i understand what you meant with "the area above the yellow line looking more recessive." Based on the photos ive seen, DJS changes the look of the upper midface/eye area as well, because the skin around the area "loosens up" and gets slightly lifted as the jaws get moved forwards/upwards. In my case the change this would bring would probably be all positive.
I have pretty well defined cheekbones despite of the recession, so i think DJS wouldn't do too much damage to how my midface looks. Sure, i would probably lose the cheekbones, but gain so much more in overall symmetry.
The yellow line was to (simply) illustrate the Lefort 1 cut area. The Lefort 1 is the cut used in bimax to displace the upper jaw. So, the illustration was meant to convey that there is a 'cut off line' regarding WHICH parts of the face are displaced/moved 'forward' and that the main RECESSION to your face won't be moving forward with the bimax. But rather, they would look MORE recessive to you via relative comparison when both of your jaws are moved forward via a bimax procedure.
I just give the information as to how things work. I will also mention that it's a very common complaint of people who start with recession to the upper midface area to notice MORE of it subsequent to bimax advancement. Your recession isn't to what is called the 'cheek bones'. It's to the (lower) orbital rim area below the eyes.
In closing, I've given my 'take' on the matter. Subsequent my giving my take, people can 'take it or leave it' and do what they want to do anyway. Like it's not my style to try to 'convince' anyone to NOT to this or that after I give an assessment as to why I would not encourage it.
ETA:
The basic angle measures; SNA and SNB, which are relative to the anterior cranial base, don't convey your jaws are set 'backwards'. They DON'T convey you are RETROGNATHIC (backward set jaws). That said, what sounds like you are wanting is a more PROGNATHIC appearance.
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This is a possibility. I had my rhinoplasty before considering any of these things. However, my nose is not upturned as it so i think it still has plenty of space to move. I wouldn't mind a slightly upturned nose. Also, my jaws would ideally be moved forwards just a bit, since it's just as much about rotating them.
I actually like my hairline, it looks great with a flattop. I just have a seriously bad haircut in some of the pics. Imo, DJS could vastly improve my looks, especially the side profile.
I mean, you like what makes you worse and dislike what makes you good. If you want to look worse thats what you Will probably get from bimax. You are probably mistaking the orbital implants/ fat grafting most aesthetic surgeons do with bimax with the result of bimax itself (for example. Most of raffainis great transformations). Bimax Wont give you better eye area.
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I mean, you like what makes you worse and dislike what makes you good. If you want to look worse thats what you Will probably get from bimax. You are probably mistaking the orbital implants/ fat grafting most aesthetic surgeons do with bimax with the result of bimax itself (for example. Most of raffainis great transformations). Bimax Wont give you better eye area.
Good point. I've done a morph of him giving him a more PROGNATHIC look which seems to be what he wants. His angle measures, by no means are consistent with retrognathic (backwards jaws) which he thinks he has. So his desire for DJS via CCW 'translates' into his wanting a more prognathic appearance. Now, I'm not claiming that the morph makes him look much better. I'm just saying it's a representation or 'translation' of MORE FORWARD jaws which would kick up INCREASED SNA and SNB angles that are very consistent with PROGNATHIC jaws.
Illustration included in this post.
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I mean, you like what makes you worse and dislike what makes you good. If you want to look worse thats what you Will probably get from bimax. You are probably mistaking the orbital implants/ fat grafting most aesthetic surgeons do with bimax with the result of bimax itself (for example. Most of raffainis great transformations). Bimax Wont give you better eye area.
Well i guess there is a possibility there's some subjectivity involved in the matter. Bimax could very well give me a better eye area, because my main concern here is the "stretched" look of the lower orbital rim area, that is the "long shadows" under my eyes. The setback look in the area after surgery is unfortunate, but you guys are concentrating on this way too much, it is a minor concern compared to all other aesthetic issues i have right now that the bimax might solve.
In any case, bimax wouldn't make this issue any worse.
Good point. I've done a morph of him giving him a more PROGNATHIC look which seems to be what he wants. His angle measures, by no means are consistent with retrognathic (backwards jaws) which he thinks he has. So his desire for DJS via CCW 'translates' into his wanting a more prognathic appearance. Now, I'm not claiming that the morph makes him look much better. I'm just saying it's a representation or 'translation' of MORE FORWARD jaws which would kick up INCREASED SNA and SNB angles that are very consistent with PROGNATHIC jaws.
Illustration included in this post.
That's actually not far from the change i'm going for.
There is clearly a cant on my occlusal plane, so prognathic or not, the look i'm going for is closer to the natural look i would have if i hadn't lived the first 25 years of my life with a malocclusion.
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Well i guess there is a possibility there's some subjectivity involved in the matter. Bimax could very well give me a better eye area, because my main concern here is the "stretched" look of the lower orbital rim area, that is the "long shadows" under my eyes. The setback look in the area after surgery is unfortunate, but you guys are concentrating on this way too much, it is a minor concern compared to all other aesthetic issues i have right now that the bimax might solve.
In any case, bimax wouldn't make this issue any worse.
That's actually not far from the change i'm going for.
There is clearly a cant on my occlusal plane, so prognathic or not, the look i'm going for is closer to the natural look i would have if i hadn't lived the first 25 years of my life with a malocclusion.
Well, the morph I provided is a pretty good communication tool to use as a spring board to discuss basic preferences with a surgeon. You will be hard pressed to find a doctor who would 'know how you would have looked if you didn't have a malocclusion for 25 years.' Good luck on finding one.
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Well, the morph I provided is a pretty good communication tool to use as a spring board to discuss basic preferences with a surgeon. You will be hard pressed to find a doctor who would 'know how you would have looked if you didn't have a malocclusion for 25 years.' Good luck on finding one.
My point was that you are putting way too much emphasis on those SNA/SNB lines, look at the big picture. Everything below my eyebrows is slightly canted and my posture is bad mainly because of my set back jaws. If you had seen my nose before rhino you would understand the amount of the recession better, the tip of my nose was pointing downwards because of lack of natural support. It's the symmetry that matters to me, not the prognathism/lack of it.
That's why there has to be CCW rotation, regular bimax would probably do just what kanko said, make the problem worse.
Anyway thanks for the pic
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My point was that you are putting way too much emphasis on those SNA/SNB lines, look at the big picture. Everything below my eyebrows is slightly canted and my posture is bad mainly because of my set back jaws. If you had seen my nose before rhino you would understand the amount of the recession better, the tip of my nose was pointing downwards because of lack of natural support. It's the symmetry that matters to me, not the prognathism/lack of it.
That's why there has to be CCW rotation, regular bimax would probably do just what kanko said, make the problem worse.
Anyway thanks for the pic
My morph incorporated CCW. You will need to study up on the terms and geometrical relationships associated with bimax surgery if you wish to communicate effectively as to what you are seeking. Surgeons consider the SAME angles I mentioned here. Maxfax is all about POINTS, ANGLES, ROTATION and PLANES.....alterations/changes thereof towards goal of balancing the jaw to jaw relationship and bite. So, I need to move on to other posters who are more receptive to the type of communication that is used to describe maxillofacial relationships.
Best of luck finding a surgeon you have a rapport with as to what you want.
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My point was that you are putting way too much emphasis on those SNA/SNB lines, look at the big picture. Everything below my eyebrows is slightly canted and my posture is bad mainly because of my set back jaws. If you had seen my nose before rhino you would understand the amount of the recession better, the tip of my nose was pointing downwards because of lack of natural support. It's the symmetry that matters to me, not the prognathism/lack of it.
That's why there has to be CCW rotation, regular bimax would probably do just what kanko said, make the problem worse.
Anyway thanks for the pic
We have looked at the bigger picture and said bimax wont fix it. You just cant take it. To improve your eyes you either get implants or fill them with fat.
Your posture is not bad because of your jaws, your airways are Huge.
I mean from what you are saying it looks like you read the mew camp for crazies brochure, took it as true and obsessed with it.
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We have looked at the bigger picture and said bimax wont fix it. You just cant take it. To improve your eyes you either get implants or fill them with fat.
Your posture is not bad because of your jaws, your airways are Huge.
I mean from what you are saying it looks like you read the mew camp for crazies brochure, took it as true and obsessed with it.
I can take it just fine, your arguments just arent all that convincing. There are other measurements to consider than just the SNA/SNB lines. A genioplasty wouldnt fix the overall lack of symmetry any more than the rhinoplasty i had did. I know about the eye fillers and i will consider them after i have my bimax.
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My morph incorporated CCW. You will need to study up on the terms and geometrical relationships associated with bimax surgery if you wish to communicate effectively as to what you are seeking. Surgeons consider the SAME angles I mentioned here. Maxfax is all about POINTS, ANGLES, ROTATION and PLANES.....alterations/changes thereof towards goal of balancing the jaw to jaw relationship and bite. So, I need to move on to other posters who are more receptive to the type of communication that is used to describe maxillofacial relationships.
Best of luck finding a surgeon you have a rapport with as to what you want.
I must say I hope it didn’t seem like i wasn’t being receptive. There's just a lot i don’t know how to put into words effectively.
I don't have any other exact measurements to give, but what the previously discussed SNA/SNB lines don't seem to entail, are the appearance of my nose and the overall appearance of my mid/lower face, as if some supportive structure was missing.
The lines might say "there is no recession", but to the eye something is off, the skin around the midface is too saggy and the edges of the nostrils are too downward pointing, this would indicate that the problem is the position of the jaws being too backwards. Even if the lines don't concurr.
I think that in your morph many of these questions are answered and the overall symmetry appears vastly improved to me. The result might be PROGNATHIC, but i believe this is closer to the position my jaws would have taken in relation to the rest of my face if not for my malocclusion, as was my point in some previous messages. This would pretty much confirm my beliefs that the DJS surgery together with CCW rotation is aesthetically the right choice for me.
I will either update this post or make a new one once i get plans from my surgeon
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Glad the morph was somewhat helpful.
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I must add that the prognathism in the morph gives a nice counter to the rather ”back heavy” elongated alien/neanderthal shape of my skull. It's a big reason why a relatively mild recession makes such a great difference in my side profile.
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Its been a while, but it finally looks like my orthodontic treatment is getting close to finishing. The plan is still the same: dj surgery with a slight ccw rotation. With any luck with the finances, i will be having the surgery this year.
Which takes us to the original point of this thread: which surgeon to pick? As i understand, Alfaro is a bit overrated, and in addition as expensive as they come. I would very much like to keep the costs below 20k euros, but don't really know if this is realistic.
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Having looked at thousands of cases and read textbooks on this subject, IMO (not a doctor of course), your jaws look to be close to an ideal position. It's possible you could advance the chin a bit more to get more prognathic. It's not recessed, but it's not pronounced. So that's the area I'd focus on if "no surgery wasn't an option." I think that would look much more good and natural than going with an anti-face look.
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Why do you think CCW is a good case for you? Usually this is done through impaction, but regardless of how it is achieved, it looks like your occlusal plane is actually fairly flat. What would you be trying to gain from CCW aesthetically, especially since your nose is normal (and possibly even on the shorter side depending on the lighting) from the frontal view? You say you want an improved smile — what does your smile look like now and what are your concerns with it? Can you show a picture of you smiling? That’s also going to determine whether you need downgrafting, impaction, expansion, etc.
Imo the only thing that’s disharmonious with your face is that your lips are thin, which also is ironically one of the only things about your face that you don’t have an issue with. Jaw surgery is not some easy miracle to fix incredibly minor issues, and can increase asymmetry either objectively (midlines off, increased cant), or by exaggerating existing asymmetries. What part of your face do you think is asymmetrical? If you’re talking about how one of your cheekbones is higher than the other, this is common even in celebrities, and can look even more noticeable if you get upper jaw advancement.
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Having looked at thousands of cases and read textbooks on this subject, IMO (not a doctor of course), your jaws look to be close to an ideal position. It's possible you could advance the chin a bit more to get more prognathic. It's not recessed, but it's not pronounced. So that's the area I'd focus on if "no surgery wasn't an option." I think that would look much more good and natural than going with an anti-face look.
It's definitely a bit recessed. You just have to look at the right side of my face (the left). I had a crossbite so the recession is very uneven. From the right side it may look like there is no issue. But on the left side you can clearly see the recession.
You should have seen my nose pre nosejob. It's still not symmetrical, but pre surgery it was a mess. There was a noticable bump on the LEFT side of the nose. My whole septum is located on the left side of my face due to the crossbit. My nostrils are still uneven when i smile, and the tip of my nose is curved to the left.
I was hoping that the jaw surgery could fix this problem too. Maybe a ever so slight rotation of the jaws to the right on top of the slight ccw movement? Maybe not realistic but one can dream.
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Why do you think CCW is a good case for you? Usually this is done through impaction, but regardless of how it is achieved, it looks like your occlusal plane is actually fairly flat. What would you be trying to gain from CCW aesthetically, especially since your nose is normal (and possibly even on the shorter side depending on the lighting) from the frontal view? You say you want an improved smile — what does your smile look like now and what are your concerns with it? Can you show a picture of you smiling? That’s also going to determine whether you need downgrafting, impaction, expansion, etc.
Imo the only thing that’s disharmonious with your face is that your lips are thin, which also is ironically one of the only things about your face that you don’t have an issue with. Jaw surgery is not some easy miracle to fix incredibly minor issues, and can increase asymmetry either objectively (midlines off, increased cant), or by exaggerating existing asymmetries. What part of your face do you think is asymmetrical? If you’re talking about how one of your cheekbones is higher than the other, this is common even in celebrities, and can look even more noticeable if you get upper jaw advancement.
My whole face, as it is, is slightly canted and my posture is bad mainly because of the crossbite i had. It doesn't appear to be that asymmetrical, because i had a crossbite, so the right side developed to look "okay", exluding the slightly downwards turned chin. The left side is more clearly recessed, the jawline also looks weaker from that side. As for my smile, my nostrils get completely crooked when i smile, as i understand due to the lack of bone support from the left side of my face. If you had seen my nose pre-rhino you would understand the amount of the recession better, the tip of my nose was pointing downwards because of lack of natural support.
My frontal teeth are quite bent outwards, that was the only way we could get my jaws to fit shut. My bite is still slightly crooked despite of years of orthodontics. I was hoping that maybe my lower jaw could be set slightly behind the upper jaw in the surgery, so that the jaws would fit into their natural position. Setting the front teeth back a bit is a quite fast operation really, a couple more months of orthodontics max.
I must say, im not 100% sure that surgery is going to fix the issues i have with my looks, but as i wrote before: The lines might say "there is no recession", but to the eye something is off, the skin around the midface is too saggy and the edges of the nostrils are too downward pointing, this would indicate that the problem is the position of the jaws being too backwards. Even if the lines don't concur.
I guess i'm desperate enough to give it a shot. I do not think that a genioplasty would suffice in my case, i seriously considered it for years, but it wouldn't fix the main problem which is the canted and set back midface. It makes me look tired and old.
Also, i hate that f**king "beard". I only ever wore it because my face looks even more recessed without it.
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I have a question for you guys, everyone keeps saying my jaws are "close to the ideal position". So what? My whole face is quite clearly canted, so what difference does it make if the jaws are horizontally in position? Is it somehow required that there has to be this huge horizontal advancement of the jaws in connection to the surgery? The main thing for me would of course be the CCW rotation.
Besides, my jaws are not in an ideal position, they could definitely be slightly horizontally advanced without necessarily getting an overtly prognathic look.
I mean, i've seen much better looking people than me getting the surgery. Look at this guy https://www.youtube.com/watch?v=l_tnYd3VrbM
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I have a question for you guys, everyone keeps saying my jaws are "close to the ideal position". So what? My whole face is quite clearly canted, so what difference does it make if the jaws are horizontally in position? Is it somehow required that there has to be this huge horizontal advancement of the jaws in connection to the surgery? The main thing for me would of course be the CCW rotation.
Besides, my jaws are not in an ideal position, they could definitely be slightly horizontally advanced without necessarily getting an overtly prognathic look.
I mean, i've seen much better looking people than me getting the surgery. Look at this guy https://www.youtube.com/watch?v=l_tnYd3VrbM
Let me repeat what you said and summarize. Correct me if i am wrong.
1. Everyone in this thread thinks your jaws are in an ideal position (speaking about horizontal lines when looking from the side)
2. You say your jaws are canted. I suppose we speak about frontal vertical asymmetry in this case (vertical line from the front in the middle of the face)
3. You want more horizontal projection.
4. More horizontal projection won't fix the vertical asymmetry.
Ask yourself: IF this assumptions are correct, would DJS for advancement be the optimal solution?
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Let me repeat what you said and summarize. Correct me if i am wrong.
1. Everyone in this thread thinks your jaws are in an ideal position (speaking about horizontal lines when looking from the side)
2. You say your jaws are canted. I suppose we speak about frontal vertical asymmetry in this case (vertical line from the front in the middle of the face)
3. You want more horizontal projection.
4. More horizontal projection won't fix the vertical asymmetry.
Ask yourself: IF this assumptions are correct, would DJS for advancement be the optimal solution?
Excellent logic. I shall add that if the jaws are horizontal position there would be no (vertical) cant to be corrected.
Also, whether or not there is a cant is best established by getting a 'read out' from a surgery proposal which, for example, would give some info if one side of maxilla was planned to be elongated or shortened. At MINIMUM a consult with a maxfax to confirm or deny a cant. That would be preferable to insisting on its existence to people who don't see it.
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Let me repeat what you said and summarize. Correct me if i am wrong.
1. Everyone in this thread thinks your jaws are in an ideal position (speaking about horizontal lines when looking from the side)
2. You say your jaws are canted. I suppose we speak about frontal vertical asymmetry in this case (vertical line from the front in the middle of the face)
3. You want more horizontal projection.
4. More horizontal projection won't fix the vertical asymmetry.
Ask yourself: IF this assumptions are correct, would DJS for advancement be the optimal solution?
1. Most commenters seem to think so yes
2. I say my whole midface is canted. Everything below the eyebrows (Lefort 3)is recessed. If it was just the lower jaw, for example, it would be much easier to see. But since it's the whole midface, there is this certain "illusion" of symmetry looking from certain angles.
3. Slight horizontal projection wouldnt hurt. But the main thing im looking for is the ccw rotation, to fix the cant and the quite obvious asymmetry (the "long face") that comes with it.
4. More horizontal projection alone wouldnt fix anything. Horizontal projection that comes naturally with the rotating movement of the whole lower face, that is the key here. I haven't seen "thousands of cases" but I've seen enough and more importantly, looked into the mirror enough to understand where the problem is and how it can be fixed, IF it can be fixed.
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Excellent logic. I shall add that if the jaws are horizontal position there would be no (vertical) cant to be corrected.
Also, whether or not there is a cant is best established by getting a 'read out' from a surgery proposal which, for example, would give some info if one side of maxilla was planned to be elongated or shortened. At MINIMUM a consult with a maxfax to confirm or deny a cant. That would be preferable to insisting on its existence to people who don't see it.
I honestly don't understand why i would need to "insist" anything. Why would anyone have the need to presume that i come to this forum to lie about my condition? As i wrote before, i had a crossbite from 2 to 25 year old, and had a nosejob some years back. Those are the is reasons my face now looks as it does. 1+1=2
The bone structure i have is not genetic, aside from the bite problem itself of course. There are signs of mild recession caused by it all over the place (the downwards pointing chin, the overall vertically round shape of the face, the recessed cheekbones, the protruding eyes) if someone honestly can't see it after looking at all the photos i posted then i have to question their ability to see much anything. I have already visited a professional in my country, who confirmed the recession. But it's really not something i ever needed to get confirmed by a "professional", any person who has any eyes in the first place can see that something is not quite right with the symmetry... That right there is the whole problem.
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I honestly don't understand why i would need to "insist" anything. Why would anyone have the need to presume that i come to this forum to lie about my condition? As i wrote before, i had a crossbite from 2 to 25 year old, and had a nosejob some years back. Those are the is reasons my face now looks as it does. 1+1=2
The bone structure i have is not genetic, aside from the bite problem itself of course. There are signs of mild recession caused by it all over the place (the downwards pointing chin, the overall vertically round shape of the face, the recessed cheekbones, the protruding eyes) if someone honestly can't see it after looking at all the photos i posted then i have to question their ability to see much anything. I have already visited a professional in my country, who confirmed the recession. But it's really not something i ever needed to get confirmed by a "professional", any person who has any eyes in the first place can see that something is not quite right with the symmetry... That right there is the whole problem.
I don't think anyone said that you are lying.
"That would be preferable to insisting on its existence to people who don't see it."
This just means that some people don't SEE the problem the same way you do.
It's obvious that it is a severe problem for you personally, don't worry.
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I honestly don't understand why i would need to "insist" anything.
That is beyond my venue to explain that need. I would suggest (psyche) SELF introspection on your part because it's something in the venue of self introspection.What you clearly don't have the need for is what you (ostensibly) came here for; some facial maxfax feedback from others. When the feedback you got didn't correlate with your OWN assessments, that is when you went about INSISTING you had things others did not observe.
Why would anyone have the need to presume that i come to this forum to lie about my condition?
No one here suggested you came here to 'lie about your condition' and not my task to deal with a paranoia playout when rendering feedback.
As i wrote before, i had a crossbite from 2 to 25 year old, and had a nosejob some years back. Those are the is reasons my face now looks as it does. 1+1=2
No one here is denying you wrote that. So YES. You wrote that.
The bone structure i have is not genetic, aside from the bite problem itself of course. There are signs of mild recession caused by it all over the place (the downwards pointing chin, the overall vertically round shape of the face, the recessed cheekbones, the protruding eyes) if someone honestly can't see it after looking at all the photos i posted then i have to question their ability to see much anything.
Again, NO ONE here is denying that YOU see what YOU see. They are just conveying what they see. But when they don't see what you see or point out maxfax relationship that you have which can be considered good ones or ANYTHING ELSE that does not reflect your own opinion, THAT is EXACTLY when you start INSISTING they see what you see and if they don't, you 'question their ability to see much of anything.
In closing I shall say that what I observed in the first place is that you want your OWN OPINION reflected back to you by others and indeed you come off as INSISTING they see what you see. So, let's resolve to I'm 'BLIND', can't see what you see and lack the capacity to render anymore 'questionable' advice/feedback. GOOD and thank you for giving me an EXIT from providing any more. I'm OUT OF HERE with you.
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Again, NO ONE here is denying that YOU see what YOU see. They are just conveying what they see. But when they don't see what you see or point out maxfax relationship that you have which can be considered good ones or ANYTHING ELSE that does not reflect your own opinion, THAT is EXACTLY when you start INSISTING they see what you see and if they don't, you 'question their ability to see much of anything.
In closing I shall say that what I observed in the first place is that you want your OWN OPINION reflected back to you by others and indeed you come off as INSISTING they see what you see. So, let's resolve to I'm 'BLIND', can't see what you see and lack the capacity to render anymore 'questionable' advice/feedback. GOOD and thank you for giving me an EXIT from providing any more. I'm OUT OF HERE with you.
If the maxfax relationships that i had were good ones i certainly wouldn't be on this forum. There was a time period when those relationships were (somewhat) good ones, back when i was a teenager, the difference is quite striking and that is why i will never be satisfied with my face as it is. I can post some pics from those days if i can find them so that you can see what i mean.
Nobody certainly HAS to comment anything. It is quite frustrating telling my side of the story again and again and then just get the same old "but the horizontal lines".
Once more:
I say my whole mid/lower face is canted. Everything below the eyebrows (Lefort 3)is recessed. If it was just the lower jaw, for example, it would be much easier to see. But since it's the whole midface, there is this certain "illusion" of symmetry looking from certain angles. And it makes sense, i had a crossbite after all.
The main thing im looking for (in the DJS surgery) is the ccw rotation, to fix the cant and the quite obvious asymmetry (the "long face") that comes with it. More horizontal projection alone wouldnt fix anything. Horizontal projection that comes naturally with the rotating movement of the whole lower face, i believe that COULD drastically improve my looks.
Your, whoever's, opinion on THIS assessment? A sound plan, a complete crock of s**t, something from the between? I'm all ears. Just don't tell me again that you don't see anything wrong with my face, if you don't then get glasses and take an another look at the pics that i posted. Just pretend for a sec that i have at least some clue on what i'm talking about and i'm not just planning to throw away 20k and my health for nothing. And if you still have no idea what i mean then perhaps it is indeed better that you don't say anything.
Excellent logic. I shall add that if the jaws are horizontal position there would be no (vertical) cant to be corrected.
If the natural position of the jaws would have been more horizontally protracted if not for the recession, as it seems it would have been the case here, then naturally there can also be a vertical cant included. There is no "one horizontal position" that is optimal for all people. Again, don't get fixated on the lines, look at the big picture.
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https://imgur.com/a/DDo1NuS?
I added some pics from back when I was 19 years old at the end. Pre nosejob. See the difference?
There’s already a bit of recession, but just a bit. See how different my lips look? See how symmetric the midface is? No long face at this point yet.
I don’t mean I’m trying to get this back, because it’s impossible, i can't get my whole face down from the Lefort 3 line moved around after all. But the DJS with the CCW rotation could nevertheless get me closer to looking like this again. Opinions?
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I see that you have a 'negative vector' relationship meaning recession to the upper midface below the eyes. But that has little to do with cants or cross bites. It has more to do from lack of orbital rim projection/support. Negative vector is evidenced by dropping a straight line vertical from the surface of the eyeball. When the upper midface, orbital rim region is behind the line, which yours is, that is a negative vector relationship.
So, I see where your recession is. But I can tell you that CCW DJS does not address that area. It won't advance where your recession is located. CCW DJS will advance the area BELOW where your recession actually is and would stand to make where your recession actually is look more recessed when the jaws are advanced but the recessed area is left behind.
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I see that you have a 'negative vector' relationship meaning recession to the upper midface below the eyes. But that has little to do with cants or cross bites. It has more to do from lack of orbital rim projection/support. Negative vector is evidenced by dropping a straight line vertical from the surface of the eyeball. When the upper midface, orbital rim region is behind the line, which yours is, that is a negative vector relationship.
The situation has everything "to do with cross bites", since i had a cross bite for 25 years and that's where the whole problem is derived from..
So, I see where your recession is. But I can tell you that CCW DJS does not address that area. It won't advance where your recession is located.
I think that's a pretty weird comment to make, since my jaws are very much a part of the recessed area. It's not like my "upper midface" alone is somehow recessed, but my jaws are right where they were supposed to be all along. CCW DJS would absolutely address a part of the recessed area. I think that at this point you are just incapable of admitting that you were wrong.
CCW DJS will advance the area BELOW where your recession actually is and would stand to make where your recession actually is look more recessed when the jaws are advanced but the recessed area is left behind.
Sure, but advancing the jaws in itself was never the point, rotating the jaws was, as i think i already stated once or twice. A part of the recessed area will get left behind, and that's a shame. But CCW DJS absolutely wouldn't make me look "more recessed", i don't know what you are talking about. Notice how you are not presenting any solutions, just making problems where there aren't any. Once again, i do NOT intend to advance my jaws with the surgery, i intend to rotate them.
CCW DJS is the way to go for me, if such a thing exists. I will consider a genioplasty after this, but i doubt it will be needed. Even if i just wanted to have cheek implants, in order to counter the "upper face recession", i would have to have the CCW rotation first, in order to not make the side profile appear round(er).
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The situation has everything "to do with cross bites", since i had a cross bite for 25 years and that's where the whole problem is derived from..
I think that's a pretty weird comment to make, since my jaws are very much a part of the recessed area. It's not like my "upper midface" alone is somehow recessed, but my jaws are right where they were supposed to be all along. CCW DJS would absolutely address a part of the recessed area. I think that at this point you are just incapable of admitting that you were wrong.
Sure, but advancing the jaws in itself was never the point, rotating the jaws was, as i think i already stated once or twice. A part of the recessed area will get left behind, and that's a shame. But CCW DJS absolutely wouldn't make me look "more recessed", i don't know what you are talking about.
CCW DJS is the way to go for me, if such a thing exists. I will consider a genioplasty after this, but i doubt it will be needed.
It looks like communication is not working out here and my time and focus was not well spent in the process. So, I shall not be spending any more of it with you. But wish you the best of luck pursuing what ever path you take with your own self assessment.
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It looks like communication is not working out here and my time and focus was not well spent in the process. So, I shall not be spending any more of it with you. But wish you the best of luck pursuing what ever path you take with your own self assessment.
Thanks, it indeed looks like that. I somehow seem to have "upper midface recession", and at the same time, no recession in the jaw area. Beats me. Did i say something about looking at the big picture and not getting fixated on the lines earlier on?
I guess only time will tell if my assessments were correct. In any case, i will try and post the results here. I have my CT scan admission + instructions from surgeon ready, just waiting for the final no from the public side in order to proceed with the privately paid surgery.
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For anyone still wondering why im looking to have surgery, check out the pics I posted.
As you can see, I used to be actually good looking. Now I'm ugly. I look like a f*cking chihuahua with my eyes bulging out of my skull. Disgusting. Thats what a little cant getting relatively bigger and bigger over time as a result of an unfixed bite problem will do to you.
Djs, possibly genio, implants to the under eye-area. Maybe after some/all of these treatments I can finally look into the mirror and like what im seeing again. I find it worth trying, in any case.