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I've looked into your posting history and my responses to it. In general, your presentation initially threw me for a loop but I did crack your case and resolved it to the most applicable procedure for your case which stands to be the SOLUTION to your problem.

Makes perfect sense to me that SUPERFICIAL liposuction you pursued did very little to address your problem.

The things you mention here are UNLIKELY to solve your issue

I'm including here what I told you 4 years ago.

....your case would most likely resolves to a NECK EXPERT, a plastic surgeon conversant in correcting all the DEEP structures of the anterior triangle of the neck which include MORE structures than just the superficial fat pad and superficial platysma muscle. You could have fat very DEEP to the superficial fat pad in addition to multiple other anatomical structures DEEP to the neck that need to be altered or reconstructed to correct the salient AESTHETIC problem; OBTUSE cervicomental angle, and/or 'difficult neck' which is something in the venue of plastic surgeons very conversant in altering those structures. So there is probably MUCH more going on under chin/neck than would be corrected via a superficial fat pad being lipoed out and a chin implant being put in.

If you pursued what I mentioned above, you could get a genio (or chin implant) with that.

However, a genio alone, jaw implants or chin wing don't address the soft tissue structures very DEEP to the neck under the chin (and perhaps the hyphoid bone) that are presently obliterating seeing the lower jaw bone structure you already have. REMOVAL and RESTRUCTURING is needed to wrap tightly along the jaw line and under the chin. BULKING up (augmenting) the bone structure would just yield a BULKIER lower face. Don't expect to see a sharp (well defined) jaw line from those things because they DON'T target your problem.

I don't think it's a good idea to be asking for directives from others if you already have a surgery booked. Better idea to have some GENERAL grasp of how things work before attempting to talk specifics via medical terms with your doctor. Here goes:

A '1 to 1' ratio is a distance relationship that someone already has or doesn't have to start with. It refers to a horizontal distance between 2 landmarks on the eye vs. vertical distance from mid-pupil line to the opening between the lips. Surgery isn't going to change that type of distance relationship. (It's one that is looked at in the FRONTAL perspective.)

From your profile perspective, it doesn't look like you have a 'long' face. If it looks 'long' to you in the frontal perspective, that would be due to the slack under your chin (due to recession) giving appearance of extra length in the frontal perspective. Slack there would tend to be mitigated with lower jaw and chin advancement. 'What type of genio' would depend on the extent of CCW (if that is done) and also extent of advancement. There is option for an UPWARD SLIDE if appearance of a shorter lower 1/3d of face is needed and option for a downward slide if more length to lower 1/3rd of face is needed. Also, sometimes the lower jaw advancement along with the CCW-r can set the chin point at optimal height with no genio.

You have bi-max protrusion. But targeted correction for that is more common in Asian countries than elsewhere. It involves removing not only pre-molars but also the tooth bearing bone above the tooth which allows the protruded part to be pushed backwards. Once the protrusive part is moved backwards by removing a track of tooth bearing bone that houses a pre-molar, THEN they can move the jaws forward without exaggerating more protrusion. That type of protrusion can make the chin look more recessive via RELATIVE comparison in which case you would need a significant advancement of the lower jaw/chin to MASK it. eg. a CCW rotation.

Are you talking about a 3 piece? It's riskier for sure, and the biggest risk being necrosis of the maxilla via loss of blood flow. Surgical skill is a factor, of course...you want someone well trained who's done it a lot. I think Gunson has.

Hi everyone! Hope you’re doing well!

I'm a 27F, and I have my bi-maxillary surgery + genioplasty scheduled for next week. This week, I have an appointment with my surgeon to review the movements he will perform during the procedure.

I’d like to be prepared for this meeting and would love to hear your recommendations based on what you can see in the photos. As you can see, I have a Class 2 bite + Long Face Syndrome + Gummy smile. My premolars were extracted when I was 12 years old during my first orthodontic treatment, and my wisdom teeth were removed a few years later to prevent them from pushing my other teeth. Clearly, that wasn’t the right approach for my situation, so a few years later, I was able to start over with a new treatment to prepare for orthognathic surgery.

I'm now very close to surgery, and I have high expectations along with some anxiety, as I'm worried that my surgeon might take a conservative approach to my case. I want to be as clear as possible with him in medical terms to communicate my expectations for the surgery. That's why I'm reaching out to hear all your recommendations regarding my case.

My expectations/questions for this surgery are:

1) Achieve a 1:1:1 ratio in my face, while maintaining good jaw projection (can this be achieved only with CCW rotation?).

2) Correcting my slightly canted smile.

3) My upper teeth are also very protruded, is there a specific technique that can achieve a better jaw projection without making my upper teeth look more protruded?

4) Which would be the best movement for my genioplasty?

I am also very interested to know whether my situation requires any unconventional methods to achieve the best results to discuss this with my surgeon. For example, I've seen a case where a patient with a long face and a gummy smile underwent a quadrangular osteotomy, which significantly changed her appearance (Reference link to that case: https://www.reddit.com/r/jawsurgery/comments/18xg6uc/le_fort_3_midface_shortening_surgery/)

I also have my CT scans to share. Thanks a lot in advance!

Thanks for this detail, Kavan. The approach you mention surgeons using to try and strike a balance between nose and chin makes total sense. Also noted on finding a surgeon that is skilled in both that could achieve harmony between both the nose and chin, that is most certainly the best strategy.

My goal for the almond eye surgery is to restore a youthful appearance to my face. My eyes have always been a weak point and have always 'aged' me. Canthoplasty seems to give a more 'awake' and youthful look to ones eyes (at least in my opinion). Would getting this upward tilt not achieve that outcome?

My undereye area is also very hollow, very noticeably so and is becoming too much of an annoyance with how much I notice it. A few years ago, it was suggested to me by Taban to get oribital rim implants to correct this hollowing. Though, I have seen some successful results from PRF fillers, I just don't know how that filler would impact the desire of receiving a canthoplasty. Perhaps it's best to ask him directly.


As always, your input is much appreciated Kavan

The cantho procedure gives an uptilt to the lateral canthal area so, ya, it could look more youthful if you have a drooped down lateral canthal area at present. I'm not that familiar with how Taban puts them in to fill hollows. I'm more familiar with how Yarmemchuk (now retired) would use the orbital rim implants. He would need to do a subperiosteal midface lift as part of the process aimed at mitigating the hollow groove below the eyeball. If you don't have the 'prominent' or bulging eye, then fillers can be used to fill in the groove OR if the groove is mostly SHADOW because there is a fat pad sticking out from the orbit, above it, then there is a type of surgery that slips the orbital fat into the groove. So, you could enquirer with him about that.