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91
Aesthetics / Re: Rami asymmetry
« Last post by kavan on December 28, 2024, 12:49:20 PM »
Quote from: Sequelae on December 26, 2024, 02:08:51 PM
I am pursuing jaw surgery to correct asymmetry and mandibular recession. However, I have concerns that a typical BSSO will not be able to fix my asymmetry, as a lot of it is in the rami. My right ramus is longer; additionally, the widest part of the ramus, where it flares out, goes much further forward on this side. I appreciate that it may be difficult to understand, but I can't think of a better way to describe it. If you look at the images, you can see two distinct flair-outs on the longer side, which is what I am referring to. I don't think BSSO would be able to improve any of this.


I have been looking at alternative osteotomies, such as the High oblique sagittal split osteotomy, but it's hard to find much information on surgeons who perform this, particularly those who would take international patients. I would really appreciate any advice on this.


https://imgur.com/a/Qz3tiUt


I think your description of what you see on the FRONT scan is a good one but with reference to looking at a 3-object on a 2-D plane. A front photo of the face and/or a front scan of the scull is how something in 3-D PROJECTS ONTO the 2-plane.

For example, if your mandible was rotated to the left, the left (mandibular) angle of the jaw would receed more in the background so you didn't see a double flair and would project HIGHER on a 2D plane. The right (mandibular) angle would come more forward in the foreground bringing the double flair into view and project LOWER on the 2D plane which is pretty much what you are describing as to what you 'see'.

Thing is, with reference to a VERTICAL axis drawn through the scan that passes through the middle of the periform aperture and between the middle of the upper central incisors, the mid-line axis doesn't pass through the middle of the front lower lateral incisors. So, what you see on the FLAT plane of the 2-D projection of the scull scan looks like it could be a rotation of the mandible around a vertical axis.

This could be something where both jaw angles are similar in length and flair (or not too much dissimilar) but they project on the 2-D plane that way due to a ROTATION around a VERTICAL midline axis.

I think this could be in the venue of what they call a 'YAW'; when one side rotates backwards (receeds into the background) and the other rotates forward into the foreground. So, you would want to consult about possibly having a yaw and if and how that could be corrected.

I have no comment on mandible recession (and BSSO need) because I think that is best seen via a soft tissue profile photo.

Also, as to the asymmetry, you haven't told us WHICH side you like better. IF you liked the nice 'squaring' to the right side jaw angle area, something like soft tissue filler to the left could be used to square out the left one.

Included is an illustration.



92
Aesthetics / Re: Rami asymmetry
« Last post by Sequelae on December 28, 2024, 12:37:22 PM »
I really appreciate the reply. Would you be able to give me some of the names of these surgeons?
93
Aesthetics / Re: Rami asymmetry
« Last post by Tomasjohn on December 28, 2024, 07:03:29 AM »
A chin wing can be used to address asymmetry by cutting manipulating the lower mandibular border. I've seen cases on the web where for example only one side of the mandibular border was lowered or flared especially to address asymmetry. Many examples online. However if combined with BSSO, a higher cut for the BSSO is necessary in order to combine both treatments at the same time.

As far as i know, the pool of surgeons that perform a BSSO and a full, long chin wing simultaneously is relatively small.

I know for sure, that a certain Dr. in Berlin does it, as other members in this forum had exactly this procedure.

Also, I personally don't think the asymmetry at the gonial angle is that bad in flesh.
I think it's more the different shapes (left/right) of the bone from mid mandible to the chin.
But I think most of the asymmetry is actually visible in the lip?

94
Surgeon Reviews and Leads / Re: Dr Safi - Terrible Experience
« Last post by kavan on December 27, 2024, 03:17:02 PM »
Quote from: SV123 on December 27, 2024, 04:26:57 AM
Hi Kavan,

I believe you are right. After further conversation with Dr Safi, I am beginning to question the integrity of his character.




I do regret not spotting his red flags earlier on. For the people reading this, who are also looking for a surgeon, these were the red flags I noticed (in hindsight) which you should also look for:

- He analysed my face like a lookism user during the first online consult, giving me a verbal list of all my 'facial flaws'. He found a minor flaw in practically everything and tried to sell a solution. This is a MAJOR RED FLAG. No ethical surgeon would try to offer solutions to made up problems. To those reading this that are seeking surgery, do not let take the facial flaws pointed out by a surgeon seriously. Understand THEY WANT YOU TO BE INSECURE, so they can make money. Only go to surgeons that address the facial flaws YOU mention to them, not the other way around.

- I was lured in with the offer of bimax + 2 facial implants through the offer of financial planning and a discounted price of 42k CHF. 2 months later, Safi refused the financial planning and also increased price to 49k CHF due to 'higher demand'. This is a red flag, showing that the surgeon is not a man of his word.

- During a phone call, Safi stated that he was wary of international patients as he had experience with a supposed 'mentally ill' international patient. He spoke ill of the patient. This is a red flag. Why would a respectable surgeon slander his past patients during consults?  I actually read this patient's online reviews. Apparently Safi cut a nerve responsible for taste during an operation. One of his implants also broke. There was such a massive list of problems this online user that I basically labelled him as a mentally ill wacko who was trying to harm Safi's business.

- A super non professional consult. Safi spoke very informally during our consult, and I mean VERY informally like a teenager as he was mocking his online critics. Felt so surreal I couldn't believe this guy was going to cut open my face. This is a red flag as I expect surgeons to speak professionally.






Coming back to you Kavan, I believe the conduit you are referring to is anticel on the looksmax forum. I definitely went to Safi after reading his post. In hindsight, his long piece does feel like an advertisement for Safi. I am not sure if he was paid by Safi or not, but he did state he received a discount for his surgery in one of his posts.

Now referencing to your comments about me, I honestly feel I was traumatised by my experience with Safi (not exaggerating). I have always been sensitive to other people's opinions of me since childhood. Even when my primary school teachers would scold me of a small thing, I would remember it for months!

After denying surgery, Safi gaslit me hard, tearing down my character and calling me an 'incel', literally making a grown man cry. On top of that, I had to last 3 whole days, not knowing whether I would get a single dollar refunded, as Safi didn't give any hint of a refund before he talked to his accountants. He didn't even have the decency to assure me I would get some of my money back. I was honestly having vague suicidal thoughts during these days, which I never had before in my life. I am a from a middle class family, and it took me 1.5 years to save that money, so the thought of losing it all was too much to bear. I am also naturally frugal so that's a cherry on top!

Due to this traumatic experience, I think I developed something similar to Stockholm syndrome. Or maybe I just fell for Safi's gaslighting, believing I was the bad person for lying about having a looksmax account after seeing Safi's negative opinion of users from there.

Honestly, I can now fully see I was tricked and gaslit by the surgeon. I now have forgiven myself for the past. I am only 21 years old and have so much to look forward to in life. I can recover from the financial losses. I have also learnt a valuable lesson - to not be easily swayed by online opinions. I was so thoroughly trapped in insecurity, perpetuated by looksmax.org, that I ignored the countless red flags shown by Safi before I even booked my flight to Switzerland. I now have deleted all social media (except YouTube) since comparison is the thief of joy.

Going back to my original post, depending on my financial situation, I may choose to take legal action against Dr Safi in the future. I am still financially, and emotionally, recovering from this loss in life.




Finally, I also want to wholeheartedly thank you for your guidance Kavan with your long posts this year regarding surgery. This forum definitely deserves more attention and has much more information compared to other places like reddit.

My comments, in no particular order:

From your experience, I did notice that this Safi guy had ear marks of a con man and he CHANNELED into the Lookism board/s to attract patients from there. The tell tale sign of that was what I referred to as a 'peep' on there (anticell), I think was screen name. (nothing against that poster. just sayin' if you found Safi from him, it's wrong for Safi to be OK with him being FOUND but you being NOT found on there.) IF it was really 'true' that he did NOT want patients coming to him from that or those kinds of boards, THEN, it would follow that he would have told the conduit NOT to post his photos there if it were really true that he didn't want to be found on that board (which it does not seem to be).

Another ear mark was that as far as 'guilt' goes, it was Safi who was 'guilty' of tapping into that type of board where insecurities REVOLVE around not looking like a male model. That would explain the LITANY of facial flaws he brought to your attention as to MAXIMIZE the 'employment opportunities' he could 'fix' on your face. The GAS LIGHTING comes in when he goes about making YOU feel guilty for coming to him from the VERY board he channels patients from. In your consult with him, what you noticed but maybe could not put your finger on was that he was PREEMPTIVELY DEFENSIVE and overly so to DISCLAIM that board was a CONDUIT of how patients found him. Like some doctors ask: 'Where did you hear about me?' But he KNEW where you would have found out about him and didn't need to ask. What he 'needed' to do to put on a show to DISCLAIM, (pretend) he didn't want patients from that board.

He knew what people from that type of board wanted which was 'big giant implants' and to that regard, he had his own implant design outfit (where his brother in law did the designing). Low and behold, the guy on that board 'giant implants' (the guy behind that), who was griping about his designs being copied or otherwise pilfered, Safi knew enough about (perhaps to talk him down) mentioned to you. So, that's another indicator of another, perhaps in competition with Safi's share of patients coming from that board.

Basically, that doctor WANTS to appeal to patients from there. But INTERNALLY, probably is ashamed of himself. So EXTERNALLY, he PROJECTS his own shame on YOU. He's a master of psychological manipulation. Now, as to telling you what is 'wrong' with your face, the way to convey that type of thing is to tell the patient they could further enhance with -what ever-- during the surgery or later down the line IF they wanted. But in a way NOT to make them feel self conscious or 'bad' for not getting extras.

If he's mocking or defending himself to his on line critics to YOU in a circumstance where you found him via a conduit COMPLIMENTING his work, that's another indicator that he wants to control the narrative about what is said about him on the boards/places where he also has a peep talking him UP and of course, an indicator that he monitors (or has someone on them who reports to him) the places patients hear about him from. Again, that's an indicator of his being PREEMPTIVELY DEFENSIVE. Like he is POISED to instill a sense of disbelief in you about an unhappy patient even if you didn't know about this unhappy patient when you went there and only knew about the happy conduit.

Safi probably denied your surgery because the plan was OFF and NOT what he told you verbally. I noticed that and it would have been something the 'giant' guy on the board could have also noticed. Basically, someone ELSE could/would have noticed that if you kept your plan up there. Safi could have noticed himself when he saw your plan up there and what was off with it and cancelled the surgery based on a faulty plan because faulty plan=failed surgery=unhappy patient. There would be little other reason for him to demand you REMOVE it and then put a GUILT TRIP on you for lying to him that you were not on that board. I mean you are allowed to be on the same lookism board where he gets his patients. Although you 'lied' to him about not being on there, his LIE to you about not wanting patients from there was a BIGGER lie and one where you would not have lied to him about being on there if he did not put up a CHARADE of his 'not wanting' patients from there. Morally and ethically, he's the guilty one. Not you.

Clearly, he put you through some emotional torture by inflicting anxiety that you would not get all your money back, especially so, IF he didn't disclose to you the part where HE owned the IMPLANT DESIGN company and you didn't get your money back for what ever design was made (that you could not use or could have been faulty).

IDK. If he really doesn't want patients from the lookism boards, maybe you could go back on there and call his bluff by telling people he thinks they are all 'incels', 'mentally unstable' and doesn't want patients from there. Tell his TARGET MARKET and save them the trip and consult.
95
Surgeon Reviews and Leads / Re: Dr Safi - Terrible Experience
« Last post by SV123 on December 27, 2024, 04:26:57 AM »
Quote from: kavan on December 04, 2024, 03:56:20 PM
That's part of the OP's problem right there. He doesn't think the doctor is a bad person who would pull one over on  him. Each time the suggestion comes where the doctor SCAMMED him and he should either SUE him or be given ALL his money back, he cowers back to defend him as 'not being a bad guy' and resigns himSELF for being at fault for 'lying' to the doctor about not being on the lookism board. The doctor convinced him that he didn't want any patients from that board, demanded he delete his account (and questions about his plan) he put up there. Yet the OP never called into question (or maybe didn't observe) WHY a member on that board showing good results of the doctor (and attracting patients to him that way), STAYED on the same board where the OP was told by the doctor to delete his account.

I recall this issue some time back when he had it. But I can't reference it all because he had my posts deleted, in particular a string where I showed a screen shot of his displacement proposal read-out vs. the changes the told him verbally which differed vastly. He also was on quite a number of boards expressing same issue but had his posts deleted. What you are observing here is a complaint cycle where it does look like he was SCAMMED, but suggestions as to what legal actions to take just resolve to his defending the doctor as 'being a good guy' and resigning himself for being the 'dishonest' one. The doctor probably sees all this cowering back in 'defence' of the doctor and I would imagine that would factor into his NOT getting all his money back.

When I looked into his issue, which did have earmarks of a doctor pulling a fast one over on the OP, the OP got back on board to announce he was satisfied with the amount of money he got back from the doctor and the OP just repeated the cycle of the 'doctor is a good guy' and again resigned himself to being the dishonest one for being on a board the doctor didn't want him on. So, I felt it futile to point out what I found circumspect and deleted the screen shots I took of some facts and circumstances that looked disingenuous to me. Like when the OP resolved not to take any action other than to point out the doctor wasn't a 'bad guy', there was no need for me to retain screen shots taking up computer memory that suggested otherwise. I'll relay the gist of it though:

1: The doctor had a PEEP; a conduit, on the board the OP found the doctor on (one of the lookism boards). The conduit ATTRACTED patients to the doctor from there. However, the conduit's account remained. But it was the OP's account the doctor did not want participating on the board. Let's see. If a doctor didn't want patients from a particular board, then the account to be deleted would be the conduit's and not the OP's. I'll tell you that a con game some doctor's play is they have a SHILL on a board showing photos of a good outcome or they might talk up a doctor. They attract potential patients to a doctor and might get some 'perk' out of it. In that way, the doctor has some control over the NARRATIVE relayed about the doctor.

When a dishonest doctor finds a venue where he can CONTROL the narrative about him via a SHILL attracting patients to him, he's also going to want to control the narrative of a patient that gets channeled to him that way. Again, the OP was channeled to the doctor via the board the doctor claimed he didn't want patient's from. The OP put up a query about his plan from the doctor. Most likely the same one he put up here where I found a MISTAKE on it (on this board) as to what the plan relayed vs. what the doctor told him verbally. The fact that the doctor saw it there pretty much should have triggered suspicion that he had a PEEP on there reporting back to him before someone ELSE could have found a similar thing to call into question with his plan.

Also, the doctor went through TOO MANY protestations that he 'didn't want incels' from that particular board and the OP was not allowed to show the doctor's intellectual property on the board. Something very circumspect with that claim when a conduit showing photos of a good outcome to attract patients from there remains on the same board the doctor forbids the OP to be on.

2: An ownership search on the implant design company (the OP either got his money back on the implant design or did not) kicked up that Safi was the sole proprietor (owner of it). It's also said that his brother-in-law does the designing. In addition, ANOTHER implant designer ('Giant', who goes on the lookism type boards) said that Safi pilfers his ideas/plans.

Basically, I'd say the doctor has CONTROL over the OP's narrative and pulled one over on him where he probably still thinks HE is 'guilty' for being on a board the doctor didn't want him to be on and THAT'S why he's not going to get all his money back. He complains about his bad experience and how the doctor conducted. BUT when he gets feed back that suggests the doctor was in the wrong and/or he could/should be sued/challenged in some way, the OP cowers back to point out the doctor 'isn't a bad guy'.

So, all this resolves to the OP complaining about the doctor, getting feedback the doctor pulled one over on him, the doctor sees it and gets the OP to delete his complaints holding over his head, he might not get his money back when he complains on boards, yet the doctor 'isn't a bad guy'. So, I fail to see WHY the OP is complaining about him openly IF he 'isn't' a bad guy
and telling people he can work it out privately with the doctor.

Hi Kavan,

I believe you are right. After further conversation with Dr Safi, I am beginning to question the integrity of his character.




I do regret not spotting his red flags earlier on. For the people reading this, who are also looking for a surgeon, these were the red flags I noticed (in hindsight) which you should also look for:

- He analysed my face like a lookism user during the first online consult, giving me a verbal list of all my 'facial flaws'. He found a minor flaw in practically everything and tried to sell a solution. This is a MAJOR RED FLAG. No ethical surgeon would try to offer solutions to made up problems. To those reading this that are seeking surgery, do not let take the facial flaws pointed out by a surgeon seriously. Understand THEY WANT YOU TO BE INSECURE, so they can make money. Only go to surgeons that address the facial flaws YOU mention to them, not the other way around.

- I was lured in with the offer of bimax + 2 facial implants through the offer of financial planning and a discounted price of 42k CHF. 2 months later, Safi refused the financial planning and also increased price to 49k CHF due to 'higher demand'. This is a red flag, showing that the surgeon is not a man of his word.

- During a phone call, Safi stated that he was wary of international patients as he had experience with a supposed 'mentally ill' international patient. He spoke ill of the patient. This is a red flag. Why would a respectable surgeon slander his past patients during consults?  I actually read this patient's online reviews. Apparently Safi cut a nerve responsible for taste during an operation. One of his implants also broke. There was such a massive list of problems this online user that I basically labelled him as a mentally ill wacko who was trying to harm Safi's business.

- A super non professional consult. Safi spoke very informally during our consult, and I mean VERY informally like a teenager as he was mocking his online critics. Felt so surreal I couldn't believe this guy was going to cut open my face. This is a red flag as I expect surgeons to speak professionally.






Coming back to you Kavan, I believe the conduit you are referring to is anticel on the looksmax forum. I definitely went to Safi after reading his post. In hindsight, his long piece does feel like an advertisement for Safi. I am not sure if he was paid by Safi or not, but he did state he received a discount for his surgery in one of his posts.

Now referencing to your comments about me, I honestly feel I was traumatised by my experience with Safi (not exaggerating). I have always been sensitive to other people's opinions of me since childhood. Even when my primary school teachers would scold me of a small thing, I would remember it for months!

After denying surgery, Safi gaslit me hard, tearing down my character and calling me an 'incel', literally making a grown man cry. On top of that, I had to last 3 whole days, not knowing whether I would get a single dollar refunded, as Safi didn't give any hint of a refund before he talked to his accountants. He didn't even have the decency to assure me I would get some of my money back. I was honestly having vague suicidal thoughts during these days, which I never had before in my life. I am a from a middle class family, and it took me 1.5 years to save that money, so the thought of losing it all was too much to bear. I am also naturally frugal so that's a cherry on top!

Due to this traumatic experience, I think I developed something similar to Stockholm syndrome. Or maybe I just fell for Safi's gaslighting, believing I was the bad person for lying about having a looksmax account after seeing Safi's negative opinion of users from there.

Honestly, I can now fully see I was tricked and gaslit by the surgeon. I now have forgiven myself for the past. I am only 21 years old and have so much to look forward to in life. I can recover from the financial losses. I have also learnt a valuable lesson - to not be easily swayed by online opinions. I was so thoroughly trapped in insecurity, perpetuated by looksmax.org, that I ignored the countless red flags shown by Safi before I even booked my flight to Switzerland. I now have deleted all social media (except YouTube) since comparison is the thief of joy.

Going back to my original post, depending on my financial situation, I may choose to take legal action against Dr Safi in the future. I am still financially, and emotionally, recovering from this loss in life.




Finally, I also want to wholeheartedly thank you for your guidance Kavan with your long posts this year regarding surgery. This forum definitely deserves more attention and has much more information compared to other places like reddit.


96
Aesthetics / Rami asymmetry
« Last post by Sequelae on December 26, 2024, 02:08:51 PM »
I am pursuing jaw surgery to correct asymmetry and mandibular recession. However, I have concerns that a typical BSSO will not be able to fix my asymmetry, as a lot of it is in the rami. My right ramus is longer; additionally, the widest part of the ramus, where it flares out, goes much further forward on this side. I appreciate that it may be difficult to understand, but I can't think of a better way to describe it. If you look at the images, you can see two distinct flair-outs on the longer side, which is what I am referring to. I don't think BSSO would be able to improve any of this.


I have been looking at alternative osteotomies, such as the High oblique sagittal split osteotomy, but it's hard to find much information on surgeons who perform this, particularly those who would take international patients. I would really appreciate any advice on this.


https://imgur.com/a/Qz3tiUt
97
Aesthetics / Re: 12mm genioplasty - should I pursue/have pursued DJS?
« Last post by Tomasjohn on December 26, 2024, 09:43:51 AM »
Looks much, much better after  :)
Where did you do it, Canada?
98
Aesthetics / Re: 12mm genioplasty - should I pursue/have pursued DJS?
« Last post by kavan on December 25, 2024, 01:57:19 PM »
Quote from: GJ on December 25, 2024, 12:08:47 PM
Well he looks objectively way better, so point #1 is definitely not true.

I don't deny he might look better and in fact I said in my post that masking lower jaw recession with a large genio will kick up some improvement. Your subjective assessment (which you call 'objective'), that may be true does not make my point in #1 'definitely untrue'.
99
Aesthetics / Re: 12mm genioplasty - should I pursue/have pursued DJS?
« Last post by GJ on December 25, 2024, 12:08:47 PM »
Well he looks objectively way better, so point #1 is definitely not true.
100
Aesthetics / Re: 12mm genioplasty - should I pursue/have pursued DJS?
« Last post by kavan on December 24, 2024, 02:56:45 PM »
Firstly, I can't see your photos. Very OLD computer and I don't use a Google account. Secondly, I don't need to in order to give you some information about your concerns.

1: When people say you look 'different', it is neither a compliment nor an insult arising from a sense of envy/ jealousy. It conveys there is something 'off' with the changes. So, it is NEITHER a 'you look great what did you do?' NOR an assessment on their part that you look worse. It's a neutral statement where they don't know what to think of the changes in EITHER positive OR negative terms. 'Different' means that something is 'off' that the onlooker CAN'T assess as 'good' or 'bad'.

2: It is NOT uncommon for some doctors to OVER-COMPENSATE with a LARGE genio when a person is a candidate for lower jaw advancement and/or double jaw surgery. On the FLIP SIDE, max-fax doctors who DON'T do that, will bring out the chin POINT with the lower jaw advancement (which often is a part of DOUBLE JAW surgery where the maxilla is either advanced and/or rotated) such that any added genio will be minor.

3: As for an APNEA test for the DJS, it 'depends' whether or not the surgery is SELF PAY or IF insurance is paying for it. The type of doctors I mentioned on statement #2 are often SELF PAY and the surgery is not dependent on whether or not you have apnea. That is to say, IF it's one where counter clockwise rotation would allow them to minimize the maxilla advancement AND maximize the lower jaw advancement (and add a modest genio if that's also needed), that type of surgery would address both aesthetics AND apnea whether you had it or not OR if it looked like you could have it in the future. Like NO apnea test is needed to predict that a lower jaw advancement would OPEN the AIRWAY and help breathing with a self pay doctor who optimizes airway, bite and aesthetics.   

4: In RETROSPECT, if you were actually a candidate for DJS (and again, I can't see your photos, don't need to but it SOUNDS like you WERE a candidate for it), you COULD pursue that. Most likely they would have to REVERSE the prior genio which is not difficult to do because it's a cut right through the prior one to set it backwards given the lower jaw advancement would bring the chin point forwards. The PREPARATION or 'work up' for DJS is a lot of time in BRACES to DE-COMPENSATE the bite (to de-compensate for prior camouflage ortho). So, AGAIN, for all of that, it (most likely) DEPENDS on whether your pursuit is for a SELF PAY max-fax. An insurance one in US or something like NHS like they have in Canada or England, will just do the minimum to help with the breathing. But AESTHETIC optimization is not part of the 'financial equation' when the government or insurance is paying for it.

Conclusion: Based on what you have expressed here and also that you have expressed your situation well, it DOES sound that they over compensated with the chin and did so to MASK the lower jaw recession and that type of masking made your maxilla (mid face area) looked relatively more recessed by relative comparison. So, your pursuit for optimizing aesthetics, bite and airway would be in venue of SELF PAY doctor more than it would be government or insurance pay doctor. Also, I DON'T deny that you could look better (as GJ says you do) given that OVER COMPENSATION with a genio to MASK lower jaw recession is going to be somewhat of an 'improvement'. However,in terms of people who are actually candidates for the DJS where optimizing the balance of bite, airway and aesthetics IS part of what some self pay doctors do, I think what you say here is WITHIN REASON of that type of pursuit. This will require consultations and perhaps outside of what ever country. Hence, if that is within your capacity to pursue, I would say your concerns fit into such a pursuit.
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