Had BSSO and Lefort I osteotomy in 2003. Debating revision. Pics.

[secondtimearound]

I had a severe underbite, openbite, and asymmetry which was corrected (mostly) by a well known jaw surgeon in my city. He came well reputed so I took the approach of "trusting his judgment". Overall he did a good job for me. I have a tiny bit of residual paresthesia to my lower lip and one of my front bottom incisors is a bit numb at the gum. Otherwise I came through okay with no complications.

His surgery without a doubt made the last 12 years of my life much more livable. (I was very atrocious to look at before the surgery - people treated me immediately better post op without anything in my behaviour/confidence changing at all).

I'm not a successful and grown 32 year old adult. I have as much finances as I need for pretty much anything. Despite my overall satisfaction with my previous surgery, there are some things I wish were better. First, I wish my asymmetry had been better corrected. It's not too visible with my lips closed, but my teeth are still on a major cant (~10-20 degrees?), and my midline is very much off. It doesn't look too bad again because the surgeon seemed to have shifted my chin to compensate for the asymmetry. But the midline of the teeth is way off.

In addition, given that my surgeon performed only a simple vertical reduction sliding genioplasty (as is the norm), my chin is now very wide and square. I am now aware of v-line procedures which can fix the jaw shape for people like me by narrowing the chin a bit, and shaving away the excess bone to create a more naturally contoured jaw line.

I've attached a quick pic of what I look like now (to the left) and what I would hope a revision BSSO/Lefort and v-line would help me to look like (to the right).

The difference is not intended to be mind shattering. I'm not changing my occlusion or making any dramatic facial proportion changes. For me, it's about minor cosmetic shifts to give me the face I feel I ought to have. Cosmetically, when I look at them, the face on the right feels like the face I should have always had as an adult. When  I look at the left face, I see the big round chin and slanted face which have frustrated me since adolescence.

I'm curious. Look closely at each. What do you see when you look at these faces? I'm not being interested in getting talked into or out of anything. I just want some third party perspective.

Any thoughts? Please excuse the scruff, the dead eyes expression, and the bummy sweater. I wasn't initially intending to post this anywhere when I made.

[secondtimearound]

It's just basically (1) the midline is shifted ~3-4 mm to the right so there's better symmetry, (2) the chin is a few mm shorter, and (3) the chin is a few mm narrower. Agreed it's meant to be subtle. I don't want a new face. I would just love to fix those imperfect elements of my prior surgery. Does that make me insane for even contemplating any of this?

[molestrip]

You can fix that without jaw surgery. Have a plastic surgeon just move the lip and an orthodontist move the teeth. Even actors have midlines that are off.

As to whether you're crazy? Yes, most definitely. You're old enough to remember VCR tapes. You know how every time you copy it the video gets worse? Eventually, if you copy it enough times you can't even see the video. The same thing is happening with your soft tissue. It's an intricate web of nerves, blood vessles, and other connective tissue. Every time you cut it, it heals but with invisible internal scarring since it can never be as good as the original. As a result, each repeat surgery you do becomes more risky. Surgeons are wary of losing blood supply to the tissues and teeth since they have to cut through so much tissue already, they don't want to add scarring as a risk factor. People do it but the rewards have to be worth the risks. Total nerve sensation loss isn't uncommon in 2nd surgeries as well, same principle. On the off chance it shifts (~15%), you could need a third surgery and you're into no man's land then. I only know of one person doing it and she's desperate because she struggles to breathe right now. To the extent that you ignore these warnings, I suggest you consider Dr Alfaro in Spain. His minimally invasive technique would minimize the damage at least.

[PloskoPlus]

IMO, while your chin is heavy, it does balance your upper lip (which will only get longer with age).

[secondtimearound]

Thanks guys. I was thinking this might be the reality. I wasn't aware of how much worse a BSSO/lefort redo would be. I couldn't find any info on the subject really. Does anyone have any references on the subject?

As for the chin/jawline, maybe i can still get that done? I just want a gentle V line reshaping (2 mm shorter, ~4 mm narrower, then mandible angle contoured to match), which is a relatively minimalistic procedure by comparison. No real nerve interference required from what I gather.

[molestrip]

Yes, check out an oral surgery textbook. Even better if you've done a few surgeries, ruined a few lives, etc. Then you'll really understand the risks before gambling with yours.  My surgeons have already warned me, there will be no revisions. We get it close enough and you live with the consequences, that's the deal.

As to the nerve question, nerves are everywhere. There is no such thing as a no risk procedure. I had a 1in incision to fix a varicocele and ended up with mild allodynia in my left calf. It was worth it, I have two great kids in exchange and a nerve to donate if I need it in the future. Also, a clot dislodged and I ended up with a bruised penis for a week, which was lucky as it could have ended up in my brain (causing a stroke) or some other vital organ (the penis seems ok fortunately). These things don't happen typically but they do happen and the odds only increase the more times you have surgery. Heck, you can't even remove wisdom teeth without risking nerve damage. The secretary in my office had this done and (somehow?) ended up with motor nerve damage, her face droops on one side slightly (I don't notice but she does).

Did you achieve 80% of your goal in your first surgery? If so, then you're done.

[secondtimearound]

Thanks molestrip. I think some part of me will always wish I could be "the way I should have been". But I think I can be more than happy with what I have. It's just a question that was in the back of my head. I appreciate your levelheaded feedback.