Concerns about facial flatness/outcome of surgery

[birder333]

Heya,

I just got braces and am set to get a Lefort I maxillary advancement (with impaction, making it a CCW movement), BSSO, and sliding genioplasty. Mainly to address sleep apnea, which I unfortunately have despite being 20, skinny, and a runner. Also to fix a minor gummy smile. No TMJ aside from the occasional clicking/popping, and sometimes sounds like grains of sand in my joint when I chew (high pitched scratching).

No major malocclusion, in fact bite is pretty much right on, due to braces when younger. These braces are to flare upper teeth out and move lower teeth back more, to create maximal gap for surgery.

I have searched all over for someone who has a facial profile like mine. It seems as though my upper maxilla (under eye, nose and cheekbone complex) curves in significantly from the cheekbone edge to the nose, giving me little under eye support, and also making my cheeks quite flat (see top-down picture). This doesn't bother me much now, but I've read that this puts you at greater risk of looking strange or monkey-like after maxillary advancement. I am worried about my lower face protruding out too much after surgery due to my already set-back upper midface.

My question is:
1. Have you ever seen someone with my facial profile who underwent the same surgical procedures, and did they look ok in the end? Can you attach pictures or a link?
Any encouragement or warnings based on your knowledge of jaw surgery and aesthetic outcomes would be welcomed.

I should add: I'm not looking to turn into a supermodel. I have realistic expectations of this surgery, and I expect it to significantly help my sleep apnea, and hopefully make my smile, profile and overall facial balance better. However, I am debating whether it is worth it to have better sleep but sacrifice looking normal (at least well enough to me), in case I end up looking strange. The sleep apnea is moderate.

Thanks!




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[birder333]

Top-down photo

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[birder333]

aanndd some more

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[birder333]

Yeah I should mention I am not interested in any other cosmetic procedures ("zygomatic osteotomy?", "chin wing", cheek implants, etc.)

[TMKA]

I don't think you need to worry about the chimp face look at all because it looks like you need both jaws advanced for a more balanced look. Also, the maxilla advancement will make your nose look less prominent.

[kjohnt]

Yes you need all of those things and yes you are correct to worry about the cheeks because you will better see the obvious recession once your jaws are in a better position.  Like ugly mofo said, you'd ideally have some sort of full facial advancement or some surgeons can do cheek implants in conjunction with the bimax surgery which might be a good idea but I've not researched the subject much to be honest.  But yes, the advancement and CCW rotation alone will make you look better IMO.

[birder333]

Ok thanks to all who have answered so far.

kjohnt - I agree that for the ideal id need more advancement in the upper area. However from what you have seen and know, is the change in the upper area (when the recession is made more obvious) subtle or drastic? Given a moderate maxillary impaction and advancement.

I've heard a lot about this but have never seen pictures in before or after which actually show it...

[triot]

Yes, the upper mid recession will be more noticable. You will probably loose cheekbone definition (esp. in 45 degree view) and your midface might appear more bloated. There are a number of other aspects you have to keep in mind, as nose changes (mostly tip upturn and widening), your philtrum length (it might appear longer and more "filled out" which imo contributes to the "monkey look"). Your nasolabial folds might appear more prominent or (more likely) smothen out. If you have scleral show it might incrase or decrase etc. soft-tissue response is hard to predict.

Not trying to scare you, because you really need this procedure for your health but search for a surgeon who is aesthetically minded and discuss these points. Imo jawsurgery rarely makes someone really good-looking (even though that is not your priority) without having additional procedures, but you have only one face.

The are many before afters on the net where you can see the effects post-op I'm talking about but I can't link you to one bcs I'm on my phone.

[birder333]

Hi triot -

I will admit your answer did scare me. It is difficult weighing what seems to be a trade off just from the aesthetics point of view.
If you have time and are able I would appreciate being pointed toward photos where the upper midface recession became more obvious. I just want to know what to expect. I have seen photos of the other effects you mentioned (losing cheekbone definition, filled out lip, nose) so no need to point those photos out.
Overall would you say the trade off is worth it?
Thanks a bunch

[carlos30]

with lfi advancement alone be prepared for weaker midface, since you're already bit weak there. Then there is a high chance for wider and upturned nose, as well lengthened philtrum and other soft tissiue changes which are predictable as lottery tickets.

if u want to know, how over-advanced maxilla on weak midface looks like, google dr antipov.