surgery, please help

[SKV2]

i consulted with some dr's but before i finally pull the trigger and get it done, id like one last fresh look from some people here. im currently almost 22 yrs of age , what do you think i should get done? ive included cephs and pics obv.


lateral ceph age 15:


https://imgur.com/QMYXQ0C


lateral ceph age 19:

https://imgur.com/PwKLxIS

lateral ceph age 21:

https://imgur.com/CcMe32x


frontal , age 19:


https://imgur.com/I7KYNyY



bite, age 19:

https://imgur.com/9HjBnQe



2 profile pics, age 19:

https://imgur.com/gtEkuKr

https://imgur.com/OqxGLpE





also, i know this part includes stuff that is often argued about, but i personally do buy into the idea that oral posture directs growth during development, too many anecdotes plus the monkey study for me to turn a blind eye, and my own exp. in my case, my posture was heavily disrupted when i got an impacted canine, and imo the change was profound. i wont waste time posting an array of pics since i certainly have some that are horrendous, but i know they can vary esp when comparing a dlsr to a phone picture. in an effort to compare apples to apples as best i can, all pics ive included in the post were taken with a dlsr with the exception of the one imagine hosting 2 pictures of me in a laughing expression.. the older one on top was taken with my iphone.

certainly id love to have a better face than i did or rather im not opposed to it, but i def would like to at least be able to get my old face back, if possible, so ive included some pictures and bite of myself before all that happened to me.

frontal pics:

https://imgur.com/3gHgBRG

https://imgur.com/aZiH3pF


profile pic:


https://imgur.com/hcox0WK



comparison of profile in laughter expression:

https://imgur.com/whgJkzl



bite:


https://imgur.com/PyovNqz



thanks, any direction is appreciated.

[PloskoPlus]

Get the best jaw surgeon you can afford.

[SKV2]

Get the best jaw surgeon you can afford.

well, i already sort of have an idea of what i think i should do but didnt want that to alter what ppl here would say, wanted one final fresh look and then decide finally on what im doing. the rough sketch in my mind though id double jaw with dr g, advance both and perform ccw , and then either a genio from him or a chin wing with dr z or someone in zurich (sort of why i made that thread about the diff cuts.. not sure which would be better, his bsso cut plus his genio or ask him to perform a diff bsso cut that would allow for a chin wing, then go to z for chin wing).

regarding the midface and zygomas i honestly dont know.... i was thinking about looking into what lf1 cut g could do, as in how high can he go, and then could the area he "missed" or didnt touch be advanced with a modified version of the lf3, performed by dr s or dr ob. either that or just as high lf1 cut as g is willing to do and then look into custom implants.

when i first met with g like 2.5 yrs ago or so he wanted to advance both jaws, iirc which i prob dont by now, maxilla by 8 mm and mandible by 3, and do ccw, then genio and ha paste.

oh and ofc something must be done about the palate.... im willing to pull out the 4 wisdoms if necessary but even then id be interested in looking into how necessary that is and if they can fix impacted wisdoms. im certainly not willing to go more than that though and end up with less than 28 teeth. so either a multi segment / three piece i believe it is lefort or if that cant add enough space to suffice, then sarpe.


i do worry about the cuts made and retaining my shape since it seems when i jut out my mandible and then use my tongue to push my upper lip area right up to nasal base out, i look much better and my mandible and zygos have a shape to them that i find satisfcatory. i can always upload a pic or vid demonstrating this if requested. also worry about the midface area above where the lf1 cut would end , hence wondering about mod 3 or implants along with it. also im not entirely sure if 8mm would suffice to return my profile to where it used to be, but again im not even sure if that number is correct and it is outdated from multiple yrs ago, i need to see him again for a fresh consult (2.5 yrs ago i flew around to consult with him as well as s, r, and z).

its annoying ill be honest regarding the canine and what happened to my face and i ruminate about it quite a lot, at the end of the day i just want my face back or a face that superior to the one i had.


wanted to keep most of this about osteotomies since i view implants as a sort of stage 2 if even necessary and its something id re asses after ive exhausted what i can do with bone cuts. if i do end up going that route i suppose it will be custom made for zygoma and perhaps the mandible and chin though i hope the latter wont be necessary. i dont know enough about implant surgeons yet or materials to comment with any authority or anything but from what i do know perhaps dr eppley , but i know taban is best for anything related to eyes, so infra orbitals or maybe a custom made glabella and browridge implant. also heard conflicting things regarding silicone vs medpor so would have to research that more and speak to surgeons about it, though i know many here r waiting for xilloc or epibone to make their tech available to cosmetic surgeons so we can implant actual bone.


so.. yeah, i guess any direction in terms of concrete stuff would be greatly appreciated. also very interested to hear from lazlo and kavan on this, idk how to @ them or if thats possible


@lazlo

@kavan

[Dogmatix]

the rough sketch in my mind though id double jaw with dr g, advance both and perform ccw , and then either a genio from him or a chin wing with dr z or someone in zurich (sort of why i made that thread about the diff cuts.. not sure which would be better, his bsso cut plus his genio or ask him to perform a diff bsso cut that would allow for a chin wing, then go to z for chin wing).

I dont think it's a good idea to set up a plan with different surgeons, definitively not without telling them about it in advance. Either you let the surgeon go full retard on your face, or don't do anything at all. Telling a surgeon to leave some parts for a different surgeon doesn't seem like a good plan.

[SKV2]

I dont think it's a good idea to set up a plan with different surgeons, definitively not without telling them about it in advance. Either you let the surgeon go full retard on your face, or don't do anything at all. Telling a surgeon to leave some parts for a different surgeon doesn't seem like a good plan.

kind of hard to avoid though. certainly id want every surgeon involved to be aware of full plan and such, but for ex g doesnt offer mod lf3 so going to s or ob would be necessary for that, same with zso if i ever wanted it, and obv with implants if i end up going that route post osteotomies. for the ex u gave though it comes down to which of those 2 results would be better. i just dont know if z's chin wing would be superior to g's genio, i also dont know which bsso cut , the one that allows to chin wing or the one gunson normally does , would be better and retain the mandible shape more.

[Dogmatix]

kind of hard to avoid though. certainly id want every surgeon involved to be aware of full plan and such, but for ex g doesnt offer mod lf3 so going to s or ob would be necessary for that, same with zso if i ever wanted it, and obv with implants if i end up going that route post osteotomies. for the ex u gave though it comes down to which of those 2 results would be better. i just dont know if z's chin wing would be superior to g's genio, i also dont know which bsso cut , the one that allows to chin wing or the one gunson normally does , would be better and retain the mandible shape more.

But you need to understand that every surgeon is aiming for perfection, so even if they dont offer whatever procedure you think you need, they might do a compensation on another end to go in the same direction. When you meet the next surgeon, he might look at it and consider the last surgery a screw up for what he is trying to achieve. You might just end up travelling around doing compensations and revisions, if you go enough rounds in the loop you might end up with something good, but I doubt it. Aesthetics of a face is a complex issue and there may be many solutions, it's about harmonizing the relation between different parts, not about picking a jaw line from one picture, nose somewhere else and putting it together into a super face.

[CCW]

Get jaw surgery with Gunson, and move on with your life. Forget about the other operations. You don't need them.

[Fix_your_bite]

I'm not sure but it looks like you have an underbite? If yes, you could get it fixed with double jaw surgery. But if your occlusion is good, I don't see the point of getting jaw surgery. Your face and profile are perfectly fine.

You could get brace to fix your smile, but I feel like you have a very narrow palate, so maybe getting it expanded would be a good idea.

[PloskoPlus]

Get jaw surgery with Gunson, and move on with your life. Forget about the other operations. You don't need them.

This.

[Lazlo]

Get the best jaw surgeon you can afford.

yeah i agree if you can afford gunson go for him. I can see your bite might be off?

if not, just get a genio or something.

seriously, the complications of this surgery are no joke.

[Lazlo]

I think Gunson has the right idea. Only thing I would add is go for a stronger genioplasty than recommended. Gunson and Arnett are conservative on genios and I find their patients would look better with a stronger one. So go for at leasat 5-6mm advancement on chin --just ask for a "strong chin" more than the norm.

Otherwise, safety is the most important. And yes agreed implants etc. are a second order problem. So far I haven't found a solution for these problems except what I've heard about D. Z etc. on here. Good luck buddy.

[SKV2]

I'm not sure but it looks like you have an underbite? If yes, you could get it fixed with double jaw surgery. But if your occlusion is good, I don't see the point of getting jaw surgery. Your face and profile are perfectly fine.

You could get brace to fix your smile, but I feel like you have a very narrow palate, so maybe getting it expanded would be a good idea.

"your face and profile are perfectly fine"


plz tell me u r trying to inject humor into the thread

[SKV2]

Get jaw surgery with Gunson, and move on with your life. Forget about the other operations. You don't need them.

no can do man. in the fallout of the my face being ruined, i ended up developing a speech impediment from the psych trauma, and dropped out of uni , giving up an ib career.... so this basically is my life now. osteotomies and implants and all the other stuff, thats all there is lol.

[SKV2]

I think Gunson has the right idea. Only thing I would add is go for a stronger genioplasty than recommended. Gunson and Arnett are conservative on genios and I find their patients would look better with a stronger one. So go for at leasat 5-6mm advancement on chin --just ask for a "strong chin" more than the norm.

Otherwise, safety is the most important. And yes agreed implants etc. are a second order problem. So far I haven't found a solution for these problems except what I've heard about D. Z etc. on here. Good luck buddy.

ya implants r tricky, ive seen good and bad results. i recall the lets talk about cheekbones thread, kavan mentioning internal shape/structure of the zygoma pre op playing a huge role in whats possible.

may i ask ur thoughts on the chin wing vs genio dilemma?? getting gunson's typical mandibular cut paired with a genio from him vs a cut that allows for chin wing and then get that done with z?? i had the same interest back when i met them all the first time and gunson told me he can do that no problem , but im just not sure which route would produce the superior result both in terms of retaining mandibular shape and what u can do with the chin in each procedure.

also the midface.. should i try and get a modified lefort 3 from sinn or joachqim obwegeser along with the lefort 1 from gunson?? or just a high 1 from gunson and then get custom made implants??


due to the nature of my case, how odd would it be to simply give my surgeons the before and after pics i posted here and just request my old face back?? lol. like.. idk what caused most ppls issues, if they always had that face or got into an accident etc , but i imagine in most cases they just do a ceph analysis and 3d ct scan, use their own aesthetic eye, take into account the airway and obv making sure the bite ends up class 1 , maybe take a page out of the marquedt mask book, compare stats on the ceph ie SNA to normal range, and then go to town. in my case, we have images of the same face we r operating on, before it got f**ked up. surely thats a better benchmark for comparison than avg sna, no? i mean hell, i had a stronger chin as a 4 yr old child than i do now as a 22 yr old adult, lol. stronger zygoma too. it would just be... weird, to come out of surgery and be able to say im still uglier than i used to be, or still have a weaker chin or more recessed maxilla or weaker cheekbones than i used to have i guess. like i said im perfectly fine with them giving me a better face so at least i go up from baseline rather than just returning to it so to speak, but i dont rlly see any flaws in my face pre canine aside from s**t ears and a less than perfect under eye area, both of which r easy fixes (otoplasty and dr taban's custom infraorbital implants). only real improvement i could imagine would be adding forward growth even beyond where i already was, which might not even make the face any better. i know its a bit repetetive but just want to stress that i rlly just want my face back at the end of the day.

also recall having a friend of mine analyze my ceph and told me for my maxilla to be in same position relative to the rest of the face as it used to be, id need over 1 cm of advancement. =/ and ofc then u consider what about the part the lefort 1 misses, surely there will be some step off or large disparity between the alveolar process region and the zygoma , requiring implants or a modified version of the lf3.

side note, is it all speculation regarding when bone implants will come out? even though it seems medpor is better than silicone, it might be wise to get silicone implants while u wait for bone since they r a lot easier to remove.

[SKV2]

This.

to the ppl saying this, did u even click all the imgur links including comparing my old face before it got deformed to my current one? or just the first cephs? lol


also someone said something about bite being off, yes, back when i went to see them i was told i have class 3 bite and midface hypoplasia, which is p obv.