MMA relapse, now 7 weeks PO. How to proceed?

[GJ]

Is it bigger risk for the nose to widen the second time? Why is that?

I'd have to see the photos again, but it's likely it widened the first time.
It's likely it would widen again because the muscles that were stitched have to be cut once more. Maybe it doesn't, but it's something to ask the surgeon about (they might downplay the risk, though). I'd ask an objective surgeon who wasn't performing the surgery, personally. He's on a bit of a time crunch so it's tougher to be diligent.

[jawsandsleep]

I think he's just saying maxillary advancement impacts the nose, and this risk is part of the revision if he goes that route.  Not that revision advancement after relapse is necessarily riskier to the nose than initial advancement.

I'm not sure what you mean here.  The immediate post-op picture 'reflects' the truth much more 'accurately' than your 10 day pic.  At 10 days you still have a ton of swelling.  It can literally take 6 months to a year for all swelling to dissipate. Your choice though.

I think neither pictures reflect the reality. I dont have a front picture and the angle distorts it a little.
I understand what you are all thinking. I was ecstatic when I first saw the picture, but in the current situation I am not willing to take to risk to get to that position. Its essentially moving me from a very recessed hyperdivergent growth face into a very forward grown one. I just feel like there is a good chance the result wont be as good as it seems. There is a good reason why people discuss Lefort 3 and zygomatic osteotomies etc on this board.

[jawsandsleep]

Regarding the nose changes: https://imgur.com/gallery/bfnppEG
Barely any, but the surgeon employs some special suture technique.

[Dogmatix]

I am currently thinking about doing the mandibular set back and getting a vertical reduction genioplasty at some point. This is how I envision it: https://imgur.com/gallery/4QnSOa5
 pre OP vs plan https://imgur.com/gallery/NdBw6tm

I thought about it a lot. While the post OP picture looks good, it probably doesnt accurately reflect the truth. I believe its best to aim for a natural looking result and one that fits my asian face.

It's funny with these morphs, because what you show here looks perfectly reasonable, and it revert to previous discussion. Your post op picture also looked very good so it's the balance and I'm sure what ever you chose will give you a good result. I don't think moving the maxilla forward will give you a strange look, and I don't think moving the mandible back will either. What is best? Well you ask a forum full of people like me who want the strong jaw line and soft tissue support, moving something back is not what we do . But, I guess the net movement from where you started will still be very significant even if you move the mandible back.
Could you put up the post op pictures again as reference?

I think you should discuss this with your surgeon. Ask him what he thinks give you the best result and discuss the risks etc. Chance is that he still have same opinion as on first plan though, why would it change.

[Dogmatix]

I think neither pictures reflect the reality. I dont have a front picture and the angle distorts it a little.
I understand what you are all thinking. I was ecstatic when I first saw the picture, but in the current situation I am not willing to take to risk to get to that position. Its essentially moving me from a very recessed hyperdivergent growth face into a very forward grown one. I just feel like there is a good chance the result wont be as good as it seems. There is a good reason why people discuss Lefort 3 and zygomatic osteotomies etc on this board.

But you are a bit inconsistent. You start the thread asking what yields the best aesthetic result, you seem inclined to full bimax revision and that you liked the post op result. Now not so much.

[jawsandsleep]

I believe I am inconsistent. I find it incredible hard to get a grasp for whats right. The post OP picture always looked good, but the morph also looks good and would be a significant improvement from the current situation. I was trying to find out which way I should go and I feel like the set back is the more realistic and natural solution.

You make a good point about the preference for strong jaws. I believe its this notion that got me into all this hassle in the first place. Im not gonna lie, I was always self conscious about it and Western esthetics do place a strong preference on this trait. But my genetic make up is Asian, so maybe its not meant to be 

[Post bimax]

I believe I am inconsistent. I find it incredible hard to get a grasp for whats right. The post OP picture always looked good, but the morph also looks good and would be a significant improvement from the current situation. I was trying to find out which way I should go and I feel like the set back is the more realistic and natural solution.

You make a good point about the preference for strong jaws. I believe its this notion that got me into all this hassle in the first place. Im not gonna lie, I was always self conscious about it and Western esthetics do place a strong preference on this trait. But my genetic make up is Asian, so maybe its not meant to be 

Eastern genetics absolutely do not preclude a strong jaw.  At this point I'm not sure anyone can help you until you make up your mind about what sort of aesthetic you want and which risks you are willing to take.  And at that point, I think you'll have answered your own question.

[jawsandsleep]

Yeah, I wasnt thinking when I wrote this. My face was recessed, no matter what culture I was living in. Interestingly, Asian esthetics dont put such an emphasis on strong jaws.
And I guess you are right. I believe, I was mostly using this thread to articulate my own thoughts. I hope you guys dont mind and I thank you all for the civil discussion.

[GJ]

I believe I am inconsistent.

To me this is totally normal and unless someone went through a bad surgery they might not get it.

Back to your nose...it looks like about 1mm of widening, maybe 1.5mm. I wouldn't call that insignificant, but I'd say it's within norms and not excessive. If you get another 1mm via a revision you'll have trouble. You're likely referring to the Alar stitch. It helps, but it's not a miracle. He'll have to re-cut the muscles that he cut the first time and stitched up. How they react is hard to predict. I'd mentally plan for .5 to 1mm more of widening. Then if you don't get it, great.

I'd try to get him in a consult asap and run concerns by him. If you're happy with is answers do the revision. Don't let the board confuse you further. Listen to your gut, clear your head as to what you want, and then see if his answers are satisfactory. That's about the best you're going to do in an unfortunate situation.

[jawsandsleep]

To me this is totally normal and unless someone went through a bad surgery they might not get it.

Back to your nose...it looks like about 1mm of widening, maybe 1.5mm. I wouldn't call that insignificant, but I'd say it's within norms and not excessive. If you get another 1mm via a revision you'll have trouble. You're likely referring to the Alar stitch. It helps, but it's not a miracle. He'll have to re-cut the muscles that he cut the first time and stitched up. How they react is hard to predict. I'd mentally plan for .5 to 1mm more of widening. Then if you don't get it, great.

I'd try to get him in a consult asap and run concerns by him. If you're happy with is answers do the revision. Don't let the board confuse you further. Listen to your gut, clear your head as to what you want, and then see if his answers are satisfactory. That's about the best you're going to do in an unfortunate situation.

Thank you GJ, I appreciate your help. I just feel lost sometimes because its all happening so fast.
Basically, I am trying to see if a mandible only approach is feasible. I will have to evaluate whether the current position of the maxilla makes sense.

I wish I had more time to double check everything, but the revision is now planned for next week. I was told that I shouldnt let too much time pass as the bone continues to heal.

[GJ]

I was told that I shouldnt let too much time pass as the bone continues to heal.

From everything I've read and heard that's true, and it's ideal to do it while the bone is soft (easier cuts, etc), but you can do it later. People have revisions 20 years later. Just more risk of a bad split, etc.

[april]

I don't blame you at all for having inconsistent thoughts about this. You're in the thick of it, with a pretty significant complication (that I think no one here has gone through, nor hopes to go through) and it's always harder to think about your own case clearly and let alone after a complication. Your thoughts will be back and forth as you try work this out. Your decision is also time sensitive, which makes it so much harder.

If considering maxilla, definitely ask your surgeon about preventing future relapse. I mean, how can they be sure it won't happen all over again?

[kavan]

OP, moving the maxilla forward a second time puts a lot of risk to your nose widening more. The photos are no longer up, so I can't see how much it widened the first time. This is one reason I don't like it. In the second photo you posted, from memory, your lower jaw looked too far out for your upper face. So moving the mandible back would make more sense. Cutting the mandible a second time increases the risk of nerve damage, as you might know. So there's that to factor in. I agree with others who said you looked good in the first photo right out of surgery (again, from memory), but you were swollen and in general photos are some of the worst records for assessing anything. You mentioned soft tissue in a post, and again from memory you were Asian and appeared to have thin soft tissue that is somewhat typical in Asians. This will make any movement more apparent since the tissue doesn't hide anything, and it's another reason I think mandible, especially if you miss your old face. Mandible would get you closer to the old face, though you have to accept the actual old face is gone forever. My big issue with the maxilla is moving it a second time puts so much risk to the nose area. It's worth considering because it did look good in that one photo, but I wouldn't consider it without more info from the surgeon. Maybe request an emergency consultation to go over everything. Good luck, buddy. Tough situation.

They use a lot of things to suppress the swelling during the surgery. So a photo taken right afterwards pretty much shows how it will look (if no complications, relapse etc.) when it heals. Swelling sets in hours after surgery and peaks at day 2 or 3.

[kavan]

I think he's just saying maxillary advancement impacts the nose, and this risk is part of the revision if he goes that route.  Not that revision advancement after relapse is necessarily riskier to the nose than initial advancement.

I'm not sure what you mean here.  The immediate post-op picture 'reflects' the truth much more 'accurately' than your 10 day pic.  At 10 days you still have a ton of swelling.  It can literally take 6 months to a year for all swelling to dissipate. Your choice though.

Correct. Immediate post op reflects the outcome with NO swelling. That's why they take them.

[kavan]

I'd have to see the photos again, but it's likely it widened the first time.
It's likely it would widen again because the muscles that were stitched have to be cut once more. Maybe it doesn't, but it's something to ask the surgeon about (they might downplay the risk, though). I'd ask an objective surgeon who wasn't performing the surgery, personally. He's on a bit of a time crunch so it's tougher to be diligent.

I saw them. Although nostrils can widen with advancement.  His nose in profile looked great with the max advancement and less prominent to his face.