Consulted with Zarrinbal, Eppley, Yaremchuk...

[yamahatrophy]

Hi all. I need some objective advice regarding how to improve my side profile.

I dislike how underdeveloped my midface, nasal bridge and jaws are. It gives my face a really flat and unhealthy look, particularly the undereye region and also my nasal base which appears sunken. My lower third is also short and I have a double chin despite being fairly lean (~12/13% bodyfat). I'm not aware of any functional issues. My bite is fine as it was corrected with orthodontics a few years ago, no extractions except for my upper left wisdom tooth which was causing issues. I should point out I've had fillers placed on my nasal bridge, chin, cheeks and tear troughs about 6 months ago however the CT scan was taken before any of that was placed, however the "real" photo is recent.

My question is concerning DJS. It's an invasive and expensive surgery so obviously I would only want to go through with it if it could provide a significant improvement aesthetically. This is my question to you - in your opinion, could I get a significant aesthetic improvement with DJS? Obviously this is an impossible question to answer so I've put the "in your opinion" caveat there hoping to draw on all the experience in this forum.

I've consulted with several surgeons including well known ones here (Zarrinbal, Eppley, Yaremchuk) and even a local maxfac, none of them have suggested DJS. I asked Zarrinbal outright about bimax and he steered me straight towards a chin wing once I mentioned no functional issues (surprise surprise). I have a consult booked with Defrancq later this year when COVID-19 blows over and the feedback I get here will guide my discussions with him as I expect he will be more likely to recommend DJS than the previous surgeons.

What confuses me is that I don't seem to have a facial profile similar to any of the typical Lefort I cases. I'm white but my profile is more akin to an Asian with the low nasal bridge and flat midface, and my nasal tip is already upturned which I thought was a sign of maxillary growth...

[kavan]

I don't see any midface recesssion necessitating Lefort 1 advancement. I see a LI rotating your already overly upward rotated nose MORE more overly rotated than it is now. If you don't like your nose bridge, you would dislike it MORE with a L1 advancement because it would stay behind the base of the nose that gets advanced with L1.

I don't see any need for BIMAX surgery either. You have the type of jaw bone chin wing doctors like to see because they can get good results with the type you have.

[PloskoPlus]

You need a lateral ceph trace and your SNA and SNB numbers from there. Cephalometrics often borders on numerology, but it’s still better than eyeballing, which is what most dumb surgeons do.

[yamahatrophy]

Thanks both for the replies. I'll discuss getting a ceph trace done when I see Defrancq later this year to get some actual data.

[tim06]

Thanks both for the replies. I'll discuss getting a ceph trace done when I see Defrancq later this year to get some actual data.

Your case is really interesting as I am suffering from the same problem. I have a very underdeveloped lower third but a class 1 occlusion and never even had to wear braces. I already got a genioplasty with 11mm advancement but sadly that wasn't enough to address the issue. Did you had a rhinoplasty? I am asking since your nose looks very feminine and sadly thats what doctors recommend to someone like us, I am currently considering getting a more feminine/curved nose to mask my deficit as well.

The only other option we have are wrap around jaw implants, I will link you two results below the first one is from Defrancq and used custom PEEK implants:
https://looksmax.me/threads/rate-my-custom-jaw-implant-by-a-maxillofacial-surgeon.55106/

This one used custom silicon implants and he had just a half-sleep anesthesia not even a full sedation, I like this result a lot:
https://imgur.com/a/bjkdr

[Movebone]

Its really odd you have such an obvious double chin, you seem to have a good gonial angle. Is your jaw narrow from the front view?

[GJ]

I'd do nothing.

But if you have issues with your nose you could focus your attention there instead of on your jaws, which appear to be fine. Objectively the nose tilts up a bit for a guy, but it's fine. Kavan, can this be adjusted with a nose job?

Chin is normal. But if you want it stronger just do genio (I guess Kavan thinks your a chin wing candidate. Not my forte).

[kavan]

You need a lateral ceph trace and your SNA and SNB numbers from there. Cephalometrics often borders on numerology, but it’s still better than eyeballing, which is what most dumb surgeons do.

Very easy to find points A, B and N on his bone scan to find angle ANB which is about 2-3 degrees, normal ANB angle. His soft tissue scan doesn't show a negative vector to indicate maxillary retrusion and his nose would tend to get worse with bimax advancement.

So, what you have is someone who would be a good candidate for either a jaw implant or a chin wing who doesn't seem to want either of those.

[kavan]

I'd do nothing.

But if you have issues with your nose you could focus your attention there instead of on your jaws, which appear to be fine. Objectively the nose tilts up a bit for a guy, but it's fine. Kavan, can this be adjusted with a nose job?

Chin is normal. But if you want it stronger just do genio (I guess Kavan thinks your a chin wing candidate. Not my forte).

Well, ya. He's got the type of mandible that chin wing doctors like to work with. Like it's not angled up too high and it looks like there is enough room or 'mass' to it to stay clear of being too close to the nerve when they make the cut. A jaw implant could also drop down border of mandible and widen it. I mentioned chin wing given that he's clearly NOT averse to a bone CUT since he's asking for bimax.  He also has the type of nose rhino docs like to fix.