Thinking of going for DJS

[trandom]

Hi everyone!

I visited the doctor about my DJS and he said that I'm a really good candidate for a couple of reasons:

• Bumpy & downward nose tip
• Deep labiomental fold
• Both upper and lower jaws need advancement
• My chin has a good amount of tissue beyond the bone (he said that's what saves me right now from looking REALLY recessed)
• Strong top half of face

My doctor said that we're going to move the lower jaw around 7mm and the upper one about 4mm, to me it seems like it would make too little of a change since I've heard that other people are doing much bigger movements.

I'd like to get a second opinion from you guys.

[kavan]

Advancement of the upper jaw will give better support to the base of your nose and help reverse the downward rotation of your tip.

Advancement of the lower jaw would be with aim of balancing it with the upper and in that way your chin would move forward with the advancement without needing a sliding genio to the chin and thereby AVOID making the lower lip to chin groove DEEPER.

That's the basic 'translation' of what he's telling you.

[trandom]

From your eyeing, do you think 3mm upper + 7mm lower will do the job here?

[GJ]

From your eyeing, do you think 3mm upper + 7mm lower will do the job here?

I think that would look good/natural, but not uber masculine. So it depends what you want.

Your soft tissue appears to be on the thicker side, so you could maybe get away with more bony movement. That's up to you and the surgeon.

[kavan]

I don't opine on EXACT mm movements for the following reason:

 A 'forward' advancement has 2 displacement vectors; a horizontal and a vertical. In the absence of ceph displacement proposal where it would have a read out of the displacement vectors, there's no 'exact' displacements for me to opine on.

[Dogmatix]

7mm is not a small movement when it comes to your face, you will notice it. The problem with large movements is that even tough it might make the profile line up perfectly, it can look unnatural since you move some isolated parts of your entire skull. I had 16mm and even though the profile looks great, I sometimes think my jaw looks too prominent in relation to my facial structure.

Do you know if your doctor is capable of doing ccw rotation? It looks like you might be a candidate for it.

[kavan]

7mm is not a small movement when it comes to your face, you will notice it. The problem with large movements is that even tough it might make the profile line up perfectly, it can look unnatural since you move some isolated parts of your entire skull. I had 16mm and even though the profile looks great, I sometimes think my jaw looks too prominent in relation to my facial structure.

Do you know if your doctor is capable of doing ccw rotation? It looks like you might be a candidate for it.

He is within the range of NORMAL MPA (17 deg to 28 deg). He's in approx 25 deg range and his OP is not steep. He is NOT a clear cut candidate for CCW and could have linear advancement.

[Luka2020]

If you want to change the shape and rotation of your nose - why not just get a rhinoplasty?
Your chin and labiomental fold looks good. Your face looks balanced. Your airway doesn't look narrow.

I would not consider any surgery in your case.

[trandom]

Update: Just gotten a plan from out of the surgeons I spoke with.

I'd like to hear your guy's opinion on it, and maybe simplify it for me, I'm not 100% clear on what it means exactly, I just know that it's a DJS with CCW.

[kavan]

I have included some annotations beside your read out to explain what the displacements of some salient areas mean.

I DON'T wish to posit about what all the stuff below your displacement read out means because I'm not familiar with all surgeons sub notes.

The CCW-r is significant enough for the chin point to be horizontally displaced by 20 mm (and vertically displaced upward) without having to do a genioplasty.

About half of the CCW-r is an anterior impaction, the other half is a posterior downgraft.
The extent of the anterior impaction in addition to the horizontal displacement to the front of the maxilla would tend to kick up visible changes to the base of the nose which might be favorable to someone with a short and furled upper lip and and a downwardly rotated nose tip such as yourself. Because advancing the front of maxilla and also raising it up by impaction would tend to look like a rhinoplasty.

Whether or not you will like the changes can't be answered from here (from me). Nor can piece meal questions about stuff like; 'Is this or that millimetre movement too much or too little?'

If you have any questions about how the extent of the displacements 'sound' relative to how they will LOOK, what you will need to do is request the surgeon who planned the displacements to provide you with VISUAL that SHOWS you how all of the displacements would look together. That can be as simple as displacement profile CONTOUR diagram that outlines your present profile contour and on it, superimposes a projected NEW contour diagram. That is because VISUALS that show a patient a potential contour change outcome assist a patient to determine for him/herself if they like the look of the proposal.

A diagram is included with this post.

[trandom]

Thank you very much for taking your time kavan.

Basically, the reason I'm in doubts is that another doctor, who is also aesthetically oriented and is experienced with doing this procedure, was suggesting much more subtle changes, I'll compare between the 2:

Doctor from my country:

Who he is: He's a known max fac from my country, a lot of experience, aesthetically oriented.

What I told him I want: My meeting with him was before I discovered this forum, I came with 0 knowledge, thinking I needed a genioplasty, maybe that's why his "verbal plan" was on the cautious side.

What he suggested: Around 7mm mandible movement and 3-4mm maxilla movement, did not talk about CCW.


High profile doctor - the one that made the plan I posted:

Who he is: High profile doctor from Europe, one of the big names.

What I told him I want: I came to the meeting with more preparation than the first doc, I told him that I want a big, dominant change, we talked about CCW too.

What he suggested: The 2nd plan, which I posted here.


I am questioning things because to me it's very confusing that these plans are so different (well, the 1st plan isn't actually a plan, the doc just told me what he thinks we'll do), I'd be more comfortable if they were at least closer in terms of movement.

I must say though, that I stressed to the high profile doc that I want an ante-face and dominant lower half, I guess that also plays a part in why the plans are so different.

After seeing how the 2nd plan looks, I have a feeling that the 1st plan would leave me with a still recessed face - yes, 7mm is a lot, it will surely bring me into the normal range, but like GJ said before, it won't be uber-masculine, not even close to it from my understanding.

Also, I do have a diagram showing the visual of the plan, I REALLY like it, if there was a sure way to know that that's it's gonna look the same in real life, I wouldn't think twice.

What makes me doubt it:
I know that soft tissue reaction is not always anticipated easily.
The first plan was much less dramatic.
I've never seen such a good result as this visual.

Visual of the 2nd plan - https://imgur.com/a/aBXyXpo

[SmallJaw12]

Maybe you can check with your first surgeon if the suggested movements would include any rotation (maybe through anterior impaction). Do you have a gummy smile?

[Sergio-OMS]

Hi everyone!

I visited the doctor about my DJS and he said that I'm a really good candidate for a couple of reasons:

• Bumpy & downward nose tip
• Deep labiomental fold
• Both upper and lower jaws need advancement
• My chin has a good amount of tissue beyond the bone (he said that's what saves me right now from looking REALLY recessed)
• Strong top half of face

My doctor said that we're going to move the lower jaw around 7mm and the upper one about 4mm, to me it seems like it would make too little of a change since I've heard that other people are doing much bigger movements.

I'd like to get a second opinion from you guys.

Yes, you would benefit from the potencial aesthetic effects of an adequately planned jaw surgery.

[kavan]

Thank you very much for taking your time kavan.

Basically, the reason I'm in doubts is that another doctor, who is also aesthetically oriented and is experienced with doing this procedure, was suggesting much more subtle changes, I'll compare between the 2:

Doctor from my country:

Who he is: He's a known max fac from my country, a lot of experience, aesthetically oriented.

What I told him I want: My meeting with him was before I discovered this forum, I came with 0 knowledge, thinking I needed a genioplasty, maybe that's why his "verbal plan" was on the cautious side.

What he suggested: Around 7mm mandible movement and 3-4mm maxilla movement, did not talk about CCW.


High profile doctor - the one that made the plan I posted:

Who he is: High profile doctor from Europe, one of the big names.

What I told him I want: I came to the meeting with more preparation than the first doc, I told him that I want a big, dominant change, we talked about CCW too.

What he suggested: The 2nd plan, which I posted here.


I am questioning things because to me it's very confusing that these plans are so different (well, the 1st plan isn't actually a plan, the doc just told me what he thinks we'll do), I'd be more comfortable if they were at least closer in terms of movement.

I must say though, that I stressed to the high profile doc that I want an ante-face and dominant lower half, I guess that also plays a part in why the plans are so different.

After seeing how the 2nd plan looks, I have a feeling that the 1st plan would leave me with a still recessed face - yes, 7mm is a lot, it will surely bring me into the normal range, but like GJ said before, it won't be uber-masculine, not even close to it from my understanding.

Also, I do have a diagram showing the visual of the plan, I REALLY like it, if there was a sure way to know that that's it's gonna look the same in real life, I wouldn't think twice.

What makes me doubt it:
I know that soft tissue reaction is not always anticipated easily.
The first plan was much less dramatic.
I've never seen such a good result as this visual.

Visual of the 2nd plan - https://imgur.com/a/aBXyXpo

My hunch, when looking at just the read out along with the absence of information on your part as to your communication with the doctor and the visual was that the extent of the advancement must have arisen from a direct request on your part for something very dramatic.

The displacement plan along with the visual IS very much CONSISTENT with accommodating a request for significant advancement. It IS NOT one that would arise in the ABSENCE of such a request.

Hence, that indeed is the basic explanation behind why the plans from different doctors dramatically differ.

[CCW]

Thank you very much for taking your time kavan.

Basically, the reason I'm in doubts is that another doctor, who is also aesthetically oriented and is experienced with doing this procedure, was suggesting much more subtle changes, I'll compare between the 2:

Doctor from my country:

Who he is: He's a known max fac from my country, a lot of experience, aesthetically oriented.

What I told him I want: My meeting with him was before I discovered this forum, I came with 0 knowledge, thinking I needed a genioplasty, maybe that's why his "verbal plan" was on the cautious side.

What he suggested: Around 7mm mandible movement and 3-4mm maxilla movement, did not talk about CCW.


High profile doctor - the one that made the plan I posted:

Who he is: High profile doctor from Europe, one of the big names.

What I told him I want: I came to the meeting with more preparation than the first doc, I told him that I want a big, dominant change, we talked about CCW too.

What he suggested: The 2nd plan, which I posted here.


I am questioning things because to me it's very confusing that these plans are so different (well, the 1st plan isn't actually a plan, the doc just told me what he thinks we'll do), I'd be more comfortable if they were at least closer in terms of movement.

I must say though, that I stressed to the high profile doc that I want an ante-face and dominant lower half, I guess that also plays a part in why the plans are so different.

After seeing how the 2nd plan looks, I have a feeling that the 1st plan would leave me with a still recessed face - yes, 7mm is a lot, it will surely bring me into the normal range, but like GJ said before, it won't be uber-masculine, not even close to it from my understanding.

Also, I do have a diagram showing the visual of the plan, I REALLY like it, if there was a sure way to know that that's it's gonna look the same in real life, I wouldn't think twice.

What makes me doubt it:
I know that soft tissue reaction is not always anticipated easily.
The first plan was much less dramatic.
I've never seen such a good result as this visual.

Visual of the 2nd plan - https://imgur.com/a/aBXyXpo

Who are the doctors?