Bimax + Genioplasty + Infraorbital implants with Dr. Pagnoni [welcome to suggestions]

[KingFrost]

I am not a poaster and I don't lurk that much so please bear with me as I share my results (so far). Just wanted to share my progress for regulars and lurkers alike and also would like to receive any feedback about where to go from here once the swelling and recovery finalize over the coming months.

**Click on attachments for bigger pictures pls**

Some basic facts to know for context:

• I am a 33 year old oldcel (literally & unironically)
• I've already had surgery back in 2023 (laser eye surgery, rhinoplasty, and (silicone) chin implant). Laser eye surgery I still have no regrets with, and the rhinoplasty+ chin implant combo did improve my side view somewhat but didn't really do favors for the front. Plus the chin implant would start to feel tight and bother me years later whenever I tried to lose weight.
• Consulted with Dr. Pagnoni and told him that my main concerns, besides the recessed everything, were my nasolabial folds, long philtrum, and dark under eyes.
• For the forward movement measurements of the maxilla and mandible, I actually didn't give him specific measurements in mind. I basically told him I wanted "facial harmony" and trusted his judgment as a professional surgeon. The post op simulation and detailed measurements below are the result:
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• In short, the basic planned movements were 4.5 mm (forward) maxilla, 10.98 mm (forward) mandible, 10.25 mm genioplasty, and 10 degrees of CCW rotation of the occlusal plane from 16.7 to 6.46 degrees. Also 3.2 mm of impaction.
• I was told that I was a surgery first candidate and I opted to stay in Italy for around 2 months after the surgery to meet up with the doctor for frequent follow-up appointments as well as with the Italian orthodontist he likes to collaborate with, Dr. Fadda. Had my braces done just about a week before the actual surgery date which happened on May 7th.
• For the double jaw surgery, custom titanium plates are used, and the infraorbital implants (not saddled) are made of PEEK. And sorry to disappoint, but the infraorbital implants are not designed by Giant. They were designed by the other (unnamed) Italian designer which Dr. Pagnoni regularly works with.
• I actually didn't learn this until 2 months after the surgery, but a bone graft was used for the posterior side of the maxilla since that side experienced a downgraft -- as opposed to the anterior side which had the impaction mentioned earlier. Otherwise, a bone graft was not used in any other location.

THE PLAN
Before

After

Before & After (2.5 months post op)

I have way more comparisons from previous dates which I can post later but this is the most up-to-date one since I took these photos today. And yes, that is where my lips currently rest since I have lower lip incompetence after the surgery due to the amount of mandibular advancement. Other than the lip incompetence, I still have a good amount of swelling in the cheeks (I can feel the swelling whenever I blink my eyes), some swelling in the chin and lower lip area... and maybe a little in the upper lip/maxilla. Total numbness in the chin and lower lip at this point still but I think that's normal.

CT Scans

Infraorbital Implants

I was initially given a choice between two sets of implant designs to choose from. They were basically similar to each other, with the only notable difference being that one choice would have the implant placed one millimeter closer to the eye socket rim compared to the other one. I opted for the latter since I didn't want to risk losing eyesight or something like that.

Recovery

• I'm still waiting for the swelling and hopefully the lower lip incompetence to fix themselves over the next 6 months - 1 year (timeline I was given by Pagnoni). I frequently perform myofunctional therapy with the lips and massage my chin and lower lip scar tissue since I was informed it will help the lip incompetence heal faster/better. He did say, however, that if that doesn't work out, there is always mentalis resuspension surgery to consider.
• Same for the upper lip, since it is currently hiding my upper set of teeth. Informed by Pagnoni that as swelling in the area subsides, there will be visible upper teeth show when I talk or open my mouth. He did say, however, that if that doesn't work out, there is always lip lift surgery to consider.
• Still haven't been given the ok for chewing hard foods yet obviously; last time I talked to him he said it was fine to chew steak which honestly surprised me. I'm still focused on chewing softer foods though and getting nutrients important for bone formation (calcium, vitamin d, vitamin k2, protein, etc).
• Not experiencing any clicking or popping of the TMJ area since the surgery, which is a good sign. Fingers crossed I don't develop a non-union or anything else unfortunate later down the line
• At this point all the sutures inside of the mouth have either dissolved or fell out of my mouth since approx 7-8 weeks after the surgery. So only scar tissue remains. The last time I had a CT scan performed (almost 2 weeks ago) there were early signs of bone formation in the various maxilla, mandible, and genioplasty sites.
• My eyesight is unaffected by the infraorbital implants and I did have brutal bruising and bloodshot eyes that lasted for a month after the surgery.
• Wore elastic bands for the past 2 months according to the instructions of the Italian orthodontist and am currently wearing them for sleep only now.

Future & Suggestions

So I arrived back in the U.S. a week ago and met up with my orthodontist stateside just today (he's been in contact with Dr. Pagnoni) and he says he's going to need me to continue my braces treatment for another 1.5 years which I was not expecting. This was to address my current overjet as well as the fact that my midline between my upper/lower teeth are misaligned, along with other minor issues. I actually was not expecting to have braces for this long after the surgery which sucks. I'm probably going to go through with this anyway but please let me know if I'm an outlier when it comes to this kind of thing.

I intend to go ahead with a lip lift some time early next year to address my giga-long philtrum but I am also scared of any possible lip incompetence issues. Lip incompetence is seriously no joke.

Going off of my pictures, please let me know what else I can do to go from here. I will update this thread later at various intervals like 3 months, 4 months, 6 months, etc. to show off any progress on the recovery.

I'm tired, I'm going to go back to gaming