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:
• 
  
  
  
• 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

 

[yussimania]

Le plan

Le execution

Pagnoni summer 2027 boys

 

[narceye]

Mirin. What are Pagnoni's prices like nowadays?

 

[newtothis_]

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:
• View attachment 5402087View attachment 5402092View attachment 5402094View attachment 5402095
• 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
View attachment 5402217
After
View attachment 5402224


Before & After (2.5 months post op)
View attachment 5402157View attachment 5402158
View attachment 5402163View attachment 5402165
View attachment 5402167View attachment 5402169

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
View attachment 5402237
View attachment 5402241
View attachment 5402243
View attachment 5402244

Infraorbital Implants
View attachment 5402275View attachment 5402276

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

ima read ts give me a few years

 

[justjutting]

Whats the measurement on the infras? How do they look irl?

 

[BM7]

You look younger

 

[tyler1234]

Are u happy with the results

 

[Vir]

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:
• View attachment 5402087View attachment 5402092View attachment 5402094View attachment 5402095
• 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
View attachment 5402217
After
View attachment 5402224


Before & After (2.5 months post op)
View attachment 5402157View attachment 5402158
View attachment 5402163View attachment 5402165
View attachment 5402167View attachment 5402169

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
View attachment 5402237
View attachment 5402241
View attachment 5402243
View attachment 5402244

Infraorbital Implants
View attachment 5402275View attachment 5402276

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

I got trimax with Ramieri 1 month ago and also have some degree of lip incompetence now, although it has gotten significantly better since the first few days when I was giga swollen. Did Pagnoni say that yours was specifically caused by the bsso? Ramieri told me that mine was caused by the cw rotation I asked for in my genio in order to fix my chin to philtrum, and also told me there's not much I can do if in a few months if it doesn't go away. What are you doing to manage it? Also I woke up the day after surgery with almost full sensation in my chin and lips, and by the first week it was back to normal. I'm not sure if I'm an outlier or what, but I think 2.5 months with no feeling whatsoever is a lot

 

[vernowwww]

I got trimax with Ramieri 1 month ago and also have some degree of lip incompetence now, although it has gotten significantly better since the first few days when I was giga swollen. Did Pagnoni say that yours was specifically caused by the bsso? Ramieri told me that mine was caused by the cw rotation I asked for in my genio in order to fix my chin to philtrum, and also told me there's not much I can do if in a few months if it doesn't go away. What are you doing to manage it? Also I woke up the day after surgery with almost full sensation in my chin and lips, and by the first week it was back to normal. I'm not sure if I'm an outlier or what, but I think 2.5 months with no feeling whatsoever is a lot

I had surgery with ram and woke up with full sensation everywhere just think hes good with the nerves

 

[KingFrost]

Mirin. What are Pagnoni's prices like nowadays?

I'll PM you (since people like to PM prices for some reason) Can't PM so I'll just say it was 36k Euro for everything + 1.5 - 2k for braces

Whats the measurement on the infras? How do they look irl?

Oh they're about 3 mm in thickness but the thickness is not strictly uniform, it varies based on location of the implant. All I can say is the implants aren't overdone which is good.

Are u happy with the results

Well it's still hard to say tbh due to the amounts of swelling in the cheeks. And also the lower lip incompetence looks really bad so hopefully that heals later on.

I got trimax with Ramieri 1 month ago and also have some degree of lip incompetence now, although it has gotten significantly better since the first few days when I was giga swollen. Did Pagnoni say that yours was specifically caused by the bsso? Ramieri told me that mine was caused by the cw rotation I asked for in my genio in order to fix my chin to philtrum, and also told me there's not much I can do if in a few months if it doesn't go away. What are you doing to manage it? Also I woke up the day after surgery with almost full sensation in my chin and lips, and by the first week it was back to normal. I'm not sure if I'm an outlier or what, but I think 2.5 months with no feeling whatsoever is a lot

Yeah he said it was caused by mandibular advancement which stretched the tissue/muscle. Since my surgery was about 22 mm advancement at pogonion. I'm doing myofunctional exercises with the lips and massaging my chin and lower lip scar tissue but it hasn't really moved upwards. I can however move my lower lip upwards somewhat without much mentalis strain tho

 

[lurking truecel]

I got trimax with Ramieri 1 month ago and also have some degree of lip incompetence now, although it has gotten significantly better since the first few days when I was giga swollen. Did Pagnoni say that yours was specifically caused by the bsso? Ramieri told me that mine was caused by the cw rotation I asked for in my genio in order to fix my chin to philtrum, and also told me there's not much I can do if in a few months if it doesn't go away. What are you doing to manage it? Also I woke up the day after surgery with almost full sensation in my chin and lips, and by the first week it was back to normal. I'm not sure if I'm an outlier or what, but I think 2.5 months with no feeling whatsoever is a lot

I had surgery with ram and woke up with full sensation everywhere just think hes good with the nerves

Also woke up with full feeling everywhere from ram so that makes it 3/3

 

[KingFrost]

Some highlights of the recovery process

3rd day post op

4th day post op

5th day post op

9th day post op

 

[Acquiescence]

Based public sharer of experience

At least you look 10 years younger than you are

 

[Lookologist003]

Le execution

This is like a double entendre

 

[it_will_begin]

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:
• View attachment 5402087View attachment 5402092View attachment 5402094View attachment 5402095
• 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
View attachment 5402217
After
View attachment 5402224


Before & After (2.5 months post op)
View attachment 5402157View attachment 5402158
View attachment 5402163View attachment 5402165
View attachment 5402167View attachment 5402169

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
View attachment 5402237
View attachment 5402241
View attachment 5402243
View attachment 5402244

Infraorbital Implants
View attachment 5402275View attachment 5402276

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

You are improved, don't get me wrong: especially the infras are good.
But the bimax movement seems to don't match the outcome, the simulated side profile result seems a lot different... and seems that you're left with an open bite.
I hope it can get better with more recovery, along with the recovery of sensation.
Good to know that Ram is good to preserve nerves since I'm having surgery with him in December @lurking truecel

 

[KingFrost]

So I made a post on reddit on r/jawsurgery and someone reached out to me and offered to examine my CT scans (1 pre-op, 1 immediately post-op, and 1 two months post-op). They used the same imaging software (Dolphin Imaging) that Pagnoni and other surgeons use. Below is what they came up with:

Everything below is the result of a random guy on Reddit, so please take it with a grain of salt.

*pls click image attachments at bottom of post if you want to see them bigger*

About 4mm of relapse at the chin (between immediate post-op and 2 months post op)

Condylar sag (between immediate post-op and 2 months post op)

And some various angles of the supposed relapse (because skulls are cool)

Incisor change (due to orthodontic work)

And here's a soft tissue image from the 2 months CT scan since I haven't posted it yet. You can compare it to the soft tissue imaging from my OP post

Here's some screenshots of the chat with the guy on Reddit:

 

[KingFrost]

I will have an actual professional third-party to examine my CT scans to see if Reddit dude was in fact being based and truthful. It might take a week or two tho. Not much else to say at this moment except I still intend to go through the 1.5 year braces plan I mentioned in OP post. Oh, and I'm starting to get minor feeling back on the left side of my chin since I posted OP post.

I won't be posting update pics until the 4 month milestone. But I might as well post some extra profile angles for comparison; dates are in the image, first photo was taken like 1 day post op (so May 8th).

 

[lurking truecel]

So I made a post on reddit on r/jawsurgery and someone reached out to me and offered to examine my CT scans (1 pre-op, 1 immediately post-op, and 1 two months post-op). They used the same imaging software (Dolphin Imaging) that Pagnoni and other surgeons use. Below is what they came up with:

Everything below is the result of a random guy on Reddit, so please take it with a grain of salt.

*pls click image attachments at bottom of post if you want to see them bigger*

About 4mm of relapse at the chin (between immediate post-op and 2 months post op)
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Condylar sag (between immediate post-op and 2 months post op)
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And some various angles of the supposed relapse (because skulls are cool)
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Incisor change (due to orthodontic work)
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And here's a soft tissue image from the 2 months CT scan since I haven't posted it yet. You can compare it to the soft tissue imaging from my OP post
View attachment 5425676

Here's some screenshots of the chat with the guy on Reddit:
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I mean the most important points about this, was the scans both standing ? Looking at spine its totally diffrent. The condyle being pushed back inside the condyle when laying down vs standing. Aslo some relapse is not a question about it happening, it will happen. Overall the bsso cut on both sides looks similar. Also the condyle position overall is useless since you get swelling inside the condyles aswell from surgery itself and just slight diff jutt changes them. Ngl i think you just stumble on a idiot on reddit. And some condyle remodelling is happening to everyone post bimax but most dont even check it up. Many people describe that clikcing noise dissapear after bimax which is often more a sign of cyndyle mechanical remodelling and resorption then anything else. But people also allways link condylar remodelling with icr which is just a extreme case. Normal resorption usually just stops after a time period and stabilizes and you dont have any problems with it after.

Your problem is prob still just that your soft tissue couldnt take the downgraft

 

[KingFrost]

They were both done while lying down, but the two post-op CT scans were done in different rooms so that might explain the difference? But yeah thanks for pointing out the spine thing. As for the relapse (if there was any), I just hope it doesn't get worse later on

When you say downgraft, are you referring to the PNS? Because according to the movement chart, that's really the only part that gets a sizable downward movement.

 

[Vir]

seems like a perfect result to me
1:1 planning and execution
pagnoni my goat

 

[muragoat]

I mean the most important points about this, was the scans both standing ? Looking at spine its totally diffrent. The condyle being pushed back inside the condyle when laying down vs standing. Aslo some relapse is not a question about it happening, it will happen. Overall the bsso cut on both sides looks similar. Also the condyle position overall is useless since you get swelling inside the condyles aswell from surgery itself and just slight diff jutt changes them. Ngl i think you just stumble on a idiot on reddit. And some condyle remodelling is happening to everyone post bimax but most dont even check it up. Many people describe that clikcing noise dissapear after bimax which is often more a sign of cyndyle mechanical remodelling and resorption then anything else. But people also allways link condylar remodelling with icr which is just a extreme case. Normal resorption usually just stops after a time period and stabilizes and you dont have any problems with it after.

Your problem is prob still just that your soft tissue couldnt take the downgraft

They were both done while lying down, but the two post-op CT scans were done in different rooms so that might explain the difference? But yeah thanks for pointing out the spine thing. As for the relapse (if there was any), I just hope it doesn't get worse later on

When you say downgraft, are you referring to the PNS? Because according to the movement chart, that's really the only part that gets a sizable downward movement.

simply pag didn t seat the condyles right. i wouldn t say there is significant relapse. everything rotated cw just because of unproper condyle position during the op. the fact you can't seal your lips at 3 months post op is scary.

 

[lurking truecel]

They were both done while lying down, but the two post-op CT scans were done in different rooms so that might explain the difference? But yeah thanks for pointing out the spine thing. As for the relapse (if there was any), I just hope it doesn't get worse later on

When you say downgraft, are you referring to the PNS? Because according to the movement chart, that's really the only part that gets a sizable downward movement.

Yea you prob had diff pillows to lie on in diff height. But yea, i mean condyle pos and that stuff you cant judge, do you even now if you teeth touched the same, because it looks like the back teeth doesnt meet but the other one does.

Also the plan was more ccw rotated but it became cw rotated, and thats just execution. So overall the plan become too downgrafted feom the mandible and veen macxilla. You might have needed impaction but since you said to him no nasal folds, impaction makes nasalfolds worse so maybe thats why he went against it

 

[lurking truecel]

simply pag didn t seat the condyles right. i wouldn t say there is significant relapse. everything rotated cw just because of unproper condyle position during the op. the fact you can't seal your lips at 3 months post op is scary.

I mean since the scans post op didnt have condylar sag it must be soft tissue dragging it into that position if anything. But its prob just swelling vs none swelling and diff position in scan