BiMax + Implants (Looking for Advice)

@lurking truecel

This is what you meant with Jaw Widening (Condylar Torqueing), right?



Have you seen any examples of people that got that?

I think ive seen one Girl on Reddit that got her Jaw widened like that and she definitely looks better now, but i think most people shouldnt be doing it.


Yes it's condylar torquing, i don't have any result, but I think even in normal bimax they will torque some. It's like 5 mm max on both sides
 
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She looks very pretty from the side now and she had an Open Bite with Lip incompetence just like me which is gone now - i hope mine will will be gone too after Surgery.

@lurking truecel I feel like her posture slightly improved too immediately after surgery?

Do you think the body will naturally adjust / stop compensating with bad posture completely on itself after the surgery or will we still have to work on it because we are used to this bad posture / were walking around like that our whole life?
 
She looks very pretty from the side now and she had an Open Bite with Lip incompetence just like me which is gone now - i hope mine will will be gone too after Surgery.

@lurking truecel I feel like her posture slightly improved too immediately after surgery?

Do you think the body will naturally adjust / stop compensating with bad posture completely on itself after the surgery or will we still have to work on it because we are used to this bad posture / were walking around like that our whole life?
I mean the normal human being today have kinda shit posture so after bimax it will probably be better than average at least. But yes practicing posturing with stretching and some muscle excersizes will help to make it better and sustainable even after
 
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I mean the normal human being today have kinda shit posture so after bimax it will probably be better than average at least. But yes practicing posturing with stretching and some muscle excersizes will help to make it better and sustainable even after
 
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in the post bimax results I have never seen an elongation of the philtrum
Don't understand, can you elaborate please?

You mean in Past BiMax Results you have never seen an elongation of the Philtrum?
 
Don't understand, can you elaborate please?

You mean in Past BiMax Results you have never seen an elongation of the Philtrum?
I think i meant to say that in the results I've seen I rarely see lengthening of the philtrum
 
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@lurking truecel @iseeblue9 @NZb6Air

Do you guys know what the best Method of Capturing the NHP Position is currently?

In the Paper i read from Kühle it says this:

Digital treatment planning was performed using IPS CaseDesigner V. 2.4, a surgicalplanning and simulation software based on the individual patient datasets described below.The data included in the virtual planning were: (1) low-dose CT of the skull (DICOMdataset); (2) natural head position (NHP) standardized photos (*.jpeg); (3) intraoral scans(.stl); and (4) a digital model of the target occlusion (*.stl). These data were consecutivelyentered into IPS CaseDesigner V. 2.4 and merged to simulate the surgery based on the NHP.

https://www.researchgate.net/public...ually_Planned_Segmental_Le_Fort_I_Osteotomies

@lurking truecel Do you know how your Surgeon Captures and transfers the NHP?

The Paper above is from September 2023 tho, but i know someone took Photos of me most likely to Capture my NHP.

Capturing the NHP and transfering it to the CT or CBCT is very importent for the Surgicsl outcome and i know for a fact that Capturing the NHP with Photos isn't the best and most accurate Method.

https://www.sciencedirect.com/science/article/pii/S0278239122004128
 
I think i meant to say that in the results I've seen I rarely see lengthening of the philtrum
Oh ok, verstood.

Yeah i mean based on the Simulation and pure logic it probably jusr Streches the Skin in the area which then might make the philtrum appear longer?

I have read many comments on Reddit of People who say that their philtrum lengthened after Surgery.
 
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Dr. Augusto Pary made a Instagram Post about this:
🇺🇸🇺🇸🇺🇸
If I can say something after 15 years working with orthognathic and face surgery, it is that one of the most important factors of success is the oriented position of the head. That's point number 1 for a good result.
It sounds simple but it's not. Cl II and asymmetric patients are the ones with the most postural changes and only an attentive and experienced surgeon will know how to position them properly. This requires training and understanding what anatomical structures are the most reliable to use as a reference.
Wrong position changes the diagnosis and planning numbers, leading to suboptimal results.
And not only that, this clinical position has to be transferred identically to the CT scan.
In the following slides, I show some references that I use for this.



But that Post is also quite old ( 9. September 2022 )

What is the most accurate method of Capturing the NHP right now?
 
@lurking truecel

Should be very Important for you too since you said we have the Same Issue regarding Shit Posture.
 
@RealSurgerymax

How do you capture and Transfer the NHP into the VSP in your Cases if you don't mind saying?
 
@lurking truecel @iseeblue9 @NZb6Air

Do you guys know what the best Method of Capturing the NHP Position is currently?

In the Paper i read from Kühle it says this:



https://www.researchgate.net/public...ually_Planned_Segmental_Le_Fort_I_Osteotomies

@lurking truecel Do you know how your Surgeon Captures and transfers the NHP?

The Paper above is from September 2023 tho, but i know someone took Photos of me most likely to Capture my NHP.

Capturing the NHP and transfering it to the CT or CBCT is very importent for the Surgicsl outcome and i know for a fact that Capturing the NHP with Photos isn't the best and most accurate Method.

https://www.sciencedirect.com/science/article/pii/S0278239122004128
The NHP is of importance in 3-dimensional virtual surgical planning (3D VSP) of orthognathic surgery. It provides the surgeon with a reference of the subjects' head orientation in space in relation to maxillary and mandibular movements. Generally, the NHP of the subject is obtained from frontal and lateral photographs and manually transferred to the 3D VSP with the aid of true horizontal and vertical lines.5 A previous study performed by Zhu et al investigated the reproducibility and accuracy of manually estimating the NHP, reporting a median reproducibility of −0.3° for the roll, −1.3° for the pitch, and 0.2° for the yaw.6


The influence of inaccuracies in the manual transfer of the clinical NHP to the 3D virtual planning environment on the hard tissue and soft tissue position in VSP has not been reported. This is, however, clinically relevant as an inaccurate transfer of the NHP to 3D VSP may influence the baseline jaw and soft tissue position and consequently lead to errors in the 3D VSP and the final surgical outcome. The aim of this study was to assess the reproducibility of manually transferring the clinical NHP to the 3D VSP and its subsequent influence on the soft tissue and maxillary hard tissue position.

Conclusions​

The present study demonstrated that the manual transfer of the NHP from the clinical situation to the virtual environment influenced the soft tissue and hard tissue position and that a more reproducible method of transferring the clinical NHP is recommended.
 
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Yeah guys, for anyone who is Interested in BiMax in the Future as you can see there's a lot of Knowledge needed for a good Result.

I really don't recommend rushing this Surgery, planning is Everything for BiMax.

I'm kind of forced to do all this shit research because I've been lied to from Doctors in the Past because most people simply Trust Doctors and think they are some Gods that know everything, but that couldn't be further from the Truth…

And some of them brutally exploit this to make more Money.

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This forum isn't the Only Source for information btw, I'm just posting here because obviously (some) People here do have very very good knowledge. But I would also suggest reading Academical Papers from Surgeons.

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If yore Uninformed and get pushed / or go to some Surgeon its a Gamble either you're going to get Fucked or you're lucky and got to someone that knows what he's doing.

I listended to my Bad Gut Feeling and said fuck that when i had my first Consultation with a Surgeon.

No CBCT or CT, he wanted to Operate me based on only X-Rrays and i bet it would have been a Straight Advancement without Rotation making me look like a Monkey...

Not even sure if he would have done BSSO, maybe he would have done HSSO osteotomy like some sother Surgeon i know which is outdated and rearly used these day for good reasons!
 
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I have read many comments on Reddit of People who say that their philtrum lengthened after Surgery.
yes me too, do you think that bimax with impaction ccw rotation would reduce it ?

btw i have some questions to ask, can i pm you ?
 
yes me too, do you think that bimax with impaction ccw rotation would reduce it ?

btw i have some questions to ask, can i pm you ?
Ill go to bed soon tho, so i might not be able to give you a detailed anwser immediately if its something more complex.
 
About the Airway:

This is pure speculation, but do you guys think UARS / SleepApnea could be the Cause for my ADHD?

Meaning, could it be possible that i sufficated in my Mothers Womb or as a small Child when my Brain Developed which then caused Brain Damage?

---

I actually took Benzodiazepines for Sleep once and Benzos relax your muscles.

My Brain Chemistry is fucked because of Stimulants which i desperately need to function normally / work / live a Normal Life (i tried it without for 20 Years because i didn't know i had ADHD) and it went miserable.

And i remember sleeping on my Back once (i took Benzos to Sleep that day), woke up in the Middle of the Night due to Sleep Paralysis and literally witnessed my Airwy Colpsing (i think) because i couldnt breathe trough my Nose. I legitimately thought im going to suffocate and die in that moment.

If that actually happens every night i wouldnt be surprised whatsoever that this Shit causes Brain Damage - you literally Stop Breathing for some time if you habe real Sleep Apnea.

---

Maybe my ADHD will be better Post OP (because i will be able to breathe better), because im literally taking 70mg Vyvanse/Elvanse (Lisdexamfetamine) + 300mg Elontrol (Bupropion) (off label for ADHD) because even 70mg Vyvanse isnt enough for me.

I will try Semax too as the other Guy Suggested.
 
Nah, Doctor checked and said no TMJ.

But i do have Clicking / Popping on both Sides which is actually gone when i Jutt man lower Jaw forward.
man my doctor recommanded me i get tmj disk thingy + bimax he talked about a new type of technologie that only one surgeon does it in north america only problem is i gotta wait month and wait until they remove my braces other than that my jaw is killing me
 
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man my doctor recommanded me i get tmj disk thingy + bimax he talked about a new type of technologie that only one surgeon does it in north america only problem is i gotta wait month and wait until they remove my braces other than that my jaw is killing me
We had this discussion above actually.

Which Doctor do you meean?

Alfi?

Alfi literally says he performs BiMax with Custom Guides & Plates (for the BSSO too) purely for people with TMJ and says the outcomes are consistently Positive.
 
We had this discussion above actually.

Which Doctor do you meean?

Alfi?

Alfi literally says he performs BiMax with Custom Guides & Plates (for the BSSO too) purely for people with TMJ and says the outcomes are consistently Positive.
no i dont remmeber his full name but i know it starts with K and the surgery is around 30-40 min for the tmj issue
 
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no i dont remmeber his full name but i know it starts with K and the surgery is around 30-40 min for the tmj issue
I don't have TMJ so i really never got into that but do you mind sharing if you find out who it is / what the procedure is exactly?

Or you go and trust Dr. David Alfi and go with him if you have TMJ



20:37 - 22:22

Instead, we're seeing an entire paradigm change shift and even philosophy where TMJs become healthier consistently and predictably after surgery so in fact a lot of my patients come to the office not for even thinking about jaw surgery but just complaining of their TMJs

Logically only one Person can be right.

There's no way Dr. David Alfi can just say those things? I mean he actually operates people?!
 
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but do you mind sharing if you find out who it is / what the procedure is exactly?
yea i just gotta read the thousand of doccument he send me once i do i will send it thanks
 
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The Consultation was awesome, but a little short unfortuanately - i didn't have much time to speak with Kühle.

And yes, he actually remembered me from the Phone call i made half a year ago where i mentioned i have access to IPS CaseDesigner haha :ROFLMAO:

The Consultation was a Dysgnathia Consultation tho, meaning Surgeon + Orthodontist was present, we didn't discuss the actual Movements or Planned the Surgery - or well the Consultation wasn't for that purpose but i spoke about it with Kühle anyway a little bit because i came well prepared.

He actually does use Custom Guides & Plates for the BSSO too, but not on all Patients (i think only for Sleep Apnea cases? - not sure).

I also told him about Dr. David Alfi anf the TMJ story but Kühle didn't know who Alfi is, maybe he will look into it now tho.

They need some kind of Medical Indication to operate on me tho, but i think they found something and we can make it work.

I honestly dont even know how i got this shit covered by Insurance, present Ortho said it might have been something else (not anterior open bite) but i dont remember exactly.

Kühle literally said:

"Tell me what you want, it will be easier for me"

Should we plan purely and only for looks / astehtnics or health? :forcedsmile:

I said both (Genioplasty would probably fix my Lip Incompetence which would fix both looks and health issue) but even to that he responded we can plan the Genioplasty for perfect lip closing or for the best look / asthetic outcome :lul:

❤️❤️❤️❤️❤️❤️

i didn't really understand much but Kühle is very smart he explained stuff like condyle positioning in CT vs on the operating table, we talked about soft tissue prediction when lying down in a CT and Soft Tissue Prediction of regular CBCT when standing up

if you lay down in a ct your face is different compared to standing up with a regular cbct

when youre laying down it gives you a mini face lift (someone privately told me this who also messed around with cmf softlare like me)

We were even talking about CT Maschines where you're Standing Straight for a moment, but from what i understood those machines arent really good yet?

we also don't need to remove any teeth, kühle told me he can make the BSSO cut without removing my back teeth

didnt get the chance to ask about implants, it was the wrong consultation for that anyway and im still overweight so doesnt really make sense to discuss this yet i think but i lost a bunch of weight due to adhd meds in the past few weeks so wont take long until im lean agian

i didn't get the chance to ask if Kühle would be willing to do Genioplasty under local anesthesia (someone asked to save cost) i asked some staff instead but she couldnt tell me

people have gotten genioplasty under local anasthesia before



sound horrifiying but saves costs since you dont need a hospital stay if you have to pay privately
 
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i also called there today jfl but they told me to go to their poliklinik first. i consulted with an ortho close to my place first now and see what he says

my problem is that my only "problems" are crossbite, some snoring and teeth grinding, no idea if its enough for insurance to cover
 
i also called there today jfl but they told me to go to their poliklinik first. i consulted with an ortho close to my place first now and see what he says

my problem is that my only "problems" are crossbite, some snoring and teeth grinding, no idea if its enough for insurance to cover
yes you need to work with their poliklinik, i dont recommend going with a different ortho (even if it was possible) which i think its not.

Even if it was possible i wouldn't do it because the workflow there is fully digital and everyone knows what he has to do

i bet your local ortho doesnt even know what ips case designer is and doesnt have any clue about the workflow they use there

communication between surgeon and ortho should be perfect, you dont want to be a test subject
 
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yes you need to work with their poliklinik, i dont recommend going with a different ortho (even if it was possible) which i think its not.

Even if it was possible i wouldn't do it because the workflow there is fully digital and everyone knows what he has to do

i bet your local ortho doesnt even know what ips case designer is and doesnt have any clue about the workflow they use there

communication between surgeon and ortho should be perfect, you dont want to be a test subject
tbh i just want the diagnosis. like just want to know if surgery was even slightly possible in my case. i dont even want the ortho to work with kühle
 
tbh i just want the diagnosis. like just want to know if surgery was even slightly possible in my case. i dont even want the ortho to work with kühle
you mean if your case could be covered by insurance?

for that you can go to a local ortho (du bist ja auch deutschland) if insurance approves surgery you can transfer the "approved surgery plan" from your insurance to any other ortho or surgeon

i think i transfered my approved surgery plan 3 times

1 ortho --> 2 ortho and now poliklinik heidelberg ortho
 
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you mean if your case could be covered by insurance?

for that you can go to a local ortho (du bist ja auch deutschland) if insurance approves surgery you can transfer the "approved surgery plan" from your insurance to any other ortho or surgeon

i think i transfered my approved surgery plan 3 times

1 ortho --> 2 ortho and now poliklinik heidelberg ortho
genau das ist mein plan. bevor ich extra nh stunde nach heidelberg fahr, kann ich auch hier zum local ortho der paar minuten weg ist für die diagnose. alles andere danach falls es so weit kommt von dr kühle
 
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genau das ist mein plan. bevor ich extra nh stunde nach heidelberg fahr, kann ich auch hier zum local ortho der paar minuten weg ist für die diagnose. alles andere danach falls es so weit kommt von dr kühle
Ja, genau so habe ich es auch gemacht.
 
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Surgery Plan wurde vom Local Ortho an die krankenkasse eingereicht und genehmight (durch gutachter), dann wollte sie mir premium brackets verticken aber ich bin dann einfach gegangen
 
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genau das ist mein plan. bevor ich extra nh stunde nach heidelberg fahr, kann ich auch hier zum local ortho der paar minuten weg ist für die diagnose. alles andere danach falls es so weit kommt von dr kühle
Pass aber auf in der Poliklinik, sei NT, freundlich und nicht autitisch

ich bin nicht mal full blackpilled und blackpill kritiker, habe mich aber irgendwie echt dumm verhalten und die KFO hat es gemerkt und war echt genervt von mir - habe jetzt aber eine neue zugewiesen bekommen (angeblich weil die alte gerade anderes zutun hat und keine zeit für mich hat) ich weiß aber, dass die einfach nur mies abgefuckt von mir war (verständlicherweise).

Die neue die mir zugewiesen wurde ist aber wirklich sehr sehr nett, höflich und hört zu.

Selbes gilt übrigens auch für Chirugen (mir wurde gesagt, dass einige blackpill dweller wegen ihrem verhalten bereits von chirugen abgewiesen wurden)

Aber wenn ich sowas lese:
Before: LTN - subhuman, depending on angle, I had gyno (fixed), glasses (got LASIK), lanky low-T nerd pheno (not fixed yet), recession + shit nose. Constantly depressed, occasionally got interest from desperate LTBs or interest due to my height, but that was it. Didn't feel like having sex because it wasn't even worth it.

Now I'd say MTN - very very weak HTN due to height (once nose + swelling are down I can technically reach HTN because I have money + height). I.e. sometimes I get on the train and there is going to be a girl staring at me for like 10 seconds or so. And occasionally some Chads muster me to see if I'm a threat to their gf. Still lack muscles and confidence though (my T is abysmally low, considering TRT). I mog or are even with most of my friends facially now except for one gymcelled Chad and I'm moneymaxxed so occasionally I attract golddiggers.

I think I can mog once I get on TRT, do boxing and fix my skincare.

And occasionally some Chads muster me to see if I'm a threat to their gf.


Dann denke ich tatächlich, dass es quasi unmöglich ist von Kühle abgewiesen zu werden.




Es ist tatächlich auch keine Confidence warum ich mich hier offen zeige..

Es ist mir einfach egal was irgendwelche Blackpill Dweller die denken, dass man als normie niemals eine Freundin finden wird von mir denken.

Habt halt spaß am rotten und lasst euch von wheat waffle face ratings verkaufen lmao

Blackpill ist Flawless für echte Sub 5s, flawed für normies und übertrieben für chads

habe das oben in dem rant ja schon mal geschrieben und diskutriere tatächlich auch gerne über das thema

(die wenigsten sind echte sub 5s und wenn dann auch meisten weil sie übergewichtig sind)

wenn man wirklich sub 5 auf craniofacial level ist dann soll und kann man das ruhig fixen

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Jeder in meiner Situation würde dasselbe machen und versuchen das beste aus der OP rauszuholen wenn man sie schon bezahlt bekommt.
 
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Pass aber auf in der Poliklinik, sei NT, freundlich und nicht autitisch

ich bin nicht mal full blackpilled und blackpill kritiker, habe mich aber irgendwie echt dumm verhalten und die KFO hat es gemerkt und war echt genervt von mir - habe jetzt aber eine neue zugewiesen bekommen (angeblich weil die alte gerade anderes zutun hat und keine zeit für mich hat) ich weiß aber, dass die einfach nur mies abgefuckt von mir war (verständlicherweise).

Die neue die mir zugewiesen wurde ist aber wirklich sehr sehr nett, höflich und hört zu.

Selbes gilt übrigens auch für Chirugen (mir wurde gesagt, dass einige blackpill dweller wegen ihrem verhalten bereits von chirugen abgewiesen wurden)

Aber wenn ich sowas lese:





Dann denke ich tatächlich, dass es quasi unmöglich ist von Kühle abgewiesen zu werden.




Es ist tatächlich auch keine Confidence warum ich mich hier offen zeige..

Es ist mir einfach egal was irgendwelche Blackpill Dweller die denken, dass man als normie niemals eine Freundin finden wird von mir denken.

Habt halt spaß am rotten und lasst euch von wheat waffle face ratings verkaufen lmao

Blackpill ist Flawless für echte Sub 5s, flawed für normies und übertrieben für chads

habe das oben in dem rant ja schon mal geschrieben und diskutriere tatächlich auch gerne über das thema

(die wenigsten sind echte sub 5s und wenn dann auch meisten weil sie übergewichtig sind)

wenn man wirklich sub 5 auf craniofacial level ist dann soll und kann man das ruhig fixen

---

Jeder in meiner Situation würde dasselbe machen und versuchen das beste aus der OP rauszuholen wenn man sie schon bezahlt bekommt.
ja bin eins der älteren mitglieder von hier und bin schon relativ blackpilled aber oft am zweifeln obs wirklich so hart ist wie alle meinen... mein alter account ist von anfang 2019 aber musste ihn löschen lassen leider.

meiner meinung nach trifft die blackpill wirklich nur bei extremen zu (sehr hässlich oder sehr schön), bei allen anderen also ltn - htn, spielt das aussehen eine rolle, ist aber nicht alles im leben.

ich bin nicht hässlich, mittlerweile etwas gealtert...wurde vor paar jahren auch immer mal wieder von mädels angesprochen oder waren halt in mich verknallt, für mich wäre die OP nicht dringend notwendig deshalb bin ich manchmal auch echt am überlegen ob ich so weit gehen sollte wegen nervenschaden und schmerzhafte recovery etc. aber ja ich schaue mal...

finde echt schade das der user von dem thread den du verlinkt hast deleted ist, würde ihn gerne sehen ohne schwellungen
 
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ja bin eins der älteren mitglieder von hier und bin schon relativ blackpilled aber oft am zweifeln obs wirklich so hart ist wie alle meinen... mein alter account ist von anfang 2019 aber musste ihn löschen lassen leider.

meiner meinung nach trifft die blackpill wirklich nur bei extremen zu (sehr hässlich oder sehr schön), bei allen anderen also ltn - htn, spielt das aussehen eine rolle, ist aber nicht alles im leben.

ich bin nicht hässlich, mittlerweile etwas gealtert...wurde vor paar jahren auch immer mal wieder von mädels angesprochen oder waren halt in mich verknallt, für mich wäre die OP nicht dringend notwendig deshalb bin ich manchmal auch echt am überlegen ob ich so weit gehen sollte wegen nervenschaden und schmerzhafte recovery etc. aber ja ich schaue mal...

finde echt schade das der user von dem thread den du verlinkt hast deleted ist, würde ihn gerne sehen ohne schwellungen
Nervenschäden lassen sich so wie Kühle mit Piezosurgery die Osteotomien macht (also den Knochen durchtrennt) eigentlich fast komplett vermeiden, also sehr sehr unwahrscheinlich, dass der Verletzt wird.

Auf dem DVT oder CT sieht man auch genau wo der Nerv langläuft wenn man den Scan in IPS CaseDesigner importiert.

Ich muss diesen Offenen Biss loswerden, wenn ich Polnisch spreche bin ich bei jedem zweiten Satz am lispeln es ist wirklich schlimm...

Auf Deutsch geht es, aber man merkt es auch.

Wenn ich die OP nicht mache, müsste ich die Kieferorthopädische Behandlung komplett selbst zahlen.
 
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ja bin eins der älteren mitglieder von hier und bin schon relativ blackpilled aber oft am zweifeln obs wirklich so hart ist wie alle meinen... mein alter account ist von anfang 2019 aber musste ihn löschen lassen leider.

meiner meinung nach trifft die blackpill wirklich nur bei extremen zu (sehr hässlich oder sehr schön), bei allen anderen also ltn - htn, spielt das aussehen eine rolle, ist aber nicht alles im leben.

ich bin nicht hässlich, mittlerweile etwas gealtert...wurde vor paar jahren auch immer mal wieder von mädels angesprochen oder waren halt in mich verknallt, für mich wäre die OP nicht dringend notwendig deshalb bin ich manchmal auch echt am überlegen ob ich so weit gehen sollte wegen nervenschaden und schmerzhafte recovery etc. aber ja ich schaue mal...

finde echt schade das der user von dem thread den du verlinkt hast deleted ist, würde ihn gerne sehen ohne schwellungen
OP zieht sich bei mir ja noch bisschen, vielleicht Monate oder Jahre mal sehen (wegen KFO vorbehandlung).

Vielleicht gehts bei mir auch viel schneller, wenn ich das heute richtig verstanden habe und da gar nicht groß viel zutun ist.

Ich weiß nicht wie man das kommunizieren soll, habe mal in ner Kennlernphase damals über die OP erzählt und halt auch gesagt, dass ich das (auch) wegen dem ausshen mache.

War mieser abturn glaube ich, mädchen sind halt krass insecure und wenn die das bei dir merken / sich selbst in dir sehen ist es over. Die hat mir das dann die ganze Zeit versucht auszureden.

Werde in Zukunft denke ich einfach sagen, dass ich diesen Offnen Biss Chirugisch korrigieren lassen muss und gar nicht auf das ausshen eingehen.
 
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