The Dire
Iron
- Joined
- Nov 12, 2025
- Posts
- 116
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Alright. I'm going to do something that 99% of people on this forum don't do. I'm going to post an actual effort post.
Not a blurry bathroom selfie asking "what do I need bro." Not a coping thread about mewing for 6 months and seeing no results. An actual, researched, data backed breakdown of my face with a real surgical plan and a real budget behind it. If you're going to read one thread this month, make it this one.
I'm 18. I've been deep in this for over a year. Not casually deep. Obsessively deep. Full anthropometric analysis of every single ratio on my face, front and profile. CBCT done and rendered in 3D from every angle. Three maxillofacial surgeon consultations in the works. 35k ready to go. I'm not here to ask if I should do it. That question was answered a long time ago. I'm here because this forum, at its best, catches things that surgeons gloss over. And I want every possible angle covered before I go under.
Let me walk you through the whole thing.
THE FACE AS IT STANDS
I ran every ratio I could measure. Front and side. Categorized them from ideal all the way down to severely insufficient. I'm not going to list every number because even for this forum that would be weapons grade autism, but here's what matters.
A lot of things work. More than I expected honestly. My vertical proportions are basically textbook. All three thirds sitting exactly where they should be. Midface ratio, ideal. Interpupillary to mouth width, ideal. Bitemporal width, ideal. Eye aspect ratio, ideal. From the side the story is similar. Facial convexity, correct. Nasomental angle, ideal. Nasolabial angle, solid. Ramus to mandible ratio, good.
And here's the thing that took me way too long to understand. The nose is not the problem. I spent literally years staring at my nose thinking that was the move. Made morphs. Ran simulations. You know what a rhinoplasty alone looked like on my face? A guy with a slightly better nose and the exact same mediocre profile. Marginally better. Not transformative. Not even close to model tier.
Because the nose actually scores well. Projection is good. Rotation is good. Most angular measurements are solid. It's slightly wide at the base, sure, and there's a small hump. But these are refinement issues. Not the bottleneck.
The bottleneck is something else entirely.
Maxillomandibular recession.
Every. Single. Ratio. That scored badly traces back to this. Every single one. The recession relative to the Frankfort plane is genuinely terrible. The Z angle is dragging. The submental cervical angle is one of the worst measurements on my entire face, and it's not because I'm fat, it's because the chin and mandible literally don't project far enough to hold the soft tissue up. From the front the jaw angle is way too obtuse when it should be approaching 90 degrees. The deviation between my alar angle and jaw frontal angle is enormous.
And the midface? Yeah, the cheekbones are flat and they sit way too low. One of my absolute worst scores. But here's what most people would miss: the flat midface isn't purely a zygomatic issue. The entire maxillary complex is sitting too far back. The face doesn't project forward as a unit. The zygos being low is real, but the recession underneath is what makes the whole thing look as bad as it does.
Everything else, the eyebrow tilt being too flat, the eye asymmetry, the lip ratio, the nose width, these are all real issues. But they're paint on the car. The frame is bent. You fix the frame first. Then you paint.
THE PLAN
Phase 1: Trimax + Zygomatic Implants. Same operation. This is the one.
LeFort I to bring the maxilla forward. BSSO to advance the mandible and fix the gonial angle. Genioplasty to project the chin, and I mean primarily anterior projection, not vertical. My lower third proportion is already ideal and I'm not about to destroy one of my best ratios by making my face longer for no reason.
Zygomatic implants going in at the same time. The LeFort will give me some forward midface movement but it won't build the lateral projection I need. The zygos are flat AND low. Implants are the only thing that addresses both dimensions properly.
Now. I'm still not 100% locked on whether the implants are truly necessary or if a well executed LeFort handles enough of the midface. This is genuinely one of the things I want your opinions on. If you've seen cases where maxillary advancement alone gave adequate zygomatic projection I want to see them. If you think the implants are non negotiable with my bone structure, tell me that too.
This phase is where 70% of the ascension happens. Not an exaggeration. When you fix the recession you fix the jawline, the chin projection, the submental angle, the midface depth, the gonial angle, the profile convexity. One operation, cascading improvements across the entire face. This is the move that takes you from "he's alright" to people actually noticing you when you walk in somewhere.
Budget for this: 35k, can stretch to 40k if it's the difference between a good result and a great one.
Phase 2: Rhinoplasty. Separate budget, separate timeline.
This comes later. Way later. The rhino happens minimum 6 months after the trimax once everything has settled. Non negotiable. When you move the maxilla forward the nose moves with it. Tip position changes, nasolabial angle shifts, the entire geometric relationship between the nose and the face is different post surgery. Doing a rhino before jaw surgery is genuinely one of the dumbest moves you can make. You'd be sculpting a nose to fit a face that's about to be structurally altered. Like getting a custom suit and then gaining 15 kilos.
What actually needs work on the nose: base width mainly. The mouth to nose width ratio is one of my worst front scores. Small hump reduction. That's it. The nose has good bones (literally), it just needs to be cleaned up and harmonized with the new structure underneath.
I'll stack the money for this separately. The trimax budget is the trimax budget, I'm not cutting corners on the most important operation of my life to squeeze in a rhino at the same time.
What I'm not touching (for now): I've researched canthoplasty, supraorbital rim implants, forehead augmentation, lower face lift. I've projected the numbers on all of them. Some would help. But there's a line between strategic transformation and chasing diminishing returns, and I know where it is. The trimax + zygo is the play right now. Rhino comes after. Everything else is a maybe for later, probably never.
THE SURGEONS
Pagnoni: consultation is Monday. I want his take specifically on zygomatic implants and how they integrate with a simultaneous trimax. His orbital reconstruction work is also interesting to me given my infraorbital vector situation.
Ramieri: June 17th. Surgery First protocol, custom digital planning, the whole modern workflow. Want to see how his proposed skeletal movements compare to what I've mapped out myself.
Raffaini: still need to book with him. Want to discuss his Barcelona Line framework in person with my CBCT. Different philosophy from the other two, which is exactly why I want a third perspective.
Three elite maxillofacial surgeons. Three different approaches. I'll cross reference everything they tell me with my own analysis and with whatever comes out of this thread.
CBCT RENDERS
All attached. Frontal bone, left lateral, right lateral, soft tissue overlays, volume renders at different thresholds. The full skull, nothing hidden, nothing frauded with angles. You can see every problem I just described for yourself.
WHAT I WANT FROM THIS THREAD
The research is done. The consultations are booked. Now tell me what I'm not seeing.
Is the trimax the correct priority or would you allocate differently? Are the zygo implants a must or does the LeFort do enough? Is there something in these renders, ramus, orbital rims, any structure, that I haven't accounted for? If you had my bones and my budget, what would the plan look like?
I didn't scan my entire skull, render it in 3D, write this novel of a post, and upload it to a public forum for compliments. I did it because I want to get this right. So don't hold back.
Dire
Not a blurry bathroom selfie asking "what do I need bro." Not a coping thread about mewing for 6 months and seeing no results. An actual, researched, data backed breakdown of my face with a real surgical plan and a real budget behind it. If you're going to read one thread this month, make it this one.
I'm 18. I've been deep in this for over a year. Not casually deep. Obsessively deep. Full anthropometric analysis of every single ratio on my face, front and profile. CBCT done and rendered in 3D from every angle. Three maxillofacial surgeon consultations in the works. 35k ready to go. I'm not here to ask if I should do it. That question was answered a long time ago. I'm here because this forum, at its best, catches things that surgeons gloss over. And I want every possible angle covered before I go under.
Let me walk you through the whole thing.
THE FACE AS IT STANDS
I ran every ratio I could measure. Front and side. Categorized them from ideal all the way down to severely insufficient. I'm not going to list every number because even for this forum that would be weapons grade autism, but here's what matters.
A lot of things work. More than I expected honestly. My vertical proportions are basically textbook. All three thirds sitting exactly where they should be. Midface ratio, ideal. Interpupillary to mouth width, ideal. Bitemporal width, ideal. Eye aspect ratio, ideal. From the side the story is similar. Facial convexity, correct. Nasomental angle, ideal. Nasolabial angle, solid. Ramus to mandible ratio, good.
And here's the thing that took me way too long to understand. The nose is not the problem. I spent literally years staring at my nose thinking that was the move. Made morphs. Ran simulations. You know what a rhinoplasty alone looked like on my face? A guy with a slightly better nose and the exact same mediocre profile. Marginally better. Not transformative. Not even close to model tier.
Because the nose actually scores well. Projection is good. Rotation is good. Most angular measurements are solid. It's slightly wide at the base, sure, and there's a small hump. But these are refinement issues. Not the bottleneck.
The bottleneck is something else entirely.
Maxillomandibular recession.
Every. Single. Ratio. That scored badly traces back to this. Every single one. The recession relative to the Frankfort plane is genuinely terrible. The Z angle is dragging. The submental cervical angle is one of the worst measurements on my entire face, and it's not because I'm fat, it's because the chin and mandible literally don't project far enough to hold the soft tissue up. From the front the jaw angle is way too obtuse when it should be approaching 90 degrees. The deviation between my alar angle and jaw frontal angle is enormous.
And the midface? Yeah, the cheekbones are flat and they sit way too low. One of my absolute worst scores. But here's what most people would miss: the flat midface isn't purely a zygomatic issue. The entire maxillary complex is sitting too far back. The face doesn't project forward as a unit. The zygos being low is real, but the recession underneath is what makes the whole thing look as bad as it does.
Everything else, the eyebrow tilt being too flat, the eye asymmetry, the lip ratio, the nose width, these are all real issues. But they're paint on the car. The frame is bent. You fix the frame first. Then you paint.
THE PLAN
Phase 1: Trimax + Zygomatic Implants. Same operation. This is the one.
LeFort I to bring the maxilla forward. BSSO to advance the mandible and fix the gonial angle. Genioplasty to project the chin, and I mean primarily anterior projection, not vertical. My lower third proportion is already ideal and I'm not about to destroy one of my best ratios by making my face longer for no reason.
Zygomatic implants going in at the same time. The LeFort will give me some forward midface movement but it won't build the lateral projection I need. The zygos are flat AND low. Implants are the only thing that addresses both dimensions properly.
Now. I'm still not 100% locked on whether the implants are truly necessary or if a well executed LeFort handles enough of the midface. This is genuinely one of the things I want your opinions on. If you've seen cases where maxillary advancement alone gave adequate zygomatic projection I want to see them. If you think the implants are non negotiable with my bone structure, tell me that too.
This phase is where 70% of the ascension happens. Not an exaggeration. When you fix the recession you fix the jawline, the chin projection, the submental angle, the midface depth, the gonial angle, the profile convexity. One operation, cascading improvements across the entire face. This is the move that takes you from "he's alright" to people actually noticing you when you walk in somewhere.
Budget for this: 35k, can stretch to 40k if it's the difference between a good result and a great one.
Phase 2: Rhinoplasty. Separate budget, separate timeline.
This comes later. Way later. The rhino happens minimum 6 months after the trimax once everything has settled. Non negotiable. When you move the maxilla forward the nose moves with it. Tip position changes, nasolabial angle shifts, the entire geometric relationship between the nose and the face is different post surgery. Doing a rhino before jaw surgery is genuinely one of the dumbest moves you can make. You'd be sculpting a nose to fit a face that's about to be structurally altered. Like getting a custom suit and then gaining 15 kilos.
What actually needs work on the nose: base width mainly. The mouth to nose width ratio is one of my worst front scores. Small hump reduction. That's it. The nose has good bones (literally), it just needs to be cleaned up and harmonized with the new structure underneath.
I'll stack the money for this separately. The trimax budget is the trimax budget, I'm not cutting corners on the most important operation of my life to squeeze in a rhino at the same time.
What I'm not touching (for now): I've researched canthoplasty, supraorbital rim implants, forehead augmentation, lower face lift. I've projected the numbers on all of them. Some would help. But there's a line between strategic transformation and chasing diminishing returns, and I know where it is. The trimax + zygo is the play right now. Rhino comes after. Everything else is a maybe for later, probably never.
THE SURGEONS
Pagnoni: consultation is Monday. I want his take specifically on zygomatic implants and how they integrate with a simultaneous trimax. His orbital reconstruction work is also interesting to me given my infraorbital vector situation.
Ramieri: June 17th. Surgery First protocol, custom digital planning, the whole modern workflow. Want to see how his proposed skeletal movements compare to what I've mapped out myself.
Raffaini: still need to book with him. Want to discuss his Barcelona Line framework in person with my CBCT. Different philosophy from the other two, which is exactly why I want a third perspective.
Three elite maxillofacial surgeons. Three different approaches. I'll cross reference everything they tell me with my own analysis and with whatever comes out of this thread.
CBCT RENDERS
All attached. Frontal bone, left lateral, right lateral, soft tissue overlays, volume renders at different thresholds. The full skull, nothing hidden, nothing frauded with angles. You can see every problem I just described for yourself.
WHAT I WANT FROM THIS THREAD
The research is done. The consultations are booked. Now tell me what I'm not seeing.
Is the trimax the correct priority or would you allocate differently? Are the zygo implants a must or does the LeFort do enough? Is there something in these renders, ramus, orbital rims, any structure, that I haven't accounted for? If you had my bones and my budget, what would the plan look like?
I didn't scan my entire skull, render it in 3D, write this novel of a post, and upload it to a public forum for compliments. I did it because I want to get this right. So don't hold back.
Dire
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