CBCT posted. Trimax + Zygo + Rhino pipeline. 35k loaded. Rip me apart.

[The Dire]

Yes, it's very minimal, but I have done the measurements. The right angle of mandible / gonial angle extends ~3mm further from the midline than the right gonial angle. It also extends downwards vertically by 2 or 3mm more than on the left.
The left side of the chin is also pointing further downwards than the right side.
(the photo is flipped/mirrored; Right side of the photo is the left side of my face)

I believe what you're saying, but based on the CBCT, I have a clear asymmetry, and I can't see it in yours. And precisely because my asymmetry is obvious in my CBCT but practically invisible in reality, I doubt that yours is actually visible. To be honest, I think you're just worrying needlessly

 

[Cliff_Maxxing]

I believe what you're saying, but based on the CBCT, I have a clear asymmetry, and I can't see it in yours. And precisely because my asymmetry is obvious in my CBCT but practically invisible in reality, I doubt that yours is actually visible. To be honest, I think you're just worrying needlessly

bro tell me you don't see it and I'll call off the trimax rn

 

[kaydd]

View attachment 4851674
bro tell me you don't see it and I'll call off the trimax rn

it is visible when you try to make it out.

I think this is just your gonion notch? I don't see enough throughout the face to warrant a whole trimax

 

[LackEmpathyTherefor]

View attachment 4851674
bro tell me you don't see it and I'll call off the trimax rn

Not too visible tbh

 

[The Dire]

View attachment 4851674
bro tell me you don't see it and I'll call off the trimax rn

Honestly, if you’re only getting a Trimax to correct this asymmetry, I think it’s a foolish choice. There are many other procedures that are far less expensive and invasive and can give you the same result

 

[Cliff_Maxxing]

Honestly, if you’re only getting a Trimax to correct this asymmetry, I think it’s a foolish choice. There are many other procedures that are far less expensive and invasive and can give you the same result

such as?

 

[The Dire]

such as?

you can just do implants for example, or fillers

 

[Cliff_Maxxing]

you can just do implants for example, or fillers

Multiple filler injections will always dissolve into glop over time, so it's not a viable option for me.
I was thinking of getting the trimax and then implants, but yeah maybe just doing orthodontic work + implants would be enough to produce similar results. Much to think about...

 

[The Dire]

Multiple filler injections will always dissolve into glop over time, so it's not a viable option for me.
I was thinking of getting the trimax and then implants, but yeah maybe just doing orthodontic work + implants would be enough to produce similar results. Much to think about...

There's no ROI in doing a Trimax for fixing the asymmetry you have

 

[vermicel]

bro tell me you don't see it and I'll call off the trimax rn

Honestly, if you’re only getting a Trimax to correct this asymmetry, I think it’s a foolish choice. There are many other procedures that are far less expensive and invasive and can give you the same result

such as?

Chin wing performed only on the weaker side (see illustration below).
Although, in your particular case, the asymmetry doesn't seem to affect the chin at all, and barely the anterior part of the mandible either. So, as suggested above, a single jaw angle implant might be your best bet.

@NeedUndereyeSupport

 

[Philalethes]

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.

Spoiler: First Screenshots

---

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.

Spoiler: Side Profile

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.

Spoiler: Bone Structure

---

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.

Spoiler: CBCT 3D Video

---

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

That was sort of my plan but
Why don't you do the nose job at the same time?

 

[_Lucius]

Has an ortho or surgeon actually told you that you need surgery? Your scans don’t look like you have malocclusion.

Ramieri likely won’t be able to perform surgery first, as his operation queue is months long. And that’s even if he wants to perform surgery on you at all, same with the others..

 

[_Lucius]

That was sort of my plan but
Why don't you do the nose job at the same time?

Definitely recommend performing rhino 6-12 months after bimax as Lefort 1 advancement and rotation can change the appearance of the nose.

 

[The Dire]

That was sort of my plan but
Why don't you do the nose job at the same time?

I'll think about it, but I'd prefer to have rhinoplasty after Trimax if I can afford it, because the results will be more precise

 

[The Dire]

Has an ortho or surgeon actually told you that you need surgery? Your scans don’t look like you have malocclusion.

Ramieri likely won’t be able to perform surgery first, as his operation queue is months long. And that’s even if he wants to perform surgery on you at all, same with the others..

I spoke with Pagnoni, and he told me that my brow ridges are actually only slightly recessed, the apparent recession is just an optical illusion because my brow ridges are very pronounced. In any case, based on the research I’ve done and the renders I’ve created, if I were able to undergo a trimax procedure, I could achieve a truly significant improvement. So even if Ramieri thought I was crazy, I’d ask to have it done, and if he absolutely refused, I’d find another surgeon.

Anyway, it’s not a big deal right now because I’m going to wait at least three years before having this kind of surgery anyway, Pagnoni told me that the fat distribution in my face is still changing. That’s fine, I’ll have a lot more money in the future and a much better understanding of facial harmony, so no matter what happens, I’ll find a way to improve my appearance, whether I get the Trimax procedure from a top surgeon for 40–50k or undergo any other type of surgery

 

[_Lucius]

I spoke with Pagnoni, and he told me that my brow ridges are actually only slightly recessed, the apparent recession is just an optical illusion because my brow ridges are very pronounced. In any case, based on the research I’ve done and the renders I’ve created, if I were able to undergo a trimax procedure, I could achieve a truly significant improvement. So even if Ramieri thought I was crazy, I’d ask to have it done, and if he absolutely refused, I’d find another surgeon.

Anyway, it’s not a big deal right now because I’m going to wait at least three years before having this kind of surgery anyway, Pagnoni told me that the fat distribution in my face is still changing. That’s fine, I’ll have a lot more money in the future and a much better understanding of facial harmony, so no matter what happens, I’ll find a way to improve my appearance, whether I get the Trimax procedure from a top surgeon for 40–50k or undergo any other type of surgery

Atleast you have the sense to wait and think about it. It is never too late to get the surgery, but the sooner the better for sure.

Edit: Actually, you look like a mild to moderate asymmetry case. Might have a shot with Rams and Raff. I’d avoid Pags.

 

[The Dire]

Atleast you have the sense to wait and think about it. It is never too late to get the surgery, but the sooner the better for sure.

Edit: Actually, you look like a mild to moderate asymmetry case. Might have a shot with Rams and Raff. I’d avoid Pags.

Why would you avoid Pag? I'm also thinking about Federico Hernández-Alfaro

 

[_Lucius]

Why would you avoid Pag? I'm also thinking about Federico Hernández-Alfaro

Pags seems to be good with implants, but hilariously bad with BSSO (mandibular advancement). Many cases of bad splits and asymmetric final results.

Alfaro I’d also avoid. He’s living off marketing and not word of mouth anymore. He tends to overadvance without taking joint stability into account.

The reality is that most famous surgeons are not miracle surgeons, and similar results can be done with local surgeons. The issue with local surgeons is finding a good one and especially one with many performed cases you can look at.

 

[The Dire]

Pags seems to be good with implants, but hilariously bad with BSSO (mandibular advancement). Many cases of bad splits and asymmetric final results.

Alfaro I’d also avoid. He’s living off marketing and not word of mouth anymore. He tends to overadvance without taking joint stability into account.

The reality is that most famous surgeons are not miracle surgeons, and similar results can be done with local surgeons. The issue with local surgeons is finding a good one and especially one with many performed cases you can look at.

It's not a problem for me bro, I live in Italy, Raffaini is about a two-hour drive from where I live

Rep me pls bro

 

[Philalethes]

I'll think about it, but I'd prefer to have rhinoplasty after Trimax if I can afford it, because the results will be more precise

Where trimax?
I thought lefort 1 and then implants