Face Analysis – Looking Beyond Ratios and Cephalometrics

[ub3rpowner]

Hey guys,

I'm at the start of what is arguably the most important step of any hardmaxxing journey: planning.

It's one thing to get insurance coverage approved or to schedule consultations with private surgeons. However, the most important part is having a well-thought-out plan. You need to understand your facial "flaws," how they relate to each other, and how they fit into the bigger picture.

For example, take nose height perception. You might be inclined to say that a short-looking nose must indicate a short maxilla. However, that's overly simplistic thinking. Nasal appearance is influenced by many factors, including cartilage shape, muscle attachments, skin thickness, surrounding skeletal structure, and overall facial proportions. That's why I decided to post here today. I need fresh perspectives on my structure to help create a most detailed surgical path.

Background Information​

• I've had two consultations with a local maxillofacial surgeon (let's call him Leon). Although we haven't completed a full treatment plan yet, he suggested approximately 5 mm of maxillary advancement, 7 mm of mandibular advancement, and correction of my occlusal cant. According to Leon, this would place my jaws in a more ideal facial position. Impaction, downgrafting, and rotational movements have not yet been discussed in detail.
• A short and somewhat inconclusive sleep study at the same hospital showed airway collapse but did not result in an official diagnosis of obstructive sleep apnea (OSA). I would need a full overnight study to determine that.
• My upright CBCT showed a reasonably sized oropharyngeal airway volume of 24.7 cc. My upper jaw is slightly narrow at 34.6 mm intermolar width (M1). Leon did not consider maxillary expansion or genioplasty necessary in my case. Keep in mind that he is a hospital-based surgeon rather than an aesthetic-focused surgeon.

Measurements:

l1-sup to BL (mm): -3.3 (2.0 ± 2.0)

l1-inf to BL (mm): -5.8 (-1.2 ± 1.9)

st-Pogonion to BL (mm): 3.0 (10.6 ± 1.8)

• One additional factor is that there are several indicators suggesting I may be hypermobile, which could potentially complicate both surgery and sleep apnea findings.
• I've also had orthodontic treatment in my teens. As far as I know, this involved an activator appliance followed by fixed braces with bands.
• Believe it or not, I'm actually quite lean. Throughout adulthood I've always been on the skinny side. While I've gained some muscle and body fat over the years, my cheeks and brows seem to be among the primary areas where I store fat.

My Current Assessment​

I've spent a ridiculous amount of time studying my CT scans and, more recently, the CBCT data that I requested.

At the moment, my view is that I have:

• A long but underprojected chin
• A visually short nose
• Normal maxillary height

My main concern with Leon's plan is potential overprojection.

As you've probably noticed, I compared my 3D imaging to a lifecast of Henry Cavill. To me, it doesn't appear that my maxilla is underprojected at all in comparison. Advancing it further might potentially create a "horse-face" appearance, which is something I'd like to avoid.

Alternative Approach​

Because of that concern, I've been considering a different strategy:

• Radix augmentation and septoplasty to improve my IAA-to-JFA relationship and refine the appearance of my nasal bridge
• Jaw-widening implants combined with some form of genioplasty and chin impaction
• Infraorbital rim implants
• Localized facial fat reduction
• A forehead implant to give some backbone to my brow ridge instead of the continuous backward slope I currently have
• Anabolic cycles

Some of this could even be 'simplified' into an LF2? I'm not sure if that's even achievable or appropriate.

Questions​

I'd love to hear your thoughts.

Do you think my concerns about overprojection are ridiculous or am I onto something?

Any suggestions to bring my facial thirds into balance?

Are there any structural issues, treatment options, or considerations that I'm overlooking?

Any critique or feedback is welcome.

 

[belowavgheight]

ouu shit mirin