Had Bimax CCW Genio with Dr Ramieri, AMA

[SPFromNY914]

Wont post pics but will answer all questions honestly and detailed as possible.

Currently 2.5weeks post op.

Dude imma DM you bruh

 

[Deleted member 4797]

Did you know how long you’d stay beforehand? How did you manage the hotel when you realized you could leave before (if you booked a longer stay) or was it booked by a day-to-day basis?

All pre booked, he told me it was ok to leave 1week post op before i booked the hotel.

 

[Dutcher]

Bimax did, because the lips before werent supported by my teeth and upper jaw enough. I was an extreme birdcel though, so i imagine this lip widening effect will happen less on guys who dont have very recessed starting points.

Preface so you know how similiar we are.

I also consulted with R. Ended up with different Italian surgeon. Wont say who. I have great respext for R but i didnt like that the orthodontist is his wife or the other guy


About to go CCW 10 mm lower jaw 5 mm genio 3 mm upward jaw. So almost like you. Also narrow lips.

So you think what made the lips wider is the upper jaw brought forward? How is the palate?

 

[Dutcher]

Also my plan after surgery is Eppley with Jaw and Cheek implants like you said. To cover areas the surgery skips

 

[BradAniston]

So the next thing for you is infra-orbitral cheekbone implant ?

 

[Deleted member 9699]

the boys couldve done this for you for free in my basement brolossus

jk glad it went well man, nice to hear youre doing great.

 

[Deleted member 5891]

@Alexanderr @Gargantuan
Best of best tbh

I don't want any Jewish outsider to see this
+ more privacy for op

 

[Deleted member 4797]

So the next thing for you is infra-orbitral cheekbone implant ?

Yes, and rhinoplasty and ramus jaw angle implants

 

[Incoming]

How does your midface look from the front now?

 

[Deleted member 4797]

Preface so you know how similiar we are.

I also consulted with R. Ended up with different Italian surgeon. Wont say who. I have great respext for R but i didnt like that the orthodontist is his wife or the other guy


About to go CCW 10 mm lower jaw 5 mm genio 3 mm upward jaw. So almost like you. Also narrow lips.

So you think what made the lips wider is the upper jaw brought forward? How is the palate?

My palate is very narrow, so what widened the lips about 15% was the fact that the bone and mouth was supporting the lip corners.

If you look at my lip shape from birds eye view, looking down from above the forehead, the shape has gone from V shaped lips to more flat - - -, like my lip corners moved forward and out diagonally, now almost in line with the centre of my lips. Also they are upward facing instead of down, os these 2 factors made my lips much more attractive.

How full they are is yet to be seen, due to swelling

 

[Deleted member 4797]

Also my plan after surgery is Eppley with Jaw and Cheek implants like you said. To cover areas the surgery skips

Eppley has some fake looking results on his zygo implants, im leaning more toward infraorbital implants only, like Looksmax25 got with his bimax. They look excellent on him imo.

 

[Deleted member 4797]

How does your midface look from the front now?

Like a chipmunk a bit still, i had hollow cheeks before because of big zygos relative to rest of my face. After swelling is down hollow cheeks will improve further, at least that's the expectation.

 

[mynameismart]

How was the recovery day by day?

 

[Deleted member 5891]

After swelling is down hollow cheeks will improve further, at least that's the expectation

Why would they improve?
Because of the skin stretching through the genio?

 

[Deleted member 4797]

How was the recovery day by day?

First week is hell man, just the worst pain youve had x5. You hardly get any sleep which makes it worse, first 4 days are especially bad.

First 4 days is hell like your out on a spit and toasted, days 5-7 is like being in hell but as a background guy, whos not the centre of the torture.

 

[Deleted member 4797]

Why would they improve?
Because of the skin stretching through the genio?

Because my teeth have been brought forward and CCW rotated, stretching the cheeks and leaving empty gap behind for the cheek skin to sink into, where before this part of the cheek was padded out by my mouth and upper jaw.

 

[Deleted member 5187]

How come you chose genio and not the mini chin wing he performs iirc?

 

[Deleted member 4797]

How come you chose genio and not the mini chin wing he performs iirc?

I wanted mini chin wing, its why i chose him.

I told him i wanted this on online consultation, he said he doesnt like to do it anymore, then i said i dont mind the hollow it leaves on ramus and still want it, then he said he can do it then.

After i arrived in italy, he refused to do it

So learn from this, he absolutely doesnt perform mini chin wing anymore

 

[mynameismart]

First week is hell man, just the worst pain youve had x5. You hardly get any sleep which makes it worse, first 4 days are especially bad.

First 4 days is hell like your out on a spit and toasted, days 5-7 is like being in hell but as a background guy, whos not the centre of the torture.

Would you do it again for the results you seen yet?

Did he prescribe any painkillers?

What is the postop protocol like with Ramieri, scheduled visits etc

 

[Lev Peshkov]

Lol this is gonna be really fucking dumb question but I'm gonna want this surgery while I'm in the army, I get 6weeks leave total, can you let me know by the 6 week mark if ur still a bloat CEL?

 

[Deleted member 5187]

I wanted mini chin wing, its why i chose him.

I told him i wanted this on online consultation, he said he doesnt like to do it anymore, then i said i dont mind the hollow it leaves on ramus and still want it, then he said he can do it then.

After i arrived in italy, he refused to do it

So learn from this, he absolutely doesnt perform mini chin wing anymore

I see.
Thanks for answering my questions and godspeed on the recovery

 

[98Zdeed98]

I need bimax, but I think I could also benefit from ZSO/Malar Oestomy to bring the bones forward a bit. Do I get bimax before or after (I have the money for both)

 

[baruch]

Did you fly to Italy by yourself? Or did you bring someone to help you with the recovery? Is it necessary to have someone with you?

 

[Deleted member 4797]

Would you do it again for the results you seen yet?

Did he prescribe any painkillers?

What is the postop protocol like with Ramieri, scheduled visits etc

I guess I would reluctantly, but right now (with current swelling), I wish he did more and am upset I didn't get the best result that I think was possible, for all the pain I went through + 15k euros.

Yes you take a ton of painkillers but you still feel pain unfortunately.

Read my post earlier in the thread I detailed the whole process start to finish.

 

[Deleted member 4797]

Did you fly to Italy by yourself? Or did you bring someone to help you with the recovery? Is it necessary to have someone with you?

I went by myself, I would've with somebody else but because of cover in Italy nobody would come, and its harder to travel too for non-medical reasons.

Somebody with you would make recovery easier, cheer your spirits up, and would be a help with food and such. I suggest you bring somebody with you if possible, but you can still do it alone if you cant.

 

[mynameismart]

I guess I would reluctantly, but right now (with current swelling), I wish he did more and am upset I didn't get the best result that I think was possible, for all the pain I went through + 15k euros.

Can you expand a bit on that you didnt get the best result. Is it because you think he changed the measurements and didn’t do the mini chin wing, or was there another cause?

 

[Deleted member 4797]

I need bimax, but I think I could also benefit from ZSO/Malar Oestomy to bring the bones forward a bit. Do I get bimax before or after (I have the money for both)

Always bimax first, if bimax is in your surgery plan

 

[Deleted member 4797]

Can you expand a bit on that you didnt get the best result. Is it because you think he changed the measurements and didn’t do the mini chin wing, or was there another cause?

Yes because he didn't do the mini chin wing, and also because he did more genio than I wanted and less upper/lower jaw movements.

 

[Deleted member 4797]

Lol this is gonna be really fucking dumb question but I'm gonna want this surgery while I'm in the army, I get 6weeks leave total, can you let me know by the 6 week mark if ur still a bloat CEL?

I'll update you, ask in 6 weeks ill respond. But its practically guaranteed that the swelling will be almost all gone (90%+), and you wont look at all weird to people who dont know you had it done.

Check out Looksmax25's bimax thread, he posted pics 6weeks post op, and everything in-between:

2.5 Weeks Post DJS and Genio

So on the 22nd I underwent DJS + genio in Rome with Dr. Pagnoni, I had a rhino/chin implant in 2007 and could tell the implant was starting to recede into the bone plus I have always had sleep apnea and breathing issues. He moved my maxilla 4mm, mandible 5mm, 3mm mandible widening at ramus, did...

looksmax.org

 

[ScramFranklin]

Congratulations, I’m happy for you. I’m getting it done next year. Though Sometimes I wonder if it’s worth it seeing Gunson because of his very high price tag.

 

[Deleted member 4797]

Congratulations, I’m happy for you. I’m getting it done next year. Though Sometimes I wonder if it’s worth it seeing Gunson because of his very high price tag.

Nah its not, he cant perform magic tricks other surgeons cant do. Go with a mid-range priced surgeon, they offer basically as much quality as top guys for half the price or less. I agree not to go with a super cheap surgeon though.

 

[Deleted member 4797]

Would you do it again for the results you seen yet?

Did he prescribe any painkillers?

What is the postop protocol like with Ramieri, scheduled visits etc

https://looksmax.org/threads/had-bimax-ccw-genio-with-dr-ramieri-ama.267804/#post-4582558

Thats my whole timeline up to this point.

When the lockdown rules loosen up again, he wanted to see me so I will fly to him in Italy and return on the same day, this should've been on the first week of January (3-4weeks post-op) but lockdown rules might interfere with this.

in 2weeks (4weeks post op) I will get the screws removed from my gums, by a guy who works with Ramieri located in London (where I live), so I dont have to fly back to him.

 

[MedMaxxing]

I need bimax, but I think I could also benefit from ZSO/Malar Oestomy to bring the bones forward a bit. Do I get bimax before or after (I have the money for both)

You can do ZSO or any other cheekbone based osteotomy during Bimax since they're both interoral points of opening (where they enter for the surgery).

 

[Dutcher]

Eppley has some fake looking results on his zygo implants, im leaning more toward infraorbital implants only, like Looksmax25 got with his bimax. They look excellent on him imo.

I saw some natural zygos results. Sayian was a knock out but I agree with what you are saying they can be hit or miss compared to infra which are pretty safe.

damm bro I’m so excited my surgery is next month in Milan i will annoyyou with questions later

 

[Deleted member 4797]

I saw some natural zygos results. Sayian was a knock out but I agree with what you are saying they can be hit or miss compared to infra which are pretty safe.

damm bro I’m so excited my surgery is next month in Milan i will annoyyou with questions later

what are you getting done?

 

[Dutcher]

what are you getting done?

I will copy paste you missed it


Preface so you know how similiar we are.

I also consulted with R. Ended up with different Italian surgeon. Wont say who. I have great respext for R but i didnt like that the orthodontist is his wife or the other guy


About to go CCW 10 mm lower jaw 5 mm genio 3 mm upward jaw. So almost like you

 

[98Zdeed98]

You can do ZSO or any other cheekbone based osteotomy during Bimax since they're both interoral points of opening (where they enter for the surgery).

never knew this, im not sure if I can find high quality surgeon to do both though.

 

[Reiraku]

How do you determine a good doctor for jaw surgery? What made you choose Dr Ramieri instead of the ones in your area?

 

[Deleted member 4797]

I will copy paste you missed it


Preface so you know how similiar we are.

I also consulted with R. Ended up with different Italian surgeon. Wont say who. I have great respext for R but i didnt like that the orthodontist is his wife or the other guy


About to go CCW 10 mm lower jaw 5 mm genio 3 mm upward jaw. So almost like you

Best of luck man, PM me after you have had your surgical planning meeting.

 

[Deleted member 4797]

How do you determine a good doctor for jaw surgery? What made you choose Dr Ramieri instead of the ones in your area?

He came heavily recommended by LordMadness (who got mini chin wing), and he told me he could do mini chin wing, even though in the end he wouldn't. His results online also looked decent, but the primary reason was for the mini chin wing which ascended LordMadness greatly.

 

[MedMaxxing]

never knew this, im not sure if I can find high quality surgeon to do both though.

I consulted with Pagnoni who does it (that's how I found it out). Anybody who does ZSO likely also does Bimax so it can be done during any Bimax (no different than adding an implant in that area tbh).

 

[98Zdeed98]

I consulted with Pagnoni who does it (that's how I found it out). Anybody who does ZSO likely also does Bimax so it can be done during any Bimax (no different than adding an implant in that area tbh).

thanks for the advice, apparently I still got a lot to look into. Where is Pagnoni located?
Do you know anything about minimizing zso/malar osteotomy bone resorption?

 

[MedMaxxing]

thanks for the advice, apparently I still got a lot to look into. Where is Pagnoni located?
Do you know anything about minimizing zso/malar osteotomy bone resorption?

Italy just like Ramieri. I know Andreischev also performs a modified LF3. And no I do not but bone resorption is not all that common during osteotomies especially with titanium plates.

 

[ascentium]

Mirin. Congrats. I hope you ascend

i know you said you won’t post pics, & I respect that. But are you willing to provide a contour of your side profile, before and after?

for the aesthetic result did you have the desired advancement down to the mm prior to the pre-surgery consult with the simulation? If so were your morphs/projections in line with his simulation?

is your palate narrow? If so, why not pre-bimax widening via MSE? Or no segmental lefort to expand width?

didnt lordmadness have the infraorbital implant placed by Dr.R during the bimax. Why didn’t you?

why are you disappointed with the genio relative to mini chinwing? What are the trade offs?

 

[oatmeal]

I've communicate with OP for a while and have seen his pre and post op pics.

can say its legit. mirin

 

[Deleted member 4797]

Mirin. Congrats. I hope you ascend

i know you said you won’t post pics, & I respect that. But are you willing to provide a contour of your side profile, before and after?

for the aesthetic result did you have the desired advancement down to the mm prior to the pre-surgery consult with the simulation? If so were your morphs/projections in line with his simulation?

is your palate narrow? If so, why not pre-bimax widening via MSE? Or no segmental lefort to expand width?

didnt lordmadness have the infraorbital implant placed by Dr.R during the bimax. Why didn’t you?

why are you disappointed with the genio relative to mini chinwing? What are the trade offs?

before

after (2.5weeks post op)

No he didn't do the agreed movements, that we agreed in the pre-surgical planning. instead of 4mm upper, 11mm lower, 4mm genio, he did 3mm upper, 8mm lower, 7mm genio.

I already felt like 4mm upper was very conservative for how recessed my starting point was, but I was ok with being that conservative and no more. However he went even more, and I feel it didn't give such a great result because of this (from 2.5week post op swollen perspective).

My palate is narrow but I cba to have a drawn out waiting time to get my surgery, the additional costs, and the extra nose widening from MSE, wasn't worth it for me.

LordMadness only had bimax, no implants at all or anything else. He is planning to have implants done soon, both upper midface and ramus implants.

Genioplasty can give you an overly pointy and separated from the mandible chin, whereas mini chin wing brings your mid mandible forward WITH the chin, so that way you keep the harmony, and most importantly YOUR JAW IS FORWARD GROWN, NOT YOUR CHIN. A forward chin is not attractive, a forward jaw with a balanced chin is whats attractive. I'm also worried that as well as being too pointy and separated from my mandible, my chin looks too tall from the front since it wasn't only moved forward but also downwards for a taller chin. At this 2.5week post op moment, I wish he stuck to our original plan and gave me more upper and lower jaw advancement, so my mouth could be more forward set (which is why bimax ascends people, not because it brings the chin forward), and 4mm on the chin instead, so it would be less tall and less pointy/detached from the mandible.

 

[Deleted member 7076]

post pics tbh your replies won't have much validity without pics

 

[ascentium]

post pics tbh your replies won't have much validity without pics

bro. He just posted the contour. Please respect his need for privacy.

 

[ascentium]

before

after (2.5weeks post op)

No he didn't do the agreed movements, that we agreed in the pre-surgical planning. instead of 4mm upper, 11mm lower, 4mm genio, he did 3mm upper, 8mm lower, 7mm genio.

I already felt like 4mm upper was very conservative for how recessed my starting point was, but I was ok with being that conservative and no more. However he went even more, and I feel it didn't give such a great result because of this (from 2.5week post op swollen perspective).

My palate is narrow but I cba to have a drawn out waiting time to get my surgery, the additional costs, and the extra nose widening from MSE, wasn't worth it for me.

LordMadness only had bimax, no implants at all or anything else. He is planning to have implants done soon, both upper midface and ramus implants.

Genioplasty can give you an overly pointy and separated from the mandible chin, whereas mini chin wing brings your mid mandible forward WITH the chin, so that way you keep the harmony, and most importantly YOUR JAW IS FORWARD GROWN, NOT YOUR CHIN. A forward chin is not attractive, a forward jaw with a balanced chin is whats attractive. I'm also worried that as well as being too pointy and separated from my mandible, my chin looks too tall from the front since it wasn't only moved forward but also downwards for a taller chin. At this 2.5week post op moment, I wish he stuck to our original plan and gave me more upper and lower jaw advancement, so my mouth could be more forward set (which is why bimax ascends people, not because it brings the chin forward), and 4mm on the chin instead, so it would be less tall and less pointy/detached from the mandible.

Thanks sharing the contours. That’s a huge improvement, though I see why you are a bit frustrated with the last minute modifications to the surgical plan, I feel something like this was possible.

thanks for your forthrightness

I also appreciate you explaining the trade offs between genio & mini chin wing. I was considering genio, but now I’m not sure as my mandible is shaped like chamalets and my chin is somewhat pointy—as you said we want to increase the length of the mandible, not the projection of the chin necessarily.

wish you a speedy recovery.

 

[Deleted member 4797]

Thanks sharing the contours. That’s a huge improvement, though I see why you are a bit frustrated with the last minute modifications to the surgical plan, I feel something like this was possible.

View attachment 895780

thanks for your forthrightness

I also appreciate you explaining the trade offs between genio & mini chin wing. I was considering genio, but now I’m not sure as my mandible is shaped like chamalets and my chin is somewhat pointy—as you said we want to increase the length of the mandible, not the projection of the chin necessarily.

wish you a speedy recovery.

Exactly man, I wanted my mouth to at least line up with my brow ridge.

Unfortunately Ramieri was the only guy I could find who did mini chin wing (but then told me he didn't after I flew over to him), and he doesn't anymore, so IDK if its possible to get that procedure currently. If you do get bimax, make sure your genio is very subtle and minimal, 4mm or less.

Thank you man, recovery has been going well at the very least.. Will keep everybody updated as swelling goes down further.