I have 2 face photos and 2 photos of my CBCT scans. Should I get Bimax surgery or not?

[F_Wilks]

I apologize for the delayed response. Been hectic the past few days.

Ok but did the ortho say you don't even need to file down the teeth from the sides? How is he going to create the space? I guess if it's only the front tooth mainly he could do it without extractions.

No, he didn't. I asked about extractions, and he explained that the braces they use will actually widen your arch, creating more room to fit the teeth. I didn't mention jaw surgery during the consultation.

As for the lat ceph- I would not get it unless you're asked as it shows the same thing as the screenshot of the CBCT from the side. Also, that's kinda insane to me that he's charging you 400 for the files. Like, you already paid for the CBCT so how does it cost him to simply share the files with you? The files can usually be opened with free and publicly available software. You don't even need the medical software they use.

I didn't pay for the CBCT, it was complementary for the purpose of the free consultation. If I want to get my own copy, I have to pay.

As for the extraction for the jaw surgery, it really depends on what you want. Do you simply want to do a lefort 1 and BSSO and translate your jaw forward to create more volume? ( this might give you a slightly dogmaxxed appearance if overdone. I would be careful with excessive movements).

I agree about the danger of excessive movements, and I'm not sure exactly how much movement I want, but when I photograph myself in profile, there's a significant improvement in the appearance of my lower third whenever I'm "jutting" (i.e. pushing my jaw forwards as much as possible). It also improve my appearance in a 3/4 view. It fixes my recessed jaw and eliminates my mild "double chin", by stretching out the skin beneath my jaw.

I'm able to "jut" my lower jaw forwards exactly 6mm. Here is a link to "before/after" of myself jutting.

Image Chest

118 views on Image Chest

imgchest.com

Of course, if the upper jaw is also translated forwards, I imagine I'll need more than 6mm on the lower jaw.

Do you want to address your nasolabial angle? moving the upper jaw with lefort 1 can make your nasolabial angle less obtuse. I think there is some room for this. If the nasal framework and the infraorbital region are unchanged as with a non-modified lefort 1, it could shorten your philtrum.
Do you want to make your labiomental angle less deep? That can be done in various ways and is usually to do with the mentalis muscle and its attachment.

I'm not sure what I want for the nasolabial angle, I'd never thought of it. Wouldn't a downgraft necessarily lengthen my philtrum?

As for the labiomental angle, if you look at the "jutting" photos I linked above, you'll see my labiomental angle is very deep prior to jutting, but after jutting, it improves immensely. Would this effect be replicated by the BSSO?

Do you want to vertically lengthen your face? Your middle and lower thirds are similar but shorter than your upper third. What is your incisor show at normal smile (this also matters for stuff like downgrafting)

Here's 2 photos of myself smiling, both a normal smile and a "crazy person" smile. My smile is shaped more like a trapezoid than a crescent.

It's impossible for me to show the entirety of my upper incisors, even if I try to smile like a crazy person.

Normal smile versus exaggerated smile

137 views on Image Chest

imgchest.com

On the whole, in the absence of medical indications, you should have strong reasons to do jaw surgery for aesthetic reasons- that is, a clear goal of what you dislike and want changed.The osteotomy in BSSO is performed in close proximity to the inferior alveolar nerve (IAN), and thus IAN damage often results. The incidence of IAN deficits after mandibular osteotomies varies from 0% to 100%. Deficits include numbness or unusual sensations in the lower lip, chin, teeth, and gingiva. There is also a 5-10% chance of a permanently runny nose/ chronic sinusitus. Honestly, there is like several pages worth of post operative complications and not all of them can be reversed. This isn't to say you shouldn't pursue surgery, but I wouldn't move everything unecessarily. Sometimes, singular jaw movements etc. can achieve the desired result.

I'm already convinced that I'd benefit from the advancement of the lower jaw. What do you think about advancement/downgraft of the upper jaw?

I'd love to eliminate my "trapezoid smile", and have a "crescent shaped" smile that's shaped the same as everybody else. I'd 100% go for a downgraft to fix my smile.

Do I have a similar situation to the guy in this picture below? He had a downgraft. Here's a link to the Youtube video.

 

[sqwertyl]

Mewing + steroids + hair transplant.

That should give you a good base.

Or some kind of expander for upper + lower jaw.

Then you can reassess BiMax once you fix teeth

Your lower teeth are severely crowded.

Surgeon needs room for BSSO cut

So your best bet is to expand a bit first somehow

 

[lookmaxxer998]

I apologize for the delayed response. Been hectic the past few days.

No, he didn't. I asked about extractions, and he explained that the braces they use will actually widen your arch, creating more room to fit the teeth. I didn't mention jaw surgery during the consultation.

Ok looking at the actual teeth rather than the CBCT, yea the inclination is quite inwards. Widening the arch should fix things with regards to creating room and resolving the overcrowding.

I didn't pay for the CBCT, it was complementary for the purpose of the free consultation. If I want to get my own copy, I have to pay.

I agree about the danger of excessive movements, and I'm not sure exactly how much movement I want, but when I photograph myself in profile, there's a significant improvement in the appearance of my lower third whenever I'm "jutting" (i.e. pushing my jaw forwards as much as possible). It also improve my appearance in a 3/4 view. It fixes my recessed jaw and eliminates my mild "double chin", by stretching out the skin beneath my jaw.

I'm able to "jut" my lower jaw forwards exactly 6mm. Here is a link to "before/after" of myself jutting.

Image Chest

118 views on Image Chest

imgchest.com

Of course, if the upper jaw is also translated forwards, I imagine I'll need more than 6mm on the lower jaw.

With regards to the “jutting”, it improves the mild double chin appearance because it mimics what a sliding genioplasty does: pulling the neck muscles forward that are attached to the chin’s backside or lingual surface. The recessed jaw appears to be improved mostly because it results in an apparent change in occlusion, apparent counterclockwise rotation, apparent opening of the labiodental (mentolabial) angle and the nasomenlal line ( the line connecting the tip of the nose and the furthest point of the chin) is also rotated. Essentially you’re harmonizing the angles and ratios of your face by giving it a vertically lengthened and forward-grown appearance.

I'm not sure what I want for the nasolabial angle, I'd never thought of it. Wouldn't a downgraft necessarily lengthen my philtrum?

As for the labiomental angle, if you look at the "jutting" photos I linked above, you'll see my labiomental angle is very deep prior to jutting, but after jutting, it improves immensely. Would this effect be replicated by the BSSO?

Here's 2 photos of myself smiling, both a normal smile and a "crazy person" smile. My smile is shaped more like a trapezoid than a crescent.

It's impossible for me to show the entirety of my upper incisors, even if I try to smile like a crazy person.

Normal smile versus exaggerated smile

137 views on Image Chest

imgchest.com

I'm already convinced that I'd benefit from the advancement of the lower jaw. What do you think about advancement/downgraft of the upper jaw?

I'd love to eliminate my "trapezoid smile", and have a "crescent shaped" smile that's shaped the same as everybody else. I'd 100% go for a downgraft to fix my smile.

Do I have a similar situation to the guy in this picture below? He had a downgraft. Here's a link to the Youtube video.

Yes, I think you need a downgraft. You don't have sufficient incisor show, I think it should be 3-4mm can't remember the exact range. Also, vertical maxillary deficiency is an indication of downgrafting. Downgrafting is basically performing the Lefort 1 osteotomy and dropping the maxilla down and filling the gap with a bone grafting. Usually, any gap less than 2mm can have bone naturally fill in between ( this principle is used in distraction osteogenesis e.g. in limb lengthening surgery) but if the downgraft is more than 2mm, which it usually is, a bone graft is used. I'm not sure if rigid plate fixation is enough or not. The combined maxilla/mandible movement and orthodontics should fix your smile.

What I'd suggest:
Basically, you want to go to an orthognathic surgeon who has done a fellowship in facial plastic surgery/cosmetic surgery. Not all jaw surgeons, for example, would do stuff like facial implants, fat grafting etc. The main advantage of going to these kind of orthognathic surgeons is that they have both the jaw surgery&orthodontics training and the cosmetic surgery training. Not all jaw surgeons are aesthetically oriented- some are more sleep apnea focused. Each maxillofacial surgeon will have preferred orthodontists that they work with, mainly because it's easy to refer patients and communicate, but you can connect your maxillofacial surgeon with any orthodontist- it's not a big deal. They'll communicate and decide what they need in terms of orthodontic preparation. I think they should be able to simultaneously fix the overcrowding and prepare you for jaw surgery. The fact that you've had your wisdom tooth extracted is good because usually, they need them extracted at least 8 months before surgery. Each surgeon has a different opinion on how much movement is right, so I would suggest you go to at least 3 to see whose plan you like the most.

 

[k99]

I apologize for the delayed response. Been hectic the past few days.

No, he didn't. I asked about extractions, and he explained that the braces they use will actually widen your arch, creating more room to fit the teeth. I didn't mention jaw surgery during the consultation.

I didn't pay for the CBCT, it was complementary for the purpose of the free consultation. If I want to get my own copy, I have to pay.

I agree about the danger of excessive movements, and I'm not sure exactly how much movement I want, but when I photograph myself in profile, there's a significant improvement in the appearance of my lower third whenever I'm "jutting" (i.e. pushing my jaw forwards as much as possible). It also improve my appearance in a 3/4 view. It fixes my recessed jaw and eliminates my mild "double chin", by stretching out the skin beneath my jaw.

I'm able to "jut" my lower jaw forwards exactly 6mm. Here is a link to "before/after" of myself jutting.

Image Chest

118 views on Image Chest

imgchest.com

Of course, if the upper jaw is also translated forwards, I imagine I'll need more than 6mm on the lower jaw.

I'm not sure what I want for the nasolabial angle, I'd never thought of it. Wouldn't a downgraft necessarily lengthen my philtrum?

As for the labiomental angle, if you look at the "jutting" photos I linked above, you'll see my labiomental angle is very deep prior to jutting, but after jutting, it improves immensely. Would this effect be replicated by the BSSO?

Here's 2 photos of myself smiling, both a normal smile and a "crazy person" smile. My smile is shaped more like a trapezoid than a crescent.

It's impossible for me to show the entirety of my upper incisors, even if I try to smile like a crazy person.

Normal smile versus exaggerated smile

137 views on Image Chest

imgchest.com

I'm already convinced that I'd benefit from the advancement of the lower jaw. What do you think about advancement/downgraft of the upper jaw?

I'd love to eliminate my "trapezoid smile", and have a "crescent shaped" smile that's shaped the same as everybody else. I'd 100% go for a downgraft to fix my smile.

Do I have a similar situation to the guy in this picture below? He had a downgraft. Here's a link to the Youtube video.

u wont get these results since ur chin is already decent ur smile will be better tho

 

[F_Wilks]

With regards to the “jutting”, it improves the mild double chin appearance because it mimics what a sliding genioplasty does: pulling the neck muscles forward that are attached to the chin’s backside or lingual surface. The recessed jaw appears to be improved mostly because it results in an apparent change in occlusion, apparent counterclockwise rotation, apparent opening of the labiodental (mentolabial) angle and the nasomenlal line ( the line connecting the tip of the nose and the furthest point of the chin) is also rotated. Essentially you’re harmonizing the angles and ratios of your face by giving it a vertically lengthened and forward-grown appearance.

Does that mean I'd benefit from a sliding genioplasty, in addition to the bimax surgery? If jutting mimics the effects of a genioplasty, instead of bimax, then I'm not sure what my "baseline face" would be after bimax alone.

Also, do you think I'd be one of those people who'd benefit from counterclockwise rotation, in addition to the downgraft?

Thanks.

 

[lookmaxxer998]

Does that mean I'd benefit from a sliding genioplasty, in addition to the bimax surgery? If jutting mimics the effects of a genioplasty, instead of bimax, then I'm not sure what my "baseline face" would be after bimax alone.

Also, do you think I'd be one of those people who'd benefit from counterclockwise rotation, in addition to the downgraft?

Thanks.

Not necessarily. What I meant was that a sliding genioplasty is something that is usually used to tighten the submental region, but a BSSO can have the same effect. As for a CCW rotation, I think it is used to change the position of the occlusal plane, among other things. I'm not sure whether you need it or not.

 

[F_Wilks]

Not necessarily. What I meant was that a sliding genioplasty is something that is usually used to tighten the submental region, but a BSSO can have the same effect. As for a CCW rotation, I think it is used to change the position of the occlusal plane, among other things. I'm not sure whether you need it or not.

Earlier on you mentioned my nasolabial angle. I don't know anything about that, how important is that for aesthetics? Is that the main feature that's affected by advancement of the maxilla?

 

[geenk worg]

Is that the main feature that's affected by advancement of the maxilla?

More or less yeah. There is a range that is considered as ideal but it also depends on your nasal tip angle. For example, if your nose is upturned then the ideal nasolabial angle would be higher.
It's important to note that the placement of the subnasale could also change after lefort advancement.

 

[lookmaxxer998]

Earlier on you mentioned my nasolabial angle. I don't know anything about that, how important is that for aesthetics? Is that the main feature that's affected by advancement of the maxilla?

It's one of the aspects you need to think about when deciding how much you want to advance the maxilla. If the angle becomes too acute, it gives you a 'done-up' appearance. The premaxilla should also sufficiently blend with the nasal framework and the infraorbital rim. it should also harmonize with the browbone and the zygomatic arch. These are the common aesthetic considerations, but ofc there are also medical/functional considerations involved.

 

[F_Wilks]

It's one of the aspects you need to think about when deciding how much you want to advance the maxilla. If the angle becomes too acute, it gives you a 'done-up' appearance. The premaxilla should also sufficiently blend with the nasal framework and the infraorbital rim. it should also harmonize with the browbone and the zygomatic arch. These are the common aesthetic considerations, but ofc there are also medical/functional considerations involved.

How much knowledge of this subject do I need to have before reaching out to surgeons? Is it better to go into consultations saying "I need this, this, this, this, this, this, this!", or can I just have the rough understanding that I already have, and the surgeon will fill in the blanks and have his own ideas about how to make me look good?

I'm a newbie to the subject of facial aesthetics, and I'm a bit concerned that if I tried to do the "design your own surgery", I'd basically be practicing on myself. Is there a textbook somewhere that authoritatively explains all this? I have no idea how the people on this forum are able to learn all of this stuff without going to school for it.

Sorry for the brain vomit.

 

[lookmaxxer998]

How much knowledge of this subject do I need to have before reaching out to surgeons? Is it better to go into consultations saying "I need this, this, this, this, this, this, this!", or can I just have the rough understanding that I already have, and the surgeon will fill in the blanks and have his own ideas about how to make me look good?

I'm a newbie to the subject of facial aesthetics, and I'm a bit concerned that if I tried to do the "design your own surgery", I'd basically be practicing on myself. Is there a textbook somewhere that authoritatively explains all this? I have no idea how the people on this forum are able to learn all of this stuff without going to school for it.

Sorry for the brain vomit.

I would say it's best not to go in and start telling your surgeon what you want as a grocery list. A consult typically starts with the surgeon saying "What are your concerns/what can I help you with today?" And it's best to describe what you dislike in simple terms.

E.g. I feel that my jaw is recessed, both upper and lower, and I wish to pursue advancement surgery. I wish to also move my maxilla vertically down to fix the "short-faced" appearance by downgrafting, etc.

Just tell them all your concerns and what you believe would be a good solution. It's also best to let them know that you wish to pursue jaw surgery for cosmetic concerns (assuming this is true) as they'll probably ask questions regarding sleep apnea. You can present the findings your orthodontist stated, but it's best to keep it as a short list as you did with your post. Perhaps also take some inspiration pictures of what your ideal jaw would look like.

The surgeon usually starts by examining you orally, studying the relation of your teeth and the position of everything. In general they will ask you to stand and face forward to assess your jaw externally and ask to see your smile, etc.

After the examination, they will proceed to give a likely plan of what they would do. How many mm they plan on advancing you, how much downgrafting you may need, basically anything surgical related. At the same time, you will communicate your vision of what you would want to look like vs what he thinks is sensible to do medically. They will also tell you what you need in terms of orthodontic preparation.

People like me and other people on the forum learn about these surgeries through books and papers ( or just online research) mainly because there is some level of flexibility when it comes to cosmetic surgery (unlike medically oriented surgeries where you're just concerned about resolving the medical issue at hand).

It isn't necessary to learn about the surgery in length. What is important to do is compare and contrast plans. As I stated previously, go to multiple surgeons rather than just one, see their before and after results and judge who best fits what you want. Question in detail about your case ( asking each surgeons to justify the movements they plan, e.g. why is Xmm a good idea? And they will usually tell you why any more or any less is bad in their opinion), if multiple surgeons are converging on similar movements and suggestions, you'll know what is likely the ideal plan for you.

 

[Deleted member 26824]

Well if you do bimax, i‘d recommend downgrafting your chin

 

[F_Wilks]

Well if you do bimax, i‘d recommend downgrafting your chin

You referring to sliding genioplasty?

 

[F_Wilks]

I would say it's best not to go in and start telling your surgeon what you want as a grocery list. A consult typically starts with the surgeon saying "What are your concerns/what can I help you with today?" And it's best to describe what you dislike in simple terms.

E.g. I feel that my jaw is recessed, both upper and lower, and I wish to pursue advancement surgery. I wish to also move my maxilla vertically down to fix the "short-faced" appearance by downgrafting, etc.

Just tell them all your concerns and what you believe would be a good solution. It's also best to let them know that you wish to pursue jaw surgery for cosmetic concerns (assuming this is true) as they'll probably ask questions regarding sleep apnea. You can present the findings your orthodontist stated, but it's best to keep it as a short list as you did with your post. Perhaps also take some inspiration pictures of what your ideal jaw would look like.

The surgeon usually starts by examining you orally, studying the relation of your teeth and the position of everything. In general they will ask you to stand and face forward to assess your jaw externally and ask to see your smile, etc.

After the examination, they will proceed to give a likely plan of what they would do. How many mm they plan on advancing you, how much downgrafting you may need, basically anything surgical related. At the same time, you will communicate your vision of what you would want to look like vs what he thinks is sensible to do medically. They will also tell you what you need in terms of orthodontic preparation.

People like me and other people on the forum learn about these surgeries through books and papers ( or just online research) mainly because there is some level of flexibility when it comes to cosmetic surgery (unlike medically oriented surgeries where you're just concerned about resolving the medical issue at hand).

It isn't necessary to learn about the surgery in length. What is important to do is compare and contrast plans. As I stated previously, go to multiple surgeons rather than just one, see their before and after results and judge who best fits what you want. Question in detail about your case ( asking each surgeons to justify the movements they plan, e.g. why is Xmm a good idea? And they will usually tell you why any more or any less is bad in their opinion), if multiple surgeons are converging on similar movements and suggestions, you'll know what is likely the ideal plan for you.

I talked to another person over DM and learned that I have an asymmetry. I attached the image. Is this something that could be fixed via a high-cut Lefort 1, with rotation of maxilla? Advancement, downgraft, rotation?

Also, do you know a lot about the midface (zygo's, etc)?

 

[Deleted member 26824]

You referring to sliding genioplasty?

Yes trimax

 

[lookmaxxer998]

I talked to another person over DM and learned that I have an asymmetry. I attached the image. Is this something that could be fixed via a high-cut Lefort 1, with rotation of maxilla? Advancement, downgraft, rotation?

Also, do you know a lot about the midface (zygo's, etc)?

Yea, it can be fixed with orthognathic surgery. You should let them know that you want it fixed. They'll align your teeth with your mandible and maxilla's natural orientation and then move the mandible and/or the maxilla. See @face_surgery_parma on instagram for examples.

what do you not like about your mid face?

 

[Bitchwhipper2]

he is not reccessed as shit stop lying

People on here just love accusing others of being recessed for some reason

 

[F_Wilks]

what do you not like about your mid face?

I might not have "inferior scleral show" as you noted, but I have dark circles underneath the inner portion of my under eye area, which is why I was asking earlier about infraorbital implants. I've had the dark circles my entire life. I've read that they can be the result of underdeveloped infraorbital rims.

The other thing I don't like is that my cheekbones are recessed; I don't have visible cheek hollows, except with the right angle and the right lighting. I have neither lateral nor saggital projection of my cheekbones.

Here's images of someone who got custom infraorbital/zygomatic implants.

https://i.looksmax.org/attachments/2024/03/4018224_4ERvkrh.jpg

https://i.looksmax.org/attachments/2024/03/4018227_F0AjHIp.jpg

Before/After: https://looksmax.org/threads/insane-zygo-implant-results.1069696/#post-16037485

He even had the same issue with dark undereye circles that I had. Basically, that's the look I'd like to get.

 

[NoaA99]

I might not have "inferior scleral show" as you noted, but I have dark circles underneath the inner portion of my under eye area, which is why I was asking earlier about infraorbital implants. I've had the dark circles my entire life. I've read that they can be the result of underdeveloped infraorbital rims.

The other thing I don't like is that my cheekbones are recessed; I don't have visible cheek hollows, except with the right angle and the right lighting. I have neither lateral nor saggital projection of my cheekbones.

Here's images of someone who got custom infraorbital/zygomatic implants.

https://i.looksmax.org/attachments/2024/03/4018224_4ERvkrh.jpg

https://i.looksmax.org/attachments/2024/03/4018227_F0AjHIp.jpg

Before/After: https://looksmax.org/threads/insane-zygo-implant-results.1069696/#post-16037485

He even had the same issue with dark undereye circles that I had. Basically, that's the look I'd like to get.

Your cheekbones do not look recessed tbh

 

[lookmaxxer998]

I might not have "inferior scleral show" as you noted, but I have dark circles underneath the inner portion of my under eye area, which is why I was asking earlier about infraorbital implants. I've had the dark circles my entire life. I've read that they can be the result of underdeveloped infraorbital rims.

The other thing I don't like is that my cheekbones are recessed; I don't have visible cheek hollows, except with the right angle and the right lighting. I have neither lateral nor saggital projection of my cheekbones.

Here's images of someone who got custom infraorbital/zygomatic implants.

https://i.looksmax.org/attachments/2024/03/4018224_4ERvkrh.jpg

https://i.looksmax.org/attachments/2024/03/4018227_F0AjHIp.jpg

Before/After: https://looksmax.org/threads/insane-zygo-implant-results.1069696/#post-16037485

He even had the same issue with dark undereye circles that I had. Basically, that's the look I'd like to get.

It isn't just scleral show that indicates underdeveloped infraorbital rims and malar deficiency. You don't have nasolabial folds, marionette lines, or a negative orbital vector either. The 'dark circles' are just how tear troughs naturally look with ageing and implants don't go high enough to change under eyes, even when saddled. Sometimes people do nanofat grafting for this but I don't think you need it. Mild hollowing beneath the cheekbones is good, but your lateral projection isn't too bad either. Anterior projection (saggital development) doesn't look abnormal tbh.

Problem is that you're spending too much time listening to autists here- see the 'best of the best' section and I think there is a post comparing ideal dimorphism vs what PSL thinks good dimorphism is. You'll also see this being referred to as 'appeal' vs 'PSL'- basically means what guys think is a mogger vs what women actually think looks good. In general, your level of dimorphism should be higher than average but your face shouldn't steer too far from the facial average- the reason for this is koinophilla. Our brains are hardwired to look for low deviations from the average bc it's our brain's way of performing a 'DNA test'. Any feature that looks too grotesque or strange ( in other words high deviation from the average) our brain attributes to it to "something went wrong on the genetic or developmental level- don't mate with this person".

In practical terms, this means if you do get implants aim to look like Jeremy meeks rather than Hernan drago, as meeks is ideal in dimorphism and his cheekbones are good.

 

[F_Wilks]

The 'dark circles' are just how tear troughs naturally look with ageing and implants don't go high enough to change under eyes, even when saddled. Sometimes people do nanofat grafting for this but I don't think you need it. Mild hollowing beneath the cheekbones is good, but your lateral projection isn't too bad either. Anterior projection (saggital development) doesn't look abnormal tbh.

Wouldn't some sort of implants become necessary in my case, in the event of bimax surgery, simply to avoid the midface having a "left behind" look?

I've only uploaded photos of my frontal and side profile so far, would it help if I uploaded some 3/4 profile shots as well?