kuromilover
Iron
- Joined
- Dec 29, 2025
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Hi guys, long-time lurker, first-time poster from Italy.
I’m finally starting my hardmaxxing journey to try to fix all of my major flaws and I’m looking for the best surgeon in Italy for a complex case.
PRE-OP
Disclaimer: I’ve done some preliminary measurements on my CBCT using RadiAnt and Romexis. I’m not a pro, so if I messed up some calculations, please let me know. These should be roughly accurate though.
My Analysis (Based on CBCT):
The Surgeon Question
I’m planning to visit Ramieri, Pagnoni, and Raffaini.
I’m open to any HIGH IQ advice or suggestions regarding my skeletal plan, movements, or surgeon choice. Don't hold back.
Brutally honest feedback only. If you guys have any questions or need more info, measurements, or specific CBCT slices to help me out, just ask no problem. Thanks.
I’m finally starting my hardmaxxing journey to try to fix all of my major flaws and I’m looking for the best surgeon in Italy for a complex case.
PRE-OP
Front + Side Profile
CBCT (Front + Side) + OPG (Old Before & New After braces) (need decompensation)
Septum + Palate
Disclaimer: I’ve done some preliminary measurements on my CBCT using RadiAnt and Romexis. I’m not a pro, so if I messed up some calculations, please let me know. These should be roughly accurate though.
My Analysis (Based on CBCT):
- Gonial Angle: 131.8°
- Inter-molar Width: ~34.7mm (Narrow palate, teeth in compensation).
- Face Type: High divergence, nasolabial folds, poor midface & infraorbital support)
- Bimax (BSSO + Lefort 1) with CCW Rotation: I need to close that 132° angle and get projection.
- Skeletal Expansion (MARPE/MSE/FME/SARPE): My inter-molar width is ~34.7mm. I’m debating and honestly I don't have much knowledge about this. I want to maximize midface widening and cheekbone support. Given I'm planning Bimax anyway, which one would you guys suggest?
- Midface support: I’m leaning towards custom PEEK inframalar/infraorbital implants but I want to know if I can avoid paranasal implants by performing a High LeFort I cut and advancing the ANS, or maybe eventually both?
- Jaw/Angles: I definitely lack bone mass here too. I'm considering custom jaw implants (wraparound or angles), but I’m worried about two things: 1) Is it even possible to do Bimax + Midface + Jaw implants in a single op? 2) The budget might explode.
- Genioplasty: Undecided. If the CCW rotation provides enough projection, I might skip it, but idk tbh.
The Surgeon Question
I’m planning to visit Ramieri, Pagnoni, and Raffaini.
- Which of these do you think is the best and open to custom midface implants alongside the Bimax? (keeping in mind how much each surgeon charges)
- Should I do consultations with all three or is there a clear winner for this specific approach?
I’m open to any HIGH IQ advice or suggestions regarding my skeletal plan, movements, or surgeon choice. Don't hold back.
Brutally honest feedback only. If you guys have any questions or need more info, measurements, or specific CBCT slices to help me out, just ask no problem. Thanks.
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