Italian Jaw Journey (GTFIH) - Bimax + CCW + Expansion + Infras | Planning with Ramieri/Pagnoni/Raffaini

[lurking truecel]

they are retarded and have too much ego to admit they are a subpar choice in the surgery industry, but still retards from this forum keep going to them because they're too lazy to do their own research so they don't need to change anything just take the highest volume possible of patients and as long the patient doesn't die on the surgery table they're good

I mean i dont think you get much better surgeons if you dont pay even more tough

 

[monk321]

I mean i dont think you get much better surgeons if you dont pay even more tough

there are hidden gems here and there , you just got to do your homework , get consultations ask the right questions and before and after. Also high price only means they have more patients and they can do higher prices doesn't mean they are good at what they do it can just be good marketing like the italians

 

[roidfap1st]

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

Spoiler: Front + Side Profile

Front + Side Profile

View attachment 4847872View attachment 4847878View attachment 4847879View attachment 4847870

Spoiler: CBCT (Front + Side) + OPG

CBCT (Front + Side) + OPG (Old Before & New After braces) (need decompensation)

View attachment 4847932View attachment 4847930
View attachment 4847875View attachment 4847934View attachment 4847935

View attachment 4847941View attachment 4847945

Spoiler: Septum + Palate

Septum + Palate

View attachment 4847963View attachment 4847964

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)

I want to make sure I find a surgeon who can handle the aesthetic side of this, not just the occlusion.

• 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.

good luck dont go with dr taban

 

[lurking truecel]

there are hidden gems here and there , you just got to do your homework , get consultations ask the right questions and before and after. Also high price only means they have more patients and they can do higher prices doesn't mean they are good at what they do it can just be good marketing like the italians

Yea i mean its prob true, germany and those countries seems to have many but i see sp many bogdanoffs from surgeons people say is good. I am in disc and the whole dc is basically about going to a surgeon that has hype. Then 2-3 gets botched and then they go to the next one. Its sad really

 

[kuromilover]

But yea ram is brutally shit at genio, i thought pag was better actually, but apparenly he is dog shit too.

like atp who do i go to if they’re all gonna just gonna botch my trimax, I’d like to avoid that..

 

[lurking truecel]

like atp who do i go to if they’re all gonna just gonna botch my trimax, I’d like to avoid that..

Go to sleep and pray

 

[Deleted member 139731]

But yea ram is brutally shit at genio, i thought pag was better actually, but apparenly he is dog shit too.

everything over 4mm genio is dog shit

 

[kuromilover]

Go to sleep and pray

 

[Deleted member 139731]

sunil can and will always do

 

[kuromilover]

sunil can and will always do

who’s that

 

[Prøphet]

raffaini is 25k for bimax only without genio, fat grafts,...

Oh hell no what the fuck

25 fucking k now are we serious??

 

[Deleted member 139731]

who’s that

your last chance

 

[kuromilover]

your last chance

Imagine getting botched by this guy

 

[lurking truecel]

everything over 4mm genio is dog shit

I mean it can be good if you do it high cut

 

[lurking truecel]

Oh hell no what the fuck

25 fucking k now are we serious??

BUt you have to oay atleast 30, but raffaini is oldcel now

 

[Prøphet]

BUt you have to oay atleast 30, but raffaini is oldcel now

I thought he said ramieri nvm

 

[lurking truecel]

I thought he said ramieri nvm

Ram is still 21 k and will not become higher. But 8 month waiting time for online consult

 

[Deleted member 139731]

BUt you have to oay atleast 30, but raffaini is oldcel now

yup with hospital stay and the least of the least 30k

 

[lurking truecel]

yup with hospital stay and the least of the least 30k

Cheap for raffa cel

 

[Deleted member 139731]

Cheap for raffa cel

well he was 10k 4 years ago

 

[lurking truecel]

well he was 10k 4 years ago

For real, i doubt that

 

[Deleted member 139731]

For real, i doubt that

he admitted it on of his instagram replies yeah

 

[lurking truecel]

he admitted it on of his instagram replies yeah

I mean not really, 2018 people got quoted 15k, it was peob italians. Ram also gives like 5 k less for italians

 

[ascendtocl122]

Dammn I guess He messes up Genioplasties at times after all

Sorry that happened to you
Can we see the ct or a face

just here to appreciate ur high effort replies god bless you king

 

[Deleted member 139731]

I mean not really, 2018 people got quoted 15k, it was peob italians. Ram also gives like 5 k less for italians

damn yeah either less for italians or just straight up lying, same as his results photoshoping

 

[Deleted member 93861]

Lmao if Ram and Pag are shit at 3d genio and Giant is MIA in Thailand then who the fuck do we go to for ts

No names can do sliding genio for cheap obv but I don’t think it compares

 

[Crescent ✝]

So thing is i don't know if you saw my ct scan and my side profile but I'm pretty cooked at baseline and need to be a little bit bold to try and ascend, idk if being conservative here is the right choice

conservative = cope

you and me share very similar problems so answer my post already
Honestly another surgeon might be farther north in swizterland or germany


you have 3 hours to answer

 

[Crescent ✝]

Lmao if Ram and Pag are shit at 3d genio and Giant is MIA in Thailand then who the fuck do we go to for ts

No names can do sliding genio for cheap obv but I don’t think it compares

bimax = best

 

[kuromilover]

@kuromilover Holy mirin, I have very similar problems you have and was also planning to go to italy aswell with doctor ramieri. keep me updated, we will make it brah. also how far did the consultation suggest advancing?

​

I'm curious, would you mind sharing your ct? I didn't talk with him yet though, my consultation is on june 17th. I'll make an update post after i do my first consults with ram and pag.

 

[kuromilover]

conservative = cope

you and me share very similar problems so answer my post already
Honestly another surgeon might be farther north in swizterland or germany


you have 3 hours to answer

I've been reading what the others posted here about Ramieri and Pagnoni not being great at 3D planning and genioplasties. If that’s true, it’s basically a choice between praying they don't botch the fuck out of me or looking outside of Italy.

The problem with Germany or Switzerland is the logistics like doing ortho and decompensation there while living in Italy would be brutal and expensive (unless there's a way to get 'redirected' to an Italian ortho who follows their plan).

Since you mentioned Switzerland and Germany, which specific surgeons are you talking about? But honestly if I have to move outside of Italy to get a proper result, I’ll do it. It’s just frustrating that if there are 'hidden gems' around Europe that no one talks about, I'm basically playing a lottery—not just with the surgery itself, but even just to find a decent surgeon jfl. Sometimes I wish I'd never discovered bp

 

[_Lucius]

Ramieri has his Implate technique which means his implants are part of the custom BSSO Plate of your bimax if you get implants trough his Implate technique but he only does them in titanium (it's not the same as placing implants normally and he claims the infection risk is less) but Ramieri is less Blackpilled than Pagnoni and is not as good as Pagnoni and Raffaini when it comes to Genioplasty and will try to dodge doing a genioplasty if you don't have a bad Base

Also Pagnoni is very honest, takes you seriously, not judgy and explains as much as you want and tries to tell you the truth about what can ascend you (in his opinion)
Pagnoni is more blackpilled and will do bigger movements than Ramieri but costs a lot more than Ramieri (not gonna mention prices here so they don't hike up even more)
He has an amazing Genio but he recently had some botches last
(and this year I believe but not sure)
He is a better implant placer and mor knowledgeable about implants than Ramieri though which matters less than one thinks cause Ramieri isn't gonna make riksy movements like that and will be playing it safe like you will look better than after but (maybe) not ascended of you need a lot but if you need very minimal improvement and have. (very) good base he is probably one of the better options also price wise he is the cheapest out of them all and also pretty fair since he has empathy for his patients when it comes to revision and would try to fix your problem

Raffaini costs almost double as what Pagnoni is charging for bimax because of his reputation and he also does very good bone grafts which allows your bone to heal better together

That being said all of these surgeons had some botches and the unfortunate reality is there is always a chance you get botched

What many people don't tell people is if you have very thick skin implants have a higher chance of making your face puffy looking and uncanny or fat looking and in this case you would be limited to a very conservative design

Raffaini is probably the best of you can afford him purely when it comes to bimax and tied or slightly better than Pagnoni when it comes to Genioplasty but he will only do what he wants not what you tell him what you want
It will only be what he thinks is best for you
I'm not sure if he does implants BTW but his trimax price alone is double of what Ramieri charges for trimax plus full facial implants so Raffaini is almost as out of reach as sailer for the average normie and could be an option if you are very wealthy
I don't know if he is an option for implants

Ramieri is better at playing it safe and improving your looks or if you have a very good base cause complications would very unlikely arise in his case at least that is more or less a given but it still happens cause no surgeon is perfect

Of you have hyoid fat or a low hyoid bone you will need a Genioplasty and Mandible advancement for Bimax so your skin stretches and advances the bone forward into a better position

Implants are very good for people with thin skin cause then they show better

Look at the good results for Jaw angle implants it's either from people that had thin skin or from people that had a good base and conservative designs which can only help so much

Thats something I havent heard anyone mention her if you have very thick skin and a low hyoid bone you will probably need bimax aesthetically speaking

Hope that helps and also consider some of fferent surgeons if you are low on money
The Italian 3 are good depending on what you need one is better than the other but consult with many surgeons cause what if you need revisions guess what you will have to pay for them too

I would be careful with Pagnoni and Ramieri you should plan what you get with them cause Ramieri can underadvance and pagnoni can overadvance

If you ask Ramieri, he will do more advanced movements. He's probably the best out of the bunch if you do your own research

 

[_Lucius]

But yea ram is brutally shit at genio, i thought pag was better actually, but apparenly he is dog shit too.

Thankfully genio is easy to fix, compared to a bimax revision. Not defending either of them, but rather they be good at the actual functional surgery than the genio

 

[lurking truecel]

Thankfully genio is easy to fix, compared to a bimax revision. Not defending either of them, but rather they be good at the actual functional surgery than the genio

Lol ram is good at bimax, pag isnt. Yea i mean i think the genio has to do with you nees to fight the muscle hard when doing genio and bimax. Since bimax movements is hard to do because of muscle tension. Like surgeons litteraly describes it as hard work because its tiresome. And genio is the last stretch

 

[kuromilover]

If you ask Ramieri, he will do more advanced movements. He's probably the best out of the bunch if you do your own research

I think I have a pretty good understanding about what I want/need. Would doing trimax with him alone and then going to pagnoni for just implants be worth it? Or just do everything in 1 op?

 

[Adee]

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

Spoiler: Front + Side Profile

Front + Side Profile

View attachment 4847872View attachment 4847878View attachment 4847879View attachment 4847870

Spoiler: CBCT (Front + Side) + OPG

CBCT (Front + Side) + OPG (Old Before & New After braces) (need decompensation)

View attachment 4847932View attachment 4847930
View attachment 4847875View attachment 4847934View attachment 4847935

View attachment 4847941View attachment 4847945

Spoiler: Septum + Palate

Septum + Palate

View attachment 4847963View attachment 4847964

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)

I want to make sure I find a surgeon who can handle the aesthetic side of this, not just the occlusion.

• 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.

We look alike

 

[kuromilover]

Lol ram is good at bimax, pag isnt. Yea i mean i think the genio has to do with you nees to fight the muscle hard when doing genio and bimax. Since bimax movements is hard to do because of muscle tension. Like surgeons litteraly describes it as hard work because its tiresome. And genio is the last stretch

This, It’s one of the main reasons why I’m leaning more towards Ramieri right now, even though I haven't had my consultations yet.

After all, getting the bimax right is the most important part. I'd rather have a surgeon who is solid on the Bimax. Even If I'll need a genio revision, surely it can't be worse than messing the bimax movements up

 

[kuromilover]

We look alike
View attachment 4993799

ur a bit more downgrown than me if im not mistaken. Do you have the front?

 

[zemult]

But yea ram is brutally shit at genio, i thought pag was better actually, but apparenly he is dog shit too.

Who's great at genio in your opinion ?

 

[lurking truecel]

Who's great at genio in your opinion ?

i dont know, hasnt seen much in action more then planning so cant really judge. I mean i do think that almost any surgeon can do it. But for some reason they are sloppy with it

 

[duduboy]

conservative = cope

you and me share very similar problems so answer my post already
Honestly another surgeon might be farther north in swizterland or germany


you have 3 hours to answer

have you ever done surgery?

 

[ectomorpher]

Cazzo cerco gente come te e ho pure fatto l'account e postato per questo ma nessuno mi risponde, come mai?

perchè da quando la blackpill è diventata mainstream su tiktok qua sopra ci sono solo bambini del cazzo, tutti gli user high IQ sono ascesi e se ne sono andati, mi fa piacere pero' che c'è ancora qualcuno di serio

I’m planning to visit Ramieri, Pagnoni, and Raffaini.

brother hai mai considerato l'estero ? i prezzi mi sembrano fuori di testa in ita

 

[kuromilover]

brother hai mai considerato l'estero ? i prezzi mi sembrano fuori di testa in ita

Non è che non l'abbia considerato però
1) non saprei da chi andare o dove andare
2) per adesso vivo in italia
3) non so quali stati intendi precisamente per estero però sicuramente i prezzi sono piu bassi, ma devi tenere in considerazione tutto il resto, e comunque non è che possa andare dal primo surgeon che mi capita che costa il giusto and call it a day yknow..

Devo dire però che non ho knowledge sui surgeon, apparte x quelli piu famosi e preferirei evitare di giocare al giochino del vai da 20 surgeon diversi in 5 stati diversi spendendo migliaia di euro solo per un consulto per poi non risolvere nulla perché magari non mi torna il surgery plan / penso che si possa fare di meglio. E anche se fosse avrei da capire se effettivamente il surgeon stesso è buono o no dai risultati sui suoi pazienti prima di farmi operare, non so se mi spiego.

Potrei spostarmi ma sarebbe una grande rottura di cazzo visto che devo decompensare lortodonzia fatta precedentemente e poi generalmente per le logistiche sarebbe una merda, non puoi negare il fatto che se facessi tutto qua in italia sarebbe molto piu comodo. Più che altro non ho la sicurezza di dire ok sto facendo la scelta giusta perché questo sono sicuro che è un buon surgeon, la gente ne parla bene, ha buoni risultati ecc ecc... nel senso pure su org ognuno fa un po il cazzo che gli pare e il general consensus non è molto buono visto che gli unici surgeon di cui si parla sono quelli italiani lol

Comunque in ogni caso sei libero di enlightarmi if you know any better.

perchè da quando la blackpill è diventata mainstream su tiktok qua sopra ci sono solo bambini del cazzo, tutti gli user high IQ sono ascesi e se ne sono andati, mi fa piacere pero' che c'è ancora qualcuno di serio

non sono completamente d'accordo, però per lo meno non ci sono risposte di bambini su questo thread ahah

 

[monk321]

Lmao if Ram and Pag are shit at 3d genio and Giant is MIA in Thailand then who the fuck do we go to for ts

No names can do sliding genio for cheap obv but I don’t think it compares

Learn to do ur research instead of following the forum surgeons bubble

 

[Deleted member 93861]

Learn to do ur research instead of following the forum surgeons bubble

No I am actually more retarded then the average joe here that’s a very dangerous game to play for the low iq

 

[Crescent ✝]

Lmao if Ram and Pag are shit at 3d genio and Giant is MIA in Thailand then who the fuck do we go to for ts

No names can do sliding genio for cheap obv but I don’t think it compares

Chin surgery is a whole other category then orthognathic, so another approach could be going to two separate surgeons. skilled in either one not both

 

[Celery]

Ramieri and pagnoni do implants. Ramieri is a great surgeon.

I havent seen photoshopini doing implants. He does fat grafting and is known to photoshop the results on his insta page to make them looks more impressive than they are. He edits the before photos of the patients to make them look uglier and the after photos as well.

Not only this; but my friend who is an Italian dental student, interned for him and he was asked to use AI to make the pics look impressive saying how it’s not cheating and how he can actually achieve thet

 

[kuromilover]

Learn to do ur research instead of following the forum surgeons bubble

How does one do their own research properly when there are hundreds of surgeons in europe alone? Like I'd still be following what people say and their opinions on reddit/facebook/ some kind of other social platform, and I'd be basing myself ONLY off of their experience. Like this is exactly what I'm trying to do right now but it's not easy bro.
Even if I were to find some good surgeon with good results I'd need to pay for the consult, go to that country, if it ain't good then rinse and repeat. Is this the type of "research" I should do?

 

[monk321]

How does one do their own research properly when there are hundreds of surgeons in europe alone? Like I'd still be following what people say and their opinions on reddit/facebook/ some kind of other social platform, and I'd be basing myself ONLY off of their experience. Like this is exactly what I'm trying to do right now but it's not easy bro.
Even if I were to find some good surgeon with good results I'd need to pay for the consult, go to that country, if it ain't good then rinse and repeat. Is this the type of "research" I should do?

You just need online consultation

 

[HenryLang182]

Oh hell no what the fuck

25 fucking k now are we serious??

Ram is has increased to 25k but has genio, for that price im going with Dr Ekber (Germany) for the same.

Also he let's you be involved on the planning.

 

[Lookologist003]

ur a bit more downgrown

'Downswung' if you care for the difference.

Downswung and Downgrown: The Difference Matters

A downswung mandible is when the mandibular plane angle (MPA) is steeply downslanted and the difference between the MPA and the occlusal plane angle (OPA) is small. In other words, both the jawline and the occlusal plane are nearly equally downslanting. The lower jaw appears “swung” down. A...

looksmax.org

Not only this; but my friend who is an Italian dental student, interned for him and he was asked to use AI to make the pics look impressive saying how it’s not cheating and how he can actually achieve thet

Juicy. Damn. I thought it was just looksmaxxing course scammers that were using AI like that.