My bimax and genio plan with Dr Ramieri

[politically correct]

So here is my plan for surgery in 3 weeks

12-13mm mandible (excluding genio), 3.5mm maxilla, almost exclusively coming from CCW, 1.5mm impaction of maxilla (so will reduce maxilla height 1.5mm and have a bit less tooth show), 5mm genioplasty

Having a custom bimax with custom plates and cutting guides which will allow him to significantly widen the jaw

Thoughts welcome, my main one is whether I should have a greater vertical height increase to the chin to create a "V" effect

PS: I'm also having infraorbital malar implants at the same time, 3mm forward projection, 5mm lateral

 

[politically correct]

On the chin, wondering if I need to downgraft more to get this effect:

 

[Magnum Opus]

Would a cut here be possible?

 

[politically correct]

Would a cut here be possible?
View attachment 2099664

No idea, why do you ask? I assume if Dr Ramieri put the cuts where they are it was for a specific reason

 

[HighClassMaxing]

mirin

irl pics ?

 

[bugeye]

Total cost (along with implants)?

 

[Magnum Opus]

No idea, why do you ask? I assume if Dr Ramieri put the cuts where they are it was for a specific reason

A cut at the antegonial notch would directly decrease gonial angle without an angle stepoff

 

[politically correct]

Total cost (along with implants)?

19k euros for the bimax and genio, its 15k if you dont want the custom plates but if you want to widen the jaw they are necessary

cheek implants 5k on top, but usually 10k if not alongside bimax

 

[politically correct]

mirin

irl pics ?

sorry no pics

 

[HighClassMaxing]

sorry no pics

Inhib too high bhai ?

 

[bugeye]

Do these custom plates need to be removed later?

How does this work? They improve the forward growth from the side view unlike palatal expanders?

 

[politically correct]

Do these custom plates need to be removed later?

How does this work? They improve the forward growth from the side view unlike palatal expanders?

they are the same as regular surgical plates used to hold the jaws in place post surgery

they do not need to be removed

they enable i) larger ii) more precise iii) more complex movements of the jaw (in my case widening the jaw) while still keeping the jaw stable post surgery

 

[Mr.Proper]

If you plan to get everything in one go, then recovery may be quite hard.
About chin - tell your concerns to the doc, show him a good example of vertical lengthening.

 

[politically correct]

If you plan to get everything in one go, then recovery may be quite hard.
About chin - tell your concerns to the doc, show him a good example of vertical lengthening.

isnt it pretty standard to do trimax all at one, cheek implants generally are easy recovery ive heard? @Gaia262 you looked pretty good after 2 weeks right?

 

[longjohnmong]

How much time between when you first contacted him and your surgery? Is this surgery first, i.e. no braces?

 

[politically correct]

How much time between when you first contacted him and your surgery? Is this surgery first, i.e. no braces?

he has a 6 week waiting time

Yeah surgery first, just invisalign post for a very minor correction

 

[WeWillAscend]

what is your occlusion?, I'm assuming you have a class 2 bite. If you do how recessed would you say your jaw is?

 

[Rich giù]

they are the same as regular surgical plates used to hold the jaws in place post surgery

they do not need to be removed

they enable i) larger ii) more precise iii) more complex movements of the jaw (in my case widening the jaw) while still keeping the jaw stable post surgery

Hi

Just one thing on custom surgical plates

Said that I have my own custom plates in my chin from a genioplasty with Pagnoni, I have recently listened to a You Tube video made by another roman maxillo surgeon, Filiaci

He said that there are drawbacks from using 3D pre-fixed custom guides and plates

One drawback is, it goes without saying, the cost
4k on plates in a 19k surgery is more than 20% of the cost of the whole surgery

The main disadvantage of using 3D custom plates is that they cannot be changed during surgery
They are made to be fitting perfectly with your surgical plan, but real bones and skin are different from computer-programmed simulation

In theory, the face that you would like to have, the outcome that you agreed with your surgeon, should be achieved more easily with custom plates, but computer based simulation doesn't take into account multiple variables
It might happen that the surgeon sees, during surgery, that you would be better looking with some mm more or more proporzionate, to the human eye, with you chin advanced a bit less
Then, it would not be possible for the surgeon to adjust the correction planned during surgery, because obviously with 3D plates he can put the bone only in the position already decided

 

[Rich giù]

In my opinion, overall custom made plates and guides are better for the obvious reduction of surgical risks, but not that better for aesthetics

In such surgeries, it is also important to reduce the risk of nerve damage, and, for such purpose, custom guides are very good, you lessen the risk a lot

 

[politically correct]

what is your occlusion?, I'm assuming you have a class 2 bite. If you do how recessed would you say your jaw is?

Occlusion only off by 1-2mm, im not recessed just lack projection from aesthetic perspective

 

[politically correct]

In my opinion, overall custom made plates and guides are better for the obvious reduction of surgical risks, but not that better for aesthetics

In such surgeries, it is also important to reduce the risk of nerve damage, and, for such purpose, custom guides are very good, you lessen the risk a lot

Agree except you cant widen the condiles accurately/safely without them

 

[Going2KillMyself]

photos and everything look good. Would be a great transformation. Not sure about the impact of Infraorbitals though.

 

[roon]

do you need to get tooth extractions before surgery?

 

[Deleted member 20064]

Jaw widening with bimax is retarded, flared gonions is what gives people chad jaws, and that can be accomplished with some implants.

 

[TryingToImprove]

Jaw widening with bimax is retarded, flared gonions is what gives people chad jaws, and that can be accomplished with some implants.

Hard disagree. The greater width and more masculine ramal inclination gained from surgical widening creates a better base for implants, allowing for smaller, more natural looking PEEK or be placed.

Your infraorbital implant design is garbage, OP. Tell him you want a saddle as straight, square, and highly placed as possible.

 

[politically correct]

Hard disagree. The greater width and more masculine ramal inclination gained from surgical widening creates a better base for implants, allowing for smaller, more natural looking PEEK or be placed.

Your infraorbital implant design is garbage, OP. Tell him you want a saddle as straight, square, and highly placed as possible.

Thanks,

Dr Ramieri doesn't offer saddle, is there any more specific instructions I can give to improve the design?

 

[politically correct]

do you need to get tooth extractions before surgery?

in my case no

 

[BrownEyesWD]

How much of an overjet is being created?

You mentioned you are not recessed, would your lower jaw not look quite protrusive with those types of movements?

For the jaw widening is this something you mentioned to him or did he recommend it after seeing you/scans? How many mm is it?

I’ve been consulting with him since last year and also going with him, will probs make a post of my plan next week.

 

[longjohnmong]

Your infraorbital implant design is garbage, OP. Tell him you want a saddle as straight, square, and highly placed as possible.

Do you have any B&A of this or comparisons with the OP design?

 

[politically correct]

How much of an overjet is being created?

You mentioned you are not recessed, would your lower jaw not look quite protrusive with those types of movements?

For the jaw widening is this something you mentioned to him or did he recommend it after seeing you/scans? How many mm is it?

I’ve been consulting with him since last year and also going with him, will probs make a post of my plan next week.

What do you mean by overjet?

By protrusive do you mean the dog face look?

So on the protrusive thing:
- Dr Ramieri has a reputation for being pretty damn conservative, so I doubt he'd do it if he thought it would look bad
- Soft tissue simulations look fine
- Its mainly through CCW, very little if any linear advancement
- My starting point is comparable to the guy below, although not as bad, not actually recessed but lacks projection

- If you look at like 1/3 of sailer's patients (), you can see they arent mega recessed pre op

For jaw widening:
- I specifically asked for this, and he will only do it for you if you get custom plates and cutting guides.
- I believe about 5mm per side
- I currently have jaw implants in which he's taking out, and he's matches the width of the bimax plan to match the width of my jaw with the current implants in

 

[SurgeryEnjoyer]

So here is my plan for surgery in 3 weeks

12-13mm mandible (excluding genio), 3.5mm maxilla, almost exclusively coming from CCW, 1.5mm impaction of maxilla (so will reduce maxilla height 1.5mm and have a bit less tooth show), 5mm genioplasty

Having a custom bimax with custom plates and cutting guides which will allow him to significantly widen the jaw

Thoughts welcome, my main one is whether I should have a greater vertical height increase to the chin to create a "V" effect

PS: I'm also having infraorbital malar implants at the same time, 3mm forward projection, 5mm lateral

View attachment 2099644
View attachment 2099645

Bro can u please tell me if his wait times are long or not ? Like what was the time span between your first consultation and the date of the surgery

 

[SurgeryEnjoyer]

So here is my plan for surgery in 3 weeks

12-13mm mandible (excluding genio), 3.5mm maxilla, almost exclusively coming from CCW, 1.5mm impaction of maxilla (so will reduce maxilla height 1.5mm and have a bit less tooth show), 5mm genioplasty

Having a custom bimax with custom plates and cutting guides which will allow him to significantly widen the jaw

Thoughts welcome, my main one is whether I should have a greater vertical height increase to the chin to create a "V" effect

PS: I'm also having infraorbital malar implants at the same time, 3mm forward projection, 5mm lateral

View attachment 2099644
View attachment 2099645

Btw chill out with the vertical genio, rn your plan looks good and personally i wouldn't downgraft more since it gives too much chin height, the plan you currently have is the sweet spot imo. Because unlike what many people say i think a really tall chin looks ogre and deformed

 

[politically correct]

Bro can u please tell me if his wait times are long or not ? Like what was the time span between your first consultation and the date of the surgery

6 weeks

 

[SurgeryEnjoyer]

6 weeks

WTF FR ? NO FUCKING WAY

 

[SurgeryEnjoyer]

6 weeks

Did you already bring him a premade plan or you made it with his help

 

[Deleted member 20631]

Did you already bring him a premade plan or you made it with his help

Probably made it with his help, I would’ve got my surgery in a similar amount of time had I not been busy with school

 

[politically correct]

Did you already bring him a premade plan or you made it with his help

no we built together

 

[politically correct]

Btw chill out with the vertical genio, rn your plan looks good and personally i wouldn't downgraft more since it gives too much chin height, the plan you currently have is the sweet spot imo. Because unlike what many people say i think a really tall chin looks ogre and deformed

im only downgrafting a few mm

 

[politically correct]

Btw chill out with the vertical genio, rn your plan looks good and personally i wouldn't downgraft more since it gives too much chin height, the plan you currently have is the sweet spot imo. Because unlike what many people say i think a really tall chin looks ogre and deformed

im trying to optimise my chin to philtrum ratio

 

[SurgeryEnjoyer]

im trying to optimise my chin to philtrum ratio

Ok fair enough then

 

[politically correct]

Currently 9 days post, this was the immediately post result

 

[WannaPistachio]

I'm scheduled for surgery with Mr Ramieri. Can I ask how your recovery has been? I would be staying on my own

 

[User49]

Currently 9 days post, this was the immediately post result

age bro?

 

[politically correct]

I'm scheduled for surgery with Mr Ramieri. Can I ask how your recovery has been? I would be staying on my own

So I mean bimax recovery is rough dude being honest, first week really sucks. No real pain but just discomfort, insane swelling, dry broken lips, jaw very cramped from the elastics, cant enjoy food

I'm currently 10 days post, second week is a lot easier, the main annoying thing at this point is that you have to wear really tight elastics which feels like you are biting down on a piece of wood 24/7. Apart from that its not so bad its more just about managing boredom as you are stuck in a hotel room for 3 weeks

My advice is to stay within 5 minutes of his clinic and do a really big shop for everything you need before surgery

 

[cancercell]

On the chin, wondering if I need to downgraft more to get this effect:
View attachment 2099648View attachment 2099649

Were these just genio or jaw surgery as well great ascensions

 

[politically correct]

Were these just genio or jaw surgery as well great ascensions

the guy with the moustache is just genio

the other guy had a bimax + genio with ramieri

 

[cancercell]

the guy with the moustache is just genio

the other guy had a bimax + genio with ramieri

Hard to believe that is just genio but lifefuel for chin height cels

 

[politically correct]

Hard to believe that is just genio but lifefuel for chin height cels

if you pay for custom plates and use bone grafts etc genioplasties can be highly customised and dramatic

but yeah a vanilla sliding genio you typically see done isnt going to do that

 

[cancercell]

if you pay for custom plates and use bone grafts etc genioplasties can be highly customised and dramatic

but yeah a vanilla sliding genio you typically see done isnt going to do that

How much does a customized genio cost ballpark

 

[politically correct]

How much does a customized genio cost ballpark

no idea, my genio was free with my bimax, @RealSurgerymax any idea?