Surgery Plan/Philosophy

Hardmaxx.aze

Hardmaxx.aze

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23 (in November) years old, 184cm, currently 91kg and would rate myself facially MLTN (4.5/10).

I was born with a milder case of "hemifacial microsomia," which is basically a congenital, but not genetic condition, that develops during the gestation period, and is characterized by one side of the face being more/less developed than the other. The most common affected areas are lower jaw, ear, cheekbone, sometimes the orbit and the upper jaw.
In my case my right eye is 3.5mm lower than the left, as well as my cheekbone, my maxilla is canted and my lower jaw/chin is 3mm tilted to the right, with the right ramus being considerably shorter as well. Other than that, I have recessed infraorbital area and a mildly recessed mandible chin.

In order to overcome/"fix" this deformity I came up with a 3 year plan, which includes:

2026
1. Palate expansion with MARPE + a corticotomy, which I'm currently nearing towards the end of the active expansion phase (1 week left till stopping turns). Already expanded 6mm
2. Damon braces to start the decompensation process. Already got the lower braces, and will soon get upper as well.


2027 (Hopefully Summer)
1. Main procedure: Unilateral OBO to symmetrize the eyes. As 3.5mm is considered on the milder side of "vertical orbital dystopia," I believe it's possible to achieve close to normal levels of symmetry. Considering the cheekbone area is also lower, it would probably require a bone graft to the cheek as well.

2. Rhinoplasty with radix augmentation and alaroplasty for narrowing the alar base. Whether I will proceed with this procedure or not, depends on the surgeon's advice/plan, but I'm thinking at least the radix graft/augmentation, would be logical from a surgical perspective. If it's risky/not possible to get simultaneously with OBO, I plan to do it in the next 2 years.

3. Conservative custom infraorbital implants to increase the orbital vector. My goal is harmony and fine tuning, not some insane increase in projection. Basically, same as with the rhinoplasty, depends on the safety and also whether the implants would get in the way of a future trimax with a segmental (3 piece) Le Fort I.

I plan to get this phase with Dr. Burak Sercan Ercin and Giant.Implants (Liam). Haven't officially contacted them yet, but based on a few DMs it's possible. Will officially contact them with full proof of funds after the MARPE retention phase ends (March 2027).


Late 2028
1. Trimax, which includes a segmental (3 piece) Le Fort 1 + BSSO + genioplasty. I have a mild skeletal overbite, with consequent mandible/chin recession. Possible that the Le Fort 1, would include an impaction, since I have mild upper gum show. But the main purpose of me getting trimax is to fix the upper jaw cant, and the mandible/chin asymmetry.
2. In terms of the shorter (right) ramus the most logical solution, would probably be a custom one-sided PEEK jaw angle implant to give a symmetric appearance
My orthodontist studied with and has worked/currently works on cases with Dr. Valerio Ramieri. So all considered, I hope to get the last "hardmaxxes" done by him.


My Philosophy/Reasoning:
The most brutal part to accept is, that my deformity wasn't the result of something I/my family did during development. I was just unlucky to be born with it. And living in a 3rd world country has made it even more difficult.
I'm not claiming surgery will automatically make me happy, I just want to find out, what changing something that has affected me since birth, can do for my own life. I want to see, how it feels like to be on the other "normal" side. Ultimately I just want to find inner peace and by documenting it honestly, maybe I can give other people in a similar position something real to learn from.


P.S. I also "gymcell" and take an extensive pharmacology stack to get sub 10% bf and improve my quality of life:

Training:
I train 6× a week Pull/Push/repeat, low volume high intensity, 5-10 rep range, 3-5 minutes rest. I do 3 total sets, 1 working (failure) set on the first exercise, and 1 straight working (failure) set on the rest. My training lasts 50 minutes max.

Day 1:
1. Wide grip lat pulldowns
2. Horizontal machine rows
3. Close grip lat pulldowns
4. Reverse pec deck flyes
5. Seated bilateral dumbbell curls
6. Seated W-bar preacher curls
7. Leg: Curls/adductions/extensions (Monday/Wednesday/Friday)
8. Hyperextensions/calf raises/wieghted leg raises (Monday/Wednesday/Friday)

Day 2:
1. Incline barbell bench press
2. Chest machine press
3. Incline machine flyes
4. Machine lateral raises
5. Straight handle cable extensions
6. Single arm cable extensions
7. Leg: Extensions/curls/adductions (Tuesday/Thursday/Saturday)
8. Decline weighted ab crunches/hyperextensions/calf raises (Tuesday/Thursday/Saturday)

Diet (dropped 11kg in 5 weeks): 1600-1700 calories
1. 600g chicken breast
2. 4 whole eggs + 4 egg whites
3. 400 grams 0% cottage cheese
3. 200 grams of cucumber/tomato
4. 1 slice of black bread
5. 1lt Pepsi MAX
6. 1/2 pack of cheap cigarettes


Pharma:
1. Testosterone enanthate - 500mg a week (been on for 5 weeks, but did a year long cycle with 250-500mg from April 2024 - April 2025.
2. GH - 4 iu a day (been on for 5 weeks)
3. Anastrazole (AI) - 0.5mg 3× a week (been on for 5 weeks, used in the past with testosterone)
4. L-thyroxine (T4) - 50mcg a day (been on for 5 weeks)
5. Tirzepatide (GLP-1) - 2.5mg a week (been on for 4 weeks)
6. Finasteride - 2.5mg a day (been on since for 10 months)
7. Isotretinoin - 60mg a week (been on for 5 months)
8. Fluvoxamine (SSRI) - 50mg a day (been on for 5 weeks, used Paroxetine before for 2 years).
9. Bisoprolol (beta-blocker) - 1.25mg a day (been on for 2 years).
10. Spironolactone (diuretic) - 25mg a day (been on for 5 weeks).


Picture sequence (I know my morphs are shit):
1. Front unmorphed
2. Front morphed (OBO/rhinoplasty/infraorbital implants)
3. Left side unmorphed
4. Left side "fully" morphed
5. Right side unmorphed
6. Right side "fully" morphed
7. Physique 10 days ago (93kg)


TL;DR

I was born with a condition, which makes my face look deformed, and unharmonic, so I plan to get the required procedures to change it and improve my life.
 

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Expansion progress: July 6th to September 22nd.

Starting intermolar width was 35.5mm

Will fully post my new CBCT and cephalometry scans, once my orthodontist comes back from Italy and gives me the access (next week).
 

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