Thoughts and info on Dr. Zarrinbal?

[SurgerySoon]

I am interested in scheduling a consultation with Dr. Zarrinbal (just emailed his office staff) and was wondering what the general consensus was on him in terms of his skills as a surgeon, how redpilled he is, etc. Does anyone know if he speaks English and does Skype consultations?

Also, what other surgeons should I consider? Also looking at Raffaini and Sailer but Sailer is extremely expensive and would prefer to not spend so much money if I can go to another surgeon who can get the same results for a fraction of the price.

 

[KEy21]

I would go to arnett and gunson. If you’re already spending a lot of money then go with the best. Plus you won’t have to travel out of country.

Some of dr sailers implants look uncanny but his osteotomies are good so you should be fine in that department.

 

[Gosick]

gunson rejected @facemaxxed when he requested double jaw surgery, its likely he will reject you if you dont have any functional problems with your maxilla.

 

[KEy21]

gunson rejected @facemaxxed when he requested double jaw surgery, its likely he will reject you if you dont have any functional problems with your maxilla.

You have to know how to speak like a non autist and prove that you have money.

 

[SurgerySoon]

I would go to arnett and gunson. If you’re already spending a lot of money then go with the best. Plus you won’t have to travel out of country.

Some of dr sailers implants look uncanny but his osteotomies are good so you should be fine in that department.

Didn't one of those surgeons (I think Arnett) retire? Also, I heard there's like a 6+ month waitlist just for consultations. I probably won't have the time or money to get the surgery until next fall anyways, but I really don't want to wait like 2 years to get this shit done.

Is there anyone else in the US who has a good reputation besides Arnett and Gunson?

Also, how do I not speak like an autist? You mean don't make any mention of aesthetic goals at all? What sort of functional issue can I pretend to have that he can't really refute?

On the topic of Sailer's implants looking uncanny, I will be going back to Yaremchuk post-double jaw surgery to have him revise the midface implants (assuming they'll look even less pronounced after the DJ surgery), so I'll just be getting the osteotomies done with Sailer (or whoever I end up going with).

Another thing to consider is whether I should get eye area surgery before or after DJ surgery.

gunson rejected @facemaxxed when he requested double jaw surgery, its likely he will reject you if you dont have any functional problems with your maxilla.

I guess I'll have to make some shit up, or just go with a different surgeon who's willing to work on patients for aesthetic reasons

 

[Deusmaximus]

I live in the same city as sailer, and went there for consultation. I think him and his wife lost control, and are just to old for this job. Everything was unprofessional and strange. He is 76, and should just quit with this work. dr.defrancq in antwerp could be a very good choice.

 

[KEy21]

I live in the same city as sailer, and went there for consultation. I think him and his wife lost control, and are just to old for this job. Everything was unprofessional and strange. He is 76, and should just quit with this work.

Explain in more detail please. From the start of the consultation to the end

This would be a really good and informative post

 

[justanothergymcell]

This guy again. Still asking about other surgeries and not trying to fix his eyes.

Here is what I do know though: He does speak English but you have go to Germany for an in person consultation. Unless this has changed, you will need to go to Europe boyo.

 

[SurgerySoon]

This guy again. Still asking about other surgeries and not trying to fix his eyes.

Here is what I do know though: He does speak English but you have go to Germany for an in person consultation. Unless this has changed, you will need to go to Europe boyo.

You were the one who told me that even if I fixed my eyes, I still won't be GL enough due to my base for anything but LTRs and maybe the occasional ONS ("he will never slay in the west"). So that's exactly what I'm doing -- undergoing osteotomies to alter the fundamental bone structure of my face and create the ratios that will STILL be holding me back from being GL enough to have the kind of luck with girls to be anything but a cuck (that is to say, unless I want to spend months in Asia forcing myself to try to be attracted to women I'm not actually capable of being attracted to).

If Zarrinbal only does in-person consultations then it might not be all that much more expensive in the long run to just go with a US-based surgeon

 

[Gosick]

Didn't one of those surgeons (I think Arnett) retire? Also, I heard there's like a 6+ month waitlist just for consultations. I probably won't have the time or money to get the surgery until next fall anyways, but I really don't want to wait like 2 years to get this shit done.

Is there anyone else in the US who has a good reputation besides Arnett and Gunson?

Also, how do I not speak like an autist? You mean don't make any mention of aesthetic goals at all? What sort of functional issue can I pretend to have that he can't really refute?

On the topic of Sailer's implants looking uncanny, I will be going back to Yaremchuk post-double jaw surgery to have him revise the midface implants (assuming they'll look even less pronounced after the DJ surgery), so I'll just be getting the osteotomies done with Sailer (or whoever I end up going with).

Another thing to consider is whether I should get eye area surgery before or after DJ surgery.


I guess I'll have to make some shit up, or just go with a different surgeon who's willing to work on patients for aesthetic reasons

so your not going to get your eye area overhaul done until after you get double jaw and your midface implants revised?

 

[justanothergymcell]

You were the one who told me that even if I fixed my eyes, I still won't be GL enough due to my base for anything but LTRs and maybe the occasional ONS ("he will never slay in the west"). So that's exactly what I'm doing -- undergoing osteotomies to alter the fundamental bone structure of my face and create the ratios that will STILL be holding me back from being GL enough to have the kind of luck with girls to be anything but a cuck (that is to say, unless I want to spend months in Asia forcing myself to try to be attracted to women I'm not actually capable of being attracted to).

If Zarrinbal only does in-person consultations then it might not be all that much more expensive in the long run to just go with a US-based surgeon

Maybe try googling Dr Richard Joseph

 

[Deusmaximus]

Osteotomies are not for you. The results are so minimal, and not worth the pain from hard surgery. Just look at zarrinbals before and after pictures. So little improvement, when youre not recessed or have real bite problem.

 

[justanothergymcell]

Osteotomies are not for you. The results are so minimal, and not worth the pain from hard surgery. Just look at zarrinbals before and after pictures. So little improvement, when youre not recessed or have real bite problem.

He has a lot more to show at his office.

 

[wellthatsucks]

Osteotomies are not for you. The results are so minimal, and not worth the pain from hard surgery. Just look at zarrinbals before and after pictures. So little improvement, when youre not recessed or have real bite problem.

The chin wing results are good, ask @kota

 

[SurgerySoon]

so your not going to get your eye area overhaul done until after you get double jaw and your midface implants revised?

Not sure TBH. When I try to jut my jaws forward it kind of stretches my undereye skin, so idk if it would be a bad idea to get the eye area overhaul done first if the results could end up getting messed up when my maxilla is brought forward.

Osteotomies are not for you. The results are so minimal, and not worth the pain from hard surgery. Just look at zarrinbals before and after pictures. So little improvement, when youre not recessed or have real bite problem.

Have you seen my side profile photos? My maxilla is at least mildly recessed. Also, even if it's not legitimately recessed, it doesn't look very forward-grown at all. Although, I don't think I really it for my mandible -- I mainly need to have my maxilla brought forward, but there isn't any way to bring only the maxilla forward without messing up teeth alignment between my top and bottom jaws.

Maybe try googling Dr Richard Joseph

Just checked out some his before/afterschool. They all look good, but it seems like he might be a bit more conservative when it comes to the mm of advancement he gives to patients relative to what I'm looking to get

 

[kota]

Dr Z doesn't do Skype consultations as far as I know, I had to travel to see him in person. Also he is hard to get a hold of by e-mail, you likely need to call repeatedly until you get a hold of him just to explain your situation and book a consultation. Then there is no way to know if he will reject you even after you spend the time and money to travel to him as you're not a clear cut case for bimax.. If you already have a CT scan from your implant preparations it might be worth having an analysis of these first to know where you stand.

 

[WannaBeA6]

Just go to fucking Raffaini, he has proved himself multiple times
Ah, I remember you
You need to visit Taban instead, you have fucking NCT for christ's sake, you NEED to understand that eye area is the most important part of your face

 

[KEy21]

Not sure TBH. When I try to jut my jaws forward it kind of stretches my undereye skin, so idk if it would be a bad idea to get the eye area overhaul done first if the results could end up getting messed up when my maxilla is brought forward.


Have you seen my side profile photos? My maxilla is at least mildly recessed. Also, even if it's not legitimately recessed, it doesn't look very forward-grown at all. Although, I don't think I really it for my mandible -- I mainly need to have my maxilla brought forward, but there isn't any way to bring only the maxilla forward without messing up teeth alignment between my top and bottom jaws.


Just checked out some his before/afterschool. They all look good, but it seems like he might be a bit more conservative when it comes to the mm of advancement he gives to patients relative to what I'm looking to get

Reminder

 

[freeone12]

intresting reading, you guys should make surgeon guide usa/europe

 

[ProjectAscension]

Hey @SurgerySoon, good to see you're still active. I went to see Dr. Z for a consult back in (June?) in Berlin concerning septorhinoplasty and chin wing. He speaks good English, not sure if he does Skype consultations. Hard to get hold of through email and his secretary barely speaks any English so booking a consult is a nightmare.

The actual practice was a bit underwhelming, very empty and dank, broken lights, no AC (during the summer so it was hot). During the consult giant wasps kept flying through the window so a good chunk of the time was spent trying not to get stung. He's had some good results and no doubt a skilled surgeon but honestly, if you're in the US I would stick with a surgeon there. Had a change of goals so decided not to go through with anything with him.

 

[Gosick]

Just go to fucking Raffaini, he has proved himself multiple times
Ah, I remember you
You need to visit Taban instead, you have fucking NCT for christ's sake, you NEED to understand that eye area is the most important part of your face

i think hes going to hold off on the eye surgeries for like another year since he wants to fix his recessed maxilla and augment his zygos more

 

[SurgerySoon]

Dr Z doesn't do Skype consultations as far as I know, I had to travel to see him in person. Also he is hard to get a hold of by e-mail, you likely need to call repeatedly until you get a hold of him just to explain your situation and book a consultation. Then there is no way to know if he will reject you even after you spend the time and money to travel to him as you're not a clear cut case for bimax.. If you already have a CT scan from your implant preparations it might be worth having an analysis of these first to know where you stand.

Believe it or not, Dr. Z emailed me back earlier this morning (I filled out and submitted the contact form on his website just a day or two ago). Just like you said, he doesn't do Skype consultations -- only in-person ones. I guess I'll need to decide if I want to spend the $$$ to fly to Berlin or schedule consultations with US-based surgeons first. At least he seems to speak pretty good English.

Hey @SurgerySoon, good to see you're still active. I went to see Dr. Z for a consult back in (June?) in Berlin concerning septorhinoplasty and chin wing. He speaks good English, not sure if he does Skype consultations. Hard to get hold of through email and his secretary barely speaks any English so booking a consult is a nightmare.

The actual practice was a bit underwhelming, very empty and dank, broken lights, no AC (during the summer so it was hot). During the consult giant wasps kept flying through the window so a good chunk of the time was spent trying not to get stung. He's had some good results and no doubt a skilled surgeon but honestly, if you're in the US I would stick with a surgeon there. Had a change of goals so decided not to go through with anything with him.

Thanks for posting your feedback on your consultation experience with him. I'll probably do more research on US-based surgeons and get a consult scheduled with one here first, assuming I can find one who is open to performing DJ surgery for aesthetic purposes. Just out of curiosity, what did you end up deciding to have done instead of DJ surgery? Going the implants route instead?

Just go to fucking Raffaini, he has proved himself multiple times
Ah, I remember you
You need to visit Taban instead, you have fucking NCT for christ's sake, you NEED to understand that eye area is the most important part of your face

Yes -- if I could choose to go to any maxfac surgeon in the world, I would probably choose Raffaini. If there's any surgeon out there whose before/after results indicate that he has what it takes to turn me into an oldcel chadlite, it would be him. In fact, if I had the money and the time to fly out to Italy next week and he was down to perform the surgery, I would 100% go for it.

 

[SurgerySoon]

I know I posted my custom implant design scans in another thread, but I just remembered something. About a year before my surgery, I had gotten in touch with a lady who had gone to Dr. Y to have custom facial implant surgery, and as you can see in her implant design scan posted below, he gave her some really prominent paranasal augmentation:



On the other hand, it's almost like he intentionally avoided augmenting the paranasal area when he designed my midface implants:



I mean, WTF was he thinking? How could he not recognize from the photos I sent that my maxilla is obviously recessed and would've benefited from paranasal augmentation? Now I'll have to go back to him and pay extra $$ to have paranasal implants put in if I want to have the area augmented (in the event that I choose not to get double jaw surgery).

@KEy21 this is what I mean when I say that there are certain aspects of my surgery that really frustrate me. Besides the fact that he made the implants too small in terms of projection, he intentionally avoided augmenting the paranasal area for some incomprehensible reason

 

[ProjectAscension]

Believe it or not, Dr. Z emailed me back earlier this morning (I filled out and submitted the contact form on his website just a day or two ago). Just like you said, he doesn't do Skype consultations -- only in-person ones. I guess I'll need to decide if I want to spend the $$$ to fly to Berlin or schedule consultations with US-based surgeons first. At least he seems to speak pretty good English.


Thanks for posting your feedback on your consultation experience with him. I'll probably do more research on US-based surgeons and get a consult scheduled with one here first, assuming I can find one who is open to performing DJ surgery for aesthetic purposes. Just out of curiosity, what did you end up deciding to have done instead of DJ surgery? Going the implants route instead?


Yes -- if I could choose to go to any maxfac surgeon in the world, I would probably choose Raffaini. If there's any surgeon out there whose before/after results indicate that he has what it takes to turn me into an oldcel chadlite, it would be him. In fact, if I had the money and the time to fly out to Italy next week and he was down to perform the surgery, I would 100% go for it.

DJ was never really on the table for me. It would benefit me aesthetically for sure, however decided the time / cost / risk is not worth it (for me). Decided to start slow and go with less invasive and lower risk procedures. For my lower third I got 2ml chin filler, 2ml jawline filler and two days ago my first Kybella treatment to the submental region. Hoping this will be enough to give me a solid lower third (should know in 6 - 12 weeks depending on whether I need another Kybella treatment). If not, I'll probably get a conservative custom jawline implant with Eppley as part of the other procedures I describe below.

My midface and nose are really what screws my looks. Super flat midface giving me negative orbital vector, dark undereye circles that make me look old and tired, sunken nasal bridge, no zygos. Complete disaster basically. I've had 4ml filler total placed on the midface which has helped to some degree but it's painfully apparent that for the amount of augmentation I need, I'm going to have to get a custom midface implant from Eppley. What I like about Eppley's midface implant is he can cover the whole midface (infraorbital, malar, paranasal etc.) and it's no more expensive than just getting custom infraorbital implants. That combined with a septorhinoplasty should be enough to ascend me from subhumanity.

 

[PubertyMaxxer]

DJ was never really on the table for me. It would benefit me aesthetically for sure, however decided the time / cost / risk is not worth it (for me). Decided to start slow and go with less invasive and lower risk procedures. For my lower third I got 2ml chin filler, 2ml jawline filler and two days ago my first Kybella treatment to the submental region. Hoping this will be enough to give me a solid lower third (should know in 6 - 12 weeks depending on whether I need another Kybella treatment). If not, I'll probably get a conservative custom jawline implant with Eppley as part of the other procedures I describe below.

My midface and nose are really what screws my looks. Super flat midface giving me negative orbital vector, dark undereye circles that make me look old and tired, sunken nasal bridge, no zygos. Complete disaster basically. I've had 4ml filler total placed on the midface which has helped to some degree but it's painfully apparent that for the amount of augmentation I need, I'm going to have to get a custom midface implant from Eppley. What I like about Eppley's midface implant is he can cover the whole midface (infraorbital, malar, paranasal etc.) and it's no more expensive than just getting custom infraorbital implants. That combined with a septorhinoplasty should be enough to ascend me from subhumanity.

Also get premaxillary implant from eppley and try THE CRANE

 

[kota]

I know I posted my custom implant design scans in another thread, but I just remembered something. About a year before my surgery, I had gotten in touch with a lady who had gone to Dr. Y to have custom facial implant surgery, and as you can see in her implant design scan posted below, he gave her some really prominent paranasal augmentation:



On the other hand, it's almost like he intentionally avoided augmenting the paranasal area when he designed my midface implants:



I mean, WTF was he thinking? How could he not recognize from the photos I sent that my maxilla is obviously recessed and would've benefited from paranasal augmentation? Now I'll have to go back to him and pay extra $$ to have paranasal implants put in if I want to have the area augmented (in the event that I choose not to get double jaw surgery).

@KEy21 this is what I mean when I say that there are certain aspects of my surgery that really frustrate me. Besides the fact that he made the implants too small in terms of projection, he intentionally avoided augmenting the paranasal area for some incomprehensible reason

For what it's worth, although I don't have access to the DICOM-files, I wouldn't say your maxilla is OBVIOUSLY recessed.

 

[SurgerySoon]

DJ was never really on the table for me. It would benefit me aesthetically for sure, however decided the time / cost / risk is not worth it (for me). Decided to start slow and go with less invasive and lower risk procedures. For my lower third I got 2ml chin filler, 2ml jawline filler and two days ago my first Kybella treatment to the submental region. Hoping this will be enough to give me a solid lower third (should know in 6 - 12 weeks depending on whether I need another Kybella treatment). If not, I'll probably get a conservative custom jawline implant with Eppley as part of the other procedures I describe below.

My midface and nose are really what screws my looks. Super flat midface giving me negative orbital vector, dark undereye circles that make me look old and tired, sunken nasal bridge, no zygos. Complete disaster basically. I've had 4ml filler total placed on the midface which has helped to some degree but it's painfully apparent that for the amount of augmentation I need, I'm going to have to get a custom midface implant from Eppley. What I like about Eppley's midface implant is he can cover the whole midface (infraorbital, malar, paranasal etc.) and it's no more expensive than just getting custom infraorbital implants. That combined with a septorhinoplasty should be enough to ascend me from subhumanity.

Good luck with your surgeries. If I could go back, one change I would've made (besides making my cheek implants project more) would have been to have my surgeon design the implants to augment the paranasal area so that I could've gotten at least SOME additional projection of the maxilla (or the illusion of it, at least).

 

[Gosick]

Good luck with your surgeries. If I could go back, one change I would've made (besides making my cheek implants project more) would have been to have my surgeon design the implants to augment the paranasal area so that I could've gotten at least SOME additional projection of the maxilla (or the illusion of it, at least).

paranasal implants are thrash, eppley is a thief for charging 15k for tht thrash imo

 

[SurgerySoon]

For what it's worth, although I don't have access to the DICOM-files, I wouldn't say your maxilla is OBVIOUSLY recessed.

Do you need the DICOM files itself to determine whether the maxilla is recessed, or just the 3D scan of the skull that is compiled from the DICOM files? I can actually send you the DICOM files if you want, but if it's just the latter, then here is a series of photos I uploaded yesterday of my implant designs; the last photo in the series includes several angles of my skull (created from the DICOM files) without any implant overlays:



Are you able to estimate just by looking at the 3D model of the skull whether my maxilla is recessed or not? If so, how badly would you say it's recessed in terms of mm?

But it's like you said in a response you posted to me in another thread -- if the recession isn't that bad, then I'll just have to decide if it's worth it to go through the misery/pain/financial cost of getting LF1 + BSSO or just camouflage the issue with the wraparound jaw + paranasal implants and maybe lip fillers or a lip lift. If my degree of maxillary recession is not, in fact, severe, then I'm thinking that I might be able to get a "good enough" result from the implant procedures.

Also, you said that since my occlusal plane looks normal, I might not be able to find a surgeon who will give me CCW; if that ends up being the case (or if they refuse to give me enough to provide a noticeable improvement over what I'd get from jaw + paranasal implants), then I guess I'll have no choice but to go the more conservative route with implants.

paranasal implants are thrash, eppley is a thief for charging 15k for tht thrash imo

Have you seen the paranasal implant results from Dr. Y? They don't give results that are nearly as dramatic as LF1, of course, but I still think they can confer a decent improvement in maxillary projection to someone who isn't severely recessed. I think I posted them in another thread on here the other day, but I can post them again if you haven't seen them.

 

[kota]

Do you need the DICOM files itself to determine whether the maxilla is recessed, or just the 3D scan of the skull that is compiled from the DICOM files? I can actually send you the DICOM files if you want, but if it's just the latter, then here is a series of photos I uploaded yesterday of my implant designs; the last photo in the series includes several angles of my skull (created from the DICOM files) without any implant overlays:



Are you able to estimate just by looking at the 3D model of the skull whether my maxilla is recessed or not? If so, how badly would you say it's recessed in terms of mm?

But it's like you said in a response you posted to me in another thread -- if the recession isn't that bad, then I'll just have to decide if it's worth it to go through the misery/pain/financial cost of getting LF1 + BSSO or just camouflage the issue with the wraparound jaw + paranasal implants and maybe lip fillers or a lip lift. If my degree of maxillary recession is not, in fact, severe, then I'm thinking that I might be able to get a "good enough" result from the implant procedures.

Also, you said that since my occlusal plane looks normal, I might not be able to find a surgeon who will give me CCW; if that ends up being the case (or if they refuse to give me enough to provide a noticeable improvement over what I'd get from jaw + paranasal implants), then I guess I'll have no choice but to go the more conservative route with implants.


Have you seen the paranasal implant results from Dr. Y? They don't give results that are nearly as dramatic as LF1, of course, but I still think they can confer a decent improvement in maxillary projection to someone who isn't severely recessed. I think I posted them in another thread on here the other day, but I can post them again if you haven't seen them.

You don't necessarily need the whole DICOM-package, but these particular images lack all of the markers to make a proper cephalometric analysis. You would need something like this extracted from the DICOM-files:

https://upload.wikimedia.org/wikipe...graph.JPG/1024px-Cephalometric_radiograph.JPG

I can't make any calculations in the absence of visual landmarks. I would say both your jaws are probably within normal range. Maybe slightly recessed like myself.

 

[SurgerySoon]

You don't necessarily need the whole DICOM-package, but these particular images lack all of the markers to make a proper cephalometric analysis. You would need something like this extracted from the DICOM-files:

https://upload.wikimedia.org/wikipe...graph.JPG/1024px-Cephalometric_radiograph.JPG

I can't make any calculations in the absence of visual landmarks. I would say both your jaws are probably within normal range. Maybe slightly recessed like myself.

I'll see if I can download some sort of DICOM-viewing software so that I can obtain an image like the one you posted above.

So are you going to follow through with getting full-fledged double jaw surgery despite being only slightly recessed (as you described yourself to be)?

Assuming I really am only slightly recessed myself, that's why I'm on the fence as to whether I want to get legit DJ surgery or if I'd be personally satisfied getting the wraparound jaw + paranasal/premaxillary implants to camouflage the issue.

The thing is, I understand that implants aren't going to give nearly the same degree of improvement as DJ surgery, but if my recession is mild enough such that even the less overt degree of improvement I'd get from the implants would be "good enough," then I'm not sure if I can justify the additional costs (both financial and otherwise) of DJ surgery.

It would definitely be cheaper to go the implant route, that's for sure; since my wraparound implant has already been designed and manufactured, I would only need to pay Dr. Y his surgical fee to have it placed, which was quoted at $8500. I'm assuming that adding on paranasal + premaxillary implants would only cost a few thousand dollars more. I'm not 100% sure how much DJ surgery would cost, but I'm assuming it would be in the range of $30k+?

 

[Deleted member 4054]

Who's good is a moot point. Every one of the surgeons mentioned here will tell you you're not a candidate for orthognathic surgery. Your bite is fine, skeletal relationships are good, and occlusal plane well within the norm. It's also wrong to say double jaw surgery will give an aesthetic result superior to implants. In someone like you with normal skeletal relationships and no overt recession, the opposite is true.

You also had a very good result with your midface implants and midface lift. Maybe not as prominent as you'd like, but a very good result. Revising it is rife with potential complications for a minimal gain as every time you repeat a procedure the degree of difficulty goes up, and it requires dissecting the malar/orbital rim tissue subperiostially which will have an impact on the integrity of your previous midface lift. Honestly it would be nuts to revise it, and I'm guessing the only reason you want to is the cheek area is a point of obsession or deep insecurity for you personally. Don't do it. I also don't think you need paranasal augmentation, but if you want to run it by Yaremchuk that's fine.

All that aside, all you need at this point to start getting attention/positive reactions from women is eye surgery to make them less prominent, and if you want, the jaw angle component of the implant Yaremchuk designed.

 

[ProjectAscension]

Who's good is a moot point. Every one of the surgeons mentioned here will tell you you're not a candidate for orthognathic surgery. Your bite is fine, skeletal relationships are good, and occlusal plane well within the norm. It's also wrong to say double jaw surgery will give an aesthetic result superior to implants. In someone like you with normal skeletal relationships and no overt recession, the opposite is true.

You also had a very good result with your midface implants and midface lift. Maybe not as prominent as you'd like, but a very good result. Revising it is rife with potential complications for a minimal gain as every time you repeat a procedure the degree of difficulty goes up, and it requires dissecting the malar/orbital rim tissue subperiostially which will have an impact on the integrity of your previous midface lift. Honestly it would be nuts to revise it, and I'm guessing the only reason you want to is the cheek area is a point of obsession or deep insecurity for you personally. Don't do it. I also don't think you need paranasal augmentation, but if you want to run it by Yaremchuk that's fine.

All that aside, all you need at this point to start getting attention/positive reactions from women is eye surgery to make them less prominent, and if you want, the jaw angle component of the implant Yaremchuk designed.

100% agree. The mantra said by all top tier cosmetic surgeons (the guys off Botched, even Eppley has said this multiple times verbatim): "Perfect is the enemy of good". Cosmetic surgery will never get you a perfect result, doubly so for implants. There's just no predicting how the soft tissue will change with the implant shape, then how it will heal etc.

 

[kota]

I'll see if I can download some sort of DICOM-viewing software so that I can obtain an image like the one you posted above.

So are you going to follow through with getting full-fledged double jaw surgery despite being only slightly recessed (as you described yourself to be)?

Assuming I really am only slightly recessed myself, that's why I'm on the fence as to whether I want to get legit DJ surgery or if I'd be personally satisfied getting the wraparound jaw + paranasal/premaxillary implants to camouflage the issue.

The thing is, I understand that implants aren't going to give nearly the same degree of improvement as DJ surgery, but if my recession is mild enough such that even the less overt degree of improvement I'd get from the implants would be "good enough," then I'm not sure if I can justify the additional costs (both financial and otherwise) of DJ surgery.

It would definitely be cheaper to go the implant route, that's for sure; since my wraparound implant has already been designed and manufactured, I would only need to pay Dr. Y his surgical fee to have it placed, which was quoted at $8500. I'm assuming that adding on paranasal + premaxillary implants would only cost a few thousand dollars more. I'm not 100% sure how much DJ surgery would cost, but I'm assuming it would be in the range of $30k+?

Yes, you should be able to extract an image like that to make a basic evaluation on both jaws projection in relation to normal values. My best bet is you're within normal range.

It doesn't have to cost $30k, totally depends on which surgeon you go to. And also if you would need to pay for orthodontic treatment to go with it.

I have a surgeon lined up willing to give me bimax w/ CCW but yet undecided if worth it in my case. Chin wing already covered my main issue and my recession is mild.

 

[zq336]

Who's good is a moot point. Every one of the surgeons mentioned here will tell you you're not a candidate for orthognathic surgery. Your bite is fine, skeletal relationships are good, and occlusal plane well within the norm. It's also wrong to say double jaw surgery will give an aesthetic result superior to implants. In someone like you with normal skeletal relationships and no overt recession, the opposite is true.

You also had a very good result with your midface implants and midface lift. Maybe not as prominent as you'd like, but a very good result. Revising it is rife with potential complications for a minimal gain as every time you repeat a procedure the degree of difficulty goes up, and it requires dissecting the malar/orbital rim tissue subperiostially which will have an impact on the integrity of your previous midface lift. Honestly it would be nuts to revise it, and I'm guessing the only reason you want to is the cheek area is a point of obsession or deep insecurity for you personally. Don't do it. I also don't think you need paranasal augmentation, but if you want to run it by Yaremchuk that's fine.

All that aside, all you need at this point to start getting attention/positive reactions from women is eye surgery to make them less prominent, and if you want, the jaw angle component of the implant Yaremchuk designed.

I totally agree, the only thing holding you back is your eyes, mental state, and maybe body (haven't seen it). Pursuing anything else would be a huge waste of time and money (both of which you've probably wasted a lot of already) and would be unlikely to raise you any points. Getting eye surgery alone would probably boost you a lot.

I don't really see the benefit of paranasal implants on you, if anything it might make your nose stick out too far.

 

[SurgerySoon]

Who's good is a moot point. Every one of the surgeons mentioned here will tell you you're not a candidate for orthognathic surgery. Your bite is fine, skeletal relationships are good, and occlusal plane well within the norm. It's also wrong to say double jaw surgery will give an aesthetic result superior to implants. In someone like you with normal skeletal relationships and no overt recession, the opposite is true.

You also had a very good result with your midface implants and midface lift. Maybe not as prominent as you'd like, but a very good result. Revising it is rife with potential complications for a minimal gain as every time you repeat a procedure the degree of difficulty goes up, and it requires dissecting the malar/orbital rim tissue subperiostially which will have an impact on the integrity of your previous midface lift. Honestly it would be nuts to revise it, and I'm guessing the only reason you want to is the cheek area is a point of obsession or deep insecurity for you personally. Don't do it. I also don't think you need paranasal augmentation, but if you want to run it by Yaremchuk that's fine.

All that aside, all you need at this point to start getting attention/positive reactions from women is eye surgery to make them less prominent, and if you want, the jaw angle component of the implant Yaremchuk designed.

Appreciate the feedback. To respond to your first point -- aren't there maxfac surgeons out there who are specifically well-known for their willingness to work on patients who don't clinically qualify as candidates for orthognathic surgery? Also, you said that double jaw surgery is more likely to make someone with normal skeletal relationships look worse. I can see how there's a risk of this occurring, but at the same time, isn't a generally established/accepted tenet of modern aesthetic and attractiveness research that anteface is generally more attractive than having a more flat face? In other words, assuming the surgery itself is successful and doesn't create functional issues, won't I look better by default with having a face that looks more forward-grown?

To respond to your second point -- honestly, I would say that my whole face is a point of obsession (not just the midface/cheeks). It's just that I've wanted to start getting these surgeries for at least 7-8 years now, so I really want to get the kinds of results I set out to achieve in the first place. Also, the reason I considered paranasal implants is not because I want paranasal augmentation specifically, but just because I understand that they're marketed as a sort of "camouflage" surgery that is intended to mimic the forward growth-replicating aesthetic effect of LF1. So in other words, if I would benefit from LF1 and if paranasal implants are considered to be the implant-based substitute procedure to come somewhat close to replicating the results of LF1, then perhaps I could benefit from paranasal implants... ? (that's my line of reasoning)

I have pretty much decided that I definitely want to get the rest of the wraparound jaw implant placed by Dr. Y if I don't get double jaw surgery instead. I would like for my jawline to be less steep from the side, and I also think that by stretching out the midface tissues more, it will create more cheek hollowing, which will make the midface implants look more prominent.

100% agree. The mantra said by all top tier cosmetic surgeons (the guys off Botched, even Eppley has said this multiple times verbatim): "Perfect is the enemy of good". Cosmetic surgery will never get you a perfect result, doubly so for implants. There's just no predicting how the soft tissue will change with the implant shape, then how it will heal etc.

My problem is that my skin is apparently so thick that it makes relatively large implants (my right midface implant projects almost 6 mm, for example) look less noticeable than they would in other people's faces, which is why I simply wanted to have the exact same implant design re-manufactured to provide more augmentation.

Yes, you should be able to extract an image like that to make a basic evaluation on both jaws projection in relation to normal values. My best bet is you're within normal range.

It doesn't have to cost $30k, totally depends on which surgeon you go to. And also if you would need to pay for orthodontic treatment to go with it.

I have a surgeon lined up willing to give me bimax w/ CCW but yet undecided if worth it in my case. Chin wing already covered my main issue and my recession is mild.

Have you considered getting a custom wraparound jaw implant? Or are you going with bimax w/CCW instead to get more forward projection of the maxilla and not just the mandible?

I totally agree, the only thing holding you back is your eyes, mental state, and maybe body (haven't seen it). Pursuing anything else would be a huge waste of time and money (both of which you've probably wasted a lot of already) and would be unlikely to raise you any points. Getting eye surgery alone would probably boost you a lot.

I don't really see the benefit of paranasal implants on you, if anything it might make your nose stick out too far.

The main reason I considered paranasal augmentation was to get more forward projection of the maxilla, but I didn't think about the risk of it making my nose stick out too far. Would this be a risk with LF1 as well?

 

[kota]

Have you considered getting a custom wraparound jaw implant? Or are you going with bimax w/CCW instead to get more forward projection of the maxilla and not just the mandible?

I'm not considering jaw implants. I already have decent jaw width and ramus. I would like both jaws to be moved slightly forward (only augmenting the lower has already been done through ching wing, any more would break balance) and CCW to shorten my face sligthly, hence bimax if anything.

 

[SurgerySoon]

I'm not considering jaw implants. I already have decent jaw width and ramus. I would like both jaws to be moved slightly forward (only augmenting the lower has already been done through ching wing, any more would break balance) and CCW to shorten my face sligthly, hence bimax if anything.

So CCW can actually shorten the midface? I was under the impression that it was just done to make the jawline look less steep and to make the jaw angles not look so high (as in my case). Just out of curiosity, how does it achieve shortening of the midface?

The reason I ask is because I remember reading a thread on Lookism a while back where someone said that the only way to achieve midface shortening is by having actual bone removed from the maxilla (sort of like a modified LF1 where bone is actually removed), so I'm just trying to visualize how CCW can actually shorten the face.

Also, I don't understand why everyone is telling me that I shouldn't get bimax surgery since my occlusion is normal, when yours is also normal (at least, that's what I gather based on what you've posted) and yet you're a candidate for it... ?

 

[6ft8InTheNetherlands]

do European surgeons also do implants?

 

[kota]

So CCW can actually shorten the midface? I was under the impression that it was just done to make the jawline look less steep and to make the jaw angles not look so high (as in my case). Just out of curiosity, how does it achieve shortening of the midface?

The reason I ask is because I remember reading a thread on Lookism a while back where someone said that the only way to achieve midface shortening is by having actual bone removed from the maxilla (sort of like a modified LF1 where bone is actually removed), so I'm just trying to visualize how CCW can actually shorten the face.

Also, I don't understand why everyone is telling me that I shouldn't get bimax surgery since my occlusion is normal, when yours is also normal (at least, that's what I gather based on what you've posted) and yet you're a candidate for it... ?

If you get CCW it's done by either anterior impaction or posterior downgrafting (or both). An anterior impaction is when they take a wedge out of your maxilla, making it less vertically long. It in effect rotates both your jaws CCW since the mandible follows, so both occlusal plane and mandible plane gets uprighted.

If this shortens your midface depends on how you define midface. Your soft tissues are left intact unless you do a lip lift to lift the soft tissues along with the bones. The height of the nose isn't directly affected, although with advancement and CCW you can probably expect it to get slightly more upturned and by that maybe appear slightly shorter as well. But in regards to what you asked someone else above, the nose shouldn't look more projecting after double jaw advancement but rather the opposite in relation to the more forward maxilla.

When I posted pics online I got similar reactions regarding jaw surgery as you. Although they might have thought differently before I got the chin wing to camouflage my recession.

 

[SurgerySoon]

If you get CCW it's done by either anterior impaction or posterior downgrafting (or both). An anterior impaction is when they take a wedge out of your maxilla, making it less vertically long. It in effect rotates both your jaws CCW since the mandible follows, so both occlusal plane and mandible plane gets uprighted.

If this shortens your midface depends on how you define midface. Your soft tissues are left intact unless you do a lip lift to lift the soft tissues along with the bones. The height of the nose isn't directly affected, although with advancement and CCW you can probably expect it to get slightly more upturned and by that maybe appear slightly shorter as well. But in regards to what you asked someone else above, the nose shouldn't look more projecting after double jaw advancement but rather the opposite in relation to the more forward maxilla.

When I posted pics online I got similar reactions regarding jaw surgery as you. Although they might have thought differently before I got the chin wing to camouflage my recession.

Thanks for the explanation. Ok, so anterior impaction sounds like the procedure I referenced in my previous post that I mentioned reading about on Lookism. If it could potentially result in shortening of the midface, then maybe double jaw surgery really is the way to go. I actually haven't measured my midface ratio, although I have a suspicion that it's on the somewhat long side. One thing I've noticed about almost all extremely good-looking guys is that they have extremely compact (but not too small) midfaces. Of course, whether or not an extremely compact midface would look good on me is another question, as I've noticed that most of those guys also have wider, more compact skulls, which I don't have.

Since you mentioned that a lip lift is often done with CCW surgery, it makes me wonder if I could create the illusion of having a more compact midface just with the lip lift alone (but then that raises the question of possibly disrupting my philtrum-to-chin ratio).

Either way, I feel like I'm really going to regret it if I don't at least lend serious consideration to getting double jaw surgery.

 

[Deleted member 4054]

Appreciate the feedback. To respond to your first point -- aren't there maxfac surgeons out there who are specifically well-known for their willingness to work on patients who don't clinically qualify as candidates for orthognathic surgery? Also, you said that double jaw surgery is more likely to make someone with normal skeletal relationships look worse. I can see how there's a risk of this occurring, but at the same time, isn't a generally established/accepted tenet of modern aesthetic and attractiveness research that anteface is generally more attractive than having a more flat face? In other words, assuming the surgery itself is successful and doesn't create functional issues, won't I look better by default with having a face that looks more forward-grown?

To respond to your second point -- honestly, I would say that my whole face is a point of obsession (not just the midface/cheeks). It's just that I've wanted to start getting these surgeries for at least 7-8 years now, so I really want to get the kinds of results I set out to achieve in the first place. Also, the reason I considered paranasal implants is not because I want paranasal augmentation specifically, but just because I understand that they're marketed as a sort of "camouflage" surgery that is intended to mimic the forward growth-replicating aesthetic effect of LF1. So in other words, if I would benefit from LF1 and if paranasal implants are considered to be the implant-based substitute procedure to come somewhat close to replicating the results of LF1, then perhaps I could benefit from paranasal implants... ? (that's my line of reasoning)

I have pretty much decided that I definitely want to get the rest of the wraparound jaw implant placed by Dr. Y if I don't get double jaw surgery instead. I would like for my jawline to be less steep from the side, and I also think that by stretching out the midface tissues more, it will create more cheek hollowing, which will make the midface implants look more prominent.


My problem is that my skin is apparently so thick that it makes relatively large implants (my right midface implant projects almost 6 mm, for example) look less noticeable than they would in other people's faces, which is why I simply wanted to have the exact same implant design re-manufactured to provide more augmentation.

There are maxfax surgeons who will perform double jaw on people with normal occlusion but skeletal recession and/or a steep occlusal plane. Most oral surgeons would consider that to be "for aesthetic purposes" since their bite is fine. Few if any would operate on someone with normal occlusion, normal skeletal growth, and no substantial obstructive sleep apnea just for the purpose of creating an "anteface".

IMO, just as people with severe recession who are dead ringers for BIMAX get conned by plastic surgeons who say all they need is a chin implant, these boards do the same to people who are great implant candidates, but who become focused on bone cutting surgeries because they see the dramatic results it affords those who start severely recessed. I have a lot of first hand experience over many years with implant surgeries and bimax (and multiple surgeons). Learn from my mistakes friend

 

[zq336]

It's not even a risk, it's a guaranteed effect. The base of the nose rests on the maxilla, so pushing it forward with a Lefort 1 or paranasal implant will also move the base of your nose forward.

One of the many reasons you should not get a Lefort or implant.

 

[SurgerySoon]

There are maxfax surgeons who will perform double jaw on people with normal occlusion but skeletal recession and/or a steep occlusal plane. Most oral surgeons would consider that to be "for aesthetic purposes" since their bite is fine. Few if any would operate on someone with normal occlusion, normal skeletal growth, and no substantial obstructive sleep apnea just for the purpose of creating an "anteface".

IMO, just as people with severe recession who are dead ringers for BIMAX get conned by plastic surgeons who say all they need is a chin implant, these boards do the same to people who are great implant candidates, but who become focused on bone cutting surgeries because they see the dramatic results it affords those who start severely recessed. I have a lot of first hand experience over many years with implant surgeries and bimax (and multiple surgeons). Learn from my mistakes friend

So what if I do happen to find a maxfac surgeon who will do bimax with CCW on me in spite of having normal occlusion and all that? Assuming the surgeon has a good reputation, isn't it pretty much undeniable that I'd benefit from having my jaw brought forward to create the appearance of anteface? I guess what I don't understand is why someone has to be severely recessed in order to be a candidate for bimax/CCW.

It's not even a risk, it's a guaranteed effect. The base of the nose rests on the maxilla, so pushing it forward with a Lefort 1 or paranasal implant will also move the base of your nose forward.

One of the many reasons you should not get a Lefort or implant.

Are there any other ways to bring the maxilla forward to create the appearance of anteface that don't also involve pushing the nose forward?

 

[Deleted member 4054]

So what if I do happen to find a maxfac surgeon who will do bimax with CCW on me in spite of having normal occlusion and all that? Assuming the surgeon has a good reputation, isn't it pretty much undeniable that I'd benefit from having my jaw brought forward to create the appearance of anteface? I guess what I don't understand is why someone has to be severely recessed in order to be a candidate for bimax/CCW.


Are there any other ways to bring the maxilla forward to create the appearance of anteface that don't also involve pushing the nose forward?

A few things. Even if you get bimax, you're NOT a candidate for ccw as your occlusal plane isn't steep, which is a prerequisite for having a ccw. This is true whether the ccw is done via posterior downgraft, an anterior impaction, or a combination of the two. I suppose you may find a surgeon willing to give you an upper and lower advancement, like they would do to someone with obstructive sleep apnea, but that won't generate the aesthetic outcome you're imagining. There is also no way to move the maxilla forward, and not have the nose become wider.

Last but not least, you're in the US correct? If you ultimately choose to go the bimax route, as someone who's had it and spoken at length to a few others who've had it, it would be a mistake to have it done in Europe while living in the US. Post op complications necessitating a doctors visit happen quite often, even when everything goes relatively smoothly. You could potentially find someone local to do the follow ups, but if something goes wrong they won't want to involve themselves. Think about the prospect of hopping a 12 hour flight each way while dealing with complications. The surgeon also works closely with the orthodontist pre and/or post operatively. Logistically it's a nightmare. Plus we have plenty of great orthognathic surgeons in the US, many of which are at major universities who don't advertise online because they're already so busy. No reason to go overseas for anything other than perhaps a chin wing which seems to be exclusive to a few European docs.

 

[SurgerySoon]

A few things. Even if you get bimax, you're NOT a candidate for ccw as your occlusal plane isn't steep, which is a prerequisite for having a ccw. This is true whether the ccw is done via posterior downgraft, an anterior impaction, or a combination of the two. I suppose you may find a surgeon willing to give you an upper and lower advancement, like they would do to someone with obstructive sleep apnea, but that won't generate the aesthetic outcome you're imagining. There is also no way to move the maxilla forward, and not have the nose become wider.

Last but not least, you're in the US correct? If you ultimately choose to go the bimax route, as someone who's had it and spoken at length to a few others who've had it, it would be a mistake to have it done in Europe while living in the US. Post op complications necessitating a doctors visit happen quite often, even when everything goes relatively smoothly. You could potentially find someone local to do the follow ups, but if something goes wrong they won't want to involve themselves. Think about the prospect of hopping a 12 hour flight each way while dealing with complications. The surgeon also works closely with the orthodontist pre and/or post operatively. Logistically it's a nightmare. Plus we have plenty of great orthognathic surgeons in the US, many of which are at major universities who don't advertise online because they're already so busy. No reason to go overseas for anything other than perhaps a chin wing which seems to be exclusive to a few European docs.

Thanks for the information. So let's say that no maxfac surgeon agrees to perform bimax with CCW on me because I'm legitimately not a candidate for it, just as you said I'm not. Is there anything else I can do to get a more forward-projecting maxilla so that I can at least have some semblance of the anteface "look?" Would I be a candidate for an orthodontic appliance like an MSE, homeoblock, etc.? I know it sounds like I'm beating a dead horse here, but as someone who wants to looksmax any and all aesthetic elements that could use improving, I really feel like I'm leaving a lot of potential improvement on the table by not doing at least *something* to improve my maxilla. BTW, I'm not sure if you've read where I've mentioned it in my other posts, but I had braces from 16-19 to correct an overbite and the orthodontist used elastics (rubber bands), so I'm assuming my maxilla is at least somewhat retracted as a result of undergoing that "treatment."

 

[Deleted member 4054]

Thanks for the information. So let's say that no maxfac surgeon agrees to perform bimax with CCW on me because I'm legitimately not a candidate for it, just as you said I'm not. Is there anything else I can do to get a more forward-projecting maxilla so that I can at least have some semblance of the anteface "look?" Would I be a candidate for an orthodontic appliance like an MSE, homeoblock, etc.? I know it sounds like I'm beating a dead horse here, but as someone who wants to looksmax any and all aesthetic elements that could use improving, I really feel like I'm leaving a lot of potential improvement on the table by not doing at least *something* to improve my maxilla. BTW, I'm not sure if you've read where I've mentioned it in my other posts, but I had braces from 16-19 to correct an overbite and the orthodontist used elastics (rubber bands), so I'm assuming my maxilla is at least somewhat retracted as a result of undergoing that "treatment."

If you really like the anteface look, I suppose bimax without any significant rotation (just upper and lower advancement) is an option, assuming someone will perform it. The other thing though, is the malar and orbital region will appear more recessed after bimax, and you're already dissatisfied with your degree of malar projection

 

[SurgerySoon]

If you really like the anteface look, I suppose bimax without any significant rotation (just upper and lower advancement) is an option, assuming someone will perform it. The other thing though, is the malar and orbital region will appear more recessed after bimax, and you're already dissatisfied with your degree of malar projection

Damn. It sounds like there might not be a perfect solution for improving the projection of my maxilla, then. I definitely don't want to make my midface/orbital regions look less prominent, seeing as I'm already actively planning a revision of the midface implants to get more projection. I might just have to leave the maxilla alone, although I'm not sure yet.

BTW, what's your opinion on me getting the rest of the wraparound implant put in that Dr. Y designed for me? I'm assuming you've seen my side profile photos, where it's pretty easy to see that I have a fairly steep jawline with high-set jaw angles. Even if I don't get bimax surgery, do you at least agree that getting the rest of the implant placed to lower my jaw angles and get a bit more width would be a good idea?

Another reason I'd like to get the rest of the jaw implant placed is because I'm fairly certain that by stretching the midface tissues out, my implants will look more prominent (I've noticed that this is the case even when I bite down and flex my masseter muscles).

 

[Deleted member 4054]

Damn. It sounds like there might not be a perfect solution for improving the projection of my maxilla, then. I definitely don't want to make my midface/orbital regions look less prominent, seeing as I'm already actively planning a revision of the midface implants to get more projection. I might just have to leave the maxilla alone, although I'm not sure yet.

BTW, what's your opinion on me getting the rest of the wraparound implant put in that Dr. Y designed for me? I'm assuming you've seen my side profile photos, where it's pretty easy to see that I have a fairly steep jawline with high-set jaw angles. Even if I don't get bimax surgery, do you at least agree that getting the rest of the implant placed to lower my jaw angles and get a bit more width would be a good idea?

Another reason I'd like to get the rest of the jaw implant placed is because I'm fairly certain that by stretching the midface tissues out, my implants will look more prominent (I've noticed that this is the case even when I bite down and flex my masseter muscles).

I think putting the jaw implants in would be a good idea, and you're correct in that it would accentuate the malar region as it would create a hollowness between the cheek and jaw making both appear more defined

 

[PubertyMaxxer]

He has a lot more to show at his office.

Were you there? What did he show you?