The Dire
Iron
- Joined
- Nov 12, 2025
- Posts
- 116
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- 97
Alright so if you read my last thread you know I came in here with a full CBCT, a detailed ratio analysis, and a trimax + zygo + rhino plan with 35k ready to go. Some of you agreed, some of you told me I wasn't even recessed... Standard looksmax experience.
Well I just had the consultation with Pagnoni and I'll be honest with you. He kind of humbled me.
Let me tell you exactly what happened because I think there's genuinely useful info in here for anyone considering surgery at a young age.
So we get on the video call, he pulls up my CBCT, and the first thing he does is look at the oblique view and says he doesn't see anything substantial. I'm sitting there like ok maybe it's worse in lateral. He goes to the lateral view. Says the zygomatic area might look slightly flat but considers it normal anatomy. Not pathological. Not even really a problem.
Then he drops something I genuinely hadn't considered before. He points out my frontal sinus is hyperpneumatized, basically my brow ridge is very pronounced, and he explains that this actually shifts the visual reference line of the face forward. So when you look at the profile, the brow ridge sticks out so much that it makes everything below it LOOK more recessed than it actually is. He says if you take the nasion as the correct reference point, everything is fundamentally aligned. The recession I've been obsessing over for a year might be partially an optical illusion created by my own brow ridge.
I'm not gonna lie that one hit different.
Then he looks at my profile photo and says ok, the one thing he can see is that the chin could benefit from some advancement because the upper lip is projecting further forward than the chin. But even that he calls a minor thing. He literally said the improvement in my case would be going from a 9.5 to a 10 and that the juice isn't worth the squeeze for a full bimax. A genioplasty alone might be enough if anything.
And here comes the part that really made me rethink everything. He told me to wait. Not in a dismissive way, in a genuinely medical way. He said at 18 my soft tissue is still immature. The buccal fat that's making my face look round and undefined right now is going to naturally reduce over the next few years. The underlying bone structure will become more visible as the face masculinizes and dries out. What looks like a flat midface right now might just be soft tissue covering decent bones underneath. He said some deficits that seem real at 18 completely disappear by 23, and others become more clearly defined, which actually helps you plan better if you do end up going surgical.
His recommendation: minimum 21 years old before doing anything purely aesthetic to the face. Ideally 23 to 25. He said he's not the type to push implants on a 18 year old because the results aren't as predictable when the soft tissue is still changing.
On the nose he gave me an unexpected take. He said he'd leave it completely alone. Said the hump gives my face character and works well with the pronounced brow ridge, that the two features make sense together. Obviously that's his personal aesthetic opinion and I'm not sure I fully agree but I respect it. He's seen thousands of faces, I've only obsessed over one.
On cost if I did go with a bimax: 32k all in including genioplasty, excluding orthodontic preparation which would be mandatory. And he said if the virtual surgical planning showed that the advancement created an imbalance in the midface, he'd add infraorbital and zygomatic implants during the same surgery to keep everything harmonized.
So basically. The guy who I expected to sell me a 32k surgery told me to go home and wait 3-5 years.
Now here's where my head is at.
I think he's right. Not about everything but about the core message. I came into this so locked into the idea that I needed a trimax that I wasn't considering how much my face is still going to change on its own. I'm 18. My face is still soft. The buccal fat is still there. The facial muscles haven't fully developed. There's actual biological maturation left to happen and it doesn't make sense to surgically alter a face that hasn't finished becoming what it's going to be.
Does this mean I'm giving up on the ascension? Absolutely not. It means the plan is evolving.
Here's what I'm thinking now. The smart move might not be surgery right now. The smart move might be maximizing the natural masculinization process over the next 2 to 3 years and then reassessing what actually needs surgical correction once the soft tissue has matured. Because right now I might be trying to solve with a scalpel what time and biology would solve for free.
I'm seriously looking into running a properly researched cycle in the future to accelerate facial masculinization. Androgens have a direct effect on facial bone remodeling, fat distribution, muscle development in the face, all the things Pagnoni said are going to change naturally but slowly. This isn't something I'd do tomorrow and it's not something I'd do without extensive research and bloodwork, but it's on the table as a way to speed up what's already going to happen and potentially get to that assessment point faster and with a more masculine baseline.
Then once the face has matured, whether that's at 21 or 23, I reassess everything with fresh scans and decide what actually needs work. Maybe the genio is still the move. Maybe by then the midface projects fine on its own. Maybe the bimax does make sense at that point. But at least I'll be making that decision with a finished face instead of an unfinished one.
The rhinoplasty is the one thing that might still happen in the short to medium term. The base width and the hump are structural, they're not going to magically fix themselves with soft tissue maturation. And unlike a bimax or implants, a rhino doesn't depend on having a fully matured face to get right, as long as I'm not planning to move the maxilla later, but even if I did, all it would take is another rhinoplasty. And honestly after this consultation, a full bimax is looking way less likely than it was a week ago. So the nose might be the first real move.
I still have Ramieri on June 17th. If he looks at the same CBCT and tells me something completely different from Pagnoni that's valuable information. But I doubt it, because he is far more conservative than Pagnoni... Going in I'm now much more open to the possibility that the answer isn't a massive surgical overhaul, at least not right now.
Anyway, I know, this is a marathon, not a sprint.
Well I just had the consultation with Pagnoni and I'll be honest with you. He kind of humbled me.
Let me tell you exactly what happened because I think there's genuinely useful info in here for anyone considering surgery at a young age.
So we get on the video call, he pulls up my CBCT, and the first thing he does is look at the oblique view and says he doesn't see anything substantial. I'm sitting there like ok maybe it's worse in lateral. He goes to the lateral view. Says the zygomatic area might look slightly flat but considers it normal anatomy. Not pathological. Not even really a problem.
Then he drops something I genuinely hadn't considered before. He points out my frontal sinus is hyperpneumatized, basically my brow ridge is very pronounced, and he explains that this actually shifts the visual reference line of the face forward. So when you look at the profile, the brow ridge sticks out so much that it makes everything below it LOOK more recessed than it actually is. He says if you take the nasion as the correct reference point, everything is fundamentally aligned. The recession I've been obsessing over for a year might be partially an optical illusion created by my own brow ridge.
I'm not gonna lie that one hit different.
Then he looks at my profile photo and says ok, the one thing he can see is that the chin could benefit from some advancement because the upper lip is projecting further forward than the chin. But even that he calls a minor thing. He literally said the improvement in my case would be going from a 9.5 to a 10 and that the juice isn't worth the squeeze for a full bimax. A genioplasty alone might be enough if anything.
And here comes the part that really made me rethink everything. He told me to wait. Not in a dismissive way, in a genuinely medical way. He said at 18 my soft tissue is still immature. The buccal fat that's making my face look round and undefined right now is going to naturally reduce over the next few years. The underlying bone structure will become more visible as the face masculinizes and dries out. What looks like a flat midface right now might just be soft tissue covering decent bones underneath. He said some deficits that seem real at 18 completely disappear by 23, and others become more clearly defined, which actually helps you plan better if you do end up going surgical.
His recommendation: minimum 21 years old before doing anything purely aesthetic to the face. Ideally 23 to 25. He said he's not the type to push implants on a 18 year old because the results aren't as predictable when the soft tissue is still changing.
On the nose he gave me an unexpected take. He said he'd leave it completely alone. Said the hump gives my face character and works well with the pronounced brow ridge, that the two features make sense together. Obviously that's his personal aesthetic opinion and I'm not sure I fully agree but I respect it. He's seen thousands of faces, I've only obsessed over one.
On cost if I did go with a bimax: 32k all in including genioplasty, excluding orthodontic preparation which would be mandatory. And he said if the virtual surgical planning showed that the advancement created an imbalance in the midface, he'd add infraorbital and zygomatic implants during the same surgery to keep everything harmonized.
So basically. The guy who I expected to sell me a 32k surgery told me to go home and wait 3-5 years.
Now here's where my head is at.
I think he's right. Not about everything but about the core message. I came into this so locked into the idea that I needed a trimax that I wasn't considering how much my face is still going to change on its own. I'm 18. My face is still soft. The buccal fat is still there. The facial muscles haven't fully developed. There's actual biological maturation left to happen and it doesn't make sense to surgically alter a face that hasn't finished becoming what it's going to be.
Does this mean I'm giving up on the ascension? Absolutely not. It means the plan is evolving.
Here's what I'm thinking now. The smart move might not be surgery right now. The smart move might be maximizing the natural masculinization process over the next 2 to 3 years and then reassessing what actually needs surgical correction once the soft tissue has matured. Because right now I might be trying to solve with a scalpel what time and biology would solve for free.
I'm seriously looking into running a properly researched cycle in the future to accelerate facial masculinization. Androgens have a direct effect on facial bone remodeling, fat distribution, muscle development in the face, all the things Pagnoni said are going to change naturally but slowly. This isn't something I'd do tomorrow and it's not something I'd do without extensive research and bloodwork, but it's on the table as a way to speed up what's already going to happen and potentially get to that assessment point faster and with a more masculine baseline.
Then once the face has matured, whether that's at 21 or 23, I reassess everything with fresh scans and decide what actually needs work. Maybe the genio is still the move. Maybe by then the midface projects fine on its own. Maybe the bimax does make sense at that point. But at least I'll be making that decision with a finished face instead of an unfinished one.
The rhinoplasty is the one thing that might still happen in the short to medium term. The base width and the hump are structural, they're not going to magically fix themselves with soft tissue maturation. And unlike a bimax or implants, a rhino doesn't depend on having a fully matured face to get right, as long as I'm not planning to move the maxilla later, but even if I did, all it would take is another rhinoplasty. And honestly after this consultation, a full bimax is looking way less likely than it was a week ago. So the nose might be the first real move.
I still have Ramieri on June 17th. If he looks at the same CBCT and tells me something completely different from Pagnoni that's valuable information. But I doubt it, because he is far more conservative than Pagnoni... Going in I'm now much more open to the possibility that the answer isn't a massive surgical overhaul, at least not right now.
Anyway, I know, this is a marathon, not a sprint.
