Fear
Anatomy is Destiny
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I had LeFort I + BSSO many years ago for a moderate-to-severe Class III underbite (recessed maxilla, protruding mandible.)
While it did improve a lot about my face, I realized almost immediately after I healed that it was only the first step in a long journey.
With the benefit of hindsight, this, of course, makes sense.
The maxilla is the keystone of your face — the centerpiece.
And if the centerpiece developed incorrectly, even if you fix it, imagine how messed up everything based on it must be.
I'm therefore writing this guide to identify common procedures and surgeries that will typically be necessitated by jaw surgery.
I hope to dispel any illusions that jaw surgery will fix all your problems, spare others the same disappointment I experienced, and prepare anyone considering it for the long haul they're likely in for.
The procedures are listed from least to most involved.
1. Orthodontics
2. Infraorbital fat transfer/implants
3. Lip lift
4A. Septoplasty
4B. Turbinoplasty/turbinectomy
4C. Rhinoplasty
This list is not exhaustive, but describes what I experienced and what I've noticed in studying other jaw surgery cases.
The really important thing to remember, and think about, is that at the end of the day, you're shifting around two-thirds of your face.
So on top of what I've mentioned here, prepare to expect the unexpected.
While it did improve a lot about my face, I realized almost immediately after I healed that it was only the first step in a long journey.
With the benefit of hindsight, this, of course, makes sense.
The maxilla is the keystone of your face — the centerpiece.
And if the centerpiece developed incorrectly, even if you fix it, imagine how messed up everything based on it must be.
I'm therefore writing this guide to identify common procedures and surgeries that will typically be necessitated by jaw surgery.
I hope to dispel any illusions that jaw surgery will fix all your problems, spare others the same disappointment I experienced, and prepare anyone considering it for the long haul they're likely in for.
The procedures are listed from least to most involved.
1. Orthodontics
This may be obvious to some, but you will need braces before, during, and/or after jaw surgery.
Your teeth, 28 independent bones that have formed to accommodate a lifetime of malocclusion, will not magically come together without them.
I mention this because there are surgeons who will examine your bite and promise you can skip orthodontics.
Don't believe them.
I would recommend lingual braces over traditional ones.
They are of course preferable for vanity's sake, but beyond that, some brands of lingual can even work faster.
2. Infraorbital fat transfer/implants
Contrary to the commonly peddled narrative, maxillary advancement via LeFort I will not fix dark circles or hollow infraorbitals.
Because you are advancing the upper jaw, the already-lacking subcutaneous support below the eyes is distributed further, i.e., becomes less compacted.
The net result is to quite possibly make dark circles even worse.
Fat transfer to the area and/or infraorbital implants are the only solution.
Both have their advantages and probably work best when combined.
As with any plastic surgery, go to someone who specializes in fat transfers/eye area implants.
3. Lip lift
If you grew up with a deficient maxilla, your upper lip likely did not form correctly either.
Once your maxilla is advanced with jaw surgery, an upper lip lift may very well be in order.
You'll know for sure if, at rest, your vermilion border is still not very visible, or when talking, your teeth are still not very visible.
In my case, a lift excising almost 6 mm of skin was necessary.
Again, go to someone who specializes in lip lifts and has a demonstrated portfolio of scar-less results.
4A. Septoplasty
This will be necessary if your jaws are rotated laterally or medially to align the midline of your teeth with the midline of your face.
Any such rotation of the maxilla, which forms the base of your nose, will end up deviating your nasal septum as well.
If not fixed, this can cause serious breathing issues, and we all know the importance of nasal breathing.
4B. Turbinoplasty/turbinectomy
A deficient maxilla can cause the nose to droop downward as it grows.
This can impact the development of the nasal turbines, which are central to nasal breathing.
Parts or the entirety of your turbines may need to be removed if your nasal breathing has not improved after jaw surgery.
4C. Rhinoplasty
Again, a deficient maxilla can cause the nose to droop downward as it grows.
Once you have jaw surgery, however, your nose should at least stand more erect, but several aesthetic problems may remain.
These include a bulbous tip, an especially long nose, and structural collapse, all of which are correlated with a lack of maxillary support.
Jaw surgery will not improve any of these flaws, and in fact will likely only serve to accentuate them.
This list is not exhaustive, but describes what I experienced and what I've noticed in studying other jaw surgery cases.
The really important thing to remember, and think about, is that at the end of the day, you're shifting around two-thirds of your face.
So on top of what I've mentioned here, prepare to expect the unexpected.
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