Orthognathic surgery AFTER Rhinoplasty and cheek implants

[hazelrichardson96]

Hi everyone, sorry if this is a bit long.

I have been referred to have a consultation at the hospital for orthodontic treatment and jaw surgery but it isn't till December so i'm wondering if anyone is able to answer my questions.

I have a class 2 malocclusion and an over jet. I wasn't told how big my over jet is but I believe moving my lower jaw forward around 10mm and push my lower teeth backwards with braces would line them up perfectly so i think my over jet is around 10mm.

My teeth were like this when I was 10 years old (i'm now 20) so i think my problem developed in childhood.

I am female but have a masculine face from hormone trouble in my teenage years so would like to have Facial Feminization Surgery(ffs) first before any other changes are made to my appearance as the fear of looking masculine is enough to stop me having jaw surgery.. I want to get Forehead contouring, Brow lift ,Cheekbone augmentation and Rhinoplasty before lower jaw surgery is it possible to do it first since lower jaw surgery won't change my face above the lips much. I know it isn't recommend to do it first but I don't see any other way.

I have crowding on my bottom jaw as it is too small and my teeth need moving on the top a bit at the front so something needs to be done but I won't do any Orthographic treatment unless I can have Facial Feminization Surgery before lower jaw advancement as otherwise it will cause too much of a negative effect on my mental health.

I am happy with the position of my upper jaw and won't have any surgery to move it as upper jaw surgery changes facial profile a lot more than lower.

My plan would be get braces and wisdom teeth extracted next year and then do the Facial Feminization Surgery in June/july 2018 followed by only lower jaw surgery + palate expansion 6 months to a year later later. anyone know if this is possible?

if it isn't then is there an alternative Orthognathic treatment option. I can open my jaw wide enough to fit 3 fingers in my mouth with no problems and only have a slight click noise if I stick 4 in there. would there be any harm in delaying Orthognathic treatment for 3 years if it is the only option as I want ffs first to improve my confidence and quality of life.

Here is an album of photos showing what I look like plus at the end 3 photos of what I think I would look like without Facial Feminization Surgery https://www.flickr.com/gp/132462631@N06/234A67

[LyraM45]

I would have to disagree that upper jaw changes the face more. I feel like lower jaw (esp with rotation) actually is what can make or break the square/masculine look. BUT, here is the thing... if you need a 10mm movement, that means your bite discrepancy is pretty large. It's around the same ballpark mine was, and my bite was causing me enough issue where I didn't care what I looked like after surgery so long as they could make my bite more functional and feel better. Just my .02 there, but if your discrepancy is that large, I would first concentrate on that for concern of your over all health, IE: you probably have a smaller airway and possibly even sleep apnea (if not now, then you will later) if you're class II recessed. My advice is get the surgery and fix your functional issues. Let that heal and see what you're left with. You can always go back and add whatever you want for nose/cheeks. You may like what you get from just the jaw surgery, so who knows. At least doing it that way and adding more later if you want gives you the option to see that. You can always go back and add more, but with jaw/face surgery, it's tough (and impossible in some cases) to undo something once it's been done.

[pantlover]

Hi, I agree with LyraM45 on this one and would also suggest that you wait until AFTER jaw surgery before going on to getting other cosmetic surgeries. I just wanted to put my 2 cents in as well because cosmetic add ons such as rhinoplasty, cheek implants, and even a genioplasty were all discussed as part of my jaw surgery options.

It sounds like your bite may be pretty bad if it's currently around 10mm and remember, after braces start moving your teeth, your bite may/will probably get even worse. So even if you see a surgeon this year and they let you know a tentative plan, it def won't be set into stone until your teeth are in their correct position. And although you may only want your lower jaw moved and your upper jaw left alone, that may not give you best aesthetic or medical results. Moving the jaw (any jaw, any amount) may cause drastic changes to your face. If this is medically necessary (and it sounds like it is) go through orthodontic treatment first, then the surgery, wait for your face to settle and if you are still happy, then maybe look into other cosmetic surgeries. It won't do you much good to have the ffs now only for your face to completely change again after jaw surgery.

[uneunsae]

I am very androgynous looking myself and having my jaw moved forward transformed my slightly square-ish jawline to a nice V line. Since I am not interested in changing my androgynous look, I didn't think about it much before surgery. Talk to the plastic surgeon who will do your ffs and ask their opinion. If you are having very standard things done like the forehead contour, it might not matter. But things like cheekbones should be in balance with the rest of your features, so taking the above advice and waiting might be a better idea. Plastic surgeons take all of your features into consideration when planning surgery so what you get before jaw surgery might not suit you after surgery.

[snapdresser]

...otherwise it will cause too much of a negative effect on my mental health.

I would strongly caution you about having orthognathic surgery. It is a mind-f*ck, even if done perfectly. After 3 weeks you'll be convinced that 99% of your swelling has gone away (even though everyone tells you otherwise) and you'll hate your puffy face. You'll think they screwed it up. You'll think they went wrong with the measurements somehow along the way. I tell you this because it happened to every single person on this forum. No offense, but if you don't have the mental fortitude to handle having the jaw surgery first and seeing how you feel about it after a year or so (or at least 6 months!), then I don't think you're cut out for it. If I were you, I'd just go with the cheek augmentation, etc. and maybe some strategically placed filler and steer clear of the orthognathic surgery. Don't underestimate the mental aspect of it.

[Lovespain5]

Your face seems nice to me. I don't think you need so much surgeries.
In my opinion, you just need to move your lower jaw forward.
Ask about the Herbst appliance before deciding to have a jaw surgery.