Had double jaw surgery...additional procedures needed?

[gtrguy2886]

I had a Lefort I along with with lower jaw advancement last year. I feel pretty happy with the results in terms of my bite, but aesthetically, I'm still wondering about it. I am grateful that I was able to have my bite corrected, but for some reason it still seems that my lower jaw is too far back.I'm wondering whether some sort of procedure to move the lower jaw forward would be necessary. My nose is also pretty prominent, as you can see.

My sugeon mentioned that he could shave off the bunched up tissue in my chin and move the lower jaw forward to improve aesthetics. It is a costly procedure, but I still do feel like I have such a horrible chin that it might be necessary. I see a weak chin when I look at my profile, and I'm aware that having such a feature is about the worst thing a male could have... any suggestions are appreciated.

Sorry about the picture... I'd basically just woken up.

[katsface]

What was done with your LeFort 1? Was your upper jaw advanced, moved back, moved up, down, or rotated?

Do you know how far forward your lower jaw was moved?

Cosmetically, I think you look good. But, I think you're right that your jaw could have been moved much farther forward to take it from good to ideal. Your nasolaibial angle looks like it's obtuse. That could mean that your upper jaw should come forward as well. But keep in mind that there are other causes for that kind of angle, and I'm NOT an expert (I just play one on the internet).

I think the problem at this point would be that since your bite is good, any additional procedures would be considered cosmetic, and not covered by insurance. I won't say you should have additional surgeries. That's for you and probably a surgeon to decide. But I will say if money isn't an issue, and you think it will make you happier, go for it. I think you look great, but I also think your concerns are valid.

Do you have a before picture? It would be nice to see where you started.

[bmueller]

If your teeth line up, really all they can do is a chin advancement (genioplasty). Since you already have a well defined chin, I doubt that will look good proportionally.

I think your profile looks good and if your teeth line up correctly and your smile is beautiful, you should be happy!

[katsface]

If your teeth line up, really all they can do is a chin advancement (genioplasty). Since you already have a well defined chin, I doubt that will look good proportionally.

I think your profile looks good and if your teeth line up correctly and your smile is beautiful, you should be happy!

Can they move both jaws forward with another Lefort 1 and BSSO and keep the teeth lined up? I know people do have these surgeries for cosmetic reasons, and presumable some of those people already have good bites.

[gtrguy2886]

Thank you for the replies, and for your compliments. I don't have a before picture right now (might be able to find one), but my profile wasn't too terribly different before surgery, but of course it was pretty far from the ideal...guess I just didn't think it was a big deal. It didn't look all that much different before, and I was never really that concerned about the side (until now)...it was usually that the front looked weird, and I had some visible midface and lower face abnormalities. I should have been more specific about the actual procedures. I had a saggital split osteotomy on the lower jaw; it was moved forward 7mm. My upper jaw surgery included both a posterior impaction (2-3mm, can't really remember) and an advancement of 4mm.
Katsface, I think you're right that it looks like both jaws could stand to be moved farther forward on an aesthetic level. I did ask my surgeon about this before the procedure, and he told me that for some people it's harder because if the upper jaw is impacted or advanced too much, it becomes difficult to correct the lower jaw as well. Maybe this is why I couldn't have both jaws corrected even more? I think he did the best he could, keeping in mind that I also wanted my bite to be as good as possible. I'm also missing both maxillary laterals (congenital, now have implants), and I've been told by a surgeon that when certain teeth are missing, the jaw doesn't grow like it should. This might be part of the reason my face has looked this way for years. My smile is fine and not too gummy or anything, which was my only real aesthetic concern... until I noticed after surgery that the lower jaw (and deficient upper jaw/lip, for that matter) looked a little worse than I thought. I also had my maxillary first premolars extracted for braces, but I don't think this is affecting my aesthetics as much as it could have without the orthognathic surgery. My appearance from the front changed a bit more dramatically, which I originally thought was more important than the side profile. Pre-surgery, I also had a gummy smile above my posterior teeth (2-3mm...ew), but that's all but gone now. I don't think I was naturally gummy. I think previous work (plus other factors) left me that way, but I'm glad to have corrected that vertical maxillary excess. The slight open bite I had is also gone, although I'm concerned about relapsing into that undesirable position down the road.

What my surgeon mentioned doing in the clinic sounded like a genioplasty. I think what really shows with my lower jaw is that my mandible is too far back, while my chin is actually sufficiently prominent. The upper and lower lips are still slightly deficient, but my lip support is at least a bit better than before. As you said bmueller, I honestly don't think it would look that good to do anything unless I could have the surgery redone to move everything farther forward, but I'm already experiencing complete numbness in my upper gums. I also can't afford that, while I might be able to afford a chin procedure in a few years. After thinking about it, I'm not sure I can really do much more at this point. At least, not something that's going to make a big difference.

I've been told that part of it is just the way my face is made... The soft tissues changed slightly after surgery, but I still have a deficient profile and might have to accept it. However, if anyone has any idea what might be possible based on this additional info, I'd greatly appreciate it. I hope I helped to shed some light on my overall situation.

[gtrguy2886]

Your nasolaibial angle looks like it's obtuse.

What does that mean... When it comes to orthodontics, I only know a bit about malocclusions and facial issues from the front...don't know much about the profile terminology.

[bmueller]

Wow, sounds like your before profile must have been WAY different even if you think you don't look very different. That's a lot of movement forward and upward.

I had a botched ortho job as a kid, where they extracted 2 upper premolars and one lower premolar. It totally changed the shape of my face and the ability of my teeth to line up correctly.

As an adult, I brough my dislikes to the attention of an orthodontist and they said my problems were skeletal to begin with and needed surgery. I think I understood from my research that I will NEVER have THE perfect smile and face, some things are just not fixable after you stop growing, some things aren't reversible (teeth extractions) and some things are just genetic (small lateral incisors). I went in knowing that if I picked the best ortho and the best surgeon I could find, that I would become the best version of me possible.

I had the option of a genioplasty and had agreed to it if necessary to make me look the best. Once the surgeon was in surgery, he found that I had a well proportioned chin, it was just that my jaw was rethnogenic. He decided not to do the genio. It would have made my side profile "ideal" according to the scientific ceph drawings, but he said it would have been too strong of a chin and made me look masculine. He consulted with two other surgeons and the ortho and they all agreed this was the best option for my face structure. I think in the long run, I agree. I certainly wouldn't want to have a witch-like chin. I'm always cautious not to become those people who are addicted to plastic surgery, whom in their search for perfection, turn out looking like an alien and are never satisfied.

I hope your journey leads you to finally be happy with your face, and if that's another surgery, so be it! Please keep us updated. We are here for you, no matter what you decide!

[dannym 1980]

i think from your piks your profile is ok,you think your nose looks big lol,wait untill i post some piks lol,chin up chap your looking good!lets see some piks of you teeth?