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Picollo30.
User deleted
Hi guys
First of all let me introduce myself. Name's Paulo, i'm 39 and i'm from Porto, Portugal. I dont speak Italian but i understand a bit, so sorry about that.
The reason that brought me here is to understand more about the surgery that i think it will be done on me according to the words of the surgeon, BSSO + Le Fort 1+genio and possibly malar implants, because i have malar hypoplasia (hollow undereye are and sunken cheeks that give me a tired look).
I am a mouth breather and have asthma. I was born with some mild Treacher Collins symptoms. I started an orthodontics treatment in 2010 to treat a Class II retrognathia. Before starting the treatment in this clinic i visited some maxilo facial surgeons here in Portugal and they told me i had to go through orthognatic surgery, but the waiting time was 10 years in public hospital and if i didnt want to wait, the price would be about €15.000, a value that i couldn't afford.
So i was told of this clinic where they camouflaged my problem, they focused more on the teeth and ignored the mandibular and maxila problems. I have clicks in my jaws, i have trouble to eat some food, apples for example, i still have a gummy smile and visible nasolabial folds. I also have lots of headaches that i think might be related to the jaw problem.
Aesthetically i still have a receeded/weak jaw and chin despite the treatment and one side of the face is more developed than the other (facial assymetry) as well as the above sunken cheeks/undereye area that give a tired look and dark bags under eyes.
What they did in the clinic was:
They used a palatal expander they removed a pre molar and aligned the teeth. I didn't like the final result so i contacted a maxilo facial surgeon. I told him that it's been 5 years since im using braces, he said it was a lot, and i told him what they did in the clinic and he told me that despite the treatment being almost concluded that i could revert it somewhat,and he told me about the bilateral sagital split osteotomy and the lefort 1 (for the gummy smile) with genioplasty and /or malar/cheek implants (it depends on the outcome of the surgery).
He was also worried about the loss of fat in my face and the airway issue that he thinks could be causing or can lead to sleep apnea in the future (my 40's/50's). Judging by the cephalogram he said airways are 4 mm and he said the normal should be 1 cm and made me do a sleep study which i dont have yet.
here's the cephalogram:
and here's a pic where you can see the concave profile and weak chin/jaw (despite being masked by the beard, without the beard its even more noticeable).
and here's 2 frontal pics one from 2010 before treatment and other from 2015
In 2010 (between 2010 and 2015 i went through some cosmetic surgeries: otoplasty,canthoplasty for fixing negative canthal angle, rhinoplasty/septoplasty and multiple fat injections to my malar area that didnt work because fat was reabsorbed).
In 2015
and here's a morph a friend made for me, but someone in the jawsurgery forum said that i will look nothing like this and in fact that bsso+lefort1+genio wont help me a bit in my aesthetics and bite. I became so depressed with what he said because i really wanted to like what i see in the mirror.
I have some questions. 1) Will my face change with this surgery or it wont work? 2) Will the Le Fort 1 solve my flat cheeks problem? 3) What can i change in my face?
Thanks in advance. -
PatrickB.
User deleted
Piccolo, i could do a more thorough analysis of your face, however from what i see these are my very quick remarks:
-First of all, you had a remarkable improvement from 2010. You say the fat did not take, however i see a huge improvement in your periocular and malar region. What did you do there? if it was just fat injections, it worked very well!!! photos in higher definition would be really appreciated.
-If i were you, i would avoid lefort 1 and bsso and consider Chin wing (maybe repeating it twice for optimal results) and from the photos you posted I DO NOT see the need for a malar osteotomy.
To make a more valid assessment i would need higher definition pictures but also pics of the current occlusion which seems ok to me.
However, i stand by the point that the lefort and bsso seems an overkill to me.
pb
picollo-my evaluation was only aesthetic. considering the functional issues (especially airway space) you might want to consider the surgery, although i really need better pictures.
Consider even if you'll do a lefort and BSSO you MUST have AT LEAST one chin wing, since the gonial angles won't change (probably worsen) after the bsso.
So, if you want to do the orthognatic surgery too, it will be a very very long road and i'm not so sure it's worth it after all these years of orthodontic camouflaging!. -
Picollo30.
User deleted
thanks patrick what pics do i need and where i do send them to? . -
PatrickB.
User deleted
I would need profile pictures, frontal pictures and 3/4 and pics of your teeth at rest and smiling.
(if you can put up pics pre op it would be nice but it's not necessary).
You can upload them here!. -
Picollo30.
User deleted
I would need profile pictures, frontal pictures and 3/4 and pics of your teeth at rest and smiling.
(if you can put up pics pre op it would be nice but it's not necessary).
You can upload them here!
thanks mate, i will ask my orthodontist to mail them as she took some pics last month, because im in the end of the treatment. i dont know if my max fac does chin wing or the name of the procedure in portuguese to ask him if he could do it instead of the bsso+lefort1.
patrick do you see the recessed chin and jaw and also the facial assymetry? Can the facil assymetry be caused by the jaws that did not grew as they should? can it be fixed?. -
PatrickB.
User deleted
I see the recessed chin and the asymmetry, and most probably being a mouth breather contributed to causing asymmetries to which already you may have been genetically predisposed.
The asymmetry of the jaw angles and of the mandibular contour MAY NOT be adressed by bimaxillary surgery (while the midlines and gummy smile are adressed by this surgery).
So you NEED chin wing FOR SURE, cosmetically speaking!. -
Picollo30.
User deleted
patrick do you know if in Portugal there are surgeons that do chin wings? if there aren't can i do it later after the MMA?
i know the ideal would be the two of them, but i dont know if there are surgeons and if insurance pays for Chin Wing. -
PatrickB.
User deleted
I doubt insurance will cover chin wing!
I will look into any possible Portuguese surgeon! Tomorrow I'll let you knkw. -
eripsa.
User deleted
1) I think the issue here is more with the gonial angle of your lower jaw. Your jaw might not appear as prominent as in the morph but I think it will improve to a standard in which you will be happy with! A chin wing will probably help you improve aesthetics more
2)I think your cheekbones will improve after surgery if the surgeon moves your maxilla forwards simply because you have prominent, low cheekbones. (think about the face in 3D)
3)I think going any further than the jaw surgery is unneccessary. -
PatrickB.
User deleted
1) I think the issue here is more with the gonial angle of your lower jaw. Your jaw might not appear as prominent as in the morph but I think it will improve to a standard in which you will be happy with! A chin wing will probably help you improve aesthetics more
2)I think your cheekbones will improve after surgery if the surgeon moves your maxilla forwards simply because you have prominent, low cheekbones. (think about the face in 3D)
3)I think going any further than the jaw surgery is unneccessary
agree with point 1 and 3, yet the cheekbones will not improve moving the maxilla forwards. actually, they could worsen! i know it's not good news.. -
Goshan1.
User deleted
Wow yes the eye area looks much much better! V good results
How much does it cost for the canthoplasty? I heard this was very risky!. -
Picollo30.
User deleted
Patrick i will have the photos by tomorrow on a cd my ortho will give. can i ask you a favour if you dont mind? can i email/pm you the pictures instead of posting in the topic?
The reason is this: i was completely hummiliated by a member of another forum, who called me a deformed monster, who was pissed and angry with an analysis you made of his face, that he was one of the worst cases you've seen.
Unfortunately as you could testify i was born and grew up with some facial deformities, my plastic surgeon told me he thinks it was very mild Treacher Collins. Im not proud of being like this, and it was very hard for me to cope with this. Till i decided to do something instead of crying and complaining. Hope you understand.
Another question i wanna ask you Patrick, if i cant do the chin wing, do you think the MMA will improve my aesthetics and will malar implants/infra orbital rim implants help me with cheekbones/zygomatic area? i still have imho a sad look despite the fat grafting and dark circles under the eyes (maybe because of being mouth breather?). i think i still have a weak infraorbital riom projection.Wow yes the eye area looks much much better! V good results
How much does it cost for the canthoplasty? I heard this was very risky!
Goshan i did two procedures. First it was a canthopexy that relapsed some days later and never worked to be honest and then a canthoplasty that was a much more invasive procedure. i still have to minor scars where the sutures were but its the price to pay to want to have more youthful eyes
Both procedures were free in an semi private hospital.
As for canthopexy, in essence the corner is ‘pexed’ outward creating a longer and more narrowed eye shape. This is done with small sutures to the periosteum on the bone.
Conversely, a lateral canthoplasty is more invasive and requires fixing deeper tissues of the lower eyelid (tarsus or muscle) to the inner aspect of the lateral orbital rim. This is usually most effectively done by placing drill holes in the lateral orbital rim where a transosseous suture can be passed to ensure that the new canthal attachment is ‘high and tight’ inside the orbital rim.This is the one you want as its more effective.. -
PatrickB.
User deleted
Patrick i will have the photos by tomorrow on a cd my ortho will give. can i ask you a favour if you dont mind? can i email/pm you the pictures instead of posting in the topic?
The reason is this: i was completely hummiliated by a member of another forum, who called me a deformed monster, who was pissed and angry with an analysis you made of his face, that he was one of the worst cases you've seen.
Unfortunately as you could testify i was born and grew up with some facial deformities, my plastic surgeon told me he thinks it was very mild Treacher Collins. Im not proud of being like this, and it was very hard for me to cope with this. Till i decided to do something instead of crying and complaining. Hope you understand.
Another question i wanna ask you Patrick, if i cant do the chin wing, do you think the MMA will improve my aesthetics and will malar implants/infra orbital rim implants help me with cheekbones/zygomatic area? i still have imho a sad look despite the fat grafting and dark circles under the eyes (maybe because of being mouth breather?). i think i still have a weak infraorbital riom projection.Wow yes the eye area looks much much better! V good results
How much does it cost for the canthoplasty? I heard this was very risky!
Goshan i did two procedures. First it was a canthopexy that relapsed some days later and never worked to be honest and then a canthoplasty that was a much more invasive procedure. i still have to minor scars where the sutures were but its the price to pay to want to have more youthful eyes
Both procedures were free in an semi private hospital.
As for canthopexy, in essence the corner is ‘pexed’ outward creating a longer and more narrowed eye shape. This is done with small sutures to the periosteum on the bone.
Conversely, a lateral canthoplasty is more invasive and requires fixing deeper tissues of the lower eyelid (tarsus or muscle) to the inner aspect of the lateral orbital rim. This is usually most effectively done by placing drill holes in the lateral orbital rim where a transosseous suture can be passed to ensure that the new canthal attachment is ‘high and tight’ inside the orbital rim.This is the one you want as its more effective.
Piccollo, you are NOT a "deformed monster" by ANY MEANS. I am very honest: after all the surgeries you have you look good and you should be pleased with your appearance.
I will grant you access to the private forum as soon as possible and you may post there where that idiot does not have access.
Post the pictures and then i'll answer to your questions....in 5 minutes you will have access. -
Picollo30.
User deleted
dont worry patrick im someone wants to hummiliate me again i'm right here. i just want your honest opinion about what i need for my face. i just want to look in the mirror and like what i see you know. you encouraged me the other day but now seeing these pics im not so sure of myself or if the double jaw surgery + lefort1+genio will help me. even with canthoplasty i still have ptosis in one eye, i dont know if because of the side of the face that is less developed and cant be corrected or if there's excess skin. maybe an oculoplastic can help? btw do i still have a negative canthal tilt?
please tell me what you think. i may be a lost case
Case
https://image.forumcommunity.it/1/0/1/4/8/8.../1429218619.jpg
2010
https://image.forumcommunity.it/1/0/1/4/8/8.../1429218648.png
https://image.forumcommunity.it/1/0/1/4/8/8.../1429218680.png
2015
https://image.forumcommunity.it/1/0/1/4/8/8.../1429218701.png
https://image.forumcommunity.it/1/0/1/4/8/8.../1429218737.png
https://image.forumcommunity.it/1/0/1/4/8/8.../1429218948.png
https://image.forumcommunity.it/1/0/1/4/8/8.../1429219031.png
https://image.forumcommunity.it/1/0/1/4/8/8.../1429219086.png
https://image.forumcommunity.it/1/0/1/4/8/8.../1429219118.png
there it goes. -
Goshan1.
User deleted
I am not PatrickB - but the changes you've made are fantastic, the improvement is HUGE, wow. .
Chirurgia Ortognatica BSSO+LeFort1+Genioplastia |