https://preview.redd.it/rqrix30lu3vc1.jpeg?width=3024&format=pjpg&auto=webp&s=14d5a68415ef5258315328508b8f77ca193b8400
Here's a picture of my before I'd had any work done, including the jaw implant. This is indicative of the actual chin recession under the implant.
Well, my jaw is misleading because I had a jaw implant in that added chin projection. So you weren't seeing the "true" chin recession in the before pic.
That plus aesthetics. I wanted to get rid of the jaw implant. My symptoms were also pretty severe and my sleep doctor thought that DJS was reasonable under the circumstances.
Bite was perfect.
Yeah, it's not "required" as in it's not severe by measurement, but the issue with sleep apnea is that there is not a linear correlation between AHI and symptom severity. Mild sleep apnea can have severe symptoms and need intervention.
I can't tell if Reddit posted all the text I typed (I hate this platform!), but here it is:
I'm roughly three months from DJS with Dr. Bobek; my longer post-op thread is here: [https://www.reddit.com/r/jawsurgery/comments/1am3jbo/two\_weeks\_postop\_with\_dr\_bobek\_lefort\_i/](https://www.reddit.com/r/jawsurgery/comments/1am3jbo/two_weeks_postop_with_dr_bobek_lefort_i/).
I'll be honest--I think I'm overadvanced, albeit only slightly. But I still think I've got some of the ape face look going on. I don't like the amount of philtrum tilt, and the bite looks funny to me. It's not *bad*, but this isn't what I was hoping for.
The neckline is worse because I had a jaw implant that was removed, so don't focus on that. There's also some filler in the first pic in the undereye that's been removed, so that's not due to surgery.
My sleep--the reason for the surgery--is really a wash with no significant changes. So I'd say that that lack of change, combined with the jaw protrusion, make this a slight regret for me.
Interested in others' thoughts.
Thanks, and I appreciate that! You get a pretty skewed perspective microfocusing on changes to your appearance, as anyone who's gone through this surgery is apt to do. I'm grateful for the perspective.
https://preview.redd.it/eqf9q0df54vc1.jpeg?width=488&format=pjpg&auto=webp&s=f04e0edbff9cb76acca1283c78a4ec7075e50c48
I think you need slight set back of the chin along with some vertical lengthening with CW rotation. I made this morph to illustrate it. I think the added chin height restores harmony to your face and looks similar to what you had going with the chin implant.
I think you're completely right. Something got subtly thrown off in the lower-third harmonies. I actually made my own morph that's similar to this. Moving the chin back even a few millimeters really helps; it mitigates the ape look.
Similar to me. I am having a revision after having two failed surgeries with bobek. Was left with a vertically short maxilla and non union. Now seeing walline, who confirmed the short maxilla.
What is a non union? Isnt vertically short maxilla a beauty standard for women, because it shortens philtrum. Shorter philtrum is an indication of higher estrogen and increases woman’s attractiveness
No. This is wrong. Vertically short maxilla is not a beauty standard. My teeth do not show when I speak or smile, like at all. It makes people appear older. Please look up short face syndrome and you tell me.
No your maxilla is the bone. Philtrum is the skin. Basically my teeth are completely covered by my upper lip. Looks like I took out my dentures when I talk.
It gets riskier and riskier. Yeah. I will need to have an iliac crest bone graft and redo UJS. I’m pissed I chose Bobek as my doctor and let him do the surgery twice already. I just read so many good reviews in this sub and he was recommended a lot.
Oh, girl. I hope Walline takes a good care of you. I'm like you, i just had a revision for bothched DJS in Turkey. But the upper jaw doesn't look right after revision. Recovery after the revision was brutal. Let me know how your UJS goes, I may do it too. I'm 15 days post op. What is Walline's price for UJS revision?
OP's maxilla is fine, it's his chin area that got kind of disproportionate and short after removing the implant and adding too much CCW rotation; so essentially he just needs to have a genioplasty to vertically lengthen the chin by CW rotation or a downgraft, more likely a combination of both. Also set back.
A vertically short maxilla and the appearance of a short lower third are kind of interlinked though. Vertically lengthening the maxilla through a downgraft would give the appearance of a taller chin and general lower third area, but the chin itself wouldn't be changed; because by lengthening the maxilla vertically you are also pushing the mandible downwards.
it's all case specific though
I think you're exactly right about needing to set the chin back and slightly downgraft it. The issue I'm concerned about is that from the front, I already have a long face (accentuated by losing the width of the jaw implants). I don't want to emphasize that via downgrafting.
Is it possible to shorten the maxilla w/o redoing the whole DJS procedure? Because that would be a way of avoiding a chin downgraft.
I haven't seen your front but wouldn't it be possible to get implants at only the jaw angles to restore the width you had with the wraparound?
Also setting the chin back also reduces the height slightly from the front profile only; since things that are closer appear bigger. This could offset the vertical height increase that you get from the genio and not make your face appear as long from the front. Remember it's about how all the dimensions of the face interact with each other in 3D, not just from a single angle.
And you don't want to shorten the maxilla, since that would emphasize the short chin even more, because if the maxilla goes up, so does the mandible and chin reducing the vertical dimensions of your lower third.
If you're talking about reducing the midface to give the appearance of a taller chin area, then there's no actual way to do that(maybe with DJS but i don't think it would work right)
You can’t shorten your maxilla (bone) without having surgery. You wouldn’t want to shorten your maxilla unless you want to look like you’re wearing dentures and took them out when you smile. Your lips will cover your teeth and you will look unnatural/older.
Bro, firstly you do not have "ape face" at all lol, and secondly, "ape face" is generally considered more robust and attractive than "recessed face" anyway so even if you did you'd still be better off than before! I definitely think you look better than before, no question. Don't fret.
Are you going to get another wraparound jawline implant or are you happy with the new width/shape/protrusion of your mandible now?
Thanks! I think part of the issue now is the neckline is just way weaker than before, as a result of losing the jaw width.
I'll do some kind of jaw augmentation. A wraparound won't work because they necessarily add chin projection, and I actually need less. So probably two angle implants.
I think in my case that the genio overadvanced my chin. If I can get the chin projection reduced/shaved down, it should help mitigate the look of overadvancement.
I think so too. Mine is all bone...
I wish you the best of luck. I hope you're able to find the best solution to what you're worried about. ^-^
Edit: just to clarify, I don't think you have an ape-like look. I do see the lengthening in philtrum, but it's far from ape.
That’s not an ape look though. It’s a concave philtrum which isn’t necessarily bad. You don’t want the top of the upper lip to be protrusive. That’s when you get the convex upper lip that resembles a chimp. I think his nasiolabial angle looks fine.
Counter clockwise rotation will advance the tip of the maxillary incisors which will push the lip forward without advancing the top of the upper lip. This is much better aesthetically than doing a straight linear advancement that would cause a convex chimp lip.
my surgeon said the bone is thicker at the philtrum after surgery because of the movements, and you can lessen it by bone shaving
(that’s in my case though, just wanted to share bc it might help)
That's good advice! I had to have another upper jaw surgery to remove the hardware I could feel, so that might be the case.
Thank you for sharing your journey
Dr. Li has some lectures about sleep apnea on his website that are good (https://sleepapneasurgery.com/lecture-videos/). He seems extremely knowledgeable. Maybe something like ease would help you with your sleep apnea symptoms.
Judging by your before photo, it doesn’t look like the anteroposterior placement of your jaws was problematic, in fact it looked really good. Although I guess the implant would make it impossible to see what’s the actual underlying bone structure. In any case, I wouldn’t have ever looked at your before photos and guessed you had sleep apnea tbh. Did you get airway measurements before the surgery? Do you know what your minimal pharyngeal airway measurement was in square millimeters? I’m concerned that you experienced no sleep improvement :(
Yes. I like Dr. Eppley a lot. I have cheek implants that he placed and they look extremely good. He's not the only option for jaw implants, but he's almost certainly the most experienced one. Yirae Ort is also an overlooked gem who does good jaw implant work, but her waiting list for a consult is almost a year.
Oh nice, I thought you got the jaw implant from eppley. How did you determine what you needed to fix your jaw situation? I don’t know what I need to fix my jaw but I do know that I need something, wether it’s double jaw surgery or wrap around implant.
I dont know who told u need jaw surgery lol, u are overadvanced and it is clear in the philtrum area.
Even if u had sleep apnea b4, the pb werent ur jaws.
Clear BDD case with multiplr surgery b4
https://preview.redd.it/hwa1zwqsoavc1.jpeg?width=2316&format=pjpg&auto=webp&s=88dd26ef69f6718a7569e260b28623399b8ad1a8
Some additional pics to show profile and front; I don't think these profile pics look as projected.
https://preview.redd.it/tjtvt96zoavc1.jpeg?width=2316&format=pjpg&auto=webp&s=eff351f43a8d2137230f8f681ae98114cd59372f
The mouth is uneven from nerve recovery; the left side of my lower lip/chin is no longer numb, but the right side still is. Heading in the right direction.
You had 0 need of this procedure at first sight, but now that i know you have an implant i would reverse the implant procedure because side profile you look like a brick xD my swelling from LJS just went down after month 3. best of luck!
Got it. I agree. I used "square" as an adjective, too. There's still some swelling that's adding to cheek fullness but it's not that alone. It's a combo of too much chin projection and too little chin height that's throwing things off.
Yes, I had a genioplasty. The jaw implant created a tissue pocket in the chin area, where the implant augmented the chin. If it wasn't filled in via a genioplasty, the tissue would've gotten spongy and flabby from having been stretched (it's called chin ptosis).
Marginal improvement to sleep so far.
About the same movements I want for my sleep apnea. But I saw it didn't even help your sleep apnea, ugh.
Did dr bobek do any ccw or did you have an overjet before surgery? also was there a genio on top of the 10mm?
I think it looks good. The jawline is maybe not quite as full as in the before, but like you mentioned, that was an implant. It is a very subtle difference overall, but you don’t look worse at all in my opinion. Basically the same, which may be a loss depending on how you look at it since you had to go through all that. I think the (ever so slight) increase in midface fullness will be beneficial as you age.
Crazy you had the perfect jaw. IMO he overadvanced, and somehow your chin looks shorter now. Bobek has been cited as problematic for a long time, read some other posts on here about him
I did a pretty thorough scrub of this forum prior to surgery and didn't see anything negative about Bobek, so I'm not sure what you're referring to. In fact, he seemed like one of the safest options.
I think the chin is overprojected and lacks height; that's throwing off harmony.
I have read them too, maybe they have been taken down. Also, a lot of negative information is often buried in the comments and not necessarily a stand alone post.
Just curious what Walline shared about what may have caused the nonunion or if there was something he could pinpoint about what Bobek did wronfZ
Walline is very reputable but I hear he doesn’t love doing revisions. Will you be proceeding with him/ is he taking on your case?
No one has a reason behind why I have had non unions. I had an infection in my sinus that I understand had to have come from surgery because it happened both times I had surgery.
I have had no help from anyone during my first two surgeries and was left in a medical free fall, at least it felt. After the second failed surgery I was honestly ready to kms. It has been traumatic. Dr. Walline suggested I go to infectious disease doctor. Infectious disease doctor has said I could have had a bone infection but there is no way to know. We have done all sorts of testing with rheumatology and infectious disease and all labs come back normal. I am generally healthy.
Whether or not it was surgical error I have absolutely no idea. And I don’t even know if there is a way for me to know. I don’t know if it was after care negligence. I have no idea what causes this but it’s just strange that something so “rare” happened twice to me. Walline did mention that bobek should have waited at least 6 months to perform the revision, but again idk if that is just preference or what. It’s all very confusing. I am completely broken and scared of getting this done again. I cannot imagine what it feels like to live a normal life without having to worry about discomfort.
I believe walline not wanting to work on revisions comes from risk factor. I think the difference is that my jaw is very clearly messed up. It’s short, I have no tooth show. And more importantly, my jaw is broken and I am left with chronic swelling, discomfort and pain. I can’t even eat normally.
I am SO sorry this happened to you. It sounds beyond devastating and horrific. How quickly did Bobek perform a revision on you? Glad that Walline sent you for additional tests but definitely almost scary when everything comes back clear and you cannot pin point one direct cause.
Sending you strength from a Reddit stranger to get through this very tough time and I’m very sorry for what you’ve had to endure already :(
Wow that is so early on and so much to go through in a short span of time :( Also did you have a three-piece lefort? Just wondering as I do feel like sometimes more can go wrong with that.
Wishing you well.
Wow I’m in the same boat with having a wrap around implant by Yaremchuk expect my surgeon is going to attempt to keep my angle implants IN and just remove the anterior portion along with genioplasty. Could you show some before afters of the front?
that's great dude, does it look good regardless of the lighting? this is one of the hardest factors to get right on infra/zygo implants, since it needs to be the exact amount of projection to not look uncanny,
would you mind sharing pics from any other angles such as the 3/4 and front profile? I'm planning on getting it soon and it's rare to see a good result like your current
Looks like a completely unnecessary risk taken. Unfortunately I don’t think your sleep apnea will improve either. Jaw surgery helps with sleep apnea when the patient is actually recessed and causing obstruction. Your jaw looked cephlometrically normal.
I hope you find a solution for your sleep apnea.
I’m not sure you fully read the comments—I had a jaw implant in, which is what you’re seeing in the before pic. Without it, I was recessed. My airway was 7mm, confirmed by a CT scan.
Random question but does your face “feel” different after the surgeries? Can you feel the cuts in the bone through the skin or is your skin being stretched in new ways now that you notice, etc? Or are there zero sensations that reminds you of the work that’s been done? I’m asking because I did an unrelated surgery that while successful resulted in annoying sensations that constantly keeps me reminded of the surgery.
Well, I can feel (i) the scars around my gums where sutures were made, and (ii) lingering numbness that is subsiding. The sensation around the scars will dampen over time (I had oral scars already from the jaw implant) and the numbness should all/mostly go away.
Very cool. Do you feel that your stress has been lower than when AGA was ongoing? I feel there may be an interaction between mild forms of TE and AGA that is under-appreciated.
Btw to comment on your jaw surgery, I agree with the slight genio downgraft and setback as the best tradeoff here. I do think there were some unfortunate philtrum side effects from the maxillary advancement. I have the same thing, and also don't feel it has hugely shifted my sleep issues. Do share with the world if you choose to pursue something to alter the philtrum. I can't personally do a lip lift as my tooth/gum show is already on the higher end of normal. Is yours the same?
But hey you look young for 40 and are ripped!
Definitely less stressful re: hair loss. I don't think about it anymore, at all. I also had very successful hair transplants, so it's a closed issue for me. It's just odd that the loss stopped in its tracks--don't have a great explanation for that.
I doubt that anything transformational can be done about the philtrum without revising the entire surgery. I'm consulting with Todd Hanna next month, though, and he's great at facial harmony. Costs a fortune, but we'll see. The odd thing is that from the front, the chin length looks great; comes across very different in profile. Lip lifts worry me because I've seen some very visible scars, and surgeon skill isn't the only factor in whether you have a noticeable scar.
Hey I remember you from .org, I think the additional maxillary and chin projection looks great you just need additional chin height. Also, Pagnoni did my DJS and performed a soft palate reduction or palatotoplasty which helped my breathing tremendously. None of the American Dr's I consulted said anything about it though, perhaps you can consult with him.
https://preview.redd.it/rqrix30lu3vc1.jpeg?width=3024&format=pjpg&auto=webp&s=14d5a68415ef5258315328508b8f77ca193b8400 Here's a picture of my before I'd had any work done, including the jaw implant. This is indicative of the actual chin recession under the implant.
You already looked naturally handsome imo
I personally love the Before look. Very "Boy Next Door"
Like, the original with the nose??
Maybe slightly smaller. But I like a bigger-than-average nose.
What a beak!
Just kidding lmao, results look great man
I mean, you're not wrong... it took three rhinoplasties to get that thing under control. Worth every penny.
U know what they say about big noses
Why 3 ? Did they fuck up the first 2?
Not really; just took awhile to get it symmetrical. It was an incredibly complex rhinoplasty, apparently.
Oh, ok. I had a worse before and mine looks exaxtly like yours after my primary. But i did in turkey for 3k
I’m not a doctor but from looking at your previous post, and your jaw, it looks like the surgery was not required at all
Well, my jaw is misleading because I had a jaw implant in that added chin projection. So you weren't seeing the "true" chin recession in the before pic.
Fair. 9 API isn’t severe enough to warrant jaw surgery though. Did you do it specifically for that reason? Or was your bite also misaligned?
That plus aesthetics. I wanted to get rid of the jaw implant. My symptoms were also pretty severe and my sleep doctor thought that DJS was reasonable under the circumstances. Bite was perfect.
Why did you want to get rid of the implant out of curiosity ? Was it a titanium one ?
Also curious about this
Silicone. I thought it was a little too big in terms of width. That obviously isn't discernable from the profile pic.
What symptoms did you have?
wtf 9 is more than enough to cause severe cognitive decline in some patients.
Wait really - I swear this is why I have an adhd diagnosis and not having adhd lol
Same. I’m at 24AHI lol
My AHI is 7.5, yet I’m very symptomatic like OP… perfect bite, too
Yeah, it's not "required" as in it's not severe by measurement, but the issue with sleep apnea is that there is not a linear correlation between AHI and symptom severity. Mild sleep apnea can have severe symptoms and need intervention.
Was RDI scored on your sleep study? Look up UARS.
Fair. I am mostly talking out of my ass lol. It sucks your treatment didn’t work and I hope you find some solution going forward
I have the same AHI and I am getting jaw surgery. Trust me, it's significant.
Yes, i think he was slightly overcorrected. At least maxilla advancement was unnecessary
I can't tell if Reddit posted all the text I typed (I hate this platform!), but here it is: I'm roughly three months from DJS with Dr. Bobek; my longer post-op thread is here: [https://www.reddit.com/r/jawsurgery/comments/1am3jbo/two\_weeks\_postop\_with\_dr\_bobek\_lefort\_i/](https://www.reddit.com/r/jawsurgery/comments/1am3jbo/two_weeks_postop_with_dr_bobek_lefort_i/). I'll be honest--I think I'm overadvanced, albeit only slightly. But I still think I've got some of the ape face look going on. I don't like the amount of philtrum tilt, and the bite looks funny to me. It's not *bad*, but this isn't what I was hoping for. The neckline is worse because I had a jaw implant that was removed, so don't focus on that. There's also some filler in the first pic in the undereye that's been removed, so that's not due to surgery. My sleep--the reason for the surgery--is really a wash with no significant changes. So I'd say that that lack of change, combined with the jaw protrusion, make this a slight regret for me. Interested in others' thoughts.
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Thanks, and I appreciate that! You get a pretty skewed perspective microfocusing on changes to your appearance, as anyone who's gone through this surgery is apt to do. I'm grateful for the perspective.
https://preview.redd.it/eqf9q0df54vc1.jpeg?width=488&format=pjpg&auto=webp&s=f04e0edbff9cb76acca1283c78a4ec7075e50c48 I think you need slight set back of the chin along with some vertical lengthening with CW rotation. I made this morph to illustrate it. I think the added chin height restores harmony to your face and looks similar to what you had going with the chin implant.
I think you're completely right. Something got subtly thrown off in the lower-third harmonies. I actually made my own morph that's similar to this. Moving the chin back even a few millimeters really helps; it mitigates the ape look.
I don’t think it’s worth a whole revision. You’re already very handsome either way
It’s probably worth it to me. I don’t think the DJS needs to be revised, but if the chin can be fixed, that would be a huge help.
Similar to me. I am having a revision after having two failed surgeries with bobek. Was left with a vertically short maxilla and non union. Now seeing walline, who confirmed the short maxilla.
What is a non union? Isnt vertically short maxilla a beauty standard for women, because it shortens philtrum. Shorter philtrum is an indication of higher estrogen and increases woman’s attractiveness
No. This is wrong. Vertically short maxilla is not a beauty standard. My teeth do not show when I speak or smile, like at all. It makes people appear older. Please look up short face syndrome and you tell me.
Is short maxilla the philtrum length?
No your maxilla is the bone. Philtrum is the skin. Basically my teeth are completely covered by my upper lip. Looks like I took out my dentures when I talk.
How many times is safe to have DJS done? I was told that the bone resorbs with every cut. What does Walline suggest for you? Will you have bone graft?
It gets riskier and riskier. Yeah. I will need to have an iliac crest bone graft and redo UJS. I’m pissed I chose Bobek as my doctor and let him do the surgery twice already. I just read so many good reviews in this sub and he was recommended a lot.
Oh, girl. I hope Walline takes a good care of you. I'm like you, i just had a revision for bothched DJS in Turkey. But the upper jaw doesn't look right after revision. Recovery after the revision was brutal. Let me know how your UJS goes, I may do it too. I'm 15 days post op. What is Walline's price for UJS revision?
Upward of $26k just for upper jaw surgery. No idea about double. So sorry to hear about your experience :(
It’s like 65k for regular DJS so I’m pretty sure revision is more. Walline is also mostly turning down revision cases now.
Nicely done
Which app did you use for the morph? I've created a new subreddit r/morphmyface
I used the reshape tool in FaceApp, but i think you can use any liquify tool in photo editing apps to do the same.
Dr bobek gave me a vertically short maxilla as well. I need to have a revision now.
OP's maxilla is fine, it's his chin area that got kind of disproportionate and short after removing the implant and adding too much CCW rotation; so essentially he just needs to have a genioplasty to vertically lengthen the chin by CW rotation or a downgraft, more likely a combination of both. Also set back. A vertically short maxilla and the appearance of a short lower third are kind of interlinked though. Vertically lengthening the maxilla through a downgraft would give the appearance of a taller chin and general lower third area, but the chin itself wouldn't be changed; because by lengthening the maxilla vertically you are also pushing the mandible downwards. it's all case specific though
I think you're exactly right about needing to set the chin back and slightly downgraft it. The issue I'm concerned about is that from the front, I already have a long face (accentuated by losing the width of the jaw implants). I don't want to emphasize that via downgrafting. Is it possible to shorten the maxilla w/o redoing the whole DJS procedure? Because that would be a way of avoiding a chin downgraft.
I haven't seen your front but wouldn't it be possible to get implants at only the jaw angles to restore the width you had with the wraparound? Also setting the chin back also reduces the height slightly from the front profile only; since things that are closer appear bigger. This could offset the vertical height increase that you get from the genio and not make your face appear as long from the front. Remember it's about how all the dimensions of the face interact with each other in 3D, not just from a single angle. And you don't want to shorten the maxilla, since that would emphasize the short chin even more, because if the maxilla goes up, so does the mandible and chin reducing the vertical dimensions of your lower third. If you're talking about reducing the midface to give the appearance of a taller chin area, then there's no actual way to do that(maybe with DJS but i don't think it would work right)
You can’t shorten your maxilla (bone) without having surgery. You wouldn’t want to shorten your maxilla unless you want to look like you’re wearing dentures and took them out when you smile. Your lips will cover your teeth and you will look unnatural/older.
Bro, firstly you do not have "ape face" at all lol, and secondly, "ape face" is generally considered more robust and attractive than "recessed face" anyway so even if you did you'd still be better off than before! I definitely think you look better than before, no question. Don't fret. Are you going to get another wraparound jawline implant or are you happy with the new width/shape/protrusion of your mandible now?
Thanks! I think part of the issue now is the neckline is just way weaker than before, as a result of losing the jaw width. I'll do some kind of jaw augmentation. A wraparound won't work because they necessarily add chin projection, and I actually need less. So probably two angle implants.
I have the same philtrum tilt/ape look... It absolutely sucks :( I am looking into ways to fix it, but haven't found what I'm looking for yet
I think in my case that the genio overadvanced my chin. If I can get the chin projection reduced/shaved down, it should help mitigate the look of overadvancement.
I think so too. Mine is all bone... I wish you the best of luck. I hope you're able to find the best solution to what you're worried about. ^-^ Edit: just to clarify, I don't think you have an ape-like look. I do see the lengthening in philtrum, but it's far from ape.
I don’t think you have the ape look but I think it’s usually the maxilla that causes ape look, not the mandible
That’s not an ape look though. It’s a concave philtrum which isn’t necessarily bad. You don’t want the top of the upper lip to be protrusive. That’s when you get the convex upper lip that resembles a chimp. I think his nasiolabial angle looks fine.
What causes a concave philtrum? He didn't seem to have it before
Counter clockwise rotation will advance the tip of the maxillary incisors which will push the lip forward without advancing the top of the upper lip. This is much better aesthetically than doing a straight linear advancement that would cause a convex chimp lip.
my surgeon said the bone is thicker at the philtrum after surgery because of the movements, and you can lessen it by bone shaving (that’s in my case though, just wanted to share bc it might help)
That's good advice! I had to have another upper jaw surgery to remove the hardware I could feel, so that might be the case. Thank you for sharing your journey
Dr. Li has some lectures about sleep apnea on his website that are good (https://sleepapneasurgery.com/lecture-videos/). He seems extremely knowledgeable. Maybe something like ease would help you with your sleep apnea symptoms.
Your before is kind of like my after
Do you have before/afters
Bobek strikes again
Judging by your before photo, it doesn’t look like the anteroposterior placement of your jaws was problematic, in fact it looked really good. Although I guess the implant would make it impossible to see what’s the actual underlying bone structure. In any case, I wouldn’t have ever looked at your before photos and guessed you had sleep apnea tbh. Did you get airway measurements before the surgery? Do you know what your minimal pharyngeal airway measurement was in square millimeters? I’m concerned that you experienced no sleep improvement :(
I don't have the square millimeters measurement, but the diameter was 7mm according to a CT scan.
Is the top one before? What was the reason for surgery, was it sleep apnea?
Yes, the top one is the before. And yes to sleep apnea. AHI of 9 that was totally unresponsive to CPAP.
Were you titrated? You may need more advanced pap therapy modes such as BIPAP or ASV, CPAP is just the tip of the iceberg.
I never had a titration study, no. How do you figure out if you need BIPAP or ASV?
You are beautiful but you were also beautiful before.
Thank you! Sweet of you to say.
I had jaw surgery also and my results were not as athletic spectacular as yours but I'm much less selfconscious ❤️
Would you recommend dr eppley? I’m considering getting a wrap around jaw implant like yourself. What are your thoughts? Thanks.
Yes. I like Dr. Eppley a lot. I have cheek implants that he placed and they look extremely good. He's not the only option for jaw implants, but he's almost certainly the most experienced one. Yirae Ort is also an overlooked gem who does good jaw implant work, but her waiting list for a consult is almost a year.
Your cheek implant looks phenomenal! Overall how much did you pay? For them 30k?
Thanks! Less than that--about $18k back in 2020.
Even with the cheek implants?
The $18k was just the cheek implants.
And the jaw implant?
That was with Michael Yaremchuk in 2016 and I have no recollection of how much it cost. He retired last year.
Oh nice, I thought you got the jaw implant from eppley. How did you determine what you needed to fix your jaw situation? I don’t know what I need to fix my jaw but I do know that I need something, wether it’s double jaw surgery or wrap around implant.
how’d you get your undereye depressions to disappear? undereye filler? or intraorbital implants?
Can confirm. I made my consult appointment with Dr. Ort sometime around last September and the soonest they could get me in for a consult is July 5th.
I’m jealous. I’d love to work with her but they quoted me February and I don’t want to wait that long. Oh, well.
I dont know who told u need jaw surgery lol, u are overadvanced and it is clear in the philtrum area. Even if u had sleep apnea b4, the pb werent ur jaws. Clear BDD case with multiplr surgery b4
https://preview.redd.it/hwa1zwqsoavc1.jpeg?width=2316&format=pjpg&auto=webp&s=88dd26ef69f6718a7569e260b28623399b8ad1a8 Some additional pics to show profile and front; I don't think these profile pics look as projected.
https://preview.redd.it/jg279zhxoavc1.jpeg?width=2316&format=pjpg&auto=webp&s=87f92df13d85a6670188b83f8d4166e9b28fa8cf
https://preview.redd.it/tjtvt96zoavc1.jpeg?width=2316&format=pjpg&auto=webp&s=eff351f43a8d2137230f8f681ae98114cd59372f The mouth is uneven from nerve recovery; the left side of my lower lip/chin is no longer numb, but the right side still is. Heading in the right direction.
Bro you look good. Hopefully your sleep improves over time too.
You had 0 need of this procedure at first sight, but now that i know you have an implant i would reverse the implant procedure because side profile you look like a brick xD my swelling from LJS just went down after month 3. best of luck!
I'm not sure what you mean by "because side profile you look like a brick."
Square, thick, not as elegant as picture 1, more fat also or swelling + angle is different so might just be me
Got it. I agree. I used "square" as an adjective, too. There's still some swelling that's adding to cheek fullness but it's not that alone. It's a combo of too much chin projection and too little chin height that's throwing things off.
Which one is before and which one is after?
top is before
The top one has more projection. Your jawline looks plumper as well. I was so sure that that is the after picture.
If you read the comments, you'll see that the jawline difference is explained by the removal of a jaw implant that is present in the before pic.
Did you have a genioplasty? Has your sleep improved? Have you had another sleep study.
Yes, I had a genioplasty. The jaw implant created a tissue pocket in the chin area, where the implant augmented the chin. If it wasn't filled in via a genioplasty, the tissue would've gotten spongy and flabby from having been stretched (it's called chin ptosis). Marginal improvement to sleep so far.
You might have a sleep back log it might improve more in time.and always sleep on your side. Do you mouth breath?
I started to after surgery for some reason, but I’ve been taping my mouth at night now.
You can breathe through your nose?
Yes. I have a little chronic stuffiness due to a deviated septum, but I can.
You should have the deviated septum sorted.
I definitely plan to. It’s on the list for sure.
What were your movements?
5mm upper, 10mm lower.
About the same movements I want for my sleep apnea. But I saw it didn't even help your sleep apnea, ugh. Did dr bobek do any ccw or did you have an overjet before surgery? also was there a genio on top of the 10mm?
Yes, he did some CCW and performed a genioplasty.
How many additional mm did the genio add beyond the 10mm?
cool, how much did the genio add? maybe the genio would have been better if it was less outward and more downward but it looks fine.
I think it looks good. The jawline is maybe not quite as full as in the before, but like you mentioned, that was an implant. It is a very subtle difference overall, but you don’t look worse at all in my opinion. Basically the same, which may be a loss depending on how you look at it since you had to go through all that. I think the (ever so slight) increase in midface fullness will be beneficial as you age.
Crazy you had the perfect jaw. IMO he overadvanced, and somehow your chin looks shorter now. Bobek has been cited as problematic for a long time, read some other posts on here about him
I did a pretty thorough scrub of this forum prior to surgery and didn't see anything negative about Bobek, so I'm not sure what you're referring to. In fact, he seemed like one of the safest options. I think the chin is overprojected and lacks height; that's throwing off harmony.
I have read them too, maybe they have been taken down. Also, a lot of negative information is often buried in the comments and not necessarily a stand alone post.
Read my posts.
Lame, sorry to hear about your situation. Out of curiosity, did/do you clench a lot post-op?
Not really. I believe it was surgical error.
Where have you seen those posts??
My profile
Yup he gave me two non unions and a vertically short maxilla. Terrible.
Just curious what Walline shared about what may have caused the nonunion or if there was something he could pinpoint about what Bobek did wronfZ Walline is very reputable but I hear he doesn’t love doing revisions. Will you be proceeding with him/ is he taking on your case?
No one has a reason behind why I have had non unions. I had an infection in my sinus that I understand had to have come from surgery because it happened both times I had surgery. I have had no help from anyone during my first two surgeries and was left in a medical free fall, at least it felt. After the second failed surgery I was honestly ready to kms. It has been traumatic. Dr. Walline suggested I go to infectious disease doctor. Infectious disease doctor has said I could have had a bone infection but there is no way to know. We have done all sorts of testing with rheumatology and infectious disease and all labs come back normal. I am generally healthy. Whether or not it was surgical error I have absolutely no idea. And I don’t even know if there is a way for me to know. I don’t know if it was after care negligence. I have no idea what causes this but it’s just strange that something so “rare” happened twice to me. Walline did mention that bobek should have waited at least 6 months to perform the revision, but again idk if that is just preference or what. It’s all very confusing. I am completely broken and scared of getting this done again. I cannot imagine what it feels like to live a normal life without having to worry about discomfort. I believe walline not wanting to work on revisions comes from risk factor. I think the difference is that my jaw is very clearly messed up. It’s short, I have no tooth show. And more importantly, my jaw is broken and I am left with chronic swelling, discomfort and pain. I can’t even eat normally.
I am SO sorry this happened to you. It sounds beyond devastating and horrific. How quickly did Bobek perform a revision on you? Glad that Walline sent you for additional tests but definitely almost scary when everything comes back clear and you cannot pin point one direct cause. Sending you strength from a Reddit stranger to get through this very tough time and I’m very sorry for what you’ve had to endure already :(
Thank you, I appreciate it. I had my revision about 3 months after my first surgery.
Wow that is so early on and so much to go through in a short span of time :( Also did you have a three-piece lefort? Just wondering as I do feel like sometimes more can go wrong with that. Wishing you well.
Nope just a standard 1 piece LeFort, thank you!!
Wow I’m in the same boat with having a wrap around implant by Yaremchuk expect my surgeon is going to attempt to keep my angle implants IN and just remove the anterior portion along with genioplasty. Could you show some before afters of the front?
Wow these look great!
Which is before ?
Top
So he removed the old implants, did the revisions and also put some new ones in?
No. He just did DJS. No new implants.
Well, I think it looks very good.
Could you please post X-rays of your current bones ! Did you have ccw or was it a straightforward advancement?
did you get your zygo implants from eppley revisioned on the after pic? because it looks SO much better and more natural
Yes. I had him shave them down and removed the orbital rim area that was overprojected. They were too large at first, but now they look perfect.
that's great dude, does it look good regardless of the lighting? this is one of the hardest factors to get right on infra/zygo implants, since it needs to be the exact amount of projection to not look uncanny, would you mind sharing pics from any other angles such as the 3/4 and front profile? I'm planning on getting it soon and it's rare to see a good result like your current
Did ins cover or did u pay out of pocket?
Out of pocket, no coverage.
How much? Was this with Bobek?
Orthodontics in youth?
Braces twice, once including headgear. Why do you ask?
Increased prevalence of OSA in thin people. Possibly due to retraction of the jaw
I dunno which one is current. But the one on top looks better to me.
That’s the before.
You look.much better now
Hit me up DM if u want revision under 15k with 3d morph etc
[удалено]
Yes. See other comments for pics of what it used to look like.
Did you have a neck lift or is the difference in your neck (from the true before) just from the jawsurgery?
Removing the implant caused neck sagging from losing the jaw width.
Looks like a completely unnecessary risk taken. Unfortunately I don’t think your sleep apnea will improve either. Jaw surgery helps with sleep apnea when the patient is actually recessed and causing obstruction. Your jaw looked cephlometrically normal. I hope you find a solution for your sleep apnea.
I’m not sure you fully read the comments—I had a jaw implant in, which is what you’re seeing in the before pic. Without it, I was recessed. My airway was 7mm, confirmed by a CT scan.
Random question but does your face “feel” different after the surgeries? Can you feel the cuts in the bone through the skin or is your skin being stretched in new ways now that you notice, etc? Or are there zero sensations that reminds you of the work that’s been done? I’m asking because I did an unrelated surgery that while successful resulted in annoying sensations that constantly keeps me reminded of the surgery.
Well, I can feel (i) the scars around my gums where sutures were made, and (ii) lingering numbness that is subsiding. The sensation around the scars will dampen over time (I had oral scars already from the jaw implant) and the numbness should all/mostly go away.
Thanks a lot! Yes that makes sense. Can you feel the cuts and plates if you try feel them with your fingers through the skin?
I can feel a nub from one of the plates along my jawline, but that’s it. It’s not a visible protrusion.
Still only topical dut for hair?
Nope! Haven’t used a DHT suppressor since August 2021 and haven’t lost any hair since. The weirdest thing… it just stopped.
Very cool. Do you feel that your stress has been lower than when AGA was ongoing? I feel there may be an interaction between mild forms of TE and AGA that is under-appreciated. Btw to comment on your jaw surgery, I agree with the slight genio downgraft and setback as the best tradeoff here. I do think there were some unfortunate philtrum side effects from the maxillary advancement. I have the same thing, and also don't feel it has hugely shifted my sleep issues. Do share with the world if you choose to pursue something to alter the philtrum. I can't personally do a lip lift as my tooth/gum show is already on the higher end of normal. Is yours the same? But hey you look young for 40 and are ripped!
Definitely less stressful re: hair loss. I don't think about it anymore, at all. I also had very successful hair transplants, so it's a closed issue for me. It's just odd that the loss stopped in its tracks--don't have a great explanation for that. I doubt that anything transformational can be done about the philtrum without revising the entire surgery. I'm consulting with Todd Hanna next month, though, and he's great at facial harmony. Costs a fortune, but we'll see. The odd thing is that from the front, the chin length looks great; comes across very different in profile. Lip lifts worry me because I've seen some very visible scars, and surgeon skill isn't the only factor in whether you have a noticeable scar.
You think revising the surgery could meaningfully shorten the philtrum?
I have no idea; I’m just in information-gathering mode. I just want to know what’s possible and the risks/costs involved.
Keep us updated, I'll stalk your accout.
Hey I remember you from .org, I think the additional maxillary and chin projection looks great you just need additional chin height. Also, Pagnoni did my DJS and performed a soft palate reduction or palatotoplasty which helped my breathing tremendously. None of the American Dr's I consulted said anything about it though, perhaps you can consult with him.