High risk, high reward - thrilled with the outcome

I'm thrilled. This was a great choice and I got a fantastic outcome. It was also insanely expensive and genuinely risky from an aesthetic and functional perspective. Do your homework: if you are considering this, I would urge you to interview multiple surgeons. I went with the fourth I interviewed. I will share my situation, my goals, my approach, and my outcome. I'm not putting up photos publicly.

Context:
Weak gonial angle, well-shaped and masculine but severely recessed chin, deficient midface. 30 years old. Classic mouth breather face due to a badly deviated septum that I didn't fix until my mid 20s. I considered DJS but insurance wouldn't cover it, and reputable maxfacs didn't want to do it. My bite is pretty good from camouflage orthodontics, and I mostly solved my apnea with the septoplasty. Bad profile.

Goals:
Conservative. Looking like a male model or a gigachad sounds appealing but I did not want to look ridiculous if it went wrong. The uncanny valley is real and you don’t want to fall into it. I told my doc my goals, and he suggested a custom medpor gonial angle implant, a sliding genioplasty (10mm), and a fat transfer to the mid face. He strongly discouraged me from pursuing a mid face implant and said he could get me more natural results for cheaper with fat transfer, without the aesthetic or functional risks of the mid face implant. Other surgeons had recommended either

- a non-custom medpor gonial angle implant, genioplasty, non-custom medpor mid face implant
- a custom silicone wrap-around jaw implant, custom silicone mid face implant
- just a genioplasty

Approach:
I wanted a surgeon who was willing to push back on me and not just say yes. I wanted to minimize time under anesthesia and the odds of needing a revision. Silicone struck me as likelier to look unnatural and, while it has a lower risk of infection, it has a higher risk of displacement and long-term discomfort from capsulation because of a lack of tissue ingrowth. Medpor has a higher risk of infection but seemed likelier not to need a revision. Custom medpor was more money but seemed likelier to give me a natural result and to minimize time under anesthesia. My surgeon offered to design a custom medpor gonial angle implant for me, following a 3D CT scan, and talked me out of the mid face implant.

I liked that he worked at a teaching/research hospital. I know private practice docs have sexy instagrams, but research hospitals have actual standards and mechanisms for internal review. It seemed like my odds of having a truly catastrophic aesthetic or medical outcome were lower in that environment. My surgeon was board certified in plastics and specialized in facial plastics and reconstruction. Don’t hire a “cosmetic surgeon”, go with someone with board certs in either plastics, maxfac, or both.

One other consideration: I chose a surgeon who does lots of facial masculinization and feminization for trans people (gender confirmation surgery). That is the closest analog to this procedure, which was essentially facial masculinization for a cis man. I would recommend you consider the same, and also recommend that you support trans rights.

Outcome: four months later, I look like myself but better. I’m so happy! 90%+ of the swelling is gone. People who know me well can’t tell what happened but say things about how nice I’m looking and ask if I’ve lost weight. I think I look 30% hotter. No one has asked me to be on the cover of a magazine but I get more compliments and attention than before.

Final thoughts:
Overall, my result has been excellent: I have a sharp but natural jawline and an above-average but not shocking profile. I still have some numbness in my chin. I may get an additional fat transfer in the next couple years for a little more mid face definition, but I’m undecided. I encourage you to be prepared for the psychological roller coaster of your face changing every day for 1-3 months.