POSTED UNDER Jaw Surgery REVIEWS
DJS and still looking the same
ORIGINAL POST
Day 17 - Might Have to Do This Again
In 2017, I decided to get braces and jaw surgery to fix my side profile. I have plenty of flaws, but this was one I really couldn't accept. I felt horrible and ugly every time I saw it. I had an open bite and overjet, but those were lesser concerns to me and fixing those were just nice touches. As my treatment kicked off and progressed, I found other things I was hoping to change--like being able to breathe better and not feeling like I was almost choking on my tongue all the time; and I knew it should correct my forward head tilt, which develops from the narrowed airway, and resultant shoulder and neck pain from the head hanging forward all the time.
I was originally booked with one surgeon in Halifax that retired in the 2 years between my consultation and surgery. I was assigned a new surgeon and met him for the first time two weeks before my procedure. I really liked his energy and he seemed sensible and down to earth.
My original plan involved widening my palate, which is a bit narrow; bringing the maxilla forward; bringing the mandible forward; a bit of rotation; and a genioplasty to correct the proportion of my chin.
The surgeon I was assigned had a different plan. He impacted my maxilla (my smile had become extremely gummy with braces) but did not move it forward, nor widen my palate because he said it was wide enough. He advanced and rotated my mandible. And he was really adamant that he could make my chin look better without a genioplasty, and no big deal, I could get it done later. I agreed and took his word for it.
Big mistake.
The more I think about it, the more pointless this surgery has been. My mouth is still uncomfortably small. I still can't have a proper posture because it obstructs my breathing to do so. I still feel like I'm choking on my own tongue. My bite is correct and my smile is no longer gummy, but nothing else has changed.
And the most important thing, I look the same from the side. I've been crying since day 5 because it has become clear that no amount of a reduction in swelling is going to make my chin bone grow. It still points down, it still sits a good half inch back from where it needs to be. I've been sitting here on a liquid diet, now onto soft foods but no chewing, getting severe tmj pain I didn't have before . . . and didn't even get the results I wanted. I had a horrible time in the hospital because the medications were making me sick and I couldn't sleep. After day 3 it was okay, but recovery is that much harder knowing you don't even look or feel better. At first it was just my chin that was the problem, but the more I assess how things feel, the more depressed I become because I continue to live in discomfort. All that . . . for no meaningful benefit.
I cried at my 2-week checkup with my surgeon when I saw my x-rays because I could see little difference. When I expressed my disappointment with regards to my chin, my surgeon had no compassion and was so focussed on the "great" job he had done with my bite and told me to stop being so bummed out. "All this over your chin?" Wow . . . He said he had no regrets and my chin measured fine, he didn't want to give me a chin that was too strong; apparently, the size is all that matters, not the location relative to the rest of your face.
To his credit, he did offer to fix my chin free of charge, but who wants to get a second surgery that could have been avoided if their surgeon had understood facial proportions? Who wants to get a second surgery from someone who insists you don't need it? And now the more I think about it, the more I feel I'll need my jaws done again if I want to be comfortable, able to breathe, and avoid a relapse with my open bite. I'm going to be asking my orthodontist (who does some of my post-op checks) later this week if I can speak to another surgeon for a second opinion.
Anyway, that's all for now.
I was originally booked with one surgeon in Halifax that retired in the 2 years between my consultation and surgery. I was assigned a new surgeon and met him for the first time two weeks before my procedure. I really liked his energy and he seemed sensible and down to earth.
My original plan involved widening my palate, which is a bit narrow; bringing the maxilla forward; bringing the mandible forward; a bit of rotation; and a genioplasty to correct the proportion of my chin.
The surgeon I was assigned had a different plan. He impacted my maxilla (my smile had become extremely gummy with braces) but did not move it forward, nor widen my palate because he said it was wide enough. He advanced and rotated my mandible. And he was really adamant that he could make my chin look better without a genioplasty, and no big deal, I could get it done later. I agreed and took his word for it.
Big mistake.
The more I think about it, the more pointless this surgery has been. My mouth is still uncomfortably small. I still can't have a proper posture because it obstructs my breathing to do so. I still feel like I'm choking on my own tongue. My bite is correct and my smile is no longer gummy, but nothing else has changed.
And the most important thing, I look the same from the side. I've been crying since day 5 because it has become clear that no amount of a reduction in swelling is going to make my chin bone grow. It still points down, it still sits a good half inch back from where it needs to be. I've been sitting here on a liquid diet, now onto soft foods but no chewing, getting severe tmj pain I didn't have before . . . and didn't even get the results I wanted. I had a horrible time in the hospital because the medications were making me sick and I couldn't sleep. After day 3 it was okay, but recovery is that much harder knowing you don't even look or feel better. At first it was just my chin that was the problem, but the more I assess how things feel, the more depressed I become because I continue to live in discomfort. All that . . . for no meaningful benefit.
I cried at my 2-week checkup with my surgeon when I saw my x-rays because I could see little difference. When I expressed my disappointment with regards to my chin, my surgeon had no compassion and was so focussed on the "great" job he had done with my bite and told me to stop being so bummed out. "All this over your chin?" Wow . . . He said he had no regrets and my chin measured fine, he didn't want to give me a chin that was too strong; apparently, the size is all that matters, not the location relative to the rest of your face.
To his credit, he did offer to fix my chin free of charge, but who wants to get a second surgery that could have been avoided if their surgeon had understood facial proportions? Who wants to get a second surgery from someone who insists you don't need it? And now the more I think about it, the more I feel I'll need my jaws done again if I want to be comfortable, able to breathe, and avoid a relapse with my open bite. I'm going to be asking my orthodontist (who does some of my post-op checks) later this week if I can speak to another surgeon for a second opinion.
Anyway, that's all for now.
UPDATED FROM melere
1 month post
Day 36
Still not happy.
I wasn't thinking about it too much until I was at my 5-week checkup at my orthodontist yesterday and told them how I felt, that I felt like it was pointless and my surgery didn't change anything important to me.
I mentioned that I still feel like I'm choking on my tongue and he looked through my surgeon's notes, said, "They did move your upper forward," and said no more about it. So what the cause is, I don't know.
As for the chin, he looked at me from the side and said, "It looks fine to me. Obviously it's about what you want, but . . ." I said chins are supposed to project between the upper lip and nose, and mine is nowhere near where it's supposed to be. He straight-up told me this was not true for women and moving my chin would have risked making me look masculine. He was not unkind but I ended up crying because he was just like "We'll take your pictures next time and you'd be surprised at the difference," and the gold standard of "Wait until your swelling goes down to decide."
I am completely baffled because I like to think I have working eyes and I've been paying attention to women's chin projection; all the well-proportioned faces have the projection I noted above. But apparently my perception is wrong and so is Rickett's Esthetic Plane.
I simply don't understand. People get AMAZING results with surgery and I look more or less the same; I wish I had a before picture that better illustrated this. It's heartbreaking enough that I didn't get what I wanted, but then to be told I'm wrong, but they'll entertain my delusion . . . no one needs that. I have no chin, no chin space, yet both people on my team are insisting this looks fine and I feel crazy.
I wasn't thinking about it too much until I was at my 5-week checkup at my orthodontist yesterday and told them how I felt, that I felt like it was pointless and my surgery didn't change anything important to me.
I mentioned that I still feel like I'm choking on my tongue and he looked through my surgeon's notes, said, "They did move your upper forward," and said no more about it. So what the cause is, I don't know.
As for the chin, he looked at me from the side and said, "It looks fine to me. Obviously it's about what you want, but . . ." I said chins are supposed to project between the upper lip and nose, and mine is nowhere near where it's supposed to be. He straight-up told me this was not true for women and moving my chin would have risked making me look masculine. He was not unkind but I ended up crying because he was just like "We'll take your pictures next time and you'd be surprised at the difference," and the gold standard of "Wait until your swelling goes down to decide."
I am completely baffled because I like to think I have working eyes and I've been paying attention to women's chin projection; all the well-proportioned faces have the projection I noted above. But apparently my perception is wrong and so is Rickett's Esthetic Plane.
I simply don't understand. People get AMAZING results with surgery and I look more or less the same; I wish I had a before picture that better illustrated this. It's heartbreaking enough that I didn't get what I wanted, but then to be told I'm wrong, but they'll entertain my delusion . . . no one needs that. I have no chin, no chin space, yet both people on my team are insisting this looks fine and I feel crazy.
Replies (3)
November 1, 2020
Thanks for posting again and sorry to hear you are still feeling upset. It is common for surgeons to be dismissive about problems, but I think that at the 3 months mark, the surgeon's attitude will soften and allow you to start to discuss a possible revision if you wish to.
As for the orthodontist, I think their situation can be a little tricky. If they are used to working with that particular surgeon and have a good relationship with them, they will probably be keen to avoid saying negative things. Or at least keen to wait to the 3 months mark when vast majority of swelling is gone. It sounds from what you said that the orthodontist does recognise that your chin is still a little back, as he said it looks "fine", which is hardly a strong endorsement.
I do think that your updated photo shows some improvement in that your chin and front part of jawline is more defined. Some of the swelling in your lips has reduced so that the relationship of lips to your chin (which you mentioned can be looked at objectively by using Rickett's line) has become more favourable. From looking at your before pic, i think you may have thick lips (considered a desirable trait for women) but thin skin (again a desirable trait) and this might make Rickett's line less helpful in your particular case. There are attractive women who do not follow Rickett's ideal and i think Jennifer Hudson is a good example of this. In addition, there is improvement in the facial angle that has become measurably less convex than your initial after pic and the before pic.
I would agree somewhat with what the orthodontist says about your ideal for chin projection. In many photos online showing side profile the person is lifting their chin - the result is that the photo is nowhere close to the Frankfort horizontal. This can give the illusion that the chin projects more than it actually does. If you look at photos of female models, it is true the chin does project well but this is always set against the background of a very forward maxilla (difficult to create surgically from an "average" maxilla without looking unnatural). The result is that a good degree of convexity in the facial angle is maintained. While i believe the ideal for you could be to have your chin somewhat further forward, to place it where you suggest would (i think) not just make you look masculine but also give you a flat face/profile and create a very exaggerated labiomental sulcus.
Wishing you all the best
As for the orthodontist, I think their situation can be a little tricky. If they are used to working with that particular surgeon and have a good relationship with them, they will probably be keen to avoid saying negative things. Or at least keen to wait to the 3 months mark when vast majority of swelling is gone. It sounds from what you said that the orthodontist does recognise that your chin is still a little back, as he said it looks "fine", which is hardly a strong endorsement.
I do think that your updated photo shows some improvement in that your chin and front part of jawline is more defined. Some of the swelling in your lips has reduced so that the relationship of lips to your chin (which you mentioned can be looked at objectively by using Rickett's line) has become more favourable. From looking at your before pic, i think you may have thick lips (considered a desirable trait for women) but thin skin (again a desirable trait) and this might make Rickett's line less helpful in your particular case. There are attractive women who do not follow Rickett's ideal and i think Jennifer Hudson is a good example of this. In addition, there is improvement in the facial angle that has become measurably less convex than your initial after pic and the before pic.
I would agree somewhat with what the orthodontist says about your ideal for chin projection. In many photos online showing side profile the person is lifting their chin - the result is that the photo is nowhere close to the Frankfort horizontal. This can give the illusion that the chin projects more than it actually does. If you look at photos of female models, it is true the chin does project well but this is always set against the background of a very forward maxilla (difficult to create surgically from an "average" maxilla without looking unnatural). The result is that a good degree of convexity in the facial angle is maintained. While i believe the ideal for you could be to have your chin somewhat further forward, to place it where you suggest would (i think) not just make you look masculine but also give you a flat face/profile and create a very exaggerated labiomental sulcus.
Wishing you all the best
July 7, 2022
Wow what an extremely un-validating response to this young woman. Saying " i think the surgeon's attitude will soften.... etc." Completely dismissive and unfounded statement. Also, swelling would contribute to making her face slightly more projected, which is what she wants... SO waiting for the swelling to go down will not improve the position and projection of her lips and chin like she wants.
Do not compare this girl to Jennifer Hudson.... smh oh my god She doesn't look anything like her. Jennifer Hudson has large lips and wide dental arch that make her upper lip project beyond her nose. This young woman looks nothing like her.
Also you don't get to say "they will be keen not to say negative things...." and "this is hardly an endorsement." That's contradictory.
You don't get to decide what would be "too masculine" The doctor doesn't get to decide it either So what about Angelina Jolie? Too masculine? She wasn't asking for anything beyond something like that. Her surgeon was obviously not clear with her about how her results would turn out.
Do not compare this girl to Jennifer Hudson.... smh oh my god She doesn't look anything like her. Jennifer Hudson has large lips and wide dental arch that make her upper lip project beyond her nose. This young woman looks nothing like her.
Also you don't get to say "they will be keen not to say negative things...." and "this is hardly an endorsement." That's contradictory.
You don't get to decide what would be "too masculine" The doctor doesn't get to decide it either So what about Angelina Jolie? Too masculine? She wasn't asking for anything beyond something like that. Her surgeon was obviously not clear with her about how her results would turn out.
May 3, 2021
I agree with you that your result isn't enough of a change to have undergone the surgery. I'm no doctor but I think they needed to do a sliding genioplasty during the surgery to push your chin forward more. On the bright side your bite and smile ought to be perfect now, and a sliding genioplasty is a much easier and cheaper surgery so you should be able to get that done now and look awesome :-)
UPDATED FROM melere
1 month post
Day 37
Yesterday at work, I was still feeling upset about what happened at the orthodontist. To be told again I just need to give it time and that I was wrong is enough to make a person go crazy. Maybe I haven't emphasized enough that it's not the size of my chin, it's WHERE it is and I'm not taking issue with how I look in the mirror, I'm talking about my x-rays—and no amount of time is going to change where my chin bone is or the angle of my jaw.
But I was thinking yesterday and I realized . . . it is easier for them to say my feelings aren't valid than to admit they made a mistake. I stopped feeling crazy when I realized it's not about me really being wrong. I have verifiable proof what they say isn't true, but it isn't about the facts to them, it's about pride. You can't go the rest of your life and make zero mistakes; but some find the prospect of mistakes so unpalatable, they'll find some way to justify or nullify what happened so they don't have to accept the possibility they aren't perfect.
I'm willing to accept that this was a mistake and I could have done things much differently. I'm willing to say, “I don't want more surgery and I may just have to accept how I look, that I don't get to be beautiful in this lifetime.” I want my chin done but can't face the possibility that another surgeon, who would be a colleague of my surgeon, would agree (like my orthodontist) with this BS conclusion based on the fact that they're friends and my surgeon is “good” and apparently, therefore above making errors, like some living god of jaw surgery. The prospect of more invalidation of my perception is beyond what I can handle.
But my “team” isn't willing to accept that sometimes, people make mistakes and those mistakes hurt other people. Mistakes are our teachers and you can never grow if you refuse to admit they are possible, and inevitable. That's what bothers me. It's as clear as day this is not a success, yet they continue to deny what is right in front of them, instead telling me I am the one who's got it wrong and I'll see they're right someday—because they have a degree, and I don't, and therefore how they feel is more legitimate.
I'm set to see my surgeon next week. Then I don't see him until my braces are off—a year or more from now. I'm wondering if the orthodontist left a note about the incident on Thursday so I'm not looking forward to it, if so, but I'll be glad to not have to see him for a long time. Then one more with my orthodontist the week after, and then those too will reduce to 4-6 weeks apart.
I was really looking forward to chewing in 4 days but my left side is acting up, I feel like I injured something, so maybe it'll be more liquids still because I can't imagine trying to chew with this amount of pain and soreness. Gee, can't wait.
But I was thinking yesterday and I realized . . . it is easier for them to say my feelings aren't valid than to admit they made a mistake. I stopped feeling crazy when I realized it's not about me really being wrong. I have verifiable proof what they say isn't true, but it isn't about the facts to them, it's about pride. You can't go the rest of your life and make zero mistakes; but some find the prospect of mistakes so unpalatable, they'll find some way to justify or nullify what happened so they don't have to accept the possibility they aren't perfect.
I'm willing to accept that this was a mistake and I could have done things much differently. I'm willing to say, “I don't want more surgery and I may just have to accept how I look, that I don't get to be beautiful in this lifetime.” I want my chin done but can't face the possibility that another surgeon, who would be a colleague of my surgeon, would agree (like my orthodontist) with this BS conclusion based on the fact that they're friends and my surgeon is “good” and apparently, therefore above making errors, like some living god of jaw surgery. The prospect of more invalidation of my perception is beyond what I can handle.
But my “team” isn't willing to accept that sometimes, people make mistakes and those mistakes hurt other people. Mistakes are our teachers and you can never grow if you refuse to admit they are possible, and inevitable. That's what bothers me. It's as clear as day this is not a success, yet they continue to deny what is right in front of them, instead telling me I am the one who's got it wrong and I'll see they're right someday—because they have a degree, and I don't, and therefore how they feel is more legitimate.
I'm set to see my surgeon next week. Then I don't see him until my braces are off—a year or more from now. I'm wondering if the orthodontist left a note about the incident on Thursday so I'm not looking forward to it, if so, but I'll be glad to not have to see him for a long time. Then one more with my orthodontist the week after, and then those too will reduce to 4-6 weeks apart.
I was really looking forward to chewing in 4 days but my left side is acting up, I feel like I injured something, so maybe it'll be more liquids still because I can't imagine trying to chew with this amount of pain and soreness. Gee, can't wait.
Replies (2)
June 16, 2022
im no medical professional think its just cuz u have a recessed chin. they didnt advance the jaw a whole lot yea, but i dont think thats the problem personally. id look into a genioplasty or mentoplasty. put that picture into photoshop and drag out teh chin a little and u will see a world of difference. i wish you the best of luck :)
April 18, 2024
You’re right and it seems like they should have done a sliding genioplasty if not mandibular advancement and genio? I’m just surprised that doesn’t look like it happened???
Replies (5)
Performing an impaction of the upper jaw causes an counterclockwise rotation of the maxilla, which causes the tip of the nose to lift and i believe this may be why the upper lip may appear longer than before. This has also brought about desirable facial changes in that your mid face (paranasal region), pre-maxilla and upper lip appears further forward than before. These changes can be appreciated from the photos even though in the after your forward head tilt is greater as shown by the slope of the forehead. So some of the facial soft tissues changes from an impaction of the upper jaw mimic those from an advancement. This forward movement of the soft tissue has offset the advancement of the lower jaw so that the level of convexity (facial angle) in your side profile as a whole is extremely similar on both photos.
The lower jaw has also been rotated counterclockwise (by a greater amount than the upper jaw) so as to correct the anterior open bite and advanced to correct the overbite. I think your jaw line is better defined in the after especially given it is not subdued lighting like the before, so I think there are subtle positive changes associated with the movement of the lower jaw. If the surgeon had expanded the upper jaw, the forward movement of the lower jaw would have been less to compensate. The counterclockwise rotation of the lower jaw is a desirable change as your chin points down less than before, although this is hard to appreciate on the photo as your chin is a little ill-defined. I believe a chin implant alone might make your chin point down more and a genioplasty alone might create a deep labiomental sulcus.
If you are considering revision, i think its important to establish whether the breathing/tongue issues can be relieved just by advancing both jaws or whether upper jaw expansion is required (for functional not cosmetic reasons). And perhaps a genioplasty in addition to this.
Btw, even if you end up not having ICR, you should consider a revision surgery with Dr. Steven Sullivan out of Oklahoma City. He won't try to gaslight you about chin projection and aesthetics. I'm pre-op with him for total joint replacement due to ICR and I'm sooo excited to finally have a chin, lol!
PS - I hope you're not going to only people your ortho recommends. Sounds like you need a new ortho, too. What a piece of work.