Looksmax Had Bimax CCW Genio with Dr Ramieri, AMA

ascentium

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before

after (2.5weeks post op)


No he didn't do the agreed movements, that we agreed in the pre-surgical planning. instead of 4mm upper, 11mm lower, 4mm genio, he did 3mm upper, 8mm lower, 7mm genio.

I already felt like 4mm upper was very conservative for how recessed my starting point was, but I was ok with being that conservative and no more. However he went even more, and I feel it didn't give such a great result because of this (from 2.5week post op swollen perspective).

My palate is narrow but I cba to have a drawn out waiting time to get my surgery, the additional costs, and the extra nose widening from MSE, wasn't worth it for me.

LordMadness only had bimax, no implants at all or anything else. He is planning to have implants done soon, both upper midface and ramus implants.

Genioplasty can give you an overly pointy and separated from the mandible chin, whereas mini chin wing brings your mid mandible forward WITH the chin, so that way you keep the harmony, and most importantly YOUR JAW IS FORWARD GROWN, NOT YOUR CHIN. A forward chin is not attractive, a forward jaw with a balanced chin is whats attractive. I'm also worried that as well as being too pointy and separated from my mandible, my chin looks too tall from the front since it wasn't only moved forward but also downwards for a taller chin. At this 2.5week post op moment, I wish he stuck to our original plan and gave me more upper and lower jaw advancement, so my mouth could be more forward set (which is why bimax ascends people, not because it brings the chin forward), and 4mm on the chin instead, so it would be less tall and less pointy/detached from the mandible.

Thanks sharing the contours. That’s a huge improvement, though I see why you are a bit frustrated with the last minute modifications to the surgical plan, I feel something like this was possible.



thanks for your forthrightness

I also appreciate you explaining the trade offs between genio & mini chin wing. I was considering genio, but now I’m not sure as my mandible is shaped like chamalets and my chin is somewhat pointy—as you said we want to increase the length of the mandible, not the projection of the chin necessarily.

wish you a speedy recovery.
 
DatGuyYouLike

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Thanks sharing the contours. That’s a huge improvement, though I see why you are a bit frustrated with the last minute modifications to the surgical plan, I feel something like this was possible.

View attachment 895780

thanks for your forthrightness

I also appreciate you explaining the trade offs between genio & mini chin wing. I was considering genio, but now I’m not sure as my mandible is shaped like chamalets and my chin is somewhat pointy—as you said we want to increase the length of the mandible, not the projection of the chin necessarily.

wish you a speedy recovery.

Exactly man, I wanted my mouth to at least line up with my brow ridge.

Unfortunately Ramieri was the only guy I could find who did mini chin wing (but then told me he didn't after I flew over to him), and he doesn't anymore, so IDK if its possible to get that procedure currently. If you do get bimax, make sure your genio is very subtle and minimal, 4mm or less.

Thank you man, recovery has been going well at the very least.. Will keep everybody updated as swelling goes down further.
 
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kangarooking

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Just straight to business, not much small talk.

First week is hell on earth, will be guaranteed the worst week of your life imo.
If you’ve had your wisdom teeth removed, how would the recoveries compare?
 
ascentium

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Exactly man, I wanted my mouth to at least line up with my brow ridge.

Unfortunately Ramieri was the only guy I could find who did mini chin wing, and he doesn't anymore, so IDK if its possible to get that procedure currently. If you do get bimax, make sure your genio is very subtle and minimal, 4mm or less.

Thank you man, recovery has been going well at the very least.. Will keep everybody updated as swelling goes down further.

i feel my maxilla & midface are slightly recessed, but not enough to warrant bimax. My lips line with my brow ridge, though I’d like more of an ante face.

not a true side profile, i know, but gives an indication of where I’m at


Note the pointy chin. I have a pretty wide bigonial width, but the chin mandible narrows substantially. What osteotomy would you recommend to bring the chin forward a few mm, without compromising my gonial angle?
 
DatGuyYouLike

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If you’ve had your wisdom teeth removed, how would the recoveries compare?
not sure, mine were removed during surgery so it probably made it a little worse. I cant imagine it being anything but hell though, even without wisdom tooth removal, your nose will be bleeding a shit ton the first few days.
 
DatGuyYouLike

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i feel my maxilla & midface are slightly recessed, but not enough to warrant bimax. My lips line with my brow ridge, though I’d like more of an ante face.

not a true side profile, i know, but gives an indication of where I’m at

View attachment 895811 View attachment 895813
Note the pointy chin. I have a pretty wide bigonial width, but the chin mandible narrows substantially. What osteotomy would you recommend to bring the chin forward a few mm, without compromising my gonial angle?

dont get any surgery man your lower third is Chad tier, why take a risk for minimal potential gain. Your chin fits your jaw and face perfectly right now, chin is not meant to be a stand-out halo, its supposed to just fit in with the face and have harmony.
 
ascentium

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dont get any surgery man your lower third is Chad tier, why take a risk for minimal potential gain. Your chin fits your jaw and face perfectly right now, chin is not meant to be a stand-out halo, its supposed to just fit in with the face and have harmony.

thank you. This is why it’s good to have advice from knowledgeable people & actual looksmaxxers, as opposed to the barking teenagers.

I appreciate the consult.
 
ascentium

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Okay for the lurkers here: some surgeons wi


@datguyoulike I had this confused with Lords procedure.
 
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OP

What exactly does CCW do?

I have never understood it.
 
DatGuyYouLike

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OP

What exactly does CCW do?

I have never understood it.

Rotates your occlusal plane, can be done either through:
- impaction (shaving bone off from the front of upper jaw, above your front teeth)
- downgraft (creating a bone gap at the back of upper jaw, above the back teeth, and moving this area downwards, then the bone in-between heals up)

These rotate the occlusal plane, in an upward direction, so that the occlusal plane is more parallel to the floor, it fixes downward grown and facing jaws.

That is CCW (counter-clockwise rotation), CW (clockwise rotation) means the opposite, it is for people who's occlusal plane face excessively upwards.



During my surgery, I had quite a bit of CCW, that was done through a combination of both impaction at the front, as well as downgraft at the back.
 
Gaia262

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Gaia262

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Exactly man, I wanted my mouth to at least line up with my brow ridge.

Unfortunately Ramieri was the only guy I could find who did mini chin wing (but then told me he didn't after I flew over to him), and he doesn't anymore, so IDK if its possible to get that procedure currently. If you do get bimax, make sure your genio is very subtle and minimal, 4mm or less.

Thank you man, recovery has been going well at the very least.. Will keep everybody updated as swelling goes down further.

Did he say why he doesnt do a semi chin wing?


He did it a week ago on this patient. Albeit this could of been done months ago and now they do after pics.



 
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DatGuyYouLike

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Did he say why he doesnt do a semi chin wing?


He did it a week ago on this patient

View attachment 895984

View attachment 895981
Not really, because he said initially it was because of the gap it leaves behind, and i told him i didnt care cus i would get implant to fill that area out afterwards. Then when i came to italy he flat out said he just wont do it.

That girl probably got genio, he still calls it 'beauty full chin' on results that had genio and not mini chin wing.
 
Dutcher

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Intresting. My upper lip is in line with my browridge and i am still getting 3 mm movement. You should have at least 5 mm in my opinion
 
Dutcher

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Also philosophy questoion, how do you feel about having children? They will be stuck with fucked uo jaws like ours
 
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before

after (2.5weeks post op)


No he didn't do the agreed movements, that we agreed in the pre-surgical planning. instead of 4mm upper, 11mm lower, 4mm genio, he did 3mm upper, 8mm lower, 7mm genio.

I already felt like 4mm upper was very conservative for how recessed my starting point was, but I was ok with being that conservative and no more. However he went even more, and I feel it didn't give such a great result because of this (from 2.5week post op swollen perspective).

My palate is narrow but I cba to have a drawn out waiting time to get my surgery, the additional costs, and the extra nose widening from MSE, wasn't worth it for me.

LordMadness only had bimax, no implants at all or anything else. He is planning to have implants done soon, both upper midface and ramus implants.

Genioplasty can give you an overly pointy and separated from the mandible chin, whereas mini chin wing brings your mid mandible forward WITH the chin, so that way you keep the harmony, and most importantly YOUR JAW IS FORWARD GROWN, NOT YOUR CHIN. A forward chin is not attractive, a forward jaw with a balanced chin is whats attractive. I'm also worried that as well as being too pointy and separated from my mandible, my chin looks too tall from the front since it wasn't only moved forward but also downwards for a taller chin. At this 2.5week post op moment, I wish he stuck to our original plan and gave me more upper and lower jaw advancement, so my mouth could be more forward set (which is why bimax ascends people, not because it brings the chin forward), and 4mm on the chin instead, so it would be less tall and less pointy/detached from the mandible.
Do you see the same advancement between Ramieris morph and your silhouette?
 
streege

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Should also mention because its IMPORTANT:

After bimax, if you were truly recessed before, you will still need infraorbital implants to keep midface harmony between upper midface and new lower midface. Otherwise its not a full midface ascension.

Also likely ramus implants, this is not strictly necessary like infraorbital implants will be, but will help a lot because your ramus is not brough down with this surgery at all.

Pagnoni offers ramus widening with his bimax though, through osteotomy. This might be enough for a lot of guys, who have decent ramus height alreasy but narrow (because it only widens ramus doesnt lower it).

As far as i know, Ramieri doesnt offer this ramus widening osteotomy at the same time as the bimax (i asked and he said he doesnt do it at same time)
When you mean ramus widening, it's making it flared out right? So having sharp gonions ?
And what's the average price of that? Seems dope if not too risky.
 
RAITEIII

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I saw u saying u didnt like ur results because face looks too long. Also why wouldn't u post pic JFL you only need to show bones that's it.
 
bimaximum

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How did the smile improved ?

I know from experience that a birdcel smile gives that creepy vibe. Is it normie tier now or does the recessed orbitals keep it ‘creepy’?
 
MadTwatter

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Wont post pics but will answer all questions honestly and detailed as possible.

Currently 2.5weeks post op.
How did he hold your jaws shut without braces?
 
saturn97

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Dumb question but, did they put you an urinary catheter? If yes, did they remove it once you woke up?

I read that it has a 50% of causing a kidney stone, and tbh I d rather piss all over myself for 1 week than have to pass a stone
 
Striking resemblance

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How was the post op in terms of travel, what about the airport and metaldetectors, was the face swollen and did people stare, how long was the stay at the clinic before going back to the home country?
 
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Rotates your occlusal plane, can be done either through:
- impaction (shaving bone off from the front of upper jaw, above your front teeth)
- downgraft (creating a bone gap at the back of upper jaw, above the back teeth, and moving this area downwards, then the bone in-between heals up)

These rotate the occlusal plane, in an upward direction, so that the occlusal plane is more parallel to the floor, it fixes downward grown and facing jaws.

That is CCW (counter-clockwise rotation), CW (clockwise rotation) means the opposite, it is for people who's occlusal plane face excessively upwards.



During my surgery, I had quite a bit of CCW, that was done through a combination of both impaction at the front, as well as downgraft at the back.
Wow awesome. Has your gonial angle improved?
 
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OP how did you get much more movement on your lower jaw vs. your upper?

You said you got 3mm up top and 8mm lower jaw. Did you have an overbite?
 
MedMaxxing

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what is the ideal occlusion plane?

Flat.

Ideally you want the mandible to be parallel to the ground, not vertically pointing.
 
ascentium

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Flat.

Ideally you want the mandible to be parallel to the ground, not vertically pointing.

so as close to 90 degrees as possible?
 
DatGuyYouLike

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Also philosophy questoion, how do you feel about having children? They will be stuck with fucked uo jaws like ours
Will help them mew, and might fuck a black girl to balance out my genes lmao, i have top heavy face, they have bottom heavy, so maybe the kid can have regular forward growth genetically combined with mewing
 
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Do you see the same advancement between Ramieris morph and your silhouette?
Currently it looks less, but thats to be expected since the morph was done with different movement numbers than what was done in surgery
 
DatGuyYouLike

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When you mean ramus widening, it's making it flared out right? So having sharp gonions ?
And what's the average price of that? Seems dope if not too risky.
Ask @Looksmax25 , since he had it done, i can only offload second hand information
 
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Looking at your silhouette again, I think it shows why the results feel like a letdown. It looks like your mandibula was not advanced enough as to provide enough forward projection of your soft tissues. For example your lower lip is still behind the upper lip. A greater advancement in the BSSO would have given you a much better result.

I'd be interested to know what explanation you get when you ask him why he did not go through with the agreed measurements and changed it to something else.
 
MedMaxxing

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I wonder if you could possibly get a revision to balance that at a very cut cost.
 
facemaxxed

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Did you consult with Raffaini?

Why/why not, and why did you choose ramieri?
 
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Did you consult with Raffaini?

Why/why not, and why did you choose ramieri?
Because nobody on this site has been to Raffaini before to give a first hand account. Ramieri came highly recommended from both LordMadness and Medialcanthuscel, he has very decent prices, and i was under the impression he could do mini chin wing (he used to, but wont anymore)
 
Treasure223

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Yo congrats man! Howd it go? Did u like the results
 
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Yo congrats man! Howd it go? Did u like the results
Improved but not ideal results or best that i coudpve got imo.

In the first page i said i ascended from truecel to high tier normie/chadlite, but this was before i saw my side profile 2.5week post op in a pic.

At this point it looks like i went from truecel to normie side profile. As the swelling go down it might look worse still, because the swelling frauded more anteface than what i really had, which made me over-optimistic about the ascension.
 
Treasure223

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Improved but not ideal results or best that i coudpve got imo.

In the first page i said i ascended from truecel to high tier normie/chadlite, but this was before i saw my side profile 2.5week post op in a pic.

At this point it looks like i went from truecel to normie side profile. As the swelling go down it might look worse still, because the swelling frauded more anteface than what i really had, which made me over-optimistic about the ascension.
So it made you worse? Wtf
 
DatGuyYouLike

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So it made you worse? Wtf
Swelling going down made my side profile a little worse yes lol (less anteface) . From front obviously it looks better and better as swelling goes down.

The surgery has improved me a lott not made me wirse, i just think a better resukt would be possible because my face clearly needed more augmentation than what was given (said from 2.5weeks post op standpoint)
 
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How did the smile improved ?

I know from experience that a birdcel smile gives that creepy vibe. Is it normie tier now or does the recessed orbitals keep it ‘creepy’?

I can hardly smile properly because of the swelling and muscles around mouth dont work properly.

It used to look like this


now it will likely look something like this, once I can smile again


Still hook nose, and mouth too deep set, but improved.
 
bimaximum

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I can hardly smile properly because of the swelling and muscles around mouth dont work properly.

It used to look like this


now it will likely look something like this, once I can smile again


Still hook nose, and mouth too deep set, but improved.

Jfl.
Think about cutting the depressor septi muscle when you get your rhinoplasty
 

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