jawsurgeryforums.com
General Category => Aesthetics => Topic started by: BrazilianJaw on August 05, 2017, 08:57:32 AM
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Hello everyone,
I'm new to the group. I have seen several posts in the group about problems similar to mine. I would like your opinion, I am an orthodontically corrected class 2. I would like a greater definition in the mandibular line. I do not have functional problems nor gum smile, just a minor overbite.
What's the best option for me? Implants?
Im going to a nose job too.
Sorry for english, greetings. I Appreciate your opinion.
https://imgur.com/a/yEivY
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Lower third lengthening and rhino would benefit you more than anything else. But yes you're a good candidate for bimax, I'd be curious to see what your front looks like since profile doesn't really matter in the real world. You would benefit from orbital rim implants and paranasal implants, mostly straightforward stuff in your case
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I think youre one of the rare cases that could benifit from implants alone
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I really appreciate your opinion. Here in Brazil, we dont have many surgeons that will do a Bimax for aesthetic reasons. :(
Most of them indicated a BSSO or just genioplasty. What do you think about these options in my case?
Will a chin implant have some benefit? Is there any chin implant technique that doesnt increase the mentolabial fold?
Thank you
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That's not a slight advancement. It's a realistic morph but would require a great surgeon.
An isolated genio would most likely cause a witch's chin appearance.
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That's not a slight advancement. It's a realistic morph but would require a great surgeon.
An isolated genio would most likely cause a witch's chin appearance.
Very much this. Without CCW rotation, OP would still look recessed and have a longer face from the front for his trouble.
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I think you could get bi max. It would (most likely) involve tipping forward the upper front teeth and tipping backwards the lower front teeth (short blue lines) in the pre-prep brace stage. You would want to minimize maxilla forward displacement but maximize mandible forward displacement where it might take a posterior down graft and/or plucking the lower pre-molars.
Rhino is certainly in order (long diagonal blue line).
Kind of a conundrum though because your ANB angle is 0 (approx)--inner red vertical and re the outer red vertical your face is forward to that.
The s-n line deviates a lot from the horizont (green line) which is usually associated with the orientation of the cranium, it being 'tipped' back more than those with more horizontal orientation of the cranium. So, you would want to be careful about too much forward advancement to the jaws because it can accentuate the cranial tipping.
As to jaw implants, they don't increase in the posterior-anterior direction. But they can elongate (drop down) the border of the mandible and also increase jaw to jaw distance and angle articulation.
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Kavan, very good points. This my natural head position (not parallel to Frankfort), which accentuates my sloping forehead, but reduce the lower third recession. If I want to SNA to be in a more normal range, I will have to change (tilt down) my natural head position and make a CCW?
Thanks
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Kavan, very good points. This my natural head position (not parallel to Frankfort), which accentuates my sloping forehead, but reduce the lower third recession. If I want to SNA to be in a more normal range, I will have to change (tilt down) my natural head position and make a CCW?
Thanks
There are some adjustments they need to make for what I call 'cranial tipping'. It's not a matter of tilting your head down more. It's a matter of the cranium being oriented on an incline at an angle kind of far from the horizont. Those types of orientations CHANGE how one's face projects relative to some vertical drop lines.
I'm finding that people with 'wierd' ANB angles and forward faces to those red drop lines but when you look at them also look like they have some recession that the lines don't reveal, seem to have the tipped cranium in common. 'Weird' ANB in the sense one looks for something more than '4' for the class 2 skeletal.
Anyway, the cranial orientation, (well according to my observations) is somewhat parallel to the S-N line. Not exactly, but somewhat. Orientation in terms of drawing a line from one part of the forehead to the back of the skull such that THAT line is the LONGEST. The length of the skull is basically, the longest line you can get to where my line starts to somewhere in back where it ends.
S-N lines that are inclined a LOT away from the horizont often reveal the tipped cranial orientation. Also, not everyone actually has a horizontal Franfort line.
Here are some full cephs.
Person 'A' has the S-N line angled far away from the horizont and the maximum cranial length is somewhat parallell to the S-N line. So, you see the cranium is tipped relative to a true horizont.
Person 'B' has the S-N line closer to the horizont and the maximum cranial length is found somewhat parallel to that.
It really isn't a matter of either tipping their heads. In fact the S point does not change that much with slight head tips which is one of the reasons Steiner used it in his analysis. (Also easier to spot on an X ray than the porion point from which they draw the Frankfort horizont.) Person 'A' does not have a 'true' horizontal FH either. Person B does.
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So in people with this "cranial tipping", SNA and SNB could be very misleading in acessing protusion or recession? Soft tissue cephalometrics would have a better result in making the correct diagnosis?
Thanks
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Hard to explain because it involves knowing where some points are to look at the line orientation drawn from the points.
They are kind of a conundrum to treat because there are trade offs. For example in person, 'B', ANS-PNS (anterior to posterior nasal spine) is pretty level with the horizont but person 'A' has a positive slope to ANS-PNS. It's angled away from the horizont. Rotations of the maxilla are done to bring the maxilla (ANS-PNS) closer to a horizont. Not exactly level with it but within a degree range. So, in person 'A' a rotation of the maxilla to bring it closer to a horizont would be counter-clockwise BUT that might not look good on him. CCW might not do it for him either.
Anyway, SNA and SNB might be less than the norm but that's because the SN line is so far away from the horizont than is the case with minimal cranial tipping. ANB (which is SNA-SNB) can be 0 to about 2 which is close to the norm. So, when you look at the ANB it's close to norm but 'weird' in some people because you can still see where they could be advanced outward in anterior posterior direction.
In your case, you could most likely advance both out but they most certainly would have to make alterations to the nose to compensate for it possibly looking worse.
Basically, there are more trade offs
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you're fine. stop wasting people's time with your neurosis. next.
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you're fine. stop wasting people's time with your neurosis. next.
Should be our board motto.
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you're fine. stop wasting people's time with your neurosis. next.
Brazilian guy is not 'bird's nest hair' guy although i did use the ceph of the latter to show another example of ANB angles with the cranial tipping.
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If you wanted a beautiful jaw line, you should have kept your wisdom.
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Brazilian guy is not 'bird's nest hair' guy although i did use the ceph of the latter to show another example of ANB angles with the cranial tipping.
LOLOLOLOLOLOLOLOL "bird's nest hair" guy omg I love you all I hope you know that.
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If you wanted a beautiful jaw line, you should have kept your wisdom.
Don't understand your point. In my case, the 3 wisdow teeth that I had fail do emerge.
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I still have a lower widom teeth, included on the left side.
The difference between my left and my right side is obvious. No jaw line on the right.
I don't know why but wisdom teeth create a lot of jaw bone. Removed them is a mistake, unless you have an infection or other REAL issue (not hypothetic)
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i don't agree with cranial tipping being a measure. the guy in ceph A needs to be aligned more like ceph B for proper analysis. face is also clearly hyperdivergent
having a natural day to day dysfunctional neck posture has nothing to do with the "natural head posture" used for cephs other then the name
edit: the posture in ceph A is sheared forward and upwards, hence hiding the kyphosis. so it looks as if its not as simple as tipping the chin down
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i don't agree with cranial tipping being a measure. the guy in ceph A needs to be aligned more like ceph B for proper analysis. face is also clearly hyperdivergent
having a natural day to day dysfunctional neck posture has nothing to do with the "natural head posture" used for cephs other then the name
edit: the posture in ceph A is sheared forward and upwards, hence hiding the kyphosis. so it looks as if its not as simple as tipping the chin down
The cranial tipping/orientation should be obvious to anyone who can observe the LINES I've drawn in to show it. Person's Head alignment is not a significant factor as to the cranial orientation that significantly differs from person A to B. The angle that the S-N line makes with the constructed horizontal (the angle between the blue and red lines) would not change if person 'A' tipped his head down more. Try having some 6th grade geometry under belt before you disagree with angle orientations that are clearly obvious.
Person A has an S-N orientation about 25 degrees from a constructed horizontal. Person B has an S-N approx 7 degrees from constructed horizont. 7 degrees away from a constructed horizont is considered the norm. But when the S-N line deviates significantly from a constructed horizont it will factor in significantly with most methods of analysis commonly used .
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Hello everyone, my last year was really busy, so just now I was able to be consulted by the MaxFac that I wanted.
I asked him to try to simulate (Dolphin program) a genioplasty alone and a CCW, to compare both options.
- Genioplasty of 7 mm (most forward)
- Bimax: 4 mm forward in maxilla, total of 14 mm in pogonium advancement, with CCW
https://imgur.com/a/lpBQNVg
Photo 1: left genio after, right bimax sideview after
Photo 2: sideview before and after Genio
Photo 3: sideview before and after Bimax
Photo 4: 3/4 view of bimax
Costs of each surgery (approx): Genio: $1250. CCW: $3750.
I could go with surgery first approach if I want
My opinion: I really really like the profile of the Bimax, but the 3/4 view looks uncanny, mostly because I don’t have a great fat pad in the submalar region (creating a depression). Maybe the improve in profile is in part the nose hump reduction that will occur? Will genio + nose job be less invasive and have the same results?
I appreciate your opinion.
Thanks
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Do you have 3/4 view of the sg? I think the bimax simulation looks great
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That's darn cheap for CCW and no question it looks better. The 3/4 profile looks good too. I do think you should have shaved for the photos.
Your chin bone is solid as it is, it looks terrible in the genio simulation.
Did he say how much the posterior of your maxilla would be down grafted and what graft material he would use?
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That's darn cheap for CCW and no question it looks better. The 3/4 profile looks good too. I do think you should have shaved for the photos.
Your chin bone is solid as it is, it looks terrible in the genio simulation.
Did he say how much the posterior of your maxilla would be down grafted and what graft material he would use?
Hello Plosko, for us here in Brazil, this price is really not cheap. The people earn less, but the costs are lower too. Well, He didn’t mention any need for downgraft material, i think he wil not use anything. What do you think about the maxilla advancement of 4 mm, it’s ok?
Thanks,
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Do you have 3/4 view of the sg? I think the bimax simulation looks great
I will try to take more views of these mockups. I realize just now that i didn’t see the front view b/a
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3rd set showing the profile changes look good.More jaw to jaw balance is demonstrated in them than with just the genio. Nose contour and nose to lip angle is also improved.
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Hello everyone,
I did my bimax CCW about 20 days ago, still a bit swollen in bottom lip, in malar areas and around the nose. First week was hell, but everything was fine after that.
Starting to like my new face just now, I liked the improvement in nose hump and in the lower third on the profile view. When the swelling goes down, I will do a B/A.
In front view I still notice how narrow my lower third is, although there has been some improvement too in this aspect. Intergonial distance is, as expected, still the same and I want to adress this issue now on
How should I proceed? Full jaw implants? Chin wing?
This mockup is possible to obtain?
https://imgur.com/a/Drjdr6o
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If you wanted a beautiful jaw line, you should have kept your wisdom.
Is that really true?!
I would like to hear Kavans opinion if possible.
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Is that really true?!
I would like to hear Kavans opinion if possible.
Lower wisdom teeth need to be removed if one is to have a BSSO . Also, if one has a small jaw AND the WT are impacted, infected which can happen because in small jaws there is not enough room for them, they would need to be removed. They don't need to be removed in people with larger jaws with plenty of room for the WT in cases where the WT are not making any problems, in which case that type of person probably doesn't need a BSSO.
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Lower wisdom teeth need to be removed if one is to have a BSSO .
It's really up to the surgeon. I asked this specific questions and was told it was no problem unless something strange was found with the position of the wisdome teeth.
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It's really up to the surgeon. I asked this specific questions and was told it was no problem unless something strange was found with the position of the wisdome teeth.
Supposedly they increase the risk of a bad break.
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It's really up to the surgeon. I asked this specific questions and was told it was no problem unless something strange was found with the position of the wisdome teeth.
So, you can keep your lower wisdom teeth? Lot's of docs want them out to make the cut.
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So, you can keep your lower wisdom teeth? Lot's of docs want them out to make the cut.
Yes, I've been told I han keep them. Gunson wanted all 4 out.
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Yes, I've been told I han keep them. Gunson wanted all 4 out.
Are they fully erupted?
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Yes, I've been told I han keep them. Gunson wanted all 4 out.
Gunson also wanted all 4 out for me as did Sinn. I did not end up getting jaw surgery but I did have my wisdom teeth removed. Haven’t noticed any impact on my profile.
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Are they fully erupted?
Just a clarification. I have not had confirmed that I don't need my wisdome teeth removed. Quote from my first consultation when I asked was "No *pause* unless I see something strange". So all I'm saying is it depends on the situation and the surgeon. I believe Gunson seem to always want all wisdome teeth removed. There was never any doubt or question on any of them, it seemed like standard procedure when having surgery with him. I guess I don't need mine removed, as I've come pretty far in the process, and it would be a real setback to suddenly hear that I need to have them removed and wait 6 addition months for surgery, when they have all the x-rays since long.
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At the age of 16, my dentist removed both wisdom teeth in my lower jaw, although in my case this was not necessary.
It only became clear to me afterwards that she only wanted to make quick money.
Is this a mistake in hindsight? Would i have better jaw angles now if they were still in it?
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At the age of 16, my dentist removed both wisdom teeth in my lower jaw, although in my case this was not necessary.
It only became clear to me afterwards that she only wanted to make quick money.
Is this a mistake in hindsight? Would i have better jaw angles now if they were still in it?
NO idea if you would of had better jaw. In general, IF they fit in jaw, are not impacted (are erupted) and BSSO is not contingent on removal, they are fine to leave in. 'If not broken, don't fix it' thing....and yes, dentists do look for 'employment opportunities' in people's mouth's.
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At the age of 16, my dentist removed both wisdom teeth in my lower jaw, although in my case this was not necessary.
It only became clear to me afterwards that she only wanted to make quick money.
Is this a mistake in hindsight? Would i have better jaw angles now if they were still in it?
Neither me can say anything about the decision in your case or what the situation potentially could've been else. In general I can say that I have no understanding of pulling healthy teeth, and that you literally can see the dollar signs in the eyes of some dentists when they see your wisdome teeth.
In my case I am a bit angry of how they've treated my wisdome teeth. I had one which was growing horizontal and ever since the first x-ray it was seen the dentists told me this will have to come out. In my country all dental work is free up to 20 years or so. Well convenient enough they lingered on this and wanted to wait and I was told it might erupt more and making it easier to extract. At about 25 when all insurance and liability from the public health care for this was gone, I was suddenly told it's time to remove it. When I got to the surgeon he told me there was no way it was going to change it's position and healing is easier the earlier I do it. And also it was tangled with the alveolar nerve, so he didn't want to remove it fully, but instead cut if the crown and left the roots. If they would've sent me in as a teen they might had been able to fully remove it.
So this is one of the wisdome teeth where I fear they might "see something strange", and will have to do a complicated extraction as there is no crown left to grab.
So in general I would say, don't touch healthy wisdome teeth, and treat troubled wisdome teeth as soon as possible. The motivation they often give is that it's harder to clean and that people get problem with them later because of bad cleaning. In my opinion we might as well pull all teeth then, it gives 0 chance of future cavities.
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Hello everyone
I had my Bimax surgery 2 years ago. The postoperative period was difficult, after 6 months the result was very satisfactory, but after 1 year I noticed a tendency to return to the convex pattern (I don't know if it was due to bone accommodation or reduction of the residual edema). I noticed that the edema persisted slightly until almost 1 year and a half. Now, despite seeing improvements, I am again dissatisfied with my profile, i think my chin ia retruded again. I'm in doubt if my case is for a new Bimax surgery or jaw implants, so I did some exams that follow below.
https://imgur.com/a/mdwh8ll
I think if my lips are just perfect alligned would be the perfect case to only do jaw/chin implants, but it’s not the case. My lower lip is behind the upper lip, preventing a good chin advancement with implants in my opinion. On the other side, some minor desviation from the profile view isnt noticed for normal people in the real world. Really in doubt about what should I choose.
For the preop ceph and profile pictures see the first post of this topic.
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Did the bimax surgery make your philtrum longer? Or make it look longer? Great results nonetheless.
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I think my philtrum does looks lingerie, but the widening of the lower third of the face make this not a big problem