jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Miss01Herself on January 07, 2018, 02:38:11 PM
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Heya everyone,
I really want to have a double jaw surgery and I already had a consultation with dr. D in Belgium. He wants to first widen my upperjaw for 2 incisives implants (extracted when I was young), widen my lower jaw to align with uppers teeth and BSSO...So I dunno, what do you guys think? Based on my pictures. PS I also going to have a consultation with dr Z in Germany. Will keep you guys updated.
Many many thanks :-*
https://ibb.co/dCooSG
https://ibb.co/eDkDuw
https://ibb.co/nmSREw
https://ibb.co/h3MKZw
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Heya everyone,
I really want to have a double jaw surgery and I already had a consultation with dr. D in Belgium. He wants to first widen my upperjaw for 2 incisives implants (extracted when I was young), widen my lower jaw to align with uppers teeth and BSSO...So I dunno, what do you guys think? Based on my pictures. PS I also going to have a consultation with dr Z in Germany. Will keep you guys updated.
Many many thanks :-*
https://ibb.co/dCooSG
https://ibb.co/eDkDuw
https://ibb.co/nmSREw
https://ibb.co/h3MKZw
In the profile ceph scan, do you hold your head like how they have positioned you? It looks like your head is positioned down and you might hold it up more in 'real life'. It looks like you could have bi-max. They would first need to push the front teeth forward (braces) to prepare for it and that the lower jaw most definitely could benefit by advancement.
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The lateral ceph is kind of weird as to head position.
The combination of the SNA AND SNB values (ANB) look right: Class 2 bone structure.
But the sna angle value is really low suggesting a lot of upper jaw retrusion
The snb angle value is really low too suggesting a lot of lower jaw retrusion.
But on one of your photos that's almost a profile, you don't look THAT retruded even though you can see the lower jaw could use some forward advancement relative to the upper jaw.
The head position in this photo suggests a BOAT LOAD of bimax advancement which is why I think there is something wierd about how your head is positioned in this ceph.
What was this particular head position pose for?
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Heya everyone,
I really want to have a double jaw surgery and I already had a consultation with dr. D in Belgium. He wants to first widen my upperjaw for 2 incisives implants (extracted when I was young), widen my lower jaw to align with uppers teeth and BSSO...So I dunno, what do you guys think? Based on my pictures. PS I also going to have a consultation with dr Z in Germany. Will keep you guys updated.
Many many thanks :-*
https://ibb.co/dCooSG
https://ibb.co/eDkDuw
https://ibb.co/nmSREw
https://ibb.co/h3MKZw
How is he going to widen your lower jaw?
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How is he going to widen your lower jaw?
That's a good question. From the description given where she states space needs to be made to place tooth implants (also to the lower jaw), she could be referring to making space in the anterior-posterior direction (profile direction) where the term; 'width' or 'too widen' the lower jaw is incorrect use . To 'widen' the lower jaw refers to increasing jaw to jaw distance seen frontally.
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The lateral ceph is kind of weird as to head position.
The combination of the SNA AND SNB values (ANB) look right: Class 2 bone structure.
But the sna angle value is really low suggesting a lot of upper jaw retrusion
The snb angle value is really low too suggesting a lot of lower jaw retrusion.
But on one of your photos that's almost a profile, you don't look THAT retruded even though you can see the lower jaw could use some forward advancement relative to the upper jaw.
The head position in this photo suggests a BOAT LOAD of bimax advancement which is why I think there is something wierd about how your head is positioned in this ceph.
What was this particular head position pose for?
I honestly don't know, the nurse positioned me that way and it felt a bit unnatural but I have to say that I have a strong chin. Could that potentially mask away the retrusion of my lower jaw?
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How is he going to widen your lower jaw?
With a lower-jaw expander or maybe only repositioning the teeth with braces (not truly widen the lower jaw). Still, it's his advice based on one consultation only, he hasn't made a plan for me just yet. I have to visit the orthodontist first.
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I honestly don't know, the nurse positioned me that way and it felt a bit unnatural but I have to say that I have a strong chin. Could that potentially mask away the retrusion of my lower jaw?
Who's nurse, Dr. 'D's or the ortho's nurse?
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Who's nurse, Dr. 'D's or the ortho's nurse?
Dr. D's nurse
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Dr. D's nurse
The angle measures are significant from that head posture. They most likely want to advance you out a LOT. You would need to ask for a ceph displacement diagram based on that ceph where they show what they propose to do via using the contour of that ceph with a new proposed contour which will have a bunch of numbers and angles on it.
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https://ibb.co/eDkDuw - there's absolutely no way are you as retruded as that x-ray suggests. Did you rest your chin on something or bite down on a piece of plastic? That's what they usually make you do beforehand.
I have a significantly steep occlusal plane and look like I'm watching the floor on mine a bit, but it's natural and more or less reflected in candid photos as well.
Your chin/jaw actually look to be well projected in your own photos.
In all, I think you're really attractive as is, maybe with a bit of a gummy smile - you don't have a long face look.
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Just checked my cephs against yours. The forehead rest (top right) looks to be touching the middle of your forehead rather than just below the glabella where it meets the top of the nose. That could explain the unusual downward facing position.
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First of all a big belated "thank you" for reading and replying, haven't been much on the forum lately but I have news!!!
I finally visited Dr. Z and pretty much the scan made before were not correct, he asked me to make new ones, which I will upload when dr. Z have send it to me.
1. He agrees with fixing the inwards positioning teeth via orthodontic treatment.
2. Based on the scans I send him prior the consultation, he suggested a CCW.. after seeing me in person (and seeing the new scans), also hearing about my mandibular joint problems, a CCW is not going to be the case anymore, because it will only worsen my TMJ.
3. For the gummy smile: impaction of maybe 3mm and bringing the maxilla forward, not sure tho, it depends on the orthodontic treatment before the surgery, if the maxilla is brought forward enough.
4. For my side profile he wants to do a chin-wing and also bringing the lower jaw a bit forward (BSSO I guess? He didn't use the term)
5. I asked him about the incisor implants, that Defranq brought up in his consultation with me, and he told me that SAPE is going to change my bite completely and I have to walk around with a huge hole in my upper jaw for a couple of months. I dunno guys, he was a bit skeptical about that.
He told me that my teeth, in their current position, are good aligned and the bite is correct. If I want to widen the upper jaw for the implants, I have to fix the lower jaw afterward, is it worth it? With the TMJ in mind, how less surgery how better indeed.. I have bad joins unfortunately. It hurts when I chew long and it pops in and out every time I open up my mouth.
5. Or SKIP everything, and only go with a chin-wing, so chin-wing without the bimax guys! Because I don't look that bad. But first I have to visit my orthodontist. I scheduled an appointment for over two week.
Oh and let me know what you think! Feedback is very much appreciated :)
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Thanks for the update!
I honestly see nothing wrong (orthognathically) with your top jaw or midfacial proportions, irrespective of your small teeth and minor gum show. I guess that's because you really don't have the syndromic appearance of someone with a jaw-related issue. You are very attractive and appear to have a decent occlusal plane with no recessed looking facial features. Also, you don't look as if you have an overbite. Your midface doesn't look narrow, so jaw widening seems pointless (I know it's to do with the arch too, but I feel it only really works for those who have a narrow midface). I'm going by visuals from the pics you provided, and to me you look like a really pretty young woman. I think the ceph created a lot of confusion due to the incorrect angle, with you looking right down at the floor.
You might be the best candidate for a chin wing alone. I don't think moving the upper jaw forward in order to allow movement of the lower will give you a pleasing appearance. I think cosmetic dentistry with some minor gum removal and veneers could work for you and camouflage any perceived issues here.
If you had an element of "horse" I'd say jaw surgery, but I can just see your lower jaw is slightly weak. And I mean, even that's not bad. You still have a very nice silhouette in profile.
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Hi Miss01Herself,
As far as I know, extractions can entail TMJ disorder. You are missing your incisives and maybe your wisdom teeth,don't know if they have been extracted or if they are congenitally missing. You don't have bad joint, it's the extractions which had probably hurt them. So don't blame on your joint but on your former dentist or orthodontist.
Defrancq's idea is not absurd, your jaws are really narrow and if the only issue is the gap between your teeth, it's not a big deal if it can alleviate your pain.
Your chin is prominent comparing to your lower jaw, so I won't do nothing ith the chin alone, that is without a BSSO.
Still, you look very pretty.
If I were you I would go for a SARPE first and implants and then see. Take your time.
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I didn't know that extractions could worsen the TMJ issue, but I don't think my teeth were extracted, I think they where probably congenitally missing, I found these molds made before and after the braces when I was 12 years. But more updates: went to the orthodontist yesterday and she didn't advice me to get implants because she doesn't think I need them and why would I risk my healthy tissue and bone. Implants don't last a lifetime as well. But she agreed with bringing the teeth forward. So what do you guys think? Are implants a good idea?
https://ibb.co/bE4A7c
https://ibb.co/gX3L7c
https://ibb.co/e2aYSc
https://ibb.co/eJZ4YH
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I have also attached two recent photos ( slightly profile and forward) because the others were a bit older and some of you didn't see the long face I mentioned but here you can see it better.
https://ibb.co/hFOv7c
https://ibb.co/gVrRDH
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Firstly, I would suggest that photo presentations be organized into ONE link. IMGUR is a good place to do that. Otherwise, it's tedious to click on a bunch of separate links to cross compare.
Secondly, I'm eliminating Dr. Z from the picture. Enough already with 'chin wings for everyone'. So, I shall focus on Dr. D's plan.
From what I see on the Pan X ray, you are indeed missing 2 lateral incisors to the upper jaw. Very well could be congenital simply because it's the pre-molars that are commonly extracted for ortho work. Also, wisdom teeth but that's not issue with jaw surgery.
Although, info is limited as to Dr. D's full plan and your choice of showing your smile in oblique view instead of FRONTAL view does not help either in terms seeing what your smile looks like in frontal view, I would tend to think that making the upper jaw wider to accommodate missing teeth would be a good plan for starters.
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Its hard to tell but your airway appears to be small on the x-ray. I also have bad eyes so that doesnt help.
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Its hard to tell but your airway appears to be small on the x-ray. I also have bad eyes so that doesnt help.
For sure, it looks tiny. I'm surprised Dr. Z didn't mention anything about it and just recommended chin wing. Her OP also looks somewhat steep and profile is convex. Since she doesn't have an excessive overjet or a huge gummy smile, that'd indicate she needs CCW bimax with posterior downgrafting. I don't think Dr. D's plan is right either, so I'd get a fourth and a fifth opinion (Raffaini and Alfaro, for example).
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what’s wrong with chin-wings? When I visited dr. Z he showed me his cases and alot of his patiënts who had a chin-wing procedure looked very good afterwards, to me it kinda looked similar to patiënts who had a CCW.. Alright, i finally received my Cone-Beam Scan results: https://imgur.com/gallery/DfRGK
It’s quite a difference to the previous scan I shared lol.
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Wow, what a difference to the other scans!
I can only really comment on the aesthetic side of things. Firstly, it looks like you have really small teeth and would benefit from veneers and gum contouring after jaw surgery (if you get it).
Your actual palate doesn't look narrow i.e. high arched to me. However, sounds like widening would be the thing for missing teeth.
To be honest, your biggest "issue" when smiling in particular is the fact you have some excess facial fat. I still think your jaws and face are balanced, and that you are pretty. Your occlusion looks good and symmetric, and your OP looks good here too.
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I’m still not sure about these scans aswell tho, because she had to make them twice and I had to look up alot! I normally can’t/ don’t hold my head in that position for long.
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I’m still not sure about these scans aswell tho, because she had to make them twice and I had to look up alot! I normally can’t/ don’t hold my head in that position for long.
Sigh, I will probably have to make another at the orthodontist , third time’s a charm they say haha(i’m crying).
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They're not for everyone and this guy is a 'chin wings for everyone' guy. You would still have option of having a chin wing after a max fax surgery even if it included a BSSO. But I'm not to sure a doc doing a BSSO would want to do it after a chin wing.
As to air way, I can't really 'read' airway space. I would defer to CCW saying it's small if he sees that. Also with suggestion to consult with the 2 docs he suggested. However, I have nothing to say to actually dissuade you from Dr. D's suggestions.
As to what 'girl' said regarding the fat to the face, that could be a matter of the soft tissue POOLING on the face because it's not spread out enough due to the LACK of space you would tend to have to the upper jaw given congenital absence of the teeth. Hence, expanding the area would tend to open up more space to support the soft tissue pooling due to lack of space.
what’s wrong with chin-wings? When I visited dr. Z he showed me his cases and alot of his patiënts who had a chin-wing procedure looked very good afterwards, to me it kinda looked similar to patiënts who had a CCW.. Alright, i finally received my Cone-Beam Scan results: https://imgur.com/gallery/DfRGK
It’s quite a difference to the previous scan I shared lol.
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For sure, it looks tiny. I'm surprised Dr. Z didn't mention anything about it and just recommended chin wing. Her OP also looks somewhat steep and profile is convex. Since she doesn't have an excessive overjet or a huge gummy smile, that'd indicate she needs CCW bimax with posterior downgrafting. I don't think Dr. D's plan is right either, so I'd get a fourth and a fifth opinion (Raffaini and Alfaro, for example).
Assuming we're looking at the same images for judging this, imo she's maaaybe got a smaller than average airway, but it's clinically insignificant, as in she probably has mild to no sleep apnea. I'm comparing my imaging to hers, where mine looks narrower (comparing side view and looking overhead) and my obstructive index was like 11 (5-15 is considered mild, 20+ is health detrimental according to my sleep doc...you'd guess right if you think she DIDN'T recommend I get DJS). If she does entertain djs though, better safe than sorry to get a sleep test done. Too many factors and types of apnea to make a conclusion here.
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Assuming we're looking at the same images for judging this, imo she's maaaybe got a smaller than average airway, but it's clinically insignificant, as in she probably has mild to no sleep apnea. I'm comparing my imaging to hers, where mine looks narrower (comparing side view and looking overhead) and my obstructive index was like 11 (5-15 is considered mild, 20+ is health detrimental according to my sleep doc...you'd guess right if you think she DIDN'T recommend I get DJS). If she does entertain djs though, better safe than sorry to get a sleep test done. Too many factors and types of apnea to make a conclusion here.
The first thing dr. D recommended me was a sleep test. Did get one and the outcome was a mild sleep apnea. Anyhow I’m still insecure about lateral incisor implants in the upperjaw..especially on my age and 2 out 3 professionals I asked didn’t think I needed it. Will it have an impact on my TMJ issue? Because if it would kinda relieve me from the constant pressure I feel on my joints I will probably go for it.
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The first thing dr. D recommended me was a sleep test. Did get one and the outcome was a mild sleep apnea. Anyhow I’m still insecure about lateral incisor implants in the upperjaw..especially on my age and 2 out 3 professionals I asked didn’t think I needed it. Will it have an impact on my TMJ issue? Because if it would kinda relieve me from the constant pressure I feel on my joints I will probably go for it.
Keep in mind, his wanting to expand the maxilla area seems to be for better aesthetics. Like you would tend to have better support for your face with that as to kind of spread out the tissue more so it doesn't look like fat. to that regard, he would have to add the teeth. I can't predict how it will impact your TMJ. Good question to grill the doctor on though.
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Assuming we're looking at the same images for judging this, imo she's maaaybe got a smaller than average airway, but it's clinically insignificant, as in she probably has mild to no sleep apnea. I'm comparing my imaging to hers, where mine looks narrower (comparing side view and looking overhead) and my obstructive index was like 11 (5-15 is considered mild, 20+ is health detrimental according to my sleep doc...you'd guess right if you think she DIDN'T recommend I get DJS). If she does entertain djs though, better safe than sorry to get a sleep test done. Too many factors and types of apnea to make a conclusion here.
I was looking at this picture (https://ibb.co/h3MKZw). The CBCT scans look quite different indeed.
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Alright, it's been a while but I am in need of advice once again. So far I had orthodontic treatment for more than a year. We achieved the gap precisely for the upcoming incisive implants. But before the implants, I'm scheduled for jaw surgery. That will be in December. The past week I had a consultation with dr. Nadjmi whom will perform the surgery. The initial plan was a Lefort I, BSSO with genioplasty but his advice is changed into a BSSO and optional genioplasty. Lefort I due to small teeth is not expedient in my case he said. Genioplasty will give me a better aesthetic. He explained that we could make the chin a bit pointier or just only reduce it a bit vertically. I have a strong chin. What do you guys think about Nadjmi's plan?
PS: this is how I look after a year of orthodontics and casually mewing:
https://imgur.com/a/d71FUkW
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...
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Seems like an alright plan.
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The initially plan also included a Lefort I, from a aesthetical point of view will it benefit me if this procedure is carried out?
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I can't predict the outcome of your surgery. What i can tell you is what I said prior which is I think you would aesthetically benefit from lower jaw/chin advancement.
Does not look like you aesthetically 'need' the Lefort1. So, I would not fret about it's absence from your surgery.
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So I just got my second opinion and this surgeon told me that my midline has a 2mm deviation to the right and my chin slightly lingers to the left. He also thinks besides a BSSO and Genioplasty a CCW movement of the upper and lower jaw would benefit me. What do you think about his proposition?