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91
Curious if a lefort 2 that actually brings his center face backwards instead of forwards is really a smart move long term? Isn't he going to age better with this extra midface surface area? It doesn't look disfiguring at all as it is now either.  Not included in this decision making so far I think is the state of his airway, and how that can be impacted from any of these set backs we're talking about - lefort 1 or 2.


listen you guys are insane for even discussing having a lefort 2 setback in this case. do you think the face is like a lego sculpture that you can so easy move blocks around without significant risk to nerves, soft tissue and function. His profile and chin are "fine".  If he wants a bit more augmentation there get some filler, end of story. If his bite is fine a bsso advancement won't really help this case unless he got a very aggressive CCW which only a few guys know how to do well. Honestly, only one I really know of (Gunson). And do you really want to go through a 2 plus year fuck up of your face to achieve what will only be a minimal difference? Just get some filler.
92
Curious if a lefort 2 that actually brings his center face backwards instead of forwards is really a smart move long term? Isn't he going to age better with this extra midface surface area? It doesn't look disfiguring at all as it is now either.  Not included in this decision making so far I think is the state of his airway, and how that can be impacted from any of these set backs we're talking about - lefort 1 or 2.
93
Functional Surgery Questions / Good surgeons in the DMV area?
« Last post by cmfanel on November 13, 2017, 06:57:11 PM »
Like the title, just looking for reputable guys in the D.C, Virginia, Maryland area

Haven't had any consultations yet but im probably looking at a bimax + genio

thanks for the help
94
Aesthetics / Clockwise Rotation / Anterior Downgraft
« Last post by Tati on November 13, 2017, 03:38:21 PM »
Hi everyone,

I'll make this brief, I'm seeking revision and was suggested an anterior downgraft by a local surgeon to improve teeth show (my upper teeth show about a mm when I smile big).

I sent him scans and am waiting for a proper proposal before sharing any photos or asking for personal advice.

In the meantime, I wanted to know if someone could mention what sort of changes can be expected from said movement, and also ask if anyone out there has photos of cases or are willing to share their own.
95
I am thinking about visiting Dr. Brusco in Zurich or at least making a 3d scan of my skull and sending him an email with pictures and asking for advice. Do you know any talented surgeons in Germany for such a case?
I know about dr. Z but I guess he would just offer me a chin-wing and this is not a good solution without chin-visor osteotomy or other procedures.

Here's the deal. I just stick to helping with conceptual stuff like showing/explaining where the problem is. On you, it looks like you have excess protrusion to the Lefort 2 area and that you could use some advancement to the BSSO area. The other concept is that chin alterations won't compensate for that.

The only thing I can suggest as far as doctors are concerned is to take note of the doctors who wrote the paper about L2 set back (included here. Brazil jaw tracked it down) and research from there.
96
Aesthetics / Re: Aesthetic Recommendations
« Last post by fullbald on November 13, 2017, 02:38:43 PM »
Hi Holly,

I just had my first consultation with Dr. Boardbar recently?

Did you end up going with her?

Thanks
97

The Lefort2 area includes the Lefort 1 area.

I am thinking about visiting Dr. Brusco in Zurich or at least making a 3d scan of my skull and sending him an email with pictures and asking for advice. Do you know any talented surgeons in Germany for such a case?
I know about dr. Z but I guess he would just offer me a chin-wing and this is not a good solution without chin-visor osteotomy or other procedures.
98
Aesthetics / Re: Post double-jaw surgery concern: Upper jaw/lower jaw moved up too much?
« Last post by kavan on November 13, 2017, 01:32:50 PM »
hi kavan,

thanks for that. i see what you mean!

i guess my issue is, i feel like my upper tooth show is also not satisfactory. so i was wondering if the position of the lower jaw (and hence my excessive lower tooth show) is also related to the now higher position of my upper jaw?

what i really wanna know is, when it comes to moving the upper jaw UPWARDS, is it always an aesthetic choice? in my case, my surgeon felt that i was showing too much teeth at rest, so he decided to move my jaw upwards. but as for the precise movement, i am wondering if he really needed to move it that much, or if it was simply bad judgement on his part. from my conversations/consultations with him, i understand that they go by the numbers. the idea is to move my facial proportions into what is deemed as average/normal.

but when i look around at people around me with so-called average/normal jaws, i do feel like i see a lot of examples of more satisfactory tooth show, with their smiles looking natural and their upper teeth showing almost fully. that's unlike what i am experiencing now - right now i have to strain quite a bit to show even half the height of my upper teeth.

i also liked my original tooth show, even if it was a little excessive. i would have wanted to reduce it, but not so drastically.

anyway, i am very cautious of being overly paranoid, but i really do think that i would be happy if this were indeed a satisfactory result, but it is a fact that when i look into the mirror, i do feel like something is off, especially when i catch glimpses of myself talking/laughing. and it's not just about not being used to a new face.

again, as a disclaimer, i must say that i understand that my facial proportion has been drastically improved (as well as my facial asymmetry before the surgery), but my dissatisfactory / strange-looking upper tooth show is rather disappointing. among the issues i listed in the original post, this is almost what bothers me the most.

Displacements aimed at optimizing jaw balance are basically  multi-variable functions. Something where they choose the KEY displacements needed to optimize but for which other things may vary as a result. It's like math where one thing is the function of the other and there are constraints. It's like math where they go by the NUMBERS, choose the main constraints aimed at optimizing where you don't get to choose how every other variable in the equation varies.

Your question resolves to referring to a 'precise' movement with assumption I would know what that number was and if it was 'too much'.

Let me put it this way: If you wanted the output to be the exact amount of tooth show as you would like to see it or as you see it in other people, than you 'shoulda' gone in there with LESS retrusion of upper jaw and LESS protrusion of the lower jaw.

Sorry. I don't know any other way to explain this conceptually. You got an OPTIMAL outcome relative to the INPUT. Optimization is not a thing where every variable of the OUTPUT can be controlled or selected and it doesn't equal 'perfect'. The only way to control every variable of the output is to control every aspect of the input.
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Aesthetics / Re: Post double-jaw surgery concern: Upper jaw/lower jaw moved up too much?
« Last post by tdawg on November 13, 2017, 12:23:27 PM »
I feel you brotha. I have the opposite issue. I still have slightly excessive tooth show and significant lip incompetence after my surgery. Personally I feel like for men its better to be in your situation than mine, but I see why it bothers you. Some things to keep in mind though are that they only impacted you 3mm and they moved you forward 1 mm so the effect is less than 3mm impaction. That isnt a huge movement and it looks like you had a slightly gummy smile before. I dont think its out of the realm of possibility that your muscles havent adapted to your new bone structure yet. Think about it, you were probably compensating for your slight VME with slightly extra contraction of your lips(probably without even realizing it since you didnt have a big interlabial gap). All of a sudden you wake up one day with that excess gone but your muscles are still conditioned to contract slightly. 4 months probably isnt enough time to unlearn a lifetime of a habit. With time your upper lip might relax a bit and get you to ideal incisor display. But you are doing the right thing in seeking a 2nd opinion. If you really want to know you should probably book a consult with Gunson. It will be about 500 dollars and a trip to California but he will give it to you straight.
100
Really looks like a maxilary protusion. Perhaps a BSSO with lower extractions could bring some improvement.

In cases like these, would be possible in the same surgery to perform a lefort 2 set back and in the same procedure a lefort1 + bsso with a big maxilomandibular advancement to creates a very strong lower third?


The Lefort2 area includes the Lefort 1 area.
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