Author Topic: MMA for OSA Cosmetic Results  (Read 5766 times)

Picollo30

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MMA for OSA Cosmetic Results
« on: March 08, 2016, 03:59:46 AM »
Although this surgery is not considered cosmetic and is dedicated do cure sleep apnea, i've seen some good results when it comes to aesthetics and i've seen some people that simply stayed the same.

So my question is, do these kind of good facial results depend on how much the maxilla and the jaws are advanced? or the type of mandibular rotation used?

I will leave some before/afters that i think are good

http://www.arnettgunson.com/images/photos/sleep-apnea-summary2.jpg

http://www.drlarrywolford.com/wp-content/uploads/2015/01/Screenshot-2015-02-14-13.28.07.png

and some results where the patient simply looks the same, i think these are very poor

http://www.intechopen.com/source/html/47489/media/fig14.png

http://2.bp.blogspot.com/_-Kht-68brPQ/RlsVlF1EACI/AAAAAAAAAHs/elNG4FlspYQ/s1600-h/b4-after_f.jpg

http://2.bp.blogspot.com/_-Kht-68brPQ/RlsVUF1EABI/AAAAAAAAAHk/J0TJKps3YNM/s1600-h/b4-after-l.jpg

« Last Edit: March 08, 2016, 04:20:32 AM by Picollo30 »

JimmyTheGent

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Re: MMA for OSA Cosmetic Results
« Reply #1 on: March 08, 2016, 08:27:05 AM »
Although this surgery is not considered cosmetic and is dedicated do cure sleep apnea, i've seen some good results when it comes to aesthetics and i've seen some people that simply stayed the same.

So my question is, do these kind of good facial results depend on how much the maxilla and the jaws are advanced? or the type of mandibular rotation used?

I will leave some before/afters that i think are good

http://www.arnettgunson.com/images/photos/sleep-apnea-summary2.jpg

http://www.drlarrywolford.com/wp-content/uploads/2015/01/Screenshot-2015-02-14-13.28.07.png

and some results where the patient simply looks the same, i think these are very poor

http://www.intechopen.com/source/html/47489/media/fig14.png

http://2.bp.blogspot.com/_-Kht-68brPQ/RlsVlF1EACI/AAAAAAAAAHs/elNG4FlspYQ/s1600-h/b4-after_f.jpg

http://2.bp.blogspot.com/_-Kht-68brPQ/RlsVUF1EABI/AAAAAAAAAHk/J0TJKps3YNM/s1600-h/b4-after-l.jpg

GOOD QUESTION!!!  I was wondering this myself.  Some MMA patients show small improvements in aesthetics while others huge improvements but why??
The more I learn about the gamble that is jaw surgery the more afraid I become!!!   :-(

Picollo30

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Re: MMA for OSA Cosmetic Results
« Reply #2 on: March 08, 2016, 09:31:55 AM »
If someone knows how to answer this PLEASE do so.

Is it because some people have better genetics? is it because some people have dentofacial deformities like steep occlusal planes, retruded jaws and weak chins leading to class II convex profiles or is it because some like the first 2 surgeries were made by maxillofacial artists with a good sense of aesthetics and the last two were made ENTS instead just solely for cure of sleep apnea?

Would be great if a mix of the 2 (function and aesthetics) were taken into account in these surgeries, i'm sure many people have the same goals and hopes as myself.

PloskoPlus

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Re: MMA for OSA Cosmetic Results
« Reply #3 on: March 08, 2016, 11:04:06 AM »
AFAIK wolford does CCW always.

Picollo30

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Re: MMA for OSA Cosmetic Results
« Reply #4 on: March 08, 2016, 11:29:20 AM »
AFAIK wolford does CCW always.

plosko why do you think some results look so good while others dont? is it because of ccw use alone?

PloskoPlus

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Re: MMA for OSA Cosmetic Results
« Reply #5 on: March 08, 2016, 12:26:19 PM »
plosko why do you think some results look so good while others dont? is it because of ccw use alone?
Possibly.
The results I saw in his office were probably the best I've ever seen.

kjohnt

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Re: MMA for OSA Cosmetic Results
« Reply #6 on: March 08, 2016, 12:27:31 PM »
I almost guarantee both the good results had CCW rotation, and maybe even sliding genioplasty in conjunction.  The bad ones probably had neither.

apocal

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Re: MMA for OSA Cosmetic Results
« Reply #7 on: March 08, 2016, 05:43:18 PM »
Well, facial aesthetics is a difficult and complex topic for its one. Every face is individual. Some patients can aesthetically benefit from a Bimax so that they look much better afterwards, in other cases the difference is much less dramatic and sometimes, sadly for the patient, you could not really say whether there was a surgery because it looks quite the same as before.

Of course when you suffer from a misalignment of jaws and maybe an apnea, too the functional reasons for doing this surgery always have priority. No doubt about that. But the aesthetics should be considered, too. Except someone says it totally unimportant for him. And there are certainly rare and difficult cases where its simply not possible to consider aesthetics. Thats the exceptions.

I can only speak about the surgeons I have talked to and every surgeon weights and assesses the importance of this aspect differently. So its not only a question about the individual case or surgical skills but also about the surgeons knowledge, personal perception and attitude towards beauty and facial aesthetics and its importance. Some surgeons show an interest in patients request, others not. There are unfortunately some who really dont care at all, many care the standard way they were teached during study and a few have their one conception. So you can have luck or misfortune. With the same breath you have to point out that same patients have unrealistic desires. No surgeon is a magician. But I am convinced in most cases its quite possible to increase attractiveness. Today a forward grown face is a beauty ideal which in my opinion can be reached without higher surgical risk or effort in most cases if requested.

The first two links are an evidence of that! Woman looks really good, man too, both faces are more forward, although chin of first man is very big. I would personally not prefer that but it doesn't look bad. Second man is not that bad, can not agree, I would recommend he should make a liposuction below chin because he still has a double chin which affects the result negatively. Last man, yes not really a cosmetic improvement. Mandible could have come more forward, looks still receding. But we dont know the details of his case. His aesthetical problems are very likely not only malposition of jaws but also other areas (maybe eyes, cheek bones, jaw angles, skin etc.) Need to be analyized exactly but the most important question is not whether we like it or the doctor but whether he likes his face. He has to be satiesfied and must to live with it, not we.
« Last Edit: March 08, 2016, 05:58:17 PM by apocal »

Tezcatli

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Re: MMA for OSA Cosmetic Results
« Reply #8 on: March 08, 2016, 09:00:47 PM »
http://www.intechopen.com/source/html/47489/media/fig14.png

That guy looks a lot better.


Look, surgery will try to fix your deformities to give you better sleep and aesthetics will come as a side product. If these deformities didn't cause you to be ugly in the first place it will not change much, if you have other problems you will still be ugly. I don't think it is that hard to understand, the guy I posted is still ugly because his eye, nose and etc are not good looking but the portion that was changed(the mandible) looks a lot better.

So, if your problem is not a retruded maxilla and mandible and you only advance them you will not look much different.

molestrip

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Re: MMA for OSA Cosmetic Results
« Reply #9 on: March 09, 2016, 12:07:18 AM »
I would say the degree of transformation largely comes down to starting point and willingness of surgeon to take risk. Some patients are so far back that they can't be made normal using current surgical technique. Others aren't that bad so there's no so much improvement. Sometimes surgeons have to prioritize airway over aesthetic. Or they don't understand planning for airway and do something stupid like advance everyone the max amount possible. When it comes to risk, there's a few places they have choices. One is doing double jaw vs single jaw to make your lower face as normal as possible. Another is whether to do CCW rotations, which are less stable, increasing risks to joints, stability of teeth (note none are smiling here), and potentially leave foreign bodies embedded in bones to deal with later in life. Last is whether to do extra work, ANS shaving, alar cinch, and VY-closure. Sometimes they may do implants, lip lifts, fillers, etc but many want to steer clear of this kind of work because of increased surgical risk without functional gain. And it changes the types of customers they have to deal with.

chinnychinchin

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Re: MMA for OSA Cosmetic Results
« Reply #10 on: March 09, 2016, 01:28:57 AM »
I think involving both jaws is key to getting the most dramatic and ideal effect. CCW follows the trajectory of normal growth which is why they bring about the most natural looking results (vs. something like a jaw implant). And it seems to be rare that only one jaw is not in the right position. The upper jaw alone, if brought forward even a few mm, can have the most drastic change on the face.



« Last Edit: March 09, 2016, 01:43:19 AM by chinnychinchin »

JimmyTheGent

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Re: MMA for OSA Cosmetic Results
« Reply #11 on: March 27, 2016, 04:29:06 PM »
That first girl went from a 4 to a 9 easy.  All those results are heaven sent to me.  Id take any of those results in a hot minute provided all the functionality was on point and there wasn't too much permanent numbness.
The more I learn about the gamble that is jaw surgery the more afraid I become!!!   :-(

Picollo30

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Re: MMA for OSA Cosmetic Results
« Reply #12 on: March 29, 2016, 02:38:02 PM »
my mma left me almost the same, maybe because it was more to open the airway than anything else, but even then with the advancement that was achieved (4 mm airway to 13.8 mm), ccw rotation and all the only things that i notice different is that my jaws are not so crooked, my face looks a bit wider and my chin is a bit larger but far from what i wanted. maybe the sliding genio makes the biggest difference of the whole procedure?

kjohnt

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Re: MMA for OSA Cosmetic Results
« Reply #13 on: March 30, 2016, 01:24:46 AM »
my mma left me almost the same, maybe because it was more to open the airway than anything else, but even then with the advancement that was achieved (4 mm airway to 13.8 mm), ccw rotation and all the only things that i notice different is that my jaws are not so crooked, my face looks a bit wider and my chin is a bit larger but far from what i wanted. maybe the sliding genio makes the biggest difference of the whole procedure?

Do you have braces?  I don't remember.

edit NM the other thread says you do. 

Did you have any sort of extractions or decompensation to create a larger overtjet prior to surgery?  Post your ceph again if possible.

Tezcatli

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Re: MMA for OSA Cosmetic Results
« Reply #14 on: March 30, 2016, 01:57:10 AM »
Do you have braces?  I don't remember.

edit NM the other thread says you do. 

Did you have any sort of extractions or decompensation to create a larger overtjet prior to surgery?  Post your ceph again if possible.

From what I've seen he didn't have an overjet because his ortho gave him a camouflage treatment instead of maximizing his class II occlusion beforehand and his jaw surgery was just for OSA. That is, they advanced both jaws equally to open up the airway instead of fixing the skeletal discrepancy.

Add to that the lack of genioplasty and you get a subpar result. However I believe he did this to get free surgery from his local NHS.

My case was similar, until early this year I had a functional class I bite because of natural compensation, I talked with my surgeon and he said we can follow two plans:
1) Leave the teeth as it is and advance both jaws equally, it would improve aesthetics a bit(cheeks would pop out a bit more, nose would look smaller, gummy smile would be fixed) and open up my airway.
2) Get braces to remove compensations which would leave me with an underbite and get surgery later. That way I would still get bimax advancement but I'd be able to advance the maxilla a few mm more than the mandible which I need and have teeth in the ideal position in the end. It would take 1 year in braces beforehand plus a 6 months in braces after surgery.

I choose 2 obviously and will get surgery in 2017 but it looks worth it. I will also get a genio obviously.