Author Topic: Soft or hard tissue problem?  (Read 151 times)

Dogmatix

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Soft or hard tissue problem?
« on: January 02, 2018, 03:40:06 PM »
I'm trying to wrap my head around whats actually going on with my face and try to pin-point exactly what I'm not happy about.

It's hard for me to be very precise on my description of what I'm not happy with, it just feels off when I look at it. I'll try to explain what I see atleast.

I feel that I have "feminine" features, small/narrow jaws, bad jaw line and lack of contours in the face.

I've made a cepth scan in profile (attached), where these things kind of can be seen. I've marked out some of the things with the lower jaw. On the upper face I can feel similair things with the cheek bones not being very visible. Even though I'm not overweight at all, it's like the face is round and small however I look at it, and not the sharp well defined face one would like.

There are of course dental problems as well, but I was thinking about having focus on the aesthetical in this post, but sure it needs to be possible to wrap up with the teeth as well.

When looking at my face and I pull my entire face forward, then atleast I think it looks much better, the jawline gets enhanced etc.
So to me there are 2 approaches to the pure aesthetic problem. Either you can perform a bimax surgery and move both lower and upper jaw forward, maybe do some rotation etc to get good facial structure. I dont understand all the proportions that needs to be considered, but is there room for a procedure like this. To me it seems like if the upper jaw is advanced, it might come out of proportion with my forehead?

Or maybe it's more of a soft tissue problem. Maybe the area marked in red still will have the same problem if the jaws are advanced? How far would a plastic proceducedure that only focus on the soft tissue bring me?

What I'm trying to understand is what part of the aesthetic features that are connected to skeletal problems, and what parts that are more soft tissue problems. How will the face change with different procedures?



kavan

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Re: Soft or hard tissue problem?
« Reply #1 on: January 02, 2018, 07:09:42 PM »
It looks like you have class2 Div2 deep bite with short chin.

Your maxilla (ANS-PNS) is rotated counter clockwise to a significant degree.

You would probably need a down graft and alteration of the anterior nasal spine in order to push maxilla forward if that were needed to 'match' advancement of lower jaw. If not your nasial labial ange would get excessively obtuse which it is already. Your upper front teeth would need to pushed forward for an angled out overjet and your lower teeth pushed backwards in braces to accommodate a bi-max surgery.

The line of the anterior cranial base is 11 deg away from the horizont and the norm is 7 degrees away.

Can't elaborate on everything. But it looks to be a case for a good maxfax surgeon who would be able to compensate of the excess inclination both the anterior cranial base and the maxilla has and also do rhinoplasty techniques so the nasial labial angle gets more CLOSED than more OPEN during the bi max surgery.
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Dogmatix

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Re: Soft or hard tissue problem?
« Reply #2 on: January 03, 2018, 01:10:48 AM »
It looks like you have class2 Div2 deep bite with short chin.

Your maxilla (ANS-PNS) is rotated counter clockwise to a significant degree.

You would probably need a down graft and alteration of the anterior nasal spine in order to push maxilla forward if that were needed to 'match' advancement of lower jaw. If not your nasial labial ange would get excessively obtuse which it is already. Your upper front teeth would need to pushed forward for an angled out overjet and your lower teeth pushed backwards in braces to accommodate a bi-max surgery.

The line of the anterior cranial base is 11 deg away from the horizont and the norm is 7 degrees away.

Can't elaborate on everything. But it looks to be a case for a good maxfax surgeon who would be able to compensate of the excess inclination both the anterior cranial base and the maxilla has and also do rhinoplasty techniques so the nasial labial angle gets more CLOSED than more OPEN during the bi max surgery.

Wouldn't a rotation this way make the jaw line even less defined? Or do you mean that this is handled later with advancement forward?

kavan

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Re: Soft or hard tissue problem?
« Reply #3 on: January 03, 2018, 02:07:44 PM »
Well, there is somewhat of a mechanical conundrum because counter clockwise rotation is often needed to get a good advancement to the lower jaw but you already have excessive CCW to the ANS-PNS (maxilla). So, more CCW or even linear advancement along the inherent incline of your maxilla would tend towards making the overly obtuse nasial labial angle more obtuse. So, maybe some clockwise rotation with the bi-max advancement. Either way, the orientation of the anterior nasal spine is not a good one and it would probabably have to be cut down/reduced to close the excessive nasial labial angle with any kind of advancement.

As to soft tissue, well the part we see from the ceph, expecially the nasial labial angle is clearly a function of the bone structure underneath.

Now, IF what 'bothers' you is the upwardly angled nose along with the long lip (labial ledge) and you can isolate THAT as the problem when looking in the mirror, that could be addressed by a type of rhino that cuts down the anterior nasal spine to kind of collapse in on the overly wide nasial labial angle. If the 'long lip' after doing that bothers you, then a lip lift decreases the longness there.

For other 'soft tissue' issues, that is assessed via a face photo and not a ceph.



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Dogmatix

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Re: Soft or hard tissue problem?
« Reply #4 on: January 03, 2018, 04:37:29 PM »
Well, there is somewhat of a mechanical conundrum because counter clockwise rotation is often needed to get a good advancement to the lower jaw but you already have excessive CCW to the ANS-PNS (maxilla). So, more CCW or even linear advancement along the inherent incline of your maxilla would tend towards making the overly obtuse nasial labial angle more obtuse. So, maybe some clockwise rotation with the bi-max advancement. Either way, the orientation of the anterior nasal spine is not a good one and it would probabably have to be cut down/reduced to close the excessive nasial labial angle with any kind of advancement.

As to soft tissue, well the part we see from the ceph, expecially the nasial labial angle is clearly a function of the bone structure underneath.

Now, IF what 'bothers' you is the upwardly angled nose along with the long lip (labial ledge) and you can isolate THAT as the problem when looking in the mirror, that could be addressed by a type of rhino that cuts down the anterior nasal spine to kind of collapse in on the overly wide nasial labial angle. If the 'long lip' after doing that bothers you, then a lip lift decreases the longness there.

For other 'soft tissue' issues, that is assessed via a face photo and not a ceph.

The nose doesn't bother me and an isolated nose job is not gonna happen. There may be angles etc that can be drawn, but it has never been an issue for me and it would rather be taking a step backwards for me starting focusing on this as well. Of course it have to be considered if the structure of the face is going to be remodelled however.

Whats actually bothering me is what I marked in the picture. You can see that the skin on the throat is not "attached" to the jaw, hiding the entire jaw line.
Taking the first picture I found on google shows similair. On the picture to the right you can see that the jaw line is fully visible from the ear to the chin, opposite to what you see on the left. This is obviously before and after pictures of a surgery case, and it seems like there's some weight loss as well. But what I wonder, is the visibility of the jaw line actually a result of the surgery, or is it more weight loss, and bringing the head forward and maybe other procedures? When I'm evaluating my face in the mirror I think it looks resonable if I throw my head forward like an osterich, then I get the jaw line as in the after picture below, and I'm thinking if this is what's bothering me aesthetical, will I be disapointed by the result of a jaw surgery and maybe can address this by liposuction of the jaw line, stretching the skin or similair? I'm not overweight at all, so it's not as you can see in the picture where one might suspect that general weight loss solves some of the problem.
I'm trying to understand if jaw surgery is like throwing my head forward (literally)?

« Last Edit: January 03, 2018, 04:47:05 PM by Dogmatix »

kavan

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Re: Soft or hard tissue problem?
« Reply #5 on: January 03, 2018, 04:52:25 PM »
The person in the photo most likely had bi-max surgery and chin advancement.
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Dogmatix

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Re: Soft or hard tissue problem?
« Reply #6 on: January 03, 2018, 05:27:22 PM »
The person in the photo most likely had bi-max surgery and chin advancement.

I'm sure he did, but is that actually whats enhancing these lines of the jaw bone? I mean, the bone is there before as well, just at another angle and position. Does the bi-max actually stretch the skin and make it "attach" more to the these lines this much?


kavan

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Re: Soft or hard tissue problem?
« Reply #7 on: January 03, 2018, 05:30:31 PM »
I'm sure he did, but is that actually whats enhancing these lines of the jaw bone? I mean, the bone is there before as well, just at another angle and position. Does the bi-max actually stretch the skin and make it "attach" more to the these lines this much?

It does what you see in the photo of THAT patient.
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