Need some jaw surgery advice

[akvist1234]

First time poster here... i have a couple of issues with my jaw/face alligment that i can't quite wrap my head around  so i'm hoping for some feedback. also my english is not that great so i hope you understand me ...anyway, i was in braces for 4 years (crowding, deep bite)....my teeth were extremly crowded and they were tinted inwards....while the ortodontic work did give me straight teeth my functional and estethic issues remain....

Functional :
have trouble chewing on the right side (it seems my jaw is slanted)
right side of my face seem to be less functional apparent whem smiling or talking-less bone support?)
mouth breathing during sleep
excess saliva
occasional clicking noises

Esthetic :
midface/paranasal flatness (dull/flat face expression)
lip incompetence (lower lip protrudes/also upper&lower lip don't quite match together)
fleshy/childlike apperance (even when BF is low)
dented mouth area/nasolabial  lines (funny enough this was less obvious during the ortodonthic work due to the bulk of the braces)

So my guess is retrognathic profile/recessed maxilla...would i be a good candidate for maxillomandibular advancement? I did some email consultation with dr yaremchuk in the past but he only mentioned midface deficiency ( he advised orbital rim/cheekbone implants). if my jaws are recessed i think i would get a more natural result with jaw surgery. would jaw advancment have a positive impact on the midface?

http://imageshack.com/a/img716/1596/7bav.jpg
http://imageshack.com/a/img703/281/yu0d.jpg
http://imageshack.com/a/img827/3961/dh15.jpg
http://imageshack.com/a/img196/9704/5xyp.jpg
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[PloskoPlus]

I don't see any obvious deformity.

[sean89]

I don't see any obvious deformity.

Nor do I.

I can't see how jaw surgery would improve your face aesthetically.

[nrelax11]

Yea I also dont see anything wrong. Yes your lower lip protrudes a little but I doubt anyone notices or looks at it.

[akvist1234]

i was thinking that maxilla advancement would give me more paranasal/philtrum support. my upper lip hangs down at the corners giving me a kind of a frowning expression. there's also a lot of space beetwen my teeth and philtrum/upper lip so when i smile or talk my teeth are only 50% visible at most. Aesthetically speaking i was more satisfed while wearing braces due to to the added mouth/lips support.

[Tiny]

I see an everted lower lip.  However, it looks like you no longer have a deep bite so it's hard to say what's causing it

If you get an X-ray and you have a small airway and 2 recessed jaws then yes, you could get a bimax advancement.  It can be hard to tell from external pictures if the jaws are recessed.  There are people here who have posted pics that look OK but have 2 pretty recessed jaws

[akvist1234]

Lower lip sticking out is really baffling since i didn't have that before braces. Also, my lips had a slight upward turn at the corners. So much for the orthodontics. 4 years of braces and my after photos look like before photos.

http://imageshack.com/a/img196/4673/buz5.jpg
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[PloskoPlus]

How much tooth and gum show do you have when smiling?  You look like you are forcing your teeth to show in those pics.  This could be indicative of a recessed maxilla.  Your lower jaw profile looks good, but I think it's mostly due to the long (horizontally, vertically it's good) chin, so your mandible could also be recessed (obviously you can have a good relative bite when both jaws are recessed).  You need to see a surgeon - a couple of them, in fact.

With regards to facial fleshiness.  I have an underbite.  My maxilla is definitely retrognathic, my mandible is most likely prognathic.  I lost a bunch of weigh recently and have been the leanest possibly ever (six pack not far away).  Yet my skin is fleshy around the lower jaw.  Could be just the s**tty way body fat is distributed.

[akvist1234]

I have zero gum show and only my upper 4 teeth are visible unless i go for a forced joker-like smile. There's just a lot of space beetwen my teeth and lips, dental arches provide minimal support for the lips. I guess i could build up maxilla projection with some veneers but probably only by a 1mm and anyway that wouldn't solve my structural issues.

http://imageshack.com/a/img198/2373/sjpw.jpg

[joesun]

A lot of people chimed in and I agree that you do not need jaw surgery.  You look fine.  If you are seeking perfection through jaw surgery then you might be disappointed.

[Kristen]

No jaw surgery... You look great.. Be happy
If you have to get a filler to mid face o give more volume in that area

[PloskoPlus]

No jaw surgery... You look great.. Be happy
If you have to get a filler to mid face o give more volume in that area

Nothing beats bone.  Filler may work for women.

[PloskoPlus]

I have zero gum show and only my upper 4 teeth are visible unless i go for a forced joker-like smile. There's just a lot of space beetwen my teeth and lips, dental arches provide minimal support for the lips. I guess i could build up maxilla projection with some veneers but probably only by a 1mm and anyway that wouldn't solve my structural issues.

http://imageshack.com/a/img198/2373/sjpw.jpg

There are people who have normal occlusion, but do double jaw surgery for sleep apnea.  I read a blog of this red haired girl who did this.  To be honest I think she looked better or no worse before the surgery.  He jaws look a bit protrusive after (maybe it was the swelling, can't find her blog anymore).  Don't remember her smile.  But a very weak smile usually means the maxilla is recessed.  Since your occlusion is normal, you'd have to advance both jaws, and maybe shave down the chin to keep your profile in check.

[overbiter]

There are people who have normal occlusion, but do double jaw surgery for sleep apnea.  I read a blog of this red haired girl who did this.  To be honest I think she looked better or no worse before the surgery.  He jaws look a bit protrusive after (maybe it was the swelling, can't find her blog anymore).  Don't remember her smile.  But a very weak smile usually means the maxilla is recessed.  Since your occlusion is normal, you'd have to advance both jaws, and maybe shave down the chin to keep your profile in check.

You mean this girl? http://unrulyslumber.wordpress.com/2013/04/12/8-month-time-lapse-profile-swelling-changes/
I think she looks good after. Her jawline is super strong in the after pics, it would look terrible if it was slightly longer but it's still aesthetic. Maybe she had a big chin before the surgery and that's what made her jawline look normal, even though it was recessed.

[PloskoPlus]

You mean this girl? http://unrulyslumber.wordpress.com/2013/04/12/8-month-time-lapse-profile-swelling-changes/
I think she looks good after. Her jawline is super strong in the after pics, it would look terrible if it was slightly longer but it's still aesthetic. Maybe she had a big chin before the surgery and that's what made her jawline look normal, even though it was recessed.

Thats her.  I didn't know about scleral show when I first saw her blog last year.  I can see now that the surgery fixed hers.  Good stuff.