Surgery Questions with pictures

[paranoiagent]

Hello, my name is Sean and I'm in the very beginning phases of having my classIII underbite corrected.  I have already met with my orthodontist and will be seeing the oral surgeon on the 30th of this month.  Dr. Wolf my orthodontist has already gone over with me what he thinks i will have to have done.  He said my bottom jaw will have to be brought back and my top jaw forward.  I was told that I'm mid face deficient and in addiction to moving my top and bottom jaw forward and back, they want to move them down to lengthen my face.  I was reading up on being mid-face deficient and was getting overwhelmed by the amount of information there is.  I was reading about the different leforts and was wondering which one in your opinions you think i need.  I'm not trying to be too terrible vain, but i want to look the best i can after surgery.  I read that advancing the upper jaw can make your nose bigger and that really concerns me; my nose is big enough.  Basically I was hoping that some of the more knowledgable users could look over my  photos and X-rays and tell me what I'm suffering form and what I should ask/talk to my surgeon about. Thanks in advance. Also for some reason I wasn't given a copy of my profile X-ray, I'll try to get a copy of it if it will help.

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[Tiny]

Hi, welcome!

I don't know that much on Le forts and midface deficiencies so others will weigh in but I will say


- yes I think you need more vertical length.  Ask your surgeon how this will be stablised? Will they use a graft?

- WRT to le forts and midface, simply put - the higher the cuts, the more advancement of the midface you can get.  A Le Fort 3 will give the most but not that many surgeons do it and it is a very major surgery.  People here have had "high le fort 1" to bring forward the mid-face

- your nose isn't narrow but it doesn't look 'out of place' on your face.  If you are lengthening the maxilla then it should not get wider - it's impaction that widens noses.

- I would advise you to crop that photo ASAP to remove your name and date of birth!!!!!!!

[paranoiagent]

thanks for the reply and the suggestion, i didn't even notice my name and birth at the top of the pictures.

[PloskoPlus]

Sigh...

Kizarq,

You're such a killjoy.

[PloskoPlus]

Lose some fat, if you can.  I'm forever grateful to Tiny for suggesting this. The upside is that you will know your face better.  I'm also a class iii. My surgeon originally wanted to do a higher lefort 1, but changed his mind to a normal lefort 1 "to keep the angularity in the face".  The downside is that it will make your class iii more obvious.

[Tiny]

Lose some fat, if you can.  I'm forever grateful to Tiny for suggesting this.

Did I? I don't even remember hahaha! Should probably practise what I preach then

Sean - looking at your eye bags I think you would benefit from some orbital rim augmentation - HA paste or implants.  However, some of the stiffer fillers (like radiesse and dense hyalauronic acid) can be good for this area, if they put them deep down near the bone, under the dermis and under the muscle.  I also recommend filling out the top part of your nose because it's making the midface deficiency more obvious

Ask Kizarq says, Le Fort 3 is the best option cosmetically but because of the risks, most docs only do it for congenital defects.  High le fort 1 with advancement and vertical augmentation plus some work on cheekbones and orbital rims is probably your best option

[PloskoPlus]

Tiny,

Just look at my thread in the private forum. I posted my fat pics.

[paranoiagent]

@kizarq- Thanks for your reply, it was very informative.  So you think implants could give the same or similar effect to a lefort3? Also do you think that would be something that would be covered by my insurance?

@ploskoplus- I know I need to "loose some fat," but thanks for the suggestion.

@Tiny-  I never noticed I had bags under my eyes, or i never considered them to be bags.  I think your right though, looking at my profile I don't have much projection under my eyes from my check bones.  I will talk to my surgeon about a high lefort and see what he thinks.  My only concern with a high lefort is that i don't want my nose to get any bigger.  The bridge of my nose is very low and as a glasses wearer gets annoying with them sliding down my face all the time. I already have been looking into  a rhinoplasty to raise the bridge of my nose to meet my brow ridge, but we'll see what my face looks like after surgery.

Thanks everyone for your responses I appreciate everyone taking the time to respond.

[PloskoPlus]

Ask your surgeon if he will do an alar cinch to keep your nostrils from flaring.  The downside is that it may thin the upper lip (although you are probably OK on that front).  This is counteracted with Vy plasty - a special way of stitching up the lip when they are done with the osteotomy.

To keep the nose from upturning and the upper lip from becoming convex, the anterior nasal spine is shaved down,  sometimes completely. 

[paranoiagent]

Obviously everyone's face changes as they get older, but when i was younger before my bottom jaw grew out so far i don't think i was mid face deficient, short faced and i think i had nice cheekbones, i also think the bridge of my nose was higher. This photo is also my avatar, but it's the best photo i have from when i was younger.  Is it normal for someone's face to change that much, just from my bottom jaw growing out past my top one, or am i wrong?

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[pekay]

Obviously everyone's face changes as they get older, but when i was younger before my bottom jaw grew out so far i don't think i was mid face deficient, short faced and i think i had nice cheekbones, i also think the bridge of my nose was higher. This photo is also my avatar, but it's the best photo i have from when i was younger.  Is it normal for someone's face to change that much, just from my bottom jaw growing out past my top one, or am i wrong?

How tall are you? I have heard that too fast of a growth rate during puberty may cause under-bites but I don't know how much truth there is to that, it could be bro-science.

[PloskoPlus]

How tall are you? I have heard that too fast of a growth rate during puberty may cause under-bites but I don't know how much truth there is to that, it could be bro-science.

Pretty sure underbites are there from very early age.