Help! Class II profile with normal bite

[mary000]

Hello. I'm hoping you guys can help me out. I have always had a recessed mandible, and the angle of my jaw from ears to chin has always seemed to be very severe/long. Around 14, I had a palate expander to space out my upper teeth and I got braces and elastics to "correct" my "overbite".  Correct me if I'm wrong (Im still in the research stage) but it seems the elastics moved my maxilla back to line up with my recessed mandible, instead of the modern approach to orthodontics where appliances help to bring the mandible forward to line up with the maxilla.
Ok, so I'm 28 now, my bite is now normal, but Im wondering what I can do to fix my severe class II profile.  I was told that a genioplasty would be my only option, but Im worried that that would make my chin longer and stick out in an unaesthetic way.  I was thinking I would need double jaw surgery with some kind of rotation to make the lower third of my face less long.  Please help me to understand whats wrong with my face. I look ok from the front (long face, but fairly proportional), but as you can see- I am severely disfigured from the side.  Can I do anything to fix this?

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[jusken]

Your xray doesn't look that much different than mine did prior to surgery - it's good to see other people with similar problems as me... no offense :/

Your maxilla definitely drops down a little too much.  This causes your nose to dip a little (accentuating that hump on the bridge of your nose) and your upper lip to fall back as well.  Your mandible has grown way too far down and back - just like mine did!  I'd really stress not doing genioplasty alone for this, but do your research.

Here I made a gif so you maybe you can see what I'm talking about (the other xray was taken off some chick on deviantart - hope she doesn't mind):



I had:

1. CCW of the maxilla and brought it up
2. Sagittal split on the mandible to bring it forward
3. A weird procedure that corrected my open bit (brought the 4 front incisors down).
4. Shortening of the mandible:
           This procedure isn't done very often I'm told.  But, I'm very happy they did it.  It was like a genioplasty, except instead of sliding a piece foward, they just removed a wedge.  This made it like 4mm shorter, without making it too prominent.

Good luck!

[dantheman]

I don't really see much VME going on here. The occlusal plane isn't steep by any measure. If anything I think the ramus is deficient causing the mandible to be rotated clockwise (well counterclockwise with your superimposed animation anyways). I ain't no expert, however.

[Tiny]

In my case (although I don't have a normal bite), I was advised that they would decompensate my teeth ie. put them back where they were before the original orthodontics to 'correct' the class 2 bite.  Then there would be more overjet and space to move the lower jaw forward.  As it is, my upper teeth are pulled in and lower teeth pushed out, so they (kindof) meet

A genioplasty alone can make a difference when the chin is recessed but long.  They would slide the bone forward but upwards.  I guess it's a compromised solution

Can't see your ceph any more but if it's like juskens then in your case, and it's reasonably common, the mandible isn't actually deficient in length but the ramus is too short and the mandibular angle is not ideal meaning that you get this long face and recessed jaw.  I think it's quite difficult to fix as it's hard to lengthen the ramus.  Sometimes people get inverted-L osteotomy but this is a full-thickness cut.  I think most surgeons go for a BSSO with rotation done as far back as possible plus paste on the angle

@jusken, do you know where they did the cut for your BSSO?  Rotation?  Paste?  Curious to know!

[dantheman]

No one cares about profile?? I strongly disagree

[dantheman]

That's fair, but how often do you look someone dead on compared to at an angle? I'm ok with my front but only dead on.

[Tiny]

That's fair, but how often do you look someone dead on compared to at an angle? I'm ok with my front but only dead on.

Yes, I agree.  I don't see too many (?any) people who are significantly recessed and it doesn't show from the front.  Of course profile matters, people get rhinos all the time on noses that look fine from the front

But CK you are right in that you can have a poor profile and still be decent-looking (in the same way that you can have a class 1-profile and not be terribly attractive)

Dan, most people here who underwent jaw surgery had significant functional issues and the general tone is 'don't get jaw surgery for cosmetic reasons' (because of how tough the surgery/recovery is and the risk of side affects).  If you have no functional issues then a good genio will give you some improvement and is much easier than full jaw surgery but there are people who undergo jaw surgery for primarily cosmetic reasons

[dantheman]

My profile is quite recessed. Interestingly apart from the dark circles I don't mind my appearance from the front. From the side I lose all credibility.

[CK]

My profile is quite recessed. Interestingly apart from the dark circles I don't mind my appearance from the front. From the side I lose all credibility.

well unless u share we cant really give a serious opinion, but trust us the profile is trivial compared to the front. plus there may be less aggressive treatments to improve the profile if that is something u r determined on doing...

[dantheman]

Hey CK, under pics of retrognathia on private forum. Just bumped the thread. Cheers.

[ForeverDet]

^Impaction perhaps? AKA shortening of the maxilla.

[ForeverDet]

impaction is bringing the whole maxilla linearly up

ccw-rotation is impacting only the posterior parts of the maxilla (thus rotating the complex)

Unless I'm misreading, wouldn't posterior impaction (back of the maxilla) be clockwise rotation? With counter-clockwise they bring the back down. Regardless the anterior part of the maxilla is often impacted or manipulated in someway too, not just the posterior with CCW.

can you explain what this is and how it's done? thanks.

They remove a portion of the maxilla so it's vertically shorter. Make sense?

[sooq]

yes, posterior impaction would indeed be clockwise rotation. Unlike most, CW is what I need!

[ticktickatick]

Hello. I'm hoping you guys can help me out. I have always had a recessed mandible, and the angle of my jaw from ears to chin has always seemed to be very severe/long. Around 14, I had a palate expander to space out my upper teeth and I got braces and elastics to "correct" my "overbite".  Correct me if I'm wrong (Im still in the research stage) but it seems the elastics moved my maxilla back to line up with my recessed mandible, instead of the modern approach to orthodontics where appliances help to bring the mandible forward to line up with the maxilla.
Ok, so I'm 28 now, my bite is now normal, but Im wondering what I can do to fix my severe class II profile.  I was told that a genioplasty would be my only option, but Im worried that that would make my chin longer and stick out in an unaesthetic way.  I was thinking I would need double jaw surgery with some kind of rotation to make the lower third of my face less long.  Please help me to understand whats wrong with my face. I look ok from the front (long face, but fairly proportional), but as you can see- I am severely disfigured from the side.  Can I do anything to fix this?

A sliding genio can lengthen the face, but you can ask that most of the movement be forward and not down.

I have heard that you can go forward and up to some degree, but I don't see how it would work so well. It seems like you would have a really weird notch in your jawbone where they made the cut.

I had my mandible swung forward and my maxilla brought up. Minor genio that was mostly forward but a little bit down. Vertically my face is pretty much in perfect thirds now. However it does look longer than I think is ideal partially because I have a high forehead and a skinny face, so proportional for me is going to be on the long side.

My ideal female face is probably something like this:



She is pretty proportional vertically. But she also has a very short forehead which means she can also have a shorter feminine face.

I look more like this post-op



Angie's pretty vertically proportional too, but in my mind her longer skinnier face just isn't as pretty or feminine. But I've got a forehead almost exactly like hers so I mean what can you do. My cheekbones also aren't quite as wide or well-defined as hers, so it does make my face look a tad longer than hers though we might be the same height vertically

Anyway, to answer your question...you're worried about lengthening...in my case it was not the genio so much that made my face look longer it was swinging the mandible forward. My face looked deceptively shorter pre-op because you basically couldn't see a clear line for my lower jaw. It was all shadowed from the front. The genio's impact on the front was minor compared to the mandible being forward now.

I think profile does matter. Most people with significantly weak profiles can't help it showing up in the front somehow anyway. If you have a weak profile your whole lower jaw will sort of be shadowed in the front which will make your upper face look a lot larger.

Genio can improve the profile but with how steep your ramus is I doubt you would be happy with the improvement. Like I said, I had my maxilla moved up, and my mandible swung forward plus a small genio...from the profile the ramus angle is definitely shorter and more parallel to the ground. But from the front I still look a little long even with all that upward movement! Without moving other things up and forward I don't think you will be happy with a genio. You may look worse from the front honestly.

I am surprised by how good your bite is. I had a pretty good bite, better than probably most who go into jaw surgery, but still had some issues (I also had braces, expander, and elastics in my teens which I believe did more harm than good.) Your current bite looks perfect though. I think your profile issues cold benefit from jaw surgery but you're going to have a hard time convincing anyone reputable to do that on your perfect bite.