What kind of procedure would you guys recommend?

[terry947]

Here a link to my dropbox: (deleted)

After I got my braces off my dentist mentioned that I'd need jaw surgery to fix my open bite. From what I can tell my Maxilla is dropping and my chin/jaw is receding. I have bimaxillary protrusion and I dont even know where to start on that. Also ever since I took the time and learned about jaw surgery I've come to hate the way things sit on my face. My mid face is flat and just overall I feel self concious about it. My bi maxillary protrusion also makes my face look more " normal" but to me it looks bad.

I'd like honest answer and opinions on what would need to be done. I already spoke to a some people on here but I'd like some more opinions/recommendations.

Thanks!

Also I have the option of getting jaw surgery in Canada payed for by the government because I have tmd and sleep apnea, but I feel like the surgeries performed here wouldn't adress the mid face. So Id rather to save up some money and take the risk and get a modified lefort III. That way it addresses everything.

[Langpam]

I agree with Tumerican.

I had bimaxillary rotational advancement plus genioplasty in November and it cured my sleep apnoea as well as giving my lower face the correct proportions. (Pictures posted in the Overbites section)

I would definitely recommend finding a good maxillofacial surgeon.

[terry947]

thanks guys. Honestly, do you guys notice a mid face deficiency or am i just self conscious?

[nrelax11]

I think jaw surgery will really help you. You have good undereye support from your cheekbones

[PloskoPlus]

I think a conventional double jaw surgery should be enough for you. Mid faces are tough to evaluate aesthetically even for trained surgeons.  A Le Fort I advancement will take away the flat look, but it won't give you "plates of armour" right under your eyes.  It will sort of "tent things up" and give your face more depth and make the orbital weakness less obvious.  On the other hand, there is a chance of coming out looking a bit "chimpy".  I would also consider a zygomatic osteotomy.  Hard to give this advice given that I've only ever seen those "sandwich" ZOs done by MM, and the improvement looked marginal... but it should theoretically give you more facial width and take away the "long flat" look.

I know the Obwegesser demon->angel girl gives everyone the vapours, but I've only ever seen modified Le Fort III done on ridiculously recessed class IIIs with bulging eyes.  OK, she did not have bulging eyes, but she was a pretty severe class III. 

[terry947]

Thanks for your input everyone. I will have a consultation with an old friends dad who is a top craniofacial surgeon and ask for him opinion. I'll also get a CT scan and ceph to see whats actually going on.

The only thing I'm worried about is the chimpy look because I have slight bimaxillary protrusion, and If they move everything forward, it'll make it stand out. Then again, everything pretty recessed as well and maybe it'll balance it out. Also I have a pretty big head, even though my face is long, it looks even longer because of the fat/skin under my neck due to no support from my jaw/chin (Updates some photos to show my holding back my neck fat  ). My brother has a fairly wide horizontal face and his is only less than 1 cm wider (measured with digital calipers).

[PloskoPlus]

My brother has a fairly wide horizontal face and his is only less than 1 cm wider (measured with digital calipers).

Having read JSF and hearing about "normal" siblings, I am sort of relieved that I have no siblings at all.  I can only imagine having a brother that got all the best features of my parents as opposed to me.
You do have pretty good eyes - the most important feature, and there is no surgery for potato eyes.

[sean89]

I agree with Tumerican.

I had bimaxillary rotational advancement plus genioplasty in November and it cured my sleep apnoea as well as giving my lower face the correct proportions. (Pictures posted in the Overbites section)

I would definitely recommend finding a good maxillofacial surgeon.

I agree. You have the potential to look good but you need trimax because you have a very weak chin.

[Bazarov]

My brother has a fairly wide horizontal face and his is only less than 1 cm wider (measured with digital calipers).

It's worth noting that 1cm is the difference between 50th percentile and 95th for bizygomatic breadth.

Pretty crazy.

[terry947]

The difference between my brother and me is that he maintained tongue posture since childhood. I started mouth breathing around 5 years old, so I guess my face started to develop properly, then went down hill from there. Also when he was younger he would chew things all the time, I remember him chewing pens caps and stuff like that. Now he has a wide jaw, and shorter face. Probably 1-2 inches shorter. SUCKS ASS, but what are you gunna do about it..... thats life.

goes to show that our environment plays a huge role during our development years.

@ sean - trimax being lefort, bsso and genio?

And just to get this right Id need

1) Lefort 1 (not sure if it has to be high)
2)CCW rotation and forwards and up movement
3) Impaction
4)Bsso
5) Genioplasty.

seems like a lot no?

[PloskoPlus]

And just to get this right Id need

1) Lefort 1 (not sure if it has to be high)
2)CCW rotation and forwards and up movement
3) Impaction
4)Bsso
5) Genioplasty.

seems like a lot no?

Pretty standard actually.  A ZO would probably be worthwhile as well. Maybe chin wing instead of genio.

[terry947]

@plosko - doesnt a ZO just make the face a little wider? It doesn't affect the eye area at all, from what I've read of this forum.

[PloskoPlus]

@plosko - doesnt a ZO just make the face a little wider? It doesn't affect the eye area at all, from what I've read of this forum.

Selfies can be deceiving - my face looks long in them, but like a ball in other photos.  That's why my surgeon refused a ZO or a lefort iii.  But your face looks narrowish in your photos, so you may benefit. But it could be just lens distortion.

[terry947]

@plosko - thanks. I'll look into it. I feel like if my lower jaw was only a litter wider and my mid face protruded more forward, I wouldnt look like I have a long face. I actually measured my face and its a little under 9" from hairline to bottom of chin.

[yxcvb]

@plosko - thanks. I'll look into it. I feel like if my lower jaw was only a litter wider and my mid face protruded more forward, I wouldnt look like I have a long face. I actually measured my face and its a little under 9" from hairline to bottom of chin.

9 inches? Thats pretty crazy. You could really benefit a lot from CCW rotation with any of these surgeries, even the Lefort III. Were you a mouthbreather during childhood?