Questions about protrusion

[molestrip]

So my MMA+CCW calls for 6-7mm of maxillary advancement and 3-4mm to the nasal base. I have a narrow nose so I'm guessing widening won't be much of an issue, right? But the protrusion has me seriously worried about having a chimp look. I noticed in my surgical plan that the lips got thinner by 3mm. Lip work was mentioned in my consult but for the purpose of shortening the lip, not thinning it. Is that a trick surgeons use sometimes? I'm starting from neutral so my protrusion would be 4mm at that point. From my research, it seems that's not ideal but tolerable to lay people. Is that your impression? Another option mentioned was removing bicuspids. Anyone know if this is necessary or can removing the wisdom teeth have the same effect? Maybe I'd need both removed. How much do you think the orthodontist can reclaim by tipping the teeth back after extractions? Will I be at risk for losing teeth later on in life as the jaw bone thins?

[terry947]

well like lazlo has said a bunch of times, removing teeth are a bad idea. What If you widened the palate and tipped the  front teeth back?

[molestrip]

How much could I gain? 1-2mm? I could advance 5mm and still have PAS of 12-13mm, adequate with protrusion of 4mm. Seems like a tolerable amount.

My palate is already wide. I should get 5mm more w/3-piece and eliminates crowding. More than that will be creating a crossbite.

[terry947]

not sure why would you get a crossbite by expanding? As for gaining, depends how much you can expand. Its all speculation but of you have a narrow from U/V shape you could probably get decent gains. This is how Im thinking of fixing my bimax protrusion.

And I I'm not too sure what to do if you're palate is already wide. There might be an issue with function if you pull some teeth, I've seen some videos on youtube where people said after extractions they got tmd and countless other issues. Id say do some research before going the extraction route because theres no going back after.

[molestrip]

Right now my best options seem to be to accept the ugliness or reduce my advancement. I don't like either option. I'd like to figure out how A/G reduce the upper lip width by 3mm, as shown here. That solves all my problems and makes me a happy person. It's depressing to think I might go through this surgery, make myself ugly and possibly not cure my OSA. I'd still fix my bite, though, and I'm looking forward to having more than 3 teeth touch again.

I'm looking for pictures of white men with protrusive lips. I saw a guy today on the street who looked like he had them. It's not pretty but it's not terrible I think. I found one of a black guy here. He looks ok to me, no?

[terry947]

I just thought of this but worse case scenario, if you end up not getting any teeth removed and are unhappy with your results post jaw surgery, you can always get them removed 1-2 years down the line. It might also be worth getting a consult with A&G to get their opinion since it seems like they're very focused on aesthetics.

Also If you're similar to me, I think having a stronger jaw/chin and slight bimax protrusion is better than having a weak jaw/chin and no noticeable protrusion.

If you're white I doubt you'll look like that guy, unless you already have a flat facial profile. Not too sure though

[molestrip]

That's what the surgeon said too, only the other thread cautions against removing teeth. I don't have a flat facial profile but I also don't have a receded one either so a normal retrognathic profile. I have extra skin underneath by mandible so bimax will fix that and steepen the jaw line. Maybe the net effect is neutral then.

I visited A/G already. They'd balance out the face with cheekbone augmentations and shorten the upper lip. The plan shows 7mm of advancement but only 4mm protrusion, the difference seeming to be in the lip itself. I think it was a VY lip lift and he seemed pleased that I had thick lips to start. Is that responsible for the 3mm shrinkage? Other possibilities are pressure/stretching from more slanted teeth or the shorter lip sitting higher up on the upper teeth.

[terry947]

Hmmm interesting. Do you have an open bite? Also how long is your upper lip?

[molestrip]

I have a 2mm open bite but my wisdom and molars are significant worn down so it'd likely be much bigger when restored. My upper lip is 20mm so about 1.5mm longer than average for my age. I'd guess lack of support underneath has caused it to sag more quickly over the years.

[PloskoPlus]

I can understand being concerned about the aesthetic effects of jaw surgery for sleep apnea if you didn't  have a dentofacial deformity... but an open bite is pretty severe deformity.  I doubt you will look any worse. 

I don' think VY-plasty does anything to shorten the lip.  Maybe if done in isolation.  Its main application in jaw surgery is to preserve the vermillion.  I've had it, and my lip length is exactly the same.