Lefort 1 just for a gummy smile? Pics included

[trex0288]

Hello I am new here and haven't found a case similar to mine so I thought I would post my specific case to see what you folks think. Ever since I was young (around 5 or so) I was a habitual mouth breather mainly during sleep. Every morning I would wake up to my mouth feeling like sandpaper without fail. So it turns out I had a pretty badly deviated septum which I had fixed a few years ago (Im 27). Now I want to fix my gummy smile which I believe was a result of my mouth breathing. I went to an oral/maxillofacial surgeon and he agreed I have vertical maxillary excess. He told me he would likely do a 5mm impaction of my maxilla and would hopefully auto rotate my lower jaw in place without surgery. I am waiting for his work up on his 3D program to see if I would need lower jaw surgery as well. He also suggested I get a genioplasty since my chin is near vertical. I saw an orthodontist and he said I would be in braces for roughly a year and he also mentioned my teeth were in good shape since I had braces when I was younger. So my question to all of you is will the surgery be worth it for me? In my case my bite is fine I just hate my smile and how long my face looks. I know the impaction will shorten my face which is exactly what I want but I don't want a wider nose (apparently its worse for ethnic people which I am). Also what other changes can I expect from a surgery like this? 

http://imgur.com/a/Br5rn     -    Link to my pictures

http://drrichardjoseph.com/photos/121.php    -    This would be my ideal result but I know its not reasonable since she is white and I am ethnic. Do you think I can obtain a result similar to this?

[JawKid7]

I would say I have a similar case to yours however I have a gummy smile, underbite and a recessed maxilla, my lower jaw is completely fine. I'm a mouth breather and I can't breath through my nose, so this is probably the main reason I'm having the surgery. Since you've already fixed your deviated septum I'm assuming you can breath perfectly now? what other functional problems do you have? I guess for you it's just about if it's worth the money and if you're willing to go through a year of braces + long recovery from the surgery itself

[trex0288]

I would say I have a similar case to yours however I have a gummy smile, underbite and a recessed maxilla, my lower jaw is completely fine. I'm a mouth breather and I can't breath through my nose, so this is probably the main reason I'm having the surgery. Since you've already fixed your deviated septum I'm assuming you can breath perfectly now? what other functional problems do you have? I guess for you it's just about if it's worth the money and if you're willing to go through a year of braces + long recovery from the surgery itself

My breathing has improved probably 70-80 percent but I still get congested and I read somewhere that if you have long face syndrome it can pull your nasal cavity down because your nose droops down? There are no functional problems just cosmetic. I guess my main concern is how much my look will be impacted from surgery. Personally I would prefer a more drastic change to my face since it is so long but my surgeon told me it would be subtle.

[JawKid7]

My breathing has improved probably 70-80 percent but I still get congested and I read somewhere that if you have long face syndrome it can pull your nasal cavity down because your nose droops down? There are no functional problems just cosmetic. I guess my main concern is how much my look will be impacted from surgery. Personally I would prefer a more drastic change to my face since it is so long but my surgeon told me it would be subtle.

if the surgeon said the changes are gonna be subtle then that's probably gonna be the case. Maybe ask about some additional procedures

[PloskoPlus]

Surgery affecting facial length is always the most dramatic.

Do you have lip strain?

[trex0288]

Surgery affecting facial length is always the most dramatic.

Do you have lip strain?

I do have lip strain. I have about 7mm of tooth show when my lips are at rest. Dramatic in a good way I suppose?

[PloskoPlus]

I do have lip strain. I have about 7mm of tooth show when my lips are at rest. Dramatic in a good way I suppose?

Dramatic as in the biggest perceptible change possible for jaw surgery.  Hopefully in a good way.  If you have lip strain, you definitely need surgery.

[Bobbit]

 . . .  In my case my bite is fine I just hate my smile and how long my face looks. I know the impaction will shorten my face which is exactly what I want but I don't want a wider nose (apparently its worse for ethnic people which I am). Also what other changes can I expect from a surgery like this? 

http://imgur.com/a/Br5rn     -    Link to my pictures

Suggestion . . .   consider finding a good board certified plastic surgeon who is also trained in jaw surgery (max fac or orthognathic) 

Why ?   (awkward - being a bit blunt )  - - -  a good guess is that you have some issues with your facial features that include  the upper tooth show, the chin, and likely the nose.   The  plastic surgeon who is also cross trained as a jaw surgeon - - - can likely offer you some options that would not likely be available with a  max / fac surgeon who was not also a well trained plastic surgeon.  You could get it all done in one trip to the operating room.

[PloskoPlus]

Suggestion . . .   consider finding a good board certified plastic surgeon who is also trained in jaw surgery (max fac or orthognathic) 

Why ?   (awkward - being a bit blunt )  - - -  a good guess is that you have some issues with your facial features that include  the upper tooth show, the chin, and likely the nose.   The  plastic surgeon who is also cross trained as a jaw surgeon - - - can likely offer you some options that would not likely be available with a  max / fac surgeon who was not also a well trained plastic surgeon.  You could get it all done in one trip to the operating room.

Doing the nose at the same time as jaw surgery is a bad idea, unless it's only basic stuff.  Swelling sets in quickly.  Better wait 6, ideally 12 months after upper jaw surgery.

[trex0288]

Suggestion . . .   consider finding a good board certified plastic surgeon who is also trained in jaw surgery (max fac or orthognathic) 

Why ?   (awkward - being a bit blunt )  - - -  a good guess is that you have some issues with your facial features that include  the upper tooth show, the chin, and likely the nose.   The  plastic surgeon who is also cross trained as a jaw surgeon - - - can likely offer you some options that would not likely be available with a  max / fac surgeon who was not also a well trained plastic surgeon.  You could get it all done in one trip to the operating room.

Yea my surgeon suggested I get a genioplasty while doing the upper jaw. I was just wondering if the outcome would make me look better than I look currently.

[trex0288]

Doing the nose at the same time as jaw surgery is a bad idea, unless it's only basic stuff.  Swelling sets in quickly.  Better wait 6, ideally 12 months after upper jaw surgery.

Thanks for your input

[Bobbit]

Doing the nose at the same time as jaw surgery is a bad idea, unless it's only basic stuff.  Swelling sets in quickly.  Better wait 6, ideally 12 months after upper jaw surgery.

PP,

Yes. Agree in general.

  Depending on what he wants done and what he wants to achieve - - it might not be prudent to attempt it all in one procedure.  But that was all really the point to the post - - Until he gets his situation evaluated by some surgeon that has ALL of the surgical skill sets required to do all of the potentially appropriate procedures that he may need to reach the final result he wants - - then he really will not know the answer.

Consulting with a surgeon who only has part of the complete set of tools in his tool box - -  will likely result in some version of the old comment that the world looks like a nail to the guy with the hammer,  but it looks like a phillips head screw to the guy with the right screw driver.    He likely needs to be evaluated by somebody that has both the hammer and the screw drivers in his tool box.
 
           ********

All of that considered  - -  I have seen some  pictures taken 24 to 48 hours or so after double jaw surgery  for a couple of  people for which the swelling was one heck of a lot less than in many of the pictures seen here.  That level of swelling in those pictures - -  in my mind  - - would not likely have precluded nose work during the same procedure.   I suppose a lot of that would depend on what the individual surgeon's personal experience is with swelling in the surgeon's jaw surgery patients. 

 

[ForeverDet]

I am less concerned about your gummy smile and incisor exposure than I am about your bite. It is almost edge to edge (possible crossbite too?) and gives you that slightly under bite look. It is contributing to your lip competence/chin strain and may cause functional/pain issues down the line.

Decompensation via orthodontics is needed to reveal the actual severity of your bite than assess whether single or double jaw surgery is needed. A genioplasty may not be necessary because in the relaxed position, your chin is shaped well and prominent. It's just distorted when your close your lips.

Are you smiling naturally in the photos? Because your upper teeth look slightly small (unless it's just the angle) so it's possible those can be revealed via cosmetic dentistry more and then a smaller amount of impaction will be necessary to reduce the gumminess.

Your incisor exposure is excessive but I can see you lower lip has good posture and upper lip is nicely formed.

Also that ceph has some measurements, was that from the surgeon? It is essential for any measurements and planning to be done with your lips and bite in a relaxed position. Not when your forcing your lips closed. Because it can lead to an insufficient or worse, negative surgical outcome.

[trex0288]

I am less concerned about your gummy smile and incisor exposure than I am about your bite. It is almost edge to edge (possible crossbite too?) and gives you that slightly under bite look. It is contributing to your lip competence/chin strain and may cause functional/pain issues down the line.

Decompensation via orthodontics is needed to reveal the actual severity of your bite than assess whether single or double jaw surgery is needed. A genioplasty may not be necessary because in the relaxed position, your chin is shaped well and prominent. It's just distorted when your close your lips.

Are you smiling naturally in the photos? Because your upper teeth look slightly small (unless it's just the angle) so it's possible those can be revealed via cosmetic dentistry more and then a smaller amount of impaction will be necessary to reduce the gumminess.

Your incisor exposure is excessive but I can see you lower lip has good posture and upper lip is nicely formed.

Also that ceph has some measurements, was that from the surgeon? It is essential for any measurements and planning to be done with your lips and bite in a relaxed position. Not when your forcing your lips closed. Because it can lead to an insufficient or worse, negative surgical outcome.

Wow! you must be a doctor because everything you said was spot on. I do have edge to edge teeth. The doctor also said my old orthodontist did camouflage which pulled my lower teeth back to give me a slight overjet. The doctor did say I have a flat chin as seen in my ceph (I got the ceph from my dentist). I am smiling as hard as I can to really show what I look like when I laugh. My teeth are slightly small but I really want to shorten my face. I just want to know if I will look better than I do because my face is so long and I hate it. Maybe I have body morphia lol...Do you think the result of an impaction will make me look better? Thanks for your response and time

[trex0288]

I am less concerned about your gummy smile and incisor exposure than I am about your bite. It is almost edge to edge (possible crossbite too?) and gives you that slightly under bite look. It is contributing to your lip competence/chin strain and may cause functional/pain issues down the line.

Decompensation via orthodontics is needed to reveal the actual severity of your bite than assess whether single or double jaw surgery is needed. A genioplasty may not be necessary because in the relaxed position, your chin is shaped well and prominent. It's just distorted when your close your lips.

Are you smiling naturally in the photos? Because your upper teeth look slightly small (unless it's just the angle) so it's possible those can be revealed via cosmetic dentistry more and then a smaller amount of impaction will be necessary to reduce the gumminess.

Your incisor exposure is excessive but I can see you lower lip has good posture and upper lip is nicely formed.

Also that ceph has some measurements, was that from the surgeon? It is essential for any measurements and planning to be done with your lips and bite in a relaxed position. Not when your forcing your lips closed. Because it can lead to an insufficient or worse, negative surgical outcome.

I forgot to add my dentist told me to close my mouth during the ceph but the maxillofacial doctor took my measurements with relaxed lips and all. I am just impatiently waiting to hear back from him whether or not I will need double jaw surgery. If you look in my album, towards the end there are a few pics of me with my mouth closed and lips relaxed