What surgeries do I need?

[PloskoPlus]

Impaction but also you have to cut the mandible, it is double jaw surgery.
You can get an alar cinch to reduce alar widening but it may cause your nose to upturn more, or you can go for a rhino later. I'd use the alar cinch suture.

I don't know how much you need.

Downgraft of the posterior part of the maxilla can achieve ccw without impaction of the front of the maxilla. The really dramatic results that you see from wolford, arnett are usually a combination of posterior maxillary downgraft with anterior impaction.

[lowlhfsh]

Thanks.   Do you know what's the name of the lower jaw proccedure for achieving CCW (no set-back)?

[Tezcatli]

Thanks.   Do you know what's the name of the lower jaw proccedure for achieving CCW (no set-back)?

I believe it is also a BSSRO, Bilateral sagittal split ramus osteotomy, it is the same procedure for setting back or advancing the mandible but things will be fixed in a different manner.

Downgraft of the posterior part of the maxilla can achieve ccw without impaction of the front of the maxilla. The really dramatic results that you see from wolford, arnett are usually a combination of posterior maxillary downgraft with anterior impaction.

Hm, that is interesting, I will need to read more about it. I have a gummy smile so I will be getting impaction but I don't know if I will get downgrafting, when is it usually needed?

[PloskoPlus]

I believe it is also a BSSRO, Bilateral sagittal split ramus osteotomy, it is the same procedure for setting back or advancing the mandible but things will be fixed in a different manner.

Hm, that is interesting, I will need to read more about it. I have a gummy smile so I will be getting impaction but I don't know if I will get downgrafting, when is it usually needed?

If the occlusal plane is really really steep, to make the mandible autorotate more and make even greater mandibular advancement possible.  The long face, no lower jaw whatsoever examples you see on Wolford's and A&G's websites are basically this.

CCW can even be achieved with double-down grafts.  For example in the case of steep occlusal plane and poor tooth show - down graft a little in the front, a lot in the back, so the net effect is a CCW rotation still.

[lowlhfsh]

That seems interesting. However, I'm wondering if downgrafting maxilla when you already have a long midface is a good option to take.