What effect would a 5mm movement have on soft tissue? Class II, short maxilla.

[Icy]

Hi all!
Saw my orthodontist again yesterday, and from the measurements she's taken she believes we'll be able to get up to 5mm of forward lower jaw movement, not factoring in upper jaw movements as well. What kind of effect could this have on the soft tissue? My mouth and chin area is very downturned and is starting to look somewhat saggy (at age 23, sigh), is this kind of movement likely to exert any kind of measurable effect? I have a deep overbite, slightly short face and my teeth are quite far back in my face due to lack of forward jaw growth.

I have a pretty deficient midfacial area, so I'm also a bit concerned that it will make it worse, though my eyes are relatively normal looking, just have deep circles and tear troughs. Is there a chance that forward movement could pull on the tissue and worsen my appearance in that way? Has anyone had any experience of this happening? I find my profile really unpleasant looking and I would hate to end up looking worse off than I already do, but the surgery is very much necessary to correct my overbite.

I couldn't take a decent profile photo, so I improvised with some shots from my sister's wedding just to show what I mean. I feel like the downturned neutral expression and weak jaw is very very apparent in 3/4 view as you can see here http://i66.tinypic.com/2j3pket.jpg while looking at my face next to my sister's, her entire mouth and teeth are forward and mine recede backward as you can see here even when smiling as hard as I can. http://i66.tinypic.com/wtg178.jpg Is this type of movement going to make my mouth area look more like hers? Is it even possible to make someone with such "backward" development have a normal forward smile? When we sat down and she pulled my jaw forward to show me approximately where my lower jaw would rest after surgery, my jaw definition definitely improved, but I know soft tissue is very unpredictable...

[cantstop]

I'm clueless but I'd like to know as well since I think I also need about 5mm lower jaw advancement

[boyo]

The facial change is far more dramatic when advancing the lower maxilla vs the mandible, at least front on. Your whole midface contour is changing with upper jaw surgery. More advancement will increase the overall convexity to your face, it will make your face appear fuller around the mouth but everything else will still lag behind. This change can look bad, especially in males depending on how weak your midface is pre-op. Lower jaw surgery don't have this kind of impact on soft tissue and the result is far more predictable.

[thinkingme]

why i cant see anything bad. If u get 5 mm advancement didnt u get underbite?

[Icy]

why i cant see anything bad. If u get 5 mm advancement didnt u get underbite?

No, my teeth are being damaged by my deep overbite, and my upper jaw is too short so my upper teeth don't show well. I won't be having only lower advancement, as the lack of tooth show needs to be addressed as well. Returning my teeth to the correct angles has helped a bit, but it's still sub optimal.

[boyo]

can that be fixed by using implants in the midface area to add forward projection? (i know implants aren't ideal, but its more realistic than getting lefort 3). i wanna get both jaws advanced 10mm lmao. Thanks

Let's be honest, lf3 is no more then a pipe dream. There is one guy in here who allegedly got it and it still didn't really improve his facial attractiveness. The guy performing them on non-deformed patients are 80 years old. You're going to let this old guy cut millimeters away from your orbital nerves, risking blinding you with one simple miscalculation just so you can get your malars advanced by some couple of mm? The risk is just too big vs the reward, especially if you're not completely ugly and just want to improve your appearance. 

Implants are realistically the only choice. Getting custom made implants made of calcium phosphate would be perfect, but i'm not sure when they would be available to us. This video explains why these implants are superior to any other type of implant or body graft:

View My Video

ICY in my opinion i believe you could improve substantially with jaw surgery. Teeth and smile are very important in looking young and healthy and yours would only get far worse when you start to age (people with solid bone structure ages best). Just know that bringing your upper jaw forward may or not force you to get other types of surgery (rhinoplasty and malar implants) later on.

[PloskoPlus]

Earl's osteotomy is the best upper midface work I've seen by far. No implants compare.

[Icy]

ICY in my opinion i believe you could improve substantially with jaw surgery. Teeth and smile are very important in looking young and healthy and yours would only get far worse when you start to age (people with solid bone structure ages best). Just know that bringing your upper jaw forward may or not force you to get other types of surgery (rhinoplasty and malar implants) later on.

Agreed. I only know of one other person in my family (my mother's cousin or second cousin, not 100% sure) that has had serious jaw and teeth issues, I found out that he had underbite surgery about 25-30 years ago, but I think they only moved his lower jaw back and didn't address anything else so he looks terrible... sagging under eyes with lots of scleral show, deep sagging around the mouth, chin and jaw, very little tooth show, just not a pretty picture. He looks a good 10-15 years older than he is. Really not wanting to end up like that, even though my facial structure is quite different from his, still a bit worrying.

Now I'm aware that my midfacial issues will likely never be truly fixable, and that I'll probably have to perform damage control as I go. I'm not sure if I would trust any traditional facial implant, and fillers are not exactly a viable long term option, so I'll have to wait and see on that. I'm calling my orthodontist again today to see where we are, as she needed to liaise with the surgeon. I still need TMJ surgery and wisdom tooth extraction (had to be delayed due to illness), but she was highly optimistic that as soon as that is done and I am healed, the second surgery can take place. I have already had septo-rhinoplasty due to breathing issues, so I'm hoping I won't have to repeat that due to changes from upper jaw surgery! Question, does upper jaw surgery help with the paranasal hollowing and sagging effect at all? Pictures that I've seen are a bit ambiguous, since people are often smiling in them. I hate that people are always asking me if I'm sad due to my downward turned mouth, so it would be so nice if that was mitigated, even a little bit!  :/

[PloskoPlus]

LF1 advancement picked up all the loose skin in my paranasal area. I looked really haggard before surgery (losing 10kg 6 months brood surgery made it even worse).

[Icy]

LF1 advancement picked up all the loose skin in my paranasal area. I looked really haggard before surgery (losing 10kg 6 months brood surgery made it even worse).

Well that's quite heartening! I'm not likely to lose too much weight, I'm already quite underweight as it is, so I'll have to make sure to keep my calories high enough! I don't think my upper movement would be too large, so as to avoid potential overcorrection, what were your movements, for interest?

[PloskoPlus]

Well that's quite heartening! I'm not likely to lose too much weight, I'm already quite underweight as it is, so I'll have to make sure to keep my calories high enough! I don't think my upper movement would be too large, so as to avoid potential overcorrection, what were your movements, for interest?

Lf1 advancement 6mm. I did not lose weight after surgery.  I lost weight on purpose 6 months before surgery. My theory is those that lose a lot of weight after surgery were overweight to begin with. But then again, I had only upper jaw surgery. It's probably different with bi-max.

[Icy]

Lf1 advancement 6mm. I did not lose weight after surgery.  I lost weight on purpose 6 months before surgery. My theory is those that lose a lot of weight after surgery were overweight to begin with. But then again, I had only upper jaw surgery. It's probably different with bi-max.

Hmm, I see. I imagine my upper movements will be quite small, so I'm interested to see how things develop. I'll keep things posted here as I go!