I want to die due to my looks: Desperate to shorten long face, advance lower jaw

[CCW]

Very hypothetical and different for each individual, but in general, wouldn't a large advancement basically cancel out the midface volume you would get from CCW?

No, not really. One of the benefits of counterclockwise rotation is that you don't have to do a large maxillary advancement since most of the movement comes from the rotation. This way you avoid getting too much fullness at the base of the nose, which you often get if you do a straight advancement when counterclockwise rotation is indicated. You want to be conservative with maxillary movements, and more midface volume is not better.

This girl was advanced 42mm (Wolford).

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[CCW]

Sorry in advance for the newbie-style question, but what is the etiology of the maxilla failing to grow enough in the back? Mouth breathing? But this view still isn't consensus, right? Because I've seen authors write that the directionality is the opposite - it's the posterior deficient maxilla that causes mouth breathing and not the other way around.

Genetics mostly, I think. It's my understanding as well mouth breathing is caused by the jaws and not the other way around. The breathing pattern corrects itself when the skeletal issue is fixed.

Does this therefore correct some scleral show in a similar manner as a LeFort I?

Yes, better soft tissue support, so the lower eyelid moves up.

OP is a man and it's generally a more attractive/masculinized feature for the midface to be slightly shorter.

Yeah, I figured OP was a man, but it doesn't matter and the figure still applies. I don't really care about "midface length" because I think it's all about balance and harmony.

[PloskoPlus]

No, not really. One of the benefits of counterclockwise rotation is that you don't have to do a large maxillary advancement since most of the movement comes from the rotation. This way you avoid getting too much fullness at the base of the nose, which you often get if you do a straight advancement when counterclockwise rotation is indicated. You want to be conservative with maxillary movements, and more midface volume is not better.

This girl was advanced 42mm (Wolford).

The stuff I saw in Wolford's office was the best I've ever seen.

[Lazlo]

The stuff I saw in Wolford's office was the best I've ever seen.

No wonder. I was like if she went from that to there, then why the hell does my mandible still look recessed. Well I was advanced like 6mm (plus 9mm genioplasty) --Should have been advanced like 12mm bsso, plus 10 genioplasty for a total of 22mm.

[PloskoPlus]

No wonder. I was like if she went from that to there, then why the hell does my mandible still look recessed. Well I was advanced like 6mm (plus 9mm genioplasty) --Should have been advanced like 12mm bsso, plus 10 genioplasty for a total of 22mm.

She had a massive CCW rotation - her upper lip hardly changed at all, so probably minimal advancement of the maxilla.  Wolford invented CCW, so little wonder he can do them. 

[CCW]

She had a massive CCW rotation - her upper lip hardly changed at all, so probably minimal advancement of the maxilla.  Wolford invented CCW, so little wonder he can do them.

She was rotated from 34 degrees to 8. It makes me laugh when some some run-off-the-mill surgeon, who makes his living pulling wisdom teeth, says CCW isn't a stable movement, and this girl has remained stable for 22 years after such a huge rotation.

[PloskoPlus]

She was rotated from 34 degrees to 8. It makes me laugh when some some run-off-the-mill surgeon, who makes his living pulling wisdom teeth, says CCW isn't a stable movement, and this girl has remained stable for 22 years after such a huge rotation.

Do you have more details?  The picture says she was stable after a year, not 22 years.  Interestingly enough no mention of TJR.

[CCW]

Do you have more details?  The picture says she was stable after a year, not 22 years.  Interestingly enough no mention of TJR.

It says that on picture.

At 22-years post surgery the patient maintains good facial balance and function.

This 15 year-old patient (Figures 21 A-C, 22 A-C, 23 A) developed severe juvenile idiopathic arthritis, diagnosed at age 11 years with milder effects in multiple other joints, had severe sleep apnea, but was relatively pain free. Incisal opening was 42 mm.

The treatment plan (Figure 23 B) in a single stage surgery included:
Bilateral TMJ reconstruction and mandibular advancement in a counterclockwise direction with TMJ Concepts/Techmedica total joint prostheses
Bilateral coronoidectomies.
Multiple maxillary osteotomies to move the anterior aspect upward and posterior aspect downwards.
Genioplasty with a 14 mm alloplastic implant.
Bilateral partial inferior turbinectomies.
The traditional C-TJR-OS protocol was used to prepare this case for surgery with the surgery performed on the sterolithic model by the surgeon for manufacture of the TMJ total joint prostheses, then duplicated on the articulator mounted dental models for construction of the intermediate and final palatal splints.

With the counter-clockwise rotation of the maxillo-mandibular complex and the genioplasty, pogonion advanced forward 42 mm. The patient is seen at 1-year post surgery (Figures 21 D-F, 22 D-F) with good facial balance, no pain, skeletal and occlusal stability, and an incisal opening of 33 mm. At the age of 37 years (22 years and 3 months post surgery), she maintains good facial balance and stability, no pain, and an incisal opening of 37 mm with no dietary limitations (Figures 21 G-I, 22 G-I).

http://www.drlarrywolford.com/tmj-temporomandibular-joint-disorders/total-temporomandibular-joint-tmj-replacement-2/

She did have TJR. Wolford also had to build her a chin since she literally didn't have one.


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[PloskoPlus]

Sorry didn't see that. f**king amazing. I asked him about the horrendous reviews. He said a couple of unhappy patients create all the bad reviews and he basically does cases that nobody else will. Most people are happy and just move on with their lives. He wished that they would actually let their good experience be known.

[Lestat]

I am literally having a breakdown. Which I have almost EVERYDAY. At weekends I just sleep and don't leave the house much. I can't cope with this s**t anymore.

Suicide is cope.
Life has many great pleasures, even without society.

[MrFox]

Suicide is cope.
Life has many great pleasures, even without society.

Agreed, for all  you know there is nothing after you die, your existence and potential in this life is too great to throw away.

[CCW]

Sorry didn't see that. f**king amazing. I asked him about the horrendous reviews. He said a couple of unhappy patients create all the bad reviews and he basically does cases that nobody else will. Most people are happy and just move on with their lives. He wished that they would actually let their good experience be known.

What did they concern? The only negative things I have heard about Wolford have been about the Mitek anchors. By all accounts when it comes to jaw surgery, Wolford is one of the best in the world and a legit artist.

[PloskoPlus]

What did they concern? The only negative things I have heard about Wolford have been about the Mitek anchors. By all accounts when it comes to jaw surgery, Wolford is one of the best in the world and a legit artist.

Perhaps the TJR horror stories cast a pall on his reputation for me. But if you look on his site, his preop photos have the patient basically looking down and post op looking horizontally as if to over emphasize the effect of CCW. Fwiw he had me basically staring at the ground in his photos.

[CCW]

Perhaps the TJR horror stories cast a pall on his reputation for me. But if you look on his site, his preop photos have the patient basically looking down and post op looking horizontally as if to over emphasize the effect of CCW. Fwiw he had me basically staring at the ground in his photos.

On his site, he explains the correct head position in which patients should be evaluated. The pictures seem to follow his guidelines.

http://www.drlarrywolford.com/tmj-jaw-surgery-diagnosis-treatment/patient-evaluation-tmj-dentofacial-abnormalities/
http://www.drlarrywolford.com/tmj-temporomandibular-joint-disorders/total-temporomandibular-joint-tmj-replacement-2/

[PloskoPlus]

On his site, he explains the correct head position in which patients should be evaluated. The pictures seem to follow his guidelines.

http://www.drlarrywolford.com/tmj-jaw-surgery-diagnosis-treatment/patient-evaluation-tmj-dentofacial-abnormalities/
http://www.drlarrywolford.com/tmj-temporomandibular-joint-disorders/total-temporomandibular-joint-tmj-replacement-2/

Look more carefully. He has the preops staring at the floor.