If one has a very dolichocephalic skull pattern, retrognathia, very mild maxillary retrusion, no anterior maxillary excess, basically no ramus, and lastly, a mandibular plane angle of 40 degrees, how would bimax w/CCW rotation be of much aesthetic benefit over camouflage procedures like SG, implants, or chin/side wings? I'm describing myself but this may be the case of other 'borderline' people. Because like if you can't impact the anterior maxilla, then how are you benefiting from the CCW rotation with just a posterior downgraft alone for the rotation? Your mandibular plane angle won't change much at all. People say the biggest aesthetic benefit of bimax is from CCW and not straight forward advancement. Sure straight forward advancement helps, but can't that be masked with plastic surgery? In fact I'm already considered 'well compensated' by some with a 12mm chin implant and rhinoplasty, both I did before realizing I had retrognathia.
For instance, Gunson's plan for me is no maxilla anterior impaction, but about a 10mm posterior downgraft. 15mm lower jaw, 2mm upper jaw, and 3mm SG. That gets me 6mm more at the pogonion vs my current profile before you consider a less than perfect surgery, which could easily get me back to within 2-3mm of my current chin. Also my mandibular angle plane would barely change. It'll be 5 degrees better if that. That's due to the lack of maxilla anterior excess to impact, which would then let the lower jaw come up and reduce the MPA.
So if I were to get bimax hoping for it to be my last surgery with a ~2 point looks gain, I think I'll come out very disappointed.
The benefits of CCW, as I understand it, is to shorten the face thereby helping fill in the mid-face and getting you a more naturally forward-growth pattern looking jaw. You get this by BOTH posterior maxilla downgrafting AND anterior maxilla impaction for the full CCW rotation. One without the other significantly reduces the aesthetic potential of a textbook CCW movement. Great I don't have a gummy smile to start with, but that means bimax won't do much more than this chin implant is doing for me already. My jaw angle will still be steep and probably not anymore defined because it's so narrow and seriously dolichocephalic.
Counter argument is if you look below average anyways, then you'll need bimax just to get a 'normal' face to only then improve upon vis-a-vis PS. So then you're looking at bimax followed by a face full of implants or osteotomies as you see fit. As I stand now without any nagging medical issues to also address with bimax, I don't want use bimax solely as a cosmetic 'gateway' surgery to the actually helpful cosmetic ones. Without medical problems, it may be 'close enough' to augment what I already have and call it a day. Probably just fix my nose, think hard about a side wing + ZSO from Dr. Z, and be done.
