You're only borderline considering you already had a large implant placed. I agree you should have had jaw surgery to begin with and you were not borderline. The MPA isn't that interesting to me because it's just a measure of the amount of excess vertical growth you got but not a measure of deficiency, it's purely aesthetic. The occlusal plane is way more interesting to me and you've got a pretty steep one, that's why Dr Gunson wants to downgraft it so much. Unfortunately, he can't downgraft it too much without creating a discontinuity in the jaw line since he can't touch the ramus which is why he needs to advance both jaws. Doing that will create an imbalanced face though so it's a game of tradeoffs. I think he has a pretty good plan here, especially if it removes that foreign body from your chin. You had a really small airway before that will cause problems soon if not already. You've also got an arch form deformity that he can surgically fix which will improve the health of the teeth long term. Pretty narrow nostrils and lots of volume missing under the eyes.
Basically, you were a moderate to severe case before the implant/rhino surgery and it only looks minor now. You still have some health problems that surgery can address. I think you look ok now but you'll look a little better after. I'd want the surgery in your case and shame on the plastic surgeon for not recommending it to you the first time. And yes he knew better!
Arch deformity - My upper palate or both are narrow? An ortho said my lower is fairly narrow, but no mention of the upper and that's been the extent of it. To tjaar & molestrip regarding my airway, that ceph you saw is with my jaw properly seated in the joint. My jaw's subconsciously jut out 2-3mm to form my bite. My AHI rating is 10, from a sleep study, and my airway, per Gunson's analysis, is 186mm. My nose is basically no use for normal breathing, despite the prior septorhino. The nose cavity looks to me like it was narrowed from the surgery. Neither did surgery correct the long nose affect which is piling onto the long midface problem I have.
My jaw & midface are naturally super narrow. I am concerned that without some widening and advancement type surgery on the mid-face, correcting the jaws alone won't help much aesthetically. BTW when people say they had their jaw advanced "x"mm, are they referring to the total at the pogonion or the literal jaw cut and forward movement? If I look at straight advancement, Gunson moves my maxilla forward just 2.8mm and my mandible only 8.8mm. People here have said 15mm mandible advancements make the big aesthetic difference, and people with 12mm or less tend to be disappointed. But then Gunson rotates my mx1 tip a whole 8mm and rotates posterior down 9.6mm, which are both on the large end of the spectrum. But isn't 8.8mm of a jaw cut not nearly enough for sleep apnea treatment, let alone aesthetic treatment? Gunson said his plan would treat even severe sleep apnea, but his big movements are really in the CCW area rather than straight advancement. The latter of which I thought treats sleep apnea. Am I following this right? I checked with Dr Gary Warburton and his rough cut surgerical plan would halve Gunson's movements by 50-60%, which gives me some perspective for sure.
I think the area below my eyes and just above the apple of my cheeks have significantly hollowed out from the rhinoplasty. I presume that's the area molestrip was referring to? I suppose I'd need to see either Yaremchuk for a full head of implants post bimax, or Dr Sinn for a modified LF3 post bimax, and/or Dr Z for a ZSO and/or chin wing post bimax. It's so much easier just doing nothing honestly, ugh.
