One surgeon suggesting CW rotation, another suggesting CCW - WTF?

[ExtractionsRuinFaces]

Isn't this a bit odd? surely if one suggests CW rotation then you have a vertical deficiency in the frontal part of the maxilla? I have a lack of tooth show when talking and I have no gummy smile, why the hell would a surgeon suggest CCW in my case? my occlusal plane is fairly flat and so is my mandibular plane.

CCW would reduce my tooth show even further and give me an even more squished looking face, i just dont get why a surgeon would suggest this?

Has anyone else had surgeons recommend different things such as CW and CCW? I can see it making sense if it was between linear advancement and some kind of rotation (one surgeon saying linear advancement, the other saying CW rotation) but surgeons recommending the OPPOSITE kinds of rotation? what the hell man.

[Wraparoundshotgunimplant]

Legitimately insane.

I think you're going to have to name the surgeon 

Perhaps best for us to avoid him (or at least study him with greater scrutiny).

[ExtractionsRuinFaces]

Legitimately insane.

I think you're going to have to name the surgeon 

Perhaps best for us to avoid him (or at least study him with greater scrutiny).

The one who suggested CW is well respected and has provided good, consistent results for many members here so I trust his opinion more - CW just makes more sense for my face although I think perhaps linear advancement would be the best outcome aesthetically speaking for my FACE. CW would benefit my smile the most I reckon.

The guy who suggested CCW didn't speak good english at all but he had a translator with him and I am almost positive he was suggesting CCW. He wanted to impact the maxilla. IMPACT. My face is already short and my maxilla is honestly vertically deficient at the front. I have a normal upper lip size (15-16mm?) and NO tooth show when I speak or hang my mouth open.

[PloskoPlus]

The one who suggested CW is well respected and has provided good, consistent results for many members here so I trust his opinion more - CW just makes more sense for my face although I think perhaps linear advancement would be the best outcome aesthetically speaking for my FACE. CW would benefit my smile the most I reckon.

The guy who suggested CCW didn't speak good english at all but he had a translator with him and I am almost positive he was suggesting CCW. He wanted to impact the maxilla. IMPACT. My face is already short and my maxilla is honestly vertically deficient at the front. I have a normal upper lip size (15-16mm?) and NO tooth show when I speak or hang my mouth open.

Are you sure he did not suggest CCW via posterior down graft rather than impaction?

[ExtractionsRuinFaces]

Are you sure he did not suggest CCW via posterior down graft rather than impaction?

He said both, that he would impact the anterior maxilla and downgraft the posterior. The anterior part of my maxilla is already on the short side though, I show barely any teeth when talking and no teeth are visible if I hang my mouth open despite my short to normal size upper lip. He did say that moving the maxilla forward would "cancel out" the impaction at the anterior part but I just dont see how impaction would benefit me at all, if anything it would make me look older and WORSE.

[ditterbo]

He said both, that he would impact the anterior maxilla and downgraft the posterior. The anterior part of my maxilla is already on the short side though, I show barely any teeth when talking and no teeth are visible if I hang my mouth open despite my short to normal size upper lip. He did say that moving the maxilla forward would "cancel out" the impaction at the anterior part but I just dont see how impaction would benefit me at all, if anything it would make me look older and WORSE.

Ok so I thought anterior impaction, in a case like yours w/respect to teeth show, is purely so that your face can be shortened more by making your jaw tuck in more before it meets your upper teeth. So bottom line is that would lessen, or keep the same, your mandibular plane angle. There might be some technicality here with how a lot of foward movement cancels out the impaction.  So he claims your teeth show won't change, but you are removing bone in your face.. so that could put adjacent soft tissue structures at risk of losing support and looking more aged?

[Kingusia87]

The one who suggested CW is well respected and has provided good, consistent results for many members here so I trust his opinion more - CW just makes more sense for my face although I think perhaps linear advancement would be the best outcome aesthetically speaking for my FACE. CW would benefit my smile the most I reckon.

The guy who suggested CCW didn't speak good english at all but he had a translator with him and I am almost positive he was suggesting CCW. He wanted to impact the maxilla. IMPACT. My face is already short and my maxilla is honestly vertically deficient at the front. I have a normal upper lip size (15-16mm?) and NO tooth show when I speak or hang my mouth open.

Could you please tell us the name of the first well respected surgeon who suggest CW? I have the same problem as you and want to have more upper teeth exposure. It will be helpful for me and many of us.

[ExtractionsRuinFaces]

Ok so I thought anterior impaction, in a case like yours w/respect to teeth show, is purely so that your face can be shortened more by making your jaw tuck in more before it meets your upper teeth. So bottom line is that would lessen, or keep the same, your mandibular plane angle. There might be some technicality here with how a lot of foward movement cancels out the impaction.  So he claims your teeth show won't change, but you are removing bone in your face.. so that could put adjacent soft tissue structures at risk of losing support and looking more aged?

I think my mandibular plane angle is steep relative to my occlusal plane which seems pretty flat judging by my ceph, perhaps he was taking that into account and thought with CW my mandibular plane would be too steep. Still, I really dont think impaction in my case is a good idea at all. Impaction when NOT NEEDED can be a disaster from what I have heard, it makes you look older and more haggard basically. I thought impaction was reserved for the long face steep occlusal face type faces, I have a small face overall but the lower third of my face is proportionately short so making it EVEN SHORTER would for sure make me look worse. Neither surgeons were able to look at my cephs btw, they just eyeballed what movements I would need by looking at my face. There was a mixup with the x-ray place with the first surgeon (the one suggesting CW) and the CCW guy didnt seem that interested in my case and I think he forgot to look at the cephs I had brought (complicated to explain, i basically had a consultation with a friend at the same time who had different issues to me, this surgeon performs many things such as implants and rhino and we travelled together to see him, the surgeon was more interested in his case)

[ditterbo]

Sounds right. If your maxilla is not creating a gummy smile then sounds reasonable to me that removing maxilla that's hidden could remove support in the surrounding area.  Remove maxilla that's in excess would be less detrimental.  I bet that's why my cheeks and eye area look worse from the rhino. Removing as much bone as he did required a lot of in fracturing around the nasal opening which removes support to the surrounding area.

[buzzhead]

I cannot see where CCW would be indicated at all.  I had a short face.  My surgeon performed CW with anterior down grafting the maxilla and moving it quite a bit forward.

[ExtractionsRuinFaces]

I cannot see where CCW would be indicated at all.  I had a short face.  My surgeon performed CW with anterior down grafting the maxilla and moving it quite a bit forward.

Do you have a ceph I could look at for both pre+post surgery? I'd like to compare to mine