Surgical Plan

[mylittledog]

Hi, looking for some advice on a surgical plan / route
Would like to understand the aesthetic options given my Class III malocclusion

One surgeon I consulted with gave me his plan (SJS) which was a 7/8mm movement forwards, with slight Clockwise rotation around the ANS, and if I understood correctly a small downwards movement.

I'm particularly interested in preserving / enhancing the shape/projection of my nose since I know maxillary advancements make the nose project less, which may not be a good thing in my case.

Said surgeon also said DJS was completely unnecessary for my case, which I was happy about, but would like some other opinions about this.

https://ibb.co/x1JYTbh
https://ibb.co/rGKS3yg
https://ibb.co/SyvJpnQ
https://ibb.co/CJ25h54
https://ibb.co/3CY9qcZ

thanks

[GJ]

It looks like a case that could be solved by just moving the maxilla forward, but 8mm is a lot. It would change your nose. So he's probably right you don't need double jaw, but double jaw might produce a better result by splitting the difference in the movement of each jaw. Some people get sag under the neck when moving the mandible back, though, and there's probably some apnea risk, too. I'd say get some more consults and ask about these things.

[kavan]

Yes you have an underbite with some maxillary recession.It's only visible in profile. In 'real life', the head is moving and it would not be that noticeable. Front soft tissue  'light throw' looks great. That is to say, you have the type of max recession that looks good in the front because it's the type of contour (slightly concave right beside the nose) that collects and reflects light. A slightly concave area just happens to collect and reflect very well  (Leonardo's treatise on painting) and you have that to the upper medial cheek area and also to the philtral area.

You have a 'lucky' contour to the recession and for that reason, I would LEAVE IT BE. It works well for you.  So, NO to surgery.

[mylittledog]

It looks like a case that could be solved by just moving the maxilla forward, but 8mm is a lot. It would change your nose. So he's probably right you don't need double jaw, but double jaw might produce a better result by splitting the difference in the movement of each jaw. Some people get sag under the neck when moving the mandible back, though, and there's probably some apnea risk, too. I'd say get some more consults and ask about these things.

Thanks. I have one or two more consults lined up where I will try to figure out other potential surgical plans. About DJS I'm not sure I would be able to accept a mandibular setback, partially from principle and also the potential complications that can arise from it.

[mylittledog]

Yes you have an underbite with some maxillary recession.It's only visible in profile. In 'real life', the head is moving and it would not be that noticeable. Front soft tissue  'light throw' looks great. That is to say, you have the type of max recession that looks good in the front because it's the type of contour (slightly concave right beside the nose) that collects and reflects light. A slightly concave area just happens to collect and reflect very well  (Leonardo's treatise on painting) and you have that to the upper medial cheek area and also to the philtral area.

You have a 'lucky' contour to the recession and for that reason, I would LEAVE IT BE. It works well for you.  So, NO to surgery.

Thanks for this. Extremely interesting (I study art as well haha) - and I believe I have a lot to lose aesthetically, even with my relatively severe underbite, in due partly to the reasons you mention above.

Am I correct when saying that the inclination of the soft tissue below the base of the nose is mostly controlled by the inclination of the front teeth? If so, can this be reliably predicted with presurgical orthodontics?

In essence, are you saying that the key to how the maxilla is perceived in real life is the difference in angle between the vertical plane of the (lf2 minus lf1 area) and the lf1 part of the maxilla? Since that the defines where the light and shadow falls on the face under natural lighting?

Worth trying MSE + FM (I'm 19) to try pull the entire maxilla a whopping 1-2 mm forward?