Where does the functional end and the aesthetic begin?

[girl]

I've noticed a few posts about people wanting jaw surgery "for aesthetic reasons only". My question is: what circumstances would be defined as "aesthetic only"?

For e.g.:

- If a person's overbite is corrected with braces in childhood, there's a good chance they'll retain their skeletal class II and/or vertical maxillary excess. Yet, in such cases, the pursuit of jaw surgery could be defined as "purely aesthetic" as it concerns the appearance of the face. Even the appearance of the teeth and any excess gingival show could be defined as "aesthetic".

- If that same person hadn't had braces in childhood, they'd look more or less the same when not smiling and would function at a similar level. However, they could effectively play the overBITE card in order to pursue jaw surgery for "functional" reasons - despite being as asymptomatic as they would've been had they undergone childhood braces.   

- If either one of those cases had some functional problems, for e.g. TMJ issues, tooth loss and/or gum recession, at what point are these related to a need for jaw surgery? Nowadays, dentists dole out implants, mouthguards, and various other take-home contraptions to manage symptoms.

- Asymmetry: at what point do you take an interventionist approach to an occlusal cant? Is it 1mm, 2mm, 3mm, or more? From personal experience, significant asymmetry leads to functional problems such as gum recession, TMJ and tooth loss, yet "asymmetry" is dirty word as it's often interpreted as a purely aesthetic complaint ("everyone is asymmetrical etc.").

These lines seem extremely blurred to me. The role of functional issues in jaw surgery seems to depend on the person's individual ability to retell their story (for e.g., some people might exaggerate their functional issues, whereas shy types might downplay them) as well as the individual doctor's core beliefs and target market.

I'd be interested to hear anyone else's thoughts on this  Sorry about the long post.

[kavan]

Firstly, the goal of max fax IS to give someone normative aesthetics of both jaw and bite balance. So, aesthetics, as close as they can get it, is already an inherent objective of it.

i think it's one of those things where the expression is used loosely under a variety of circumstances and enough so that the usage of it has become ILL DEFINED.


Some examples:

Person A

has a massive skeletal imbalance with many standard deviations from normative profile. BUT has had the 'bite made right' via prior ortho. He/she will say; '..getting it for aesthetics ONLY'.
In actuality, the surgery would be done to DECREASE the many deviations from the norm and bring them closer to a balanced normative profile, at least, that would be the goal of the max fax doing it. They might peg hole it as a surgery needed only for 'medical reasons' where the 'only other' reason for it (in their mind) would be 'for aesthetics only'. Black or white categorization where they kind of block out the goal of it is to acheive a more normative jaw balance.

Person B

has a normative skeletal balance and good bite and NO deviations. They might already have the type of balance others with a LOT if IMBALANCE would like to have or that a max fax would strive to give another that did not have such balance. When person B says; 'For aesthetics only, it often applies to people who want a DIFFERENT one than what they have or thinking they will look 'more like a model' if they do that. They might even be clueless that they already have aesthetic balance and think they don't because they don't look 'like a model'.

In both examples, 'A' and 'B' who say they are getting it for 'aesthetics only' are actually BLURRING the objective of the surgery which is aimed towards NORMATIVE aesthetic balance. I find that people who say they are getting it for 'aesthetics only' either have a hard time admitting to themselves they need it to get closer to the norm or that they don't need it at all because they already have normative balance.

[girl]

Agree - the surgery isn't (or didn't use to be) an aesthetic surgery but a surgery to make someone look as boringly average (normative?) as possible. That's what I took from it, but I sense that the landscape is changing. I think it's vital for doctors to have an aesthetic flair, but I do think there's been a distinct shift in the eligibility factor over the past few years, which has made things rather confusing. The fact that both person A and person B are seeking it means that ideas surrounding what constitutes "normative" vary wildly from person to person, and doctor to doctor, and potentially even in academic and diagrammatic respects (are traditional measurements still being used and are these even standardised?)

Is there now a 3rd type of jaw surgery ("aesthetic") done to attain a certain look for Person Bs, with a tacit prior acknowledgment that there is nothing "wrong" with these patients skeletally or dentally?

I'm not sure whether the greater interest of Patient Bs, as well as jaw surgeons doing ancillary things (contouring, bone pastes, implants etc.) has put people with moderate or severe deviations from the norm at a better advantage or not. On the one hand, these new methods and technologies will allow people of all starting points to obtain better results aesthetically, but if the jaw surgery focus shifts too far away from Person As as a result, then there will be no incentive for surgeons to continue to fix difficult skeletal imbalances when they could simply do easy cases, and possibly even less impetus to fix those that come with bite issues alongside.

[kavan]

Better aesthetics, improved aesthetics has always been the goal of the surgery. 'Normative' refers to good aesthetic balance. Not 'boringly average'.

In fact the 'Wow!' factor--you know, the before and after photos people are most impressed by-- is from photos of people who start out with severe deviations and distortions from the norm where the change can be impressively dramatic.  For example, this guy had significant deviations from the norm and was brought to normative aesthetics. The respose is 'wow!' or 'looks great'. Not, 'Oh, he/she now looks boringly average.'
Point is that aesthetic improvements are more obvious and more appreciated in cases where there are significant deviations from the norm and that aesthetic improvement is a GOAL of the surgeon. It's not a thing where striving for normative balance some how rules out or precludes good aesthetics.

Now a person looking at that photo who already has normative balance, getting for 'aesthetics only', who assumes he could get a better 'Wow!' factor because he already looks good and jumping up some points might bring him in to 'model' territory would be more likely to be disappointed.

[girl]

Late replying to this thread...

I had a certain article in mind when I referred to a boringly average face:

Her face type is definitely a sort of "every(wo)man" face.

Yeah, I agree that those B&As show a great improvement. But a lot of recent results for long face types seem to fall well short of that transformative example, and this is what concerns me. I've seen people in a similar position to him and they still retain all the features of a long face afterward, albeit with an improved smile. I'm left thinking that there was a big missed opportunity to properly correct the problem. Therefore, I'd guess that the idea of what's "normative" varies greatly from surgeon to surgeon - even though it really shouldn't vary much at all, tbh. 

[kavan]

Late replying to this thread...

I had a certain article in mind when I referred to a boringly average face:

Her face type is definitely a sort of "every(wo)man" face.

Yeah, I agree that those B&As show a great improvement. But a lot of recent results for long face types seem to fall well short of that transformative example, and this is what concerns me. I've seen people in a similar position to him and they still retain all the features of a long face afterward, albeit with an improved smile. I'm left thinking that there was a big missed opportunity to properly correct the problem. Therefore, I'd guess that the idea of what's "normative" varies greatly from surgeon to surgeon - even though it really shouldn't vary much at all, tbh.

Well, in the patient example I gave (black and white Posnick patient), his face was 'long' WHERE it can be CORRECTED; impaction of anterior maxilla for CCW, with concomitant CCW of jaw and sliding upward genio. He had the EXCESS to the anterior maxilla. However, when the excess length to the face spans the area between root of nose and base of nose (maxillae beside periform aperture length is long because the nose height is long), that type of excess length to face is not as correctable as when the excess is isolated to anterior maxilla below base of nose.

As to the photo of the woman, her face could be described as 'pleasant' and 'balanced' just as noted in the description. However, it would not be described as 'glamorous', 'striking' or 'like a model'.

[PloskoPlus]

IMO, 80% of looks is the eyes.