Professor in maxillofacial surgery told me there is nothing he can do for me

[tim06]

I consulted a professor in maxillofacial surgery and he told me to cope with my looks and he can't do anything since my bite is correct.

What can I do now? He also told me further lengthening the chin would not be a good option.

[Lestat]

If your bite is fine then chin wing would be a good option for you!

[kavan]

I already told you what you had; protrusion to the Lefort 2 area which is HARD to correct. So for all intents and purposes an L2 setback is not going to be on the table. What I'm ultimately saying is that the aesthetic imbalance is protrusion to an area where hardly any doc is going to offer or suggest correction to it. The other option; isolated BSSO to mask the protrusion isn't on the table either unless you can engage a max fax to give you a class 3 dental relationship. What's left is the 'chin wings for everybody' doc. Although it could increase the anterior posterior distance of the whole lower jaw, for which you would probably have to get the chin implant removed to do it, to the best of my knowledge it's not going to take the LOWER LIP with it as would a BSSO so that the lips line up and/or mask the protrusion to where you have it.

[tim06]

I already told you what you had; protrusion to the Lefort 2 area which is HARD to correct. So for all intents and purposes an L2 setback is not going to be on the table. What I'm ultimately saying is that the aesthetic imbalance is protrusion to an area where hardly any doc is going to offer or suggest correction to it. The other option; isolated BSSO to mask the protrusion isn't on the table either unless you can engage a max fax to give you a class 3 dental relationship. What's left is the 'chin wings for everybody' doc. Although it could increase the anterior posterior distance of the whole lower jaw, for which you would probably have to get the chin implant removed to do it, to the best of my knowledge it's not going to take the LOWER LIP with it as would a BSSO so that the lips line up and/or mask the protrusion to where you have it.

I don't have a chin implant, but a sliding genioplasty with 10 mm advancement in the past. The 'chin wings for everybody' doc would give me a chin wing, but that wouldn't really help me since like you mentioned it would just increase the size of the mandibular fold and make me look ridiculous.

Visor osteotomy of the anterior mandible as done by Triaca and Brusco seems to be the only option left.

[kavan]

I don't have a chin implant, but a sliding genioplasty with 10 mm advancement in the past. The 'chin wings for everybody' doc would give me a chin wing, but that wouldn't really help me since like you mentioned it would just increase the size of the mandibular fold and make me look ridiculous.

Visor osteotomy of the anterior mandible as done by Triaca and Brusco seems to be the only option left.

OK, thanx for clarification because i think you can still get chin wing with prior genio. But  it won't take the lower lip with it. It's the lip line up that's more of a problem than the fold between lip and chin.

[ditterbo]

Some max facs that I've spoken to seem to have no problem creating a class 3 problem, even extracting 2 bicuspids to do it, all for the sake of orthognathic balance without any medical issues. By that experience, doesn't seem like that big a stretch for you to find a surgeon willing to move the jaw forward. Probably the ones known for more aggressive CCW maneuvers would entertain your situation (not implying you need CCW).

[PloskoPlus]

I'm not sure if there is any other surgical field where opinions between surgeons regarding treatment plans can vary as radically as they can in orthognathic surgery.  This can also be a regional thing.  For example in my lucky country, nobody does CCW rotations, as in nobody in a country of 30 million.  That's just the local surgical school.  In a place like Texas, you'll find that a great many surgeons will, because surprise, surprise, that's where CCW was invented.  Swiss and German surgeons favour chin wings now as a way to simulate CCW rotation, because, surprise, surprise, it was invented (or at least popularised) in Switzerland.

So don't despair.  Since you're in Europe, consult with Alfaro.  FWIW, while your upper lip does protrude, I don't think it's that big of a deal - profiles are overrated.

[kavan]

Some max facs that I've spoken to seem to have no problem creating a class 3 problem, even extracting 2 bicuspids to do it, all for the sake of orthognathic balance without any medical issues. By that experience, doesn't seem like that big a stretch for you to find a surgeon willing to move the jaw forward. Probably the ones known for more aggressive CCW maneuvers would entertain your situation (not implying you need CCW).

Years back a maxfax (one who studied with Wolford) told me that Class2 and Class3 isn't defacto a 'malocclusion' and that Class 1 isn't defacto good occlusion BECAUSE there is Class 1 MAL occlusion. That is to say there is 'good' Class2 and Class3 occlusion. That is to say there are situations where the back MOLARS meet in Class 2 or Class 3 occlusion but in these cases the former does not also involve the upper FRONT teeth being overjetted too far forward from the lower teeth and the latter does not also involve the lower FRONT teeth being too far forward from the upper front teeth.

[kavan]

Tim,

Do any of these maxfax pros you visit do a CEPH for you?

[secondtimearound]

I'm not sure if there is any other surgical field where opinions between surgeons regarding treatment plans can vary as radically as they can in orthognathic surgery.  This can also be a regional thing.  For example in my lucky country, nobody does CCW rotations, as in nobody in a country of 30 million.  That's just the local surgical school.  In a place like Texas, you'll find that a great many surgeons will, because surprise, surprise, that's where CCW was invented.  Swiss and German surgeons favour chin wings now as a way to simulate CCW rotation, because, surprise, surprise, it was invented (or at least popularised) in Switzerland.

So don't despair.  Since you're in Europe, consult with Alfaro.  FWIW, while your upper lip does protrude, I don't think it's that big of a deal - profiles are overrated.

Don't forget the incredible multitude of jawline surgeries only available in Korea and neighboring nations.

SARPE vs. Multipiece LF1 is also a regional preference/skill as discussed in other threads recently.

Jaw surgery has become insanely regional. It's quite bizarre.

[girl]

Who was this professor?

[Bobbit]

Don't forget the incredible multitude of jawline surgeries only available in Korea and neighboring nations.

Jaw surgery has become insanely regional. It's quite bizarre.

Ah... that is an interesting statement,  since I have personally been invited into the OR and watched some of those procedures done here in the United States by a well trained surgeon.

That statement is a pure myth.  One often repeated.  But still a myth.

[solo322]

I already told you what you had; protrusion to the Lefort 2 area which is HARD to correct. So for all intents and purposes an L2 setback is not going to be on the table. What I'm ultimately saying is that the aesthetic imbalance is protrusion to an area where hardly any doc is going to offer or suggest correction to it. The other option; isolated BSSO to mask the protrusion isn't on the table either unless you can engage a max fax to give you a class 3 dental relationship. What's left is the 'chin wings for everybody' doc. Although it could increase the anterior posterior distance of the whole lower jaw, for which you would probably have to get the chin implant removed to do it, to the best of my knowledge it's not going to take the LOWER LIP with it as would a BSSO so that the lips line up and/or mask the protrusion to where you have it.

Hey, so how did you know that his case is " protrusion to the Lefort 2 area". Any chance you some detail links about these diagnosis? I would like to read some

[kavan]

Hey, so how did you know that his case is " protrusion to the Lefort 2 area". Any chance you some detail links about these diagnosis? I would like to read some

Any chance you can google Lefort 2 and look at the AREA it involves. Also, I saw his photos before he blacked parts out.

[solo322]

I looked at them before. I didn't understand how to decide with area the protrusion was from his profile, since Lefort 2 is above Lefort 1 and link to the lower jaw . Ok,nvm,got it