CCW rotation effect on lips and philtrum

[kavan]

I really think surgeons and orthodontists need to better inform their patients of the trade-offs. This all makes complete sense in hindsight - once the problem has been deconstructed - but when signing up to ortho & surgery most wouldn't be aware at all of the potential soft tissue changes.

In every consult I've been in I have only ever been asked about what I DON'T like -- not once have I been asked what I DO like.

Granted I haven't consulted with Gunson, and I know he likes to maintain aesthetics.

If I had been told prior to signing up to ortho that my upper lip would become thinner, longer and cover more teeth, I think I would've walked away because I liked my fuller upper lip and smile. Yes it's ridiculously obvious now that it's exactly what happens when you make teeth more vertical, but it didn't even cross my mind until it was too late.

I remember, over 11 years ago, when I first consulted with a maxfax about getting my jaw advanced where at the time, I didn't know I had a deep bite, he asked me what did I like best about my face and I told him' 'my NOSE'. He told me the rotation he would have to do to advance out my lower jaw would be rotating my nose upward and it seemed at the time, his implicit assumption was that I would NOT like that look because my nose was great which is probably why he asked me what I liked best about my face. That said, I KEPT my maxfax deformity because I did not want to alter my nose.

[Tati]

If I may ask, did you pass on surgery back then only? Or have you never gone through with any procedure?

I'm curious since you seem to have dedicated a good amount of time (maybe money) to gathering knowledge in this field..

[kavan]

didn't get it.

[some1afterall]

I’ve consulted with Gunson, Karas, and Deschamps-Braly. I’m paranoid now after thinking of going through another major surgery, paying top $$$, many months of recovery and ending up with an unsatisfactory result. Gunson is supposed to be the best with aesthetics, right? But I’ve heard even he has bad results ;(

Days like today I think I look pretty normal and maybe the minor jaw pain and lip incompetence might be ok when considering risk/reward. If maxillary advancement and ccw rotation makes my nose even wider or with more nostril show I’d be bummed and if my philtrum got longer with even less the upper lip unsupported I’d be hiding in a closet.

Maybe I should just get a rhinoplasty. Anyone heard of good ones in the Bay Area? I like Dr Behmand in Walnut Creek’s results.

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[kavan]

I’ve consulted with Gunson, Karas, and Deschamps-Braly. I’m paranoid now after thinking of going through another major surgery, paying top $$$, many months of recovery and ending up with an unsatisfactory result. Gunson is supposed to be the best with aesthetics, right? But I’ve heard even he has bad results ;(

Days like today I think I look pretty normal and maybe the minor jaw pain and lip incompetence might be ok when considering risk/reward. If maxillary advancement and ccw rotation makes my nose even wider or with more nostril show I’d be bummed and if my philtrum got longer with even less the upper lip unsupported I’d be hiding in a closet.

Maybe I should just get a rhinoplasty. Anyone heard of good ones in the Bay Area? I like Dr Behmand in Walnut Creek’s results.

I think you have to isolate what bothers you most and to resolve to either full blown revision bi-max, isolated CHIN correction or plastic surgery help. Although Gunson could give better lip support via the CCW and advancement so your philtrum is on a 'diagonal' plane and not a vertical one that makes it look longer to you, you should discuss possibility of trade-offs to the nose base with him and inquire if a trade off at the nose base would also make the rest of your nose look better.  At most, I would suggest getting his PLAN for you, his ceph displacement DIAGRAM and to LOOK at what he's going to do to the CHIN. In the event you sought out an ISOLATED genio, you would want to consider the TYPE on Gunson's plan.

[CCW]

I’ve consulted with Gunson, Karas, and Deschamps-Braly. I’m paranoid now after thinking of going through another major surgery, paying top $$$, many months of recovery and ending up with an unsatisfactory result. Gunson is supposed to be the best with aesthetics, right? But I’ve heard even he has bad results ;(

Days like today I think I look pretty normal and maybe the minor jaw pain and lip incompetence might be ok when considering risk/reward. If maxillary advancement and ccw rotation makes my nose even wider or with more nostril show I’d be bummed and if my philtrum got longer with even less the upper lip unsupported I’d be hiding in a closet.

Maybe I should just get a rhinoplasty. Anyone heard of good ones in the Bay Area? I like Dr Behmand in Walnut Creek’s results.

Dr. Relle, but he's in LA. Gunson and him would be my recommendations for California based surgeons.

[some1afterall]

I have Gunson’s ceph, it did include 5mm chin shortening.

[some1afterall]

He said ccw and small maxilla advancement would better support lip/philtrum but I wonder for what trade off from the frontal view.

[kavan]

Image does not show.

[some1afterall]

Maybe this worked?

[kavan]

Yes. that one worked.

[PloskoPlus]

Looks like a substantial revision.  Did he give you a table of movements as well?

[some1afterall]

Maybe that's this?

Maxilla                   A-P           Vert

ANS                      -0.5         -2.3
PSN                      -0.1         +6.6
Mx1 tip                +5.1         -3.4
Molar MB cusp tip +3.6          +2.8

Mandible                A-P           Vert
Md1 tip                  +5.5        -4.6
Molar MB cup tip.   +5.5         +1.5
B point                  +10.0       -3.2
Pog                       +9.5         -8.1
Genioplasty           -3.3           -4.2

[kavan]

Looks like a substantial revision.  Did he give you a table of movements as well?

Indeed very substantial with posterior downgraft for the CCW and the chin shortening.

[some1afterall]

I didn’t realize it was such an involved plan. Sounds like I should do some more reading and research. Does it seem like a risky/unstable surgical plan? He didn’t say anything about that during the consult.