Thoughts on my surgical plan? BSSO, LeFort 1, and Genio for OSA

[bex]

First post here, so my apologies if this isn't the right place to post this! I'll be getting a BSSO, Lefort 1 and a sliding genioplasty next week to (fingers crossed) resolve severe obstructive sleep apnea. I'm young and super active, so I'll be plenty happy if the only outcome of this surgery is getting my life back and not having a heart attack before age 30.

That said, I'd be lying if I said that I wasn't thinking a little bit about aesthetics, and the possibility of certain aspects of my face looking more balanced. Even though my surgeon and I have talked through how the movements will change my face, it's hard to visualize it.

Curious to hear any thoughts on my surgical plan (see attached images), and how it might improve (or not) any facial imbalances? Thanks in advance for taking a look and sharing your thoughts!

[kavan]

Well, it's hard to verbalize a visual for someone but in general you will be seeing yourself with a more FORWARD face which will probably look a lot 'different' to you. In terms of aesthetics, a forward face is preferable to one that's set behind. Your nose might look different to you because the spine of it is brought forward. There will also be changes you will see to the lips.

Your photo precludes a closer look at what you have relative to the bone structure because photos relative to the bone structure would be non smiling profile and frontal shots.

[Lazlo]

You have the most gorgeous orbital sockets.

[ditterbo]

You have the most gorgeous orbital sockets.

It's the lateral angle on the top corners doing it, lol. I'm jealous of all these jaw patients with normal sized looking rami, but anyways... we're creeps.

This plan might not be is not enough CCW rotation for the best aesthetic result, but yeah like Kavan said we're missing the right type of shots to judge well.

[Lazlo]

I literally wanna make love to your skull. Not you. Just your skull.

[GJ]

I bet she's glad she joined.

[bex]

Wheeeelp, s**t got real weird, real quick! But now I'm less confused by the fetish warning on another jaw surgery forum, lol.

Kavan:Fair enough on the photos - these are poor quality, but hopefully, give a better idea of bone structure. I'm curious to hear more about your thoughts on the changes I might see to my lips/philtrum area; for whatever reason, that part of my face seems...masculine to me? That said, I like my smile and hope that doesn't change too much; doc said to expect a little more show (especially upper teeth).

Lazlo + Ditterbo: Now I'm kind of curious...How does one have poor/deficient orbital sockets? And how does that impact aesthetics? One area I'm hoping will improve are the giant dark circles under my eyes, I think that's more of a sleep apnea issue than anything else, but I was thinking that could also be impacted by all of the bone movement.

Ditterbow: Can you speak more about why you think it's not enough CCW rotation?


Thanks again for sharing your thoughts -  I really appreciate it!

[kavan]

The surgery makes no changes to the eyes.

[some1afterall]

You have a similar lower face profile as I had before genioplasty-it’s so nice and soft and feminine. Don’t get a genioplasty!!! Your nose will widen and turn up some, although yours seems relatively narrow so maybe that’s not a problem.

[bex]

Kavan: Thanks, that's what I thought. Hopefully the dark circles will go away once I'm not waking up 40x/hr.

some1afterall: Appreciate the kind words, thanks! Funny you say that though, because I feel like that's the one area (from an aesthetics standpoint) of my face that I'm totally comfortable changing - there's nothing there! Plus, the SG will be a big part of what helps resolve the OSA.

[kavan]

As to ditterbo's comment to you:

I can't opine on 'enough CCW'. But based on looking at the 'after' RIGHT skull diagrams and measuring (approx) the angle of the mandibular plane RELATIVE to a HORIZONT, my (hand held protractor which is not going to be 'exact') has approximated  about 34 degrees for the before skull and about 28 degrees for the after skull. So the RELATIVE DIFFERENTIAL for CHANGE in mandibular plane angle is about 6 degrees and that is in the DIRECTION of CCW.

Also, when we look at the DIRECTIONS of the DISPLACEMENTS in the chart, we see POINTS like the; 'ANS', 'A', 'B' and 'Pog' all moving in the UPWARD (vertical) DIRECTION in addition to being moved in the (horizontal) Anterior direction. So, those two directional displacements TOGETHER are in direction of CCW, upward and out.

Since your lower jaw and chin are BOTH recessive, those areas will improve aesthetically with the forward advancement to BOTH. Advancing the lower jaw forward, more often than not is first CONTINGENT on moving the upper jaw forward. Since the mandibular plane angle in the skull model had been DECREASED about 6 degrees in direction of CCW, that basically indicates the upper jaw will be moved in direction of CCW. Since I don't see any slices removed from it or slices added to it, I'm assuming your natural orientation of ANS-PNS (maxilla is already inclined in CCW direction). Given that the PRIORITY here is to RELIEVE you of SLEEP APNEA, I would conclude that 'enough' displacement of both jaws and chin was planned in there for what has to be PRIORITIZED and also enough to give you much better aesthetic projection to both the chin and lower jaw.

Sometimes in sleep apnea cases, the upper jaw can look a bit protrusive if it has to be moved more than ideally optimal to accommodate the lower jaw advancement they need to do in which case, you might see nose changes and changes to the upper lip area. Can't predict what those will be from here. Just to say that IF they are unfavorable, adjustments to contours can often be done later down the line by plastic surgery techniques.

As to 'someone....'s' comment to you, you don't have same thing she had (a situation where they needed to move downward) and if you look at the directions in the chart, they are all moving upward. Given that a genio is part of helping to address the sleep apnea and that chart indicates your chin point will be moving UPWARD and not downward as in her genio, you were wise to realize you didn't have to worry about getting the genio aspect of it.

[some1afterall]

@ kavan - why do you give me such a hard time? Does genioplasty really help OSA? I thought the BSSO was the primary move that opens up the airway.

[kavan]

@ kavan - why do you give me such a hard time? Does genioplasty really help OSA? I thought the BSSO was the primary move that opens up the airway.

Because you didn't have all your eggs in one basket as far as introducing all the info that would needed to be introduced in terms of what you actually had or what bothers you most and you're kind of a moving target with those things. As to 'hard time', I've given you a lot of feedback. Yes, genio can help with OSA along with the BSSO.

AS to 'hard time' with regard to what I told the OP, I would ask WHY on earth would you even take umbrage with my telling the OP she did NOT have the SAME issue you had (downward movement) and that she was WISE not to worry about getting the genio.

[ditterbo]

I agree it's got some CCW, so should see some improvement. Just eyeballing it (so not accurate at all), the maxilla anterior advancement seems unnecessarily high.  Your post-op simulated occlusion plane is one clue to me that you could afford more CCW by way of posterior downgraft, allowing less anterior movement of the maxilla. May turn into a multisegment lefort. This is just my speculation again, and Kavan can/might say something to the contrary with better information. 

ETA It's an interesting conundrum with the long philtrum. Idk how impacting the (anterior) skeletal maxilla area would help with that because the issue shows with your skin area, not in the gums when you smile. You'd have to plan a boney surgery followed on by plastic surgery, I guess.

[some1afterall]

Good point ditterbo-I was wondering about effects on philtrum area as well.