SARPE + Bimax Questions (X-Rays provided)

[beyondconfusedtbh]

Well first off I think my surgeon agreed my head was tilted in the xray, and he examined my face again there itself. This probably influenced the following.

For the bi-max we agreed on rotation done through anterior impaction & posterior downgrafting + advancement (of maxilla mainly) but I was told it'd be easier to focus on it after the SARPE :/

I'm really confused right now. I have such a long & narrow midface, can this just not be treated in my case?
How on earth could i have such a disproportionately long midface and a perfectly fine occlusal plane?

If this is of any valuable information I had some s**tty orthodontic treatment when I was younger (braces).

Also, I'm struggling to understand the whole tilt thing kavan. See attached

PS: surgeon in question also recommended ZSO (obviously must take it with a grain of salt) But after seeing the bone cuts I'm not sure if it'd produce a good effect. Should I consider it in conjuction with HA paste? Anyone got any experience?

[beyondconfusedtbh]

I've been reading up + trying to figure this stuff out but idk if im getting anywhere.

Can I still get impaction & shorten my midface? Someone clue me in because I feel like an idiot right now.

Thanks everyone who's helped so far, its greatly appreciated.

[PloskoPlus]

Most of "midface length" is the nose, which cannot be shortened.

[beyondconfusedtbh]

I'm aware of that, but as others have stated a good fix to 'long face' is through the means i stated.

[beyondconfusedtbh]

Can I private message one of you some pictures? I understand you’re all busy but perhaps it’d be easier to explain for both parties.

[kavan]

Well first off I think my surgeon agreed my head was tilted in the xray, and he examined my face again there itself. This probably influenced the following.

For the bi-max we agreed on rotation done through anterior impaction & posterior downgrafting + advancement (of maxilla mainly) but I was told it'd be easier to focus on it after the SARPE :/

I'm really confused right now. I have such a long & narrow midface, can this just not be treated in my case?
How on earth could i have such a disproportionately long midface and a perfectly fine occlusal plane?

If this is of any valuable information I had some s**tty orthodontic treatment when I was younger (braces).

Also, I'm struggling to understand the whole tilt thing kavan. See attached

PS: surgeon in question also recommended ZSO (obviously must take it with a grain of salt) But after seeing the bone cuts I'm not sure if it'd produce a good effect. Should I consider it in conjuction with HA paste? Anyone got any experience?

Yes, INDEED, it would be EASIER for you to focus on the bimax AFTER the SARPE.

In fact because you are indeed 'beyond confused', you need to focus on ONLY the surgery you are planning on getting FIRST and not be throwing wrenches into the gears regarding multiple surgery possibilities.

If you are FIRST getting SARPE, that should address SOME narrowness to the face. Your (potential) satisfaction with some improvement from THAT should engender some confidence in the surgeon doing more things later down the line. This ASSUMES it would be the SAME surgeon.

IF other things are to be done with different surgeons, it's just tossing MORE wrenches into the gears of your understanding to start pondering them now.

For now, just focus on what you are BOOKED for sugery.

There is a fine line between 'beyond confused' to 'beyond help' if you keep TOSSING IN more complex things with 'who knows who' doctors and in the absence of photos in the FLESH and other typle information as to which doctors. Such photos should be posted on the boards or ask GJ if you can get access to private section of board if you are SHY about open postings of your photos.

[beyondconfusedtbh]

Yeah you're right, I'll forget about bimax for now & focus on the surgery at hand. Thanks kavan

[kavan]

Yes. Do things gradually that CAN be done gradually in SEPARATE surgeries.

[beyondconfusedtbh]

Thanks, I still have one question though. How is it that SARPE has an effect ‘externally’ on the face?

[kavan]

Thanks, I still have one question though. How is it that SARPE has an effect ‘externally’ on the face?

Time to put on your thinking cap to answer this question for yourself. Think about it. You can do it.

[beyondconfusedtbh]

Time to put on your thinking cap to answer this question for yourself. Think about it. You can do it.

From my understanding these are the (potential, as some may not be noticeable) changes:

Smaller buccal corridors meaning i'll have a fuller smile.

Will fill out upper part of my cheeks a bit

Widen the base of nose & cheekbones*

Slight CW rotation of the maxilla*

The first two are fairly obvious but the last two I'm not entirely sure about, it would make sense that there would perhaps be a slight change to the nose & cheekbones but I can't see it being even SLIGHTLY noticeable. Maybe it just depends on the extent of the expansion.

Anyway, feel free to correct me if I'm mistaken.

[kavan]

From my understanding these are the (potential, as some may not be noticeable) changes:

Smaller buccal corridors meaning i'll have a fuller smile.

Will fill out upper part of my cheeks a bit

Widen the base of nose & cheekbones*

Slight CW rotation of the maxilla*

The first two are fairly obvious but the last two I'm not entirely sure about, it would make sense that there would perhaps be a slight change to the nose & cheekbones but I can't see it being even SLIGHTLY noticeable. Maybe it just depends on the extent of the expansion.

Anyway, feel free to correct me if I'm mistaken.

Let's start with WHY you are getting the surgery and what your surgeon told you this would do.

[jawguy123]

Widen the base of nose & cheekbones*

...

The first two are fairly obvious but the last two I'm not entirely sure about, it would make sense that there would perhaps be a slight change to the nose & cheekbones but I can't see it being even SLIGHTLY noticeable. Maybe it just depends on the extent of the expansion.

Anyway, feel free to correct me if I'm mistaken.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655960/

The widening of the nose could definitely be noticeable.

[beyondconfusedtbh]

Let's start with WHY you are getting the surgery and what your surgeon told you this would do.

I currently have a pretty narrow palate, can't fit my tongue of the roof of my mouth & have a cross bite on the left side + some malocclusion (due to prior orthodontic treatment.)

I asked Dr. Z if these problems could be addressed while I was explaining my reasons for Bi-max. He told me that these issues should be solved PRIOR to bi-max, and then recommended SARPE + orthodontic treatment post op.

Obviously the impacted wisdom tooth on the upper jaw would be addressed further down the line (if that's even relevant at all)

[beyondconfusedtbh]

If I was to just summarise I guess the SARPE would be in the interest of creating more room in my mouth (smaller buccal corridors) & setting the teeth up to be aligned later on down the line.

This is why I was asking about the other aesthetic implications, as they're more than welcome (well maybe not the nose thing but there's preventions/ solutions) but they were not the focal point during my consultation & so I did not ask about them.