Aesthetics advice

[dammit_daniel]

Good to see you have a surgeon providing you with a good plan. Did you already have braces before (any extractions?) or need any lengthy treatment prior to surgery?

Hi Haven, yes he's pretty thorough although hard to get a hold of sometimes haha. Yeah I had braces in my teenage years and had a permanent retainer on my lower teeth so my bite is still pretty good according to my ortho and only minor adjustments are required and time in braces is expected to be 4-5 months. No extractions, just recently had all my wisdom teeth out. Apparently the holes left behind from the wisdom teeth are quite small so my max fac said I can probably have the operation sooner than the standard 6 month wait after wisdom teeth removal.

[haven]

Nice to hear. Avoiding extractions means you don't need to endure years of braces. I honestly don't see much difference in the second plan so the safe route would be to go with the first option as it doesn't come with risk of relapse?

Did you ever ask if getting invisalign could be used for your pre surgical ortho?

[dammit_daniel]

Nice to hear. Avoiding extractions means you don't need to endure years of braces. I honestly don't see much difference in the second plan so the safe route would be to go with the first option as it doesn't come with risk of relapse?

Did you ever ask if getting invisalign could be used for your pre surgical ortho?

Yeah the ortho said I could possibly have extractions on lower teeth and would only need lower jaw surgery, but I said I didn't want to go down that route. Yeah I guess the less risk the better. No I didn't ask about invisalign. I don't know much about it, but it looks like a clear retainer you wear? I will be needing "thick" wires on the braces according to the ortho for the surgery, so I think for me I would just rather get the braces for the short time and be ready for surgery.

[ODog]

I think this morph looks fantastic. Can you clarify how large the bi-bad movements will be ? You’re saying it was originally scheduled for 3mm advancement but I see 8 mm beside the maxilla and mandible osteotomy notes. Am I reading it wrong (probably)?

[april]

So will the posterior downgraft be 8.9mm? I think I'm reading that right.

[dammit_daniel]

I think this morph looks fantastic. Can you clarify how large the bi-bad movements will be ? You’re saying it was originally scheduled for 3mm advancement but I see 8 mm beside the maxilla and mandible osteotomy notes. Am I reading it wrong (probably)?

Hey, the doctor has noted the following for the original plan with 2.2mm of "foward advancement" and 10.5 degrees ccw ..


10.5 degree CCW of maxilla and mandibular.

Upper incisor edge advanced 8mmm, with no change vertically or transversely.

Posterior down graft of maxila with posterior nasal spine moving inferiorly 8.9mm and anteriorly 2.9mm

Lower incisor edge advanced 7.4mm and move inferiorly 0.3mm.

Pogonion would be moved forward 13.9mm and downwards 1.6mm.

Originally it was scheduled for 2.2mm of "foward advancement" of all jaws and the 2nd possible plan is 5.2mm of "forward movement" of all jaws.

I think you can tell the amount of translational movement by looking at the ANS point because this point is the centre of the ccw rotation (I think) and therefore not subject to movement from the CCW rotation. In the first plan it says 2.2mm and the second it says 5.2mm.

[ODog]

I’m astonished there could be that much of a change in profile with 2 mm of advancement. Wow.

[april]

Hope recovery is going well Daniel. Did you end up going with the larger advancement?

[dammit_daniel]

Hey April, recovery is going well. Intense symptoms seem to be eleviating day to day. I would like to say a big thank you to the moderators, especially Kavan, and board members of this forum for their assistance with understanding the complex nature of jaw surgeries. The knowledge contained by some people here is amazing and I don't think is available anywhere else on the internet and would likely cost alot of money to to obtain through consultations. You really feel more at ease going to a consultation to discuss surgery when you know the terminology and things to look out for in a good surgeon.

Heres the final plan that we went with. The other variation links can be see earlier in this thread.

https://imgur.com/a/zhd17hR

It changed 2 days out from surgery. It was different to anything that was proposed earlier, and I was really happy about how it looked. Just waiting to see if the result is ok.

Some notes about the movement:
-The CCW rotation angle decreases compared to earlier suggestions. The surgeon said it was because orthodontics had shifted my teeth. I think the difference was about 2 degrees which resulting in additonal jaw advancement of both jaws being required to get it closer to where the incisors should be, with a measurement I am not familiar with(does anyone know what measurement is used for this?). I really liked this effect as the ANS point now projected my nose tip out more and my dropping nose looked for pronounced.
-The final chin placement I believe was a few mm behind the true vertical. A genio was a possibility however I turned it down because of the additional risk of nerve damage and cost. I actually thought the additional rotation suggested before in this post looked too "chiny" however I liked the nose projection. I think the new plan was the best of both worlds
-I did see additional advancement just out of interest. I thought it looked off and the surgeon said he was not comfortable with that amount of projection and there would be less bone healing contact with the maxilla and therefore a higher chance of relapse.

Questions If anyone would be kind enough to answer for me:

If anyone with knowledge about this movement could view my before and after on this video I would really appreciate it.

https://www.youtube.com/watch?v=4PK-kg7PQYA&feature=youtu.be - Before and After Ceph

If you pause it at the start and end and use your finger or something you can see my chin point has actually moved up vertically? According to the plan it should of actually decreased vertically by 1mm. What has happened or am I misunderstanding this? Also the asymmetry between each jawline has been fixed as you can see one jaw is lower than the other previously. How has this been fixed?

If anyone would like to know more about the operation I'm happy to answer questions. I will update with before and after photos once swelling goes down.
Discussion about the functional improvements can be found here: http://jawsurgeryforums.com/index.php?topic=7505.msg65936#new

[kavan]

Hey April, recovery is going well. Intense symptoms seem to be eleviating day to day. I would like to say a big thank you to the moderators, especially Kavan, and board members of this forum for their assistance with understanding the complex nature of jaw surgeries. The knowledge contained by some people here is amazing and I don't think is available anywhere else on the internet and would likely cost alot of money to to obtain through consultations. You really feel more at ease going to a consultation to discuss surgery when you know the terminology and things to look out for in a good surgeon.

Heres the final plan that we went with. The other variation links can be see earlier in this thread.

https://imgur.com/a/zhd17hR

It changed 2 days out from surgery. It was different to anything that was proposed earlier, and I was really happy about how it looked. Just waiting to see if the result is ok.

Some notes about the movement:
-The CCW rotation angle decreases compared to earlier suggestions. The surgeon said it was because orthodontics had shifted my teeth. I think the difference was about 2 degrees which resulting in additonal jaw advancement of both jaws to get it closer to where the incisors should be, with a measurement I am not familiar with(does anyone know what measurement is used for this?). I really liked this effect as the ANS point now projected my nose tip out more and my dropping nose looked for pronounced.
-The final chin placement I believe was a few mm behind the true vertical. A genio was a possibility however I turned it down because of the additional risk of nerve damage and cost. I actually though the additional rotation suggested before in this post looked too "chiny" however I liked the nose projection. I think the new plan was the best of both worlds
-I did see additional advancement just out of interest. I thought it looked off and the surgeon said he was not comfortable with that amount of projection and there would be less bone healing contact with the maxilla and therefore a higher chance of relapse.

Questions If anyone would be kind enough to answer for me:

If anyone with knowledge about this movement could view my before and after on this video I would really appreciate it.

https://www.youtube.com/watch?v=4PK-kg7PQYA&feature=youtu.be - Before and After Ceph

If you pause it at the start and end and use your finger or something you can see my chin point has actually moved up vertically? According to the plan it should of actually decreased vertically by 1mm. What has happened or am I misunderstanding this? Also the asymmetry between each jawline has been fixed as you can see one jaw is lower than the other previously. How has this been fixed?

If anyone would like to know more about the operation I'm happy to answer questions. I will update with before and after photos once swelling goes down.
Discussion about the functional improvements can be found here: http://jawsurgeryforums.com/index.php?topic=7505.msg65936#new[/i]

Thanx.  Well, it would be easier to look at if you just showed the before and after side by side and no video.

With CCW, it would rotate the pogonian (outer most point of chin) so what you saw on your x rays is consistent with what CCW would do to the chin point. Not sure but the - (negative) 1.2 displacement of Pog you see on your read out could refer to a decrease of it's position in the downward direction.

[dammit_daniel]

Thanx.  Well, it would be easier to look at if you just showed the before and after side by side and no video.

With CCW, it would rotate the pogonian (outer most point of chin) so what you saw on your x rays is consistent with what CCW would do to the chin point. Not sure but the - (negative) 1.2 displacement of Pog you see on your read out could refer to a decrease of it's position in the downward direction.

Speak of the devil! Thanks for continuing to follow my case 

I think I what was happening was the angle I took the photo on look liked my chin had increased vertically in reality it hasn't.

https://imgur.com/a/dE4mUcx - Heres a photo where photos cephs are level.

The chin points looks slightly lower now to me, which is what the plan said all along!

[kavan]

Speak of the devil! Thanks for continuing to follow my case 

I think I what was happening was the angle I took the photo on look liked my chin had increased vertically in reality it hasn't.

https://imgur.com/a/dE4mUcx - Heres a photo where photos cephs are level.

The chin points looks slightly lower now to me, which is what the plan said all along!

It looks rotated in direction of CCW to me.

[dammit_daniel]

Hey guys, I'm 9 weeks post op so I thought I'd put some photos and comparisons up for those interested

https://imgur.com/a/To6yGd8

I still have swelling on cheeks and upper lip.
It looks like the morph was way off in determining where my chin would end up. Not sure how it could be so off..I'm still happy with the new profile.
Breathing has improved but not as much as I would like, I am hoping there is further swelling to go down.

[april]

I think you look great. Sure, you could've had a bit further chin projection, but you look handsome with noticeable improvements to your jawline, upper lip and nose.

[ditterbo]

This is really weird to see, from where I'm sitting. You had a similarish starting point to me, maybe 4mm better just off the planned pogonion change (Gunson wants like 18-19mm for me where I see your plan called for 14mm).  But then your actual pogonion advancement was like 2-4mm shy of plan, and now you look a lot like me with my 12mm chin implant, albeit with a better labiomental crease. So Gunson's plan is a 6mm advancement from where I'm at, but in reality... could end up quite close to the same chin advancement I already got with the implant.

https://imgur.com/iDCdf9v

Still looks like a great aesthetic improvement, for you, and hopefully without the unique lip drama I'm forever suffering from my first go-around with a chin implant (current is a revision). I'm probably staying put until I make a lot more $$, TMJ tech improves, and/or bimax improves.