Aesthetics advice

[dammit_daniel]

Hi all,

Can I please get advice on my surgeons plan for bimax surgery.
The purpose of the bimax surgery is to open up my airways due to sleep apnea. The surgeon has recomended bimax aswell as advancement and no genioplasty.

Can I get advice on the pictures attached in the link from a aesthetics point of view?

https://imgur.com/a/UZltISJ

Many thanks

[emanresu]

Not an expert, but aesthetically, it looks good to me. The proposed movements include counterclockwise rotation with a posterior downgraft, which is typically a good sign because it shows the surgeon is familiar with more complex procedures. The CCW along with your steeper occlusal plane also explains why you don't need a genioplasty, as you'll get a good amount of forward projection from the jaw swinging down. Mind sharing or PMing me the doctor's name?

[dammit_daniel]

Thanks for sharing your opinion  The surgeon is Dr Lance West in New Zealand.

[dammit_daniel]

Would further advancement look better? Or would it be too far?

[CCW]

Would further advancement look better? Or would it be too far?

No, I think your surgeon's plan looks good.

[kavan]

The aesthetic and plan looks quite similar to what Gunson would do. For example the posterior down graft and the True Vertical Line (TVL) where he has it. Your doc must have studied (or payed attention) to what Gunson does. It's an optimized aesthetic as in good facial balance and where teeth should be as far as bite. You also got the BONUS of a morph WITH it.

[katapult2]

Is Gunson only doing CCW Rotation? Isn't it more optimal to do simultaneously with rotation a linear forwardmovement (translation) of the maxilla too?

When I see plans of surgeons who can do CCW rotation method they only do the rotation part. When I see surgeons who have no experience in CCW, they only do a linear forwardmovement without the rotation. Wouldn't it be better for the most cases if there is a good mix between these two extrem methods (only linear vs only rotation)?

With this question I only referring to cases, who needs a maximandibular advancement.

[jawguy123]

Is Gunson only doing CCW Rotation? Isn't it more optimal to do simultaneously with rotation a linear forwardmovement (translation) of the maxilla too?

When I see plans of surgeons who can do CCW rotation method they only do the rotation part. When I see surgeons who have no experience in CCW, they only do a linear forwardmovement without the rotation. Wouldn't it be better for the most cases if there is a good mix between these two extrem methods (only linear vs only rotation)?

With this question I only referring to cases, who needs a maximandibular advancement.

Often surgeons who do CCW (through posterior downgrafting) will also advance ANS, so I think the premise of your question is slightly flawed.

Also, why is CW so underrepresented on this board?

[GJ]

Also, why is CW so underrepresented on this board?

Because it's for Class 3 skeletons, and those cases are pretty straightforward (jaw puns!).

[jawguy123]

Because it's for Class 3 skeletons, and those cases are pretty straightforward (jaw puns!).

Lol -- what about short faces though (which can be Class I or class II deep bite)?

[GJ]

Lol -- what about short faces though (which can be Class I or class II deep bite)?

Yeah, it's appropriate for those, but that's fairly rare. I've seen some come through here. CelticCaveGirl comes to mind.

[dammit_daniel]

Thanks for all the input guys. As someone who is new (and quite nervous)  to all of this your input gives me reassurance that my doc knows what hes doing!
Also saw the doc this morning, he said he wouldn't want to advance any further as he thought the risk of relapse would be greater, although he said this was more likely with woman?

[dammit_daniel]

Hi just reviving this post to seek opinions on the aesthetics view on further advancement by 3mm, onto of the original plan. So I think forward advancement would be 5.2mm instead of 3.2mm, but CCW rotation angle remains the same.
My surgeon is floating this idea of further advancement. He said that he wouldn't necessarily do this extra advancement and I'm not even sure if this is to improvement outcomes for treating sleep apnea or if hes just playing around with how I would look (Something I will clear up with him). He did say that this would increase the odds of relapse occuring. Are there any other issues that are more likely to occur the further you advance? (Nose,Nerve damage, lip problems, teeth appearance?)

Here are the photos with additional 3mm advancement https://imgur.com/a/lCiK9rz

And the original plan(linked at the start of this thread) https://imgur.com/a/UZltISJ

I personally kind of like the additional 3mm, but does it look a bit off because I already have a vertically long face? Part of why I like it is my nose appears straighter.
I understand now the jaws/chin are further than the true vertical line. But does this automatically become less aesthetically pleasing for me and others in general or do some face types suit this look more than others?
How accurate are these dolphin simulated images? Does it usually simulate the nose changes adequately?
And would the extra 3mm really be worth the additional chance of relapse?(would both jaws relapse further than 3mm backwards, simultaneously or just random amounts?). Both advancements are ,I think, great improvements; so maybe it is trivial.

Any opinions would be kindly appreciated. Thanks.

[PloskoPlus]

Not a fan of over-projected chins.  That being said, you have quite a long nose, and your forehead is not short.  I think in theory you should be able to get away with a lot of advancement without ending up with a too long lower third. 

[haven]

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?