Advice on Jaw Surgery

[JourneyToSerenity]

Hi all,

I suffer from an anterior open bite with maxillary excess large gummy smile], jaws at a cant [slightly higher on the left than the right], narrow upper and lower palate, with a significant lip incompetence at rest[can only breath through the mouth], prominent droopy lower lip with a deep mentolabial fold. All this has lead to various functional problems that affect my day to day life.

What I want corrected:

Aesthetically
- Lip incompetence corrected
- Removal of Gummy smile
- For my lower lip to roll upwards and look normal instead of drooping
- I have a long face, want to shorten the height of the face

Functionally
- To improve my breathing + increase airways
- Tongue to firmly be placed in the roof of my mouth, instead of lying on my lower jaw

I’ve seen various surgeons, but the two most experience ones, seem to also be mentioned on here quite a few times, recommended me to have :

[For sake of anonymity - I’ll refrain from mentioning their names at least for now]

Dr. A - Initially Sarpe followed by several months of braces and a bimax surgery with maxillary impaction with account slight counter clockwise rotation of the lower jaw[?} and a genioplasty

Dr. B -  Three way segmental fort  to expand the upper jaw, and bimax surgery after several months of having fixed braces attached.

Forgive me, I have quite a few questions.

Questions:

In layman terms, what is counter clockwise rotation?

Which is preferable three way segmental fort or SARPE to expand the upper jaw?

Also, if they're expanding the upper jaw, how can the lower jaw which is also narrow and isn't going to be expanded, be able to match the expanded upper jaw and lead to a perfect malocclusion?

Does anyone have any material or know how one is able to fix the droopy lower lip appearance[ you can quite visibly see the vermelean border when my lower lip is at rest]. Here is a video of an orthodontist basically explaining what I have, but my lower lip is a lot more fuller/puffier and inverted than Paris H.

https://www.youtube.com/watch?v=eoQ8IJT8iNA

Initially, I was set to go all ahead for surgery in the UK. After seeing various comments on here, it seems posters prefer mainland Europe surgeons as they’re more skilled.

Of these, Alfaro, Zarrinbal and Raffaini seem to be the most prominent of the European surgeons. Is this correct?

Has anyone had similar complications to mine able to point me in the right direction of which surgeon I should see?

[XXRyanXXL]

CCW rotation means both jaws are rotated counter-clockwise. Usually a downgraft is placed at the back of the jaw to add additional rotation.
Here's a short video.
https://video.doktorsitesi.com/maxillary-mandibular-advancement-ccw-rotation-genioplasty

Any type of anterior impaction for gummy smile will in fact, reduce the facial height, and cure your gummy smile. As a matter of fact, I believe you can attack all your conditions with a simple procedure. Even advancing the lower chin can have a prominent effect on lip incontence, and the canting of the jaws can be accomplished by a 3 piece le forte I with differential placement.

[JourneyToSerenity]

CCW rotation means both jaws are rotated counter-clockwise. Usually a downgraft is placed at the back of the jaw to add additional rotation.
Here's a short video.
https://video.doktorsitesi.com/maxillary-mandibular-advancement-ccw-rotation-genioplasty

Cheers, Ryan. Thanks a million. I forgot to mention that i will be having maxillomandibular advancement, too. Why is the counter-clockwise rotation needed in the first place, is it to fix the cant of the jaws?

What's troubling me, is when an impaction is done to correct an anterior open bite, the back of the maxilla is removed and the upper jaw is moved upwards towards the floor of the nose, but here a 'downgraft' is placed at roof of the maxilla, doesn't that defeat the purpose of an impaction? Or, is the downgraft ever so small and nowhere near as big as to what's shown in that video?

Any type of anterior impaction for gummy smile will in fact, reduce the facial height, and cure your gummy smile. As a matter of fact,

I thought that, too. But wont having your mandible brought forward and a genioplasty increase the vertical height of the face?

I believe you can attack all your conditions with a simple procedure.

What procedure is that?

Even advancing the lower chin can have a prominent effect on lip incontence, and the canting of the jaws can be accomplished by a 3 piece le forte I with differential placement.

Isn't 3 piece le forte I for the upper jaw only? As my bottom jaw is also at a cant. Anyway, isn't the cant correctable when surgery is done to the maxilla in the form of an impaction + advancement?

I've heard from several surgeons that there are more stability issues with 3 piece le forte I in comparison to sarpe + impaction + advancement which lead me to be a tad apprehensive despite the one surgeon's recommendation. I'm curious, though, as to why you would recommend the 3 piece leforte I?