Need help with Bi-max

[ODog]

I was wondering if somebody is willing to look at some private profile pics and give me an estimate of how much bi-max advancement I would need to achieve good aesthetic results. The problem is, I am in Canada so the surgery is mostly paid for but I don’t want my movements to be overly conservative either, which tends to be the case up here where aesthetics isn’t a priority. I might think about getting it done in the States, but I really don’t know what, for example, a 5 mm BSSO will do for my profile.

My lateral ceph is here : https://imgur.com/gallery/VaktGWO

Hoping somebody can give me an idea on how much advancement I’d need according to the Ceph. I am class III underbite but my lower jaw is pretty underdeveloped as well, which is better visible on my profile pics. That’s why it’d be ideal for someone help me out privately !! Thank you.

[GJ]

Did you consult with anyone?

Class III should almost always be the upper jaw moving forward and the lower jaw back. Your ceph doesn't support Class III diagnosis. So, I'm wondering who told you that. It looks like you have a very mild anterior open bite, slightly exaggerated Curve of Spee, and otherwise normal jaws.

Do you actually have functional problems chewing, etc?

[ODog]

Yes, of course, I’ve consulted with two surgeons. Both diagnosed me as class III with cross bite (narrow upper jaw)? open bite, and retrognathic upper jaw. I’ve been in braces for a year and 3 months now, decompensating the overjet of my upper teeth.

First surgeon wanted to move the upper jaw forwad and maybe impact it posteriorly since the back of my upper jaw is longer than be front, and also I have no tooth show at rest.

My second surgeon, the one whom I’m going with, is advancing upper jaw, lower jaw, and advancement genio. He said he is moving the lower forward about 5 mm and the genio should add some more. Given the profile pic I sent you do you think that is enough ? Also I am assuming since my upper jaw is more retrognathic relative to my lower jaw he will have to advance that about 8 mm ?

If you look at the profile shot I’ve emailed you (I corrects the file size) you’ll see that there is absolutely no way I could move the lower back as my lower jaw is small as it is.

[GJ]

Yes, of course, I’ve consulted with two surgeons. Both diagnosed me as class III with cross bite (narrow upper jaw)? open bite, and retrognathic upper jaw. I’ve been in braces for a year and 3 months now, decompensating the overjet of my upper teeth.

First surgeon wanted to move the upper jaw forwad and maybe impact it posteriorly since the back of my upper jaw is longer than be front, and also I have no tooth show at rest.

My second surgeon, the one whom I’m going with, is advancing upper jaw, lower jaw, and advancement genio. He said he is moving the lower forward about 5 mm and the genio should add some more. Given the profile pic I sent you do you think that is enough ? Also I am assuming since my upper jaw is more retrognathic relative to my lower jaw he will have to advance that about 8 mm ?

If you look at the profile shot I’ve emailed you (I corrects the file size) you’ll see that there is absolutely no way I could move the lower back as my lower jaw is small as it is.

Yeah, if he's moving the lower jaw forward 5mm then he has to move the upper further. Ask how much, because I fear this is getting into "chimp" territory...

Personally I think leave the lower where it is and use a genio for any advancement, then advance the upper to fix the overbite, is a better plan if you can't move the lower jaw back at all. Sounds like that was the first surgeon's plan. Seems more in line with the scan you showed us and your profile in the flesh (though, a beard does not help assessment).

[ODog]

Please, take a look at the new pic without a beard. Did you receive the corrected file size? I sent to you without a subject line. I think I can definitely use advancement of the mandible. I have a double chin and am not fat. I also tried getting the double chin cosmetically removed and they said it’s not possible as the cause of the sag is small jaws.

My beard really makes my mandible look more grown that it is.