Re: Dr Hernandez Alfaro

[Dogmatix]

Anyone want to comment on this result?
https://www.instagram.com/p/BtN5LwwlL6w/

[kavan]

With the IG photo, he has people go to his link to see what she got. Aside from the translation glitches, the description is:

"Sara visited us because she had an open bite that prevented her from eating normally. To correct his problems, he underwent bimaxillary surgery and septoplasty."

It also says: 'Class 111' (Class 3)

Unless I missed something, that is not much of a description of what she got. She looks like class 3 in both photos but a better class 3 in the after but still has a class 3 'look' as far as what appears to be some over projection to the chin. But as you might know, for a maxfax surgery to correct a very bad bite problem which he says she had, this could be an example of a trade-off.

[Dogmatix]

With the IG photo, he has people go to his link to see what she got. Aside from the translation glitches, the description is:

"Sara visited us because she had an open bite that prevented her from eating normally. To correct his problems, he underwent bimaxillary surgery and septoplasty."

It also says: 'Class 111' (Class 3)

Unless I missed something, that is not much of a description of what she got. She looks like class 3 in both photos but a better class 3 in the after but still has a class 3 'look' as far as what appears to be some over projection to the chin. But as you might know, for a maxfax surgery to correct a very bad bite problem which he says she had, this could be an example of a trade-off.

Correct, there is a link to his site where the case is presented, but not much more info as you say.
https://www.institutomaxilofacial.com/es/caso-clinico/sara-3/

The chin is obviously advanced, one can see that the jaw line is much more defined all the way from the ear. My first thought was that it seemed a bit too much, but after getting used to it I started thinking it was good. But it's interesting as you say, the bite was severly open pre treatment, and maybe it was that the mandible had to be rotated this far to close the bite.

Too bad surgeons are more sales oriented and present the aesthetics, and don't provide the technical information to understand what's going on.
Is it possible to guess in what range the advancement of the mandible was here?

[kavan]

Correct, there is a link to his site where the case is presented, but not much more info as you say.
https://www.institutomaxilofacial.com/es/caso-clinico/sara-3/

The chin is obviously advanced, one can see that the jaw line is much more defined all the way from the ear. My first thought was that it seemed a bit too much, but after getting used to it I started thinking it was good. But it's interesting as you say, the bite was severly open pre treatment, and maybe it was that the mandible had to be rotated this far to close the bite.

Too bad surgeons are more sales oriented and present the aesthetics, and don't provide the technical information to understand what's going on.
Is it possible to guess in what range the advancement of the mandible was here?

There's a way to look at thing with reference to relative distances if you wanted to take a very approximate guess. You check things that don't change like the ear from 2 consistent points just to see if the photos are taken from approximate same distance. Then you drop a vertical from the eyeball and take a look of what went forward relative to that line. Then you can pick points on the lips to see how far they are from the vertical drop if you want to look at the relative (horizontal) mm differential on the photo. The SCALE of the photo, which we don't have would be needed to approximate the horizontal displacements on the photo to the advancements of the surgery. BUT STILL, it's just better to look at RELATIVE changes from some constant landmarks because the surgery would have a LOT of displacements relative to bone landmarks and we are just looking at a photo.

[Dogmatix]

There's a way to look at thing with reference to relative distances if you wanted to take a very approximate guess. You check things that don't change like the ear from 2 consistent points just to see if the photos are taken from approximate same distance. Then you drop a vertical from the eyeball and take a look of what went forward relative to that line. Then you can pick points on the lips to see how far they are from the vertical drop if you want to look at the relative (horizontal) mm differential on the photo. The SCALE of the photo, which we don't have would be needed to approximate the horizontal displacements on the photo to the advancements of the surgery. BUT STILL, it's just better to look at RELATIVE changes from some constant landmarks because the surgery would have a LOT of displacements relative to bone landmarks and we are just looking at a photo.

Thanks. This does put some perspective on it. Also when looking at the ear angle, one can see that the head position is slightly more rotated on the after picture, giving even more projection. For what it's worth, it seems like the chin advancement is more than her nose sticks out. I don't know what her nose meassures, but mine is about 2cm. At least it's obvious it's a big advancement.

I think I'm gonna decide this is a good result. What throws me off a bit is that the jaw line looks a bit banana shaped. But looking at the anterior part and how the lips allign with the nose, it looks really good, maybe a bit over projection at the chin.

[kavan]

Thanks. This does put some perspective on it. Also when looking at the ear angle, one can see that the head position is slightly more rotated on the after picture, giving even more projection. For what it's worth, it seems like the chin advancement is more than her nose sticks out. I don't know what her nose meassures, but mine is about 2cm. At least it's obvious it's a big advancement.

I think I'm gonna decide this is a good result. What throws me off a bit is that the jaw line looks a bit banana shaped. But looking at the anterior part and how the lips allign with the nose, it looks really good, maybe a bit over projection at the chin.

Well the important part about the ear measure is we just want to determine the distance from the camera is about the same which we can do even without the 'exact' points to the ear. The angle difference from the ear distance measure I made can be about 2 degrees and that's fine because that's within an error of not having the 'exact' landmarks points to the ear.

[april]

If the chin wasn't so overprojected she'd look amazing!

We don't know what she requested, but I would have assumed a strong chin trade off could have been forseen and dealt with in some way.

I'm guessing with an anterior open bite like that, some of the closure would've been via multisegment.

[Lazlo]

no she has an amazing jawline and chin projection. in real life it would look dazzling. wish i had achieved that kind of result. maybe if I do a round 2 with Dr. Gunson....

I wonder how much ALfaro charges?

[CCW]

If the chin wasn't so overprojected she'd look amazing!

We don't know what she requested, but I would have assumed a strong chin trade off could have been forseen and dealt with in some way.

I'm guessing with an anterior open bite like that, some of the closure would've been via multisegment.

It looks fine when she's not smiling. That's a normal Class I profile, and the chin is not overprojected.

[kavan]

Agree. She looks fine, if not great, when she's not smiling. But consider the responses to the OPs initial question were in direct reference to Alfaro's IG photo of her smiling.

[PloskoPlus]

In the 3/4 view the chin is excessive.

[jawsandsleep]

I scheduled an online appointment with him next week! Let's see what happens

[Ramalito]

Meeting with Alfaro and Joan Birbe next month. I’ts confusing because Alfaro has so many before and afters on his website but not that many GREAT ones, and Joan Birbe has just a couple but the ones I’ve seen are amazing. I mean look at this girl..

[Dogmatix]

Meeting with Alfaro and Joan Birbe next month. I’ts confusing because Alfaro has so many before and afters on his website but not that many GREAT ones, and Joan Birbe has just a couple but the ones I’ve seen are amazing. I mean look at this girl..

I'm sure Birbe is good, but you can't compare consistent mug-shot pictures with a selfie, probably taken by the patient.

[PloskoPlus]

I'm sure Birbe is good, but you can't compare consistent mug-shot pictures with a selfie, probably taken by the patient.

Absolutely.