Alar/Base Widening Post Jaw Surgery

[Post bimax]

Have you really seen bad scars from alar base reduction? I had 10mm straight advancement with Posnick and my nostril flare is pretty bad now so I was considering that in the future.

[jusken]

Have you really seen bad scars from alar base reduction? I had 10mm straight advancement with Posnick and my nostril flare is pretty bad now so I was considering that in the future.

I've seen pretty terrible results with very visible scars, but I've also seen good results with very subtle scars.  The question is: how often do the bad results happen even in skissed hands?   This is clearly something that requires a specialist, I just don't like the external scar issue.  I'm still going to get a couple opinions on it, but I've also become a lot more cautious generally with respect to surgical operations.

PS: is the word ski-lled not allowed?

[kavan]

Cool, thanks for the breakdown kavan.  Yes, I remember Gunson talking to me about the multi-segment LF1 and the risks associated with it - so he did perform that.

I'm very confident that there is a fundamental problem with changing the shape of the nasal base - a nose adapts to a recessed maxilla and becomes longer, etc.  This is a fairly obvious trade-off, I simply wasn't totally prepared for it going into it.  Certain movements would clearly make a more unfavorable change, but in any case you're left with essentially a smaller space for the nose.  This would produce a favorable change if you have a very narrow nose for instance or a wide face where such a small width increase is relatively less significant.   Given all the jaw surgery cases I've seen, many people get a 'divergent' nasal shape - a slightly wide and flared look.

I'd change it 100% if there were no other trade-offs...  but that seems unlikely here.

Well, then. That explains the alar base width increase. The trade-off I was referring to was  nose base changes as a function of advancing the maxilla EVEN WITH CCW and EVEN WITH Gunson.

Scars from a wedge section removal from the alar rim area in order to taper them in and narrow the width are hidden in the alar crease area. So, they should not be very visible providing you're light skinned, scar well and don't have keloid issues.

[kavan]

I've seen pretty terrible results with very visible scars, but I've also seen good results with very subtle scars.  The question is: how often do the bad results happen even in skissed hands?   This is clearly something that requires a specialist, I just don't like the external scar issue.  I'm still going to get a couple opinions on it, but I've also become a lot more cautious generally with respect to surgical operations.

PS: is the word ski-lled not allowed?

The work 'Ki-l-l' is not allowed as in someone having suicidal ideations wanting to do that to themselves. So words with that in it change.

[kavan]

Have you really seen bad scars from alar base reduction? I had 10mm straight advancement with Posnick and my nostril flare is pretty bad now so I was considering that in the future.

I was hoping you would see this thread to reflect on the other thread.

[GJ]

I should change that banned word list now that the lunatics have left the asylum.

[Post bimax]

I should change that banned word list now that the lunatics have left the asylum.

Does that mean we're all still in the asylum

[JourneyToSerenity]

Jusken, sorry to intrude into your thread, but since I’m due to have the same procedure, I would appreciate if you could spare some time to answer a few questions.

Since you had segmented lefort, have you encountered any problems or stability issues with regards to your bite or jaw?

Have you experienced any pain or nerve issues as a result of widening the maxilla? Have any root canal problems arisen as a result of the segmented lefort surgery?

How was Gunson’s post-operative care? How many years, if at all, does he continue to check up on your progress?

Lastly, after your initial consultation, how long did you have to wait for a surgery date?

[jusken]

Jusken, sorry to intrude into your thread, but since I’m due to have the same procedure, I would appreciate if you could spare some time to answer a few questions.

Since you had segmented lefort, have you encountered any problems or stability issues with regards to your bite or jaw?

Have you experienced any pain or nerve issues as a result of widening the maxilla? Have any root canal problems arisen as a result of the segmented lefort surgery?

How was Gunson’s post-operative care? How many years, if at all, does he continue to check up on your progress?

Lastly, after your initial consultation, how long did you have to wait for a surgery date?

No stability issues.  No pain or nerve issues (in upper lip area*), in fact the procedure was almost entirely painless from start to finish.  I don't have any root canals, but haven't needed any either.  Gunson did warn of teeth discoloration as a risk, but thankfully no problems there.  Gunson's post-op care is very thorough and he mandates a good number of follow-ups.  I saw Gunson up to about a year after - but only like once in the final 6 months of that period.  It was about 5 months after my consult - but about 3 months after I decided to go through with it.

I could have gotten extremely luck for all I know in terms of avoiding risks - I did very little research prior to any of this.  I consulted with one other orthognathic surgeon, and Gunson was far more thorough.  Gunson is definitely very good, but I also don't want to deify him to anyone - all of these procedures are extremely medieval and you can easily come out worse off (especially for aesthetics only).

The only area that is fairly numb still for me is my lower lip, and I would put it at like 20% numb.  This seems to be the most common area though given the accounts I've come across.

[JourneyToSerenity]

No stability issues.  No pain or nerve issues (in upper lip area*), in fact the procedure was almost entirely painless from start to finish.  I don't have any root canals, but haven't needed any either.  Gunson did warn of teeth discoloration as a risk, but thankfully no problems there.  Gunson's post-op care is very thorough and he mandates a good number of follow-ups.  I saw Gunson up to about a year after - but only like once in the final 6 months of that period.  It was about 5 months after my consult - but about 3 months after I decided to go through with it.

I could have gotten extremely luck for all I know in terms of avoiding risks - I did very little research prior to any of this.  I consulted with one other orthognathic surgeon, and Gunson was far more thorough.  Gunson is definitely very good, but I also don't want to deify him to anyone - all of these procedures are extremely medieval and you can easily come out worse off (especially for aesthetics only).

The only area that is fairly numb still for me is my lower lip, and I would put it at like 20% numb.  This seems to be the most common area though given the accounts I've come across.

Thanks a million for that, Jusken. Much appreciated! Agreed - there’s video of Raffaini doing orthognathic surgery on yt, from what I saw, it looked extremely grim.  Anyway, good to hear everything went well.

[Post bimax]

I wonder if maxillary setback would turn down the nose tip and/or reduce nostril flare?  Or would those effects remain as a side effect of initial advancement.  I have a feeling at least the flare would remain.

[jusken]

I wonder if maxillary setback would turn down the nose tip and/or reduce nostril flare?  Or would those effects remain as a side effect of initial advancement.  I have a feeling at least the flare would remain.

Since your nose is supported by your maxilla, any changes will affect your nose.  In a LF1, any displacement forward or up will cause some flaring - though CCW can mitigate this to some extent.

[GJ]

though CCW can mitigate this to some extent.

In theory, but I've seen this happen with CCW a lot, too.
So it's something more complex. Might be the starting point with your nostrils, too. If they're a little flared to begin with, maybe you're just screwed no matter what way things move.

Edit: it looks like Kavan already touched on this above. Next time someone consults with Gunson maybe ask the exact reason why it happens even with CCW.

[Post bimax]

Since your nose is supported by your maxilla, any changes will affect your nose.  In a LF1, any displacement forward or up will cause some flaring - though CCW can mitigate this to some extent.

Yeah, I understand that.  I'm wondering if reversing a LF1 would also reverse these effects.

[kavan]

Yeah, I understand that.  I'm wondering if reversing a LF1 would also reverse these effects.

You would also have to reverse the BSSO that went with the LF1.