Bimax for aesthetics, looking for advice

[april]

What causes the 'chin curve' to become deep? I always wondered

I'm not sure if it's just chin and lip anatomy or if it's sometimes also influenced by the angle of the lower teeth.

I was looking at your plan compared to some recent-ish Dr Gunson plans

1) Your projected profile compared to a Gunson profile looks different. He often gets the chin to touch the TVL (even despite that being slightly outside of their own analysis norms). He usually achieves this by doing larger CCW rotations, which swings the chin more forward.

2) In Gunson plans, the upper incisor inclination and position look more angled like \ , whereas your incisors are a bit more vertical looking. ie. if you were to draw a vertical line down between ANS and your upper incisor tip, your incisor tip would still be behind the ANS. *This may have already improved to some degree with your current ortho work

3) The TVL/subnasale in your plan advances quite significantly because of the maxillary advancement. I'm not sure what the impacts of this would be overall, but with the advancement + impaction, I would be prepared for some nasal changes.

Take my observations with a grain of salt because I dunno if any of the above matters, I also don't know what your anatomical limitations are, and your plan is pre-ortho work anyway. But I think it wouldn't hurt to get a 2nd opinion regardless.

[PloskoPlus]

Yet quite a few of Gunson's Class II patients look mildly recessed afterwards.  Granted they were the severe cases.

[kavan]

The visible 'chin curve' is the called the mentolabial fold.  As I understand it, the mentolabial angle (angle created by the intersection of the pogonion to crease and lower lip to crease) and chin projection are the primary influences on mentolabial fold appearance.  A more 'acute' angle will create a more obvious fold, which will deepen with horizontal projection. This (I think) is why Kavan suggested avoiding a genioplasty which would shorten the chin. A more obtuse angle will soften the fold but lengthen the face.

Although the groove between lip and chin can get deeper as a function of sliding genio, that wasn't really the reason I told him to hold off on pursuing a genio. The reason was given in my Reply # 7 on this string. To re-cap, it was because sliding (advancement) genio comes with some vertical SHORTENING. Deep bite cases often have 'short chins'. Hence SHORTER isn't indicated.

[Post bimax]

Although the groove between lip and chin can get deeper as a function of sliding genio, that wasn't really the reason I told him to hold off on pursuing a genio. The reason was given in my Reply # 7 on this string. To re-cap, it was because sliding (advancement) genio comes with some vertical SHORTENING. Deep bite cases often have 'short chins'. Hence SHORTER isn't indicated.

Ah okay. I didn’t go back and read the posts and was just drawing from memory. Maybe having lived with AOB most of my life I’m less sensitive to deep bite problems lol.

[CCW]

Yet quite a few of Gunson's Class II patients look mildly recessed afterwards.  Granted they were the severe cases.

That's one of the reasons why his female patients tend to look better than his male patients.

[april]

Although you're talking about severe cases, its a bit of a bummer if some of these plans don't translate well to real life. Because Gunson's plans no doubt look really good on paper with the male chin touching the line. Have you seen one of these severe/mildly recessed results vs their plan to compare?

[PloskoPlus]

Although you're talking about severe cases, its a bit of a bummer if some of these plans don't translate well to real life. Because Gunson's plans no doubt look really good on paper with the male chin touching the line. Have you seen one of these severe/mildly recessed results vs their plan to compare?

In the Gunson revision proposed to me, my chin wouldn't be touching the line.

[april]

How far off?

[djsbelgium]

TECHNICALLY, NO.  In terms of how the cheek bones might look RELATIVE to a Lefort 1 advancement (eg. they might look  less pronounced RELATIVE to an area below them being brought forward), how that might look to YOU, can't be answered. Hence my suggestion to WAIT till a later time to evaluate whether or not you want cheek augmentation.

ETA: I don't answer questions concerning areas (such as cheek bones) that I CAN'T see on your PRESENT photos. No full frontal photo WITH EYES showing and/or no 3/4 (oblique view) where cheek curve is shown= no specific feedback as to cheek bones other than to tell you they can be addressed later down the line.

I'd like to keep some anonymity. Can i PM you pictures or post in the thread and cover my eyes to some extent?

[kavan]

I'd like to keep some anonymity. Can i PM you pictures or post in the thread and cover my eyes to some extent?

Sorry. I don't accept PMs for private advice.