Gunson Consult

[Austinou88]

I'd see him in person. "Can't tell from photos" would not make me feel great.
Your ortho will be prepping you based on Gunson's interpretation of photos, so the surgical plan could change dramatically the day of surgery because of this.

Dang, yeah you're right. That doesn't make me feel too sure about his plans now.

Should I try and setup an in-person followup then, based upon my concerns with that part?

[Austinou88]

Chimps don't have a narrow nasio-labial angle. They have an exaggerated conVEX lip.

Man, I loved the job Rohrich did on my nose. But I wish I would of known better, and waited till after I addressed my lower third issues.

How bad do you think it's going to end up being/changing after all these movements?

[Austinou88]

The angle of your head in your profile shot is being partially obscured by your jacket, but looks like you have forward head posture.  I did a quick morph assuming what your head angle would be possibly looking straight ahead.  One issue you'd have with these movements is that the angle of your nose currently matches your current facial development and has a  low angle.  If you went ahead with these movements, assuming you didn't do something about your nose angle, it would be heavily compressed by the forward movement and you'd have the wide flat nose look.  I changed this in the morph too.. so I guess it works if you factor all that in?

Man, I wish I would of known better before getting my Rhinoplasty. So this is certain to change for sure than?

Well I think I will just go and see Maubrie than for some temporary fillers afterwards, at least until I can get in for a revision.

[Austinou88]

Look at the contour displacement diagram, (the one where YOUR profile is shown in black and the proposed displacement contour is shown in red). From there, you should at least be able to self IDENTIFY with your OWN profile contour and SEE whether or not the proposed one (in red) makes a POSITIVE difference to your profile. Whether or not the proposed contour changes will make much of an aesthetic difference should be SELF EVIDENT. You should at least be able to observe which contour looks better. If not, there is no point in discussing 'aesthetics', motivation for 'better aesthetics' in the absence of knowing whether or not you could recognize one if you saw it diagrammed on your own face.

Here, you were given a visual. So, what does it look like to YOU...better aesthetic or not?

Ah okay, thanks for explaining that Kavan. Looking at it now more clearly, the advancements look huge! I like it, everything looks more balanced and projected.

I guess my question should of also included, is Gunson giving me the most max asthetic plan possible? Are there any movements that he could of changed (gone further on, not do, do, tweaked, and etc.) that he didn't do?

[GJ]

Dang, yeah you're right. That doesn't make me feel too sure about his plans now.

Should I try and setup an in-person followup then, based upon my concerns with that part?

I would if it's not too much a ha$$le to get there.

Good planning is a big % of the success with this surgery. I don't see how it's possible to have good planning via distance vs in the flesh. The latter is just not going to be as accurate.

If it's too much a hassle to go in-person then this will have to do, but just realize the odds for problems go up a bit. If anything is really amiss the day of surgical prep Gunson will likely call it off.

PS. The plan looks fine from what I can gather. Some linear and some CCW. The linear should open the upper airway, and the CCW should open the lower airway (more linked to apnea). I think your profile looks alright right now, so it will probably be a bit extreme in terms of how masculine you look after. If that's the look you want, this should do it. Since you're going in for (severe) apnea treatment you might just have to accept the aesthetics.

[Dogmatix]

Dang, yeah you're right. That doesn't make me feel too sure about his plans now.

Should I try and setup an in-person followup then, based upon my concerns with that part?

Why bother if you've already decided you will use another surgeon? You've got the concept of what Gunson would do to you, the difference will probably be to fine tune the mm's. What's interesting that you can bring from this is that he doesn't see any need for any big rotations etc, mainly a straight advancement. No other surgeon will be able to replicate down to the mm any way, probably not even Gunson if he would do your case twice.

[kavan]

Why bother if you've already decided you will use another surgeon? You've got the concept of what Gunson would do to you, the difference will probably be to fine tune the mm's. What's interesting that you can bring from this is that he doesn't see any need for any big rotations etc, mainly a straight advancement. No other surgeon will be able to replicate down to the mm any way, probably not even Gunson if he would do your case twice.

BINGO! But he hasn't made clear to GJ (or anyone else in his initial string) that he's not going to Gunson.

[kavan]

Austin,


I'm sorry, but I'm not going to address every spin off question you have because I want to see less ENTROPY in the way you relay and respond to information and more ORDER in processing it. What I mean by 'entropy' is the act of expanding 'all over the place' with questions that don't reflect you've 'crystallized' the purpose of the information given. Let me just say that the level or type of information I will give to people has to be contingent on my recognizing they can process it in an orderly way.

Let's take a closer look here. An entry is made where a person giving you advice doesn't observe something that's obvious; he doesn't see that chimps have overly conVEX muzzles (chimp lip) and not 'narrow' nasio-labial angles.

Looking at the diagram it seems your nasolabial angle will become too narrow possibly giving you the dreaded "chimp lip".

I clarify so that you don't get confused by his entry or think the plan will give you chimp lip or otherwise make you look worse.

Chimps don't have a narrow nasio-labial angle. They have an exaggerated conVEX lip.

...and what happens next, the clarification given so you DON'T WORRY that this plan is going to make you look worse spring boards off of someone who made a faulty observation and you want to know how 'bad' I think you are going to look. Entropy question. So, I'm only going to address questions that I feel are logical extensions of the prior information given and not those that I feel come out of an ENTROPY generator and mind you, a number of people here said the plan would give great improvement.
 

Man, I loved the job Rohrich did on my nose. But I wish I would of known better, and waited till after I addressed my lower third issues.

How bad do you think it's going to end up being/changing after all these movements?

-----

Let's take another example of entropy in this string.

Lefortitude responds to my first entry to you where he might think I'm being too harsh by telling you to observe what should be self evident to you (as to whether you like the contour diagram change or not).

When I first noticed something was wrong, I could not put my finger on it for the longest time. Is it my chin? my nose? my maxillas fine, no my maxillas narrow, no recessed, no its my orbitals, must be my superior orbit, no my inferior orbit etc etc. Maybe I'm aesthetically blind, but it took me a lot of research, morphing, analyzing to understand facial aesthetics.  Maybe there are others like me, to varying degrees.

With his statement, although this is something where you KNOW your going off topic, you want to engage him in a bullet list of EYE topics. That's entropy; going all over the place with questions that are not really extensions of what the other person said or even the topic of your string. However, if he wants to indulge in that with reference to your photos where you have the eyes WHITED OUT, it's his shot to call.
-----

Then we have some posters, to whom you have not MADE CLEAR you went to Gunson for a PLAN to take to your military doctor and you are not actually getting the surgery with Gunson.

There's O'Dog trying to explain what you mean from your question, thinking you're asking because you want to know if the surgery is worth Gunson's HEFTY PRICE tag. Also, GJ tells you to go IN PERSON so that Gunson can solidify his plans so there are no changes the day of surgery. So, there you have people giving  feedback based on their ASSUMPTION you are having this surgery with Gunson where they would have known you were not getting surgery with him if you had stated that in your first post and clarified it was a plan that you wanted to take to the military doctors.
-----
Last but not least is the question for me.

Ah okay, thanks for explaining that Kavan. Looking at it now more clearly, the advancements look huge! I like it, everything looks more balanced and projected.

I guess my question should of also included, is Gunson giving me the most max asthetic plan possible? Are there any movements that he could of changed (gone further on, not do, do, tweaked, and etc.) that he didn't do?

The plan reflects Gunson's aesthetic and his ability to balance all of the many individual parts for aesthetic balance and correction of sleep apnea. That is what you went for; a PLAN that reflected his aesthetics combined with correcting apnea. You got what you went to get; a PLAN to to show your military doctors that shows them how CCW can be used to optimize aesthetics while correcting sleep apnea. All you need to know is that YOU LIKE the aesthetic shown in the plan. It's not needed for me to critique his plan in terms of which displacements he could have done to give the max aesthetic possible. What's needed is for you to FOCUS on being able to identify on the illustration with it coming very close to an aesthetic you would like, realizing the plan is to OPTIMIZE sleep apnea problem with GOOD aesthetic balance. So, entropy question of what movements he could have should have done to 'maximize' aesthetics is disqualified here.
----

[Austinou88]

I would if it's not too much a ha$$le to get there.

Good planning is a big % of the success with this surgery. I don't see how it's possible to have good planning via distance vs in the flesh. The latter is just not going to be as accurate.

If it's too much a hassle to go in-person then this will have to do, but just realize the odds for problems go up a bit. If anything is really amiss the day of surgical prep Gunson will likely call it off.

PS. The plan looks fine from what I can gather. Some linear and some CCW. The linear should open the upper airway, and the CCW should open the lower airway (more linked to apnea). I think your profile looks alright right now, so it will probably be a bit extreme in terms of how masculine you look after. If that's the look you want, this should do it. Since you're going in for (severe) apnea treatment you might just have to accept the aesthetics.

Yeah I'm going to check on that tomorrow just to see if nothing else.

Apologize, one thing I did forget to mention was that I brought Gunsons plan to the Military MaxFac, and showed them it. The Resident asked who did it and I told him Arnett & Gunson. He then showed it to the Military MaxFac in charge of him, who is the one I requested by name, and he said the same thing. He trained under Wolford for a while, and everyone at the facility, and other facility's, say he's the best. The plan isn't too complicated for a decent surgeon to execute is it?

They didn't agree to the plan, but I tried pushing it as much as possible. I'm waiting to hear back from the surgeon, but I spoke with him the other day and he said he had a couple of different treatment options open to me. Just need to send over my Sleep Study Results once I get them, just did my second sleep study last night.

I noticed that the technology they use at the Military Hospital though doesn't seem like it's the most up to date and advanced stuff. Since it's a Residency Facility, I think they are probably also doing more an old school style way of teaching, instead of all virtual. Not sure though.

At my consult with the Military MaxFac I brought in all the records I've acquired so far. He was really happy for some reason, probably because I had basically everything he needed to plan out the surgery.

Just curious though, does good, high quality imaging also play an important role in a successful surgery outcome?

Is there any important imaging besides the typical Ceph, Pan, CT Scans, and Photographs I should obtain and send them? Anything that would help my surgeon out tremendously? I've heard about things such as 3D Ceph Analysis (from Cephx?), Cone Beam CT (CBCT), Frontal Ceph, and iTero Scan.

As long as it looks better, I'm open to as much change as possible lol. More worried about my facial front though. Hope that can be a lot more balanced out.

[Austinou88]

Austin,


I'm sorry, but I'm not going to address every spin off question you have because I want to see less ENTROPY in the way you relay and respond to information and more ORDER in processing it. What I mean by 'entropy' is the act of expanding 'all over the place' with questions that don't reflect you've 'crystallized' the purpose of the information given. Let me just say that the level or type of information I will give to people has to be contingent on my recognizing they can process it in an orderly way.

Let's take a closer look here. An entry is made where a person giving you advice doesn't observe something that's obvious; he doesn't see that chimps have overly conVEX muzzles (chimp lip) and not 'narrow' nasio-labial angles.

I clarify so that you don't get confused by his entry or think the plan will give you chimp lip or otherwise make you look worse.

...and what happens next, the clarification given so you DON'T WORRY that this plan is going to make you look worse spring boards off of someone who made a faulty observation and you want to know how 'bad' I think you are going to look. Entropy question. So, I'm only going to address questions that I feel are logical extensions of the prior information given and not those that I feel come out of an ENTROPY generator and mind you, a number of people here said the plan would give great improvement.
 -----

Let's take another example of entropy in this string.

Lefortitude responds to my first entry to you where he might think I'm being too harsh by telling you to observe what should be self evident to you (as to whether you like the contour diagram change or not).

With his statement, although this is something where you KNOW your going off topic, you want to engage him in a bullet list of EYE topics. That's entropy; going all over the place with questions that are not really extensions of what the other person said or even the topic of your string. However, if he wants to indulge in that with reference to your photos where you have the eyes WHITED OUT, it's his shot to call.
-----

Then we have some posters, to whom you have not MADE CLEAR you went to Gunson for a PLAN to take to your military doctor and you are not actually getting the surgery with Gunson.

There's O'Dog trying to explain what you mean from your question, thinking you're asking because you want to know if the surgery is worth Gunson's HEFTY PRICE tag. Also, GJ tells you to go IN PERSON so that Gunson can solidify his plans so there are no changes the day of surgery. So, there you have people giving  feedback based on their ASSUMPTION you are having this surgery with Gunson where they would have known you were not getting surgery with him if you had stated that in your first post and clarified it was a plan that you wanted to take to the military doctors.
-----
Last but not least is the question for me.

The plan reflects Gunson's aesthetic and his ability to balance all of the many individual parts for aesthetic balance and correction of sleep apnea. That is what you went for; a PLAN that reflected his aesthetics combined with correcting apnea. You got what you went to get; a PLAN to to show your military doctors that shows them how CCW can be used to optimize aesthetics while correcting sleep apnea. All you need to know is that YOU LIKE the aesthetic shown in the plan. It's not needed for me to critique his plan in terms of which displacements he could have done to give the max aesthetic possible. What's needed is for you to FOCUS on being able to identify on the illustration with it coming very close to an aesthetic you would like, realizing the plan is to OPTIMIZE sleep apnea problem with GOOD aesthetic balance. So, entropy question of what movements he could have should have done to 'maximize' aesthetics is disqualified here.
----

Oh wow, I didn't even realize I was doing that. I guess I felt like I needed to respond to each reply, otherwise I would come off disrespectful. I see how that can end up being counterproductive now, my apologies. And I understand your points raised. I'll make sure to correct the way I go about my responses here out.

I guess I should of been more straight forward with Gunson, on how my focus is actually 100% asthetics. I asked him if this was maxing out asthetics though, which he replied yes. That I'd get the benefit of both. But maybe that meant only in terms of working alongside and correcting the sleep apnea, like you mentioned?

If better asthetics would be possible, with disregard for fixing the sleep apnea, then that's a plan I would be more interested in for sure! I know that may sound crazy, but it seems my sleep apnea is almost entirely central apnea instead of obstructive.

I don't have anything I'm particularly ooking for in terms of asthetics, just whatever movement will yield the most pleasing results. Change as much as required to give the greatest pleasing results. Pretty much the same thing I told Rohrich on my nose.

I do like the illustration though, and I guess my question should of been, can anything be changed further for even better pleasing asthetics.

[kavan]

Oh wow, I didn't even realize I was doing that. I guess I felt like I needed to respond to each reply, otherwise I would come off disrespectful. I see how that can end up being counterproductive now, my apologies. And I understand your points raised. I'll make sure to correct the way I go about my responses here out.

I guess I should of been more straight forward with Gunson, on how my focus is actually 100% asthetics. I asked him if this was maxing out asthetics though, which he replied yes. That I'd get the benefit of both. But maybe that meant only in terms of working alongside and correcting the sleep apnea, like you mentioned?

If better asthetics would be possible, with disregard for fixing the sleep apnea, then that's a plan I would be more interested in for sure! I know that may sound crazy, but it seems my sleep apnea is almost entirely central apnea instead of obstructive.

I don't have anything I'm particularly ooking for in terms of asthetics, just whatever movement will yield the most pleasing results. Change as much as required to give the greatest pleasing results. Pretty much the same thing I told Rohrich on my nose.

I do like the illustration though, and I guess my question should of been, can anything be changed further for even better pleasing asthetics.

You can respond to each reply, but stick to questions that would follow from the reply. Gunson told you right when he said you would get benefits of both. Keep in mind that your insurance is paying for sleep apnea surgery and not for 'aesthetics alone' and if you can get the military doctors to follow plan as close as possible, then you will have both.

[Austinou88]

Good to go. Is it possible Gunson would of came up with a different approach if it was just for asthetic reasons only?

Yeah, but since I have to have it at the Military Facility, the insurance doesn't pay anything. I'm concerned though because a Resident will be involved in some of the surgery. I can't remove him from the equation. He works under the staff surgeon I requested, who's pretty good. Then again, I remember Rohrich suprising me with some Resident the day of my surgery. Everything turned out fine though.

So, was that morph just what a Genio would look like on me?

[kavan]

Good to go. Is it possible Gunson would of came up with a different approach if it was just for asthetic reasons only?

Yeah, but since I have to have it at the Military Facility, the insurance doesn't pay anything. I'm concerned though because a Resident will be involved in some of the surgery. I can't remove him from the equation. He works under the staff surgeon I requested, who's pretty good. Then again, I remember Rohrich suprising me with some Resident the day of my surgery. Everything turned out fine though.

So, was that morph just what a Genio would look like on me?

Gunson's suggestion incorporated more aesthetic changes simply because he suggested HA bone granules to augment some of the bone structure which is something your military doctors probably will not do for 'aesthetics only'.

I suppose, perhaps there could be a different approach IF it were just for aesthetics 'only'. I mean I can't rule out that possibility. But I CAN'T PONDER all the possible combinations and permutations of movements just to address the question. If that's a burning question for you, ask Gunson.

The salient thing is that you have a plan from Gunson that includes a posterior down graft and that is associated with both better aesthetics and better breathing and the plan shows you a profile contour that should be enough for you to determine IF you like that and that profile contour is CONSISTENT with A GOOD aesthetic.

I don't know WHAT 'morph' you are talking about. My comments on this string refer to Gunson's contour diagram and not to any morphs.

[PloskoPlus]

The posterior downgraft is so small relative to other movements it will probably make little difference.

[Post bimax]

The posterior downgraft is so small relative to other movements it will probably make little difference.

It could make THE difference though, otherwise it would probably be omitted. It's unclear to me what multiplicative impact small OP angle variations have on the horizontal displacements.