Isolated Downgraft affect on face/smile

[IconVillage]

Hi all,

I spoke with Dr. Sinn and when I mentioned that I'm not too happy with the tooth show of my smile he mentioned how he could downgraft the maxilla in order for more tooth show. I am not planning on getting a BSSO or LF1 so this would be an isolated procedure. What effect would moving the maxilla down have on the face? Would the face, philtrum, nose get longer? Additionally, could this procedure even be done without also performing surgery on the lower jaw? Here are pictures for reference of my mouth open slightly, a normal smile, the biggest smile I can do, and lastly moving my upper lip up as far as I can (which I would consider to be ideal tooth show).

https://imgur.com/a/06IhLae

[PloskoPlus]

Downgrafting the maxilla is a lf1. It would rotate your lower jaw down and make your profile weaker.

[GJ]

What effect would moving the maxilla down have on the face? Would the face, philtrum, nose get longer?
https://imgur.com/a/06IhLae

The face and philtrum will get longer. The nose can't move, so it might actually look shorter.

Your face looks extremely compact/short, so that might be the reason he's suggesting it. Whether it can be done in isolation depends on your bite relationship. My concern would be your airway gets smaller in that scenario as the upper jaw locks your lower jaw further back, cutting off the lower airway some. As PP mentions, it will weaken the profile, too. You might be a better candidate for a linear movement of both jaws since your plane looks flat.

[IconVillage]

The face and philtrum will get longer. The nose can't move, so it might actually look shorter.

Your face looks extremely compact/short, so that might be the reason he's suggesting it. Whether it can be done in isolation depends on your bite relationship. My concern would be your airway gets smaller in that scenario as the upper jaw locks your lower jaw further back, cutting off the lower airway some. As PP mentions, it will weaken the profile, too. You might be a better candidate for a linear movement of both jaws since your plane looks flat.

Thanks for the replies! He's not really suggesting it per se, he just asked me if I like my smile to which I said I would prefer more tooth show, and he replied, "More tooth? Well I can move the jaw down in a simple procedure if that's what you want..." For reference I am a class one bite.

It's unfortunate to hear that downgrafting will negatively impact the profile if down in isolation as improvement of the profile is the whole reason I'm getting surgery in the first place! You are correct, my occlusal plane is flat, but I think at this point I've decided against jaw surgery for various reasons (borderline case, recovery time, unpredictability of procedure, Sinn saying he doesn't think I'd be happy with the results of a jaw surgery). Seems as if an isolated downgrafting is not the solution, perhaps an upper lip lift for increase tooth show?

It's curious you say my face is extremely compact/short, I've always thought it was sort of long and that's what worried me about downgraft. Perhaps that's just an illusion from the pictures I provided? Here are some more pictures of my full face so you can judge the compactness:

https://imgur.com/a/HS9D4JG

You can see from the 2nd picture that the tooth show isn't bad when I smile largely, but I'd prefer a tiny bit more tooth show (so that the top of the tooth is visible).

[GJ]

The tooth show looks fine and that extra mm you want wouldn't warrant jaw surgery.
Some of that is due to the muscles, too, so you might not get what you expect.

Your face looks less compact in those photos, but still on the shorter side. I'd say it's average to slightly short just eyeballing it.

[Post bimax]

Could go with a small lip lift. Much cheaper

[DRIVVEN]

Hi all,

I spoke with Dr. Sinn and when I mentioned that I'm not too happy with the tooth show of my smile he mentioned how he could downgraft the maxilla in order for more tooth show. I am not planning on getting a BSSO or LF1 so this would be an isolated procedure. What effect would moving the maxilla down have on the face? Would the face, philtrum, nose get longer? Additionally, could this procedure even be done without also performing surgery on the lower jaw? Here are pictures for reference of my mouth open slightly, a normal smile, the biggest smile I can do, and lastly moving my upper lip up as far as I can (which I would consider to be ideal tooth show).

I just looked at your pictures and it looks like you have perfect lip seal and that your lips are closed at rest, this helps the muscles of your face, your chin and even your neck muscles to function well.  If you take your perfect lip seal and raise the upper lip to get more tooth show, your lips will not be sealed at rest—this lip incompetence could cause a whole serious of other problems with the facial muscles and function. I would not get a lip lift.

[Post bimax]

I just looked at your pictures and it looks like you have perfect lip seal and that your lips are closed at rest, this helps the muscles of your face, your chin and even your neck muscles to function well.  If you take your perfect lip seal and raise the upper lip to get more tooth show, your lips will not be sealed at rest—this lip incompetence could cause a whole serious of other problems with the facial muscles and function. I would not get a lip lift.

Couldn’t downgraft also do this though?

[GJ]

Couldn’t downgraft also do this though?

Yes.
He doesn't need any surgery of any kind. His tooth show is within normal and his lips seal without strain.
He can try to shoot for improvement. It's his body. But IMO that's not a risk worth taking. It's skewed toward problems more than an ideal/solution.

[april]

I just looked at your pictures and it looks like you have perfect lip seal and that your lips are closed at rest, this helps the muscles of your face, your chin and even your neck muscles to function well.  If you take your perfect lip seal and raise the upper lip to get more tooth show, your lips will not be sealed at rest—this lip incompetence could cause a whole serious of other problems with the facial muscles and function. I would not get a lip lift.

I've been thinking about lip lift vs downgraft and getting so confused.

Is a lip lift guaranteed to cause lip incompetence?

Would the extra fullness to the upper lip (red part of the lip) gained during the lip lift help maintain some lip seal?

OPs lip is already pretty full, so it might look too full after a lip lift anyway. And the full lip may actually be why he doesn't show as much teeth as he'd prefer.