I'm having surgery

[fullofsoubts]

I think it will be worth it for you.  Alfaro is a great choice for you because hes one of the few worldwide who really puts a big emphasis on aesthetics in his clinical practice.  Theres no way to know for sure how you will look after, but most often it's favorable!

best of luck, keep us posted on your experience if you decide to proceed.

Hello Lefortitude   

My main motivation is aesthetics so I hope you are right!

I'm waiting for the invisalign to arrive to my orthodontist office so I can start. I had to do the 3D scan twice because when I got the gingivectomy the position of my gums changed and had to do it again.

I think my case may be similar to this one on their page: https://www.institutomaxilofacial.com/es/caso-clinico/silvia-2/

She looks much better after. But she also got a rhinoplasty and has a ton of makeup on lol

Thank you four your words, I will keep you posted 

[fullofsoubts]

Although I can't predict your outcome, as to your fears of having NO tooth show, he would factor tooth show at rest and smiling, how much, into the surgery. You still have gummy smile and long teeth.

Lower lip hang gets addressed/alleviated when the bone is advanced forward which gives more support, from BSSO and chin.

Even if the nose doesn't change much, the new relationship that the jaws have to the face (which should be an improvement) can make the nose look different. For example, same nose on parts of the face that changed can look different.

If you'd be seeking out a nose guy after surgery, it's possible to compensate if issue is loss of nose support. Rebuilding sills, I'm not so sure. Maybe possible to have micro injections of either fat, filler or silicone to construct a small ledge like the sill was.

ETA: Bullhorn is always performed SUBNASA. Not inside the nostrils. So, ya, you got that 'Italian LL' where the LURE is to tell patients it's 'no scar' LL.

The scar I got is so ugly and bad done that I'm happy he did it on the inside. But of course I would prefer to get a well done bullhorn lip lift.

If anybody is reading this and is thinking about getting a lip lift, please look for a surgeon who specializes in lip lifts and do tons of them, there are a few of them out there and I still think is a fantastic procedure when is well done. I would do it again a million times, but of course with another surgeon.

That's great to know about the lower lip! Regarding the nose.. we will see but I guess I'll start saving for a rhinoplasty just in case lol

Again, thank you for your help 

If anyone has any question regarding Alfaro or my experience I will be happy to share my experience if that can help anybody   

[Lazlo]

Hello Lefortitude   

My main motivation is aesthetics so I hope you are right!

I'm waiting for the invisalign to arrive to my orthodontist office so I can start. I had to do the 3D scan twice because when I got the gingivectomy the position of my gums changed and had to do it again.

I think my case may be similar to this one on their page: https://www.institutomaxilofacial.com/es/caso-clinico/silvia-2/

She looks much better after. But she also got a rhinoplasty and has a ton of makeup on lol

Thank you four your words, I will keep you posted 

why is her mandible angle still so steep in the after? It looks like it's hardly changed. I thought Alfaro does aggressive CCW rotation? Shouldn't that make the mandible angles more perpendicular and the mandible rest on a flat plane? 

[Lazlo]

also, out of curiosity, does Alfaro do posterior downgraft for CCW like Gunson? Thanks.

[ArtVandelay]

also, out of curiosity, does Alfaro do posterior downgraft for CCW like Gunson? Thanks.

I'm not sure if "like" refers to something specific like the extremes but Alfaro's plan for me did have 4mm PNS downward, ANS unchanged, CCW with a posterior downgraft.

[kavan]

why is her mandible angle still so steep in the after? It looks like it's hardly changed. I thought Alfaro does aggressive CCW rotation? Shouldn't that make the mandible angles more perpendicular and the mandible rest on a flat plane?

Sorry Lazlo. But the way you ask your question sounds kind of retarded. 

1: Perpendicularity or perpendicular to refers to the relationship between 2 LINES (or planes) that intersect at a 90 degree angle. The angle itself is called either a 90 degree angle or a right angle. Angles themselves don't become 'more perpendicular' by rotating them. They remain the same angles.

2: If you're referring to a 90 degree angle, not all 90 degree angles 'rest on a flat plane' because not all 90 degree angles are formed by one line being parallel to a vertical plane intersecting with another that is parallel to the horizontal plane.  90 degree angles can also be formed by one line being (for example) 'X' degrees CW away from the vertical plane and the the other line being 'X' degrees CW away from the horizontal plane, in which case they won't be resting on a flat plane but angled (or rotated CW) 'X' degrees away from a flat plane. Only 90 degree angles formed by the intersection of one line being parallel to the vertical plane and the other line being parallel to the horizontal plane will 'rest on a flat plane'

3: The 'mandible angle'--the angle of the mandible or gonial angle-- is the angle formed by the posterior border of the ramus and the inferior border of body of the mandible.

It's NOT the same thing as the mandibular PLANE angle, the part of the lower jaw that can look STEEP. The MPA is (basically) the angle of inclination the inferior border of the mandibular body has away from a horizontal plane. The MPA is DIFFERENT angle from the angle of the mandible (gonial angle or 'mandible angle').

A ROTATION does NOT change the angle of the mandible. Angle of mandible stays the SAME. What changes, via rotation (coming from the maxilla), is the angle of INCLINATION the inferior border of the body of the mandible has with a horizontal plane. Angle of mandible and Mandibular Plane Angle (MPA) are 2 different angles.
------------------

The question:  'Why is her mandible [PLANE] angle still steep' resolves to ASSUMING that 'just because he does aggressive CCW', he did so on that patient.

The description does NOT say WHAT KIND of rotation she had. But it does give a CLUE that it was most likely NOT 'aggressive CCW'. The clue is that it says she had  OPEN BITE (most likely anterior open bite) which is often treated by removing a wedge section from the posterior maxilla which is CW. There is NOTHING in the description of what she had that gives rise to assuming she had CCW, yet alone 'aggressive CCW'.

So, here's some questions for YOU:

Are you assuming that just because a doctor can do aggressive CCW rotation, that can be done in ALL patients?

If 'Yes', then FAULTY ASSUMPTION

Why are you assuming that just because he does aggressive CCW rotation, he DID so in THAT patient?


Why AREN'T you assuming that because her MPA is still steep (or as steep as prior) he DIDN'T do 'aggressive CCW' on her?

[april]

Looks like she also had anterior impaction of some sort cause the amount of incisor display at rest and on smile changed.

[Lazlo]

Sorry Lazlo. But the way you ask your question sounds kind of retarded. 

1: Perpendicularity or perpendicular to refers to the relationship between 2 LINES (or planes) that intersect at a 90 degree angle. The angle itself is called either a 90 degree angle or a right angle. Angles themselves don't become 'more perpendicular' by rotating them. They remain the same angles.

2: If you're referring to a 90 degree angle, not all 90 degree angles 'rest on a flat plane' because not all 90 degree angles are formed by one line being parallel to a vertical plane intersecting with another that is parallel to the horizontal plane.  90 degree angles can also be formed by one line being (for example) 'X' degrees CW away from the vertical plane and the the other line being 'X' degrees CW away from the horizontal plane, in which case they won't be resting on a flat plane but angled (or rotated CW) 'X' degrees away from a flat plane. Only 90 degree angles formed by the intersection of one line being parallel to the vertical plane and the other line being parallel to the horizontal plane will 'rest on a flat plane'

3: The 'mandible angle'--the angle of the mandible or gonial angle-- is the angle formed by the posterior border of the ramus and the inferior border of body of the mandible.

It's NOT the same thing as the mandibular PLANE angle, the part of the lower jaw that can look STEEP. The MPA is (basically) the angle of inclination the inferior border of the mandibular body has away from a horizontal plane. The MPA is DIFFERENT angle from the angle of the mandible (gonial angle or 'mandible angle').

A ROTATION does NOT change the angle of the mandible. Angle of mandible stays the SAME. What changes, via rotation (coming from the maxilla), is the angle of INCLINATION the inferior border of the body of the mandible has with a horizontal plane. Angle of mandible and Mandibular Plane Angle (MPA) are 2 different angles.
------------------

The question:  'Why is her mandible [PLANE] angle still steep' resolves to ASSUMING that 'just because he does aggressive CCW', he did so on that patient.

The description does NOT say WHAT KIND of rotation she had. But it does give a CLUE that it was most likely NOT 'aggressive CCW'. The clue is that it says she had  OPEN BITE (most likely anterior open bite) which is often treated by removing a wedge section from the posterior maxilla which is CW. There is NOTHING in the description of what she had that gives rise to assuming she had CCW, yet alone 'aggressive CCW'.

So, here's some questions for YOU:

Are you assuming that just because a doctor can do aggressive CCW rotation, that can be done in ALL patients?

If 'Yes', then FAULTY ASSUMPTION

Why are you assuming that just because he does aggressive CCW rotation, he DID so in THAT patient?


Why AREN'T you assuming that because her MPA is still steep (or as steep as prior) he DIDN'T do 'aggressive CCW' on her?

cool thanks for clarifying. do you know at all if alfaro does aggressive ccw and posterior downgraft? I just don't know if he has that in his skillset. i've heard he does (don't remember the source) just want it confirmed. thanks!

[Dogmatix]

cool thanks for clarifying. do you know at all if alfaro does aggressive ccw and posterior downgraft? I just don't know if he has that in his skillset. i've heard he does (don't remember the source) just want it confirmed. thanks!

Confirmed

[kavan]

cool thanks for clarifying. do you know at all if alfaro does aggressive ccw and posterior downgraft? I just don't know if he has that in his skillset. i've heard he does (don't remember the source) just want it confirmed. thanks!

If you mean does he do a CCW posterior downgraft  close to 10mm 'like' Gunson can do, (if called for), to the best of my knowledge, yes.

ETA: Ya, it does look like she had some CCW (some anterior impaction) but not the type which is significant (aggressive) CCW posterior downgraft.

[fullofsoubts]

Hello again!

This week I finally started with my invisalign and now my orthodontist wants to impact my upper teeth with the invisalign. She thinks that maybe this way the maxillary impaction will not be necessary. And if, after the orthodontic treatment still have some gummy smile, then to do the double jaw surgery and impact the maxilla. But I'm not sure about that 

She says we will see it as we go along.

What would be the aesthetic differences in impacting the maxilla with surgery and intruding the upper teeth with invisalign ? All I know is that in the beginning Alfaro wanted to do double surgery on me, maxillary impaction and bring jaw forward, plus genioplasty correction. I don't know if he wanted to rotate it or something. Will he be able to do it this way ?

If I impact the teeth with invisalign and then decide I need more impaction will it be enough room to move the jaws ?

Also I have lip incompetence, if she impacts my teeth with invisalign, will this be corrected ? Or that can only be solved with maxillary impaction ?

I also don't like that if my upper teeth is intruded with the invisalign then my lower teeth will be more exposed.

I'm thinking about writing an email to Alfaro office with my doubts but my orthodontist thinks It`s not necessary.

What do you think ?

[kavan]

Your photos are now gone to hard to opine.

In GENERAL, it depends on whether or not you have either too much TOOTH show or GUM show. If your teeth are really long (too much tooth show), then orthodontic impaction will make tooth show less IF 'long' teeth are problem. However if long frontal maxilla is problem, that shows itself as too much GUM SHOW. Intruding teeth will not make the gum show less.

[fullofsoubts]

Hello Kavan 

If I’m not mistaken she told me she will impact the upper teeth with invisalign from the bone.
She sent me the clincheck video and that is what it looks like. Also I just had a gingivectomy a couple of months ago.. So intruding just the teeth would make not sense? 

I have both problems: long teeth and long maxilla. I will post the pictures again and I’ll try to post the clincheck video too.
One of my main concerns is that if I do the impaction only with invisalign, will the surgeon be able to move the jaw forward as much as with double jaw surgery ?

Thank you! 

[kavan]

When you say 'impact' the teeth, I think you mean INTRUSION. To the best of my knowledge, I don't think intrusion shortens the bone or makes less gum show. It just makes LESS tooth show.

I'm just telling you to self evaluate...you know...you can see if you have excess gum show or excess tooth show. Excess gum show is addressed by surgical impaction. THat also takes care of the excess tooth show.

If you are having surgery, your ortho has to work WITH the surgeon as in acheive what he's asking him/her to acheive in preparation for surgery.

If you do something that is NOT in the surgeon's PLANS for the surgery, it CHANGES the plan. So, IF his plan is to IMPACT the maxilla to make less BOTH tooth and gum show and he's counting on the extent of that impaction for the CCW rotation he wants for lower jaw to swing up more--or whatever else-- you could be altering his plans if you are working INDEPENDENTLY with the ortho as opposed to the surgeon giving the directives to him/her as to what he wants the ortho to achieve.

[april]

These bloody orthos. Always going rogue.

Does Alfaro give your ortho some sort of direction/instructions? If not, maybe ask that he does.