ok, thank you for your answer. You misunderstood something, because my english is very poor. I am sorry for that and I try to rephrase some points:
First at all I am mid 20's old. I wrote that I was 20. Second, I never went to ortho. to consult about a non-surgery solution.
It is the opposite, because I have to undergo a combined ortho+surgery treat or otherwise my insurance won't pay for it.
I had only one ortho., who said by himself: "yes I could fix it without surgery and you dont't need any surgery, because your face is harmonic."
All the other orthos. said that I need a surgery and I never complained about that. However they tried to get rid of me.
Let just summarize some points, so I can be sure that I inderstood it right:
You also think, that maxilla impaction is not enough to bring my chin more forward. So I should also get a sliding genio. Please allow me again to state the question: Wouldn't the maxilla impaction alone improve my aesthetic drastical, so is the sliding genio just the cherry on the top? Just to make it clear: I see on my ceph and if I use a double mirrow, that I haven't a chin outside. But in the ceph I see that I have skeletal chin. I mean, my "real" chin doesn't look like this: http://www.storoe.com/wp-content/uploads/2014/12/weak-chin-orthognathic-surgery-storoe1.png
If I understood you correct, there are objective measurements why my bottom jaw is considered as long? I don't want to know them exactly. I just want to know if there are standards for that.
What do you mean by cut my maxilla into multiple segments? So is there a way to expand my maxilla in the same surgery as the bimax? Because I only know, and that is what all ortho. told me, this way: https://en.wikipedia.org/wiki/Palatal_expansion#/media/File:Hyrax_rapid_palatal_expander.png
And last question: If I get a palate expansion, why should I remove my premolars or did I understand you wrong? If the premolars should be removed, wouldn't it be better to remove my 1. Molars, because they are broken in my case. I thought the palate expansion should solve the problem with my proclined teeth.
It is quite offtopic to discuss the other stuff, but just my 2 cents: In germany everybody expects that a doctor can explain you exactly why you should undergo a treatment. If I go to a jawsurgerist, because I have a medical issue and he says, I need a chin surgery then in Germany everybody will ask him, why exactly do I need it and if it is for better aesthetics, how do I know that it will look better?
You should understand that in germany many people would think I have a mental illness. Nobody would consider me as deformed, maybe a little bit different, but not as deformed. If I would tell anybody that I want a surgery for aesthetic issues, they would consider me as crazy. So let say that, my outlook is very german. But it is not a discussion for this topic.
20, mid 20s, you still have plenty of time to study all of the surgical displacements done in maxfax as they apply to the aesthetic relationships of the jaws and bite, particularly your own. In that way, you'll be better able to identify with the surgical suggestions you get for aesthetic improvement such that they will be SELF EVIDENT. The point was that taking that sort of time would allow you to better RELATE suggestions you get to an aesthetic goal.
The net rotation for helping to close the anterior open bite is in the clockwise direction. The part that is posterior impaction will allow jaw to swing up somewhat because it's the posterior part that's pushing jaw down and back. However, if the front upper teeth need to brought down also in CW, the net CW rotation will still leave you with a high mandibular plane angle. The high MPA contributes to jaw looking long. To OFFSET that a genio would need to be done, a type that shortens the chin and brings it more forward.
Segmental osteteotomy; maxilla cut into multiple segments is when they MIGHT need to do the posterior impaction on the back segments and an anterior downgraft on the front segments, in which case that's a 3 piece segment or ANY case where they might need to move 3 segments of the maxilla independent of each other.
Expanding the maxilla via SURGERY would be to cut it in half through the 2 front teeth which would just makes MORE segments. Better to expand via the DEVICE you linked to which allows expansion without another cut.
The reason to remove pre-molars is when they want to push the teeth backwards in a situation where the teeth are too PROCLINED and they wish to ADVANCE the jaws; a situation where they don't want to advance jaws with PROCLINED teeth.
In Germany, you can consult with Zarrinbal.
End of answers to questions. See paragraph #1 even if you're older than 20.
