Bimax advancement (CCW rotation) plus genio (pics attached)

[jellyflower]

Hi guys,

My surgeon is proposing to do a CCW bimax (upper jaw advancement of 3-5 mm, and lower jaw advancement of 8-10 mm) and a modest genioplasty.

I've been in braces for 2 years and am ready for the surgery - I'm just having second thoughts about the plan. Specifically, I'm worried about moving the maxilla forwards as I’m worried it will make my nose too upturned, because it is already somewhat upturned. I'm also worried about the dreaded 'chimp look' of the upper lip.

I've uploaded pics below and also uploaded a video as I always think a video is clearer.

Please give me any advice you have. (Please do not repost or embed the pics).


https://youtu.be/se1FqFmBsMw  (I show my profile towards the end)

https://imgur.com/a/3VJyD5h

[PloskoPlus]

Where will the CCW come from? You don't have a gummy smile. Your tooth show looks perfect. Will you have a posterior downgraft? AFAIK, no surgeon in UK does this. IMO, advancing the maxilla is a bad idea in your case. No surgery has the potential to make you look uglier than a maxillary overadvancement.

[jellyflower]

Where will the CCW come from? You don't have a gummy smile. Your tooth show looks perfect. Will you have a posterior downgraft? AFAIK, no surgeon in UK does this. IMO, advancing the maxilla is a bad idea in your case. No surgery has the potential to make you look uglier than a maxillary overadvancement.

I don't know the answer to this unfortunately - my surgeon hasn't mentioned a posterior downgraft or impaction.

He's UK based and definitely intends to do CCW rotation.

[GJ]

To me that plan seems appropriate.
There is a difference between a 3mm movement and a 5mm movement, though, in terms of the upper jaw and how much projection you'll get from the lower, so I'd try to get that clarified.

You shouldn't get the chimp look from CCW rotation that small, so I'd say that concern is completely unwarranted.

The nose could be an issue. To me your nose doesn't look upturned right now. Looks normal/level from what I see. But let's say it is a little upturned...you can expect that to worsen to a degree. Whether it's worth it depends on you as an individual and all the pros/cons, but mentally prepare for it now. You can ask the surgeon if he knows how to perform and is willing to do an alar cinch and maybe remove some of the ANS (anterior nasal spin), if they are needed, to help compensate for any adverse affects.

Your upper lip should sit a little better after surgery and won't be as extreme as you make it when you just your jaw. You have to remember that "advancement" of the upper jaw during CCW is minimal. It's more like a rotation than an advancement if he's pivoting the jaw on a fixed point. If he actually intends to advance it and pivot it that's different and would probably not be appropriate. But a pure CCW on a fixed point does make sense to me based off what I see.

You have good general features and seem like a nice guy. You should turn out okay if the surgeon executes properly. That would be my biggest concern, not the plan. Just my opinion.

There's a private forum if you want your case there. It does require a small donation for entrance. Also, you'll get fewer eyes/opinions on it than here in the public section. Email me if interested in that.

[ghiggson90]

Hi guys,

My surgeon is proposing to do a CCW bimax (upper jaw advancement of 3-5 mm, and lower jaw advancement of 8-10 mm) and a modest genioplasty.

I've been in braces for 2 years and am ready for the surgery - I'm just having second thoughts about the plan. Specifically, I'm worried about moving the maxilla forwards as I’m worried it will make my nose too upturned, because it is already somewhat upturned. I'm also worried about the dreaded 'chimp look' of the upper lip.

I've uploaded pics below and also uploaded a video as I always think a video is clearer.

Please give me any advice you have. (Please do not repost or embed the pics).


https://youtu.be/se1FqFmBsMw  (I show my profile towards the end)

https://imgur.com/a/3VJyD5h

You're quite handsome already, I think the risks do not outweigh the benefits here.

I would recommend running the specifics of your surgeon's plan by this forum before pulling the trigger.

[kavan]

I don't think your nose is upturned. But the nose to lip angle looks open due to what they sometimes call 'tethering'. This could be because of a  prominent nasal spine, in which case, they could shave it down a little--only a litte-- to offset any further tethering or even any unwanted rotation. You have great face structure/aesthetic as is. So the surgery will make that greater on someone like you which is good thing. I would not worry about chimp lip with the modest amount of CCW you are getting. Thank you for posting appropriate photos.

[PloskoPlus]

You're quite handsome already, I think the risks do not outweigh the benefits here.

I would recommend running the specifics of your surgeon's plan by this forum before pulling the trigger.

I agree with the above.  You look great from the front.  You look mildly retrognathic from profile, but who cares?  The danger is that a bad plan will leave you with a longer face from the front, yet you may still look recessed from profile.

[april]

I watched your video. You mentioned about your upper lip angling out when you jutted forward and how that's something you wanted to avoid. The way your upper lip is angling out in the video is not a chimp lip, in case you were worried. A chimp lip is more when the upper lip is shaped like )

How big is your overjet?

We can probably assume it's going to be a small CCW rotation because the mandible advancement is also relatively small/modest 8-10 mm (well small compared to the massive advancements surgeons like Gunson are able to achieve with CCW).

But I'd definitely want some clarification about those maxilla numbers and also where the CCW is going to take place.

CCW should counteract the risk of a chimp lip, but if you're also getting maxilla (ANS) advancement with the rotation I'm guessing there's gotta be some sort of balance/ratio between rotation and advancement in order to get it right.

Can you share your ceph x-ray too?

Best of luck

[djsbelgium]

I'm not as knowledgeable as other users around here, but have you considered getting lower jaw done only? Wouldn't have to worry about your nose or upper lip then.

You look great from the front but there can be made significant improvement in the side profile.

Edit:
As you said, they're looking to advance the upper jaw only 3-5mm. If they lean towards 3mm it might not be worth it.
However 8-10mm in the lower jaw is a big improvement and worthwhile either way in my opinion.
Ask the surgeon to sketch a surgical plan, if he wants to move the upper jaw by 3mm only then you can consider getting lower done only.

[Post bimax]

I'm not as knowledgeable as other users around here, but have you considered getting lower jaw done only? Wouldn't have to worry about your nose or upper lip then.

You look great from the front but there can be made significant improvement in the side profile.

Edit:
As you said, they're looking to advance the upper jaw only 3-5mm. If they lean towards 3mm it might not be worth it.
However 8-10mm in the lower jaw is a big improvement and worthwhile either way in my opinion.
Ask the surgeon to sketch a surgical plan, if he wants to move the upper jaw by 3mm only then you can consider getting lower done only.

He can't only advance one jaw if his occlusion is fine

[Post bimax]

For what it's worth, I think you are a great bimax with CCW candidate. Err on the side of 3mm rather than 5mm for your upper jaw movement.  I think you'll look great with almost no downsides provided your surgeon executes.

[jellyflower]

Thanks for all the replies guys, really appreciate it.

I’ve got a Skype appointment with Dr Gunson in an hour, so I’ll be posting his plan here very soon.

My UK surgeon is able to do the surgery at the end of October, but I need to decide by 4pm tomorrow if I want that slot.

I’m still not 100% sure yet, so I think I’ll probably delay, which will mean doing it in February.

I’ve attached the ceph - is anyone able to analyse it?

Many thanks

[ghiggson90]

Thanks for all the replies guys, really appreciate it.

I’ve got a Skype appointment with Dr Gunson in an hour, so I’ll be posting his plan here very soon.

My UK surgeon is able to do the surgery at the end of October, but I need to decide by 4pm tomorrow if I want that slot.

I’m still not 100% sure yet, so I think I’ll probably delay, which will mean doing it in February.

I’ve attached the ceph - is anyone able to analyse it?

Many thanks

Update?

[jellyflower]

Update?

Sorry for the delay.

So Dr Gunson's plan aligned very closely with my UK surgeon's plan, BUT he said that I'm not actually ready for surgery at the moment because my teeth have been tilted too far backwards by the orthodontics, meaning that it would not be possible to advance my jaws far enough without giving my teeth a class II bite.

So my teeth will need to be tilted a bit forwards first.

I have just been informed today that my UK surgeon has a space to operate in early January, but I'm not sure if this gives enough time for my teeth to be tilted forward enough.

Dr Gunson's treatment plan:

Bimax with small genio

Rough estimates of movements:
Chin would move forward ~11mm
Maximum ~3-4mm advancement behind my nose
Tip of upper incisor would move forward ~7-8mm from it's current position (partly from the orthodontics to tilt my teeth foward, and partly from the surgery)


I've seen posts from other people who's had consults with Dr Gunson and they posted images of treatment plans showing before and after outlines of the face - but I didn't get one of these. Anyone know if this is something I can request?