What could I do ,my face is too short?

[Pipilika]

Hello ,I have some problems with my face ,my face is too short ,my bone cheeks are promminent ,but I have a mandibular assymmetry( my left mandibular ram is shorter than the right mandibular ram ).
 So ,what should I do? What procedures?
 Excuse me ,but I m new to max fac surgery

[Pipilika]

Nobody can help me with a few hints?
Should I post here my ceph and radiographies plus tomography 3 d( i have tomographic 3D reconstruction too

[PloskoPlus]

Nobody can help me with a few hints?
Should I post here my ceph and radiographies plus tomography 3 d( i have tomographic 3D reconstruction too

Post your ceph. Closeups of your bite.

[Pipilika]

 I will post  few radiographies of my skull and 3d Ct , if someone with some experience can tell me his opinion.
https://i.imgur.com/4Kh1Mp2.jpg
https://i.imgur.com/t4viVTd.jpg?1
https://i.imgur.com/g1bDhCL.jpg
https://i.imgur.com/THwt0R0.jpg
https://imgur.com/xQeUmh1
https://imgur.com/JJk7X41

[ArtVandelay]

If your bite and airway is fine, which it appears to be, I would stay away from orthognathic surgery, not worth the risks for your case. To address the lower asymmetry look into a chin wing, and for that you'll have to go to Europe as I'm not aware of any US surgeons that perform it.

[Post bimax]

You should also post face pictures.

For future reference, you should look straight ahead in CEPHs with neutral head posture.  You're staring at the ceiling in the one you posted

[Pipilika]

hello guys again, I was very busy these days,I will post ssssome real pics with me.
But ,I had consulted a plastic rhino surgeon 8 years ago, and told me my nose is overporjected.
Is iit that true?
Could someone tell me how is my ANS(anterior spine nose)?

[kavan]

You should also post face pictures.

For future reference, you should look straight ahead in CEPHs with neutral head posture.  You're staring at the ceiling in the one you posted

His doctor might want him to do that because the doc probably wants to rotate CLOCKWISE due to the deep bite, low MPA and the short lower 1/3.

[Post bimax]

His doctor might want him to do that because the doc probably wants to rotate CLOCKWISE due to the deep bite, low MPA and the short lower 1/3.

That's possible.  Though in every surgeon's office I've been to, the CEPH room has a fixed point to stare at and encouragement to look "straight" (granted my growth pattern is the opposite of his).  It just seems as though the the wacky CEPH angles typically come from orthodontists or other non-maxfac sources.

The 3D scan indicates he got these at a surgeon's office so maybe that really is what he wanted.

[Pipilika]

I will post here a few pics ,also, and orthopantomogram.
Pics are some newer,some older.
https://i.imgur.com/H179lsm.jpg
https://i.imgur.com/M4KjlAI.jpg
https://i.imgur.com/rNqQzfa.jpg
https://i.imgur.com/FsA21uw.jpg
https://i.imgur.com/m1s4KLs.jpg
https://i.imgur.com/x3duXNy.jpg
https://i.imgur.com/pSHT7TM.jpg
https://i.imgur.com/nDtKT91.jpg
https://i.imgur.com/4Kh1Mp2.jpg
Let me tell one more time what bothers me, I think my faace is too short ,too broad,my zygoma are too low set ,that asymetry and lack of definition to the mandible(lack of definition to the lower thrid).
Wshat could I do?Please recommend me something.

[kavan]

I will post here a few pics ,also, and orthopantomogram.
Pics are some newer,some older.
https://i.imgur.com/H179lsm.jpg
https://i.imgur.com/M4KjlAI.jpg
https://i.imgur.com/rNqQzfa.jpg
https://i.imgur.com/FsA21uw.jpg
https://i.imgur.com/m1s4KLs.jpg
https://i.imgur.com/x3duXNy.jpg
https://i.imgur.com/pSHT7TM.jpg
https://i.imgur.com/nDtKT91.jpg
https://i.imgur.com/4Kh1Mp2.jpg
Let me tell one more time what bothers me, I think my faace is too short ,too broad,my zygoma are too low set ,that asymetry and lack of definition to the mandible(lack of definition to the lower thrid).
Wshat could I do?Please recommend me something.

You know what bothers me? People who put their photos on SEPARATE links when they can put all of them on SAME link. Sorry dude. Won't be keeping  multiple tabs open just to look at someone's pics.

[kavan]

You have a SHORT MIDFACE. But not any to much jaw recession.  The main thing that can be done via maxfax surgery is an over-all DOWN GRAFT to the MAXILLA which will in turn, kind of thrust the lower jaw area downward to give more length to the face.

For SHORT FACE, the down grafts are usually with more to the front than to the back which is a clockwise rotation. How much tooth show you have when lips are open and/or when smiling will determine the extent of the down graft as to whether it's a uniformly down or if it's more down in the front than in the back. IF you have NOT MUCH tooth show when lips are slightly parted, then the downgraft can be thicker and/or more in CW direction. IF you have a lot of tooth show, then too much of a down graft would give too much tooth show. The IDEAL combination for downgrafting the maxilla for SHORT FACE is when the person also has MINIMAL tooth show.

So, over-all DOWNGRAFT to the maxilla, thickness of it and also whether uniform or in clockwise direction to be determined via measures that take into consideration your TEETH.

With SHORT FACE, in addition to the downgraft, the chin is often brought in diagonally downward direction. It is a type of genio that is NOT a sliding genio (which brings forward BUT also shortens). But rather the type of genio that 'advances' chin in diagonally downward direction is one where a BONE BUTTRESS needs to be sandwiched between the cut. Said bone buttress can be a 'block' made from hydroxyappatite.

You will need to find a surgeon who does DOWNGRAFTS to the entire maxilla

For lower jaw ASYMMETRY, this may be addressed during the surgery or just left there and addressed via custom jaw implants later down the line. Soft tissue fillers can be used to MASK residual asymmetry there.

OTHER:

Your nose is NOT over projected. It is just that you don't have enough 'face space' which can make even a NORMAL NOSE look 'bigger' due to the smaller face space. You are NOT a candidate for rhino first. Your nose would most likely look better to you after a surgery that addresses SHORT MIDFACE.

Your jaw to jaw balance looks 'even' from profile soft tissue perspective. That is to say, recession of one or both jaws is not the key aesthetic culprit to your aesthetics. However, some minor advancement could be done if that factored into balancing the bite.

Assessment based on 2 face (soft tissue) photos. Limit for looking is 2 photos per poster when every photo is on a separate link.

[Pipilika]

Kavan, thanks for your input and thousands of excuses for not uploading to a single post.
Now ,I ve learned my lesson.
 I ve uploaded again (to a single post this time),I ve posted there my radiographies, CT ,and some pics ,one of them smiling, as you can see)
 My doc told me also to increase the teeth show by a bimax procedure, in order to get me look younger.
Although ,he told me this surgery has an effect of lifting ,diminishing nasolabial folds.Is this valid?
I am a bit tired now,but tomorrow I will post my surgical plan, I dont remember exactly ,but he *my surgeon) had told me about a CCW rotation, not CW,and logically you re right ,CCW is for longer faces to make them shorter, not opposite.
Here it s the post on imgur
https://imgur.com/a/p2PZRWk
Also, I am waiting for the others input ,just curious

[kavan]

Kavan, thanks for your input and thousands of excuses for not uploading to a single post.
Now ,I ve learned my lesson.
 I ve uploaded again (to a single post this time),I ve posted there my radiographies, CT ,and some pics ,one of them smiling, as you can see)
 My doc told me also to increase the teeth show by a bimax procedure, in order to get me look younger.
Although ,he told me this surgery has an effect of lifting ,diminishing nasolabial folds.Is this valid?
I am a bit tired now,but tomorrow I will post my surgical plan, I dont remember exactly ,but he *my surgeon) had told me about a CCW rotation, not CW,and logically you re right ,CCW is for longer faces to make them shorter, not opposite.
Here it s the post on imgur
https://imgur.com/a/p2PZRWk
Also, I am waiting for the others input ,just curious

Assuming the doctor had you tilt your head upward for the FIRST ceph in series of photos, which is the CCW direction, leads me to believe he's wanting to do a CW rotation. He's looking at your low mandibular plane angle which is close to HORIZONTAL=0= very LOW with that head rotation.

When doctors want to do the CCW rotation of the jaws, they either have the patients rotate the head downward in CW direction or they rotate the ceph more in that direction.

Regarding the THIRD ceph in series, like I said prior, jaw recession is not really an issue.

As I said prior, the SALIENT 'thing' is an OVER ALL DOWN GRAFT. The thickness of it can be uniform, more in front or more in back. If thickness is uniform, there is no rotation. If thickness is more in front, the rotation is CW. If thickness of it is more in back, the rotation is CCW.

Since all 3 are OVERALL THICKNESS grafts, all of them would increase the facial height and more 'face space' as to diminish soft tissue crowding. Which one will depend on tooth show/orientation.

[Pipilika]

I have not found yet my surgical plan.
I wiill post it later.Doctor was telling about downgraft,you have told me I have to find a surgeon who perform downgraft to the entire maxilla, it s posibble to make downgrafts only localized?