Need advice for face analysis+surgery

[savemyjaw]

Hello everyone,

I've been reading into this whole topic for a while now and I feel like I have a rough idea of what's wrong with my face. For one I suspect a Maxilla recession, along with recessed jaws and a narrow Mandible. I've been talking with an Orthodonist recently (well numerous, but only one was willing to understand my concerns) and he agreed that my recession might obstruct my airways which might make a Bimax surgery necessary. Now I know that this is a huge procedure and might not solve every issue, so I hope you can help me figure out what else is needed. I'll attach some regular pictures and some X-rays I had done. When smiling I think it's most obvious that there is some recession. I don't mind spending a lot and going through a lot of pain, so suggest whatever you feel is needed.

Thanks in advance

[savemyjaw]

And the X-rays

[kavan]

complex case:

tethering of upper lip to base of nose, overly obtuse nasial labial angle, could be protrusive ANS. Could need deprojection rhinoplasty BEFORE any maxfax surgery.

hardware/screws already in maxilla

lot's of soft tissue thickness to nasial labial area (lefort 1 area)

profile collapses in at the aveolar process area when smiling

Pushing forward the maxilla in a Lefort 1, therefore looks to be impeded by the following:

a: screws present

b: soft tissue profile to lefort 1 area would get overly exaggerated and unattractively protrusive with advancement in absence of rhino with ANS reduction BEFORE ANY maxfax


Consider consulting with a GOOD rhinoplasty doctor about possibility of Anterior Nasal Spine (ANS) needing to be addressed along with deprojection rhinoplasty. A maxfax will NOT tell you about that problem. NOR can many to most address that 'wrench in the gears' during surgery. Some people need to have that addressed before having bimax surgery.

[savemyjaw]

complex case:

tethering of upper lip to base of nose, overly obtuse nasial labial angle, could be protrusive ANS. Could need deprojection rhinoplasty BEFORE any maxfax surgery.

hardware/screws already in maxilla

lot's of soft tissue thickness to nasial labial area (lefort 1 area)

profile collapses in at the aveolar process area when smiling

Pushing forward the maxilla in a Lefort 1, therefore looks to be impeded by the following:

a: screws present

b: soft tissue profile to lefort 1 area would get overly exaggerated and unattractively protrusive with advancement in absence of rhino with ANS reduction BEFORE ANY maxfax


Consider consulting with a GOOD rhinoplasty doctor about possibility of Anterior Nasal Spine (ANS) needing to be addressed along with deprojection rhinoplasty. A maxfax will NOT tell you about that problem. NOR can many to most address that 'wrench in the gears' during surgery. Some people need to have that addressed before having bimax surgery.

Thanks a lot for your reply. I consider myself a good english speaker, but some of what you said was a little bit above my level. So I'd have to do a lot of deprojection in my nose area. I'm a little afraid of that, because all the soft tissue makes it look like my face is more forward grown in that area, when I frown it's very obvious that my whole midface is recessed, so I'd have that look where the nose sits/starts right under the eyes when looking at it from the side. Also I'm not sure what you mean by wrench in the gears? I'll get into touch with a rhinoplasty surgeon about the problem you mentioned, other than that maybe go over what you said in more simple terms, would be really appreciated.

[kavan]

I'm presently doing a short not format for intitial responses because when I say too much and get too detailed and find posters have a hard time understanding, it's better to start off with short notes to establish that.

It sounds like you are seeing the same thing I'm saying which is that the profile collapses in when smiling. Alveolar process is the part of the jaw bone that HOLDS THE TEETH, the bone underneath (posterior to) your gums

 This arises from soft tissue making your upper face look MORE forward grown than what the bone area itself if doing. So, when you push your face forward (with a lefort 1), it would tend to look overly protrusive and that would be due to relatively thick soft tissue over the bone and also due the orientation of the nose base where the ANS is. So, IMO, you would need to explore possibility of a deprojection rhino. With ANS reduction where when one gets ANS reduction, they ALSO usually need OTHER rhinoplasty support techniques with that so the nose does not 'hook' down. 'Wrench in gears' refers to many maxfax docs NOT being very conversant in the litany of rhino techniques that might go along with deprojection rhino with ANS reduction.
Hence, consult with good rhino guy first. You don't have the type of structure to get the rhino after the bimax. You would also have to tell the rhino guy that you PLAN on having the maxilla projected outward later down the line.