I'm looking for recommendations based on my ceph x-ray

[Mrtn]

I think your upper jaw is fine as is, I do not understand what bothers you about it - yes, CCW should make the angle smaller but as GJ told you before, jaw surgery isn't that nuanced. If you do not like the way your upper jaw looks now, I honestly think you will not like the way it will look after because there is no way to predict down to the millimeter what it will exactly look like. In terms of aesthetics, jaw surgery is mostly about making people look 'normal', not to make an already normal looking person slightly different exactly the way they want it - it simply does not work that way. Honestly, you should just be happy you have an upper jaw that already looks nice / normal - not everyone is quite so lucky.

By the way, you know the picture of the woman you posted earlier - do you happen to have a PDF copy of the whole study? I would be interested in reading it and tried to download it but didn't work for me.

You're totally right about this. I just want to make my mandible look 'normal' compared to my upper jaw, without making my upper area looking worse, that's my expectation of this whole surgery which seems to be achievable. Anything else is plus and hoping not making worse.

About the file, I just downloaded it for you, uploaded here: https://gofile.io/d/atdsXC
Not sure if I can attach this here or share the link, the mods will decide. If not, I'll share with you privately later.

[InvisalignOnly]

You're totally right about this. I just want to make my mandible look 'normal' compared to my upper jaw, without making my upper area looking worse, that's my expectation of this whole surgery which seems to be achievable. Anything else is plus and hoping not making worse.

About the file, I just downloaded it for you, uploaded here: https://gofile.io/d/atdsXC
Not sure if I can attach this here or share the link, the mods will decide. If not, I'll share with you privately later.

Thanks a lot for the link! I managed to download it and just finished reading it. I think it's a realistic goal that you are trying to advance your mandible / chin area without making the upper jaw area look worse, which is why I am saying - as the surgeon told you as well - that maxillary setback or anything along those lines would probably not be a good move in your case. In my case, one of the reasons they wanted to move the upper back was that advancing my chin too much would have given me a too strong chin, but I am a woman with a small face, with you being a man, I do not think they have to worry about advancing your mandible / chin too far forward. If you read the study, you will notice that all patients included were female, and the authors explain - illustrated with pictures - that in their cases, bringing the mandible / chin forward to meet the protruding maxilla would not have looked good, but there should be nothing wrong with bringing the mandible / chin forward on a male (within limits obviously, but your maxilla is not that far forward at all).

[kavan]

The doctor who recommended ASO, seems to change his mind only to CCW rotation after seeing my ceph.
I contacted the places that do ASO but they all seem to not recommend it, based on my ceph and pictures. I asked them the reason and they said that a jaw rotation alone (that you recommended me in the first place) is enough with genioplasty, because my protrusion is not severe enough to have ASO for it. As far as I understand correctly, my protrusion will remain the same after CCW (should not be worse I assume), which will look 'less protruded' due to the balanced mandible, however there is a chance that my lower third will look too much 'forward' with only CCW and genioplasty.

Please disclose the answers to the following questions:
---------------------------------------------------------

WHEN did you ascertain a follow up response from the doctor/s who initially suggested ASO but who now doesn't/don't recommend it any more?

a: BEFORE you engaged (recent) feedback from me and subsequent to a CHOICE/decision  to OMIT this information.

b: AFTER you got recent feedback from me to consult with doctor/s who do the ASO. For example, you ascertained this NEW info from them within a time span of approx less than 2 hours subsequent to my feedback.

WHICH ONE?


IF 'a', then that would resolve to a decision/choice on your part to engage me in giving feedback in the ABSENCE of information that could have/would have factored into my feedback. So, if 'a',now the ball is in your court to re-adapt or otherwise process my prior response (given in the absence of this information) in accordance to the presence of this information.

IF 'b' then my suggestion to CONSULT with doctor/s who perform the ASO should be sufficient for you to process the 'new' information from them. Also, all the information I provided to you prior http://jawsurgeryforums.com/index.php/topic,8062.0.html should be sufficient.

Best of luck in what ever decision you make.

[Mrtn]

Please disclose the answers to the following questions:
---------------------------------------------------------

WHEN did you ascertain a follow up response from the doctor/s who initially suggested ASO but who now doesn't/don't recommend it any more?

a: BEFORE you engaged (recent) feedback from me and subsequent to a CHOICE/decision  to OMIT this information.

b: AFTER you got recent feedback from me to consult with doctor/s who do the ASO. For example, you ascertained this NEW info from them within a time span of approx less than 2 hours subsequent to my feedback.

WHICH ONE?


IF 'a', then that would resolve to a decision/choice on your part to engage me in giving feedback in the ABSENCE of information that could have/would have factored into my feedback. So, if 'a',now the ball is in your court to re-adapt or otherwise process my prior response (given in the absence of this information) in accordance to the presence of this information.

IF 'b' then my suggestion to CONSULT with doctor/s who perform the ASO should be sufficient for you to process the 'new' information from them. Also, all the information I provided to you prior http://jawsurgeryforums.com/index.php/topic,8062.0.html should be sufficient.

Best of luck in what ever decision you make.

I asked the doctors after you suggestion to get ASO. Only one doctor recommended me ASO way before our conversation about it, and then I sent him my ceph (after your suggestion for ASO) and then he changed his mind about it. After this, I specifically asked other docs if they suggest ASO (bigger clinics in Korea), and they did not. So the answer is B. (Btw the 2 hours correct, most Korean clinics have a fast response rate.)



 I assume you're a person who's trying to give the 'best' advice possible for people here for the 'best outcome' for their surgery based on your current knowledge in this field, and I assume doctors want the same thing for their patients, especially in a places where most people get maxillofacial surgery only to improve their aesthetics. I'm just curious of your opinion, why do you think doctors so against the plan you suggested me about ASO?

Edit: one of the clinics told me, (a new one I asked) they don't recommend ASO for my case because I might end up look like a 'grandpa'. I assume they mean that my maxilla would too flat after the extraction. They said, they only perform this kind surgery for severe protruded cases. What I don't understand, if they did ASO, they could just move my maxilla more forward to a less protrusive (but still not 'grandpa flat') position to achieve the best results. Anyways, I just wanted to share this, none of the clinics would perform ASO on me so far in combination with DJ/genio.

[kavan]

I asked the doctors after you suggestion to get ASO. Only one doctor recommended me ASO way before our conversation about it, and then I sent him my ceph (after your suggestion for ASO) and then he changed his mind about it. After this, I specifically asked other docs if they suggest ASO (bigger clinics in Korea), and they did not. So the answer is B. (Btw the 2 hours correct, most Korean clinics have a fast response rate.)



 I assume you're a person who's trying to give the 'best' advice possible for people here for the 'best outcome' for their surgery based on your current knowledge in this field, and I assume doctors want the same thing for their patients, especially in a places where most people get maxillofacial surgery only to improve their aesthetics. I'm just curious of your opinion, why do you think doctors so against the plan you suggested me about ASO?

Edit: one of the clinics told me, (a new one I asked) they don't recommend ASO for my case because I might end up look like a 'grandpa'. I assume they mean that my maxilla would too flat after the extraction. They said, they only perform this kind surgery for severe protruded cases. What I don't understand, if they did ASO, they could just move my maxilla more forward to a less protrusive (but still not 'grandpa flat') position to achieve the best results. Anyways, I just wanted to share this, none of the clinics would perform ASO on me so far in combination with DJ/genio.

I told you that of the PRIOR choices you listed from doctors (in your very first post on this board), the one with ASO option and the double jaw surgery with chin was the closest choice. (kind of like a multiple choice question I also told you to consult with such doctors. You did. (It's always needed to cross reference advice from non-doctors--I'm not a doctor--with advice you get here.) They re-evaluated. I have nothing against their re-evaluation. As to my suggesting the ASO, it was in reference to a doctor telling you PRIOR that would be how to address the protrusion you had and also the SNA angle of the ceph was very high to an area that could be pushed backwards via the ASO. 

Did you address your curiosity to doctor/s who initially suggested the ASO as to why THEY suggested that?

That said, the ASO now being ruled out, your choices resolve to a type of surgery that does NOT move the protrusive area any more forward than it is now which could either be CCW double jaw surgery with chin advance OR single jaw surgery with pre-molar extraction to the lower jaw to accommodate a BSSO and chin advancement along with it. You may cross reference either option with what ever surgeons you choose to consult with further.

[Mrtn]

Did you address your curiosity to doctor/s who initially suggested the ASO as to why THEY suggested that?

Interestingly the doctor who suggested me ASO as an option in the first place, didn't really answer why he changed his mind after seeing my x-ray. He told me my columella philtrum angle makes me a bad candidate for ASO (after seeing my x-ray and some new pictures I sent).

What I suspect is that the pictures I sent that time were with a bit longer beard and that might alter his view on my upper jaw area, and now it cleared out with the x-ray and pictures with shaven face.

[InvisalignOnly]

Interestingly the doctor who suggested me ASO as an option in the first place, didn't really answer why he changed his mind after seeing my x-ray. He told me my columella philtrum angle makes me a bad candidate for ASO (after seeing my x-ray and some new pictures I sent).

He did answer you (angle etc.), and other doctors also explained to you why this pretty extreme procedure to bring the maxilla backwards is not for you. You should be grateful that they are being honest with you - they could just agree to do anything for money if they wanted to. ASO cannot be done in 'degrees', they remove teeth and bring the whole maxilla back quite a bit, maybe as much as 7-8mm? I am telling you from my own personal experience that bringing my maxilla back 4mm changed my face lots and I feel it was slightly too much, and look how much more protruded my maxilla was compared to yours - I attached a before-after picture of my profile (no I was not smiling in the before photo, that was my face at rest). ASO would be a disaster on your face, be happy people are telling you that now so you do not have to find out the hard way when it's too late.

One of the reasons ASO is common in some parts of Asia is that their beauty ideal is very different from Western ideals; they tend to dislike a strong jawline / chin even on males, so they prefer to bring everything back instead of advancing the lower part to match the protruding maxilla. You are a Western guy living - presumably - in a Western country, why would you want a flat face and a weak chin / jaw to match? Does not make any sense.

[Mrtn]

He did answer you (angle etc.), and other doctors also explained to you why this pretty extreme procedure to bring the maxilla backwards is not for you. You should be grateful that they are being honest with you - they could just agree to do anything for money if they wanted to. ASO cannot be done in 'degrees', they remove teeth and bring the whole maxilla back quite a bit, maybe as much as 7-8mm? I am telling you from my own personal experience that bringing my maxilla back 4mm changed my face lots and I feel it was slightly too much, and look how much more protruded my maxilla was compared to yours - I attached a before-after picture of my profile (no I was not smiling in the before photo, that was my face at rest). ASO would be a disaster on your face, be happy people are telling you that now so you do not have to find out the hard way when it's too late.

One of the reasons ASO is common in some parts of Asia is that their beauty ideal is very different from Western ideals; they tend to dislike a strong jawline / chin even on males, so they prefer to bring everything back instead of advancing the lower part to match the protruding maxilla. You are a Western guy living - presumably - in a Western country, why would you want a flat face and a weak chin / jaw to match? Does not make any sense.

You're absolutely right and I agree with you about western/Asian beauty standards too. And yes, the docs also told me that ASO is mostly used in severe cases, and mine is not in that category. Thanks for your replies and that you shared your story with me!

[InvisalignOnly]

Thanks for your replies and that you shared your story with me!

No problem, I thought it might be useful for others reading this too, in case they are interested in total maxillary setback - it is quite uncommon so there isn't much information available about it. I am grateful for the study you shared, very interesting for me. Hope you find a doctor that can recommend the most suitable surgery for you and that you will be happy with the result.