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

[InvisalignOnly]

I was looking at chin wing surgery but honestly I don't know why should I choose it over double jaw with genio? What are the benefits?

It's a lot less invasive and a lot less can go wrong. Might be cheaper too, depending on where you would get it done.

[Mrtn]

It's a lot less invasive and a lot less can go wrong. Might be cheaper too, depending on where you would get it done.

I'm not sure if it's the ideal solution for me because I'm hoping to get a bit better philtrum to chin ratio and a little bit of better upper lip support with double jaw, but maybe it's just a dream.

[GJ]

Thanks! That's all I wanted to know. One of the surgeon I asked only told me to get genio because double jaw in my case wouldn't really make a "dramatic difference".
Non x-ray pictures: https://imgur.com/a/aHIufNN

This is one of those rare cases where I think extracting two lower bicuspids and advancing the lower jaw only, could work...
Upper jaw looks to be in the proper place, face is short, etc.

[Mrtn]

This is one of those rare cases where I think extracting two lower bicuspids and advancing the lower jaw only, could work...
Upper jaw looks to be in the proper place, face is short, etc.

I think Kavan told me the same when I posted my pictures for the first time without x-ray, as an alternative. So I have a stupid question. I supposed to tell this plan to the surgeon and tell him what I exactly want? Because when I communicate with them, they would never even consider the option you mentioned, I only heard this here on this forum before. I mean I'm not an expert and I shouldn't tell (should I) tell the surgeon the method of the whole operation.

And something that really bothers me is my philtrum area which could be a bit improved by double jaw, but maybe I'm wrong. My philtrum looks long and I think my face also would benefit if the philtrum chin ratio could be improved somehow. (Example: when I smile, my lower third looks way more appealing, and I wish to have that ratio.)

[GJ]

The surgery isn't nuanced enough to create the exact philtrum that you want.

You shouldn't tell the surgeon what to do, but you can sure ask him if what Kavan and I see is viable, and get their reasoning as to why it isn't (i.e. if they're not recommending it, ask why). Maybe there's good reason we're not thinking of.

[Mrtn]

The surgery isn't nuanced enough to create the exact philtrum that you want.

You shouldn't tell the surgeon what to do, but you can sure ask him if what Kavan and I see is viable, and get their reasoning as to why it isn't (i.e. if they're not recommending it, ask why). Maybe there's good reason we're not thinking of.

Something that I also found that could be an option (maybe I'm totally wrong) is maxillary setback. On the picture I attached the lady shows a little bit similar profile like mine. So what if my maxilla gets a backward movement instead of my mandible a forward one? I thought about this because I have noticeable nasolabial folds around it from really young age. However, I can't see how this works, especially on the attached picture.

[kavan]

Fair enough. I'll dig in a bit more, it's just so contradictive. Two doctors told me to get genio. I don't know them, I don't know you, so I'm just trying to use what information I have online and from real doctors so far. Those doctors could perform double jaw but they didn't suggest it. I don't know why, or why not, but I need to consider their opinion too against yours.

That is exactly why a  prior existing capacity for grasping concepts along with a basic FOUNDATION to build on is needed to digest or make order out of information. Without a basic capacity to process information along with that already being built on, somewhat via education, people who lack that won't be able to identify which answer makes the most logical sense or otherwise make order out of conflicting information.

Concepts in maxfax are NOT 'rocket science'. Conceptually, it's in the venue of elementary geometry; points, lines, angles, planes, rotations, distance relationships etc. If someone has that under belt, it's the BASIS for grasping the material in the educational links as to which lines are used to evaluate basic distance, angle relationships etc in a ceph X ray. It's needed to have some kind of basis in order to resolve and put into perspective maxfax types of info and relationships. Explanations from me will beyond them to 'digest' or put other feedback into perspective and it will then beyond me to UNCONFUSE them. I can give people information but I can't provide what ever capacity is needed to PROCESS it.

That said, I'll give you the most likely choice based on NOW looking at your X rays and the options suggested to you prior by some surgeons. But if it's something you don't understand or is confusing because you got/get different feedback elsewhere, I'm not going to take this any further as to clarifying all the confusion you have. That's because the interaction in the prior thread: http://jawsurgeryforums.com/index.php/topic,8062.0.html was not one I found fruitful.

The protrusive area seen to the philtal region confirms a prior suggestion you got for an ASO to move back only the protrusive area affecting the nose to lip angle (philtral area). The X ray confirms an excessively high SNA angle and a normal SNB angle. Of the suggestions you got which you listed on your first post to this board, of those choices, the suggestion that includes the ASO along with double jaw and chin is the one to consult further about.So, you'd be looking to consult with maxfax surgeons who ALSO do the ASOs. ASO is not 'total maxillary set back.

[Mrtn]

That is exactly why a  prior existing capacity for grasping concepts along with a basic FOUNDATION to build on is needed to digest or make order out of information. Without a basic capacity to process information along with that already being built on, somewhat via education, people who lack that won't be able to identify which answer makes the most logical sense or otherwise make order out of conflicting information.

Concepts in maxfax are NOT 'rocket science'. Conceptually, it's in the venue of elementary geometry; points, lines, angles, planes, rotations, distance relationships etc. If someone has that under belt, it's the BASIS for grasping the material in the educational links as to which lines are used to evaluate basic distance, angle relationships etc in a ceph X ray. It's needed to have some kind of basis in order to resolve and put into perspective maxfax types of info and relationships. Explanations from me will beyond them to 'digest' or put other feedback into perspective and it will then beyond me to UNCONFUSE them. I can give people information but I can't provide what ever capacity is needed to PROCESS it.

That said, I'll give you the most likely choice based on NOW looking at your X rays and the options suggested to you prior by some surgeons. But if it's something you don't understand or is confusing because you got/get different feedback elsewhere, I'm not going to take this any further as to clarifying all the confusion you have. That's because the interaction in the prior thread: http://jawsurgeryforums.com/index.php/topic,8062.0.html was not one I found fruitful.

The protrusive area seen to the philtal region confirms a prior suggestion you got for an ASO to move back only the protrusive area affecting the nose to lip angle (philtral area). The X ray confirms an excessively high SNA angle and a normal SNB angle. Of the suggestions you got which you listed on your first post to this board, of those choices, the suggestion that includes the ASO along with double jaw and chin is the one to consult further about.So, you'd be looking to consult with maxfax surgeons who ALSO do the ASOs. ASO is not 'total maxillary set back.

Thank you Kavan, I appreciate your suggestion. I will look into this, I also believe this would bring the best results for my particular case. In reality it looks a bit scary, it's basically the most invasive surgery a person can get for the jaw (I assume), so there are a lot to consider here. I will consult with the doc who suggested me this, and get back if I have any new information.

Do you know anybody who got this surgery before (here on the forum or generally)? Because it's something I only saw in Korea done on Asian people (which is fine for me), but I have never seen any before-afters on Caucasians. Is it because the problem is so unique or they use different approach in western countries to address the issue?

[kavan]

Thank you Kavan, I appreciate your suggestion. I will look into this, I also believe this would bring the best results for my particular case. In reality it looks a bit scary, it's basically the most invasive surgery a person can get for the jaw (I assume), so there are a lot to consider here. I will consult with the doc who suggested me this, and get back if I have any new information.

Do you know anybody who got this surgery before (here on the forum or generally)? Because it's something I only saw in Korea done on Asian people (which is fine for me), but I have never seen any before-afters on Caucasians. Is it because the problem is so unique or they use different approach in western countries to address the issue?

It's not really a 'unique' problem. It's just that that sort of protrusion is more common in Asian countries.  you would have to google around to find articles with photos.

[Mrtn]

It's not really a 'unique' problem. It's just that that sort of protrusion is more common in Asian countries.  you would have to google around to find articles with photos.

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.

[InvisalignOnly]

I am Caucasian and had a 4mm total maxillary setback 3 months ago (ASO was originally discussed as an alternative). There are very few non-Asian people that would truly benefit from moving the maxilla back and I really do not think you are one of those. I attached my old ceph so you can see what my maxilla looked like - it truly 'jumped out' of my face plus I had vertical maxillary excess and lip incompetence. Moving the maxilla back was an alternative to over-impaction in my case, but you do not have any of these issues so it would be totally unnecessary for you.

Even for me, I feel like 4mm was too much, it looks okay but if I could go back in time, I would probably ask for 2mm or so and my starting point was 'extreme', unlike yours. In short, based on personal experience, I would not recommend maxillary setback for you (in fact I would not recommend it to anybody unless it is truly an exceptional case).

[Mrtn]

I am Caucasian and had a 4mm total maxillary setback 3 months ago (ASO was originally discussed as an alternative). There are very few non-Asian people that would truly benefit from moving the maxilla back and I really do not think you are one of those. I attached my old ceph so you can see what my maxilla looked like - it truly 'jumped out' of my face plus I had vertical maxillary excess and lip incompetence. Moving the maxilla back was an alternative to over-impaction in my case, but you do not have any of these issues so it would be totally unnecessary for you.

Even for me, I feel like 4mm was too much, it looks okay but if I could go back in time, I would probably ask for 2mm or so and my starting point was 'extreme', unlike yours. In short, based on personal experience, I would not recommend maxillary setback for you (in fact I would not recommend it to anybody unless it is truly an exceptional case).

Thanks! I'm wondering why didn't you get ASO? Maybe it's better for less severe cases or something else?

Btw, the surgeon told me the following for my case about ASO: "Your columella philtrum angle is very obtuse angle.  It is not good for ASO." Maybe he is worried if my nasolabial angle will get bigger with ASO? I thought it can improve that angle (make it smaller in my case) but it seems not. I'm wondering if CCW will (could) close the angle a little bit at least.

[InvisalignOnly]

Thanks! I'm wondering why didn't you get ASO? Maybe it's better for less severe cases or something else?

Btw, the surgeon told me the following for my case about ASO: "Your columella philtrum angle is very obtuse angle.  It is not good for ASO." Maybe he is worried if my nasolabial angle will get bigger with ASO? I thought it can improve that angle (make it smaller in my case) but it seems not. I'm wondering if CCW will (could) close the angle a little bit at least.

My doctor thought the setback was the best option for me instead of ASO - it's not like you can pick and choose, they have their own reasons why they choose one over the other, considering all aspects of the surgery. I do not understand a lot of these technical terms about angles etc. but attached a before-after picture of a girl; that's pretty much the way my maxilla changed from profile, you can see for yourself. I still do not think this would look good on you but I do not have the terminology to explain why.

[Mrtn]

My doctor thought the setback was the best option for me instead of ASO - it's not like you can pick and choose, they have their own reasons why they choose one over the other, considering all aspects of the surgery. Why do you think the nasolabial angle would get smaller with ASO? Mine got much bigger after the setback which is a good thing in my case as it used to be extremely small (acute, I think they call it?) before. Of course it would get bigger, they are moving the maxilla backwards compared to the base of your nose.

Well I supposed to get a smaller angle (so totally opposite your case), because it's already big. So ASO itself wouldn't do the trick for me, because I need a smaller angle or to not make it bigger at least. I'm not sure if ASO combined with double jaw why not better than only double jaw alone, but the doctor told me ASO is not recommended anymore. CCW with genio was recommended by two surgeons so far after my ceph x-ray. My other option to make the angle smaller is nosejob or philtrum shortening surgery, but it's also a bit complicated. Would be nicer to make it better with jaw surgery but not sure if it's be possible. CCW should make the angle smaller based on my research.

[InvisalignOnly]

Well I supposed to get a smaller angle (so totally opposite your case), because it's already big. So ASO itself wouldn't do the trick for me, because I need a smaller angle or to not make it bigger at least. I'm not sure if ASO combined with double jaw why not better than only double jaw alone, but the doctor told me ASO is not recommended anymore. CCW with genio was recommended by two surgeons so far after my ceph x-ray. My other option to make the angle smaller is nosejob or philtrum shortening surgery, but it's also a bit complicated. Would be nicer to make it better with jaw surgery but not sure if it's be possible. CCW should make the angle smaller based on my research.

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.