Two docs (A and B) recommended different treatment programs. I have a link to the side by side comparison (simulation by dolphine software w/ movements)
I need Bimax sugery for airway expansion/bite. My airway is very low percentile (19mm2) on a scale of 0-400 mm2.
CCW for both
obviously, these are SUPER rough predictions and CAN change.... but which one is better? A combo of both?
OTHER Differences....
A also suggest 2-3 cuts into my maxilla for my cant on right side (lefort 1, 2- or 3 piece), B isn't sure yet and needs to run it in their software more, but most likely not....
As movements (4 mm top/ 10 mm bottom) provide for maximum airway expansion BUT there is some chimp lip going on....I heard that these dolphin visual soft tissue simulations aren't very accurate though...opinions?
BS is less movment (4 mm top, 7-8 bottom)
Both include genioplasty setback (recut a wedge out).
HX:
recessed maxilla, very recessed mandible, mandible pushes soft tissue back in sleep and i breathe poorly at night. I constantly jut lower jaw forward subconsciously during daytime to breathe better.
-all 4 bicuspids pulled
- When I smile I have "dark corners" b/c my top+bottom arch is super narrow.
--Went from a class II to a slightly better class II. one side (R) has a 2 mm cant (can't close that side, or can partially touch/close both sides jaggedly) and bottom jaw only meets top jaw when i horizontally jut out bottom jaw to meet top jaw.
Prior surgical history 8 years ago : genioplasty (5 mm forward, 2 mm down), then had 2-3 mm of fat graft on the chin (like old school horizontally projecting chin implants). The genio was designed at 5 mm to have enough projection, but the fat graft doc without permission went and loaded my chin up with fat graft blobs... (communication error between the two surgeons....) didn't reabsorb, 80% stayed...
some other questions:
Every US surgeon consult has done an analysis (software or by hand) treating the chin fat blob like bone. When I brought it up, most acted confused and hesitant to treat that as an issue. others said they will just move my mandible forward less during the BSSO (like 7 MM instead of the planned 10-11 mm) so that my chin won't look like a witch. But that's LESS airway expansion! And depending on the fat blob for chin aesthetics is risky...fat fades with age and less movements comromises airway expansion.
what would you guys do about the fat blob in the chin? it's 3.5 mm of projection from chin bone (pogonion to b point) and I don't know which part is fat/muscle/the submental angle is VERY ACUTE. Also don't know what layer it's at. I went to 1 fat graft specialist and he didn't know what layer the fat was in...seem confused on removal Some do, though.
btw, does anybody know anything about the difficulties of redraping the soft tissue after a revision genio? Some docs simply won't redo genios for that reason, saying that the muscles/soft tissues that are streched in a genio are different from those streched in a BSSO and that a genio revision (reduction of first genio w/ a wedge) would leave sagging that's not compensated by the BSSO.
thanks!!!