My Dolphin Before and After Tracings

[sanddunes]

Hey guys,

I am supposed to have surgery next week and I got copies of the Dolphin cephalometric tracings today.  They seem like they may be a little off, but I'm not sure.

I hope you all can help me critique them.

The lower jaw is coming forward 7.1mm, upper jaw is coming forward 5mm with autorotation (I have never heard this term, I thought it was either CW or CCW rotation).  There is not going to be any impaction aside from the 1mm from the cuts.

To me, the jaw still looks a little steep.  I am wondering if I need more rotation?  Also, the mentolabial groove is still kind of deep in the after.  I was thinking it would get smaller.   

Today the Doctor mentioned that he might need to do genioplasty also, but he would be able to tell better during the surgery.  Is it normal to decide that on the day of a surgery?  Should I just wait until 6 months after to decide if I need genioplasty?  I don't really like the idea of them "winging" it in the operating room without planning ahead of time.

The bottom photo is the predicted result (sorry it scanned pretty grainy)

I guess overall I am just feeling a little overwhelmed that the surgery is one week away.  I just don't want to do the wrong thing...


[attachment deleted by admin]

[Tiny]

Given that you don't look recessed IMO, I wouldn't have thought you'd need a genioplasty after a 7mm advancement...

If they do a genioplasty to advance (rather than lengthen) then it will probably make the mentolabial groove worse

I really don't think these profile mock ups are that accurate...

[sanddunes]

Given that you don't look recessed IMO, I wouldn't have thought you'd need a genioplasty after a 7mm advancement...

If they do a genioplasty to advance (rather than lengthen) then it will probably make the mentolabial groove worse

I really don't think these profile mock ups are that accurate...

Yeah that was my thought also.  It seems like with a genioplasty the mentolabial groove would get even deeper.

I am also wondering if my mentolabial groove will seem smaller once the lower lip has more support.  Right now my lower lip kind of hangs out which increases the mentolabial groove.  The dolphin software does not seem to show any changes with lip support in the after.  I am kind of leaning torwards just doing the jaw surgery for now and waiting to see if I need genioplasty.

As for the profile mock ups not being that accurate, what do you mean?  I think you are probably right...for example, the jawline should be more defined after moving it forward 7mm.  The dolphin software does not seem to reflect the skin being pulled tighter forward. 

[pekay]

me personally, i would be a little more worried about the 5mm upper jaw advancement at your age (you look to be in your early 30s) your skin isn't as taut/firm/elastic like of a 20 year old and while 5mm isn't exactly very aggressive, it ain't very tame either.

[sanddunes]

me personally, i would be a little more worried about the 5mm upper jaw advancement at your age (you look to be in your early 30s) your skin isn't as taut/firm/elastic like of a 20 year old and while 5mm isn't exactly very aggressive, it ain't very tame either.

What is the risk?  The upper jaw advances causing sagging skin?  Won't stronger bone structure give more support to soft tissues?

[pekay]

What is the risk?  The upper jaw advances causing sagging skin?  Won't stronger bone structure give more support to soft tissues?

tear through deformity becomes more pronounced after upper jaw advancement

[x]

tear through deformity becomes more pronounced after upper jaw advancement

Quadrangular lefort could alleviate this issue to an extent seeing as how he's only having advancement*




*just basing this off location of the cuts, don't think I've ever actually seen a quadrangular lefort b/a

[pekay]

Quadrangular lefort could alleviate this issue to an extent seeing as how he's only having advancement*




*just basing this off location of the cuts, don't think I've ever actually seen a quadrangular lefort b/a

Well yeah but how many surgeons offer that? also a quadrangular lefort may change your face dramatically (for the better or worse) and you could end up with a distorted sense of self perception

[x]

Well yeah but how many surgeons offer that? also a quadrangular lefort may change your face dramatically (for the better or worse) and you could end up with a distorted sense of self perception

easy, just putting the info out there

I know the mayo clinic guy (E.E. Keller I think?) does it and has written a few articles on it.

Maybe Lazlo can chime in on the differences in cuts between the Quad Lefort I and Quad II cause they look pretty similar in cut locations. I think the I cuts a tad lower in the malar/orbital area but parathesia risk is greatly reduced so the tradeoff definitely seems worth it (in favor of Quad I)

[sanddunes]

Does anybody know what autorotation is vs CCW or CW rotation.  I havn't really seen it discussed much anywhere on these forums