My Surgeon's Bimax Plan

[yamahatrophy]

Previous Thread: http://jawsurgeryforums.com/index.php/topic,8007.msg73992.html

Diagnosis: Bimaxillary Retrusion - Class I - Microgenia - Asymmetry
Proposal: Bimax, genioplasty, rhinoplasty

@kavan I'd be particularly interested in your thoughts. In my previous thread I didn't have any ceph data available and based on the profile photo you didn't think DJS would be necessary. You were also concerned about the impact of maxilla advancement on my nose as it is already slightly upturned however a rhinoplasty will be performed at the same time to prevent this by lowering the tip and increasing bridge projection.

My goals are to correct the misalignment of my lower jaw, have a more convex side profile, reduce my overjet, and reduce the "double chin" effect due to a short lower jaw. Obviously I trust the surgeon however wanted to put this thread out there to get a few more eyes on it.

[GJ]

It's hard to believe you found a surgeon willing to operate on you.

I see no dental issues except maybe a small overjet, which appears correctable if you just retrocline the upper incisors a bit.

A genio could be justified based on aesthetic preference, but that's the most that's here. I sense a bad outcome because it's a bad diagnosis. But good luck. I hope I'm wrong.

[ArtVandelay]

It sounds like your main concerns are aesthetic, if so I wouldn't risk DJS since you look fine and it's not with the risk.

Can you PM me your surgeon's name?

Out of curiosity how many maxfac's recommended jaw surgery out of how many did you consult with?

[kavan]

Sorry but it's hard for me to focus attention when the request for me to do so involves keeping multiple tabs open requiring me to flit around back and forth among multiple links to render advice. I see no reason people can't organize all their info on one link, use the text option to give description of each photo or file so that what they want looked at can be found in one place. It positions me to multi-task where as multi tasking is antithetical to focused attention.

Also, there are other wrenches in the gears when I look at the surgeon's plan which includes a visual that looks (to me) to run counter with the measures. For example, when I look at a plan from Alfaro or Gunson, when the measure read out resolves to a CCW rotation, I also see that in the visual. In your visual, it looks like the maxilla is being rotated downward (CW) but the read out relays CCW. The chin movement on the visual looks like a diagonally downward genio. But the read out conveys a horizontal displacement of 4mm along with a vertical displacement of UP and NOT down.

Then comes a 'GOAL' stated by you to have a CONVEX profile whereas the goals of maxfax are usually to CORRECT a convex profile and not to achieve one.

I don't like risking giving the wrong advice. This presentation which includes a displacement read out that runs counter to the visual presentation is beyond my familiarity. I can't explain it to myself which precludes me from advising you on it. So, I'm needing to side step on this one.

However, if there's a prize for 'Stump Kavan' or scramble Kavan's brain, this wins.

[yamahatrophy]

Thanks for the above replies, I'm not sure "stump kavan" is a prize I'd want associated with my major surgical plan  It has been good to get some outside opinions, Zarrinbal was of the same opinion when I had an in-person consult with him last year which is why I was on the fence over whether I needed this. I'll be giving the bimax a miss and stick to filler, rhinoplasty and submental liposuction.

Thanks again peeps!

[kavan]

Thanks for the above replies, I'm not sure "stump kavan" is a prize I'd want associated with my major surgical plan  It has been good to get some outside opinions, Zarrinbal was of the same opinion when I had an in-person consult with him last year which is why I was on the fence over whether I needed this. I'll be giving the bimax a miss and stick to filler, rhinoplasty and submental liposuction.

Thanks again peeps!

I just reviewed your posting history and checked what was said on it. I found that doctors advised against bimax surgery and that you had a good experience/consult with the chin wing doctor I suggested you would be a good candidate for. Basically, your case was one that could be corrected by methods other than bimax surgery; chin wing and rhinoplasty.

Your most recent query and presentation inviting 'my thoughts' resolved to a request to HURL me into CONVOLUTIONS I'd rather not be hurled into. When I give advice that basically NAILS it for someone, it's not meant to be an invitation toward that end.

[yamahatrophy]

Your most recent query and presentation inviting 'my thoughts' resolved to a request to HURL me into CONVOLUTIONS I'd rather not be hurled into. When I give advice that basically NAILS it for someone, it's not meant to be an invitation toward that end.

I understand it isn't an invitation to that end but my view is that - you've been on these forums for a long time and have seen many surgical plans along with (some) of the outcomes of those plans, and know a lot about this surgery in general so I respect your opinion on the matter. The fact that the plan isn't clear and there are apparent inconsistencies is one of the three red flags that led to that decision. One other being GJ's input and the last a thread about a patient that this surgeon performed an aesthetic bimax on who definitely didn't need one and had a bad outcome. So it's a combination of the three. Either way, I think scrapping the bimax is the sensible option.

[kavan]

I understand it isn't an invitation to that end but my view is that - you've been on these forums for a long time and have seen many surgical plans along with (some) of the outcomes of those plans, and know a lot about this surgery in general so I respect your opinion on the matter. The fact that the plan isn't clear and there are apparent inconsistencies is one of the three red flags that led to that decision. One other being GJ's input and the last a thread about a patient that this surgeon performed an aesthetic bimax on who definitely didn't need one and had a bad outcome. So it's a combination of the three. Either way, I think scrapping the bimax is the sensible option.

Well, you certainly had enough prior info to scrap bimax even before introducing the plans of this 'who knows who' doctor. Direct us to the link to the thread where this surgeon you introduced as 'MY' (your) surgeon performed surgery on another person who didn't need it who got a bad result.

[GJ]

Who is the surgeon willing to do bimax on you? You can PM me. It's somewhat irresponsible, unless I'm missing something in the records.

[GJ]

I'll be giving the bimax a miss and stick to filler, rhinoplasty and submental liposuction.

I'm not sure you need any of them. But trying to look at this objectively, I can see if someone is a perfectionist, or has the uber masculine aesthetic in mind, they might want a genio and/or to tinker with the nose.

I don't really see any objective case for the rest, and you need to realize nobody sees your face the way you do. For some reason, your mind has been infected with the misinformation virus. It's been going around...

[kavan]

Who is the surgeon willing to do bimax on you? You can PM me. It's somewhat irresponsible, unless I'm missing something in the records.

We need him to post the LINK to the thread where the surgeon he was considering is on record for doing surgery on someone not needing it and who got a poor result.

[GJ]

We need him to post the LINK to the thread where the surgeon he was considering is on record for doing surgery on someone not needing it and who got a poor result.

I don't need that.

I'm just curious who this surgeon is willing to do bimax on him.

[GJ]

To be fair, I've seen many uber accomplished surgeons do surgery on class I patients. Have yet to see a good result. I've seen a handful resulting in a trail of tears.

It's really unfortunate. The surgeons seem to find ways to justify it (i.e. a pay day?). It's worth an academic study in itself to figure out why they do it.

[kavan]

I don't need that.

I'm just curious who this surgeon is willing to do bimax on him.

Wouldn't the surgeon's name be on the link?