Am i getting big enough movements?

[lilaboy]

Hi,

so i decided to go with a bimax, small LF1 and BSSO (still not sure if i shouldve gone with bsso only but its decided already).

So my problem is: when i jut my lower jaw to my optimal Position, my lower jaw gains on vertical height. That means my chin moves vertically down from the front view.

My surgeon send me a plan where he advances my chin 1mm to the front and 2mm down. Is this even noticiable?

Problem is i want more chin height, but i dont want to make it pointy.

See pics below


Ps. Does a bimax or bsso make the lower third actually less vertically tall?





Side profile is where im jutting my jaw so my lower jaw goes to the front and down

[GJ]

You look like a good candidate for extracting two lower teeth and moving the lower jaw only. Upper jaw looks to be in an ideal position. You also look to have some room to move lower only already - ceph showing a pretty large overjet.

Why bimax?

[kavan]

The proposal depicted on the skull model looks like a great plan for you.

[lilaboy]

You look like a good candidate for extracting two lower teeth and moving the lower jaw only. Upper jaw looks to be in an ideal position. You also look to have some room to move lower only already - ceph showing a pretty large overjet.

Why bimax?

Didnt know that it was possible tho.

Yea surgeon suggested bsso only 6mm but i opted for a bimax, 8-10mm

Im secondguessing myself everyday

[lilaboy]

The proposal depicted on the skull model looks like a great plan for you.

Im just really scared of my nasal spine, flat midface and chimlips.

[GJ]

Yea surgeon suggested bsso only 6mm but i opted for a bimax, 8-10mm

I like his idea better, and you can get more advancement of the lower jaw if you extract lower premolars.

I find upper jaw movement risky in your case. Philtrum is already long and convex. Unless he is doing CCW, that likely gets worse. Plus the position of the upper jaw looks pretty good relative to your other features.

But, that's just my opinion.

[lilaboy]

I like his idea better, and you can get more advancement of the lower jaw if you extract lower premolars.

I find upper jaw movement risky in your case. Philtrum is already long and convex. Unless he is doing CCW, that likely gets worse. Plus the position of the upper jaw looks pretty good relative to your other features.

But, that's just my opinion.

Will LF1 make my philtrum longer?

I dont really understand how removing teeth will give me more bsso advancement. Need to look it up and ask my surgeon

[kavan]

The MPA associated with the BSSO decreases only by about 1 degree (so there is a little CCW going on to get the extra jaw advancement) and the 'down and out' genio increases anterior vertical facial height. The BSSO advancement is pretty much along your native MPA and forward advancement is in direction of downward and outward. Although jutting out the jaw does not exactly mimic outcomes of a bsso, the direction when one juts out is down and out. So, relative to what you told the surgeon you wanted to see (more lower jaw advancement than originally offered with the 6mm advance),  the proposal depicted on the skull model looks like a very good plan.

Your 'dilemma' now becomes one of being OFFERED the OPTION of having the extra lower jaw advancement you want (more than the single jaw surgery could offer) and deciding whether or not you would accept the possible trade-offs of changing the upper jaw to get the lower jaw advancement you want. Because there's NO option of getting the extra lower jaw advancement you want but not changing the upper jaw to do it.


The surgeon gave you 2 options:

First option was BSSO only (of 6mm?) + down and out genio which often involves removal of 2 lower jaw pre-molars.

Second option was to accommodate a request of MORE BSSO (lower jaw) advancement than that obtainable by lower jaw only. So, YES. If you want lower jaw advanced 8-10mm, then the surgeons's proposal accommodates that.


Ultimately, you (and of course other people too) want to be CERTAIN, that you will like the outcomes you see in the mirror. No one comes out and says that exactly. But that's what they want to know when asking questions about what the surgery will do for them specifically.

The deal is that no exact CERTAINTY can be had for anyone on here given the premise, (whether they state it outright or not), is they want to be certain they will like what they see in the mirror. Why? Because the very nature of choosing between 2 options is one of making a decision under UNCERTAINTY. That is especially so when 'risk aversion' is expressed with either option offered to you. For example, with option #1, you're risk averse to the possible outcome of not getting the all the lower jaw advancement you would like. But with option #2 that accommodates the the 'big enough' jaw advancement you wouldn't be getting with option #1, you become risk averse to possible unwanted outcome to the base of the nose region.

Now I can't give you a CERTAIN prediction of which Option with possible outcomes you are going to like seeing in the mirror more than the other one. But I CAN tell you HOW to make a decision under uncertainty when 'risk aversion' is expressed with either option.


Here's HOW to make a decision under uncertainty:

1: Realize there is NO option to have BOTH the desired 8-10mm lower jaw advancement in the absence of the upper jaw surgery.

2:RISK AVERSION:  What aesthetic outcome or 'risk' are you LEAST averse to (least afraid of)?

Option 1:

Possible outcome:

Having 6mm lower jaw only, sacrificing 2 pre-molars to have it and then seeing in mirror the advancement (although it would be an improvement) falls short of the advancement you were hoping to see?

Option 2:
 
Possible outcome.

Having the 8-10 advancement of lower jaw that you want but also having changes to the philtral area that you might not like?

So, Option 1 vs. Option 2 resolves to one of not having the extent of advancement you wanted for the lower jaw vs. having the extent you wanted for the lower jaw but with possible TRADE OFF of (unwanted) philtral changes.

Now, those 2 options and possible outcomes don't preclude your being happy with the outcomes of EITHER. Like you could be happy with lower jaw only and you could be happy with more lower jaw advancement and find it was worth trade off a philtral change (which most likely would not be major since it's a modest upper jaw advancement) in order to increase the lower jaw advancement. But.....

Since you've expressed 2 'risk aversion' concerns with EACH option offered to you; that of option 1 possibly not being 'enough' lower jaw advance for you and option 2 being one of 'enough' lower jaw advancement for you but with trade-off of possible philtral changes that you MAY or MAY NOT be happy with in X-change for having the the 8-10 lower jaw advancement you want, the decision UNDER UNCERTAINTY that you need to make is which option has the possible outcome that you would be LEAST risk averse to. (Which one would you be least unhappy with based on a possible outcome you are more afraid of.)

Another way of saying this is to ask yourself: What part of your face (here the base of the nose area) would you NOT want to risk in any way to change at all and is the 'trade-off' of NOT getting all the lower jaw advancement you would like a 'risk' you would RATHER take in 'X-change' of NOT changing the upper jaw area at all?

That's the decision analysis under uncertainty that you need to make.

[kavan]

Will LF1 make my philtrum longer?

I dont really understand how removing teeth will give me more bsso advancement. Need to look it up and ask my surgeon

They pluck a premolar from each side of the lower jaw, push the teeth in front of that backwards, the lower lip goes backwards with it which gives more of an overbite WHILE WAITING for the lower front teeth (in braces) to move backwards. After the wait is over, they move the lower jaw forward. So, while waiting, your lower lip will be more behind your upper lip and and you will look like you have an increased overbite.

[GJ]

The surgeon gave you 2 options:

First option was BSSO only (of 6mm?) + down and out genio which often involves removal of 2 lower jaw pre-molars.

My understanding is he's at 6mm overjet right now, so he can do a BSSO around that amount.

He can then get a handful more mm by electing to extract lower premolars.

[kavan]

My understanding is he's at 6mm overjet right now, so he can do a BSSO around that amount.

He can then get a handful more mm by electing to extract lower premolars.

Ok, thanx, so he doesn't have to trade in his teeth to get the 6mm.

[GJ]

Ok, thanx, so he doesn't have to trade in his teeth to get the 6mm.

That's my understanding. OP, please clarify.

[lilaboy]

Ok, thanx, so he doesn't have to trade in his teeth to get the 6mm.

@Gj

yes i can get 6mm BSSO without extracting my teeth. thats how large my overbite/jet is.
thank you for the answer.


If i see this correctly im getting CCW of 1 degree right? Or is it CW?
Im not sure if 2-3mm of LF1 will make significant changes to my philtrum and or nose, but mm are miles on the face, as everyone says.
I could tell me surgeon to lower the amount of LF1, so maybe 1,5mm and a little less BSSO. Is this a good idea?

[kavan]

@Gj

yes i can get 6mm BSSO without extracting my teeth. thats how large my overbite/jet is.
thank you for the answer.


If i see this correctly im getting CCW of 1 degree right? Or is it CW?
Im not sure if 2-3mm of LF1 will make significant changes to my philtrum and or nose, but mm are miles on the face, as everyone says.
I could tell me surgeon to lower the amount of LF1, so maybe 1,5mm and a little less BSSO. Is this a good idea?

I'm seeing a little CCW to get the extra advancement. But since it's only 1 degree and measured with a hand held protractor on the screen, it's not something that you have to fret about as to making your face 'short'.

Not having CERTAINTY about something as in not being sure if the LF1 will make significant changes was the whole point of my LONG message on this thread which makes clear not all can be predicted with certainty for you and also HOW TO make a decision under UNCERTAINTY.

I NEVER think it's a 'good idea' for someone not understanding this stuff to tell their surgeon what to do.