Can someone please analyze my CEPH in detail? Appreciate any help and advice

[kavan]

Also my surgeon specifically said he does not feel comfortable doing a rhinoplasty at the same time as the revision bimax. He also said its best to see what the nose looks like after the advancement, as it will look smaller. I was thinking of getting rhinoplasty after jaw surgery if need be, can the whole ANS issue be sorted with a rhinoplasty surgeon afterwards?

So, you already have a surgeon given you call him 'my surgeon'. Is this the same one who did NOT provide you with a ceph analysis? Same one where you need OTHERS to give you a ceph analysis because your surgeon does NOT?

 Ponder what I told you in my last post:

'..sometimes a jaw surgeon might hold back in bringing the maxilla forward BECAUSE of the prominent ANS.'

'...you would need a pretty good maxfax who could also cut the ANS down as part of the maxillary advancement and also be poised to compensate with other rhino techniques to bridge and tip area. '

'...The GENERAL rule of thumb is to have the bimax surgery BEFORE a rhino. However, a prominent ANS is the only exception to this where the rhino can be performed before the bimax...'


Does it sound to you that you have a pretty good surgeon? Sounds to me like the type who would hold back bringing the maxilla forward enough and because of the prominent nasal spine.

[jaw_surgery_advice]

So, you already have a surgeon given you call him 'my surgeon'. Is this the same one who did NOT provide you with a ceph analysis? Same one where you need OTHERS to give you a ceph analysis because your surgeon does NOT?

 Ponder what I told you in my last post:

'..sometimes a jaw surgeon might hold back in bringing the maxilla forward BECAUSE of the prominent ANS.'

'...you would need a pretty good maxfax who could also cut the ANS down as part of the maxillary advancement and also be poised to compensate with other rhino techniques to bridge and tip area. '

'...The GENERAL rule of thumb is to have the bimax surgery BEFORE a rhino. However, a prominent ANS is the only exception to this where the rhino can be performed before the bimax...'


Does it sound to you that you have a pretty good surgeon? Sounds to me like the type who would hold back bringing the maxilla forward enough and because of the prominent nasal spine.

Sorry, I got the ceph from my orthodontist, and they gave me no analysis. The surgeon did give me analysis. He did say that there needs to be maxillomandibular advancement, and he will be using a "European" style of genioplasty. Also some lower jaw reconstruction? No mention of ANS.

Please look at the treatment plan: https://imgur.com/aWC8eb2

Also I will mention the ANS concern to him.

But can you notice the ANS in this picture of my profile? I know theres a beard, I hope you can still see it? : https://imgur.com/9rzmFrb

[kavan]

Sorry, I got the ceph from my orthodontist, and they gave me no analysis. The surgeon did give me analysis. He did say that there needs to be maxillomandibular advancement, and he will be using a "European" style of genioplasty. Also some lower jaw reconstruction? No mention of ANS.

Please look at the treatment plan: https://imgur.com/aWC8eb2

Also I will mention the ANS concern to him.

But can you notice the ANS in this picture of my profile? I know theres a beard, I hope you can still see it? : https://imgur.com/9rzmFrb

That isn't a 'treatment plan' or a ceph analysis. You've already been told we don't evaluate structures THROUGH A BEARD. You have been given sufficient information about the ANS and how it's evaluated. Yet, very little gets through to you.  Looks like further info from me will go NO WHERE due to lack of capacity to 'digest' info already given.  Sorry, communication is not working out here for that reason. Best of luck in what ever you decide. I'm OUTTA HERE with this one.

[jaw_surgery_advice]

That isn't a 'treatment plan' or a ceph analysis. You've already been told we don't evaluate structures THROUGH A BEARD. You have been given sufficient information about the ANS and how it's evaluated. Yet, very little gets through to you.  Looks like further info from me will go NO WHERE due to lack of capacity to 'digest' info already given.  Sorry, communication is not working out here for that reason. Best of luck in what ever you decide. I'm OUTTA HERE with this one.

Sorry. Could you just help me? I just want to know simply if the ANS is left untouched during bimax, but the surgeon still advances the maxilla, can the ANS be dealt with afterwards from a rhino professional?

[kavan]

Sorry. Could you just help me? I just want to know simply if the ANS is left untouched during bimax, but the surgeon still advances the maxilla, can the ANS be dealt with afterwards from a rhino professional?

You seem pretty much beyond help. I'll give it ONE MORE try. But if that doesn't work, you're on your own.

Some of your angle measurements that relate to bimax recession are still on the LOW side of the norm. I bet the FIRST surgeon held back on advancing BOTH JAWS did so due to the overly prominent ANS which might be the reason WHY you are STILL bimax RECESSED.

Instead of answering your question, I'm going to propose a more intelligent question to ask which is: 'Do you think the next surgeon will hold back on the maxillary advancement due to my ANS?'

The answer to that would be most likely YES. Maxfax surgeons who are not well versed in rhino techniques are reluctant to advance the maxilla, if they feel the prominent ANS will result in a GREATER DEFORMITY to the nose base/upper lip area than you already have.

Your nose base is already OVER PROJECTED due to the ANS and would look MUCH WORSE with any maxillary advancement. IF you did not have the prominent ANS, you would be able to get MORE bimax advancement. So, yes, you could get the rhino with ANS cut down after your bimax surgery. But you would probably be looking for yet a 3rd REVISION maxfax surgery because the surgeon needed to hold back on the maxillary advancement which would limit getting a good lower jaw advancement. Also, it will NOT be your surgeons 'fault' if you don't get a good bimax advancement with this upcoming surgery. That's because it would not be his fault if he's not well versed in rhino techniques and because that is so, it's highly unlikely he's going to leave you with a MUCH WORSE deformity to the nose base/upper lip area than you already have in order to give you a good bimax advancement.

IDK. Maybe tell him you want to INCREASE the EXTREME OVER PROJECTION deformity to the nose base area so you can increase the bimax advancement and then get a rhino later on. See what he says.

[jaw_surgery_advice]

You seem pretty much beyond help. I'll give it ONE MORE try. But if that doesn't work, you're on your own.

Some of your angle measurements that relate to bimax recession are still on the LOW side of the norm. I bet the FIRST surgeon held back on advancing BOTH JAWS did so due to the overly prominent ANS which might be the reason WHY you are STILL bimax RECESSED.

Instead of answering your question, I'm going to propose a more intelligent question to ask which is: 'Do you think the next surgeon will hold back on the maxillary advancement due to my ANS?'

The answer to that would be most likely YES. Maxfax surgeons who are not well versed in rhino techniques are reluctant to advance the maxilla, if they feel the prominent ANS will result in a GREATER DEFORMITY to the nose base/upper lip area than you already have.

Your nose base is already OVER PROJECTED due to the ANS and would look MUCH WORSE with any maxillary advancement. IF you did not have the prominent ANS, you would be able to get MORE bimax advancement. So, yes, you could get the rhino with ANS cut down after your bimax surgery. But you would probably be looking for yet a 3rd REVISION maxfax surgery because the surgeon needed to hold back on the maxillary advancement which would limit getting a good lower jaw advancement. Also, it will NOT be your surgeons 'fault' if you don't get a good bimax advancement with this upcoming surgery. That's because it would not be his fault if he's not well versed in rhino techniques and because that is so, it's highly unlikely he's going to leave you with a MUCH WORSE deformity to the nose base/upper lip area than you already have in order to give you a good bimax advancement.

IDK. Maybe tell him you want to INCREASE the EXTREME OVER PROJECTION deformity to the nose base area so you can increase the bimax advancement and then get a rhino later on. See what he says.

Thanks. I understand what youre saying and I am processing it. Also do you mind if I ask since I am unexperienced, where did you notice the ANS? To me it all looks normal, but I want to see from your perspective.

Also, just to get your opinion, do you think it would possible if the surgeon advances the maxilla leaving the ANS looking worse, that a rhinoplasty can fix it after? I will ask the surgeon, but do you think its possible?

[kavan]

Thanks. I understand what youre saying and I am processing it. Also do you mind if I ask since I am unexperienced, where did you notice the ANS? To me it all looks normal, but I want to see from your perspective.

Also, just to get your opinion, do you think it would possible if the surgeon advances the maxilla leaving the ANS looking worse, that a rhinoplasty can fix it after? I will ask the surgeon, but do you think its possible?

I saw the ANS in your CEPH and you had same thing going on as in the TUTORIAL I gave you a link to. You have an OVER PROJECTED nasal base and also TETHERING of your upper lip to your nasal base just like those seen in the TUTORIAL link I gave you about DEPROJECTION RHINOPLASTY FOR THOSE WITH A PROMINENT ANS.

Will 'a rhinoplasty' fix it later? Not just 'a rhino' but an EXTREMELY GOOD rhinoplasty surgeon which is best to FIND BEFORE you get the maxfax. But in your case, it is better to have this done before the maxfax. Prominent ANS is exception to general rule of max fax first, rhino later. With prominent ANS, it's rhino first, maxfax later.

[jaw_surgery_advice]

I saw the ANS in your CEPH and you had same thing going on as in the TUTORIAL I gave you a link to. You have an OVER PROJECTED nasal base and also TETHERING of your upper lip to your nasal base just like those seen in the TUTORIAL link I gave you about DEPROJECTION RHINOPLASTY FOR THOSE WITH A PROMINENT ANS.

Will 'a rhinoplasty' fix it later? Not just 'a rhino' but an EXTREMELY GOOD rhinoplasty surgeon which is best to FIND BEFORE you get the maxfax. But in your case, it is better to have this done before the maxfax. Prominent ANS is exception to general rule of max fax first, rhino later. With prominent ANS, it's rhino first, maxfax later.

Understood. Thank you.

So if you were to make a treatment plan for me, how would it look? Do you have any more details you an give me for maximum aesthetics? Dont mean to ask to much questions, you just seem more knowledgable than anyone else

[kavan]

Understood. Thank you.

So if you were to make a treatment plan for me, how would it look? Do you have any more details you an give me for maximum aesthetics? Dont mean to ask to much questions, you just seem more knowledgable than anyone else

I'm not making a treatment plan for you. I've given you my advice which is to have a deprojection rhino before maxfax surgery or find a doctor who will address the ANS during your surgery and then have a rhino doctor address the REST of the nose. You need bimax advancement but the prominent ANS will limit the amount of advancement you can get. Your nose base at the ANS makes you look more recessed than you actually are.

[jaw_surgery_advice]

I'm not making a treatment plan for you. I've given you my advice which is to have a deprojection rhino before maxfax surgery or find a doctor who will address the ANS during your surgery and then have a rhino doctor address the REST of the nose. You need bimax advancement but the prominent ANS will limit the amount of advancement you can get. Your nose base at the ANS makes you look more recessed than you actually are.

Wouldn't a prominent ANS sticking out sort of give the illusion of looking less recessed than someone really is? Since it sticks out and forward?

Also, last question, say, the surgeon did advance the maxilla regardless of the ANS and it come out wonky looking. Would a rhino surgeon be able to fix it afterwards? Sort of like going in the opposite order of what you said, where I should get the rhino first. Could that work? Last question I promise

[kavan]

Wouldn't a prominent ANS sticking out sort of give the illusion of looking less recessed than someone really is? Since it sticks out and forward?

Yes. Of course. Just like sporting a turban and a beard would.

Also, last question, say, the surgeon did advance the maxilla regardless of the ANS and it come out wonky looking. Would a rhino surgeon be able to fix it afterwards? Sort of like going in the opposite order of what you said, where I should get the rhino first. Could that work? Last question I promise

Seems to me your repeated question is basically a hypothesis that a rhino surgeon would be able to fix it afterwards. Since I can't predict that for you, the best way to find that out for SURE is to use the scientific method which is to experiment with the maxfax first and see IF a rhino surgeon could correct all afterwards. That's the only way you will know for sure. Let us know how that works out for you.

[GJ]

Not to add more complexity to the situation, but I know A/G recommend fixing any nose issues after jaw surgery.

[jaw_surgery_advice]

Not to add more complexity to the situation, but I know A/G recommend fixing any nose issues after jaw surgery.

What do you mean by this?

[kavan]

Not to add more complexity to the situation, but I know A/G recommend fixing any nose issues after jaw surgery.

True in most cases. Prominent ANS is exception.

[kavan]

To this I should add; UNLESS the doctor can make a 'V' shape  NOTCH below the ANS so he can bring the rest of the maxilla forward without the ANS going with it.

True in most cases. Prominent ANS is exception.