What would you advise to achieve the desired results ? With scans

[RhinoAndWhat]

I got my Scans today and would love to know your guys opinions.
I know I will need a rhino. But wat do I need in the jaw area?
Thanks in advance.

Im not sure what I need. I always thought my teeth are very slanted inwards so I was hoping for orthodontist treatment to make my upper teeth straight and then move the mandible forward with a bsso and do the rest with a mini chin wing. But looking at the Scans my teeth seem rather straight.
My surgeon suggested a chin wing. He didn’t see the scans yet. I’m a bit opposed to that idea since I already have a deep fold between chin and upper lip and the upper lip has barely if any support by my teeth already. If you watch closely the morph has a better supported upper lip and the lip is less „flat“. It’s less convex shaped and better supported by the maxilla in the morph. I think it’s not as noticeable in the pictures as it really is.  I was hoping to somehow get the upper lip better supported by my upper teeth which would also result in a better smile as well. Idk if a lefort or orthodontist treatment is the best way here. I would also like to have less of a nasolabial fold.

Scans and  morph



Some real picture morphs(probably better for advise) the biggest movement is in the fold between chin and lower lip. If I measured correctly it’s 1-1,2cm advanced. The chin or mandible got advanced the same or slightly less than that:


align left facing:
align right facing:

for measurements:  the aligned pictures suqares are each roughly 3,4cm long and wide

(not so happy with this one):

[RhinoAndWhat]

So far I talked with 2 other people online and I haven’t seen my surgeon yet but so far there are 3 ways. If you have an opinion or different ideas please share.

1) simply a chin wing. As I said I’m mostly opposed due to my already deep fold between chin and lower lip. I feel like I need a actual lower jaw advancement to support the soft tissue accordingly. The positive about this is it doesn’t risk losing hollowness in my cheeks.

2) is my favorite so far. The idea is that I could get braces to make my upper teeth straighter, as in more outwards slanted and braces for my lower teeth but make them more inwards slanted to allow for a bsso. Additionally to that a genio to fix asymmetry and additional advancement. . The Bsso cut should be a non high cut to not lose hollowness in my cheeks.
I like the idea but I’m not sure about how much advancement is possible by slanting my lower teeth more inwards and straightening the upper teeth. It might not be enough. Also I’m not sure how my lower teeth can be slanted inwards even more.

The guy who told me that idea said that my maxilla is only 2-3mm behind the alfaro line so that nobody will offer me a lefort 1.

3) Idea is extracting 2 lower premolars. Then use braces to set my lower teeth back about 5mm. Then I can get a bimax with a lefort 1 and bsso (again no high cut). Additionally a extended genio for assymetry and if needed for additional advancement.
Im not really a fan of this approach because I don’t like extracting my teeth but this idea seems more realistic To me that 2) because extracting premolars will defneitly allow for my lower teeth to be pushed back. It will also allow for s bigger bsso advancement.

[Lazlo]

So far I talked with 2 other people online and I haven’t seen my surgeon yet but so far there are 3 ways. If you have an opinion or different ideas please share.

1) simply a chin wing. As I said I’m mostly opposed due to my already deep fold between chin and lower lip. I feel like I need a actual lower jaw advancement to support the soft tissue accordingly. The positive about this is it doesn’t risk losing hollowness in my cheeks.

2) is my favorite so far. The idea is that I could get braces to make my upper teeth straighter, as in more outwards slanted and braces for my lower teeth but make them more inwards slanted to allow for a bsso. Additionally to that a genio to fix asymmetry and additional advancement. . The Bsso cut should be a non high cut to not lose hollowness in my cheeks.
I like the idea but I’m not sure about how much advancement is possible by slanting my lower teeth more inwards and straightening the upper teeth. It might not be enough. Also I’m not sure how my lower teeth can be slanted inwards even more.

The guy who told me that idea said that my maxilla is only 2-3mm behind the alfaro line so that nobody will offer me a lefort 1.

3) Idea is extracting 2 lower premolars. Then use braces to set my lower teeth back about 5mm. Then I can get a bimax with a lefort 1 and bsso (again no high cut). Additionally a extended genio for assymetry and if needed for additional advancement.
Im not really a fan of this approach because I don’t like extracting my teeth but this idea seems more realistic To me that 2) because extracting premolars will defneitly allow for my lower teeth to be pushed back. It will also allow for s bigger bsso advancement.



Another question I had was how realistic is a non high bsso cut? Is it common? He told me the surgeon I’m currently consulting with usually does a high cut. Does that mean if I demand a non high cut he will refuse or if he doesn’t will fck it up? Or are different cute common practice and every surgeon can cut every cut basically ?

your morph shows a very significant advancement. I'm not sure anything short of jawsurgery plus an aggressive genio, plus fillers on a regular basis --but I mean it's doable. It's just you'd need to either be spending 2-3 grand on fillers  every year to keep it somewhat as aggressively advanced as you have morphed it. So I would advice getting the procedure that advances you the most. Chin wing alone definitely won't achieve that after result.

[RhinoAndWhat]

your morph shows a very significant advancement. I'm not sure anything short of jawsurgery plus an aggressive genio, plus fillers on a regular basis --but I mean it's doable. It's just you'd need to either be spending 2-3 grand on fillers  every year to keep it somewhat as aggressively advanced as you have morphed it. So I would advice getting the procedure that advances you the most. Chin wing alone definitely won't achieve that after result.

thanks for reply. Looking at the morphs again i defenitly overdid the advancement. I do not want to look like a dog. It was defenitly weird looking. I redid 2 of them

align left facing:
align right facing:

for measurements:  the aligned pictures suqares are each roughly 3,4cm long and wide
 
If I measured correctly the fold between chin and lower lip advanced 1-1,2 cm and the chin or mandible the same or slightly less
Do you still think its too much of an advancement? I would like to avoid fillers. Im guessing if i did a chin Wing i would need regular fillers for the fold?

The reason why I overadvanced the mandibe and chin in the first version of morphs was due to my overprojecting upper lip. I was trying to achieve a more harmonious look by aligning the browridge, the upper lip and the lower lip and chin. I didnt do that in the new version. But do you know of a way to reduce the upper lip? I think the protruding upper lip really makes it look like im very recessed while the scans show I am not that recessed. It would mean i need less advancement in the mandible/chin if the current morphs are still too much.

[GJ]

These are your morphs, right? Not a doctor's?

If the left in each is how you look now, then it looks like your upper jaw is in the correct position, but your lower isn't. I haven't read the thread so apologies if this was mentioned, but it looks like a case where extracting lower premolars might not be a bad option to get that liner advancement. Since the upper jaw is in the correct place and the lower isn't, this seems the most reasonable way to get the necessary advancement. If you want more support for your upper lip, you might be able to procline the upper incisors to achieve that, but based on the photos I don't see the need for more support. The support as-is looks fine.

[RhinoAndWhat]

These are your morphs, right? Not a doctor's?

If the left in each is how you look now, then it looks like your upper jaw is in the correct position, but your lower isn't. I haven't read the thread so apologies if this was mentioned, but it looks like a case where extracting lower premolars might not be a bad option to get that liner advancement. Since the upper jaw is in the correct place and the lower isn't, this seems the most reasonable way to get the necessary advancement. If you want more support for your upper lip, you might be able to profile the upper incisors to achieve that, but based on the photos I don't see the need for more support. The support as-is looks fine.

 Thanks and Yes, If the picture contains two pictures side to side the left one is the before and the right one is the after.
These morphs are made by me since my surgeon suggested I bring some to our next consultation.
The grid thingey is to make it ez for you to estimate the movements and say if they are realistic and so on.

[GJ]

I just realized that I wrote "profile the upper incisors"...what I meant to write is "procline the upper incisors" to get your desired lip support.

[Post bimax]

Honestly I think the first morphs look amazing, although both sets are good.  Especially the side-by-sides with your hand on your head.  You're fortunate in that you have a great baseline for JS with a relatively low MPA with decent ramus length.  This degree of advancement is borderline possible surgically with BSSO+genio in your case.  I would definitely see a surgeon to figure out how much you can get without extractions, but as GJ said this might be a rare case where that isn't the worst idea.

[GJ]

but as GJ said this might be a rare case where that isn't the worst idea.

Yeah, the only time I think it's the best option is if the patient has their upper jaw in the proper location and a flat bite plane. He seems to have both, so it might be best (though not perfectly ideal given extractions are always a negative). The net result should be a huge positive given the upper jaw isn't touched, and therefore the nose isn't touched, and that's the area that always gives the worst outcomes for class 2 patients.

[RhinoAndWhat]

Yeah, the only time I think it's the best option is if the patient has their upper jaw in the proper location and a flat bite plane. He seems to have both, so it might be best (though not perfectly ideal given extractions are always a negative). The net result should be a huge positive given the upper jaw isn't touched, and therefore the nose isn't touched, and that's the area that always gives the worst outcomes for class 2 patients.

I just thought about it and wouldnt a bsso with set back teeth be the same as a plane chin wing?
If not, where is the difference ?