Recommended bimax advancement with downgrafting of maxilla and CW rotation

[CK14]

I’m 27 and have been self conscious about my lower third ever since I had camouflage orthodontics which involved removing bicuspid molars and pulling my jaw backwards with elastics about 10 years ago. Lack of teeth show, teeth too far back and short face are my main aesthetic complaints, I also am quite a loud snorer and have been told I stop breathing sometimes in my sleep when I’ve been drinking alcohol. .

I had an online consultation with Dr. Alfaro and he diagnosed me with biretrusion, short face syndrome and narrow airway and recommended me to have bimaxillary advancement and clockwise rotation with downgrafting of the maxilla. This is to open the airway of course and to maximise  aesthetics, although I have although I have planned movements yet.
From what I have read and seen of others’ before/after pictures this is the ideal solution.
From an aesthetic point of view does it have the potential to give much of an improvement? I believe it would but it’s hard to be objective when speaking about my own face.

Some pics and ceph are in the link below
https://imgur.com/a/FrKPdzW

[kavan]

Sounds about right to me. Your maxilla (and ANS/nose base area) would need to come outward and chin would need to go backwards. That is consistent with suggestion of a CLOCKWISE rotation. A downgraft to the anterior maxilla is what gives the clockwise rotation.

Your ceph (and photos) reveal your mouth area looks 'caved in' because the chin area is too far outward to the nose base area. Hence, the nose base area would need to be moved outward and the chin area would need to move backwards and that is achieved via the CLOCKWISE rotation. Both jaws will then be in a better position relative to each other to be advanced 'forward'. For example the CW-r sets the chin in a backwards and down orientation. So, when it's then brought 'forward' via the BSSO advancement your frontal face will cast longer. When the clockwise rotation sets your front teeth lower, there will be more frontal tooth show and with the' 'forward' advancement to the maxilla, your teeth will no longer be so backward to your mouth. So, your desire for aesthetic improvement, from my POV, is consistent with with the proposed rotations and advancements. If you only  got bimax advancement WITHOUT the CW rotation, you would get more of a caved in looking mouth area. See included diagram: CW rotation around incisor point.

DISCLOSURE: My feedback is with aim to shed some light on the basic RELATIONSHIPS that are consistent with the suggestions and/or basic displacements proposed to you. They are not invitations to calculate mm movements or to predict surgical outcomes.

[GJ]

Agree with what has been said by Kavan and the surgeon, but with regard to apnea, realize that a CW rotation might increase the volume of the upper airway, but actually decrease volume of the lower airway (as the lower jaw moves back). You should get a formal test for that as well as a formal measurement of the airway volume, and then reassess the CW plan. You don't want to breathe worse after.

[kavan]

Agree with what has been said by Kavan and the surgeon, but with regard to apnea, realize that a CW rotation might increase the volume of the upper airway, but actually decrease volume of the lower airway (as the lower jaw moves back). You should get a formal test for that as well as a formal measurement of the airway volume, and then reassess the CW plan. You don't want to breathe worse after.

Although the lower jaw moves backward and down with the CW rotation, the goal is to orient it so it's in a better position to be advanced. The lower jaw can't be advanced given mouth area is CAVED IN which is why the rotation has to change to advance it. Since the recommendation includes bimax advancement, the lower jaw therefore will be advanced along with the rotation.

[CK14]

Thanks for the helpful and detailed answers guys.