Scheduled with Alfaro for surgery but slightly worried about aesthetics.

[krizzobizzle]

So I'm currently in braces prepping for surgery and scheduled to have it Mr Alfaro Hernandez in Barcelona.

My only worry is that I really want to personalise the treatment plan, but I'm worried that even with detailed advice it may still deviate towards his aesthetic preference of longer more fuller faces.

Some cases I worry because I really prefer the before pictures, and I shouldn't feel that way about a 30-40k surgery.

I think its combination of the faces being too long and too full in the upper jaw region. Sometimes the chins being too large.

Maybe it's a a consequence off too much counter clockwise rotation and anterior maxillary movements.

As a female this is really not going to look good on my faceI feel.

Heres is a more visual example. I'm not a fan of the result of this patient

https://www.institutomaxilofacial.com/es/caso-clinico/leanne/

But I am more of a fan of this patient (I know she only had bsso here)

https://www.institutomaxilofacial.com/es/caso-clinico/nazly/

I guess the question I am trying to ask to be concise is:

1 ) Do other people feel the same about some of his results being too long in the face. It tends to look much better on male patients.

2 ) What is the best way to communicate this to him? should i just be blunt and upfront about my aesthetic preferences and make sure that there is minimal movements both vertically and anteriorly?

[GJ]

1 ) Do other people feel the same about some of his results being too long in the face. It tends to look much better on male patients.

2 ) What is the best way to communicate this to him? should i just be blunt and upfront about my aesthetic preferences and make sure that there is minimal movements both vertically and anteriorly?

1. No. Looks balanced. A short face tends to age worse, too. Something to keep in mind.
2. Yes, just be blunt and express that you have a preference. But you don't want to plan your own surgery, so this is a slippery slope.

[kavan]

In both cases, he's working with the face and bite the person already starts with. In the case you don't like, she starts with a very high slope to the jaw line (her jaw angle is up high close to her ear). So, that did not change significantly with the surgery, nor could it be expected to. In the case you do like, she STARTS with a short lower 1/3rd of the face and her jaw angle is LOWER on her face (further down from the ear). So, adding MORE length to her face (and projection) made her look better.

Basically, OUTCOMES are a FUNCTION of STARTING POINTS. So, if you start with a back jaw angle very high towards the ear; a very HIGH 'slope' to the jaw line which is something that contributes to apparent 'length' to the face, you can't expect to have an outcome similar to someone with a short face who has a jaw angle LOWER on the face who looks better because she also NEEDED MORE length to the face.

[krizzobizzle]

Here is a scan of my starting point. Hope this helps.

Class 2 deep bite overjet/overbite with good chin position which likely needs set back.

Scheduled for surgery with Mr Hernandez after orthodontics.

https://imgur.com/IwHcqAJ

[krizzobizzle]

Will follow up with some pictures.

[kavan]

Scan shows a very creative approach to move part of the mandible forward; the part anterior to the posterior jaw implant. The dentition looks more like class 2 division 1 more than it looks like class 2 division 2 which is 'deep bite'. Although I could be wrong about the bite being Div 1 and not div 2 'deep bite', it doesn't matter because the 'slope' of jaw line (MPA) is NOT a HIGH one like the example you didn't like. It's on the lower side as far as Mandibular Plane Angles go. So, any 'elongation' from forward advancement would tend more toward giving needed length rather than making area look 'too long'. So, I would not fret about the example you didn't like. The one you liked looks to be more applicable. Chin adjustments most likely can be made in accordance to your personal preferences.

ETA: You don't say what your division of Class 2 is. You say; deep bite overbite/overjet. Thing is that Class 2 'deep bite' usually means over bite where top front teeth are kind of vertical and cover too much of the lower front teeth whereas an overJET is front teeth angled outwards way infront of lower teeth where there is horizontal distance between upper and lower front teeth. So, your dentition looks more like an overJET to me than overBITE which is why I said class 2 Div 1. However, 'overbite' vs. 'overjet' can be confusing

[krizzobizzle]

Crude pic. Will get lateral ceph on Tuesday via email from ortho - https://imgur.com/Z2dUojk

I'm trans so please excuse me for being slightly worried about a longer face. I'm 5'9-10 so I cant get away with it as much as a 5'6 woman could.

So thats why I'm scared of the upper jaw being moved because it can masculinise the face in some of Alfaros examples.

You can see the short lower third and deep labiomental fold which is probably from good chin position.

I guess Its worth asking if I could get away with just a BSSO, but I wouldn't get the full benefit.

[GJ]

Your face is extremely short, so I wouldn't worry too much about surgery making it too long. They'd have to do something very dramatic (i.e. an error).

Given your overjet, I think you can get away with BSSO only. If you're worried about the chin being too large don't get a genio and reassess after the BSSO. I don't see any reason to move the upper jaw based on what you've provided. Should be a really good result if executed correctly.

[krizzobizzle]

Thanks GJ.

I'll send some more pics tomorrow and maybe you can tell me if you think what you said still holds true. Really appreciated.

[kavan]

Crude pic. Will get lateral ceph on Tuesday via email from ortho - https://imgur.com/Z2dUojk

I'm trans so please excuse me for being slightly worried about a longer face. I'm 5'9-10 so I cant get away with it as much as a 5'6 woman could.

So thats why I'm scared of the upper jaw being moved because it can masculinise the face in some of Alfaros examples.

You can see the short lower third and deep labiomental fold which is probably from good chin position.

I guess Its worth asking if I could get away with just a BSSO, but I wouldn't get the full benefit.

When I see a totally different 'worry question', I wonder if the person read my prior response/s. I shall include again. Also, to get the bite right, for teeth to 'mesh' and for aesthetic balance, it's more common than not for the lefort 1 to be included in a surgery. Your options for discussing your preferences with the doctor can be isolated to chin alteration.

the 'slope' of jaw line (MPA) is NOT a HIGH one like the example you didn't like. It's on the lower side as far as Mandibular Plane Angles go. So, any 'elongation' from forward advancement would tend more toward giving needed length rather than making area look 'too long'. So, I would not fret about the example you didn't like. The one you liked looks to be more applicable. Chin adjustments most likely can be made in accordance to your personal preferences.

[krizzobizzle]

Are you talking about genioplasty vs no genioplasty or just the "type of genioplasty"

My chin is in a good position so if the mandible is brought forward I'm assuming its going to either need to be (1) rotated clockwise or (2) set back slightly.

My labiomental fold is very deep.

[Dogmatix]

Alfaro is not the type of surgeon who will discuss the treatment or ask the patient what they prefer. He owns the entire process and have autonomity in the planning and execution.