What do you think about my surgery plan?

[morgan118]

Please see relevant images here: https://imgur.com/a/C3ALLFr

What I'm trying to achieve:

• Improved facial harmony
• Greater upper airway volume (family history of sleep apnea)
• Improved jaw mechanics (currently suffering with mild TMD)

Movements:

CCW Rotation

Maxilla: Forward 2.4mm
Mandible: Forward 5.7mm

Genio Forward: 6mm
Genio Down 3mm

Mandible Widened Right Side: 4.7mm
Mandible Widened Left Side: 2.5mm

Many thanks

[GJ]

The plan looks about right for what you want. The thing is, with the chin moving forward 6mm and down 3mm, and your lower incisor position (i.e. you appear to have a protrusive lower lip), you might get an undesirable gap in the LMG. This would probably only be noticeable in shadows. But it's something to consider and discuss before the surgery.

[morgan118]

Thanks for the input GJ.

Actually I had the same concerns around chin to lower lip fold and voiced this to the surgeon - he responded that I'll have custom plates with the genio resulting in augmentation of the LMG making it's appearance less pronounced. I'm really not convinced by this proposal as I've not seen results from something similar done before.

Further to the above I ended up getting a consultation with another surgeon. He recommended moving the lower incisors back 4mm in order to allow space for a larger forward movement of the mandible. With his plan I would also require extraction of some lower wisdom teeth and premolars. This would require braces for at least a year prior to surgery and naturally, I would like to get surgery out of the way sooner rather than later, however, it seems like I might just have to just be patient and wear braces first in order to get the best aesthetic result.

Please see the following link for a diagram of the second surgeons plan:

https://imgur.com/a/iqOOHiC

Approximate Movements:

CCW Rotation

Maxilla: Forward 2mm
Mandible: Forward 9mm

Genio: 7mm

Any comments on the above would be greatly appreciated

[GJ]

The plates in the chin can help with the depth of the LMG. Conversely, removing them can make it worse, and should only be done if they are causing pain or functional problems (via scar tissue). This type of thing can vary wildly depending on the type of skin, thickness, incisor position, etc.